pikachu715

I've been a med- surg nurse for 5 years. My sense of confidence changed when I started transitioning to labor and delivery. I suddenly went from expert to novice again. Initially, I was even scared to talk to expectant moms and fathers. Soon, I got a reality check that L and D isn't all rainbows and sunshine. It requires detailed observation and sometimes QUICK action. After 3 months of preceptorship, I feel that I am still struggling to transition to L and D. I think part of it has to do with my anxiety. I have anxiety when I make small mistakes and it spirals into something like a panic attack, which effects my performance. Another part is that I am finding it difficult to work with my two preceptors. One has OCD and wants me to do everything her way. She tells me how to chart and what to do before I have a chance to think on my own. My other preceptor is more lay back. She lets me complete my shift on my own and gives me pointers on when to up pit/ intervene with my pt. However, when I have questions, she appears irritated and occasionally condescending. The areas that I need help in are: completing recovery in 2 hours, remembering to turn off epidural after laceration repair, determining if I should turn patient base on FHM (sometimes I over react when there are small variable decels), and react in emergency situations. Do anybody have suggestions on how to over come anxiety at L and D?

I am trying to comply with HIPPA.

I am trying to comply with HIPPA.

It's normal to not know and to feel incompetent. Trust me we've all been there. Okay, you didn't perform so well at your clinicals. But you will improve. What you need to do is after each clinical, go over how your day was. What went well and what didn't. How can you make your work flow better and how can you had handled things differently. If you're taking a long time with looking up medications this time, when you go home look up the same medications and try to familiarize yourself with them. Next time, when you are giving out meds you will probably recognize them from before. Also, look up at home what you had questions about of your previous care; ex. nursing interventions for chron's disease. Be proactive in improving your skills. As a new nurse, it's okay to ask for help. Do not ever push yourself to take on duties that you're unsure of-- ex. putting in a NGT for the first time. You rather that your preceptor hold your hand through this skill than to cause a pneumothorax and cause the pt respiratory failure.

Most job applications ask for past work experience. No GPA required. Even when I was applying for new graduate positions, the hospitals did not ask for GPA results.

If possible get your BSN so that it gives you a more of an edge when applying for jobs. Applying for a RN job can be competitive. There are always opportunities to do overtime as a RN. Winter time is when hospitals are usually short staffed. However, beware that when you do overtime you are being held accountable to the same nursing standards as usual. You don't get to slack off because you are working an extra shift or that you're on your 11th day. An error is an error. I always decline extra shifts if I know I am too mentally tired.

Problem: Hospital protocol states that all PEG tube residual is discarded. However, family wants PEG tube residual returned to the pt. There is also a standing order by the doctor to "Discard any PEG tube residual. Follow hospital protocol regarding flushing, medication administration, and managing PEG tube." I work night shift. I understand that if PEG tube residual is x > 2x the hourly rate, I hold the PEG tube feeding for two hours then recheck the residual. But to discard all PEG residual regardless whether it is 5 ml or 50 ml seems unreasonable. If the residuals were greater than x 300 ml I will definitely discard the residual and call MD. I don't entirely agree with the hospital protocol to discard all PEG tube residual. My nursing supervisor states that I should call up the hospitalist in the middle of the night and talk to him/ her about the family concerns. What will you do?

Take microbiology first. It is more interesting. You get to learn about different cell parts, elements that make a pathogen, and gram staining. This knowledge sets a good foundation for you to know about drugs. I am not sure if your pharmacy course goes into deep detail but a major part of how drugs work is that it effects pathogens' cell membrane.

This is not a homework question. This incident did not occur to me but to another nurse.

Me too. I always stay in the room and witness a patient consume their medications.

Pt (non verbal and cannot write) with chronic bilateral knee pain. Takes norco at home. When in the hospital, RN brought norco to pt's room but left with medication on the table top. Pt's son pocketed the medication. Son states that he gave it to the father already. RN insist on retrieving the medication wrapper to scan. RN found that the son has pocketed the medication. Son states that he gave the pt home norco instead. When asked for the home medication bottle, son said he only had that one dose. RN notify care team that pt's son will pocket medication. RN cannot verify whether pt has taken home medication. PT is quiet and not reporting pain anymore. Should the MD be called? What should the next step be?

The foley on the pt was changed. Low to no UO from new foley. Nephrostomy tube was unclamped and pt went home with nephrostomy tubes.

The hospital is trying to earn back the money they are paying you. Ha.

I work the night shift and we got ice cream sandwhiches (one each) in the middle of the night.

This is not a hw question.