RNAnna

Let's hear it for being a "do gooder"! I would rather be labled as a "do-gooder" than go against my pricipals, beliefs, and the law where people's lives are concerned. I know and understand the need for Hospice care and comfort measures - I administer them myself. But I am not, as some nurses have told me, going to hasten the end of their lives just because it might be easier on the family. It's just not right. As to a He said, She said issue, you can use this thread as documentation of what you observed about your preceptor. I see nothing wrong with going to your manager and discussing this with them. If your manager comes off as being less than concerned, it is time to get out. As nurses, we are not supposed to play around with drug orders or dosages. It is not in our scope of practice and it is against the law. In this situation, I would have to say that you should think about your own license and take appropriate action. It would be interesting to see how much of your preceptor's drug practices are documented. There are a lot of people who think that they are doing good in the world who are actually taking away something from others. In this case, the preceptor took away the family's time with the pt and their natural grieving process. RNAnna

Hi I actually took a year and a half after I graduated to get my first job. It was a year after I was licensed that I started. Everyone wanted to know what I was doing during that time. Actually, it really is none of their business. They can't technically ask you that question. I always answered politely that I was taking care of family matters. If there was a place where I was really interested in working, I might go into a few details...... Father-in-law had a stroke.... ended up passing away..... nursing the family instead of nursing others at that time. That was all that they wanted to know. Once they heard there was a death in the family, it usually ended the conversation. Why did you "wait so long"??? Well, there could be many reasons. You were studying for the NCLEX, concentrating on getting licensed..... you were taking a well deserved brake after graduation before starting what you knew would be a demanding time in your life (orientation).... you were taking care of personal matters .... You were looking in different areas and now are widening your search (be careful of that one, they may ask what areas you were looking). There are so many reasons why someone might take care of some business after graduation that the answers could be endless. Think about what your reason was and then try to use different words that would sound good to an HR person without being dishonest. It is never what you say, but always how you say it. Anna

Hello. We don't tape our reports. We do them live, which has it's own set of anxiety provoking symptoms. I'm always afraid that I'm going to leave something out, or that someone is going to ask me something that I don't know. Anyway, the report follows a typical patturn: Pt. name, age, Dr., and Dx. Then it is Allergies, code status, and current assessment. Abnormal labs that have been passed on from the day shift, or that have come in on my shift (I work pms), then I do what I did on my shift.... prns, dressing changes, diet eaten and tollerated, new orders, if I called the Dr. for anything, any changes in condition.... things like that. I end up with the I & Os with IV and PCA amounts thrown in. There are sometimes when I have the night shift interrupt me to ask questions inthe middle of my report and that throws me off. I'm getting better at asking for questions at the end. If I don't know something, I tell them I don't know. We are all human and there are somethings that we just can't do when we are as busy as we all are. Just try to do your best. That is all anyone can ever ask. You might try to tape a "fake" report at home and see how it goes. Eventually it will flow a lot easier. I have the sheet that I take report on on the opposite side of the sheet that I do all my work. That way I have all the information together when I give report. It works for me. Hopefully you will find a system that works for you. I've always thought that they more systems that we are exposed to, the easier it will be to find our own. Hope everything turns out for you. Let us know. Anna

Hi. I've been having a hard time lately. Not only because I am working way more hours than I am scheduled for and we are really busy at the moment, but also because at our rural hospital (25 beds) we also have some hospice pts that come in. A couple of weeks ago, durring the busiest time of night, one of my hospice pts died. He went peacefully and wasn't in any pain. It was really a blessing in a way. It took a lot out of me mentally and emotionally. I haven't recieved any training on berevement for nurses who work with these pts. I don't even know if any is available. I would like to know what other facilities do. If you have a pt that passes on, does your facility support you in any way? And if so, how? I could have used a "debriefing" of sorts after this incident but I haven't had time to talk about it to anyone because I'm either working or sleeping. I would love to hear from some others who may have some words of wisdom for me. Thanks Anna

My favorite is that nurses are able to give medical advice in the grocery store. I live in Rural Iowa and in small towns everyone thinks that they can "get that looked at" by the nurse next door. Or the person who says "My sister-in-law says that she's having XYZ symptoms and I'm getting worried. What do you think it could be?". Don't they know that we can't diagnose? Here's another one: I had two pts this weekend who had MRIs. Each of the families hounded me about the results. They think that once a diagnostic test or study is done, we know the answers and results right away. There's my two cents. I think everything else was covered by DusktilDawn. Anna

It is really difficult to have that chatty pt and have to leave because you have other pts to care for. I just got off orientation and admit that was one of my problems too. I'm just tooo nice for my own good. I don't want to cut someone off and be rude, but I've learned ways to get around the "looking rude" thing. Always have a smile on your face when you tell them that you have to attend to something else, and asure them that you are never far away if they need anything. Can't stop them talking? Keep backing up toward the door, and when you get to the point of no return, let them know that you will be back. If you do that, make sure that you go back at some point in time. When you go back let them know that you only have a couple of minutes between things that you have to take care of. This lets them know that you care about them enough to come back, but you have other things to do as well as listen to them. Over time, you will be able to listen to them and program a pump at the same time. While they are talking, keep taking care of business. Check their IV site, IV pump, foley, PCA, dressing, anything to make you look busier. Then when you are done, you can say, "ok, well, I see you have your call light.....you know that I am never too far away. Call if you need anything." There are some pts that you know are chatty from the night before that the next evening, you have to go in and say hello, tell them how long you will be on shift, and let them know that you are caring for six others that evening. Most people understand the nursing shortage, and if you tell them that you are their nurse, but you have other people that you are caring for, they are less likely to take up your time. Then you have control of when you talk to them. I've also gone in when there are visitors. Said hi to all, and said, "Well, I'll let you visit.....". They then get the feeling that you care about them just because you stopped. I know that all of this sounds like tricking the pt. but sometimes we have to use different techniques just to get it all done. I've also posted my method of organizing my "brain" on another thread on this forum. so, if you want to see it, look for the other recient thread on organization and you will find it there. Anna

I had to grin at Haunted's post. I'm just off of orientation, but I am an "older new nurse" so I can understand the humor and smile with her. We all go throught the time management crisis. The thing that bothered me soooooo much while in school and on Orientation, was when I asked how to organize things, everyone just said, "well, you have to find your own system in time". What time? Who has time? Until one day, a wise younger than me nurse, and my DON sat down and said "this is what works for me". Then I just started looking at everyone's brain and checking out how they do it. And now, I'm going to pass it along to you. I have a two sided brain. One side is the report side, and the other is the working side. I take report at the beginning of shift on all of my pts and put all the information in the appropriate places that I've created on my computer. It took a little time for me to just know where all of it was, but now my eye just goes to the right spot when I want to write something or if I want to refer to it. There are places for not only the obvious name, room, dr.,dx, allergies, diet,and such, but some larger blank spots to write in lab values and med changes that occured throughout the day (I work pms). The second side of the brain is really the most important. It is layed out in a grid pattern. Along the top row is where I put the room and name of the pt. that I am caring for. The left hand collumn is labled with the hous of the shift. one hour for each grid space. This way, I can find any given hour and read across what has to be done with any given pt. So, I get report. Then I go and check the MAR to see what meds need to be given to what pt and when. I write that down on the grid in the appropriate time slot. PO x 2, IV x 1, things like that. There is an extra unlabled row at the bottom of the grid that I use to write the prns for each pt. Especially the pain meds with how often. "Toradol q 6". All of the other things, enemas, dressing changes, neuro checks, go into the grid as well. things that don't have a time frame, you have some discression as to when to put them down. I had a "enemas til clear" pt recently (yippy) and was able to space out the enemas so that they had time to work and could be spaced out around other things that I needed to do on the floor. You can look at your shift at a glance and see when you have things scheduled. Remember there may be some blank spaces. These spaces you use for charting, dinner, bathroom...... It works for me. I can't say that it will work for anyone else. But if you don't have an idea of how anyone else organizes, then you are lost without a map. Hope this all works out well for you

Hi - It sounds like a lot of you are from central and southern Iowa. I feel like the lone person from the beautiful Northeast Iowa bluff country - where nursing is not bluffing. It's Decorah for me. But I work at Mercy Medical in New Hampton, Iowa. It's a little bit of a commute, but it's a good time to change gears and get the head into the game. If there are any of you from Luther College or Northeast Iowa Community College out there, I've been to both. Now the question I have is why in the world is it that if I cross the boarder either north or east (Mayo or Gundersen in LaCrosse) would I get payed at least $4 more an hour at a base pay rate? Let's get that changed. Anna

I just got off orientation. Things are going great. I love my job. I love what I do. I just am really frustrated giving report to the next shift and the new "know it all" who is just orienting. She is being oriented by an experienced nurse who was hired at our facility less than a year ago. The preceptor has a lot of knowledge, but the two are feeding off of each other's "superior knowledge" and making it difficult to give report. They interrupt continually and break the train of thought and information that is being passed along. Because of that, there is something that gets missed no matter how small and they will find it and use it. It's as if they are starting to start a shift war. Our facility was never a back biting environment before this. We were a very respectful place. Let's face it, we are all human, and we all understand that there are some days that are just crazy and something may get left for the next shift. In this case the next shift is the night shift. I've talked to my supervisor about this and I'm not sure how to handle it. I am not a confrontational type of person. It is difficult for me to tell them to stop giggling in report about something that happened last night or to have a little respect when I am telling them something that they may already know from the previous night's work instead of saying "Yeah, yeah, we know, we had him last night.......did he ride the call light for you too???" I just think it is unprofessional and I am trying to learn the right way to do things rather than acting like a child when it comes to patient care. I know that I don't know it all. I got a really good GPA just like this other gal, but I still don't know it all. Thanks for letting me vent. Anna

Gradiated compression knee hi's. I broke my ankle in three places in November and I have to wear them to keep the ankle stable and to keep the swelling under control. I've tried lot's of brands. In fact, I was wearing Nursemates when I broke the ankle. I didn't like the Nursemates because I found them tight across the calf. They cut off my circulation. I now buy Jobst opaque knee hi's. They aren't like the Jobst that we use in the hospital and they certainly are not TEDs. They are like regular hose only stronger, better, and more expensive. I was able to have my doctor prescribe them so that they are covered under my insurance. Jobst also makes trouser socks and sports socks that are gradiated compression socks. They are all wonderful and I wouldn't go a day at work without them. Anna

Hi Redred, The Nursing made Incredibly Easy series of books has one specifically on charting. I've never looked at it myself, but I've heard good things about it. There are also quite a few books about nursing and the law - which is what charting is all about. Go to amazon or barnes and noble and do a search on nursing documentation. There may even be a documentation book in Mosbey's little pocket handbook series. This may even be a good question to post in the specialty pages so you can hit a few more nurses in your field. They might know which resources will fit your specialty the best. Anna

At our facility we always ask the pt on admission what meds they take and when they take them. So, if the pt isn't taking X,Y, and Z together at home, they aren't taking them together in the hospital. I think every facility has thier own times as to what BID and QID times are. In our facility bid means 08 and 2000. So, we adjust as neccessary for the particular client. We try to match thier schedule with our schedule as closely as possible and it seems to work well. There are some things that we have to give on a "off schedule" to accomodate the pt. but not many. If the pt is not taking the medications together at home, I would consult the physician and explain the situation and document that you notified someone. That would at least cover your rear if it isn't changed. And if you don't feel right about giving particular meds together, don't do it. Always notify the charge nurse and possibly the dr., document, and if they say do it, and you still don't feel right about it, stand firm. Your pt's life and license is more important than what a dr. orders. They are human too. Dr.s do make mistakes. Anna

Ok, so here is the delema. I have several charge nurses that are telling me different things about piggybacking meds. I'm a new nurse and trying to do everything right which is impossible since we are all human, but I am getting frustrated by this piggyback issue. One charge tells me that each med needs it's own secondary tubing. Another charge tells me that if you back flush the tubing, there should be no reason to use more than one secondary tubing line no matter how many meds you piggyback in a night. I'm feeling like I'm caught in the middle because the multiple line charge is a very strong personality that makes me feel stupid as if it is her mission in life, and the single line charge is my manager. So, here is the question. how do you piggyback in your facility? Multiple or single lines? backflush or not? I'd like to hear from some other nurses so I can understand this issue without feeling in the middle of an arguement that should be taking place on the management level. Anna

It seems that there are quite a few of us that look at ourselves as the "old new nurse". I'm 41 and in my first nursing job. Sometimes I wonder why. I remember in school when we all were excited about the prospect of finally "being there" and now that we are, we're scared to death. At least I am. There are a lot of night that I come home and know that I've done the right thing and have chosen the right field. There are other times that I've come home and toss and turn all night trying to remember why I wanted to do this. We currently have a pt. who is very young who came in with acute paritonitis. When she was in surgery, they were shocked to find that she had CA everywhere. she had a complete historectomy, bowel resection, and a colostomy - talk about a life changing situation. She is the pt. that I know that I made the right decision for. She is the reason that I got into this. No matter how much I screw up in my first year, this pt. will stick with me always. She's already talking about walking in the relay for life next year! We all have our days. I'm just learning that I need to leave my day at the hospital and when I'm at home, do the things that I do at home. It is a hard lesson to learn. Keep the faith. Give it a year. There are always other aspects of nursing if you find that what you are doing doesn't suit you. What finally made me realize that I am doing ok was watching another older nurse being oriented to the job several months after I started. I watched him draw up a med during his first week and It took forever. I remember being where he was right then and realized that it really does get better. Anna

Believe me I understand how you feel both physically and emotionally right about now - or at least I have a bit of understanding. I'm 41 yrs. Three days after I was hired for my current position, I fell down some stairs (not at work) and broke my ankle in three places. Trimalliolar fracture. I live in a rural area and the ER doc looked at the x-rays and asked if I wanted to be transfered south to the University of Iowa hospitals or north to the Mayo Clinic. So, I spent the next week in bed in the mayo clinic and had surgery on the ankle. Three months at home, most of it in bed (you know they love you when they empty your commode), and I was finally released for work. I'm on a med/surg floor but being a rural 18 bed facility, it is all med/surg. We run our tails off. I still limp from the surgery, but I have found that gradiated compression knee hi's are the way to go. I alway take some sort of NSAID before I go to work because I know that it will work to keep the swelling down while the compression socks do their thing. As nurses we all abuse our bodies to a certain extent. Those of us with some physical challenges need to work with our doctors and come up with some creative ways to keep us upright. I also have orthotics in my nursing shoes (Rockers R-clogs lites). My feet and ankles still hurt to the point of keeping me up at night sometimes. My doctor and I are trying various things to keep that at a minimum. As a first year nurse neither my doctor or I know exactly how my body will react, so we are taking it as it comes. I also have some narcotics left from the surgery that I take very sparringly when I absolutely have to (with the doc's blessing). Med/surg is very demanding. I'm learning how to run my tail off. luckily we only work hour shifts and I work pms. Sometimes it is "quiet", if that is possible, and sometimes it is like the evening this week when we had 4 admits within an hour. I figure I will do this for a year or two, and then see what my options are. I'm sorry for the very long post. I hope you find your way in the world of nursing. Remember in nursing, there are no limitations - except your nurse practice act. You can go anywhere and do anything in nursing. But right now, just figure out how to get through tomorrow. Anna

Do you have a preceptor??? Your preceptor should be guiding you through the first few weeks so that you can start to make your own goals. I am also new to nursing, so take what I say with a pillar of salt, but I would spent the first week trying to find where everything is on the floor, learning the paperwork and taking a couple of pts. You can gradually take more pts. as you gain confidence (something I'm still working on) and become familiar with the routine of the floor. Yesterday I went into work early and while in the med room I watched a new hire/new grad draw up a med. He looked so nervous, it reminded me how far I've come. Always keep in mind that every nurse there had a "first job" once upon a time, and they were nervous too. Not only that, but they probably made a few mistakes in their time too. Keep that in mind and remember to breathe now and again. Anna

I know of one hospital - one of the larger in the country - that has a M/S psych floor. You may be able to combine the two and get the best of both worlds. I personally agree. I love psych. I want to work psych, but I am in a very rural area and so I am trying to incorporate psych aspects into my current M/S position. You would be amazed at how under served the psych clients are in this area of the country, and how many clients that I have that have mental health issues. I feel that I am caring for the whole person this way. Anna

While looking for a new job, I would also say that this needs to be reported to someone. If going up the chain of command is not an option, I would be thinking about talking to the state board of nursing and making them aware of the situation. We are talking about your license here. If you are taking care of some of these pts. and mistakes have been made - not by you but by another nurse - as one of the care givers on this chart, you could get dragged into a legal situation. Get outside malpractice insurance and call the board of nursing. Anna

Thanks to both of you. It is difficult to have a couple of days off and have to think about how to address this situation before I go back to work on Friday. I've had a few really resentful and angry thoughts toward my preceptor, and toward how my orientation has been organized (or not) :innerconf After this weekend I will be working a more full time schedule (not by choice) and I will be working with a different preceptor The gal that I have been working with is going on vacation which is a bit of luck as I will be orienting with a preceptor who is much better suited to my personality and communication style. I don't want to say negative things about the nurse that I've been working with, but I really don't understand how she can tell me how well I'm doing and then tell the DON something completely different. We've had a little feedback difficulty all along. So, I have another weekend to get through and try to make it a learning experience. Then I can gleen new perspective through the eyes of another nurse. I'm starting to warm to that possibility :Melody: I'm still looking for different time management and prioritization tips and would like to hear from anyone about things that helped you when you first started out. Were there any materials/books/"brains", or whatever that were particularly helpful? Thanks again. Anna

I've posted my woes on the first year RN forum, but I would like the opinion of all of you more experienced M/S nurses out there. I've been having a rollercoaster of an orientation. just when I think everything is going well, and I'm getting the hang of things because my preceptor is telling me how well I'm doing, I find out that "there are a few things that need improvement". It seems that if I am organized and doing tasks in a timely mannor, I'm not quite prioritizing well. And if I am prioritizing really well, I'm not getting tasks done in a timely mannor. So hit those flippers and send the ball right back up into the bumpers to rack up some more points (for all you pinball wizards out there). I don't like being the ball anymore. I really thought I was doing well, and then again, maybe I'm just having a bad day, but there seems to be something missing and I don't know that it's from me. Isn't the preceptor supposed to assist with issues of time management and prioritization? When I ask what she might have done differently given the same set of circumstances, she always tells me that she doesn't think she would have done anything differently. "you're doing just fine". I am seeking advice on time management and priorities. Oh, and advice on how to handle the whole situation would be nice too. I'm not sure if I should be angry, or cry. I just don't want to be on the casualty list in the "gottem" section of the nurses who eat their young society. Anna

Ok, we've all had those feelings. The nasty nagging feeling that you're just never going to get it right no matter what you do. Bingo. Ding, ding, ding, I've just won the jackpot. I had a meeting with my manager and chief nursing officer (aka DON). It seems that I have great people skills, I am very good when it comes to documentation, and I have a very professional mannor. But if I am prioritizing well, it seems that I'm not doing things in a timely mannor and if I am being timely, I am not prioritizing. Help me out here. Shouldn't my preceptor be teaching me these things rather than just telling me that "you're doing fine"? She does tell me that I need to manage time better, but then doesn't give any suggestions as to how to get it done. I'm not sure I like being backed into this corner and feeling like someone is going to get the dart set out for some target practice. So, I need some help. Any ideas on prioritization or time management? Does anyone talk about these issues with their preceptors? What kind of feedback do your preceptors give you, because I'm starting to think that my preceptor isn't into this precepting thing. Either that or I'm her first and she hasn't had any teaching skills. Or, like me, she just may not have a clue about how and why she does things the way she does. Any thoughts would be greatly appreciated. Anna

Hi Grace, Each facility has their own policies on orientation. It does seem that the larger facilities have longer orientations and preceptorships. Personally, I think it should be standardized, but that is just my opinion. Just think of the confidence you can build with a longer orientation. That can be a very valuable thing. My facility individualizes orientation to the orientatee. Some people pick things up really fast. Some people have to think it all through before coming to a conclution and then making it a habit and routine. I'm somewhere in the middle. Anna

I want to thank all of you. I took a couple days to change my attitude and disapointment into positive outlooks and opportunities. And it was in part due to your kind words and wisdom. It is very strange that I post replies to people on this forum and say things that I need to hear myself. But sometimes it needs to come from someone else. We've had a low enough cences the last two days that my preceptor and I have been able to talk about the whole orientation experience. She and I have very different organizational skills. We now both acknowledge this and understand that we will never thrive on the other's system. So, we are going to spend the time perfecting what works for me rather than me trying to fit her style into my day. Sounds better already. I have realized that I have a long time to be a nurse. I don't have to be disappointed in my performance just yet. Or ever. Thank you all who have posted here. Anna

Good for you! Perhaps the method wasn't the best, but you were putting yourself and your license at risk. If that is the way they treat their staff, who knows what kind of insurance the facility carries to guard against malpractice claims (I hope you carry your own insurance too). Off the top of my head....... I once spoke to someone who is very knowledgable about this whole reference business. Legally an employer can only tell the next employer that you worked there (or not), your attendance record, and if there were any disciplinary actions taken against you. All else is opinion and is concidered slander if offered. YOu can always ask the next employer not to use them for a reference. It's an idea, but it could work. There is that box on most aplications that asks if they may contact a specific past employer. You also have the advantage of being freshly out of school and can use your clinical references for your next hire without raising too much fuss. And if in an interview, do not go on about how horrible it was. Siimply say that it was not the place for you and you needed a safer environment in which to practice. All nursing is not like that. I am a new hire, second carreer nurse, and I know enough nurses to know that each environment is a completely different situation no matter what the specialty. Take heart that the right place will come. I specifically looked at the working environment as a huge criteria to accepting my first nursing position. It came. I'm there. You will be there too. Take a break to breathe for about a week (you've earned it) and then get back at it. I had to do a lot of cold calling, but it worked. Anna

Hi all, The book that I keep going back to is Training wheels for nurses. Bijou Spice is right, it is a wonderful book. I pick it up when I am frustrated and maybe just had a bad day at work and it reminds me that we all have either been there, or are there right now. It makes me feel part of a group rather than all alone with my difficulties. It is funny, smart, serious, and timely. I don't think I'll stop using it even after my first year as a nurse. The biggest thing that I've learned is Confidence. Even if you don't have it, you have to look like you do. :chuckle Anna