pebblebeach

Update since my original post: I left this job - for a few reasons, but a huge reason was that they DID end up hiring someone specifically for this task to handle prior auths - an experienced LPN who was excellent - patients were getting PAs/appeals done in a timely fashion (and therefore, their meds on time, most importantly) I constantly echoed my praise for this person and how valued they were to the RNs and patients overall care - unfortunately, management didn't listen, the LPN quit for a better opportunity - and they didn't replace her. The PA avalanche piled back up in DAYS after LPN left. I immediately started looking for other jobs. IMO, It is now ESSENTIAL to designate a separate position for this need now; the RNs do not have the time - and frankly, it's a waste of a good RN to have them sitting on hold w/ BCBS for 2 hours when they could be... I don't know, giving vaccines, educating patients on their meds, triaging pts on phone whether to go to ER or not during a pandemic, etc. etc. It's a tremendous urgent need that is just going to keep growing, and clinic management needs to recognize that need, or people will get fed up and leave.

Hi clinic RNs, I was previously a bedside nurse who transitioned to clinic life. We deal with a lot of patients on biologics (humira, etc.). The biggest learning curve for me coming from bedside is the barrage of insurance denials, prior authorization appeals, and of course the multiple phone transfers, being on hold, faxes lost and re-sent, and follow-up involved. The RNs who have worked there for years have said that 2019 has been the worst year yet in terms of pushback from insurance, and has taken up more of their time now more than ever. It takes so long to initiate and complete these requests that other clinical tasks are getting ignored. If you deal with a lot of this at your clinic, how is it delegated? I've heard of clinics hiring LPNs or RNs specifically to work on specialty med insurance/PAs, but that's not in the budget. Curious to know what your practice has tried - even if it failed. Thanks.

Don't you feel though that only two shifts is a little bit of a knee jerk reaction to having a different preceptor than the new grad anticipated? My preceptor had a very different nursing style than what mine ultimately is (or what I thought a nurse "should" be like), did some things slightly off-book, but was a respected nurse who cared for her patients safely and efficiently. Ultimately I took the lessons that worked for me and left the habits that didn't appeal to me behind. I had another preceptor for night shift who had some IMO awful habits, was not particularly friendly, but WAS very skilled when it came to meds, IV tricks -- and you know what? Some of our patients like her better b/c she's no bulls***. So, I learned everything I could from her, looked for mentors elsewhere, and came back to her whenever I needed help with an IV. No matter who OPs preceptor is, the floor is going to be filled with personalities and nursing styles she will like and dislike. It doesn't MATTER if you like like or dislike them, or if she finds taking Adderall in front of someone rude or not, because after orientation you're on your own, and it's the pt who matters, not your feelings. And this is coming from a sensitive millennial here (although elder millennial- hard to consider myself in the same group as those that don't remember not having cell phones), so I'm generally not in the tough love crowd, but two shifts in and wanting out? I do have empathy (my first reaction to my unfriendly night shift preceptor was shock... then, OK, so this person isn't my BFF, cool) but I think OP needs to be patient. If it's been 5 or 6 shifts and nothing at all has improved, or worsened? OK, make a plan. It's been two!

When I worked nights I had an alarm set on my phone to take my birth control pill, Lexapro, etc. Now wondering how many new nurses I've traumatized with "She took her Lexapro right IN FRONT OF ME!" ? Sorry not sorry, barely have time to eat a full lunch let alone whisk away to privacy when I need to take my pills. OP, I've also been the lost puppy, but it's been two shifts. It's great to be eager to learn but the learning curve (especially in ICU) is steep and slow vs. nursing school cramming and regurgitating. Be patient.

I have posted a couple photos from work (on a private social media account) with zero mention of patients - just positive reflections ... i.e. on my one year anniversary as a nurse, a selfie of my good friend and I in the break room. I go by the rule also that I wouldn't post anything my boss or coworkers would be surprised by, and I don't vent on social media, certainly not about work anyway. So if our nametags are visible... and someone zooms in on them, that's a punishable offense? (Perhaps if someone doesn't like me enough to report it... yikes)

"This student nurse recently forgot how to prime and hang IV bags and even scan them in." Just defending the slower learners over here in the cheap seats... ? This is a pretty advanced skill for a new student nurse. What is muscle memory to us is brand new to students. Clamping, back-priming, making sure all air bubbles are out, aligning it with the pump and programming the pump? and troubleshooting beeps?! and that slight manual gravity adjustment that can't really be taught to get a secondary in just the right spot -- to do that super quickly and correctly took me a while as a new RN. Doing all of that without repetition of the steps explained to me (yes, multiple times), as a student? No way. Also, experienced nurses have all forgotten to scan a 500cc saline prime bag before, no? +1 to patience

I completely agree with all of this, but if there are no spare films available to you except for in the kits, what else do you do? I wish more of the individual supplies in our kits (right now blood culture bags and port access trays come to mind) left some of the critical items in it (biopatch, angelwings) out separately, so that if you need another you don't have to open another kit. I always wonder who makes the decision of what is packaged together and separately, why is there suddenly a new brand of tape, etc. etc. Medical waste is such an overwhelming problem, as a new nurse I feel swamped enough by simply staying on top of my tasks right now, but at some pt in my career I would like to focus on it. I worked as a tech on an ortho unit years ago, and somehow this hospital could afford a pack of Pampers wipes (like- Costco size ones) for each patient in the admission bucket. The pt would usually ask for more during their stay. Well, come discharge, there's 3 unopened Pampers packs left in the room that have to be thrown out bc the pt has a history of MRSA or something -- meanwhile they could be used by parents who can't afford wipes. That one really got to me. Maybe opened kits/leftover supplies in non-iso rooms can be donated to a nursing school?

I feel you. It took me years in therapy to stop comparing myself to others' issues, i.e. "well my childhood was fine, my parents are great, I've never been abused," etc. etc. It's my belief now after a lot of self-work that every single one of us has experienced trauma in some way. Go to one appointment - what's the worst that could happen? Sending you good vibes, you'll get through this!

Yes. I wouldn't worry so much about the label (bipolar vs. "just anxious") right now. All feelings -- annoyance, hopelessness, flat -- can be "normal," the deviation is how loud the volume is on those emotions. For me, without help, the volume is on full blast. You said you have a prescription for Lamictal. Assuming this was from a psychiatrist? Do you have a therapist in addition to a psychiatrist? (I recommend both, if you can afford it.) If so - bring up the concerns specifically about nursing. Notice when you get annoyed at work, how often, etc. so you can get to the root of it. Yes, maybe the person is just annoying. But does it feel like you're crawling out of your skin, or like you can't focus because you're so annoyed? Therapists can help with those things. Psychiatrists help when you need an Ambien prescription because you can't sleep between shifts. Are you open with your close friends or family about this? That can help immensely. I journal, old-school pen to paper. It helps with identifying how soft or loud I am on that volume scale. Journaling when adjusting to a new med is useful too, literally a sentence or a couple words everyday -- "felt nauseous, more depressed than yesterday, etc etc." It helps to have a timeline and then be able to go back to your MD with that. I'm able to be a good (good enough, sometimes) nurse because of the above -- my small little support system - therapist, psychiatrist, family, friends -- and my meds. I can't tell from your post if you're a new nurse or experienced nurse, but from a newer nurse struggling on night shift, I struggle too, it's a battle like any other illness. You're not alone. Don't worry about the label for now. Feel free to message me on here if you want. ❤️

Agreed. I have the positive attitude part down and I continue to work on good habits. I've definitely heard of instances where RNs bring in a doctor's note to get out of night shift after a v. short time on nights. In contrast ... my coworker with sickle cell? She could NOT adjust to nights. She was a fighter until the bitter end, though.

It wasn't my intention to scare -- I'm sorry! I just wanted to be honest about my experience, as nights is not for everyone. I have had to find solutions to the nausea, mental health, etc. and as long as I am consistent, I know I will survive night shift until a spot opens up on days. I did forget to point out (as many have already) that the teamwork on nights really is great.

Congrats on the gig! I started out in a new grad orientation program too, and we started out on nights. I have always been very sensitive to sleep, and my psychologist strongly advised me to not go on night shift, but it really wasn't a choice. So I went into it with a positive attitude and pretended I could be a night person. I've had a hard time. I do all the tricks -- blackout curtains, the original Dohm white noise machine (go big or go Dohm), essential oil diffuser, eyemask, etc. Sleeping between shifts isn't a huge issue now. In the beginning I would have so much adrenaline from shifts getting home that I couldn't turn my brain off -- give that a few weeks and I was tired enough to let that go, lol I've never been the sleepy type on the job, I'm the opposite -- engaged and high-alert (sometimes to a fault -- fine line between alert and anxious). The big problem for me is my days off. I've read all Googlable advice on this: Set an alarm if you nap - GET UP no matter what - and switch yourself back to a daytime schedule. (Or stay nocturnal all week - which I tried once and was so dreary I never did it again, but it may work for some) So, I finish the three shifts consecutive (I prefer that, btw - continuity with pt care and with report is wonderful) and the fourth day is the day to switch back. I will nap for a couple hours, wake up to the alarm and feel like the crankiest human on the planet & like I haven't rested at all, or I'll "listen to my body" (fine line there, again) and next thing I know it's dark (AM or PM? who knows!) I have several missed calls from concerned friends & fam, and I haven't hydrated in 16-18 hours. My mood may be lighter, but my body feels like it's been hit my a truck. I think only graveyard shifters who have experienced this crash can relate to that feeling. I've also never dealt with nausea before and have discovered I cannot eat on nights. (Coming from a big snacker who loves food, this sucks) So I will try to have a healthy meal when I get home or before work, and then bring a smoothie or something my stomach can handle during the shift. I've lost 14 lbs since starting night shift and not in a good way. I've added iron, Vitamin D supplements, and Miralax to my daily routine (don't even get me started on the change in BM habits... my GI tract doesn't know what the hell is going on) My mental health has taken a hit for sure. I have managed my depression pretty well for almost a decade now with a combination of therapy and SSRIs, but having that baseline history of depression added to chronic sleep debt (and sometimes forgetting to take my med because I was so strung out at first w/ what day/time it was) I have had... rough weeks. Two days particularly come to mind when I felt truly bottomed out. Waking up crying, feeling worthless, the whole lot. Thankfully I have been in that spot before, and even knew as it was happening -- "this is chemical, you're exhausted, this is temporary" Still lousy, though. All that said, I know this is not forever. Nights are not for me long-term. The pay is nice, but I'd rather get paid less and feel like a functioning human on my days off. One hack that has helped, I carpool with a coworker on our days that we are scheduled together, and we play goofy songs (Spice Girls, etc) on the drive and sing like fools, it helps my mood so much on those days coming into the shift. Or if I drive solo, I'll sing my heart out to Aretha Franklin or something equally over the top. Whatever works! Keep us posted how you're doing. Wanted to share from the perspective of someone who is on nights but not thriving, but I know I'll get through it.

GREAT movie ?

Thanks, Kareegansee! I will definitely keep my options open, and plan to keep in touch with the Neuro ICU director (we're only a couple floors apart at the facility). I see you're in the SICU, is that where you started out as a nurse?

I'm about to start a BMT residency and this post was super, super helpful, especially the patient education resources. Thank you! edit: oops, that was supposed to be a reply to buckeye nurse RN