blackdiamond407

I have been working on an oncology unit for 2 years and I love it. I really love my patients. I do administer chemo but it's maybe once a week or so. I am contemplating a slight change in career - I am considering the move to an infusion center but I know that this will mean coming into contact with chemo a great deal more than I do currently. I feel comfortable administering the chemo but I am wondering if anyone knows the potential long term affects of administering chemo. I have tried using google but sometimes I cannot determine if the information I find there is accurate. I am young and I have not had children yet so I am wondering if the chemo will affect my ability to have children in the future. I am also wondering if the chemo will put me at high risk for cancer myself. I always wear all of the PPE but I am wondering if this is sufficient. Any information/advice that anyone may have is much appreciated - thanks!

I received a pt with an order to transfuse if hemoglobin drops below 8. When the blood was drawn for the pt, the hemoglobin was 7.3 so I was preparing to start a blood transfusion when I noted there was no consent for a blood transfusion in the patient's chart. As it was dinner-time already, I called the hospitalist and asked him to do the patient's consent. He refused. I called the doctor who wrote the order for the blood transfusion and she was also unable to do the consent as she was home. The doctor who wrote the order stated to call the attending. I proceeded to call the attending multiple times until my shift was over. I called the nursing supervisor and she stated to have the oncoming nurse continue to page the attending. Of course I wrote a nursing note objectively stating that I paged the attending multiple times and endorsed for the night nurse to continue to page. When I came back to work the next day, the night nurse stated that she was able to reach the attending at midnight and he stated he would come in during my shift to do the consent. I was thrilled. The consent was signed and I didn't think anything of it. Upon getting ready to leave later on, I noted by chance that the doctor had written a response to my nurse's note from the previous night where I stated I could not reach him. He wrote that he told all the nurses including me how to reach him on his cell phone. He also wrote that he had spoken with me and told me he would come in the following day to do the consent and that my nurse's note was unacceptable and incorrect. I was very upset. He did not tell me or my fellow nurses or the nursing supervisor how to reach him. In addition, he lied in stating he spoke to me the day I needed the consent. I was very upset. I feel that his note makes me look incompetent. Has something like this happened to anyone else? Should I have done something when I noted his lies in his note? Could I get in trouble for this? The situation has greatly upset me and any advice anyone has would be most appreciated.

Thank you all for your insightful responses. They are all truly appreciated and have given me a lot to think about. Regarding LTC and acute care, I believe that the rules regarding care are the same but I believe that there are different expectations regarding LTC and acute care facilities, if this makes sense. I always do try to educate my patients regarding their medications and why they were ordered. Sometimes, however, no matter how much education you provide, the patient still does not want the medication. For example, I had a patient with a UTI diagnosis. She took an antibiotic for two days in a row. The third day, she refused to take the antibiotic. I told her about the negatives of stopping antibiotics but she insisted the antibiotic was making her urinate more frequently. I told her that urinary frequency was a symptom of UTI but she still did not want the antibiotic. Regarding BP meds, it is my thinking that the doctor has written parameters for a reason. For example, if the patient's BP is 110 and the order calls to hold the med if BP

I worked in sub-acute for 7 months and I have now been in acute care for 2 months. A friend of mine told me I should be more careful when I hold medications and I am a little confused about when to call the doctor and when not to call the doctor. For example, my friend said that if a patient's blood pressure is below the parameters placed on the order, that I must keep re-taking the blood pressure every 2 hours to see if the blood pressure medication should be administered. In the past, if the patient's blood pressure was below the parameters and if there was an order to hold the bp med I would hold it and state that the med was not given as per the parameters. Is this incorrect? Should I keep checking BP every 2 hours and give medication if it goes above the parameters? Some patients get the BP med 3 times a day and that it could get confusing. In addition, should MD be notified if patient refuses medication? For example, what if patient refuses colace? Should MD be aware? What about if the patient refuses an antibiotic? In past I have just stated that patient refused the medication as they have a right to do but now I am thinking maybe I should have called the doctor. I am just hoping that I will not get in trouble. My friend stated that these may count as medication errors. I love my job and I would never want to loose it.

Thanks! I think you are right. Sometimes an anxious patient can make you anxious, especially if you are still in the learning process. I am quite sure that her tubes were not dislodged as the patient went to the hospital for a procedure and I did not get any messages that the tubes were indeed dislodged. Thanks for the advice! Much appreciated!

Hello All! Advice desperately needed. I am a nurse of 5 months working in sub-acute care and I still have a lot to learn. I was changing the dressing on a pt's biliary drain the other day. The tubing of the drain is stitched in the skin. When removing the old dressing, I pulled a little on the drain and the patient said it was painful. The drain remained in place. It did not become removed from the site. Stitches also remained in place. I finished removing the old dressing and placed a new one. The patient is one of those patients that is always asking questions. Every day she asks if her doctor knows what she's taking and she always thinks something new is wrong. I am constantly calling the MD to ensure that what she is worried about is to be expected (which is always is) and I am constantly documenting because she is always making comments like, "everything here is so disorganized regarding my care!" Which is not true. She is just anxious. Anyway, today when changing her dressing she stated that she is afraid that the drain was dislodged the other day. Now she has me worried because she is saying it so much and I am still a new nurse. She is going to the hospital for a procedure tomorrow. If her drain is dislodged, is this something that I will get in trouble for? Or is that something that they will just fix at the hospital? Just another general question. I change a lot of PICC line dressings and I am always worried they will be dislodged. If someone's PICC line is dislodged is this something the nurse will get in trouble for? Or would they just send the patient back to the hospital to get a new one? Are these scenarios cause for a lawsuit? I realize that we are supposed to try to keep these items in place but I also feel that human error does sometimes happen and I am wondering what happens in these scenarios. Any advice is appreciated. Thanks!

Violetsmom, I agree with you. In the beginning, I felt that the comment had bad intentions. I thought about it a great deal, though, and figured that if the supervisor really wanted to get me in trouble then he would write me up. I have not been written up yet since being hired. I have a feeling that my supervisor just wants to be taken seriously, although I could be very wrong. My supervisor was also born in another country so it is possible that the way that he presents things could easily be misunderstood. I hope I am right. Overall I enjoy my job and do not like the idea of someone trying to have me fired.

Ruby, I think this is great input. Walking away from my conversation with my supervisor I felt as if I were being spied on but I agree that it must be normal for new grads to be watched and now that I realize this I feel better about the situation. Honestly, I have nothing to hide. Anything I can't get to I endorse to the next shift. It is true that I share my patients with my supervisor and it is both of our responsibilities to watch over them together. If we do not all work together to protect our patients then it can put everyone's license at risk. I think ultimately my supervisor is just looking out for me and wants me to be more careful. iPink, I agree that my supervisor could have chosen his words better. I think that the way he approached me is what upset me most. I had a nurse of 14 years shadow me a week ago because I was supposed to orient them to my cart. The nurse said I did a great job for a new grad and that she was going to tell my supervisor she was very impressed. I think that my supervisor's comment shook my confidence and that is also what upset me greatly. I was starting to feel in control of my cart and I did not go home anxious every day. Receiving my supervisor's feedback shook my confidence and made me slightly anxious again. That being said, we all make mistakes. Even experienced nurses. I am going to look at this as a learning opportunity and I will try to go in to work just as confident as before. I now know for next time what is expected of me and I will do a better job next time.

Thanks. He said that even though the MD was notified, there needed to be a nurse's note stating that the MD was notified. That is the reason as to why I am being watched apparently. I realize the grass is not always greener but I am torn because I have an aunt who has worked both LTC and the hospital and she has been telling me to go to the hospital. As a matter of fact, I trained an RN last week who has been a nurse 12 years and she told me I should go to the hospital too! That is why I am so torn. I have so many people telling me to go to the hospital that I don't know what to do.

Hello All. Seeking advice regarding my job. I have been working over 5 months as a new grad in LTC/sub-acute facility. I work on a cart that has a mix of sub-acute patients, LTC patients, and hospice patients. Most days I love my job. I have about 20 patients but it's usually manageable. The patients love me and I have an amazing rapport with the aides. They come and tell me everything. Up until today I have received great feedback from my DON. He has asked me multiple times if I am planning to leave for a hospital. I have also had other supervisors ask me the same because they say they do not want to lose me. Today my DON informed me he was upset because nothing was done the day prior regarding a critical lab. A fellow nurse took the lab via phone and handed it to me via sticky note. The supervisor takes care of the labs once they are faxed in so I didn't think much of it. The DON was under the impression nothing was done regarding the lab because the supervisor did not write a nurses note and neither did I. The supervisor wrote on the lab itself that the MD was aware and just wanted us to monitor the patient. I told the DON this after the fact and he said this was unacceptable. He told me he was going to be watching me from now on. I said, "ok." At the end of the shift, the DON made me give him report and told me once again I was going to be watched. I did not know what to say so I said that it was ok with me to be watched because that means there is someone to check to make sure I'm doing everything right. The DON said that I would regret saying that and that it is not a good thing that I am being watched. I have a few things running through my head but as I am a new nurse I have a few questions because I am not sure what the nursing world is like. Is it normal for a DON to tell a nurse that he will be watching from now? It almost seems like a scare tactic to me. My facility has trouble retaining nurses and they seemed to want me to stay but this experience is very off putting to me. I have also heard that one of the nighttime supervisors is constantly asking people about me to check up on me so I am upset about this as well. Is this normal behavior? I am considering applying to jobs in the hospital because maybe this experience means I cannot handle 20 patients. If I apply to a hospital, should I ask them not to contact my current employer? Does this look bad to the hospital? I do not want my current job to know that I am leaving as I told them I was planning on staying. Overall I would rather not leave my job but I do not like the idea of being watched and spied on. I put my heart and soul into my work and I do as much as humanly possible in 8 hours. I just feel that my hard work is going unappreciated.

Thank you all for responding. If the BS is close to 60, I would personally call the doctor. Usually on our sliding scale orders it says call MD if sugar is 400. This particular patient has had a poor appetite lately so we typically wait until she has almost finished a good portion of her meal before administering rapid-acting insulin. Even if you ask her if she will eat what's on her plate, sometimes she will say yes and then eat nothing which is why we wait to see how much she will eat. I've noticed sometimes it's hard to know what to expect with a diabetic's BS because they can be so unpredictable. For example, I have another patient whose BS can be in the 70's before a meal. He has a pretty hefty dose of insulin ordered. When you check his sugar before the next meal it can be in the 300's even if he only ate 20% of his meal. I am beginning to realize that each diabetic's insulin protocol can differ drastically based upon how their body responds to both the insulin and the meals in which they eat.

Just a quick question regarding insulin administration. I work in a LTC facility. Most patients have two orders for insulin administration: a standing order and a sliding scale order. The standing order for one of our patients is as follows: Give 8 units of humalog SC before dinner. The other order is a sliding scale that starts at 150. If hypothetically the patient's blood sugar is 89 before dinner and she eats all of her food it is my understanding that the patient would get 8 units of humalog as per the order. Is this correct? I just want to make sure that I explained this to a new hire correctly. Any feedback would be much appreciated. Thanks!

These are all very good points. Here I Stand, you have some very strong points. My major concern is that I do not want to be a "yes" woman and endanger my patients. The staffing issue at my facility is unfortunate but I am starting to understand that it is not my fault that they are understaffed. The orientation period for new grads at my job is only 2 weeks. It sounds like some new grads quit after the first 2 weeks because they feel overwhelmed when they are by themselves. I have only been on my own about 2/3 weeks now. I feel less overwhelmed from when I started but I am constantly finding myself in situations in which I am not sure what is the best thing to do. Luckily I have very supportive supervisors who always give me advice when needed. CapeCodMermaid, I am very impressed with your dedication and work ethic! I think you are all right, though. What it comes down to is what is too much for me and what I can handle. I think this is something I have to think about. As a new grad I did not think I would have this type of a problem because I thought that I would be fighting to get shifts instead of fighting for time off. Thanks for your input! Much appreciated!

Thank you all for the feedback! Mhy, I'm not sure if working a shift and a half is an option but I will definitely ask so that I will know in the future. I think a 13 hour shift would be much more manageable for me. I do want the administration to think of me as an asset and someone willing to help out when needed. The problem is that I am not sure if the extra shifts are available because of the other employee quitting or because it is a chronic problem. There seems to be a high turnover at my place of work as I heard that a lot of the nurses there are new so that is why I am not sure if OT will be a temporary or more regular request. Been There, I definitely do not think that I can be as sharp at the end of a 17 hour shift. I worked my first one on Monday to see what it was like and I felt so burnt out. My med pass for the second half of the shift was much slower and it took me longer to think about things. Not only that but I felt unsafe driving home and that worried me. Brandon, I think you are right that I have to consider whether I want to be "just" a good employee and come in on my regular shifts or if I am looking for possible extra recognition that may come with helping out. I think part of the problem is that I am still new and that I am very tired after work and right now I think that I see my days off as more valuable than the extra money. Some may think this is crazy, and this may change with time when my work day becomes somewhat more "routine" but for now this is how I see things. Not A Hat, I also feel the same way about making an error.By taking on that shift,I believe that I am saying, "I feel that I can safely practice for 17 hours." I believe that is the way that the BON will view things as well. They will not care that I was trying to be helpful and I bet my facility would not back me up if something happened. This is definitely something to take into consideration. VANurse, I agree with you in the sense that I believe places feel that new grads are desperate for a job and will do anything to keep it and therefore they are trying to pressure people into feeling that they need to take on extra shifts. I noticed that they always ask me and another new grad to take on extra shifts first. After weighing all my options and taking into consideration all of the feedback I made a decision. I consulted my employee handbook and it says that employees cannot be forced to work over 40 hours a week unless of emergency. It also says that employees cannot be fired for refusing OT. I know that HR said they would call one other person regarding the day to see if they would like to work it. I am not going to mention it and just assume that I am not working that extra day. If the man from HR who does the schedule asks me about it, I will tell him to save me as a last resort. If they truly cannot get anyone else to work the shift, I will do it, but there are a few people who work PT who state that they would like more shifts and I am hoping they will give them the option of working that shift first. Thanks again everyone for the feedback! I was not sure if this was a common problem in nursing since I am new and I wanted to see what others had to say.

Hello, New grad with my first job in LTC. I was offered very generous salary and a full time position. I am to get every other weekend off and full time hours. On weeks that I do not have weekends off, my days off are not in a row. I definitely enjoy the job and I'm learning a lot. I have been at my job one month. When hired, I was told that it is important to come when called in if possible and that everyone should be a team player. This monday (03/03) I was to work 7 AM to 3:30 PM. I work 8.5 hour shifts. The DON asked me to work a double for overtime in the middle of my shift on monday (which is 7 AM to 11:30 PM). I was aware that a new nurse just quit and I agreed to the shift. It was very rough and I am still tired but I agreed to the shift to be a team player. I then worked my regular shift on Tuesday, Wednesday, and Thursday. I have Friday off and am working Sat and Sun. I was just asked to work a double this Saturday and I declined. I felt guilty but I am still tired from Monday! Then, I was asked if I could work next Sunday, which would be my Sunday off. I said that I had plans Saturday night. I was told to think about working the shift. Here is my dilemma. I want to be a team player and I don't want to lose my job because i am not willing to work all the time but I also don't want to be overworked. I am tired and don't have time to do things that I enjoy and I was looking forward to my weekend off with my fiance since we don't normally have days off together. Am I foolish not to take the overtime and come across as a team player? No one has said anything to me yet but I am wondering if I will at some point get in trouble for not taking on as many shifts as my facility would like. What do others think? I am not complaining about having hours and being paid well, I just am not sure how to reasonably balance life and work as a new nurse. I don't know what to expect and what is expected of me. If anyone has any advice it'd be greatly appreciated. Thanks!