krissyycupcake

Unfortunately my knowledge of when to impliment it and when not to isn't great. But we have been told to impliment it on any and all patients meeting it. And many times my charge nurse of the night is also telling me the same-to follow up with the needed orders and fill out the papers ER should have started. Do you have any advice for resources, as I am struggling to find good ones on the floor? Maybe any good online sites or references I can brush up on, any clinical books to keep on me at work?

But aren't some NGs made of material that isn't safe for extended periods of time? At a NH, I was told no longer than 2 weeks. So I was looking for some sort of basis of information to know for my current location. And I'm also aware that a lot of sepsis protocol patients aren't truly septic, but when we have a checkbox that should be filled out and implemented by ER (on every patient, per my DON) and they're sent to me without it even started or acknowledged and my DON stays late the next night to scold me for it, it gets frustrating. The nurse to patient ratio doesn't bother me at all. I've had 12 and still managed on our floor. I just felt uncomfortable being my own sitter with an assignment as well-this has happened on multiple occasions. I really do appreciate this other aspect of feedback because there's only one other closeby local hospital and I don't want to burn any bridges this early in my career by quitting somewhere too soon.

We are union! I will have to look into this. And the IV was started within 20 minutes of me calling our supervisor.. but our supervisors initial response was "it's not necessarily their job to start them".. on a potentially septic patient... we had to basically threaten to rrt the patient as soon as we would receive her to get her to do anything.

I appreciate all these comments. I don't want to give up on my first hospital job, but some nights have left a bitter taste in my mouth. My biggest concern is that the next few years will shape who I am as a nurse and that this isn't going to help me become the nurse I want to be. I know no place is rainbows and butterflies.

It's mostly 50/50. We have a good amount of seasoned nurses, and many around 5 years who are confident in their own choices. Most of the seasoned nurses actually respond with "wow I don't know what I would do in that situation "

This is also something I agree with. I had an NG tube in for 5 days. I know they're temporary. I call our GI floor to ask how long our policy is for them after looking through manuals and references and finding nothing. I'm told "oh we've had them in longer, don't worry about it." I tried to explain I wasn't worried but still just wanted to KNOW for reference in my brain! And I was told they didn't know. I feel like half my shift is a big guessing game and/or fighting with my supervisor over a mess from ER. Especially with this protocol. There is just no consistency between standard of care. Google is a better resource than my coworkers, which is terrifying. I have often asked for and received wrong advice I knew wasn't safe for the patient. Example of this is getting an order at 10pm at night from a specialist. The computer flagged it as an interaction with an SSRI. My charge nurse told me to override it as physician aware. I wasn't comfortable doing that because it's not like he physically had that pts med list with him and it was late and antidepressants probably aren't high on the ID drs concern. I ended up digging for info from pharmacy and getting tons of new orders (including telemetry) because the risk of ssri syndrome was actually extremely high and common with these 2 meds. I know my first year is supposed to suck but I am just feeling so stressed any time I get an admission or am scheduled to be there. I worked LTC as an LPN (different world, I know) but I have never watched so much inconsistency or lack of care.

To add to my post, I have also been shorted a sitter, and received a patient assignment. I had to be my own sitter on top of my other 5 patients.

After my initial taking it all personal pity party, I did speak to other night nurses (some twice her age), and she unfortunately speaks that way to everyone with the slightest mistakes.

Hi, I have been employed at a local hospital for 4 months now. I work a general med surg floor and I am hitting the point where I feel unsafe and like I am screaming at a brick wall. We often get ER patients who meet sepsis criteria (we have a protocol) and within 3 hours fluids need given, with a lactic drawn, and an antibiotic. During ER report I tell the nurse these things need done before pt can come to the floor. Her reponse is that they can't get an IV. We had to page the supervisor and complain and suddenly she has an IV in. Then we had to call the dr after she arrived and get the orders (after the 3 hour mark). He was told he didn't know her labs were that critical. This happens, often. We actually have a frequently filled sheet to add admissions that shouldn't have came to our floor... is this normal? To have to take unsafe pts at least once a shift? No one between days and nights knows policies for AM procedures. I've tried to be proactive and ask for a sheet, but no one has done anything. So during AM report, I am always yelled at for doing something that no one knows to do. Advice is absolutely terrible. I will ask how to approach a situation and be told "I dont know" (from nurses for 30+ years) or "don't worry about it." Example: distended abdomen with fecal management system and decreased output from it. I asked how to know if its clogged or not in right or how to irrigate it and was told to not worry about it. These are just a handful of things I've witnessed. There is just no continuity between what I'm scolded for during days and what I'm told at night. We often get patients meant for ICU or a telemetry floor, neither of which we are prepared to handle. Our DON actually stayed late one night to lecture me and tell me I should have RRTd a stable patient when she came to the floor, as they shouldn't have came there originally. (Not any blame on the supervisor or ER for sending her like that)

Oops, completely forgot to peek back at this post. The fluids were actually not ordered but were apparently a policy to order that I was never told of. However, there's apparently a huge gap on night shift's knowledge of what is "policy" and what isn't for different procedures (a month later and I am still getting wrong info at night and angry morning nurses). So, even asking night shift nurses at a later date than my post they told me they wouldn't have thought to hang anything either. The nurse's rationale for yelling [her words] is because she's the only nurse who has to fix the entire floor, works 6-7 days a week and has the idea that the entire floor would not function efficiently if she was not there everyday. She refers to 99% of the floor as stupid. And yes, she did yell. Not full out screaming, but loud enough a coworker heard it down the hallway. There is a severe inconsitency between policies on our floor, especially between days and nights

So, I am a newer RN. I have been alone for 3 weeks now. This morning during report, I had a patient going for a procedure. We do bedside report. My coworker proceeded to yell at me, in front of the patient how her fluids weren't hung and consent was not signed (she refused to sign until her daughter arrived..who I did call). I was unaware of this doctors fluid prep, and not told in report. I apologized because I honestly didn't know. She then continued yelling and told me I needed to ask, because no one is going to just tell me these things. All of this was completely degrading, and in front of the patient... When we did clinicals, all fluids were hung in preop. I obviously was wrong for not knowing the preprocedure process..but I still found myself crying the entire way home because now my patient is going to view me as completely incompetent. Reporting this nurse is not feasible because she is good friends with the DON. I normally have tough skin (been yelled at by doctors as an LPN and brushed it off). I am just feeling so small and down about how this unfolded. This nurse has a reputation for running off new nurses and tearing apart everyone during their report. Any advice is appreciated. And for reference, I did not see fluids ordered.

If it's full, it can prevent the uterus from involution and lead to postpartum hemorrhage. Her fundus was firm and at the level of the umbillicus. It can also cause damage to the urinary bladder muscles, kidney infections & UTIs because her muscles are already weakened from delivery.

I have a patient who delivered this morning. 2nd degree perineal laceration with her lady partsl delivery. She had an epidural but only voided twice since it was discontinued with 50-100ml amounts. My first nursing diagnosis was Acute pain r/T 2nd degree perineal laceration AEB pt states "my pain is 5/10 from the delivery and I'm swollen like a peach." My second diagnosis is risk for infection r/T second degree perineal laceration from lady partsl delivery. My third diagnosis I wanted to use something related to a risk for urinary retention? I'm not sure if I'm heading in the right direction here, so any advice is welcome. She did state she has no urge to void and has only voided when being toileted and didn't realize she was voiding.