MomaNurse

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.

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.

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!

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?

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.

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.

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!

That's great! Often I find those roll into permanent positions. I hope you have good luck with it!

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.

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!

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.

Death by cookie! Love it!

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!

Congratulations!!

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.

I understand your frustration, but viva is speakin my language! Steppenwolf and corona? Ummm yeah! You will have to set some rules with your younger patients. Boundaries that you will not let them get away with pushing. You are responsible for upwards of 50 patient's health and safety, not working in a hotel. If they can't be bothered to be continent, you shouldn't have to be bothered to clean someone who can do it themselves. And I'll be dipped if I'd flip through channels for them! The good part is you're in a facility. Talk to the activities staff. They should be interviewing each resident for activity preferences. Suggest a movie night with current movies. Junk food within reason can be served. Naturally you want to get with the manager and psych to see if behavior modification is appropriate. Like, call me once for something you refuse to do for yourself and you can't go to movie night. And make sure you praise, praise, praise when they do anything independently or don't call you for stupid stuff. You would be surprised, and sickened, at how well it works.

Until you find another job, you will have to do some tightening up. Get more time off. Don't fall into working 12 or 16 hours just to get more days off during the week. When you go to work, arrive a little early. Go through the med cart, treatment cart, supply room, kitchen. Quickly scan for lack of supplies. Call the kitchen for snacks and drinks before they get busy or go home. Take the time to stock up before you start so you don't have to leave your cart mid-pass. Check insulins, syringes, test strips, any Meds and creams you will need. Call supervisor right away or tell the floor manager about the needs for your current shift. You might have to call the pharmacy or supply clerk yourself if you work off shift then report to the manager in the morning. Assume the shift nurses you follow are straight out, not just lazy. If you begin to get refills of needed supplies, they will likely follow suit. Lastly, don't get caught up in what others do or used to do. I used to work 48 to 56 hours a week, too. Didn't take better care of the patients than I do now. And I can tell you it doesn't feel good to see all that sick time cap off when I knew I was really just feeding my ego with all the comments about my being there ALL THE TIME. If you're calling in that much, you need to make the changes that you have control over. Once you get more rest between shifts, you might like being where you are. Good luck to you!

When your patient is going down, do not forget the basics. Hungry, thirsty, tired, constipated, retaining urine or in pain stimulate some impossibly wild behaviors. Most times you don't have to dig deep to get to the answer. And volunteer for projects. Any way you can start participating in things that will broaden your knowledge base in geriatric management will keep you in good graces and improve your patient care.

Not the padded floor mats that are used to prevent injury from falling out if bed. Black or dark colored mats like a rug that are used in hospitals or facilities. An advanced dementia patient prone to wandering will likely perceive dark color as a void. It's pretty effective. That way you can save the bubble wrap to keep their fingers busy popping!

Ask your Portuguese staff for advice. What are they saying to her? How are they soothing her? Can you learn some basics in Portuguese? Make a book with some translated words and phrases. Put basic pictures in like a communication board.

I have a work phone. But when you're at the bedside and it's not going well, a little pandora goes a long way! I look things up for patient care. Once a case manager called and was talking about equipment. I got online at the bedside with the patient and spouse. We all looked at the same page of devices that the case manager was looking at. Weeks of telephone tag ended because the patient and spouse were able to decide then and there. Besides the patient care aspect, totally against it. You're working. And unless everyone involved has encrypted texting or a VPN or something, I wouldn't get caught dead texting about a patient. Hippa people scare me.

If there's an area where the patient could come to harm, put down a black mat. For example that isolation room or stairwell door. The wanderer will perceive it as a hole in the floor and won't cross it.

You should look for another job. She's taking advantage and won't stop because you will always pick up. The DON/ADON should be a team. I would be careful not to put your foot down too hard til you get hired elsewhere. I think your DON could play some games or just up and get rid of you.

Piddle? Nocturia. Another argument for mandatory catherization at work. I do the same even in the day. If I keep this up, my kidneys won't work at all! Now I have to go see a man about a horse...

I'm sure you are exhausted! It's been a while, but I used to write one sentence translation for each paragraph read in those horrible, dry ego driven texts. I would write each sentence in a notebook and when I went to study for tests I would just read my notebook. Same for class notes. I would come home, pair it down and put pertinent stuff in the study notebook. The suggestion of recording yourself or class is good. I could never listen to myself, but I would listen to recorded material while in a very relaxed state, like I was meditating on it. That way I was able to rest and relax while studying. You are just far enough on your journey that you can't see the beginning or end of it. Keep going, you can do it!!