traumaprincess

TJRN, I personally think that it is normal to feel like school did not prepare you for the real world. It did though, you are probably just not aware of how much you change as a nurse each day you are working. It will get easier and real life and school will all merge eventually so that it all starts to make sense. The more you push yourself to learn while you are at work the faster you will learn. Do not be afraid of what you do not know. Let it be a challenge for you. It is ok to think you do not know enough. You are not suppose to know it all yet. You will never know it all. That is what is so great about what we do, the opportunity for learning is endless.

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I am not new but I will NEVER forget how I felt. If you feel like you need more orientation you can always ask for more. Just know that you are not expected to know everything and there is always going to be someone who will help you if you ask for help. Know when to get help. Question everything out of the norm. It took a year before I started to feel even half way comfortable. I am really glad I never quit though, even though it was tough it was definately worth the struggle because I love what I do now. There is A LOT to know. You will NEVER know it all. It is more important to know yourself and your limitations. It is ok to ask a lot of questions and I personally think it makes you a better nurse. I hope things get better for you. Good luck in your new career.

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That is interesting, then if she does not want to take phone orders and write them herself she needs to tell the doctor to hold while she gets someone who can do it. Because no matter what the NPA says the person who hears the order should be the one who writes it. Maybe someone needs to talk to her about what her responsibilities are. That is frustrating. Maybe next time you should politely tell her that she needs to write the orders she took. It cannot take that much time out of her shift, and it will eventually avoid a mistake being made when the order goes from dr to her to someone else to the chart. There are too many chances for error in communication.

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Congrats!!!!

Sorry, I guess I was confusing. Basically what I am trying to say is this does not have to be about RN or LPN. This is basic nursing knowledge, you write your own verbal orders, you do not ask anyone else to write what you heard, nor do you write what someone else heard. Period. Everyone at your facility probably needs to be aware of this. JMHO

Just a thought so you might avoid a big RN vs LPN thing.... I will not write orders that another RN takes either. If someone is comfortable taking the phone order they need to write it themselves. Otherwise it just gets into a he said she said etc... if the order is ever written wrong or if it is written on the wrong patient etc. So, the person who heard the order, read the order back to the MD should be the only person who WRITES the order(maybe this is what needs to be said to her). I have had another RN ask me to write her verbal order and I told her no, let me help you with this or that, you go and write what YOU heard. No feathers were ruffled and I felt good about myself at the end of the day. It is not that I do not trust others, it is just that I like to be positive about what I take responsibility for??? I never want to shoo away help, but I have had drs insist they did not say what I wrote. If I actually did not hear it how could I stand proud by what I wrote??? So, you could tell her, "you are sure she is trying to be helpful, but you just are not comfortable writing T.O you did not actually take, but thanks so much for your help."

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This is a great thread!!! I just have to add my two stories. I got report from the ER RN, she said I would be receiving Dr. so and so... She gave me report and I waited for the patient. When the patient arrived she was this sweet elderly lady. I aked her what she liked to be called, she told me Dr. so and so. After a while of talking to her it seemed she had VERY little medical experience. I said what is your doctorate in? She said English. Aha. Second story. A patients daughter seemed to have some medical knowledge. But not enough for me to believe that she was a medical MD even though she introduced herself as Dr. so and so. After talking to her for some time I was convinced that she could not be an MD, even though it seemed that was what she wanted me to believe. I asked her what her medical specialty was. She paused for a bit and then told me she was a veterinarian. I would have to agree with llg definition I found: MD:New Latin medicinae doctor doctor of medicine; Doctor:1 a : an eminent theologian declared a sound expounder of doctrine by the Roman Catholic Church -- called also doctor of the church b : a learned or authoritative teacher c : a person who has earned one of the highest academic degrees (as a PhD) conferred by a university d : a person awarded an honorary doctorate (as an LLD or Litt D) by a college or university

Congratulations!!!! How does it feel to write RN behind your name????!!!! WooooHOooooo!

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35 min one way. That is if there are no traffic issues.

Even in larger units self scheduling seems to work. And it is something that is usually a huge morale boost for staff nurses. Our nurses, PCTs, and Secretaries all do self scheduling. There is a calendar in the back so you can request days off up to a year ahead (except holidays), you write in the date you requested it and it is a first come first get. We have to work our manditory weekends but we can choose what weekend we want to work. Pretty much anything will be allowed as long as the numbers come out even. Our manager assigned one of the charge nurses to be the one who makes the numbers even. Each schedule a different group of nurses are the "chosen" ones to get their schedule changed if they sign up on a day that there are too many and leave spaces on some days with not enough. It works out well and the manager has nothing to do with the scheduling. Hopes this makes sense

I really think that EVERY nursing job is hard. There is no easy nursing job. There are so many different areas in nursing. Each person needs to find where they are happy and go there. I have trained several floor nurses coming into ICU. Sometimes these nurses start out thinking it is going to be easier because they are responsible for less patients. Sometimes they have liked the reality of how busy just two patients can be. Other times they have found that they hate the environment and even with all of their experience they become overwhelmed and they have left to go back to what they were doing before. It is good sometimes for us to see how other areas function. It seems sometimes that nurses, and just people in general, think they are the busiest or working the hardest when in reality others are in the same boat. Recently a nurse with 15 years ER experience came to work in our unit. She has said so many times how hard it is to work in our unit. She never sits, runs all night long, she has been very overwhelmed (her words). I had to laugh with her one night when she said this, I told her that I was quite sure I would have to run out of the ER crying after half a shift, with how overwhelming that would be for me. It is funny how many house sups then think a nurse is a nurse and can work in any area. Yes, maybe we can but it does make most of us very uncomfortable. As far as med surg patients being sicker, yes they are, they are because icu patients are also sicker, so the patients who use to stay in icu a little longer get pushed out to make room for only the sickest. Therefore the acuity in the icu is also higher lately. Anyway..... I guess my whole point is, if you think you will like the type of busy one area has to offer, and you are feeling froggy, JUMP. But I really do not think there is an easier nurse job to be found. I could be wrong though, maybe I just have been working in all the wrong places;) JMHO

Jetsetter, I loved your post!!! You did such a great job seeing both sides. I think report is just another way we as nurses take the opportunity to be hostile or act superior, rather than trying to understand that the nurse on the other end of the phone is just as busy and stressed as you are. It may be a different kind of busy or stress but they are still just as busy. We are nurses. We work hard. Our job is not easy. And really the only thing that makes it easier is when we all try to be compassionate and kind toward each other. One hospital I worked in had a pre printed form for the ED nurses. They could fill it out and it was the generic report sheet. Some of the ED and ICU nurses got together to create this form so that everything that was really pertinent was on it. It seemed to work pretty well. The hospital I am at now is doing that with the OR also. ICU nurses are very detail oriented. They are suppose to be. But sometimes they seem to not understand that other areas have different functions and therefore a different perspective. I am usually in charge and I hear so many rediculous complaints about report. If you have time to whine about the info you did not get you have time to research and get the info you need. If I am REALLY WORRIED about the lab results I can look them up on the computer before the patient even gets there. And what is to worry about? If you are worried about the H&H maybe you should be more worried about the BP, HR, etc..... Is the patiet symptomatic??? And are you going to call the dr for orders before you even get the patient to your unit? No, so find out the info you did not get when the patient arrives. I personally would rather just get the patient in as soon as possible so we can start doing our thing. I have been known to meet the ER nurse in CT or in the ER and help them transfer a patient if they are too swamped because if it is a really critical patient they need the attention an ICU nurse can give. I would rather not make them wait until someone is able to transfer them. Maybe we should worry more about the patient then the nurse giving us report? They are doing the best they can.

I am an ICU nurse. We are definately from different planets. I agree with you all though. I here all the time from other nurses about how little info they get from the ER. It makes me laugh. I think many times it is an experience level. They don't even know what to focus on yet. I try to remind them that the patient just got to the hospital and it takes time to gather all the info they sometimes see as so important. This is all any ICU really needs to know, why they came in, what you have done, what I need to have ready in the room when you get there ie: vent, etc. Mostly I want to get a feel for what to expect when the patient rolls in. It is also nice to know initial assessment for the presenting or abnormal issues like if they have a head injury I like to know what the initial neuro assessment etc.... And I get grilled for silly info during my report sometimes also, like to the next shift or when the patient transfers to the floor. Everyone has different things they get hung up on. I also tell people that they will need to find that information for themselves and I continue on with what is pertinent. I think humor is always good, maybe if you ever get really frustrated you should point out to the person on the phone that we do work in different worlds with different focus.

I guess my opinion is very different from the others here. I think patients get overwhelmed and stressed especially when intubated when visitors keep waking them and talking to them. I have to wake my patient so many times for patient care that it is no wonder they get so confused after being so sleep deprived. Additionally I have had to have several family members taken to the ED when they had anxiety attacks, chest pain, etc from their own worry and sleep deprivation. When the patients are feeling better, have been transeferred to the floor and can communicate for themselves when they are tired and want decreased stimulation I think that is an appropriate place for unlimited visitation. Many ICU patients benefit from quiet time. This is only my opinion of course. I have worked in ICU with no visitation limits and units that are locked down and have very strict visitation rules. I have found that it is good to have the visitation rules in writing to give all families fair treatment. It is also important to avoid nurses being judged too harshly for wanting their patient to have quiet time. And if there are rules they should be adhered to unless the situation is different, ie: patient is dying, it is a new patient that arrived during the non visitation hours etc..... These are the visitation policies I have found to work well in the units I worked in: One ICU allowed visitation from 0830 to 1700. Then from 2000 to 2100. After 2100 patients were allowed to rest between nursing care and there was no one to wake them out of their sleep or to stimulate them out of their sedated state. There were only two visitors at the bedside at a time and we encouraged only close family members to help provide privacy to the patient until they could speek for themselves. It worked well and seemed very organized. My mother was in the Neuro ICU there and I had to adhere to the same rules. Family and my mother were all fine with it and my mom got the rest she needed. Another hospital allowed visitors to come in at preset times. Every 2 hours and for 1 hour. It was also limited to 2 people at the bedside at a time. Unfortunately during the night people would still come in at 0300 and wake the patient who may have just gotten back to sleep after being turned, given meds, resp tx etc. I thought the 0300 visitation was probably not necessary. The hours and rules were printed out and given to family on admit. I have rarely heard complaints about this. In fact I have had both family and pt thank me for asking visitation to be limited or calm and quiet. I have had family thankful that the rules were clearly printed so that they would not feel the need to sit and police the door of their family member and they would not have to enforce rules with their own family when they felt there were just too many or too loud of visitors coming. As much as I value family being involved in pt care, I also really think patients sometimes just need a little time to rest. The ICU is such a stimulating environment with the alarms, frequent treatments, and frequent assessments that sometimes these poor patients just need a little quiet time. IMHO I am sorry, I forgot to add this.... In order to have consistency for family and make them feel like they are all special it is important that all nurses follow the visitation rules. If there are exceptions, like once there was only one visitor for a patient and she was keeping the patient calm I let her remain, in a large unit I think it works best if the charge nurse is notified that exceptions are being made. It is just good to know in case there are any complaints. It is nice to be able to tell another familiy member that the rules are not adhered to because this person is dying, etc. Just so they can understand. I really have not had complaints from other family though. They seem to all talk in the waiting room and they know when someone is going through death etc.

I would love to join all of you! I have gained 40 lbs in nine mo. It is time to start taking care of myself and reducing the unneeded stress! What a great thread.

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