Elysianna

Better staffing ratios! More nurses = more time/attention devoted to each patient. But, i think that would involve increasing the perceived value of nurses. You see, the majority of the work I do every night for my patients is not of monetary value for the hospital. Unlike the way that respiratory therapy or speech therapy is billed, with itemized billing for services rendered, nursing care is a huge, homogenous blob of time. No one is itemizing the care I give in a bill - and therefore, in the perception of accounting personnel, my efforts are not as valuable. There's no nitpicky list of every little bit of care I give. Even though it is documented, the system simply isn't set up to bill for every facet of nursing care. (Imagine THAT bill!) I don't know what the answer is to that problem. Maybe an addition to Epic that combs through the chart for all those specific cares? That might work in the big hospitals like mine, but how would it work in a TCU or LTC?

The husband of a patient with dementia was spending the night at the bedside. The NST and I walked in to turn her just in time to catch him backhanding her across the face, hard enough to knock her partially out of her bed. The NST grabbed the husband, I rescued our patient from falling the rest of the way, and grabbed my phone to call security. The husband eventually left in cuffs. I have to say I was wildly impressed with the NST's ability to keep his cool. He very calmly strong-armed the husband from the room, then stood quietly talking to the husband until security could arrive. I was so furious that I was shaking, but he was cool as a cucumber. I wish I had that much grace under fire.

I'm so glad to know I'm not the only one having these dreams! Do you suppose it's a nurse's version of the dream about not going to class all semester and having to take the final (possibly while nude)? I had the very dream you described last night, and was frantically trying to run through the unit and at least put eyes on each one of my patients before having to give report, knowing full well that I hadn't even looked at them all shift. I had assumed these dreams are related to the fact that I'm still a fairly new nurse, but since you've been dreaming like this for 13 years, I suppose I'd better get used to it. :)

That's one powerful penlight you've got, spotangel! :)

NursinginChaos, is there an update on the baby?

I feel you, asjohnson02. I've been working as a nurse for 6 months, and still feel like my shifts are spent scrambling, trying not to miss anything, struggling to keep up. I see the experienced RNs around me chatting casually at the nurses' station, clearly caught up, and I'm racing to get everything done, read over labs, read over histories, make sure I'm not missing anything. And I wonder, am I ever going to get to where they are? Am I ever going to be so calm and nonchalant about this job? It seems every shift includes finding out another thing that I should have been tracking/watching for/doing that I missed through inexperience. I've cried on my way home quite a few times. I often feel like I'm letting my patients down by not managing my time better. I'm told, frequently, by experienced, kind nurses (I'm very lucky, and work at an amazing hospital, with a very positive, supportive culture) that it takes at least a year to get a firm grip on the time management piece of the job. Many of them have said it takes as much as 2 years before you stop feeling like an incompetent boob every day. I'm certainly still struggling with that feeling. But then, I look back at the first few weeks, and can see how far I've come. I can handle the max nurse: patient ratio in my area and keep everyone alive, get meds passed, get care done, even if I am having to delegate some of that care. I've learned an incredible amount, even if I have lost some of the theoretical and anatomical knowledge that was crammed into my head for the NCLEX. I read nursing journal articles about best practice, and understand them, and can implement them into my plans of care. I am developing that "instinct" that tells the nurse that something's just not quite right with this patient, that makes me look closer, possibly leading to calling a rapid response. (I caught the first signs of an infarct the other night, potentially saving a life, certainly saving neurological function). One day, I'm going to be a very good nurse. That day is NOT today. But I can see it on the distant horizon. Yes, I still make mistakes, miss things, feel like a doofus. But I'm making progress. SO ARE YOU. Cardiac is an incredibly complex, intense area. You are learning so much, even if it feels a bit like "one step forward, two steps back" for some shifts. You're getting better. And the fact that you posted this shows that you care, deeply, about gaining skill and competence, about making a real difference. You have the drive and the attitude, and you'll gain the skill. Take heart in that, grit your teeth, and keep doing what you're doing. Everyone starts out feeling like a fool. Remember those experienced nurses who say, "it gets better" and "it takes time"? They say it for a reason. We'll get there, asjohnson02. We'll be amazing one day. :)

AvaRose, did you find out what happened with the patient?

I learned the joys of caring for a patient with factitious disorder/Munchausens. When my obs patient with a long history of admissions for nonspecific ailments was due to be discharged the next day, he suddenly developed a new headache that was "intolerable" (yet he could still play games on his phone), and complaints of nausea (yet he ate 100% of his meals), in addition to his original complaint. Could he have some IV Dilaudid for the headache and some IV Phenergan for the nausea, please? He pulled out 3 IVs in 2 days because they were "burning." Couldn't we just put in a PICC line like last time, please? One psych consult, coming up! I learned that the sweetest, kindest little old lady on earth can still swear a blue streak when having an NG tube inserted. Man, did she blister some ears! I was rather impressed with her vocabulary, to be honest. She'd have made a Marine blush. I learned that the minimum safe distance to stand while assessing a patient with altered mental status is about a foot more than I thought it was. i got a bloody nose to prove it. ...and because of that incident, I learned about the wonderful kindness of my coworkers, and the way that they will rush to one's aid when one gets socked in the snoot by a man with hypercalcemia!

One of my good friends wears the hijab, but when we did psych rotations in nursing school, she modified her head covering for safety. Instead of wearing her scarf around her neck, she wore a modest blouse and tied her scarf around her head (see an example photo below). This ensured that the scarf could not be used to strangle her - it would simply slip off of her head if it were grabbed. She said it felt like a good compromise between safety and her commitment to wearing hijab.

I switched from an entirely different career of more than 20 years, and I was very successful at it, so being an RN is a pay cut. But the old job was just that - a job, with no passion or enthusiasm for what I was doing. Becoming a nurse was a long-held dream, and getting to do it is worth cutting my salary in half!

Oh, hppy, I'm so sorry. Grab a slice of cheesecake or something decadent, and try to allow yourself to breathe that sigh of relief that's down in there somewhere. She's safe now, you've done the right thing; but goodness, what a rotten day for you and your siblings. (((hugs)))

Thanks, rob4546! :)

Hi, Jules - thanks for answering! It's for class, but I'll be using these med cards to study for the NCLEX as well. Mostly, I'm trying to figure out what's most important in med knowledge for the NCLEX - is it A) Know the most common side effects, etc. or B) Only the extremely unusual side effects, etc., that are particular to this med?

Hi - this is my first time posting a topic, so please be gentle! :) I'm down to my last two semesters of nursing school. (Hooray!) One thing I've never gotten the hang of is narrowing down my study information when making drug cards for studying/reference. I'm never sure which adverse effect is important vs. which can be safely left out; or which nursing implications or patient teaching info can be left off the card. I know I'm supposed to narrow it down to a teeny, tiny bit of info, so I can recall it, but when making my study cards, I always end up cramming in as much info as can possibly fit. This is obviously not the ideal situation. My question is: How do you choose which info from the drug guide is incredibly important, must-know information, and which can be safely left off? Any tips or pointers would be VERY welcome! - Elysianna