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Evaluate this situation. What did I miss?
I agree that it was probably because the patient seemed to be responding well to treatment and then spiked a fever that the doc was upset. Early intervention could get control without too much trauma to the patient. But it's something to discuss with your director. I know you feel bad or you wouldn't be searching for answers. That's a sign of a really good nurse. Just don't beat yourself up. Learn what caused it and move on.
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What school does not prepare you for
After receiving the MD order, you write the interim or telephone order, then you "order" or call the imaging company or lab to come do it. You're right the nurse never says "oops, belly ache without a bm in 5days let's get a KUB" and then has it done. We call doctor next, and receive orders. Then ordering as in calling the MD/NP/PA order to the diagnosic contractor we do. It can be confusing. In clinicals on site everything was a luxury.
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Let go from my first patient - Please help me understand!
I'm pretty sure your employer would have told you if dad gave a reason, much less one that was sensational! I wouldn't obsess over it. Tend your wounds and don't let it effect your next case. Good luck!
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Never before have I been so disrespected by co-workers in the workplace
I was thinking palliatist, but pulmonologist makes so much more sense! First, look for a new job. But do it before baby comes-- just trust me on this! Next, it's not unusual for an anxiety patients signs to go wacko while titrating off haldol. Two MDs consulted. They decided to treat cause not symptoms. Actually pretty smart. Yeah BP meds could have been ordered (I'm thinking they were not standing orders because you're obviously on the ball) in the interim. But I've seen a risperdal do more for the cause, and subsequently the symptom, than any BP meds were doing. (200+/100+ Pt had prn risperdal for HTN and it worked! Nitropaste, BP Meds scheduled or prn did nothing!) I get that you have nasty coworkers but give yourself a smile next time you see them. Just imagine to yourself telling the docs how they criticized and seconded guessed THEIR decision. Guided imagery is great isn't it?
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Ethical dilemma
Actually Jade, you're absolutely right! (I must be off my game lately.) Once is one time too many! There are hotlines or she could make a police report. As OP struggled with, it would not have been overreacting to just call first. No matter how you view it, it's child abuse.
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Clinicals
Whatever the nurse's motives, nobody deserves to have the door shut on them. It's just plain rude, especially when the nurse started out by ignoring an outgoing introduction. I'm sorry you're up against such resistance. It is hard to have a student with me, but I chose to work in a facility that takes students. If I don't want to have a student, I will have to look for a place that doesn't have them or arrange with my manager not to have one.
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Ethical dilemma
I'm with you on this! You did the right thing. You tried to keep what happened in the classroom in the classroom by talking to the teachers first. They did the wrong thing. You had no choice but to go up the chain of command. Now they have it in writing incase there's as next time. Be proud and let those teachers know you won't put up with it. I am shocked she has a job too. If there is a next time, be sure to report it to her licensing board and/of the police. I hope the child's parents know what you did for their kid. I'm sure they are grateful!
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Feeling stuck
That's great! Often I find those roll into permanent positions. I hope you have good luck with it!
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Doctor's attitudes
Maybe you could run your SBAR by a colleague before you call so you have confidence to stand your ground with the docs with this reaction. I agree that this should be reported up the chain. It's unprofessional, neglectful and abusive at best. Management needs to give them a refresher on communication.
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Feeling stuck
You should keep looking until you secure a position. I think it would be ok to call the recruiter in a few more days and ask if there's anything you could do to help that paperwork come along any faster. But maybe that's just me. Good luck!
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On working with LPNs in the clinical setting
I just answered you older post, but wished I'd seen this first. There is a reason why you can't get a job in acute care before doing some time in LTC first. You need to learn how to run 30 patient's comprehensive care on a daily basis first. All the Meds, treatments, labs, assessments and coordinate other disciplines, family, MD, specialists. You need to be a team player and get your basics. The RN/LPN thing will serve as antagonistic only, so just drop that and talk about nurses. But I understand it seems that there's an obvious generalization that can be made where you work and this is part of your dilemma. So knowing your last post and this I can only say you can't move on to where you really want to be until you become proficient at this. Sorry to say, it was your choice to do the easier route of ADN vs the longer route of getting the straight education for HIT, your real goal. You had to do what YOU had to do. Don't blame the LTC because you are forced to do it this way. Lastly, stand up to the nurse rolling her eyes at you in narc count. She needs to understand you are a new grad not stupid. And that you are not going to tolerate disregard for procedure when it comes to controlled substances. She needs to document her narcs before you come to do count. Count will be done with both of you checking the book the card then the book. Liquids will be checked for color, viscosity and odor, not just approximate amount. If there's a problem with this, you will refuse the cart until it is done per policy. If it is habitual, you will report her. Now that's one objective problem. The other things are subjective. Unfortunately it seems you're standing in judgement of more seasoned nurses when you should actually be seeking their help with survival tips. I would offer to share some of the humble pie you will need to eat to get back to the position you belong. It would benefit you to ask for help from your COworkers no matter what the alphabet soup after his or her name. Otherwise I don't see you being able to get the experience you need to move on to what you really want to do.
- If You Give a Patient a Cookie
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What school does not prepare you for
Yes it's unfair that you're not focusing on all areas of nursing more thoroughly. Especially when this population is living forever these days! I remember crying everyday after work with a friend I graduated with. I felt bamboozled and almost embarrassed. I went through school and graduated thinking I was solid, a top performer and could step into any job confidently. I interviewed and yes, sure, no problem I can do everything you ask! Then I get to the cart. Somehow the LTC looked darker than I remembered in the interview... My RN was wonderful! Yet I cursed my teachers for not preparing me more! I knew nothing! Is this a liquid or a tablet? I can't find it in that guys meds. Wait, there's house stock? Ugh! I forgot about the narc drawer. And in the end, when I realized my RN was snickering the whole time, I realized it was actually an eye drop I was looking for... I don't know if it was easier to be a unlicensed grad nurse with an RN supervising me or licensed and out on my own. I had someone there every step of the way until she was sure I could independently do it her way. Looking back, I don't think nursing school could have prepared me for what LTC nurses do even if there was a full semester dedicated to it. In my opinion it's a specialty. You must stop the thinking that you are solely responsible for each and every resident on your assignment. Your license does not really hang in the balance if you miss Mr Smith's sniffles and he ends up with pneumonia next week. There are two other shifts and many other disciplines coming in contact with him. I guarantee someone will catch it if you miss it. You've gone from not knowing a lot about nursing to being great at graduation. Now you shouldn't be expecting yourself to be great at something you've never done. Just remember that in a year this will be old hat. Stick with it and you will be training and supporting a new grad. I don't know you, but your DON does. She thinks you are worth the investment so you must be special! Just remember your basics, ask questions even if you think they're dumb, don't be afraid to ask another nurse to put their eyes on your patient to see if they agree with your assessment (I still do this) and never be embarrassed to ask to be educated again if you forget something. We can't always remember how to do an infrequent procedure or what that lab value means. Give yourself a break! It's a rollercoaster, but it's also one heck of a ride!
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Freaking Out!!!!
Congratulations!!
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Calling in sick on 4th shift
Off topic: sunnychris CUTEST baby!! Now that that's out of the way, I agree with glycerine82. Maybe your are just stressed. It could also be something else. You might want to go to your doc. If everything checks out ok, consider getting off of nights. Hope you feel better soon.