Vanilla101

I've worked in large teaching hospitals for most of my career, and have been a student, a preceptor & a clinical instructor at both the undergraduate & graduate levels. I've been seemingly drafted into both precepting & into being a clinical instructor. I have had complaints from students who felt like they were not wanted by their preceptor. At my facility, it is part of the staff RN's title (after a year of experience) and written into their job description that they will be clinical preceptors for students who attend our affiliated schools. Staff nurses should not be surprised when they get assigned a student at 07:00, that's not nice.

Before pumps, Dial-a-Flows were the BOMB! The first generation of pumps only measured rates in ml/hr. Weight based drugs had to be calculated by hand, fortunately pocket calculators had been invented by then. The current pumps that have the formulary programmed in & calculate weight based rates are wonderful, but not foolproof. Overriding the pump, hanging the wrong drug on the pump, inaccurate programming or failing to scan can have disasterous outcomes. Overall, it's all about attention to detail.

When applying for a new job, the hiring hospital will call HR of the former employer. HR will let the hiring hospital know if the candidate is "eligible for rehire". Its basically a way of finding out if the employee has been fired. Hospitals check the Internet routinely on new hires. As part of leadership, I can cite dozens of instances of nurses turning their colleagues in for inappropriate posts on social media & other websites. An inappropriate post would certainly include even a hint of a HIPPA violation, but also the naming a former place of employment in a negative way. Coworkers can, and will turn each other in. The vast majority of staff caught posting inappropriately are either terminated or receive a high level disciplinary notice.

The standard process for orientees in virtually all hospitals is to have regular meetings with your preceptor & a representative from your units leadership. At these meetings issues in practice may be discussed, and you will always know where you stand. Management shouldn't be able to terminate you unless they have consistent documentation of poor performance being a pattern. Management is also responsible for providing remedial education to help you perform your job competently at the new grad level. this also needs to be well documented, and it must include your success after education. If I were you, I would request a new preceptor, watch & learn, have regular meetings with her & leadership, and frame your questions so that your preceptor doesn't get offended, but rather regards you as someone willing to learn from her. Everybody has a different practice. delegating tasks to the appropriate ancillary personnel avoids micromanagement and allows for you to complete your RN responsibilities.

Is this a joke letter? Why didn't you go into teaching? If you are unwilling to do weekends/holidays, you probably won't get a job. These jobs go to experienced nurses. Oh, get ready for night shift as well.

It's why mock codes are so important. The room doesn't need to be full, the room should be clear of extra people. It's more help to the team, especially when (as the author noted) the other patients on the unit, especially the roommate of the patient coding are comforted and taken care of by extra staff and there is less noise than there needs to be.

For an extra whitening boost, use blueing. It's in the laundry section at the supermarket, look for it carefully, it's one of those things that's hidden away and there are usually only about three bottles. Follow the directions CAREFULLY!

First thing, travel light, everything should fit in your pockets. I recommend a stethoscope. Second, a penlight. There are some nice ones for physical exams, but I assume you will be working nights as a newbie. A small, but not too small, maglite works very well. Have at least 2, even three of your favorite type of pens on you. You will constantly be loosing them, and others, including patients/families, will ask to borrow one. Keep a full pack in your locker. Hemostats come in handy when you need one, and if you will be working SICU, bandage scissors are nice to have. These are the basics. You'll see what you need as you get experience. If you will be taking a critical care class, you will be going over the basics of pharmacology, lines, devices and drains, signs of common diagnosis's, (shock, respiratory failure, heart failure, renal failure, etc. The most important thing to review prior to the class (or the start of your employment). Is reading telemetry strips and knowing what's on the heart monitor. Dubin's is a good text to look at. The things that I look for in an orientee (I run the orientations in our CCU) are a positive attitude, asking lots of questions, jumping in to help others, not acting too comfortable right away, promptness, appearance, etc. really just common sense stuff. Good luck!

My mistake, I should have clarified. To decrease self extubations, in restrained or unrestrained patients, there also must be other interventions put in place by the team, such as sedation vacations and respiratory driven protocols. With the use of these, our unit has achieved a 40% reduction in self extubations. I do maintain the view that restraining a patient is not going to prevent self extubations in patients who really want that tube out.

"I don't believe a single nurse, save possibly the ICU, who doesn't admit to "copy paste". Trust me, it's done in the ICU. It's not considered illegal if the nurse accurately documents changes from the previous assessment by changing what they wrote prior. It does, however, increase the chance of error.

About self extubations: it's been shown in the literature that unrestrained patients do not have significantly higher rates of self extubations than restrained patients who use all sorts of creative maneuvers to get the tube out. They will shake their heads. Use their tounges. Sit up and bring their head down to their hands. Or bite the tube clean through. There is no substitute for eyes on the patient. Of course this isn't always achievable, but ICU nurses spend a lot of time in patients rooms, assessing everything about the patient, including restraints. Yes, turning and positioning does happen Q2 hours on my unit. So does releasing restraints and monitoring them per protocol. So these tasks are completed, not always at the exact time such as 8,10,12. If one has enough time to watch other nurses and see how their tasks match up with their charting, then one has time to do their own work and not have to falsify charting.

Trust me, management/administration doesn't mind if you say no. They also don't mind if you don't answer your phone. As a bedside nurse for 25+years! I learned this. I also figured out that if we were short staffed on a dayI WAS THERE all of us on that day would have to "suck it up" and take more patients. I never felt bad about others not wanting to come in, so I didn't feel bad about not doing OT if I didn't want to. These days, whether your doing OT or not, your going to get slammed either way.

Honestly, there is no big philosophical question here. Gay people are ordinary people. There really isn't anything to talk about.

EVERY ICU in the hospital gives you something to learn. All ICU patients are sick, their illness, medical, surgical, trauma, etc., requires a higher level of nursing care. Any ICU will sharpen your assessment skills, increase time management skills, and teach attention to detail. I have worked in all the ICU's at one time or another, my preference is Coronary Care. Personally, I don't like to see blood unless it's in a bag going into a patient. That's why I don't do trauma/surgery. That said, if you want to be a flight nurse, the SICU or the ED/Trauma unit would be good. Please also realize that ED/Trauma is MUCH different than any ICU. So is flight nursing. These areas require good ICU skills, plus the ability to super-multitask in a crazy environment. I have a few friends who have been flight nurses who are also RN's and certified paramedics. This helps, as it is difficult to get flight nursing jobs.

Patients who are admitted to med/surg/trauma floors are there because their condition might change for the worse. (They may need an ICU/ICR setting if it does). Be aware of S&S of worsening condition in your vital sign patterns and assessments. These basic things will take you in the right direction, even if you have a lot to learn.

The nurse who was orienting you was wrong for not helping you. The unit that you were transporting the patient from could have offered someone to help. I've been a nurse for 28 years, I don't know of very many people who would have not helped.....especially if they worked together on the same unit!

In my first post, I wish to make sure that people are human, and DO make errors. That does not mean they don't go on to be great nurses. There should always be a system in place to prevent such things, such as the 5 rights. Also know the common policy and procedures by heart, and look up the ones you need but don't know. Good luck with your career, you will do just fine.

It was harm. As stated, the patient needed a c-section. Not only was it harm, it could have been easily prevented had you followed policy, the five rights, even if your preceptor didn't. That's the ultimate resposibility of the person hanging the med. It was a preventable harm, and hundreds of thousands of people die each year because of preventable medical and nursing errors.

That's a great idea, I'll let you know what they say

Sure. I no longer desire to practice as an NP, when I left the NP world, I took on the role of CNS. I enjoy the job. But I will no longer be able to accumulate the hours needed for recertification as an NP. Unlike most states, mine does not require ANCC or AANP certification for practice as an NP. I am keeping my NP license, I worked hard for it.

I work as a CNS, and was trained as an NP.in addition to earning my CCRN, I want CNS certification. I've looked, and it seems that ANCC has retired the CNS Core test, but may still offer the adult course. If not, is there any other company that provides a course?

I am referring to: "if he sends the patient at change of shift, I'm sending him back and writing him (nurse) up." While I would perhaps agree that the patient becomes a unit responsibly when the unit RN accepts the patient, I maintain (please remember that I have, for all intents and purposes worked in an ICU setting) that sending a patient (ICU patients are unstable by default) back to the ED creates a further delay in care and is not acceptable, and causes further delay in treatment. A delay in care can cause harm, thus meeting criteria for malpractice. She had an SBAR report, and at that point would have only needed an update on the patient from an ED RN. And, there are several ways (mentioned in the the previous posts) she could have facilitated the transfer herself. I have never sent back to thE ED from the ICU. I have seen patients die in hallways due to a breech in the acceptable standard of care. So please at least remember that it is not a good idea to traipse around, back and forth, from the unit to the ED. It's just bad practice.

First, as others have mentioned, the ED does NOT benefit by keeping patients until change of shift. They get patients continuously until they get SO MANY that the hospital puts the ED on diversion. Second, also as others have mentioned, you could have called the ED earlier and offered to get the patient yourself. That would have helped the situation and fostered teamwork. Third, there is hardly any "glitz and glamour" in the ED when you're witnessing a victim of abuse, a drunk is throwing up on you, or your getting cursed out by a patient. The ED is also the most dangerous place to work in the hospital. I have colleagues who have been bitten, punched, had to take cover if a firearm was taken out, or kicked. My state has made such assaults on RN's a felony, but it took a very serious injury to an RN to make it so. Don't get me wrong, there are rewarding aspects of working the ED as well. Your comments do not indicate that you were in the ED at all during the wait time. It is, then, a safe assumption that you had no idea what other things were demanding the attention of the team. You don't know for a fact that the patient wasn't being monitored. It may have been bad judgement to send a patient such as yours to the floor rather than the ICU, but that's not a nursing decision. As a Registered professional Nurse on a telemetry unit, you are trained to assess and intervene on patients who are unstable at any point in time, including admission. In such situations, the patient May or may not need ICU level care. If they do need ICU level care, they still require close monitoring on the telemetry unit by an MD/RN until a bed is made available on the receiving unit. Lastly, ANY patient admitted to the hospital and brought to the unit becomes the receiving units responsibility immediately. It is malpractice to send an inpatient who requires close monitoring and a team with an attending physician back to the ED, especially in the situation described. I've been an Inpatient unit manager for a number of years. If this were to occur in my area, there would be immediate disciplinary action after a review of the event. Please don't misunderstand. I am responding to comments posted, and cannot judge anyone personally or professionally. I am using this forum to share my opinion only, hoping that someone will learn from this. In medical malpractice cases, nurses are not exempt from being held accountable for their professional judgement. In this situation, had the patient been returned to the ED, and harm had occurred, the RN would have likely been held 100% responsible as it would have been her decision, a decision that showed poor nursing judgement, negligence and not doing what is best for the patient.