usetimewisely

This does give a different perspective. I hadn't considered that they could possibly be respecting my input. That's actually kinda nice. I can think of a few right of the top of my head that always say thank you when I call them, after my (sometimes lengthy) report. Makes sense.

Thanks for all the responses. I suppose half of the issue is knowing a persons preference. Some let me give a full SBAR report, some don't want to hear it all, instead just get to the point. Then there are days where it seems that they INTENTIONALLY place you in the middle of all these providers with conflicting orders. (I've learned a few ways to deal with that though.) Good news is I think I've put in effort and managed to build good working rapport with most of them. So, maybe they're a little more tolerant of my "newness". Anyway, thanks for the responses.

Ok, so I've been with my current employer now for a while. There is still lots for me to learn, but I'm really trying to hold my weight even though I've been working for less than a year. I think I'm doing ok, but one thing I have noticed: when I collect info and call to update a doctor about a patient, and expect some intervention, the general answer is "what do you want?" I don't always have an answer for this. Sometimes I'll ask for things that may point me in a better direction with what's going on with the patient. An ABG, or an EKG, for example. But there are times when I don't know what to do/expect/anticipate. But more times than not, I'll get whatever order I ask for. For example, a patient whose lung sounds have changed, have increased respiratory effort, becoming confused, I would call to report. More crackles were noted, no change in maintenance fluid rate, and blood pressure steadily climbing up. So in my call, I explain lasix helped them on the previous shift, maybe she needs more. The answer..."ok, sure." Then they give me specifics for the order. About 30 minutes later, respiratory comes to get an ABG (because they suggested it) and it was all outta whack. I felt I had asked for the wrong order. Different day, different patient. Bit of blood loss from somewhere in the gi tract. Heart rate suddenly goes up and stays around 130s. So I look at full set if vitals, fluids running, and last H and H (over 12 hours ago). Inform the GI MD, and ask if maybe the pt needs fluids (he only had a protonix drip), or to get another CBC. He orders fluids thinking the pt is depleted. 2 hours go by, and the admitting MD asks why his heart rate is 120's to130's. Informed him that last MD started fluids to correct this, and it's now trending down. Since he was already scheduled CBC in am, he didn't want another. Well, he ordered one to be done anyway, so I called lab. It had dropped....not quire low enough to infuse yet, so I report this....to now a THIRD MD. He seems to not. Be worried about this..."we'll just watch it for now." Morning lab H and H was loooooow! And guess which doctor asked about it...the one who ordered the CBC. So, again, I was left feeling like I should have pushed harder the first time I asked for it, or pushed harder to infuse when the initial drop was noted. Anyway, what I'm tryna say is I feel like I'm a good advocate until I see I've asked for the wrong thing. Then i feel bad, and a little peeved that i find myself in this position. I still feel that my job is to paint the picture for them, and THEY decide what should be done for the patient. But being an advocate kinda blurs the lines for me in that regard. Sometimes, I can't tell what is best to be ordered. Shoot, I'm still new!! But sometimes the impression I'm left to deal from the doctors is...."well, what do you want me to do about that?" *sigh* Where do you draw the line? Is this just because I'm new?

I wanted to ask you if this was a class or course that was created within your facility, or is it something readily available for me to look up? We can possibly benefit from this at my job.

Duplicate

Ok, thanks yal. Helps me quite a bit. I call myself mentally preparing for a code as the primary nurse. I think I'd feel better if I could do a mock code. Where I work, we don't do those. So, on to the next best thing, I use my imagination. Now that I've read these responses, my question seems a little silly now. But....it was answered! So thanks again!

Ok, so lately, I have been struggling with how to be prepared if I ever have to run a code on one of my patients. I do a good job with learning their history, and reporting changes during my shift. But, in a true code, how to you address a patient's allergies? Especially when they have a list a mile long! I feel like I'd be the thorn in everyones side since I'd be afraid to push meds that have been ordered, but not reviewed and cleared by pharmacy. To me, that's an extra safety step I'm skipping if I just pull it out and give it like I've seen others do. On the other side of things, maybe they are just that familiar with the drugs, while I still have to look up stuff with my scheduled med pass. How do you handle pushing meds with patient allergies?

Yeah, its like something funny in my mind happens. I feel like if I say something to upset anybody, I'll feel the wrath! They are very judgemental of each other. They smile and all, but they voice what they have to "clean up." I don't like walking on eggshells, but that's all I've been able to do while trying to keep the peace. I actually have no problem being direct, but firm. But it seems that it's not allowed since I'm new. I can't wait to drop this new grad title. Surprisingly, the doctors treat me much better than the nurses.

Thanks for the response. One point in time, that's exactly what I thought was happening. So, I started writing down more specifics with her. But even with that, I have had to tell her to slow down. She'll fly through previous medical history, allergies, anything to get out the door. In the past, I used to be worried I'd miss something important when nurses jump all around in a disorganized report. Now, it's not a problem for me. They can tell me whatever they like, and we'll check current orders and any drips before they leave. Cuts down on all that writing.... With this one nurse, I'll just keep speaking up in order to get what I need. And with the older about the nickname, I'll try the ignoring. It'll be a few days before I can try it out since I'm off. I'm curious to see how it unfolds. I have decided that I need a new goal for myself. I was a CNA for 4 years, and sometimes I got through the really stupid things, or bad treatment, by thinking "It'll be fine. I'll be a nurse soon. This minor stuff doesn't even matter...so let it go". Some kind of project to work on, or joining an organization. I'm not sure. Maybe that'll help though.

This is my first post here, maybe someone can give me some advice. I started working as a new grad in the ICU this summer and was so happy! All of my efforts led up to being an ICU nurse. Not to use as a stepping stone for something else, but to actually BE an ICU nurse. Now, I realize that staff will have to deal with my mistakes for a while. And for the most part, everyone has been helpful and understanding when I seek their advice. But there are a few people that seem to make extra effort in making things difficult for me. One nurse simply flies through report, saying she has kids at home to get to. When I ask her questions, such as "looks like her abx has been running for more than 24 hours. Is there a reason for that? She simply blows me off... "I'm not sure. But you can figure it out newbie" while she grabs for her coat. Another nurse, who has been there for many years, insists on calling me "little girl". I absolutely HATE that. It's so condenscending!! Who in their right mind wants a little girl looking after them while sick in the icu?? And here she is, addressing me in this manner while yelling across the unit. As mad as it makes me, I smile and tell her "I know you really like that nick name, but please don't call me that. It's demeaning". She always responds along the lines of.... "Well, I call everybody that", "you're just so young", "well, I'll be 62 years old on fill in the space", or she continues on working as if I haven't even spoken. Plenty of little things like this happen regularly. And it seems the expectation is to just "suck it up and deal with it" because I'm new. Otherwise, I'll be one of those nurses who whine and complain. Everyone else around me can be as opinionated as they like, and they brush off their mistakes I find when picking up their assignment. Perhaps it's because I ask about it by looking for clarity, not looking for someone to "catch". But you best believe if I have a mistake, its a write up. Thankfully, I have a supportive manager who seems to be fair, and I am getting close with other coworkers. They realize that although I'm not loud, I do well with holding my own assignment and trust I'll come get help when needed. My problem is the lack of respect from these few. And I don't know how to go from here without becoming a tattletail. Just because I am new to the RN role does not mean I am new to all things. At it's better for us all to realize that we are peers now... I'm no longer orienting, and the day will come when you need me to help you... Sick of the double standards.