What can you teach me today?

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Hi,

I recently switched jobs from a small rural hospital (80 beds) to a larger (400 beds). When they got to sick for the rural hospital the larger is where they were usually sent. SO these patients are much sicker than I am used to. I am a NIGHT SHIFTER and I LOVE IT! But.... we do not have the benefits of

1. Docs coming thru and explaining Why they are ordering such and such test. Why these labs are needed/significant or Why this med needs to be given /held.

2. We lack seasoned nurses. I have almost 3 years experience and am in the top 5!

SO PLEASE share with me anything you know or have learned today!!

I am asking for your PEARLS OF WISDOM and I promise to share with my cohorts! Even if you think I should already know it, post it! I may have forgotten!!

Looking forward to your posts....

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Specializes in neuro, med/surg/, cardiac care.

Not sure what specifically you are looking for newtele. Is it cardiac related materials or dealing with docs or what? I have been nursing twenty years and just nights as well. When you do nights, you have to be a more independant worker as there is not all the support staff to help you out , so a good knowledge base is important and critical thinking as well. Most nights i am the senior person on so I not only have 7 patients to look after on my own , but also am in charge, have to deal with the lack of staffing issues for sick calls, and be a resource person to the new and junior staff members. Can be an awfully big pair of shoes to fill some nights but I do love being looked up to for support. Nights is also a good time to really look through your charts without all the background noise to interrupt your thoughts. I call it "investigating", really looking through those lab reports, docs notes, homecare notes etc to see what is going on get these folks on their way home hopefully sooner. If there is anything more specific, I would be happy to share it with you.

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That knowledge base is what I am looking for. I know that a lot of it comes with time and experience. But even more of it comes from nurses with life experience of what happens not the books from what should happen. Any pearls, actual pt. experiences where you ran across something and thought WOW, I have GOT to remember that for next time!

And by the way SEVEN patients- how that H@*# do you do that and have ANY time for looking in the charts?!??!?!?!

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Specializes in Travel Nursing, ICU, tele, etc.

Know your chest pain protocol inside and out. For instance, does your facility recommend that you get an EKG before administering nitro if possible, so that ischemic changes can be captured? Be very organized when managing chest pain: As you take their pressure, ask them their pain level, to describe it, does it radiate etc...are they nauseous, diaphoretic, pale? Did anything lead up to the chest pain? Record the exact time you gave the first nitro, along with that pain level and pressure. Remember to start O2. Morphine is also given if the SBP holds. You may need to give ASA as well, depending what the EKG says. Remember the goal for chest pain is always NO pain. I'm sure you know the rest...so I won't repeat it here. But being very able and confident with managing chest pain will serve you well. I'm sure you know the acronym MONA: for Morphine, Oxygen, Nitro, Aspirin, which is used in ACS, but also helpful to keep in mind in chest pain.

Be familiar with your ACS order set and what the specifics are there for. For instance, serial enzymes will be done, know the significance of those enzymes and when they peak, duration etc. A beta blocker will probably be ordered etc...

Also, as a night tele nurse, you will be the one doing most of the preop or preprocedure prep and checklists for CABs and PTCAs, knowing what is required and how to do those efficiently and thoroughly will also serve you well. For CABS you will have a hibiclens scrub to do or assist your pt to do it if they are stable enough. You will need to verify that everything that is required before surgery, like X-rays, labs, consent forms, etc. are done, are normal and can be found in the proper places. For PTCA pt's having enough IV sites of the correct gages are important. You will need to be able to connect with your patient and families in a way that will help relieve some of their stress.

Know that if your pt is having a lot of ectopy it is within your scope of practice (I imagine, but you'd better be certain) that you can order K+ and Mag levels per protocol. If they are low, you call the Doc and get replacement orders if you don't already have protocols in place.

Know your basic rhythms and what is the likely treatment. For instance, if a pt converts into a rapid a fib, what are the possible orders you may receive. Know your Cardizem gtt protocol, because that is often what is started. How do you explain new onset a fib to a patient? They are often totally freaked out about it and the stress only makes it worse. What is true about a fib if they can't be converted? (People manage it successfully for years).

Once you do ACLS and even before, know how to operate your defibrillator. Know where the emergent intubation tray is kept, know where the temporary pacer is and the chest tube insertion kits. Make yourself available during a code, get in there and help even if it isn't your patient. Do compressions if you need to. Watch and learn. Run and get stuff if needed.

You are heading for a very exciting place to work!!! Know your protocols!! Get copies of them and know the reason everything is on there. If you don't know, ask.

;););)

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deeDawntee--

Thanks for posting that. Even though I've been working tele for over a year, that was a succinct little refresher course!

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Thanks for the info. You are right that it is a very exciting place to work. Things get get very tricky very quickly. I thought that would scare the h*** out of me. Truth is I LOVE IT! Don't get me wrong. I don't want ANYONE to have the rythems that stop YOUR heart for an instant. But I am getting better at knowing how AWESOME it is to be able to do something about it! Thanks for the insight. I'm sure I will have many more questions as time goes on!!

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Specializes in Travel Nursing, ICU, tele, etc.
Thanks for the info. You are right that it is a very exciting place to work. Things get get very tricky very quickly. I thought that would scare the h*** out of me. Truth is I LOVE IT! Don't get me wrong. I don't want ANYONE to have the rythems that stop YOUR heart for an instant. But I am getting better at knowing how AWESOME it is to be able to do something about it! Thanks for the insight. I'm sure I will have many more questions as time goes on!!

You are so welcome! Keep on asking!

And it is OK if you find saving people's lives in a code situation exciting...don't beat yourself up for that (I've seen many a new nurse worry about that.) The adrenalin rush and seeing the whole team come together is one of the times where nursing is at its best, and it IS exciting!!

Good luck in your new venture!! ;););)

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