maolin

Many times I will leave a postit note for the MD in the MD prog notes - usually an FYI or request for comfort orders, etc - that way you know the doc is informed and don't have to rely on the message being passed down 2 shifts later.

You're going to see a LOT of indigent & homeless @ Seton's ER as well - fresh off the street many times (not always cleaned, buffed & puffed, as they will become once admitted). All Seton campuses are not for profit, charity hospitals. While Brack will see many, Seton gets a fair amount as well.

I still say do stepdown. Again, the ratios are better and there is more "controlled chaos" on a unit vs. the ER (this said from a recovering EMS adrenaline junkie). There are great reasons to work ER - huge variety of diagnosis & lots of procedures/interventions vs a unit, pt population from the very young to very old. Huge patient attrition - leaving you little time to get to know the patient and their "whole picture". Lucky you - so many great jobs to choose from! That gives you a little bit of an edge negotiating compensation packages, too, so don't leave anything on the table!

I vote for Stepdown/PCU. While it's a cardiac specialty unit, you're going to have a lot of comorbids with those patients. It will be easier for you to do a tele/IM from there then the other way around. You could always pick up extra shifts on the tele unit if you can't decide. But I think the stepdown is your best bet. A girl I went to school with is on that unit and she LOVES it. Great ratios, great staff, lots of continuing ed opportunities in Seton's network. They are big on evidence based practice - very proactive with all the latest & greatest. (I haven't worked Brack, but have worked in that network) Good luck!

Taco palenque! Just about the only great thing about The Valley. My pseudospouse is from Brownsville. We drive down there from Austin 3-4 times a year. And I dread it every time. Though I haven't worked down there (as much as my MIL has tried to talk me into it), I feel your pain & frustration. Have you considered travelling? Hubby can stay down there and you can take little 3 mo assignments elsewhere to revitalize your passion for nursing and come home in between. It might be a win/win for you. Hope you weathered Dolly ok...best wishes!

Greetings, I have been doing a ton of research & reading lately about travel nursing and am about the take the plunge. So I'll likely be a regular poster in the travel forum now. Travel nursing seems to be the perfect means to our end (end = early retirement, hopefully not the celestial kind ) - try out several West Coast locations to determine where to put the solar-powered-ecofriendly-off-the-grid-earth-sheltered-hobbit-hole-dream-house-and-Border-Collie-farm. I cohabitate with my pseudospouse. We've been happily UNmarried for 10 yrs. We intend to keep our house in Austin as home base and return in between assignments until we are ready to sell & permanently relocate (love Austin, but can't handle one more summer here & have always been drawn to the West coast). My partner bought the house a few months before we met and so it's only in his name. I have never paid him rent or split the house payments because it's paid in full. He is our breadwinner & also takes care of all the household expenses. (yes, I realize how very lucky I am to have found The Perfect Man! :redbeathe) We've been cohabitating for about 8 years now. I know that I'll need to keep my TXDL, insurance & vote here in Austin in order to keep Austin as home. Since I don't pay for housing, I'm not on the deed and have no utilities in my name, can I still claim it as my tax home? Will my housing stipends still be tax free or taxable because the Austin house wouldn't be considered my tax home? TIA and thanks for all the good info in the stickies & the forum - I feel very well prepared for this exciting new angle.

I'd like to add that aside from the smoker issue you have, you are upset because you were drowning and hardly able to keep up, while this nurse was caught up, done charting and had the gall to take a few breaks. This other nurse has been a nurse longer...she's had time to master time management and charting and caring for a full load. She had 6 pts AND charge - that's a lot. It is frustrating as a new grad nurse the first year or so. You feel like your drowning and this other nurse wasn't there to help you stay afloat. As others have said, perhaps because she was selfish, or she was oblivious to your needs. You'll learn the time management, you'll learn to make taking a break a priority (the routine work will still be there when your break is finished...and some things can wait until after you've breaked), you'll learn to speak up and ask for a hand when you need one. It won't be long before you will manage to stay caught up, chart and exercise your breaks & lunches and be out of there on time. I heard when starting out that you learn the best time management skills from the smokers. They usually aren't cutting corners or doing less work so they can go smoke...they generally aren't negligent, thoughtless people. They just have more experience and have learned efficient time management. Good luck to you!

So, let me get this right....you were left to oversee the other nurses' patients while they attended this event, but you weren't even aware they were going to be gone...and for 2 hours?!?! I'm assuming they didn't give you a report on their assignments when they went either? Or have a way to contacting them while they were off the floor? Smacks of abandonment to me....not cool! Management may not report it as abandonment...but can't you report it directly to the BON? Even anonymously? I'd consider other options...this isn't a safe practice environment.

they're not all bad... on an IMC unit... "May I help you?" "I'm ready to go to sleep and just wanted to tell you I love you. See you in the morning" "We love you too. Sweet dreams." My fav call light ever.

...when your preceptor corners you in the supply room, sticks her finger in your face and procedes to cuss you out and promising you won't make it thru orientation. And you have no idea what you did wrong. And you were warned on day one by no less than 5 other nurses to watch your back because this preceptor was EVIL. Clearly a simple personality conflict gone to the extreme! I quit immediately the next morning. There are too many great places to work to put up with that brand of toxicity. As others said, it was a blessing in the end. I also made sure to name names in the 3rd party exit interview. I took their expensive investment in my new grad training the the competion. Happily ever after.

Perhaps a bipap might help in this case - the pt will feel like she's getting the amt of air she's been begging for and it will help her blow off all that extra co2. Some ativan and or morphine might be of benefit as well.

excellent point. many of our forgein born docs with hard to pronouce names allow us address them by abreviated nick names - it's easier for the patients and staff - who likes their name butchered? the docs rather like it too - gives us all a sense of a less formal relationship. these are also the type of docs that don't have that "high and mighty" ego.

I'd caution you about spreading yourself too thin and taking on another job, even though it sounds like HH will be more to your liking. Given the stress and anxiety of your MS job, you need to take full advantage of your time off to recuperate. If it's absolutely not possible to exit the MS position because of the contract, be sure to take extra care of yourself. I think the time spent in a 2nd job might add to your anxiety, especially the first few weeks when you're learning the new job. It's not usual for a new grad to go into HH, they typically want 1-2yrs experience - that they would hire a new grad 3 mos out and only 3 wks flying solo - big red flag.

I agree face to face, and align your reason to the effect of you have learned a lot there, but feel it's time to expand your skillset...etc. I find this is most receptive and garners support from your current team, rather than leaving with the sense you are bailing on them. Perhaps offer to stay to help train the new hire to fill your shifts. Best of luck to you!

I found EKG's Made Easy most helpful in learning to interpret rhythms. I would also like to suggest sitting with your facility's monitor tech for a few hours and practice measuring out the strips, identifying PQRSTs and interpretting the rhythm - read as many strips as you can - practice makes perfect. As far as interpreting radiology images - do you read the films on a backlight, or view them on a computer? We view our radiology films via a system call PACS - it was cool because I could adjust color settings, invert white/gray, adjust contrast to view lines better (when confirming placement for a DHT for example)

Good call on holding back on the morphine - at least you had some parameters to work with and he was able to get some pain relief - it wasn't a 6mg or nothing. I'm curious, did he have any PO med options as well? I might have considered that as an adjunct to the morphine - a nice slower onset, less drastric bp effect and longer action.

I had a surprising amout of relief after taking a flexril along with a couple of IB (for an injured back, but happened to be on my period at the time) - pharmocologically, it's a skeletal muscle relaxer, but I'm a believer in my newly discovered off label use. I get really bad back pain in addition to the usual pelvic cramping - and the worse the cramps, the more I tense up. The flexeril helps that and makes the uterine cramps tolerable. I have to watch the NSAID intake these days as it feels like I have an ulcer trying to set up shop.

It can be given undiluted and each 40mg pushed over 1-2min. Gahart's IV drug book is an excellent reference to have handy.

varying shades of purple - maroon to violet.

What a nightmare! In hindsight, I would have invoked safe harbor when the weight of the assignment became clear, and especially when given an admit. That would have demanded the attention of your CoC and your license would have been under protection should the unthinkable happen and harm came to any of your 6-7 pts. It unfortunate to have the need for such a law, but a small comfort that Texas nurses have the protection with Safe Harbor. http://www.bne.state.tx.us/practice/safe.html I hope you have a few days off to rest and recover after a shift like that. Good luck to you!

You know, I think that the recent flood of call in's on my unit and working short the last 2 weeks would have been avoided if that first RN would have simply called in sick instead of being a martyr and coming in. But, alas, guilted into coming in and now we're all scrambling around 2 weeks later because everyone one else has caught it. If your infectious, stay home. I can't catch your headache, bad back or raging PMS (or PMDD), but I would rather not deal with your strep throat or stomach bug. KWIM?

Heehee- you know you're a nurse when you read this post as asking if I've been to the toilet. UOP = "urine output" in my world. Since this is the DL forum, I'm assuming you are actually referring to Univ. of Phoenix? It's been a long day, worked last night and haven't been to bed yet. Getting cheeky. Afriad nothing useful in my post - haven't attended O of P myself.

All. The. Time.

I'm a nightshifter and I love it. It's funny that you said the noc crew look tired - I often think to myself that the day crew always look worn out - both coming and going. I love night shift. I tend to get overstimulated and very cranky when I was on days - I'm not a morning person, and there is too much coming and going on days. The lights are all on, light through the windows, the entire healthcare population is buzzing around - family, meals, phones. Too much for me! Still being a new nurse, being on the night shift gives me a better opportunity to learn. I can take a little bit more time for tasks & skills so I can make sure I'm doing it correctly - and I don't feel rushed. I like reading charts & analyse labs & trends. Because a lot of the services aren't 24h, there are more tasks I have to do because that department went home already - which broadens my skillset. I feel like I get to absorb so much more than when I was on days. And for whatever reason - it seems a 12h noc goes by faster than even the craziest 12h day shift. I like that we turn off all the flourescent lighting and have softer, warmer track & task lighting. Such a calming effect (yet, I don't get sleepy at all). Have you ever seen Joe vs. The Volcano (Tom Hanks)? I love that scene w/ the lights. They really do suck the life force out of you. I didn't have much difficulty changing my body's rhthym either. I've always been a night owl, so I don't poop out on my shift. If I'm working the next day, I have to work at getting to bed early enough to get enough sleep. While I had to hit the snooze button from 0500-0545 when I was on days, I naturally wake around 1600, well rested & with time to dine with family, shower, do makeup (that was sacrificed on days), and be ready to work. :monkeydance:

Some meds need to be taken on empty stomach because the molecules from the med could combine with certain foods and render it useless because it's been inactivated. Also, to avoid potentially toxic interactions.