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Tephra

Tephra

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  1. Tephra

    Any hints for organization?

    Did you have some sort of daily task checksheet you worked off in school? If that was helpful to you, you can modify that to help guide your work. If not, maybe you can make up a form that includes typical tasks/assessments needed for your shift and work off that. Only problem is, papers tend to get lost LOL. (After time, the routine becomes imprinted into your brain and you won't need the checksheet but it does seem to help the new grads.) Many hospitals work off a computer-printed Kardex/MAR (mine does) -- I have a place on it that I make notes of things that will need doing during the shift (dsg changes, labs to be drawn, docs to call, questions/advisories for the next shift, etc.). I cross them off as I get to them.
  2. Tephra

    Night-shift in ICU

    Hi Charmed -- welcome to allnurses. :) I loooooooove my ICU night shift job. You don't say how long you've been doing this... is this new and you're just adjusting? Or has it been a long time? Now for the hints (nothing you prob don't already know, just getting the behaviors in place is the hard part: 1. Hydrate well. I bring a small cooler with bottles of water now, dump ice over them to make it a treat. 2. Eat well. Healthy light main meal, lots of veggies, healthy snax (sliced fresh veggies, fruit, granola, low fat cheese/crackers). DON'T graze from the vending machine. 3. Avoid the coffee (and other caffeinated drinks). Acidic and likely contributing to the nausea, belly ache, and dizziness. Also makes it difficult to sleep when you get home. 4. Make a small ritual of relaxation when you get home (quick soak in the tub, quick shower, massage your own temples or feet, spend time with your cat/pet, quick relaxing nookie LOL, whatever helps you rest). 5. Get 30"-60" of exercise when you wake. It'll give you energy for the day once you get into a rhythm (if you don't exercise now, build up slowly). Walking is great and centering. Well that's a start. Let us know what else we can do to help! :)
  3. Tephra

    Does you hospital have magnet status?

    I was very impressed with the "Magnet Hospital" concept when the first few hospitals were announced. But...... ..since then, the concept seems to have been "diluted". My hospital was named this year. Woo. Hoo. Although I will say my hospital is one of the better ones locally, their recruitment, retention, and recognition efforts are abysmal. During the Magnet visit, multiple breakfasts/lunches/meetings were arranged... at every one, there were management folks and/or unit "cheerleaders" who always wear the rose-colored glasses (I saw the schedules and who was to attend). Although there were short times scheduled for individual talks with the Magnet reviewers, I can't say what the attendance was (I work weekend nights myself, not much scheduled for our availability -- although if I thought it mattered, I'd have come in). And as for why I don't think my opinion matters... for one thing, Magnet status is simply a marketing tool nowadays. I see no need to block it with what the reviewers would likely see as "isolated griping," I'd rather patients come to our hospital. But despite yearly nursing interest surveys, despite management frequently asking what we want ("More money!" "Retention bonuses!" "Better benefits!"), we don't get them. I see new grads complaining about their "low" $3000 one-year completion bonuses.. the nurses that continue to have low productivity and results even after a year on staff and with continued education and reinforcement. And yet my 8 years loyalty with this place merits nothing more than my piddling annual raise.
  4. Tephra

    How many mistakes have you made?

    Listen, hon, my nursing instructors told me (first semester), "If you meet a nurse who tells you she/he has never made a med error, they're either brand-new or they're lying." Been there, done that, got the t-shirt (LOL! or is it a hair shirt...because that's what we all feel like we're wearing when we realize what we've done!). I use my mistakes as examples to help teach the new nurses. Better you realize that you made the mistake than never realize something happened at all. :)
  5. Thanks again for everyone's response. :) NRSKaren, appreciate your response too, as someone with a positive experience (and I did check out your links). Just a thought (NOT an attack!) :) : If someone said, "Sorry we did not EXCEED your expectations" when they hadn't even MET them (as in that missed visit), I'd be even more annoyed. My best bet, from reading your posts now and in the past, is that your commendations are a reflection on YOUR personal excellence, not the system's. :) My concern is that admin is seeking to "overlay" a customer service system/philosophy without actually giving the meat-'n-potatoes backing to it. It's nice to say, this is how we'll all do things, but you can't get employee satisfaction with big smiles and forced scripts. For example, at my hospital major concerns are pay issues, retention, staffing and perceived admin indifference (LOL! I know, I know, that's everyone out there too). I fear that a happy new customer service plan will just be plastered over the underlying problems with no attempt to raise salaries, retain long-term employees, or hear the problems from below. I'm sure those who promote these service systems (and who are paid to do so, let's don't forget) would say that's not what they intend, but it's the individual systems' IMPLEMENTATION that I fear. Also, per your response, "Saying a similar heartfelt sentiment is what it's all about" -- that's what most of us are already doing, lol! But a canned response is never heartfelt, IMHO. I've already heard one too many knotheads mumbling out a greeting by rote without feeling or concern and I'd rather a personalized response ANYTIME. I agree, there are folks out there with minimal customer service and/or social skills. I'm super-frustrated that I have to go sit with them! This just sounds like it could be a lowest-common-denominator scheme... because some are lacking, all will have to be standardized. Again, how any one system IMPLEMENTS it can be at issue. If the plan allows for individual variation and personality, then I'm more willing to listen. If I get a card with printed scripts to attach to my ID badge for easy reference, well, let's just say Tephra's gonna have a few giggles at admin's expense. :)
  6. Oops, forgot the link to the old threads on scripting (I'm not sure what form ours will take yet):: https://allnurses.com/forums/search.php?s=&action=showresults&searchid=540470&sortby=&sortorder=
  7. Appreciate y'all's thoughts. And I agree, we sure spend a lot of time apologizing for other departments (or the imagined slights that patients/families feel have been inflicted), or doing their job ("Why didn't I get X on my tray?" "That lab tech bruised me!" "My trash is overflowing!" etc etc.). But oddly, it's only RNs and LVS invited to these meetings per the message. I'm betting the other depts. likely will have their own meetings. We'll see. Will follow up later this month after meetings.
  8. Welp, it's coming. There was an announcement on our computer system today "inviting" (it'll be required attendance) all nurses to town hall meetings on "excellence in care" or something similar. I asked my supe about this excellence thingy and told her that since usually that means I need to grab my ankles I was concerned (please forgive me, but I'm a night nurse and we just don't know any better than such talk, lol!). We chatted about "magnet hospitals" and "satisfaction" etc, then she mentioned.... (hold on it's coming)... scripting!!!!! Have to say, first heard of it on this forum and appreciate those that posted the early warnings. I felt better armed to discuss things with her and express concerns. Sounds like it's a done deal here though and arguing will be like trying to get upstream to spawn (what percentage of salmon actually survive that anyway **sigh**). Oh I WILL be going to the soonest meeting, believe me. (Have to get some zzzz's before work tonight... so I'm not seagull posting -- will check back for your thoughts early Sunday if not this eve. :) )
  9. Tephra

    Hospital Acuities.........or NOT!!!

    We have an acuity system in place. It's mostly a *retrospective* classification, used annually to justify staffing. Although it generates numbers that are used to determine "load" in M/S, i.e., "Susan's patient crew is a total of 58 points, while Jenny's group is a 67 -- Susan gets first admit" -- it didn't seem to make a difference in staffing. The grid that we followed recommended staffing levels per total acuity but staffing still depended on number of warm bodies available. However -- acuity was used against us in ICU -- we didn't fill in the numbers high enough one year and we lost one FTE the next year, based on that. I'm no fan of acuities. If you hold to guidelines based on them, they *might* work. But how many times have y'all been told, "Just try to 'get by' 'make do' 'get through the shift' with what you've got, and dang the acuities?
  10. Tephra

    bring in the clowns!, er i mean residents!

    Pardon, didn't reference properly, CSNY there... always a lovely song and a great reminder. :) Crosby Stills Nash & Young - Teach Your Children The baby docs will be what we help them become.
  11. Tephra

    bring in the clowns!, er i mean residents!

    LOL @ this thread! Doncha know, the other day I looked at the calendar, laughed, and said to the hubby, "Hey, July 1st is coming!" He grinned, and said, "Yeah, should we go out for dinner or something?" I looked at him in confusion, then remembered... July 1st is our anniversary! LOL! We were referencing two COMPLETELY different concepts! LOL! Hey, y'all, we ALL gotta start somewhere. "Teach your children well..." .. I never mind early July anymore. :) You who are on the road Must have a code that you can live by And so become yourself Because the past is just a good bye. Teach your children well, Their father's hell did slowly go by, And feed them on your dreams The one they picks, the one you'll know by. Don't you ever ask them why, if they told you, you will cry, So just look at them and sigh and know they love you. And you, of tender years, Can't know the fears that your elders grew by, And so please help them with your youth, They seek the truth before they can die. Teach your parents well, Their children's hell will slowly go by, And feed them on your dreams The one they picks, the one you'll know by. Don't you ever ask them why, if they told you, you will cry, So just look at them and sigh and know they love you.
  12. Tephra

    Nurse, what's your number?

    Ooooh I had a phone when I worked Med-surg at my hospital. I hated hated HATED it. The desk clerk would ring calls through -- didn't matter if you were in deep isolation garb in an MRSA room, or elbow-deep in poopoolito elsewhere. And goodness forbid if you didn't answer -- a chewing out from the desk cler, charge nurse, and caller (later). How respectful is it to be talking with a patient and family and have to stop to take a call? All we learn about the time to relate to and teach your patients -- and instead you're supposed to be available immediately on the phone. It SEEMS like a good idea but only if you're not doing something at the time it rings (and that's pretty infrequent!). There's something to be said for the idea that someone else will help, or you will call back. Does your personal physician, accountant, or child's teacher drop everything to talk to you? Hmmm. :)
  13. Tephra

    When to give up?

    Hey nrs-jlm, hope things are smoothing out for you. Sounds like you've got a good plan! The experience you're getting will be invaluable anywhere. And thanks for the reminder of how tough it can be. We've got a couple of raw new grads on out ICU and I've decided we need to try harder for them. :)
  14. Tephra

    Organ donation question!

    Hey gizzy... good question! Here's the deal... you don't really need *anything* signed *as long as* your loved ones know your wishes, and agree to abide by them. One of our "donor moms" gave her teenage son's organs for transplant as a result of a 5-minute, off the cuff conversation with him several months before he died. That's all it takes. The signed card/license/etc. would be very helpful in an emergency to "get the ball rolling". (And yet, if your loved ones WON'T abide by your wishes, all manner of signed cards/forms/etc. may not help. The time it might take the hospital to get legal permissions/avoid lawsuits might be too long for the organs to be useful. Sad but true. Make sure the important folks know what's important to you.) As for location.. organs are offered locally (through the local OPO - Organ Procurement Organization) to the sickest patients there. If refused or not needed locally, the organ is offered to ever-widening circles up to the limit of the ischemia time for the organ (how long it can fly in a cooler full of special slush and still be viable): Table 1: Approximate preservation times for various organs ----------------------------------------------------------------------------- Kidney -- up to 72 hours Liver -- up to 18 hours Heart -- up to 5 hours Heart/Lung -- up to 5 hours Pancreas -- up to 20 hours Corneas -- up to 10 days Bone Marrow -- varies by individual program Skin -- 5 years or more Bone -- 5 years or more Heart Valves -- 5 years or more ( http://www.kidney.org/general/news/25facts.cfm ) Offhand, I'm guessing there can't be many limits to geography/race/sex (as in someone saying, "I'll only give my husband's organs to a black/white/asian/etc. man from Texas" but organs are offered locally to start. Does that help a little? :) Also, lotsa good info at: http://www.unos.org/ Appreciate all you donors, and I respect the choices that others may make too. I'm a big fan of recycling, in any form! :)
  15. Tephra

    LPN's are Nurses Too? Aren't they?

    Congrats JustJenn! Don't let anyone sneer at ya... time to edjumicate them as to what an LPN is. A thought... get through your program, get some experience, and get an employer who'll pay tuition to get an RN... why? Payscale. I know it's already been said.. but in many places, you'll be doing (nearly or) the same work as someone who gets paid X bucks more per hour. Use the system to help yourself.. just a thought. :^) And hey nursiepooh (moe)... that there was some eloquent post! Bravo!
  16. Tephra

    Another organ dilemma so soon....

    Just wanted to add a little bit here -- I lurk more than post but I always appreciate the wide variety of folks and thoughts on here. :^) I'm in Tranplant ICU (liver/kidney/pancreas). More of our liver patients are Hep C than ETOH, but many suffer from both. Patients are required to be "dry" for at least 6 months, more often a year. They pass an extended evaluation process that includes a social worker's estimation of their psychologic state/social resources and support. Most people can and DO stay sober before and after transplant! (Not all -- I've been at the bedsides of two men who started drinking again after their liver transplants. They both died. I assure you, *neither* would have been re-evaluated for another transplant.) Deciding when to transplant is a fine line -- the patient must be sick enough to need it urgently, and yet healthy enough to survive the surgery and recover. Likely, both Mickey Mantle and Erma Bombeck were too close to the edge of their illness when they got their transplants. But that's not just celebs... it happens on a daily basis with us "regular" folks too. Personally, I don't care who gets my organs when I don't need them anymore. My husband has instructions to "part me out". I've shared the sorrow of too many families waiting on the organ that didn't come in time. (That said, I do respect others' choices! :) {{{donormom}}} Thanks for sharing your story. Lovely little 'claine! :)