Mrs.D.

Well I can only speak to my eastern MA acute care hospital that has a union… but ratios aren’t not in the contract. Our tele floor can take up to 5 patients 7a-11p, and up to 6 patients 11-7a. Most of the time it is actually 4 patients if we’re not in a surge from the ED. Management knows this and our unit census caps attest to this. They have never tried to pass these established ratios in my four years, but if they did ask me to take a 6th patient on days I would laugh and say, try again. It just wouldn’t happen. It’s not safe. So hopefully they’re saying those ratios because they know the limits and are proud of them to attract a nurse. As opposed to lying to gain a nurse that will be quickly overwhelmed and leave. Good luck!

Thank you for this, it was a helpful reminder as someone who is about to precept her first new grad. I had an amazing preceptor, and I want to be that lifeline for my new grad who is due to meet me in a week or two. Do you have any other resources that I might use to set her up for success? I train many others, just not new grads. I literally have no idea what I’m doing in this department. I’ve avoided it until now because I think of it as such a big deal. I know I have a lot to offer—I enjoy where I work, continue to learn every day, and I have a good work ethic—but I don’t know what to teach... Thanks.

I can’t speak to trends, but on my tele medsurg unit we take 3-5 patients. Usually we start with 3-4, and end with 4-5. We do have techs, though. Covid status is irrelevant to the assignment for us. I’m sorry you’re feeling like you’re getting screwed.

I don’t have much for advice with the anxiety, but maybe the stress response. Do you have a Fitbit? It may seem silly, but there’s an App on Fitbit (maybe others too) called “Relax”. When you play it, it vibrates at a normal breathing rate to encourage you to calm and focus. I found it very helpful during covid when I was stressed to the max—at home AND at work. Man that was a hard time. It’s so simple, but was so helpful. The PPs have good advice. Are you smart, a good teammate, a good learner, a good listener? Are you capable? Did they hire you knowing your experience? You’ll fit exactly as you are. Just do your best. You’re not expected to know everything. At my hospital, a 1.5 yr nurse new-to-us is very much still a new grad. Work hard and pay attention and you’ll be great. Good luck, and CONGRATS!

We utilize this on our medical cardiology floor. It’s a floor RN with a passion for knowledge and teaching who’s willing to take on more responsibility [and has energy... because it’s on top of our usual duties]. Anyone can volunteer to the director who then chooses whether to accept or not. They receive a couple of dollars bump in pay. They are the go-to person with clinical questions who is most up to date with policy and procedures. They tell us when P&P has changed. They do check offs for required skills. They give cardiac education to new grads and new-to-us RNs in the form of 4-hour paid lectures outside of work hours. Probably other stuff. They work closely with the director and charge nurse. Basically our RN cardiac/medsurg specialist. We have one on every shift. We’re not VA, but we are unionized. We’ve found this RN very useful. We just lost ours to maternity leave who’s not coming back to work, and I’ve considered offering, but I’m too chicken sh*t. I hope to have the confidence next year, if there’s a spot. I’m nearly at 2 years experience and have a passion for policy and teaching skills and concepts. But maybe not the energy or experience... We will see.

This looks fun, I’ve never done a case study here. I’m not an OB nurse... VSS. I guess I’d be concerned that’s shes lost one pregnancy in the past. The pooling in the lady parts means amniotic fluid versus urine, so maybe* only acutely low fluid. Don’t babies have to be delivered within 24 hours of rupture because of risk for infection? She seems good for a lady partsl unless Hx of cesareans. Aren’t babies of smokers small for their age normally? How small and how long have they been small? 34 weeks is good to be delivered with steroids to the lungs, yes? For psych/social, does she have any trauma from the previous loss? Are pregnant women allowed to have nicotine patches or anxiety meds? Although her VS may show that she’s compensating well with the anxiety and may not need anything. Looking forward to more posts ?

I do not have your hair type, but I only wash my hair 1-2x/week to keep it healthy. I do pull it back in a ponytail so it’s out of my face, though. I don’t wear a cap, generally. I don’t see any reason to change your habits unless you feel you need to. In that case, I agree that a cap would be helpful. They have cute ones on Etsy.

I hear you, I really do. I had a shift like this yesterday. I’m almost 2 years in and I feel pretty dang proficient on the average day, but some days we spend 12 hours just trying to keep up. I was at work one hour late charting because most of it had to be ignored during the day. I just woke up from a “nightmare” where I couldn’t keep up at work. I had those as a waitress and now as a nurse apparently... It’s hard after a shift like this, but just try to push it out of your head. Nursing is a 24 hour job and you can’t do everything, all the time—as much as we try to. Can you think of a couple of great things you did that made a difference for the patients? For me, I discovered a new delayed reaction to a med allergy and thoroughly treated and documented a pretty helpless patients skin issues. I feel he received the best nursing care I could give. Fortunately, I have a supportive team and no one made me feel bad for my less than 110% that we all try to give day in and out. I’m sorry you don’t have that. That definitely helps. I hope your next shift is a breath of fresh air.

With my privilege, I honestly thought racism was a thing of the past. I just don’t SEE it. I’ve never had to really notice or acknowledged the little microaggressions that add up for you. But I’ve been reading a lot these last few months. I have one experience witnessing racism in the hospital that really hasn’t sat right with me. I had an old white lady as a patient. When I went to check on her, she referred to my tech as “the black girl”. I responded by saying, “her name is Barbara”. Barbara is a respected and experienced tech on my floor. Definitely not just a girl either. It’s been a while since this happened, but it eats me up that I didn’t say more. People think, “oh, it’s just an old white person and that’s how they are”, but they can be educated too. I wish I’d have said, “this woman takes care of your most intimate needs. You should learn her name and not only remember that she has black skin.” I don’t know... I just know I should have said more and I missed an opportunity. I’m sorry that you’re still made to feel like you’re “other”. To me, you have value, and like anyone else on my unit, I want you to feel comfortable, important, and included. My eyes and ears are now open, and you will have my voice if I witness overt racism, or microagressions that would normally be ignored. I’ll also have your back if you want to stand up for yourself and just need a back up or listening ear. I’m not sure what else to say except I’m learning, I’m sorry for my past failures, and I will do better.

I work medical cardiology, so medsurg plus cardiac patients. It’s really going to depend where you work because medsurg has so many specialties like oncology, neuro, ortho too. I’m sure they regularly use stuff I’ve never heard of or would need to look up. Some IV push & drips are amiodarone, sotalol, diltiazem, labetalol, metoprolol (lopressor), nitroglycerin, and electrolytes like potassium and magnesium. I feel like I push the lopressor and diltiazem the most, and hang the electrolytes erryday. I feel like it depends on the doctor’s preferences that you work with often. These meds are for things like atrial fibrillation with RVR, severe hypertension, SVT, chest pain with rising troponins—those are all very common on my floor. We recently did a bedside adenosine cardiovert, that was interesting... Never be afraid to call the pharmacy. Ask for advice from your coworkers, for sure—even just to come with you the first time, but just remember that it’s your *** if you don’t follow hospital policy and something goes wrong. So print it out if you need to. I generally like to look up the guidelines myself, if I can’t remember. Know where your IV drug administration guidelines are (the DAG) for push times, dilutions, common dosages, etc. Know which meds require a BEDSIDE cardiac monitor and WHY. Wherever you work will train you. If the floor has a patient going on a dilt drip, nitro drip, heparin drip, etc., chances are they will find you to teach you. If not, mention to the charge to spread the word that you haven’t done X, Y, Z, and if there’s time you’d love someone to show you if they get it. And ALWAYS mention if you haven’t done something and you’re nervous. There’s no shame and even if you think you’ve got it on your own with the policy (which is cool too), we can keep an eye out for questions. Good luck, don’t stress, it’ll all come in time. ?

I wonder if posting here will give a notification to the nurses who commented to help me. I don’t know what made me go back and read the few old posts I have. I just wanted to say thank you again for your help. Who would have thought I’d be a medical cardiology/tele nurse now? I’m still fascinated by the wild things that go on with the human body! And I totally get the “never say never” phrase too. It’s amazing, the development of critical thinking as we can knowledge and experience. Thank you for having a hand in guiding me. I’m still learning every day! ♥️

Eventually you learn the nuances of the lines and you can read any strip at 20 paces while continuing to walk past the monitor on your way to do something else LOL. If you plan to travel, I would just suck up the discomfort of not being a master of tele and volunteer in the tele room. When you travel, especially now, you’ll be lucky to have 3 shifts training before going live. You will be expected to have your nursing knowledge, but need to be trained to the floor and the hospital’s protocols. It’ll make you more confident to be fluent in tele! False alarms happen often from patients removing leads, artifact, and parameters not being patient/condition specific. Technically, we’re supposed to adjust parameters and leads every AM. But really we do it when we first hear the alarm. It’s annoying, but doable. For example, when we arrive in the AM, we print a strip (they’re formally assessed Q4h), and go over any “events” that are registered (Brady, tachy, Vtach, etc.). If I were to see that there are a thousand events for tachycardia of 121, and we know the patient becomes tachy every time he walks, I’m going to adjust the parameters to 125 or 130. Since I know his baseline, I only want the warning if he’s over 130. Also, the alarms can be set for various volumes for the seriousness of the alarm, or even no volume—but the strip will light up yellow on the monitor if it happens. For example, without parameters being set, there will be an alarm for a high rate of PVCs. If this patient is known to have a ton of ectopy without issue or electrolyte imbalances (meaning his baseline and not something we are trying to fix), I can both set the threshold for what number of PVCs I want to receive an alarm for, but also make it so that there is no “alarm” noise, but rather 1 “beep” and a yellow box around his strip. So I can look up to the monitor if I hear the beep to see if I’m comfortable with the number of PVCs and how frequently those PVC bursts are happening. It may sound like a lot, but you learn the software and figure it out over time. You have to play with it. Customize it how you’re comfortable, and also, there are a lot of monitors on our floor, so you can have one in view most of the time. I feel like the set up you have at your hospital gives the nurse less autonomy. The RNs in the tele room don’t know the patient, so I’m wondering how they can set the parameters correctly, or feel comfortable doing so ?. I could see where that would be more frustrating I think We usually have 3-4 patients on the 7-7 shift, but can go to 5 if we’re swamped. April was like that with so many covid patients and nurses out for various reasons. Our hospital was paying over $5k/week for travelers, though, so they all came and saved the day. It made things a bit more bearable. 5 covid patients is no bueno. Can you guys see the tele, or can only the tele room see the tele? Dang this is long... I had coffee LOL.

Hmm. I’ve never heard of a tele room. I’m a medsurg RN from Massachusetts. Our unit is categorized as “medical cardiology/telemetry”, so I’m considered a tele nurse. Every RN on the 40-bed medsurg unit is a tele educated nurse (we have to pass a class). We have 3 monitors that encompass all patients in the middle and on both ends of the floor. We all monitor the tele for our own patients for the duration of the shift. We also will check on any patient if we happen to see something ugly and we happen to be in front of the monitors when it alarms. We’ve had a TON of travel nurses since March, and we expect them to be able to do the same. Of course you can always ask questions if a strip is troubling you—I still do occasionally. But you should know all the dangerous stuff. I’m assuming (please educate me if I’m wrong as I’m curious about this), that for your hospital there’s one RN that sits in a room with all of the tele monitors and... calls you if they see something bad? Is that right? Then you check on the patient and confirm what was found on the tele? Do you have to do any of the strips on your own patients, or do they do them all? I’d love that ?. So often it’s a false alarm and the leads need changing. Or they’ve been NSR for two weeks and don’t actually need tele monitoring, so it’s just one more needless thing to do. It’s such a pain in the butt.

I’m sorry this board isn’t active, but in case you make your way back here... I think being anxious of making a medication error is good judgment on your part. This aspect of our job has the potential to cause great harm if not done properly. You will be taught how to be safe and cautious in school. When you have your first job, you will be oriented, ideally for 3+ months. *You will make a mistake.* I did while I was precepting. I realized my mistake and told my preceptor. We checked the patients vitals and paged the doctor. We put in a safety (incident report that is NOT for punishment, but to hopefully help the establishment put more safeguards in place if they notice patterns). I cried. Spoke to the manager who was understanding, and cried again. So many nurses on the floor that day told me of when they did it. I was anxious the rest of the day. The patient was fine and I made sure to follow my checks more closely in the future. I’ll never make that same mistake again. In case you’re curious, I had two patients medications on my cart. I scanned the current patients meds and placed back down on my cart. I picked up the wrong patients medication and administered it to the wrong patient. Earlier this week I received report from an orienting new grad. She made a med error. This time it did harm the patient. She gave too much insulin. She had the correct blood sugar, but read the order incorrectly. However, because she educated the patient on signs and symptoms of hypoglycemia, the patient called her when she became shaken and sweaty. Patients blood sugar had dropped below 30 (very scary for RN and patient!). All the steps were followed for a med error and hypoglycemia. She reported to me that she cried. I told her that I had a med error while precepting and also cried when it happened. She knows her mistake and she will never make it again. The patient is fine. Please don’t pass up nursing because of your fears and cautions. That’s what will keep you methodical and thoughtful. You might shake the first few times you give meds, but it’s expected by your teachers and preceptors. You can admit that you’re nervous, but do not let it distract you—let it focus you. It’s a scary and important job! Good luck!

Hey, CONGRATS on your new degree. I’m not in Boston, but I’m in Mass at an acute care hospital. When we’ve hired RNs with only 0-2 years acute rehab/LTC experience, we consider them new grads and they go into that program-which is actually so helpful for them. I was hired straight from college, but we were oriented together. They were much more confident because of the new grad program. I love that my hospital is willing to do that for them. So maybe look for new grad programs? Good luck!