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  1. dennis8

    maybe transferring to days?!

    I felt the same way and the only way to find out was to do it. I switched to days after being on nights for 1 year. I did day shift for 3 months and realized that I hated it. I love helping my patients and doing my skills, but I never felt like I could do that with doctors and other staff pulling you left and right. Accuchecks 3x a day with each meal. Family members egging you for things that are beyond your control. On good days it was great, on bad days it felt twice as worse as my worst night. The only consolation was being able to be on the same day time schedule with my wife. Day shift is definitely doable but it can be stressful at times with so many tasks and more getting piled up by the hour. I went back to nights and havent looked back since. At least I knew I tried it and I have no regrets. I am looking into trying something new after I get my 2 years in med surge but aiming for a day shift job. Kudos to day shift med surg nurses.
  2. dennis8

    tips for prioritizing

    As Sour Lemon said, it's a good idea to make rounds on patient's first to get an idea on what PRNs you will need to bring on your med pass. That's a potential time savings of 6 pyxis trips! I typically will try to do assessments as I do intial rounds if time permits. Sometimes I have an admit or discharge right at the start of shift which I will priortize first. If not, I do med pass first and then chart assessments. I have had bad experiences with doing a late med pass and then something else comes up like a code, admit, or even getting floated!
  3. dennis8

    Facing a dilemma! Help!?

    The anxiety is normal. Some will have more than others. I absolutely dreaded going to work on my days off when I first started out in Med Surg. 5 months in I got to know most of my coworkers well, got comfortable with the environment, and started enjoying the unkown as it gave me new learning experiences. Almost 2 years now and I don't feel dread at all (except when I know I will be getting a certain patient back lol). I believe the trick is to have a go to person for advice and help. That definitely helped me during my difficult phase. I say go for the new grad program and stick to the clinic job per diem. Then again, if you have no problem doing non-acute, you can still make that into a career. Best of luck!
  4. dennis8

    Nights vs. Days

    I believe it depends on where you work. In California there are mandated patient to nurse ratios. It will always be 1:4 or 1:5 (depending if they are on telemetry) which is very nice. I worked both day and night shift in the hospital I am currently working in. I started nights, went to days for a couple months, then went back to nights. In my personal opinion, the difference was night and day (pun intended). During day time you have to deal with family (which can be the hardest thing you will deal with), physical therapy, administration, 10 doctors giving orders for one patient, a discharge, an admit, another discharge, another admit, and 3x a day accuchecks before each meal, and alot of other things that only happen when normal people are awake. At night, its usually busier at the beginning of shift and slowly dies down. Most patients that have discharge orders would be gone before shift change, or leave an hour or two after the shift starts. The nocturnal doctors will be in and out throughout the night. Most daily meds will be given during the daytime, which leaves fewer at night (for most patients). Admissions can come any time of the day, but at least at night you will typically have a bit more time to work on it. What I really hate about nights is trying to get a hold of certain doctors. Then again, this is based on my experience at my current workplace. Alot of things must be factored in such as your boss, your coworkers, your facility rules, and alot of other things that are workplace specific. Best of luck!
  5. dennis8

    Specific Questions

    I use a sheet of white paper, fold it in four. Put a patient sticker on each corner for identifiers. I write down pertinent labs on the top right side, and any other very important information on the bottom right. The rest of the space is for new verbal or telephone orders from doctors before i put them in the computer. I try to keep things very minimal. If I need other info I can read it off the SBAR. To be honest if you have alot of patients running continuous fluids, it's almost impossible to keep up with everything when you are busy. What I do (depending on your facility policy) is I get an extra bag of fluid ready on the IV pole. So when the patient's call light goes off for the beeping IV, I can easily swap it out (and replace the extra bag before end of shift for the next nurse). PCA pumps are always a headache in my facility because they keep all the syringes in the ortho unit. I'm glad I rarely deal with them in my unit. Not me. On our unit we have this posted on the wall Y-Site Compatibility Wall Charts – King Guide to Parenteral Admixtures there may be better ones out there. Not sure what you mean. When we have to dilute meds the pharmacy will usually let us know via the pyxis or the EMAR what to dilute the medication with. Not too sure. But what I can tell you is not to give too many narcotics at the same time (especially IV) or it will decrease respiratory drive/lower BP of the patient. Some chronic pain patients will have alot of PRNs. Regarding interactions, I always call pharmacy and check our drug resource from our charting system when I have doubts. It was a while back but there was a certain medication that pharmacy told me should not be given since the patient was on maintenance fluids with potassium added. Can't recall what it was though. Typically the order should tell you what to mix a med with if it needs diluting. If you have questions your pharmacy should be able to help you. To be safe, you should ask your preceptor. Everything will always differ from one facility to another. Best of luck.
  6. dennis8

    I forgot to return blood to the bloodbank

    Hello OP. I had a similar experience recently. I work in Med-Surg and I made a stupid mistake. Had a patient who was going for procedure in the AM and an order to transfuse platelets at 0800. I work nights so typically an order at 0800 would fall on the day shift nurse to do the transfusion but I always try to help out when I can. At around 6:30 I ask my buddy coworker to fetch platelets. He comes back around 6:45 and we verify the platelets and patient. I stupidly spike the bag of platelets and prime the tubing before checking vitals. When I checked the temperature it's 100.2. Well... I didn't want to begin the transfusion while the patient was having a fever. In our facility we need to hang the platelets within 20 minutes of receiving. I don't know if it was because of the sleepiness or all my other patients suddenly needing things, but I just documented that the patient had a fever and I will endorse the transfusion to the next shift. Told the AM nurse in report that the platelets is still up there but patient is running a fever. I was hoping that the fever would go down and she would be able to hang it. Anywho, I didn't hear about anything until the following week when I was off work and I got a call from a coworker to call our unit. I was told by the day shift charge nurse that the lab manager was getting fussy about the spiked bag of clotted platelets that was returned to lab. To make matters worse, the patient was a former worker at the lab so the bosses in the lab were even more concerned about the issue. Long story short, the day shift charge spoke to the lab director and vouched for me. I spoke with my unit supervisor who said that it was a stupid mistake but she knows that I won't do it again. I signed a paper that states that the unit supervisor reviewed with me regarding the policies and procedures of blood product administration. From level 1-5 it was a level 1 or verbal discipline. She stated that it doesn't stay on my record. If it happens again, she can't guarantee that though (it definitely won't!). But based on what you said, it doesn't seem like it's mainly your fault. Until the investigation is over, I wish you the best of luck!
  7. dennis8

    New grad need help

    I know the feeling of dreading going to work the first time I started working as a nurse. Even on my days off I would dread the thought of going to work in the coming days. I know it's hard to imagine, but it does get easier with time. Around the 1 year mark I felt like I had a good grasp of how the unit runs. But in my situation, my coworkers were all helpful and understanding. If you work days, have you tried applying to a night position? Nights tend to be less busy and you would have more time to learn the ropes. You would also have a new set of coworkers at night who may be different than the ones you currently work with. Best of luck.
  8. dennis8

    Totally stuck

    Hello, Twin0912. If you want to be a nurse in an office/administrative setting, these positions require some degree of bedside experience. To become a CRNA or PA also entails having bedside experience. In California, to even be considered for admission to a CRNA program, most schools require you to have at least a year of critical care experience. If you truly hate working bedside, I would suggest a non-nursing related field. Good luck!
  9. dennis8

    MedSurg to GI

    Thanks for all the tips brownbook! I like the idea of picking up extra shifts on med surg if they allow it in my hospital. As soon as my wife settles in to her new job I think I will put in my application and hope for the best. Thanks again!
  10. dennis8

    Med-Surg help!

    That is how everyone feels when they first start out on Med Surg. As Daisy4RN says above me, it definitely gets easier over time. You learn to roll with punches and get into the groove of your unit and coworkers. Best of luck!
  11. dennis8

    You're getting and admit. ::...Fine::

    In my unit, they try their best to give us just 1 admit on a shift. But that totally depends on how many you discharge and if they downgrade patients from ICU or stepdown (they don't count downgrades as admits because the assessments are done). The most you would get in a shift would be 2. I have had 3 admits once though on a particularly busy night.
  12. dennis8

    Giving OTC medications to your aides/coworkers?

    I've given my charge nurse some of my caffeine pills on those nights where coffee doesn't help lol. I don't see a problem in giving OTC meds as long as they are from your own supply and not from the facility's.
  13. dennis8

    MedSurg to GI

    Thank you for the input brownbook! Have you worked on a med surg/tele floor before too? In the event I get accepted, I'm just worried about being able to go back to med surg at a different hospital in case GI doesn't work out for me. My plan is to get a year or two of GI experience and transfer over to a closer/better paying hospital. I don't want to pass up the opportunity since I already have my foot in the door in the hospital and employees get first dibs. Management is good and the coworkers are like family but I think it's time to move on for personal and career growth. Edit: And float pool sounds like a good idea! Unfortunately my hospital only offers a cross training program for ED and critical areas like stepdown units and ICU and the competition is very stiff.
  14. dennis8

    MedSurg to GI

    Hi everyone. I'm still fairly new to the nursing field and have been interested in trying different areas before I decide on where I want to focus my career. I did 3 months in my first job which was at a SNF. I mostly accepted the job because I couldnt get a job in acute care. Shortly after, I finally got accepted to the hospital that I am currently working in as a Med Surg RN. Been working here for a year and 3 months now. After seeing patient's go down for GI procedures and speaking briefly to one of the nurses, I feel very curious and interested in putting in my application. Will I lose any skills making the jump? It's only inpatient procedures and I believe mostly focused on GI procedures like colonoscopy, endoscopies, ERCP etc. Also, what is the outlook on transferring back to the MedSurg setting after being on a specialty floor? Do employers look at previous experience or do I have to start from scratch?
  15. Hi guys, I needed help with an assignment. One of my papers is about delegation in the state that you're practicing in. I looked all over the California Nurse Practice Act and I cannot for the life of me find their definition of delegation. I'm supposed to compare it with the definition of another state's practice act and when I looked up other state's definitions I can easily find it. If anyone knows where I can find the definition for California I highly appreciate it.