07302003

I found that midnights gave me good balance as a mom: could see them in the AM, and before I went to work. It was just that I felt so exhausted all the time I couldn't stick with it.... But I loved working the actual shift and the balance in my life.

Geographic location - Midwest large metro area Pay rate: $30/hour In which area / specialty do you work? Transplant What type of license do you have (RN or LPN)? RN, BSN What type of degree and/or certification do you have? BSN How many years of experience do you have? 7 Are you full-time, part-time, or casual / per diem / PRN status? FT What shift do you work? 9a-5p, hours somewhat flexible. Rotate on call duties, with on call pay and overtime. Do you receive any shift differential? n/a, days, no weekends, no holidays. Are you a manager or supervisor? no FYI: I got this job because I spent 6 years in Med Surg / Tele / ICU. I actually brought home more $$$ working 36 hour nights in the ICU, due to the differentials.

So if asked, what med would you give to reverse the Versed? What s/s would you be looking for that the patient is in trouble? The med error, in the scheme of things, is not a big deal - minor, reversible, and most importantly, you owned up to it. I think that taking responsibility for your own errors is key. And you learn from it, and change your practice.

Where I was (and it may depend on state / hospital) RN's don't touch the vent except for oxygen breaths, however, there is a lot of collaboration if the patient needs settings changed, etc. RT's cannot take verbal orders from a doc, so the RN does. Also, because the RN is at bedside monitoring the patient closely, and the RT may have a large assignment, we identify the need for setting changes. We take and send ABG's. It depends on your hospital, hopefully you'll be somewhere with a large teaching hospital - make sure you're somewhere where you have a lot of autonomy to manage your patient if that is what you're used to.

As others have said, there is no way to fix this patient without a liver transplant, and if they're non-compliant it's unlikely they are listed or will be listed. With the boluses just pay attention to breathing, that they don't get fluid overloaded. But again, they can be dialyzed or intubated if needed. No long term solution though. The only thing to do differently is to remind the MD that patient is ESRD on HD (because there's no way all docs can keep all the patients straight), which might only lessen the amount of the bolus, but boluses are given to these patients if they're dry. And in terms of advocacy, the patient sounds like they're end of life, end of disease process, so making sure they and the family understand and end of life wishes are respected.

Turf it, to the charge nurse, the unit manager, the house manager, especially complaints. That is why they are there, and they often have the time and patience and people skills to deal with it. Your job is the safety of the other patients, and if they are interfering with that, invoke the chain of command. If someone dies because you were listening to another family carry on, you are at fault. "Let me get ahold of someone who can help you." When you invoke the chain of command they feel like their concerns are validated. If patient satisfaction is a priority management should be there to back you up.

If you value your job and career, suck it up and smile. Meet with the manager, thank her for her concern, "as you know I'm a new nurse and I appreciate your time. I do feel overwhelmed at times, because I want to do a great job taking care of my patients. I want to be successful in this job". Come up with a plan. I would clock out for breaks even if you work through them. People do that to keep a job. Your manager is probably under fire for staffing costs over budget, and will see you not taking a lunch as a prioritization / disorganization issue. And look for another job... if you're already employed you can take your time about finding something you want to do, somewhere with good benefits and a good environment to work in, you won't accept the first thing that comes along... Best of luck!

As I've gotten older and wiser I've found that it is NOT worth a power struggle, or judgement. I sit down with the patient with pain issues at the start of my shift, talk to them, assess their pain, history, etc, and make a plan. Do you want to be given the meds if you are asleep and they are due? Sometimes I would write their dosing times on the whiteboard. Explain, I will do everything I can to be on time, except if there's an issue with another patient, and deliver their meds as on time as possible. And if I think they're really legitimately under-medicated we make a plan to try the current regimen and then I call the doctor and advocate for more relief. And then the patient is happy, not on the call light as much, you are happy, and the shift goes well. And hopefully you made a difference by listening and respect for them. And I do the same thing for patients I judge as "seekers" - if the doctor wrote for it Q2 then you'll get it, no skin off my back. I worked the floor for many years and am now in ICU. But I'm always running late and behind because I spend time doing this type of nursing!

I've found that unless your previous work experience was *in nursing*, those who hire don't count it as experience. So they're looking at you as having no management experience. So you may have to take a more entry level management salary to get nursing management experience. But, if you decide you want to do that, I'd make sure to get hired in somewhere with growth potential, like one of the big hospital systems. Just my 2 cents.

I always use the same secondary tubing for antibiotics and electrolyte replacements, unless the secondary is something that has major incompatibility issues, like dilantin or some antibiotic that doesn't work with D5 or 0.9 NS (pharmacy always labels those well for us).... Just backflush with 0.9 NS and hang! If you think about it, every time you disconnect and re-connect tubing you could be introducing pathogens. And, it's a waste of money and time.

Danskos hands down! They last over 5 years (if you don't get patent leather or prints) and get me through 12 hour shifts. If you're not sure about plunking down $125 for a pair, go into a store, figure out your size, and buy a used pair on ebay. I promise you, if they work for you the money won't be an issue the next time! I've bought used pairs for work, as they only get worn to work. But if you're a size wide or narrow, your only option is may be new and full price...

I have my Grandma's scissors... she was a WWII RN (and after).

Mine wouldn't get better this winter, saw my primary care doctor who wrote a prescription for extra strength hydrocortisone cream once daily, it's worked WONDERS!

This guy is a sociopath, who would want him as a co-worker, but for the big picture.... would you want someone with this LACK of morals or honor to be taking care of your mother or father in a healthcare setting? That's what makes me puke....

I'm so sorry that happened to you. Med surg is very hard. My only thought, which hindsight is 20/20, and it comes with experience, is that when working med-surg I would, before I get involved in anything else, go into each room, eyeball each patient (are they breathing?), introduce myself (are they responsive? at their baseline?), see if they have any immediate needs (pain meds?) and tell them when I'll be back. Because you can't always believe the report you've been given, and patient's conditions change. Poop and incontinence can wait until you make sure the rest of your patients are breathing. If the patient is alert, just let them know you'll be back after you've briefly checked on your other patients. It sounds awful, and callous, but poop can wait - you want to make sure no one is circling the drain or having respiratory distress first.