veronica butterfly

Wow, sounds like all of you are perfect nurses, have perfect shifts, perfect staffing, perfect policies on overtime... Of course, it's not good nursing to leave someone lying in poop or to pass on a sh*tty job to oncoming staff, but everyone is railing on the OP like she's the most horrible nurse ever. Every place I've ever worked is usually short-staffed and everyone is crunched for time. My most recent hospital job had an incredibly strict overtime policy too and also forbidden to punch out and finish working. The last "shift change poop situation" I encountered was not even my patient. I was walking on the way to give report to oncoming staff and a pt's dtr came out to say her mom had to use the bathroom. Dtr was irate, call light had already been dinging for 10 minutes. CVA pt, 2 person transfer, aphasic, fully dressed in rehab setting. I couldn't find any help due to shift change, the dtr absolutely refused to wait for me to find help so she and I got her on the toilet. Totally unsafe... 15 minutes later I go out to give report and guess what? The oncoming nurse is mad at me because now she is getting report late and now her shift is starting out bad. And of course I had to stay even later and fill out paperwork stating why I was on overtime... Bottom line is we have got to be forgiving to our coworkers! Most of us are working our orifices off and giving the best care we can. Stuff is always going to be left undone, it's just the nature of the beast. The job is hard enough without nurses turning on each other.

I've been Med/Surg for 6 years and change my plan of attack daily and depending on the patients. Every day on Med/Surg is so different and I really rely on my intuition. This last weekend I had two heavy pts and two "easy" pts. I knew the nursing assistants were with the heavy pts a lot early on (getting them up to chair for breakfast, toileting, turning) so I knew they were being tended to and started with my two easiest pts, did their assessments, gave the meds, and actually charted everything. Then by 9 am I knew I had the rest of the morning with the tough ones. Sometimes you get an assignment where you've got one pt that needs a lot of watching from the get-go and you spend your time with them, and your other 3-4 you end up ignoring. Many of my pts I do a "mini-assessment" on. If it's a young person in their 40's in with a rule out MI, I listen to their heart, take their vitals, and make sure everything is in place to go to their stress test. Bye-bye--the folks they're going to see in the next couple of hours (resp therapists, nuc med techs, cardiologists) are a lot smarter than me and that's what the pt is there for. I don't spend time looking for pressure sores, etc. Get r done... If someone is in with abd pain, I focus on the abd... If they've got cellulitis and they're diabetic, I focus on their wounds, edema, and blood sugars. Old folks with chf, a broken hip, kidney disease.... them I do a super thorough assessment on. I usually don't do my dressing changes til later in the morning or early afternoon. If it's an ortho pt, they can eat, poop, do PT and then when they're back to bed by noon, I can do their daily dressing change then. There's no hurry with the daily dressing change. You just eventually get a feel for what needs to be done asap and what can wait. Sometimes I group my meds together, but usually if they're spaced apart an hour or two, it's for a reason. Flomax needs to be given after a meal, Synthroid before... Antibiotics need to be given at a regular interval so they kill the germs... I had a c-diff pt with a lactobacillus capsule that directions on the MAR stated specifically should be given 2 hours apart from any ORAL antibiotic. Guess what, no one was following that direction. If it was you or your loved one, wouldn't you want the directions followed? Our pts waiting for surgery are NPO but they have to have their beta blockers, so I give them with a very small sip of water. Any other questions, I call the doc and ask (and chart the answer!). Med/Surg can be brutal, follow your gut and do your best...

12 hour day shifts are KILLER! (I just got home from one!). Day shifts are invaluable for experience and learning though, I hope you try and hang in there for awhile. It will get better, I promise!!

Hang in there, Bonnie! Med/Surg days feel crazy to everyone and it sounds completely normal how you're feeling. Keep in touch with your manager about how she thinks you're doing, or if you had a preceptor, can you get support from them or have them check your charting? I think we all stayed late to chart when we were first new, but 10 pm sounds too late, I always hit a wall with charting about 1/2 hour after the shift is over. Are you working 8 hour days or 12 hour days? I worked evening 3-11:30pm when I was first new to Med/Surg, I thought that was the perfect shift. You get enough experience to learn things, see pts when they're awake, and then it (usually!) winds down by the end of the shift when everybody goes nighty-night... How you feel right now is very normal, don't be too hard on yourself!

I use vertical columns, 4 to a page, double-sided so 8 total. The vertical makes sense to me... I have Room _____ Pt Name_________ age_________Doc________ Admit date_____ Code_______ Dx_____________ allergies____ PMH________________ BS times/insulins Vitals Drains CMS Dressings, etc Weight I/O Labs Meds (I put times and any other info I might need here) __________________________ Report (any misc stuff...)

Be sure to use the resources around you, respiratory therapy, charge nurse, and your coworkers. If you are having a gut feeling that someone isn't doing well, have someone come and take a look at your pt. When I was a new nurse, I thought I had to know all this myself. It's much easier to pick up the phone and ask for help. Pharmacy is a great help for med questions too.

I saw this show too. She talked about how depressed she was and at times she didn't have much desire to keep living. She is on public assistance and the medications make her feel sick, she doesn't have much stamina or energy. And she put her boyfriend's life at risk by having unprotected sex with him to try and conceive a child. I understand the desire to have a child, but to risk her boyfriend and her child's health to fulfill that desire is very selfish, and not too wise. Why not adopt an older child, maybe even one who is HIV+? Sounds like she is intelligent and had a great job before, I would hope she would try to fight through her depression... And I felt sick for her, what a shame that happened to her, her husband really sounds like a pig...

Hello! I am a med/surg nurse and a mom to a 14 year profoundly developmentally delayed boy who has intractable seizures (lennox gaustalt). He is not able to walk, but can sit up. Spends much of his day on a very padded futon on the floor or in his wheelchair. When he is on his futon, he changes positions frequently from lying, turning, to sitting "indian style" He is very slim and the way he sits puts a lot of pressure on his coccyx. He cannot follow directions and wiggles out of position often. When he is in his wheelchair, he often 'thrusts' forward. A few years ago, he had a bout of flu with diarrhea which gave him a wound on his coccyx (he is incontinent always). This healed up quickly, but left a red, blanchable spot which I have managed to protect up until now. I've used Eucerin or Lantiseptic as a barrier cream and always padded his surfaces well with eggcrate foam, etc. It has looked redder lately and today I noticed a very tiny piece of skin, like an opened blister, on the tailbone. I put barrier cream on it and he has been on his side much of the day (must instinctively know it hurts??) and it seems to have healed, but yet still red. Any advice/experience on a good product to put on the coccyx to PREVENT another sore from occurring? I feel I can't always control his environment as I'm not with him 24 hrs a day... At work, we use duoderm or tegaderm on small wounds or skin tears, but I'm trying to prevent a sore, not cover one and get it to heal. I did go and get some Tegaderm and put it on him, I feel at least it may keep moisture off it and prevent abrasion. Thanks for any input!

I think you've got to trust your gut. Is there one area that appeals to you? or that you understand more? If you don't feel any 'pulling' yet, maybe you need to stay put where you are until something tugs at you. I've been med/surg for 4 years. I always thought I'd stay just a year or two and then specialize. And then the recession hit, and I'm nervous to make a move due to job insecurity. I like giving chemo, and I like taking care of post-ops, but I still like the variety of med/surg..... so I stay.... Good luck in finding a specialty!

Our Med/Surg floor at a regional medical center has always had telemetry patients. When I first starting working there 4 yrs ago, the RN was not involved really. We had these pts with heart monitors and we had no idea what it meant. The ICU huc/tech would watch the monitor and then page you if something was wrong. But we didn't have telemetry training so when they would tell us things, we just didn't get what to do, if we needed to react/call doc, etc. It was like they were speaking another language to us. Then policy changed to where the RN was responsible for reading the strip and knowing what the heart rhythm was, while at the same time the ICU tech watched the monitor continuously because we couldn't--we had other pts to care for. They sent us to telemetry training. This was very scary at first, but now at least we understand which heart rhythms are worrisome, can bear monitoring etc. We still don't have time to read our strips on time, but at least we 'get it'.... When we see a change or a rhythm that's not normal, we know what to do.. or at least know when to worry! If you've got telemetry pts, you really need the extra training...

For pain... Dilaudid, morphine, percoset, toradol for GI... protonix, prilosec, pepcid B/P...atenolol, HCTZ for nausea.... zofran, inapsine, phenergan insulins.... glargine, regular, novolog Good Luck!!

Yes we take the cap off and draw out blood with a luer lock syringe that fits perfectly on the picc hub.

Depending on what is going on, I adjust my 'technique'... I usually start gently, but if I am working on getting clots or sludge out, I usually have to irrigate a little more aggressively. If the need to irrigate is there, you probably have to work at it a bit.

Are there any areas you are particularly interested in? Otherwise, telemetry/cardiac units, oncology, or emergency department if they will take interns. Those would be departments where you'd see a fair amount of variety.

Our main general surgeon always wants us to give the sub-q heparin... She is smart as a whip and wonderful doc, however, I always document that I spoke to her and she wants the heparin given. ALWAYS makes me nervous...