First Day Shift as a night nurse

Today was my first day doing a day shift. They were short during the day and over on nights so the manager asked if I wanted to do the day shift. I wanted to see what it was like so I agreed. Here are some differences:

    Insulin 3 times for those with diabetes – the timing for sugars is crucial during the day. You do the fingerstick around when they order meals and you give insulin humalog after the plate is in front of them. It’s not too hard when only one patient has DM but not as easy when you have more. I mostly crossed my fingers that their sugars are below 169 (typically).
    Admission/Discharge/Procedures — today my day wasn’t too bad because I didn’t have any of these happening except one cardiac procedure. But when there are many of these, I can imagine that the day is much more hectic.
    More resources more readily — more doctors, PAs, PT, RTs, more help from PCAs… It makes life much easier to get things done. You still have to think– tell the doctor or the PA? But at night, you nearly always consult the PA first. Doctors make more orders during the day so you have a better idea of what’s going on with the patient.
    Not worried about sleep — you don’t have to think about waking someone up. You can just proceed with whatever you have to do because they are supposed to be awake.

Free Scrub Giveaway — and Happy Nurses Week!!

Thank you “Life With Jess” readers for making this blog popular! And Happy Nurses Week!!!

A couple weeks ago, Uniformed Scrubs asked if I would like to give my readers a sneak preview of the Enzyme Washed V-Neck Grosgrain Ribbon Top nurse scrubs by Dickies. It will be available in about a month or so. I said yes!

dickies 84790 missy fit

I like it because:

  1. Mobility – I can swing my arms 360 degrees, twist and turn at ease.
  2. Soft fabric – It is so soft to touch and so smooth on my skin.
  3. Deep pockets – I don’t lose my essentials when I lean over or bend down.
  4. Feminine – It cinches in the back to create a feminine shape.

Unfortunately I wasn’t provided with the color that I wear at my hospital. Fortunately for my readers, I will be giving this one away for free! As long as you don’t mind that I’ve tried it on twice after I showered and you want royal blue in XS, it’s yours! I’ll even pay for shipping. 🙂

I want to give it away because 1) I want quality scrubs put to good use, and 2) in NYC, space is essential! Please write in the comments section on why you should win. The contest will end on Memorial Day – Monday, May 27, 2013. I will announce the winner shortly after that. Good luck!

If you’re interested in purchasing one of these Dickies Scrub Set, use the coupon code “trueblue” at uniformedscrubs.com for 15% off until July 31st, 2013.

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Life After Orientation

I just attended my first Life After Orientation. It’s an hour of talking to the nurse educator and the VP of Nursing. It’s probably better to go with a list of things to talk about next time but here were a few topics.

  • Delegation to the ancillary staff, especially regarding fingersticks, stat EKGs, answering call bells
  • Handout off to the next nurse – IV rounds with both nurses and bedside handoff; making sure there’s enough fluids in the bag for the next few hours and the patient is medicated for pain prior to report (if necessary)
  • Breaks – before going on break, do a quick round to make sure everyone is ok. Then tell the 2 nurses next to you on the unit, the charge nurse and ancillary staff you’re on break. It’s a good way to recharge and eat!!

Hospitals talk about patient satisfaction scores all the time now because it’s one of the major factors for reimbursement. I have to say that I’m proud of the unit I’m on because it just went from the lowest to the highest scores in the hospital. We aim to have nearly every score above 90%.

Ok that’s it for now.

Mental preparation is key

The New Nurse basics: Introduce self. Discuss the goal for the day. Address concerns.

1. Introduce self
Patients and co-workers will work with you better when they know who to contact. Memorizing their names will be golden.

2. Discuss the goal for the day
Mental preparation is key. Patients will be ready for the next step. Co-workers can plan their time.

3. Address concerns

    Water? Bathroom?
    If time allows, address it yourself. If not, delegate to ancillary staff.
    Pain? Medications? Sleeping or breathing issue? Family questions?
    Try to solve concerns on your own. If there is any doubt, ask the charge nurse or nurse educator. If necessary, escalate the concern to the appropriate person.

Nursing: Medical Vs Lay Language Barrier

“He is going to draw your blood.”

“I don’t understand.”

2 minutes later… After my PCA already drew the patient’s blood, I thought about a different way to word it.

“He took your blood.”

“Oh!!”

When someone doesn’t understand something, it doesn’t mean he is confused. And it doesn’t mean you repeat the same thing over and over. Or try to pass it off as something that she won’t understand. It means that you have to use different wording to get your message across. And the wording should be in a way an average person would know.

Sometimes it’s difficult to switch from “speaking medical” to “speaking with patients”. But I feel that a fine balance between the two is essential to being a great nurse.

Write down the list of Qs you have for the MD

Last night, I had a patient who had several questions that I couldn’t answer and the house PA couldn’t answer. I asked her to write down her questions so that she was ready to address everything and so that she wouldn’t forget.

Her doctor came just as I was about to leave, and she thanked me for having that suggestion.


As for pain, it’s best to stay on top of the pain and not let it get out of control. Sometimes it’s better to go with something stronger. And narcotics aren’t addictive if you take it for pain at the hospital. It just becomes addictive if you start taking it all the time.


My second night alone went well. Had my first direct admission. Thankfully, he had all of his medications with him and his previous medication list was given by another hospital. That helped! Then I had two more transfers. The charge nurse spread them apart so that made it so much easier to handle. And they already received their night time medications so I only had to assess them (and of course write a note). I have to be so thankful for the PCA and CCP for helping!

The nurse educator was also helpful! It was another set of hands and eyes for me because I know that the charge nurse also had a lot on her plate with admissions!


What I’ll take away from tonight: Always try to help the others when I’m free. Ask questions and ask for help when I don’t know something.

First Day on my own was awesome

My first day on my own was awesome because:

    My charge nurse was awesome. Answered all of my 101 questions. Haha
    My patients were awesome. They were patient. And thankful.
    My ex-preceptor was still my preceptor (yup yup still teaching and still learning).
    All the nurses checked in on me. And answered my other 101 questions. And gave me advice. Gotta love that.
    My ancillary staff were helpful and nice. What more can you want??

I learned:

    If I don’t know about a medication interaction, call the pharmacy.
    I should look at the hemoglobin A1c. If it’s high, the patient probably has DM. And I should probably teach about it.
    Steroids increase glucose levels. I can’t believe I forgot.
    Always prep more saline flushes than you think you need. Alcohol wipes are good too.
    When in doubt, ask the charge nurse.
    Listen to the patient and be her advocate.

Ok, I gotta sleep during the day and go back for more tonight. 🙂

What I learned during my preceptorship as a new nurse

Wow, I cannot believe that it’s March 2nd now. It’s been 12 shifts with my preceptor (3 shifts a week for a month) and now, starting on Sunday (tomorrow!), I’ll be getting handoff without backup in case I miss something. I guess I’ll be asking the day nurse a lot of questions. And I’ll just be asking a lot of questions in general.

While I’ve been doing most things on my own now already, I still have trouble figuring out who to call. But I guess if I really can’t figure it out, I’ll still ask around or go to the charge nurse.

Here are a couple of things I’ve learned:

    Do things as soon as you can. For example, 6am medications should start to be given out at 5am. While I’ll try to give them at the same time the bloods are drawn, sometimes it’s just not possible. And things can change really quick so it’s best to stay ahead. Because you never know when you might stay in a room longer than you anticipated.
    Getting a digital watch with date and military time. It’s easier to stay oriented and it’s one less thing to think about. Converting 9pm to 2100 isn’t that hard but when you see that the last time you gave a med was 1600 and figuring the next time you can give it PRN is 2200 and you look at your watch and see that it’s 9:23… Well, you get the picture.
    Be organized and anticipate! Sometimes, I walk into a patient’s room and realized that I forgot something. Normally I just ask the patient to hold on a moment while I go get whatever it is I forgot. But if it’s a contact room… Well then I’m just standing, waiting to see if anyone else will pass by to give me a helping hand. And if that doesn’t happen, then I try to find if there’s anything else I might need before I strip off the gown and gloves to get whatever else I need.
    Find out things that I don’t know. Ask, look it up on Lexi-Comp. In healthcare, there’s always something new to learn!

A couple of things that happened so far definitely put a smile on my face.

    After taking care of a patient the night before, I came back the next night. When I peeked in to introduce myself, the patient said to me and her family that I was her favorite nurse.
    A patient noticed that I was a new nurse at the beginning of the night. In the morning, I asked her how she knew and what I could do better. She knew because I wasn’t as organized (as in, have all my stuff together before walking into the room!) but that I did a great job for her.
    A patient asked me to sign his heart pillow. To me, that means I’m a part of his memory during his stay.

Seeing the patients get better because of what I did and initiated is probably one of the best parts about nursing. Noticing that there’s a change in vital signs or behavior or condition — I can do that. Making sure that is taken care of by taking the right steps and contacting the right people — this part is something that I will need to work on.

While I’m becoming more proficient at assessing, medicating, and documenting, I have to work on telling patients what to expect and discussing his or her goals for the next day so that they are mentally ready for the next day. I find that when patients know more or less what will happen that they are less anxious and take more control of their health.

***

As for my outside-of-the-hospital life, my sleeping pattern is all messed up. Sometimes I sleep like a vampire and other times I’m awake when the birds are chirping. I’ve been working two days on, two days off and I have 3 sets of uniform. Since I wear two and only have one left over, that means I’m doing laundry every 4 days. For me, that is really often. And it’s using up all my quarters. I need to go get more after this load.

Since I live close by to somewhere where they have 4 dishes, rice and soup for $4.50, I eat half at home before I go to work and bring the other half to work to eat during break. I also bring 2-4 clementines. On my days off, I really ought to cook more but I still eat out. At least I’m trying to eat more vegetables and less meat.

As for meeting with friends, I’ve noticed that I’m becoming more spontaneous. In my life, I’m so used to planning everything out but things can change in a moment and throw everything off. So sometimes it’s just better to ask, “hey, are you free tonight?” and if the answer is yes, then just go.

And that’s exactly what happened last night. Off to have fun. Until next time — smile! 🙂

NYC Blizzard Nemo – and I’m working through it

It’s snowing a lot outside.
The nursing home called to ask if I can work
tomorrow morning from 7a to 3p.
I said yes mostly because
If I said no, they would be short.
And those working conditions
Are not safe.

Although I can hear people plowing the streets now,
I hoped that the sidewalks are still clear
Or at least mostly clear
By morning.

I should be used to the snow
I am from the Mitt
But it’s been 6 years out
I even slid when I drove,
And shiver every time
I’m back home.

I gotta go get ready.