bluebirdflyx

Thanks everyone for taking the time to respond. There are lights above the doors, and at one desk you can see on the paging system what room is calling, but from a majority of the seats unless you get up you cannot see which room it is. I will start being more vocal about delegation. I'm new to this role and in addition I still work the floor so I have to work alongside everyone. I think before the next shift starts I will have a huddle and tell everyone up front they need to step up their game and help distribute the workload.

I guess I should clarify that from the nurse's station we only have a visual on a few rooms. Often times when a light starts ringing no one can see what room it's coming from so it makes it difficult to direct a particular nurse. At this point it seems to become a standoff to see who is going to get up and see who's calling.

I would appreciate some feedback on how to get nurses to help answer call lights. I work on a med-surg/oncology floor. I alternate working both the floor and also as charge nurse. Our ratio is typically 5-6 and we have 1-2 CNAs. We have a paging system at the UC desk so we can page back into the room and ask the patient what they need. If the UC is not at the desk (they leave at midnight) and a call light goes off, I have a select few RNs and some CNAs who WILL NOT get up and answer the light. They will not go to the phone to what the patient needs nor will they go directly to the room. I mean they will not budge from their seats. Whether or not it's their patient doesn't seem to factor in, they will let them go and go. It doesn't seem to be an RN vs. CNA problem; it is made very clear at our facility that answering call lights is everyone's responsibility, but some of these people turn into Helen Keller the second an IV starts beeping or a call bell rings. I am not referring to nurses who are busy with other patients, reviewing orders, calling docs, or any of the other tasks that bog us down. I am talking about nurses who are sitting at the nurse's station playing on their phones, talking with other nurses, etc. I feel they are blatantly taking advantage of those of us who cannot sit by while the lights and alarms go off as they know we'll answer them eventually. It's not an option ignore the lights in return because only the patients will suffer. Does anyone have any advice on how to facilitate a change and get these nurses off their behinds?

You should apply for a regular CNA position. Often times those CNAs will get cross-trained to work as Unit Coordinators and from there it will be easier to move into a full time UC position.

^^ I do the same thing as Peihan - come in a little early and get ready. If for some reason I can't come in early that day I'll still take at least a minute or two to look through the chart for some key things I'll need to know for report such as labs or vitals that are out of whack, overdue meds, or STAT orders. I try to catch anything I'll need to address right away or clarify with the off-going nurse. I've gotten pretty fast at clicking through those few screens with the pertinent info. When (and if) I have time to look through the chart I will read the H&P, the consultation notes, and then skip ahead to that days notes. You can get a picture of where the patient started and where they are now. If they've been in for several days I don't normally read through each days note unless I'm looking for something specific.

Maybe I'm the exception to the rule but I don't really mind drug seeking patients. Generally all they want is their Dilaudid (or cocktail of choice) every 4 hours or so and as long as it's ordered and appropriate I'll give it without any issues. I make them request it, I don't turn PRNs into scheduled meds, but once they ask I don't keep them waiting long. I find this keeps them calm and they don't give me a bunch of crap about it. I don't like it or agree with it, I feel for them and hope they get help, but I'm only there for 12 hours and am not looking to make my shift any harder than it has to be. I do make it clear that I'm not interested in watching them put on a show nor am I going to participate in the histrionics of it all. Ultimately I'd like to see the system get fixed but right now it's totally out of control and stressing out over it each and every shift won't change anything. The doctors are going to continue to admit these patients and order the meds; you have to learn to pick your battles.

One of the things that will factor into being calm and confident as a nurse is experience and repetition. Your situation was unique, stressful, and challenging for you, but it's likely the nurses see patients like you day after day and night after night. I know I do. Once you have seen the same patient situation over and over you'll know what to say and how to help. You say you were freaking out but to the nurse it's just par for the course. As I type that it sounds insensitive but I hope I'm making my point. Unfortunately on my floor most patients never seem adequately prepared (lack of education provided by the surgeon BEFORE surgery) for the amount of pain and discomfort they will face. I try to provide as much education as I can immediately into my shift about what they should be expecting. A little education goes a long way.

If you come into work, see your assignment on the board and begin sighing/rolling eyes/complaining and that becomes a reportable offense then every nurse on my floor is in trouble because that's a nightly occurrence.

Truthfully the NCLEX was the easiest test I took in nursing school. Probably because they prepped us so much for it, but there was so much hype and so much build up that when I finally finished it my thoughts were "THAT was it????" I took it with two friends and we were all finished within 45 minutes. We used Hurst and Kaplan and I felt the combo of the two programs was very successful.

There are topics about the Pearson Vue trick on this site ad nauseam. That being said, I got the same notice and I passed.

The NCLEX is a one time deal (granted you pass the first time) and is nationwide. Once you pass the NCLEX you can apply for a license in the state of your choosing. However, that license doesn't follow you from state to state. You will have to apply to have your license endorsed to California, or wherever you want to go. This doesn't require another test, just an application and fee. I don't believe you can sit for the NCLEX until after you graduate from school, so I'm not sure how you plan to take it before graduating. You might want to look into that part.

Are they all connected via the same tracts or separate wounds? For example if one is a large wound that has a fistula and GI contents in it and another is not connected I might dress them differently. But if they're all really part of the same large wound then I'd prepare my supplies, pack them all, and dress them all at the same time.

The floor I work on sounds very similar to yours. I would recommend that you switch to night shift if you can. That's what I did and it made a huge difference. The adjustment to my sleep schedule wasn't as bad as I thought it would be. I'm not as new as you are but I was still feeling very overwhelmed on days and like I had no clue what was going on. There wasn't 5 minutes to slow down and think. I was getting pulled in 100 different directions and my phone was ringing off the hook. I'm able to spend more time with the patients, reading their charts, and looking things up when I need to. There are few, if any, MD's rounding, no PT/OT, no dietitians, and no management asking questions or interrupting me. I'm not trying to work around the patient's three meals and various visitors, etc. Night shift can still get busy but it's a much calmer pace and I'm much more suited for it. I don't foresee going back to day shift anytime soon!

Throughout my pre-reqs I was a straight A student. I was soooo pissed when I got an A- in microbiology. My first semester of nursing school was a real eye opener when I barely made it out of Nursing 101 with a C. There was so much going on with skills labs and clinicals and real human patients (OMG!) that I was overwhelmed. My grades improved with subsequent classes but nursing school really will weed people out and level the playing field. The next eye opener comes once you (and everyone else) has passed NCLEX and you land your first job as an RN. Guess what happens then? Nobody gives two hoots about what you did in nursing school!! You were the best and brightest snowflake who made extra flashcards or took the lead in the group project? Really, nobody cares. Your "elite knowledge" will only impress me if you use it to remember where the supplies are or the door codes so you don't ask me 500 times. Keep your head down, mind your own studies, and fly under the radar. Hopefully you will find a group in nursing school who will be on the same wavelength and you can partner up and get through it together.

Unfortunately there is no guarantee you'll find a job after school no matter which path you take. I graduated with some RN's that were previously LPN's or CNA's and they struggled to find a job. Others got hired right away. A lot factors into getting hired as a new grad and most of it is luck and timing. I don't believe the city in which you attend school will matter, what is more important is where you will be looking for a job. Find out what the market for new grads is in the different areas and try to speak with nursing recruiters about their hiring criteria. I chose to go the ADN route so I could start working as an RN sooner rather than later. About two years later I finished an RN-BSN bridge program. I wanted to be an RN and I wanted it ASAP, however I would not have racked up a huge amount of debt or gone to an expensive accelerated program just to cut 1-2 years off my schooling. If you want to get started with your RN career then I don't see the point in spending 6-12 months working as an EMT. If you had 2-5 years to invest in that career it might give you the network or experience you need but 6 months? You'll barely be off orientation, it won't count for anything. Just my 2 cents.

Hopefully someone else has something more constructive to say because all I can say is that if it were me all she'd be seeing is my rear end high tailing it out of there and never coming back (after giving proper report to the next staff member, of course). She sounds very whiny and needy. This could be her trying to gain a sense of control over her situation or that could just be her baseline personality. Either way don't torture yourself and don't let them falsely accuse you of neglect or abuse. In the acute care setting it's more tolerable for me because I know these types will only be there a day or so. At most I'll have them my entire three day run but it's rare they'll still be there the following week. In home health this could be long term patient and it's just not worth it. I'd rather work at Taco Bell.

Try not to drive yourself crazy in an attempt to explain the "why" behind other people's behavior. You will never find satisfaction. Personally, I am a chronic over-analyzer myself so I understand your need make sense of this but try to let it go. The entire situation is annoying but look on the bright side and consider yourself lucky to have gotten out of the situation before something really ugly happened. You may have dodged a bullet. There will always be patients or family members that you just don't gel with despite your best efforts. Ask yourself if this will matter in 3 months, 6 months, etc. Chances are a year from now and you won't even remember their names.

I would absolutely go to HR myself, or the union rep (I don't have a union so I'm not sure how it works) to preemptively explain my side of situation. Consult a lawyer if you need to. Try again to switch schedules or units, going as high up the chain of command that you can to get approval for this. Be realistic and prepared for the consequences. Brush up your resume and start looking for other jobs. If push comes to shove give your two weeks notice and leave while you can still remain eligible for rehire.

What I've had to do with labs, and other patho/A&P type stuff, is study on my off time. I've gone through my nursing school books, researched online, and even made notes and flashcards just like I did in school. Each time I come across a patient with something interesting or something I am not familiar with I go home and study about it. It would be nice to do this during my shift but it's not realistic to have that kind of free time. There is a website I found somewhere here on AN called icufaqs.org. While some of the info only pertains to ICU a lot of it is applicable to my Med-surg/Oncology floor. There is a section specific to labs that is very helpful. On my brain sheet I made a diagram for fishbone labs, or skeleton labs as I've seen it called, and I forced myself to memorize it and write it out on each patient until it became second nature. Don't just look at the most current lab result but try to look at the trend. Are they going up...down? If the WBC is elevated at 18, note if it's down from 24 or if it's up from 9. That will dictate your next move. For me it's a daily process to put the big picture together and I believe it just takes time and effort. Good luck!

This week I learned to never speak anything into the universe you don't want to become a reality. Sitting at the nurse's station speaking with a fellow RN about the type of patients we prefer and our interests, I mention how I don't enjoy cardiac cases. I've never gotten a good handle on it and it's just not my cup of tea. No exaggeration - two minutes later, I get handed a new admit: Multiple MI's, CVA x 6, angiogram +/- stent placement, and premed for iodine allergy.

Others have given some good advice so I will just add that I think you should learn to embrace my favorite interpersonal motto: "Don't mistake my kindness for weakness." I have had to overcome kindness, shyness, and a general temperament that doesn't like to rock the boat in order to stand up for myself and set boundaries with coworkers.

Ricky Gervais joked at the Golden Globes about Jennifer Lawrence surviving on $52 million a year. He mentioned nurses, and recognized that not everyone gets that kind of paycheck. I had some thoughts this morning I wanted to share. It's 5 a.m. and the alarm clock is blaring. Here we go again. I really hope I have coffee. I haven't been to the grocery store in five days. Oh well, my pets have food and that's all that matters. I check my purse for some cash. If I'm lucky I might get a 30 min lunch break and the cafeteria doesn't take IOU's. Three bucks, that'll do. Nursing is a hard job. Helping others during their worst times, their darkest days, takes a toll. My patients cry and so do their families. I cry for them too but not here. Here I have too much to do; my feelings need to be compartmentalized. A patient down the hall needs water, another needs morphine. A doctor is paging me to the desk, I've got chemotherapy running on two patients, and my 98 year old lady with dementia is trying to climb out of bed for the 3rd time this morning. The mental exhaustion from trying to stay on task while not daring to make a mistake kicks in about six hours into my shift. Right about the time I think I might have time for a bathroom break. Nope, not now. Sometimes I get scared I'll run out of compassion. Is there a finite amount we're all issued? I'm burning through mine at a rapid rate. Nine hours on my feet and three and a half more to go. Keep it all in perspective, I remind myself. Keep it together. They need you a little while longer. On the way home I roll down the window to keep myself awake. I feel like I could cry now but I don't. Maybe I am jaded after all. The gas light dings, focusing my attention again. I'll have to fill up on a credit card; pay day isn't until next week. I decline a friend's invitation to go out. I need a shower and my bed. I have to do it all again tomorrow. Perhaps I've forgotten how to socialize. I'll try again on my day off. My next day off finally rolls around and I daydream of a maid service while I scrub my toilet. Guiltily I take my dogs to the park; we could all use some fresh air. They're my equivalent of latch-key kids. Later, as I mend a whole in my scrub pants I imagine what it would be like to have fancy clothes. A beautiful gown to wear to a party. A vacation. Vacation…it's been years since I've had one. Difficult to do living paycheck to paycheck, with two jobs and a 50k student loan debt. Someday. I get a call from the daughter of an old woman I'm a hospice volunteer for. She wants to know if I have time to come read to her mother this week. Of course I do. I'll go when I'm finished at the clinic where I donate time helping the underserved in my community. Performing wound care on the feet of a homeless man is a humbling experience. You see, it's important for me to give back because I have been given so much. There are people who work harder and longer hours than I do. I understand there are some who only dream of having the fortune and opportunities I've had. I am a grateful person. It's embarrassing to complain. Still, I wonder what it would be like to have millions of dollars. I daydream of a life outside of this daily grind. The peace of mind that comes with financial security eludes me. They say money doesn't buy happiness, but I'd sure be a little cheerier if I could have a house of my own and a working dishwasher, you know? Nevertheless, we must all play the roles we've been given. This is my life. I have been called to be a nurse. I may struggle now but I work toward a better future, just like everyone else. Mine would make an interesting story, maybe even a movie. I hope they get Jennifer Lawrence to play me. She rocks.

I understand where you are coming from. I had six days (yes that's days, not weeks) orientation on a med-surg floor and hit the ground running with a ratio usually around 1:7 or 1:8. While I felt overwhelmed with the amount of things I had to do each day, I never lost my composure or cried on my way home like some nurses say they do. However, like others have said it takes a while to see the big picture and that takes time. I'm still working on it. Make sure the reason you feel confident isn't because you're missing things that would be stressing out a more experienced nurse who was aware of them. I hope you're on a floor where the other nurses will continue to be supportive and receptive to questions. My worst days came when my preceptors were no where to be found and the other nurses were too busy or couldn't be bothered to help me.

This is exactly how I feel. I will gladly give prescribed pain medication without judgement or argument. I even get along really well with patients (even the known abusers) because they see that I try hard to keep them on schedule. It doesn't matter to me why you need the medication, I understand that you need it. But when it becomes status dramaticus - you've lost me.

Interdry works well if you can keep it in place. I have also used non-scented deodorant to help decrease sweating, as well as Calmoseptine. I have found that sometimes Nystop powder can be abrasive or clumpy, and makes the problem worse.