PaperPushingRN

Like I stated in the title, I feel 5 patients on day shift on medsurg is too many. I feel like I am in a constant marathon from the time I hit the floor!! And it is STRESSFUL!!! Am I alone in this?......

Hey, Been there done that. Can I ask where you do prior authorization from home? I have been looking into that and think that might be a great fit for me. Thanks.

I missed floor nursing and direct patient care. Once I graduated from nursing school I worked for about a year and a half on a busy med/surge floor but moved to another city near my family when I got pregnant with my twins. At the time there were not any floor nursing jobs so I ended up in case management. A part of me misses floor nursing and direct patient care. I figure I can always go back to case management or prior authorizations when I get older.

Sooo....I just got let go from my floor nursing job and I am conflicted. I feel like I am a good nurse but I had a really bad night which just led to my being let go. I have to admit I did miss stuff on my shift and that is all valid. The night in question was a sh*t-show for me and honestly I have had more of those than not. I have been a paper-pushing nurse for about 6 years, I worked as a staff nurse for almost 2 years and then went into case management and prior authorization. I just returned to floor nursing about 6 months ago on a busy med/surg floor. I feel that I have tried to keep up with the demands of floor nursing but obviously I have not been able to hack it. Our floor is frequently short staffed, no CNA's or just 1 so you are on your own basically. The night in question started out with me having 4 patients, 3 isolation patients -1 confirmed C-Diff, 1 droplet (rule out meningitis) and contact isolation for C-Diff and 1 neutropenic precaution. My 4th patient was a bowel prep. 2 of my patients were post-ops who still had post-op vitals to be done. There was 1 CNA for the whole floor. Also, 3 of my patients were blood sugars and 1 had basically round-the-clock IV antibiotics and another had several night IV antibiotics as well. I had medications to be given basically the entire night. When I started the night I asked the CNA if she could help with some of the post-op vitals and she said she would try. I started out with 1 of my post-op patients who was also the bowel prep. I found out when I was doing my assessment with this patient that none of the post-op vitals had been done at all and the patient had been on the floor for several hours before my shift even started so I preceded to start the post-op vitals with the 15 minutes x4. I gave all the meds and did the assessment to this patient however I did not chart my entire assessment as frequently I will make "place markers" and just chart the exceptions and come back later to complete the full assessments. I next went to my other post-op patient who was the confirmed C-Diff and did her assessment and gave meds. I then went to my next patient with all the IV antibiotics and did the same thing (meds, assessment etc.). I was literally running the entire night. I did not have time to chart at all and several hours into the shift the charge nurse called to give me another patient as one of the nurses was leaving. I explained to the charge nurse that this assignment was crazy and there is no way I going to be able to keep up with it. She then explained to me that all the nurses had as many patients and that is all. Mind you the acuity of the other patients were 2-3 out of 4 and all of mine were 3-4. I ended up getting a new admission anyway from the ED and the charge nurse finally sent a nurse that came in to help to help me around 11pm or so. She did my blood sugars which were late and several of my meds. I then proceeded to do my admission. Like I said I was running all night with hanging antibiotics, helping my bowel prep to the bedside commode and doing my admission. I completed all of my assessments -we are required to do 2 for the 12 hour shift- but I did not have time to chart them. I also had 2 lab draws because the patients had a port and PICC so the nurses have to do those. I was still passing meds or hanging antibiotics till about 6:30 am. Our 12 hour shift is from 6:30 pm until 7am. The nurse educator had told me a previous time that technically we had 72 hours to complete our charting -this was on a previous occasion when I had another bad night and did not have time to chart- so my intention was to come back that night and complete all my charting as I had to do another 12 night shift and I had to get my kids to school that morning. I gave report and told the oncoming nurses that I had not had time to complete my charting as I was running all night. I don't know where my head was at because although I did all of my assessments I did not do any other vitals on my other patients. We had 1 CNA so she did not do them either. I had been in all of the patients rooms multiple times for meds, assisting to the commode or my assessments but just did not do the damn vitals. I have not made it a practice not to complete my charting before I leave work but I figured I would do them when I come in that night because I knew it would take me at least 1-2 hours and I am about an hour from home and I needed to sleep cause I had to work that night. Now, I am fully aware I did not practice good or safe nursing that night and take responsibility for that. I should also mention that I explained my crazy assignment to the head nurse supervisor when she came to our floor but her only concern was the fact that I should not have been given the contact isolation patients along with a neutropenic precaution AND I voiced my concerns to the charge nurse twice. Some of the nurses complained that my charting was not completed and that now has led to me being let go. I do not want to make excuses for my dropping the ball as I totally did. If this is what nursing has become then maybe I am better behind a desk where I cannot drop the ball and possibly compromise patient safety. I honestly missed floor nursing but I did not feel like I had the time to really grasp it because at least in my case I was usually just running all night and frustrated when there was no CNA support and I was just passing medications. I feel I still had a lot to learn and get better at with many things. But now I am questioning my entire ability to make it as a floor nurse. Sorry this is so long. :)

LISTEN.....remember in chemistry when you followed the labels? This is totally applicable when doing nursing calculation!!!!! And it is tons easier and makes a hell of a lot more sense to me than the equation they try to teach you. In chemistry you flip the equations with the labels to cancel them out and leave the one you need. I used this method in nursing school and aced all the nursing math!! In this case they are trying to confuse you with extra information. All you need to look at is the fact that the correct medication dose is supplied in a 125 mL bag. You want to end up with mL/hr 125 mL -----60 min _______ X _______ = 30 min ------1 hour you cancel out the minutes which will leave you with mL per hour -- 125 x 60 divided by 30 = 250 mL/hr This did not necessarily need to use this equation method BUT if you get in the habit and solve the problem following the labels I guarantee this will make the calculations so easy. You cannot get the wrong answer when you follow the labels.

WOW!!! I LOVE audiobooks too!!! I am a mother of 7 year old twins and work as a UR nurse for an insurance company. I ABSOLUTELY love reading books too and since I started audiobooks a couple years ago I have read....probably at least 400 books?....I have a membership with audible.com but often will buy extra books/credits for books when I have read the 2 that are included in my membership. I am able to listen to my audiobooks while working and I will listen in the car on the way home and while cooking. "Reading" with audiobooks is really a passion of mine. If I had to actually read a book it would never happen but audiobooks have allowed me to indulge!! I am sooooo glad to hear someone loves audiobooks as much as I do. Maybe we can swap some book selections. My first audiobook was by Terry Brooks as part of the Wishsong series and I love reading series. I have completed sooooo many series. I just got my sister (who is a also a nurse lol) into listening to audiobooks too and she is hooked on the J.D. Robb In Death series. She is only on like book 16 but I have already read all like 43 books and just finished her most recent one that came out on Sept. 6th.

Hello fellow Nurses, I am looking for a little advise. I have considered going back to school to upgrade my ADN to a BSN but not sure if it is worth it at this time. I became an RN in 2008 and worked med-surg and on a pediatric neuro unit for almost 2 years but when I had my twins -twin boys that are turning 7 years old, I moved back to the city where my family was and started case management because there were no jobs at the time in the hospital. So I have been doing case management for about 6 years. Currently, I am in Utilization Review at an insurance company and the pay is good but it is 8-4:30 pm. Honestly by the time I get off work, get the twins from daycare and get home and attempt to make a decent meal I am VERY tired!!! I am a single parent. It seems like the market goes back and forth with hiring ADN's and not wanting to hire them and pushing ADN's to upgrade to BSN. I would like to make myself more marketable as eventually I would like to move out of state and not sure if I will have a problem because I only have an ADN. Is there a way to just take one class toward the BSN so I can at least be doing something toward that end goal? Or is it even worth it at all?

Always follow the labels!!! You will get the right answer every time. Remember chemistry? Take the information (labels) you have and know what (label) you are trying to get. In this case you need to know how many hours. The med infusing is 50 mL and the infusion rate is 100 mL/hour 50 mL x 1 hr = 0.5 hrs 100 mL because you the mL cancel out, so if it will take 0.5 hours or a half hour and it was started at 0730 it will be done at 0800 Follow the labels and flip the "fractions" to cancel out the labels you don't need so you can end up with the ones you do need and then just multiply the top of the fractions first then divide by the total of the bottom. I hope this helps. It makes PERFECT sense to me but I may not be explaining it properly. Cheers... :)

I have a VERY simple way to calculate math problems!!!!! Remember chemistry?.... Follow the labels!!! I aced math in nursing school using this method as it made the most sense to me. [TABLE=width: 864] [TR] [TD]3 mg [/TD] [TD] x [/TD] [TD]250 mL [/TD] [TD] x [/TD] [TD]1 g [/TD] [TD] x [/TD] [TD]60 min [/TD] [TD] = [/TD] [TD] 22.5 mL/hr [/TD] [/TR] [TR] [TD]1 min [/TD] [TD][/TD] [TD]2 g [/TD] [TD][/TD] [TD]1,000 mg [/TD] [TD][/TD] [TD]1 hr [/TD] [/TR] [/TABLE] This did not copy the best but if you follow this you flip the "information" around to cancel out the labels. This way all the labels will be cancelled out except for mL/hr which is what you need and you just do the math, multiply the top numbers and divide by the bottom numbers. So for the top it is 3x250x1x60 = 45,000 divided by 2,000 = 22.5 mL/hr Hope this helps!! :)