ladedah1

I'm not going to lie... I was utterly confused until I finally went back to the top and read the OP's listed specialty. Until today, the only DSP that I was ever aware of was Day Shift Problem... so I seriously read this whole post thinking this was something to do with nurses helping each other out around shift change! I must be losing my mind! ?

Confused, impulsive patients who won't stay in bed at night: Turn down the thermostat in their room and get them a toasty blanket from the warmer. Might take a bit, but it often puts them to sleep (or at least reduces the number of impulsive bed exits) !

This is simply not true. When a person has ADHD it is always a factor, even if well managed with medications. If we give a patient medication for pain, we expect pain management, not pain resolution. This same concept applies to ADHD. Making the symptoms of ADHD manageable does not make it dissappear and, therefore, it cannot be an irrelevant factor. In addition to medications, it requires that a person have a great deal of strategy and coping mechanisms... which can in turn become strained by other stressors and factors that are affecting that person's life.

Sounds like a busy day! Hospitals are a 24 hour operation. It sounds like you did a lot to try to set the next shift up for success. The fact that they dropped the ball is not your fault. This is the kind of situation that makes me grateful for the team-style set-up my hospital has. Pharmacy manages heparin drip titrations, boluses, orders, schedules timed draws for anti-Xa and / or aptt, and monitors for results (of course, contacting us in a timely fashion if it's missing, too!). Phlebotomy does our draws, but if they're a hard stick, we can call the specialist team. If the drip rate needs to change, the pharmacist calls us directly to let us know. If we're super busy, we have a free charge that we can delegate it to (though it is a double check). As a result, heparin drips run very smoothly where I'm at. While it sounds like you encountered quite a few issues, it also sounds like a system that could benefit from some process improvement. It's so easy to blame ourselves when everything goes awry, but sometimes it can very well be the result of a flawed system that lacks useful safeguards and fails to take the full context of your daily duties into account. I don't know why everyone always seems to be under the misconception that having an orientee is somehow considered offering a nurse "extra help" and should therefore merit a more difficult assignment. What it really is, is extra work (even if it's an experienced traveler and not a new nurse). You may have two sets of hands, but it results in slower progress - not to mention all the time it actually takes for teaching about policies, routines, protocols, and the location of stuff (heaven forbid, they come from a place using different software!). In the end, orienting someone with a difficult assignment creates a burden for both parties: you're both running around like chickens with your heads chopped off, you're both distracted, and the nurse your supposed to be teaching ends up with no meaningful or cohesive information. Either way, I'm sorry that things went so crappy. Nonetheless, what has happened has happened and cannot be changed; just breathe and try not to be so hard on yourself. The only thing you can do is try to learn from any mistakes (like the lab sticker issue) and still aim to do your best. Maybe you could even sign up for a process / quality / safety improvement team if you have one there? Sounds like they could use some new ideas ? Good luck!

I guess it depends on which city. The hospital I work at is in a city and is right in the middle of the downtown area. It has a few of its own ramps, though, and has bought up a lot of parking in the immediate area. We don't pay for parking. I still think it's a bunch of crap to charge employees for using hospital-owned parking if you need them to show up to work... though, I suppose it could also depend on whether or not a hospital actually owns the parking options. If the parking isn't owned by the hospital, it can't very well control whether parking is free.

Seems like free parking should be something that just comes with the job if you ask me. How do they expect you to get there? Teleport? Charging for parking - being that it is often a necessity when it comes to showing up to do your job - is a load of crap. Why not just hand out pay cuts while they're at it? I don't - and never have - paid for parking at my work (ramp or otherwise).

Depends on the reason for the order. If the patient failed their swallow, it is definitely not OK to provide oral meds. Sometimes I've seen newer doctors add exceptions for "sips with meds" on NPO orders for these types of patients (whether by mistake or because they didn't really think it through) and I will not hesitate to call them and question the order. If the patient is not safe to swallow, then they are not safe to swallow. Now - if the patient is NPO for a procedure - that is often a different case, as these patients can often swallow fine and are only NPO temporarily for procedural safety. In this case, if an order for NPO does not have an any listed exceptions, then the doc would need to add an exception for "sips with meds" (or similar) to the NPO order before we give oral medications. Often, the orders for such patients will be written that way from the start; if not, clarification should be sought before giving oral meds.

I can actually summarize how my relationship has survived my nursing career in two hyphenated words: Part-Time. Seriously. Stress level is virtually nonexistent when you cut out just one shift a week. Energy recovers easily, too. I'm not saying that I'm less tired after work days... it's just that the lingering emotional exhaustion isn't really there. Work is a blip in your life... not the other way around. Though it probably doesn't hurt that I've been with my husband for forever, either. After all... any spouse that can survive the "nursing school" phase, can probably hack it through the career phase just fine?

If it were me, I would send out an email to everyone who would typically be receiving the newsletter and ask them what they would like to see and / or think others may need to learn more about. You could also use a survey service such as Survey Monkey or unit-based suggestion boxes (which would both promote anonymity and, thus, the most honest responses). While we may be able to provide you with ideas about what we might personally want to learn more about, knowledge gaps and / or infrequently used skills tend to vary from workplace to workplace. Soliciting ideas from your own people will likely yield more applicable subject matter and also provide others with the opportunity to participate :) Either way, I applaud you for being so involved and helping to educate others!

Definitely the O2 Stat... or, even worse, "statting" (as in "She's been statting at 95% since the RT increased her high flow"). Seriously? What do these people think their abbreviating? O2 staturation?? ??? If a person wants to sound like a really uneducated nurse, using any variant of stat in the same sentence as O2 (with the exception of STAT orders for O2) sure gets them off to a great start!

Absolutely agree! Been on nights my whole career (though, technically, I was a night owl to begin with) and have never had a problem. Everyone I know works around my schedule (and many are happy to know there is at least one person they can still call when they are still awake at midnight ?). The one exception is delivery people (who always drop off packages between 11am and 1pm); if it's between shifts, I just sleep on the couch when I know a package is coming (so my dogs jump on on me when the Ring alert goes off), get the package (before porch pirates can), and then fall righ back to sleep ?.

"Looming?" Where I work, it already feels like a crisis. My unit is 75% travel nurses and we're still consistently taking 2 more patients than our original (safe) ratios demand. We're magnet, yet still hemorrhaging staff like nobody's business. Heaven forbid there be an actual shortage.

Hasn't ever really been a problem on my unit (we're definitely of the whole-unit only survives as one mentality), so I wouldn't really know. Heaven help the person who thinks that they can try to bully me or my fellow coworkers... as we're certainly not push-overs, either ?

A couple years back, my unit was tracking both bedside report and overtime simultaneously. When we inevitably ended up with overtime, they would make rounds asking what factors we believe contributed and what changes could be made to help us get out on time in the future. Whenever we pointed out that the overtime was related to some aspect of bedside report (toileting, questions, excessive pt input, etc.), they would basically gloss over our feedback and bring it back to our need to delegate to our techs (as though we didn't know when to delegate!). Oh, sure, that's a real solution ?. I'm sorry, Mrs. I-have-to-pee-real-bad, we're busy with report right now. You'll just have to wait for the tech (who is currently toileting the other five people we just woke up)... would just love to see the HCAHPS scores and fall charts associated with that response! Don't get me wrong, laying eyes on the patient can certainly help catch problems before they become catastrophic. But if their focus is truly on increasing the quality of care, then they have to be willing to accept that there is a higher price tag associated with it. They should really get out of the office and into the real world; things that seem possible on paper (I.e. bedside report and no overtime) rarely go according to plan.

We have a lot of contract nurses where I work right now... that said, it's been a lot of fun learning all the interesting practice tips and terminology they bring with them from allover the country. I about died of laughter when I heard people calling the Purewick (for those who haven't heard of this before, it's an external catheter device for female patients) a "Cooter Canoe" or "Crotch Rocket." We've historically called it the "banana" ... but "Cooter Canoe" ? Way better! ???