viprn21

Idk where you're located but I'm taking chemistry at Tarrant County College

I'm 26 now, but I became an RN at 18. I had a lot of the same issues you had. First off, don't dwell on rude patients and families. Some people are just nasty, and being in a hospital doesn't help. It's rushed, it's uncomfortable, the situation in general just sucks, and naturally rude people just get ruder when they're in the hospital. Not to mention a lot of people have entitlement issues. Oftentimes difficult patients/families will test you when they first meet you, as evidenced by the lady who demanded the foley come out immediately. People will oftentimes get more aggressive when they think they can get away with it--you've probably seen a lot more nurses get bad treatment from patients than doctors do. It's because they know they can be mean to nurses without consequences but not doctors. Assertiveness is a necessary skill in this business. Remember that you are not a waitress or a hostess, you are a nurse. You are there to save their ***, not kiss it. And despite a lot of the conditioning you got in nursing school, you have a lot of power as a nurse. Recognizing that power helps put you in a position where you won't get pushed around so much. Read up on building assertive skills and practice them outside the hospital. It takes practice. But it is a skill and it can be learned. One last thing--staring young kind of sucks, but it will pay off. Keep with it, and good luck with your career!

Good points. Accurate I&O count is an indication for foleys, and post op hearts and critically unstable patients for sure need a foley. But being on a vent alone is not an indication for a foley.

You're stronger than me! I just can't function getting up that early

I exercise on my days off. I don't feel bad about not exercising on workdays. Out of a 24hr day, I spend 13-14 of them at work (I am counting getting ready for work and commute in this estimation). I like to get 8 hours of sleep (this is very important to me, I understand some people do well with less). So that leaves me 2-3 hours in a 24 hour period to myself, and I'm spending a good part of that time feeding myself and doing other necessary things, such as self-hygiene and pet care. So realistically I get about one hour to myself on my work weekends. I'm not willing to sacrifice precious sleep for exercise when I'm already exhausted. But there are ways to make healthy choices throughout the day and incorporate them into your work routine. Take the stairs instead of the elevator if you can. If you buy your lunches currently, try to start packing them instead. If you're a snacker, slowly start replacing your snacks with healthier options. If you're one of those people who can fit in that exercise on a workday and it helps you feel better, great! If not, don't feel bad. Self-care isn't pushing yourself to do more, it's accepting that you have enough to do and prioritizing the most important things.

I don't think so. Your seat tied to your clinical site, so if your assignment is unacceptable then you'll have to waive your seat.

Ooh exciting! That was my second choice, but I wanted to stay at Harris since I've been there for a few years. Bet your residency is gonna be exciting!

Foleys and CVCs are like ETTs...assess for readiness to remove at least daily. We had a similar push the past few years at my facility and I was frustrated at first, but over time I've come to see it's better for the patients. We have what are called PureWicks, they're basically a giant tampon attached to suction that sits between the patient's labia and catches the urine. It doesn't work on every single patient, but it's awesome when it does work. And males can use condom catheters.

Lol I knew someone would get upset I said that. Of course. I presumed that didn't need saying. My point is that nurses have move power than most of us seem to realize. However, I've seen plenty of mistakes made because "that's what the doctor ordered" and I can't stand for that. And no, we never make unilateral decisions. However, I AM the one who is directly responsible for keeping the patients safe, and if that means deviating from orders, I'm going to do that. That being said, I'm fortunate to work in a facility where physicians and supervisors take my concerns seriously, so it's very rare that situations escalate that far. There was a case recently in my area where a physician ordered an inappropriate treatment. The day nurse refused to follow it, full stop, would not even consider doing it. Night shift carried out the order and the patient died. Guess who got canned? Not the doctor who wrote the order, the nurse who carried it out. Sure, you can point at a lot of points where the system failed (including the supervisors who refused to listen to the day shift nurse), but at the end of the day, you're responsible for your own practice. It's easy to argue all day about the what-ifs. Sure, I've gotten into disagreements with physicians and supervisors over my actions, but I consider that an important ongoing discussion and part of the job. My litmus test is this: before I do something, I ask myself if I'm willing to stand in front of a judge and jury and the patient's family and explain what I did and why. If the answer is no, I don't do it. It's never let me down. Edit to add: Sometimes the doctor can't/won't call you back and it's important to be able to handle a situation without having your hand held. It's your job. I'd imagine you were probably under a bit of pressure from the patient and/or his family to get his pain under control. It's understandable, especially since the administration frequently prioritizes patient satisfaction over patient safety. It is good that you are reflecting on all of this and you recognize what went wrong and where, but also, don't dwell on it too much. What happened, happened, and all you can do from it is learn from it and move on. Is that a facility rule or a state rule? That sucks a lot. I've worked at facilities that micromanage like that and quit because of it.

I'm sorry for the long spiel then!

Wait, you gave him narcotics because you thought there was airway compromise and altered mental status? This was absolutely the wrong reason to give dilaudid. Narcotics decrease your respiratory drive, making it less likely to clear those secretions and will worsen the mental status. Mental status doesn't decrease from pain alone, there was most definitely something else going on--especially if he only got 0.5 of dilaudid. Narcotics can be used for respiratory distress, but that's when the work of breathing is increased; in those cases, morphine is preferred, unless the patient has an allergy in which case yes you'd use dilaudid. It also sounds like this patient was not properly monitored. If you're not able to safely monitor a patient, something is wrong with your assignment or you are not properly prioritizing your tasks. I'm questioning the judgment of the doctor for putting them on the floor when it sounds like they should have been put in a step-down. The fact that it took you two hours to check on a patient with priority needs is a huge red flag. I understand ortho floors are VERY busy, but you are never too busy to ensure your patients are safe. It takes 30 seconds to pop in the room and look at the patient. From what I know from this situation, I would have only given half or a quarter of dilaudid, or called the doctor for a non narctoic PRN (IV tylenol is in many cases a good option). In addition, it's OK to not give pain medicine if you think it is not safe, even if the patient is in pain. If the patient has excessive pain because the doctor did not order the appropriate type or amount of pain medicine, that's on the doctor; but if harm comes to the patient because the doctor ordered an inappropriate type or amount of pain medicine and you gave it, that's on you. The nurse is the last line of defense between the patient and a medical error. If there's any doubt in your mind at all, STOP. Listen to the nurse sense! I may catch flack for this, but it's perfectly OK to give half a dose of pain medicine or even a quarter if you have any doubts about how the patient responds to the full dose. I've had a lot of people tell me "That's practicing medicine without a license" because you're giving a different amount of medicine than the doctor ordered. That's just not true. You do not have to blindly follow an order because that's what the doctor wrote. Doctors are humans, they make mistakes and bad judgments. You don't need a charted justification, your gut feeling is enough. You can always give the rest later if you need to, and as you've learned reversing narcotics sucks. It's much, much easier to do things right the first time than it is to clean up a messy job later. I hope I didn't come across as mean. Your value as a nurse is not decreased from this incident. I would be lying if I said I'd never made similar mistakes; I most definitely have given narcan a few times for narcotics I've personally administered. But sometimes that's how the dice roll; these medicines are risky and these things happen. You're not defined by your mistakes, you're defined how you learn from them. In addition, don't be afraid to stand up to the doctors, even if they're mean! They can yell at you, they can be assholes, they can ignore you, but what they CANNOT do is fire you or take away your license. I've even found that standing up to "difficult" doctors is what makes them respect you in the end.

Lol I wish my facility at least reimbursed me for my certification. And it's not really for the patients, it's for you. I mean, yes, getting your certification will probably improve your skills and your benefits your patients (I say probably because I've met some really awful certified nurses. Not all of them but they're out there), but you're right, they don't know what it means and they don't care. Getting my certification opened a lot of professional doors for me, so even if I did not directly make money off it (in the form of a raise or bonus) it did improve my career a lot. My manager's eyes lit up when I mentioned it in the interview, and I'm pretty certain it gave me the edge I needed to land that job (and it turned out to be the best job I've ever had). Plus, it was a point of pride for me to complete the CCRN because a lot of people told me I would never make it in the ICU. They can't tell you that when you're board-certified in critical care ?

When I was a baby ICU nurse one of my preceptors told me that you have to chart tattoos and scars because then you look negligent and unobservant if you don't. As a grown-up ICU nurse, I feel I have more important things to do than make sure the chart is perfect. Nurse the patient not the chart

So I got accepted into a CRNA program and start next August. I'm sure this is what I want to do, but I'm kind of balking at taking out over $100K. I have a mortgage, which was twice the price of the program, but it feels different because the house was an investment of sorts and I've heard horror stories about student loans (plus there's no guarantee I'll even complete the program and will still be stuck with massive debt). Other than the mortgage and a loan for a car that I've paid off, I've never had any debts...So I wanted to hear from actual CRNAs about what the debt is like. Is it worth the price tag?

I turned mine in after the priority deadline. *shrug*