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.

First job in 2009 I made $18/hr, now I'm at a different skilled facility doing sub acute care in MI making $22/hr on midnights. part time so no benefits for me. Our facility also doesn't offer shift premiums.

my first orientation lasted 3 weeks on day shift, working 24 hrs a week. That included the hr stuff and mandatory online courses. My second orientation was about 2 weeks on midnights, about 3 years later... Now, at the same LTC facility, nurses get 2 weeks with a couple different nurses over the building to get a feel for the job. Rehab, where I'm at, is different... they get 2 weeks of days full time and 2 weeks of nights full time. (I'm a night shifter) Even after that, we keep an eye on our newbies and offer extra help when we can. Because it's HARD! No one should be thrown in feeling lost or alone.

Old post but maybe someone will read this and get some reassurance. I'm a midnight nurse, on rehab and we take very acute people. We are no strangers to codes, complications, and crashing. Wd work with dozens of doctors and people come from out of state to be with us. After dealing with that many doctors, I can safely say every physicians group has someone on call every night. They have answering services that page out for us (tablet style, not pager. So they know what's up when they call back.) I also have a few private cell numbers for docs who know I don't page unless something is seriously wrong. They hand it out to certain nurses. During the day we have the in house np and PT doc to help when issues arise. Nights, not so much. So 1, assess. Is it something that can be fixed by giving that hydralazine a little early? Is the patient experiencing something we aren't expecting? Do we have the means and time in house to fix it, without doing something illegal or paging the on call? If we can fix it, or try to, we do. There are many interventions we can initiate that we don't need to call doc for. Always let shift mates know what's up and call super and say heads up, patient x has this going on. If patient is declining rapidly, or we can't fix it, 2, we page out. I will not page more than twice. Doc doesn't page back after the second time, 15 mins apart, you probably won't. Only wait if condition allows it. If we are paging out, there's no doubt this patient is going to the hospital. It's bad if we page at 0330. Our policy also states we can page the medical director or assistant med director if necessary. While we are waiting for return page, we team up- one monitors the patient, usually with a CNA. The others start printing mars and copying transfer packet stuff. At this point we are waiting for that verbal order to ship. If it's obvious we can't wait, we call EMS and building super writes the standing order to ship. EMS will have a number straight to dispatch. If there's a code, that is the ONLY time 911 gets called. We run it and work until EMS gets there. Doc gets pages after for an update. Things like critical labs, drastic lab changes in certain values, x Ray or ekg results that are severe get paged. Asymptomatic patients our docs prefer we wait until the am to call, symptomatic is immediate, or if they say "call me when this comes in" then obviously we call. I do like to clarify that one though, because they forget our lab and x Ray is 24 hr and we do get results in the middle of the night. the longer you work, the more honed your skill and gut will become. Confer with co workers. We talk and bounce ideas and ask "what do you think?" All the time. If your nurse sense is tingling, there's something going on.

Coast Guard for 4 years :)

I learned to count my rooms! 47 patients, 3 nurses and I had 19 of them because I'm a dingbat and walked in and got report on my usual group. 1 empty bed in my 20, were a 60 bed rehab unit. Didn't notice until we were almost done with hs meds... By that point I was like whatever I'll keep them. We don't tend to shift groups unless someone's got a huge amount of empty beds... And I didn't even notice the empty rooms I walked by coming in... I also learned that tsh elevation is common in hypothyroidism... Never made the connection until now! It was an aha! Moment, followed by a dang I feel dumb it took this long to figure that one out. Somehow I missed that bit until now. i learned what someone looks like after they fall in the shower at home and have an INR of 10+ Upon arriving in hospital. A human should not be that purple... I am shocked someone can have that much blood lost by bruising and be ok. Doc said she's lucky she didn't die. Even had bleeding in her joints. I learned I can make our night doc laugh hysterically by offering him some of "our finest ice water" complimentary, of course. Fresh off my cart. Docs get slap happy by 2230. They laugh at everything. I finally met met our in house physiatrist! And he's awesome! He hung around at report time and cracked jokes at our desk with us. He's written a book, has huge clinics, and loves being social with all of us. I love docs that are human.

We had state here too lol! Happy nurses week, we got you a suprise...

We all got light blue t shirts with the facility logo, and on the back they say "nurses are angels in comfy shoes". We get to wear them as part of our uniforms. Last year we got stainless steel travel mugs (the big kind with a handle) with the logo, and a pack of Starbucks via packets. This year was awesome, they had free food, lots of games raffles and prizes, they even took an ad out on the electronic billboard in town thanking us! We got bought out by a nonprofit healthcare system, and how we get treated has changed greatly. I'm a midnighter and our kitchen staff stay late to cook us food on our staff appreciation days. We get cookouts and pasta dinners, they order us pizza frequently, and we have baked goodies and an ice cream bar in the break room every so often. My specific unit buys "team shirts" that we design every year, so this was nice that we got facility wide ones too. edited to add- we got gift baskets on each unit from all our cohorts, hospice, dialysis, the local hospitals... Our admin team handles sending out our gift baskets. Some of the doctors said "happy nurses week" to us too, but they go to so many facilities it'd put them in bankruptcy to buy us all baskets! We did get some boxes of donuts and cookies from families too

I am a U.S. trained LPN working in Michigan but living in ontario... Our local ontario hospital tried to phase out RPNs. Now they're laying off hordes of BSNs and forcing retirement to hire them back in. A hospital full of BSNs is too expensive... So the less acute units like maternity recovery, day surgery etc are using RPNs because they're cheaper. My aunt worked in Rhode island and was told she had to obtain a BSN... She went back to college in her mid 50's and just graduated this week. In the end, it's going to come down to the almighty dollar. If BSNs are going to be mandatory, pay will need to increase to compensate for more schooling. For profit companies aren't going to tolerate parting with that money for long, non profits won't be able to sustain it. LTC is shifting towards med techs slowly, and hospitals here (local to me) in Michigan are hiring med techs now too. It all will depend on the money. LPNs will be here, just like they have been, if for no other reason than we're cheaper. I don't see BSN minimum becoming mandatory nationwide in the near future.

We we too have this battle on in house management and I had a nursing supervisor question shipping a resident. I looked at her and said "doc says pt needs to go, he wants pt direct admitted. If you want to disobey a direct order, here's all the paperwork and here's the doctors number. Talk to him. I'm charting you took over care." She decided pt needed to go after all. Inservices have been about minimizing re admissions... How bout don't accept people we can't care for? Don't discharge unstable people? Don't wait until they code to transfer? It's frustrating.

1. Keep that enthusiasm! If you think it'll suck, it will. It can ALWAYS get worse. 2. Don't get your CNAs mad at you... Trust me. I've seen how much help they give the nurses who bark orders and treat them like crap and refuse to answer lights. Your CNAs will make your shift great or awful. Love them. Help them. They know those residents better than you do. 3. Don't hate on other shifts. Each shift has its challenges. 4. Be flexible. I pick up part shifts or come in early if my day nurses have a family thing or or an emergency. So if I'm stuck, since I help out, they help me. If you don't offer to help your coworkers, they won't offer to help you. I'll even go to another unit and help if someone's declining and the nurse needs extra hands. We all have portable phones, my aides can page if they need me. 5. Food goes a long way. We have cake night where someone brings in a cake, and we line up all the med carts and bleach wipe everything and audit. I like to bring in "everybody doesn't suck pizza" every so often. 4 hot n readys can boost morale like you wouldn't believe... We have one nurse who brings in large coffee for everyone, one who will buy Taco Bell, another who's a magician with a crock pot... Even a bag of chips to munch while charting is fabulous. Nothing's worse than a hangry nurse. 6. Stay humble. There will always be something you don't know. 7. Be friends with your crash cart... Go through it on your down time so you know that baby inside and out. Learn how to hook up the suction. Look at your blood draw and Iv start kits. 8. Ask other nurses if you can come help with procedures. Does it necessarily take 2 people to straight cath? No. But you'll see much more anatomical differences. 9. Always make sure you check your meds. Sign date and check off important stuff on Iv bags. I like to check next to pt name, Iv solution, drug added and underline flow rate. That way I can guarantee I checked it, pharmacy makes mistakes. Check drug cards... If pharm fills a 200mg metoprolol order with a card of 50's, giving one isn't going to help anyone. I highlight in pink any different dosing. 10. We also have a "when in doubt, ship em out" unwritten rule. I'd rather be in sh!t for sending a patient when doc doesn't page back, than be in trouble for someone dying because something got missed. If you're paging a doc after hours, it's something major and probably life threatening anyway. 11. Ask your nurses what docs like to hear when you call them for things like positive ua's, abnormal labs, decline in condition. Always have recent MANUAL vitals. Keep the chart infront of you. Don't be afraid to carry it to the cart of you need to be there and you're waiting for a page back. Ask what labs they like to order. I have one who always wants a cbc with diff, so when he says just cbc we know what he wants. 12. Be nice to ems. We had the same crew that came to our facility... They work the same nights I do. I got the one grumpy guy to laugh and now he's not so tense and angry when he rolls in our doors. Sometimes we even share our food if they're dropping off instead of picking up. 13. Write detailed communications to docs with a clear intention. One doc complains about the facility he goes to where the nurses just write pt needs to be seen for x. He would rather see "pt has increased edema, weight increased by x in 2 days, lung sounds are x, no diuretics ordered. Vitals xyz. Please advise, thanks!" 14. Ask for help. Ask for input and opinions. Someone may have an off the wall tip from way back in the day. Or spot something you don't. And that's ok. 15. Every human body has an anomaly, it's just a matter of whether or not it's been found or is problematic. A surgeon told me that. 16. Don't be afraid of chest compressions. If you're starting them, your patient has no vital signs. They're dead. Dead people cant feel pain. You're going to break some ribs if you do it right. That ones courtesy of a paramedic when I was in nursing school. 17. "Textbook" presentations are for nursing school and tv. You'll see off the wall symptoms that in a roundabout way all correlate. 18... This ones a biggie. Know you can vent. You can lose your mind. Cry. Know who's safe to do that with. Any nurse who says she's never cried at work is either a freak of nature or lying. We see death. We sit with patients waiting for that last breath. We get screamed at by families. We see horrible dynamics play out in front of us. Our job can be as heartbreaking and soul crushing as it can be joyous. Joke. It's ok. 19. Doctors have bad days. They have families. They have days they're not on call. They have emergencies in their personal lives. They're human. Even the ones that forget that last bit. 20. Let your trainer train you, but also offer to help. Jump in with both feet and know you'll be ok. You'll probably be on the fringes until the regular staff can be confident in you. It's ok. They don't hate you, they want to know you can hold your own. If you help your trainer, she will help you back. And other nurses will trust you because she does. Or even better, see if you can train with a few different people! Thats long... And that's all I've got :) you'll do fine! Always cover your a**, chin up buttercup, shake it off, keep on trucking... And all those other platitudes.