Galendria

I agree that it can be frustrating to see patients eating food that is counterproductive to their health. At the hospital I work at patients don't order delivery super often, but there is a cookie shop, Wendy's, coffee shop/bakery, gift shop with candy, etc. on site. Plus family quite often brings food in. Really all that we can do as nurses is educate, notify the doctor if the diet order isn't being followed (especially for things such as fluid restriction and renal diet), and ask diabetics to be honest about everything they are eating so that carbs can be accurately covered with insulin. As far as a patient chowing down on food while giving IV pain and nausea meds go....our doctors actually have developed some pretty good protocols for patient populations that typically exhibit those behaviors on my floor (mostly pancreatitis and crohn's flare admits). Typically if they are eating solid foods they are placed on PO pain and nausea meds. This has worked reasonably well.

I agree with the previous poster that it could be the brand of soup/sanitizer used. If so human resources needs to provide you with an alternative if you have a documented allergy. Also, does your facility still use latex gloves? I personally have become sensitive to latex after years in healthcare and my hands broke out constantly from the gloves until I figured out what the problem was. Switching to latex-free gloves solved the problem for me :)

I work at a level 1 trauma/regional referral teaching hospital on a very busy med surg/telemetry floor. Our matrix calls for us to have a 1:5 nurse patient ratio, with the occasional nurse able to only take 4 patients. The charge RN typically has 1-2 patients. *If we had the staff* the nursing assistants would have 9-11 patients each. What's been killing us lately is that all our assistants are graduating and moving on, so we have less help. I feel like PCAs/techs/whatever your facility calls them are the unsung heroes that help make current nurse:patient ratios bearable. Stellar techs make days SO much better. In the past I've also worked in another hospital as a new grad on a post-op floor with epidurals, trachs, tubes coming out of every bodily orifice and a patient ratio of 6:1. That sucked big time. I also worked on a pediatric surgical floor for 7 years with a patient ratio of 1:4-5 unless we had call offs that couldn't be covered. I really enjoyed that position, and felt like we were typically adequately staffed. Now with 4 years at my current job (and often functioning as charge RN so I see the "big picture" of how each nurse on my 39 bed unit is coping with the ratios) I have a few thoughts on the 1:5 ratio that seems to be here to stay at my hospital. First, I feel bad complaining b/c so many other hospitals make their nurses manage with higher ratios. That being said, when the patients are *stable* (key word) 5 patients isn't so bad. Unfortunately, patients usually get referred here from other hospitals because they need a higher level of care which means they are pretty time intensive by med-surg standards. Insulin drips and other interventions that require RN action every hour are very unsafe with 1:5 ratio in my opinion. It's not unheard of to have 2 or even 3 rapid responses called during a 12 hour shift, and that takes up a significant amount of time for not just the primary RN, but also the charge RN and anyone else playing "gopher" or helping to cover the floor. Then if there isn't a progressive care bed available to transfer the patient to right way that also becomes an issue. I guess my point is that when managers/administrators create matrixes they seem to have an ideal work environment in mind where all the patients are "typical", and all the ancillary staff will always be available. The real world is not like that, and so we have discussions like this

A lot of great info has been brought up (and debated!) in previous posts. Back to the original question of the poster though I think several points are important to keep in mind... 1. Run heparin (along with all drips like insulin, etc.) in a dedicated line if possible (along with following any policies/procedures at your facility). 2. If you have more meds to give than IVs consult compatibility resources at your facility (like micromedix) or your pharmacist. I also suggest labeling all tubing close to the patient to avoid confusion, Y the tubing close to the patient, and avoid bolusing through a line with a drip (like another poster mentioned). Great question! :)

I know of the school b/c I'm originally from South Carolina. No one where I live now would know what I meant if I said MUSC though.

1. Urban Ohio teaching hospital 2. 11 years experience--med surg 3. Base pay=$30.71 4. $5 shift dif from 3pm-7am. Additional $5 weekend dif. $3 charge dif. $3 over-percent dif (for hours 36-40). Double time and a half when working holidays. Cost of living varies widely depending the area of the city one lives in. My husband and I live in a "nicer" area with good schools. We pay around $925 per month for a 2 bedroom townhouse with an attached garage. This is a huge difference from my first 7 years an an RN working in the Carolinas. I got a 13% pay raise when I moved to Ohio!

This is a crazy long thread, but I just wanted to add my 2 cents in. 1. I'm a gun owner. I grew up in the southeast where guns, bows, hunting, and fishing are a way of life. 2. I would never be offended if a healthcare worker asked me either at my or my child's checkup if guns were secured correctly. 3. Asking about gun safety was routine at the children's hospital I worked at during admission assessment. Right along with car safety, bike safety, water safety, prescription drug/household cleaner safety, etc. Our priority as health care providers is to provide preventive teaching to families. Education isn't always initially welcome (think the 500 lb person who is chugging Coca-Cola all day long being advised to switch to diet soda or the smoker with COPD who is advised to quit smoking, or the end stage liver failure patient who wants to go on the transplant list but needs to stop drinking to do so). Every now and then a parent might be offended that routine household screening questions are being asked....but does that mean we stop screening? I don't think so. 4. Now that I work in adult med-surg we don't routinely screen for gun access as much, but if my patient is suicidal you bet I ask. Especially in a patient with a plan. Bottom line, guns are not evil, but sometimes they are used incorrectly. Ensuring guns are secured correctly in households with children is extremely important.

I would respond as a visitor the same way I respond if there is a car accident, someone collapsing at the gym, etc. I would offer first responder CPR/first aid until more advanced help arrived (police/EMS outside the hospital; code team inside). When I'm not clocked in I function in my role as a BLS instructor/provider, not an RN. I wouldn't say start an IV on someone in a car wreck, but I would apply pressure to bleeding wounds, do chest compressions, etc. Same thing as a visitor in the hospital. Hope this helps!

Is your clinical coordinator a RN or advance practice nurse? I'm a bit confused because in your story she seems to be suggesting a plan of care/new orders to the family which isn't really in a nurse's scope of practice, especially since she wasn't collaborating with the physician when she did so. We have a clinical coordinator on the med-surg unit I work on as well (and I feel that that role has been a great addition to our unit). However, our coordinator rounds *with* physicians, works to increase communication between patients/families and the physician, coordinates care with consulting services, PT/OT/social work/case management, and makes follow-up phone calls when patients are discharged. Our coordinator definitely never acts divisively like the story you told in your post. I'm also a bit confused as to the goals of care. You mentioned that the family didn't want "comfort measures" but in an elderly patient with respiratory congestion (I would be concerned about declining respiratory function), increasing narcotics seems like it would be harmful to the patient *unless* a comfort care only approach was taken. Even then, I've never seen a PCA pump used in a confused patient. What I have done is give Q 1 hour Morphine to a DNR-comfort care patient, along with an agent to dry secretions and anti-anxiety medications. Contrary to the beliefs of some managers, families generally *do* notice when staff RNs genuinely care about their patient, perform basic comfort measures such as oral care/turning/etc., advocate for them, and work together with the physician and other disciplines. Trying to boost nurse scores on surveys by bad mouthing the physician is never a good idea and erodes any teamwork which may be occurring on the unit. Surveys are a tool, but stories like this one which portray patient satisfaction as a goal above all others make me worried for the future of nursing.

Thank you *so* much for linking the medical mistakes thread. I have been solid laughing for 15 minutes now. I had no idea so many miracles happen around us, every day!

If you are only 2 weeks into your orientation, then as a new grad (ideally) you should still be receiving quite a lot of support and assistance from your preceptor. Do you have a consistent preceptor that you feel comfortable talking to? Are you receiving feedback? Does your nurse educator meet with you to ask how things are going and what you are learning? I've been a nurse for 11 years, and have been precepting for about 8 of them. I want to say first of all that being nervous is completely normal. I still remember being absolutely terrified when I started my first job (on a very busy post-op unit whose patients had tubes coming out of every bodily orifice). I actually worry if my orientee has an apparent complete lack of nerves or doesn't call me with questions and/or to come check that they "set an infusion up right" before starting it. I tend to follow those orientees a bit closer, go in behind them in rooms to check their work, etc. because it is *normal* to want your preceptor to check after you for the first 2-3 weeks. Its normal to ask her questions your entire orientation (which will ideally be at least 10 weeks). It's normal to still have questions after you finish orientation (especially during the first 6 months). Being a nurse is serious business, and even now, even after 11 years, I triple check my work and bounce questions off my co-workers if I am doing something I haven't done in a while. That said, your confidence should slowly increase over the next few weeks. If, after the half way point of your orientation you are still feeling mind-numbing fear, talk to your preceptor, and/or talk to your nurse educator. In the meantime take full advantage of the safety features that are in place for med administration. Follow your 5 rights to a T, use bar code scanning, guardrails on your IV pumps, 2nd nurse verification for high risk meds, and any other best practice safety checks that your hospital uses. We are all human, and those features are in place to protect us and the patients. Best of luck!!

We can phone in for meetings at my hospital, and they actually still pay us for our time! Its magical :)

Both my nursing jobs have been at large teaching hospitals in the heart of big cities. I just love the action, learning experience, and variety that big hospitals provide over smaller community hospitals. When I worked at the first hospital my husband and I lived one county over and I had a 30 mile/45 minutish commute. When we moved to the mid-west we were lucky and found a nice townhouse in a good neighborhood about 12 miles from the hospital. We dream of owning land in the country one day though, and with that will come a much longer commute. I have co-workers who drive 2+ hours to get to work. I even have one co-worker who lives about 3 hours away, works back to back 12 hour shifts, stays in the city between with a relative, and then drives home for her 4 days off. At my previous job in North Carolina I had a co-worker who lived in Tennessee and did the same sort of thing (back to back shifts and renting a hotel in town between) because she couldn't find a NICU with the acuity and pay of our pediatric hospital's closer to home. I guess it all depends on what you like. For those of us like me who thrive in the teaching hospitals, where we work isn't an option (well not really). So it all comes down to how far from downtown we want to live, and how long a commute we can stand :)

Your post title made me *giggle*. What exactly are you and the family charging? The exit...the new snack machine...the cafeteria before all the coffee is gone?

Like other posters have said, my hospital gives a bit longer orientation to new grads than experienced nurses (12 weeks vs. 8 weeks). However, I think the real reason (and its controversial) that hospitals think new grads are expensive is the perceived higher turnover rate that they have versus experienced nurses. Whether this is true or not I don't know, but I have seen more than a few new grads come to my floor, get 12 weeks of orientation, stick out the mandatory time to stay, and then transfer either to another floor or to travel nursing. I have a feeling that hospitals have that thought in mind when they say new grads are expensive to train :/

Like a previous poster, my facility asks us to strip the linen off the bed, and remove all tubing/suction/containers with bodily fluid in them after a patient is discharged. Housekeeping then comes in and deep cleans the room/bathroom, removes trash/linen, and sets up the room for the next patient with a made bed and clean linen. Yes what they are asking you to do is "legal", but I wonder if they are providing you with the proper supplies to clean the room like it should be done. Do you have mops, appropriate spray, cleaning cloths, supplies to clean the bathroom, etc? It seems like a *very* excessive job for a nurse and takes a significant amount of time away from providing patient care.

My husband got an abscess, and our doctor jumped to the conclusion that it was MRSA since I've been in the healthcare field for 17 years now. Cultures came back and turns out our house still has boring old susceptible to everything staph germs lying about. Guess I've been pretty good with my barrier precautions!

I worked as a pediatric nurse for 7 years before relocation made me move back into the world of adult nursing. First of all, I'm happy that the nurses in your life made such an impact on you, and have utmost respect for you in that you are endeavoring to make the experiences of other children with conditions such as yours better. That's awesome!! As to your question about child life specialists. First of all, volunteers cannot do everything they do. At the hospital I worked at our child life department had 3 tiers. At the bottom was volunteers who would pass out toys and books to rooms and help out in the play rooms. 2nd tier was child life assistants who supervised the play rooms, made sure toys were disinfected to specifications, and would play with children in their rooms at the request of nurses and/or families. At the top were specialists and they were generally bachelors or sometimes even masters degree. They had tools such as tablets, pictures, etc. to prep children of all ages for a variety of surgeries and procedures. They would assist during procedures, prep siblings on what they would see in ICU rooms before they visited, offer grief assistance to siblings, etc. Our children's hospital was attached to an adult hospital, so they would sometimes prep the children of adult patients too. We were fortunate to have *tons* of donations from area businesses and families so I'm not sure that all children's hospitals have such a well financed department. Others concerns about job security are valid. We had several nurses who tried to get jobs as specialists first and the market was just too slim for them, but on the flip side there are therapists who I friended on online media who have relocated to other cities and found jobs as child life specialists there without too much difficulty. Bottom line, it is a rewarding and needed career and if its something that appeals to you I would suggest that you at least look into it at depth. Best of luck!!

I also work from 7am to 7:30pm. The unofficial "rule" for both shifts is that if a admission comes before 6:30 am/pm the previous shift will attempt to do most of the admission. If they arrive after 6:30am/pm the previous shift settles the patient, gets crucial stuff such as height/weight, vital signs, allergies, and stat orders done, makes sure they are safe, and then oncoming nurse takes over. As with all things we are only human. Because what goes around comes around...and because I know extra work is hard at the beginning of a shift...I do try to do as much as I can for the oncoming nurse. But I won't stay past the end of my shift to do a last minute admission or discharge either. Also, it goes without saying, work left for the next shift is taken better if previous shift nurses aren't all sitting around the nurses station on their phones or gabbing at 6:45 am/pm On a final note though, the one time I always stay (even past time to leave) is my patient suddenly becomes unstable at end of shift, of if that last minute admission that arrived at 6:55 pm looks green around the gills. Usually by 8 pm the emergency response team has arrived and been given all pertinent details, the doctor is at the bedside, oncoming charge RN knows the scoop, oncoming bedside nurse is more organized, and I can head home then.

Wow, and I thought my short LPN gig before I finished nursing school was bad! That place had a ratio of 22 patients to 1 LPN on 7am-7pm shift and 44 patients to 1 LPN on 7pm-7am shift. I still felt as if my entire day was a never ending med pass. I take my hat off to you, and wish you the best as you take the next step!

Loriangel I agree with your puzzlement. I care for many patients in their 40's and 50's who are DNR-arrest, and I personally will probably change my code status to DNR when and if I am lucky enough to reach my 80's. Its a great option that our state has given us.

Is your assistant nurse manager also the charge nurse? If not, were they available to help? Its also ok to ask other nurses for help (and ideally on floors with good teamwork, they should be offering to help you if they see you are drowning). Some hospitals (especially those with unions) have a form you can fill out that says you are taking the assignment against your better judgment. We have a form like that, and if a nurse fills it out it goes to the union, our nurse manager (who has to file a response to the complaint), and the departmental manager. Sorry to hear about that day. Days like that are the pits

I work in a state where patients can ask to be DNR--comfort care without a terminal diagnosis, so the amount of supportive care we give is quite varied...from traditional comfort care for the dying patient with liberalized diet, no labs, daily v/s, no accu-checks, etc to more traditional care for a hospitalized patient where they might receive IV antibiotics for a UTI, a heparin drip, respiratory treatments, etc. Its really up to what the patient and/or their family want and what their goals are at that point in time. On the flip side, I have sat at a close family member's bedside while they spent a week in the ICU fighting before we decided to switch to comfort care. Toomuchbaloney's post was right on in that numbers aren't really important anymore. My family and I appreciated the nurses who focused on what my family member needed, and what made her comfortable. Sometimes too family members who have lost all sense of control will ask the nurse to do something. And if that something is small (like oxygen via NC), doesn't hurt the patient, and is covered by a doctor's order, nurses can make the family member feel they contributed by honoring their wish. In the end, I asked the nurses to turn off the bedside monitor because watching the numbers go down, knowing what they meant as a nurse, was just too much to take.

There's a reason our hospital has "gut feeling something is wrong" on the list of reasons nurses can call for the emergency response team. Sometimes we "just know".

I agree with RubyVee that exercise can be extremely helpful. I prefer biking to walking, but there's nothing like pounding out the miles and getting endorphins flowing to relieve some of the tension and stress from a bad shift. Also, getting plenty of sleep, eating well in general, and packing lots of quick snacks for shifts can help. After 17 years in healthcare (I started working as a CNA while still in high school), and almost 11 years as an RN, I've come to several conclusions about nursing. First, being a nurse is still my passion. Yes, some days are really, really hard...but I can't imagine doing anything else. Second, having good co-workers is key, especially in floor nursing where knowing someone has your back makes or breaks days. Third, I only have 1 brain, 2 hands, and 12 hours. I do my very best to take the best care of my patients with those available resources, but in the end I'm only human. Fourth, sometimes successful shifts are measured by nobody dying and nobody crying :) . And finally, when I start to feel stressed out I look at the small things. I try to find some way to make a difference every day. Maybe its just something small like taking 3 minutes to hold a patient's hand and listen to them, or maybe its bigger. But in the end, we as nurses *do* make a difference, and sometimes we just have to dig through the bureaucracy to find our moments of zen.