When did I become an old nurse?

[highlandlass1592, BSN, RN]

I currently work in a bit of a unique position which basically involves working as an NP but not an NP yet. ( I have protocols to cover just about every contingency that might happen to our patients and if something DOES happen outside of protocol, I have a resident and attendings to back me up.) So last night, was working with a younger nurse who came in complaining that the way an order written was "too hard" for him to figure out a dosing schedule for an antibiotic. I was trying to explain that if an order says "dose q 12 hours" and if it's only ordered for 2 days, then you need to give 4 doses. He was adament that the order should have been written "stop after 4 doses" because he just doesn't have time with his 4 patients to stop and figure out how many doses of a med that patient had gotten.

I was a bit stunned by that....we currently have an electronic order system and eMar that shows when meds were ordered, when given, who gave, etc. It takes about 3 clicks, less than a minute to totally research an order. Back in the "old days", before electronic orders, I remember having to sift through multiple OR notes, anesthesia notes, PACU papers (none of which seemed to end up in the section of the chart they were supposed to), sometimes taking an hour to figure out not only what had been done for this patient but what had NOT been done. This nurse was complaining he didn't have time to make 3 clicks to ensure his patient's safety. I just don't get it. I remember having to take all this extra time which can take up a lot of time, all to make sure I was doing the right thing. I still spend my time sifting through progress notes, consult recommendations, lack of charting by other care providers to still ensure my patients get the appropriate care. I've currently got 25 patients I'm overseeing-which entails knowing their history, post-op course, current treatment plan-you get the idea. He's got 4 and can't take one minute to flip through an order screen!

It struck me then that I was definitely working under a different ethic than this nurse. I'm not saying he's a bad nurse, not at all. He's young and is growing his skills as a young nurse should. But I was just speechless that he was complaining I wasn't making it easier for him to do his job! I'm sorry, when did nursing stop requiring someone to critically think through a situation? When I staff in our sister ICU, I'm still required to investigate, critically think-I have to make decisions based up my patients situation and diagnosis and act appropriately.

Please don't think this is an "older vs. younger" nurse thread. I'm not intending that. I guess I was floored to realize that I had such a disconnect with this newer/younger nurse. I was also floored when he found the time for an hour to watch a rebroadcast of a baseball game on tv in the lounge..but didn't have 2 minutes to research a med issue for his patient???

It's been a tough summer in my house...2 shifts left to vacation, much needed. Then getting ready to start grad school soon, I hope (waiting on finances to clear). But last night, made me feel OLD. Thanks for reading.

[MrChicagoRN, RN]

I currently work in a bit of a unique position which basically involves working as an NP but not an NP yet. ( I have protocols to cover just about every contingency that might happen to our patients and if something DOES happen outside of protocol, I have a resident and attendings to back me up.) So last night, was working with a younger nurse who came in complaining that the way an order written was "too hard" for him to figure out a dosing schedule for an antibiotic. I was trying to explain that if an order says "dose q 12 hours" and if it's only ordered for 2 days, then you need to give 4 doses. He was adament that the order should have been written "stop after 4 doses" because he just doesn't have time with his 4 patients to stop and figure out how many doses of a med that patient had gotten.

Yeah, Q12 x 2 days is pretty clear, but I personally would prefer Q12 x 48hours, or 4 doses.

In any event I'd have replied; "I explained it to you; you won't accept the explanation. What do YOU plan to do now? Feel free to call the physician to clarify if you feel that would be faster than making 4 clicks with the mouse."

I don't think it's really an age thing. I've seen nurses of all ages struggling with critical thinking regarding order interpretation. Sure, many orders are confusing but, this seems pretty straight forward.

[TrafalgarRN]

You are not old:D just that people are leaving critical thinking at home with the advent of electronic systems. If i'm not wrong all systems i have worked with will automatically stop after the given doses and also if good report is given the 4 doses will be given and on the second day one can have the provider discontinue the order. I have worked with new nurses who under the fear of "losing their license" will wait for the MD to write an order for a saline lock in the ED. I mean if a patient is diaphoretic, complaining of chest pain then if you really use your brains then that EKG, monitor, Saline lock better be in place in less than 10 minutes. If they look like they are having a stroke i don't see how a finger stick will hurt. If an MD orders IV fluids and IV meds the saline lock is already implied and do what you have to do and then later on you can get an order for the Saline Lock. I see many doctors get frustrated when such things happen because they wonder if they are dealing with robots.

So that young nurse needs someone to talk to him and explain that life won't be all easy every time and an extra 15 minutes to get to know his patients is expected. As one doctor once told me, "Do what you have to but don't kill the patient and i will cover the orders". With that in mind i expect nurse to always check their scope of practice.

[Biffbradford]

Oh, there must be an 'app' for that. Let me Google it up. LIC

On another forum, someone posted some numbers both in horsepower and in kilowatts. Someone asked if there was an 'app' for that conversion. I replied "Yes, it's called math." and I got the 'huh?' in reply.

[netglow, ASN, RN]

That's because you're old Biff.

:)

[Exhaustipated, ADN, BSN]

If you're an old nurse, then I'm just plain old, since I'm not a nurse yet (starting pre-reqs in 2 days....yay!). In the past few years, I'd had to deal with a number of different medicines for both my son and one of our dogs. Every 12 hrs for 2 days, every 6 hrs for 4 days, etc...I always figure out (usually using fingers and toes 0.o ) how many doses that means so I can make sure the pharmacy didn't short me on pills.

[traumaRUs, MSN, APRN]

I would be more concerned working as an "NP but not an NP."

[demylenated, BSN, RN]

Um, doesn't seem like an old vs. new nurse thing to me... just seems a little lacking of a competance level.

As someone else said, though... the NP but not an NP is throwing me off, esp since you haven't even finished (or started) Grad school.

That is like me practicing as an RN but not being one yet (I am an LPN almost finished with RN school), just because I can... BUT, I am sure you left a lot of that story out for brevity, so... BUT, if you're writing orders... sounds like your butt is hanging in the wind.

[Forever Sunshine, ASN, RN]

We don't have any EMARs yet. Our MARs are printed out and if we add anything in we have to write it in. In this case antibiotics are most frequently written in.

q12h x 2 days sounds pretty basic. I would have asked him whats so confusing about it? Its given at 6am and 6pm tomorrow and the next day. Not that hard. I'm a new nurse too.

[OCNRN63, RN]

I would be more concerned working as an "NP but not an NP."

When I read that I thought, "What's up with that?"

[Katie5]

How does this relate to being an, "old nurse"?