newnurse

30 October 2007 @ 09:59 am

Orientation is over

So my orientation period is over. I guess that means I am supposed to be able to do a bunch of stuff on my own. I worked on Sunday and had 5 patients and due to a low number of patients on the whole unit we didn't have a CNA. I love CNA's they are the unsung superstar of the unit. So not only did I have my assessments, doctor's orders and all around nursy stuff I also had to do bed linen changes, pass ice water, take vitals, pass trays, collect trays and all around waitress work I had my other stuff oh and I had to chart all of this too! If you don't chart it, it didn't happen. In the end I did stay on top of everything and complete almost all of my orders. I also put out a few fires as far as patients go too.
I had a 20 y.o. female with a history of Chron's disease that had been with us for 7 days. I was her admitting nurse and attempted to insert a nasogastric tube in her per M. D. order and she cried the whole time and got a bloody nose and I still couldn't get it in so we called a more experienced nurse from IMC who got it no problem. She did switch to a smaller tube but the patient balling the whole time didn't help. So this girl was raised by her grandma who was for the most part o-k but grandma was very controlling and felt that she had to know everything that was going on. Here's the thing. The girl is 20 and no longer a minor and so this is no longer grandma's business and I had to basically tell her as much without her flipping out. The problem is that the girl says one thing to me and the Doc and another to grandma. So when I had her on Sunday she kept telling the Dr. she wanted to go home so he wrote her discharge papers and when grandma showed up thinking she wasn't ready to be discharged the girl says "oh well my pain is still not managed and I don't want to go home I don't think I can tolerate eating yet" (she was on TPN for nutrition until the day before). I call the doc and tell him and gets super pissed and says she is discharged and if she wants she can try and get readmitted thru the ER. I can't say this to her so I put a nice polish on what he said but basically you are discharged. Well grandma has a fit. She starts going off about how the girl hasn't had the proper diet today and she can't eat the stuff we bring her and I have to gently remind granny that the patient can basically order what ever they want and the patient knows what she is able to eat with her disease but if she chooses something else we can't stop her from eating cruciferous vegetables if she orders them. Crazy! So I had to clear the room so I could give the patient the discharge papers and pull her PICC line what she again cried the whole time. Then grandma says well we can't get her prescriptions tonight because our pharmacy is closed. Guess what tough noogies because you don't get to stay in the hospital for that. You also don't get to stay simply if you are in pain. That still baffles me people have surgery, they are cut open things are taken out, then rearranged and people get so mad about the pain. Do people really think surgery is completely pain free? No such thing. Your meds will help but sorry you are still going to be in pain.
Anyway. so the pt and her granny get escorted out to the car and the minute the car door closes granny starts hollering and cursing up a storm. Hmmmm, wonder how this girl got Chron's?
So in the end I was proud of myself and how I managed everything. The next big thing is that I am in a basic telemetry course and we have our test on Thursday. We have to indentify 20 EKG strips with 5 different criteria. The whole unit knows that I am in the class and I basically HAVE to pass and if I don't everyone will no too. Nice no pressure JUST DON"T FAIL! We'll see

Current Mood:

groggy

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30 September 2007 @ 08:21 am

Week 3

O-K I finally did it. I made a medication error. I am so pissed at myself. I always want to take full responsibility for all of my screw ups and see what I can learn from them. Luckily there was no adverse reaction to the patient. I was working with my preceptor and I think since we are paired up they just give us a shit load of patients. We had 3 mother/baby patients with baby rooming in and three other patients so that is like 9 patients because we are responsible for these bambinos too!. I didn't think we would get the mother/baby stuff too often. I need to read up on my newborn assessment and fundal massage crap. Oh and you chart on mother/baby on another computer chart all together called QS which I never heard of, used or was trained on but you still chart other stuff on our in house computer charting!! Great!
So anyway. We split the patients up between us however I am still new so I was there to do some stuff with my preceptor while being responsible for my own patients. So we did PKU testing on one of the babies and got to assess another baby with a heart murmur which sounds freaky so I wanted to hear it. Anyway, I was caring for a patient with a chronic migraine. Imagine having one for 16 days. So the patient likes to keep the lights off in the room and I had the bathroom light on to see all the meds. There was a ton of meds in her locked cabinet as the patient has been there so long and there was a visitor talking to the patient and long story short she gets an anti-seizure med in the evening and I gave it to her in the morning. The computer scanned the med and was trying to tell me the time frame was to early and I just skipped it like an idiot because I was thinking of all the other stuff we had to do and gave the med. I realized it later when I was looking more closely at her chart and then had to tell my preceptor who was totally cool about it. We documented it, observed the patient who was fine and told the charge nurse. So I feel like a total dipshit and I know this will come up in my meeting tomorrow with the regular charge nurse and unit director. I hate messing up and I don't want them to think they have to be checking on me all the time now.
So what did I learn? Well be present for what task you are currently performing, slow down, if it seems weird or off check the chart. I guess I am lucky that it was something like this that rattled me and the patient was totally fine and not a situation where I caused a code or something. I just hate messing up.

Current Mood:

embarrassed

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27 September 2007 @ 08:36 am

I think I can do this

O-K started a new week yesterday and a new perspective and I feel much better. I am now on my third preceptor after they told me I would have one. Here's a lesson kids. What they promise you in a job interview doesn't always materialize in the actual job. But the third one has been the best so far. She is very nice and above all is easy to ask questions to. There are a lot of things I know how to do in theory that I have never actually done like drive a stick shift. That if in a life and death cirmcunstance I would burn up a clutch trying to drive if it meant I was the only one able to drive and myself or a passenger were in immediate danger. This translates to nursing in many ways. While I have never removed a central line which is an IV that is inserted by an MD that has a catheter that reaches the heart! I could do it if I absolutely had to but why don't you show me how to do it first. So I was shown and I have done. Big deal to me! I am also learning about ostomy care which is tough for the patient with a new ostomy and me trying to be cool and not react. Ughhh. I did awesome, learned something new and now it's not a big deal.
The current challenge remains the old crap computer charting program. They scare the s@$t out of you about your charting and calculate some score based on how you are charting and if it's not good you get pulled into the office for a discussion! Oh no not a discussion, yes they really talk to you about it. So in light of this I am going to another computer class today on my day off to try and avoid said discussion and be a computer superstar. We'll see.
Lighter note, I get my first paycheck this week. I am so excited. It will be the biggest paycheck I have ever gotten. Yay me for going back to school!

Current Mood:

loved

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22 September 2007 @ 04:01 pm

Well I survived the first week on the floor. I had two different preceptors. The first day it was an older lady whose husband and daughter are both nurses. I couldn't really tell if she thought I was great or a complete idiot. Every hospital has different syringes and med containers and I was gettin used to everything and felt like I was asking a million questions and she reacted in such a weird way to me.   At the end of the day she said nice things to me about how I did but it's difficult to silence my inner critic. The next two days were with a nurse my age but with lots more experience. She is smart and good at her job but she did cut corners a bit and the charge nurse was keeping an eye on us the whole time and on the end of the third day I had a meeting with the Charge and Unit Director and they asked to me explain how I performed some tasks like delivering the meds to each patient and I knew my preceptor was doing it wrong but I told them how we did it and they were like well that's not how we want you to do it and I am thinking no s#$t but I was doing as I was told. In my nursing program our clinical instructors were really rigid and taught us "White Tower" nursing which it totally by the book. I am a very rules oriented person and if you set out the standards for me to perform my job I will do it. I don't need to reinvent stufff. So long story short I am getting 3 patients of my own starting this week and will still have the preceptor to check on me and make sure I am doing it right. This will be my third preceptor after they told me I would have the same one the whole time. There have been a few other inconsistencies with things they said in the interview and the reality on the floor. It's a little annoying to me but probably par for the course.

I keep getting calls to interview at other hospitals now that I took this job. Why didn't they want me a month ago? Their loss.

On a much happier note we saw Morrissey last night at the Palms. He was sooooooo AWESOME!!! He did a lot of Smith's songs. I was transported back to high school in a good way. His band was amazing and we had GREAT seats.   I am still reliving the show in my head. There are so many of my friends that I wish were there with me. (J).

So anyhow. Back to work this week. I have to go to an in-service Monday morning at 7 am on my day off put on by one of the Oncology Docs that basically got the hospital to create our unit. Everyone goes on about how great she is but in the two times I saw her they wouldn't introduce me to her because she was in a completely foul mood. Nice. Whatever. I will show up take notes and come home. Although I do have to stop over at employee health for a flu shot. OUCH!

Current Mood:

okay

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14 September 2007 @ 12:31 pm

End of the first week

So I completed my first week of training. A friend of mine who already works in the same hospital said I would be bored out of my mind and he wasn't kidding. We reviewed all the basic policies and procedures stuff and nothing irks me more that a policy having to be written because people can't just stop doing somthing. I guess the CEO said employees could not longer where the Crocs shoes that have the big open holes in them but could where the other style shoes that are closed made by Crocs.   Well people just couldn't be told this so there is a policy now. That's why we have so many laws in order to protect people from their own ignorance. That's why there are warning labels on everything like don't blow dry your hair in the bathtub. You know someone had to do that and the lawyers got together and said here is our solution so now if someone does it you can't sue. So you may ask "Why can't you wear Crocs with holes in them?" Well good friend it would be very easy for a needle to land right in one of the holes and now you have to go to employee health and get stuck a million times to make sure you didn't just give yourself Hep B or HIV.
Anyway, I start on my unit Monday and I am so excited. I am ready to do some stuff. My scedule for the first month is pretty sweet. Only 3 days a week albeit 12 hour shifts but I get lots of days off in between. I am already loving this nurse schedule business.
I got to talk to a lot of other more experienced nurses in orientation who gave me good advice on advancing to critical care in the future and there were a lot of international nurses in the class too. Some of the Int'l ones just got to town this week. I can't imagine that adjustment!
The dog is happy I am home today. He has been real sad that I haven't been here with him. I know it's harder for people with actual children but bear with me. He has a lot of different expressions on his face and I can tell when he's real sad, Really, I can.

Current Mood:

excited

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06 September 2007 @ 10:29 am

Talked off the ledge

O-K after much panic and obsessed musings I am now back to normal. I was able to speak to my BFF JLS and I am now over this change in my current potential employment. JLS calmed me down and back to reality that all new nurses start graveyard and I will just have to make it work. I did speak to my new manager as well and she said the first 5 weeks of training will be on dayshift and that she is actively looking for new hires for the night shift and I am without a doubt the person that would go to the dayshift after the night shift is staffed.
JLS reminded me of the brightside that I will have friends on other units at night and it won't be forever. Now that panic is over I need to find another thing to obsess about. Let me go check on the dog.

Current Mood:

hopeful

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06 September 2007 @ 08:36 am

O-K so I haven't even started my new job and I am already not happy! I get a call yesterday from the HR manager involved in hiring me. She said the Unit Manager from where I am to start contacted her to say that she had 3 nurses quit on Graveyard shift and she can't possibly start me on days due to the shortage! I was totally about to cry because the fact that I was told I could work days was the reason I accepted the job on the spot. I know as a new grad it is rare to start on days and we all have to put in our time but I was also waiting for an interview in an ER at another hospital with the knowledge that it would be graveyard for a year or so until I could bid for a dayshift. GD collective bargaining agreements! So I was justifying taking a less challenging first job compared to ER because it was days and my husband and I still like each other a lot and want to see each other. The HR manager told me that I could be moved to days after about 2 months according to the manager but of course can't put it in writing due to aforementioned collective bargaining agreement. Basically if I start and work my 2 months and can move to days if one of the other nurses on grave has more seniority than me and want to move to days they can bid for the spot and I am SOL.
The Unit Manager is supposed to call me today to discuss this further. I already told the HR lady that I am still going to go forward with the offer and start orientation on Monday but we are starting off on the wrong foot big time! My husband said I could decline the position and hold out for something else because he is awesome but I am going nuts not working. It's not about finances I am sitting at home watching Oprah re-runs and steadily gaining weight every week. I gotta go to work.
I will be honest though during the interview the Manager and Charge Nurse blathered on about how great the unit is and how everyone laughs and treats each other like family. There are only 14 nurses on the unit and then 3 quit makes me wonder! They also went on about the lower nurse patient ratio on this unit but obviously it's higher at night because people are mostly sleeping but not always. Ughhhhh... Great I am a big believer in signs and things happening for a reason that's why I went to nursing school in the first place. There were so many things turning me away from my criminal justice degree. So what does this mean?

Current Mood:

cranky