littlespitfire

I'm a millennial and I carry minimum 4 pens, a sharpie, a highlighter and a dry erase... most of which I lose and re- find over a 12 hour shift, no less than hourly. I buy my inkjoy pens in bulk boxes of 30, and have converted many on my unit to these bad boys. write like a dream, cheap enough to not worry if it falls in a toilet. edited to add- I carry scissors, steth on a hip clip, alcohol swabs, flushes, hand sanitizer, and my portable phone that's about the size of a brick. and my report sheets. there's usually syringe caps and flush caps in there too for good measure.

OH!!! and another- doc has stethoscope on pt's chest, right over heart, turns to look at me and says "can you get a pulse for me?"

oh another! on call doc paged about combative pt- gave IM orders, then started laughing and said "good luck with that"

Doc: *peers over desk to see what we are all looking at* "how do you read that? It's horrible!" Nurses: *all look at him, stunned* one nurse said "well, you wrote it, so..." same doc after his signature was confused for another doc's "his is CLEARLY a squiggle. MINE is a WAVE. Completely different." "I'm changing those insulin orders. freeze it and throw it at them" Obviously irritated that day...

Our night shift new grad hires get 3 weeks on days and 3 weeks on nights after they complete a classroom portion of orientation... we are a mix of both RN and LPN... The only 5 things so far I've not been able to do is 1) insert an IV.. I can draw blood but no IV insertion... so I regularly volunteer to do stat labs and my RNs help with my IV starts. 2) DRAW off a PICC. I can administer meds, flush and do dressing changes, no drawing blood. (in general our docs insert single lumens and we don't typically draw off those unless its the only option anyway, so this is rarely an issue) 3) remove a PICC. not a problem, we have one nurse who LOVES to pull PICC lines. 4) manage a mediport. the ones we get are chemo, so the RNs do the changing of the needles and meds. 5) drain a chest tube. we take long term chest tubes, just started taking them, and our RNs were trained recently. that may trickle down to us too, no word yet on final policy. If your LPN coworkers are experienced and well trained, they can be a wealth of info and help. We work as a team on our unit, we have our primary patients but have no problem helping others when SHTF and jumping in on crashing patients and codes. Ask for more training time if you need it- any place willing to refuse that request probably isn't a great place to be at anyway.

60 bed unit here- subacute/ rehab... days theres 4 floor nurses, 7 CNAs, 1 nurse assistant (cbg, helps with admits, daily weights etc) 1 admissions nurse, and in house wound care and NP. we also have in house PT doc and his NP, but they also have a clinic outside our facility so they're not here every day. I'm on nights- 3 nurses and 4 CNAs with building supervisor to help if needed. we are "high acuity" compared to other facilities in the area. Nurses work 12s, CNAs work either 12s or 8s. Long term nurses work 8s and our facility has 11- 16 bed units just long term. each unit has a nurse with 2 CNAs. afternoons they go up to 22 patients, and nights it hoes between 50- 70 patients depending what area you work in.

blood draws! if I can feel it, I can hit it. And... poop. I have long skinny alien fingers, and have been dubbed the "poop whisperer". Suppositories and digging people out. I don't suggest becoming "that nurse" everyone goes to when their patient won't sh*t

I'm right handed... I hold the syringe in my right hand, bevel up, between thumb and forefinger. I always stabilize my hand with my other fingers on pt's arm. My left hand I use to hold pt's arm steady, with my thumb under my right hand pulling the skin taut in the opposite direction I'm inserting the needle. Good luck!

I work in MI... We most certainly take phone orders. I can't hang blood, or do IV push meds. I frequently deal with PICC lines, ports, and drains/ostomies coming out of body parts. I am trained to run peritoneal dialysis. Long story short, there's lots we can do, and some we can't... But most will require extra training. My facility offers all extra training in house for us. Michigan Legislature - 368-1978-15-172 there's our MI public health code for nursing :) hope that helps!

I've been in rehab for 5 years, our unit has 60 beds. Days has 4 nurses, 8 CNA's and in house wound care. When we are full we have a 5th nurse to help with treatments. We also have an in house NP, a nurse assistant who does accuchecks and helps with CNA stuff, and a discharge/admit nurse. I work nights- we have 2 nurses if census is 48 or less, 3 if we are 49 or more. We rarely are below 49. Our usual CNA count is 4, but occasionally we have 3. We also have a ward secretary until 2130. Our PT dept is awesome and very highly staffed, there's easily a dozen of them. and we have a Physiatrist and his NP who comes in a few times a week to address issues. And then there's the resident support staff- who cook, clean, do laundry and help transport residents in house. (big facility- 250+ beds) I think we are pretty lucky, our ratios are decent.

Pet peeve- poor grammar or spelling in a fax to a physician. I've seen them so bad, doc circled the phrase and wrote "what?" Sometimes I feel like people try to over "professionalize" their communications, and it ends up sounding like a medical soap opera script.

Oh yes, we have had that and also a microphone that records sound levels. At the nurses stations. We had to remind management that 1, our bed alarms set off the yacker tracker. As did med cart drawers. And phones. And 2, their choice of placement didn't take into account the a+ox1 screamers we have lined up in front of the nurses stations at night, since we do not have sitters. So the "noise" was often unavoidable.

I've had the pleasure of dealing with quite a few docs and nurses as patients... We recently also had a police chief and a catholic priest. And a professional psychic. My favorite so far was a retired (not by choice) cardiothoracic surgeon, who was practicing up until he had a stroke, fell after the stroke, and broke a hip. He loved to teach, and he could get you in his room for 30+ minutes with hysterical stories and interesting tidbits of info. He was a diabetic doctor who hid his m&ms from his wife, who was The Boss. They both were amazing. I like to know my patients professions so I can address them appropriately. calling them by their professional title seems to give them a bit of dignity and control back... It's like saying "hey, I know you have a life outside those bedrails." It hasn't been intimidating yet, but we have had a few *rude* medical professional family members, who would call other doctors from cell phones, name drop, and try to steamroll over staff. They have been few and far between though.

I have had quite a few patients with liquor orders... I worked in a rural retirement home for a bit, and many of the doctors had written orders for "1 pleasure beverage of choice at hs" and one doctor said he preferred to see his patients have a small glass of wine over taking a narcotic sleeping pill. where I work now, in a rehab facility, I've had a few doctors say these patients are adults, if they want a beer with dinner, they deserve it. It can't be any worse than any other med we administer... many have some really horrid possible side effects and bad interactions, and we take those calculated risks daily.

Habitual night walker here. I have been on night shifts or late shifts since I was a teen... Hell hath no fury like me in the morning if I am awakened. Even as a kid I would stay up late and preferred to sleep in. Now that "bad habit" is paying off . Fortunately, I am one of those lucky few who can and will swing between day and night shift when necessary (overtime or trading shifts) and will often work both day and night shift in a week. I have 3 kids, 6, 5, and 3. They're all in school while I sleep. Our shift runs 1900-0730. Being a night owl prior to night shift working seems to help.