Off probation — what does that mean?

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I’m off probation now at the hospital.

That means I passed the series of “tests”—
doing 2 head to toe assessments,
giving out medications through different routes,
going over the chest tube, suction set up, code master (defibrillator, pacer, and cardioversion),
doing drip calculations and entering into the IV pump,
going over the telemetry monitor, and
taking the 50 question EKG exam and passing with a score greater than 90%.

It means no more checking each narcotic.
And trust me, on an ortho floor, a lot of people are in pain, pain, pain.

It means no more checking insulin units.
Yes, I know how to draw up x units of humalog, lantus, and the like.

It means I’ve been doing this for 6 months.
And that means I got 2 weeks of vacation time!

It should mean that I know what I’m doing.
Although I will keep asking questions. And questioning orders that don’t make sense.

It means that I will begin to float to other units.
I won’t be on home turf all the time anymore.
Other med-surg floors and the ER.
I have to admit, I’m a little scared.

It means that I’m ready — and mostly excited!! 🙂

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. 🙂

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.

How to Sleep As A Night Shift Nurse

This was one of the first questions that I asked my mom who used to work nights as a RN. I also got some advice from a coworker who’s been working nights for a year and half and so far, it’s worked out. I followed their recommendations and I made it through my first three 12-hour night shifts in a row without being overly tired. I thought this was pretty helpful so here it goes.

There are three scenarios.

1) The Night Before the First Night Shift

Sleep in to about 9am-11am. Eat lunch, run some errands. About 3-4 hours before you plan on leaving home to go to work, take a nap. Get up about 1 hour prior to eat, get food ready, and change to go to work.

2) You Have a Back-to-Back Night Shift

This one is easy. Some people like to eat when they arrive home. I personally don’t. I come home, shower (to wash off all of the bacteria from the day — I don’t want to bring MRSA into my bed!!), set up my uniform and food for the next day, and sleep for 8 hours. I need 8 hours. Otherwise, I am a tired mess. But some seasoned nurses (such as my preceptor who is awesome btw) sleep for 5 hours so they can do other things. I wake up about an hour before I leave my home to eat my ‘breakfast’***.

***I thought about the definition of breakfast. Technically, after I wake up from an 8-hour sleep, I have to ‘break my fast’ by eating breakfast. But my sister claims that breakfast, lunch, dinner is defined by time of day. For example, if you sleep in until 10am and then you eat, then that is considered brunch (although my sister claims that brunch only exists on weekends. But how can that be??). I guess when I go on break, I’m either eating a 2am meal or a ‘lunch’. What do you think?***

3) The Day After The Last Night Shift

Sleep until noon (more or less). Try to stay up until 8pm-10pm. Get some errands done or just relax or go work or go to school or whatever you want to do. Then go back to sleep.

I hoped that helped. Besides sleep, probably the next important thing is what to eat. You have to fuel yourself with good energy so you can take care of others!

My move to the hospital

To update you from what has happened from Christmas to now (one month later), I got interviews at a hospital and received the clinical nurse position on a medical-surgical telemetry floor with a focus on orthopedics. I am super pumped.

Yesterday, I received my schedule for the first two weeks. It looks bad — and good. The first 3 days that I’m working nights is IN A ROW and I heard that was a killer. Early exposure to the worst will make me relieved when I don’t have 3 in a row, right? Or maybe I’ll realize that 3 in a row isn’t as bad as people say. At least I’ll have 6 days off after that. I’ll have to figure out what to do with that time!!

The hospital also provides good preceptor selection and training so I really hope that will help felicitate my learning.

I’ve already finished the first two weeks of orientation and I have one more week left. I can really tell that they have developed great nurse educators, clinical nurse specialists, CWOCN (Certified Wound and Ostomy Care Nurse), and overall people here. I think that it’ll be a really supportive environment but I’ll find out soon enough!

Since this hospital focuses on the heart, we spent a great deal of time learning about different cardiovascular diseases, pre & post procedures, EKG readings, stroke, arrhythmias, emergency situations. We also went through different systems (GI, GU, neuro and Skin!!!! wound/ostomy care, and pressure ulcer prevention ~for 2012 0.81% developed PU throughout the whole hospital compared to 2011 when it was at 1.11%).

Intentional Hourly Rounding is also something that I haven’t heard of, but it makes a lot of sense. Ask about personal needs, pain, positioning, education, etc. Ultimately, this is to help prevent falls.

Epic went live at this hospital in December. Based on what people have said, they really like the program and it has helped a lot with documentation. I completed day 2 of Epic training yesterday, and I feel that it’ll be a great tool and hopefully help accelerate the documentation process. In the ‘doc flowsheets’ it asks a lot of questions that you would normally write down in a note. My question is, do I still have to write a progress note based on some abnormals? I think the answer is, probably, but from there, I can copy and paste, and right click to create a note.

Next week, there are 3 exams. Core exam, EKG exam, and Philips monitor. And there’s technically an Epic exam. I have to pass with a 90% or higher (yup, it was the same for the NLN medication exam that I had to take prior to officially having this position). I think that it adds a little more pressure on the employees to do well, but it also puts higher standards for the hospital. And that in the end, the patients receive better care.

This weekend, I’ll definitely be practicing EKG strips. And studying.

Unclog a GTube, Feel a Thrill, Hear a Bruit, and Mr. Perez

I practiced my finger stick on Mr. Perez today. Mr. Perez is a mannequin. What I learned was that the test strips are accurate and to wipe down the glucometer with PDI after every use. Microscopic amounts of blood is usually left on there and there have been cases of hepatitis being spread because people aren’t careful with infection control! So wipe it down before using it on someone else.

I also crushed medication and gave meds via the stomach (G Tube). First, push in 15 ml of air and listen for a swoosh. It should indicate that it’s patent. Unfortunately for me, it did not so when I first put in 30 ml of water to first flush, it didn’t do anything. Thankfully my instructor was nearby watching so she helped me unclog the adapter and the tube. I am actually interested in the research — what is the best way to clean out a clogged tube??

Lastly, for someone who is on dialysis (due to kidney failure), it is important to assess for a bruit and thrill. For a thrill, I felt a vibration pulsating with the beat of his heart. For the bruit, I used my stethoscope to hear a shoe — shoe— shoe— sound. Again, it’s with the beat of the heart. My coworker made a good observation — the artery may have a louder bruit compared for the vein. Interesting.

When You Make A Mistake

First, you have to have the guts to admit that you made a mistake. No one is perfect, and we make mistakes. The next step is to take ownership of that mistake and apologize for it. Say what you learned from it and what you will do differently next time.

Each day, you want to take another step to becoming better. One way is to understand your mistake and to make every effort to make sure it doesn’t happen again.

For me, I made the mistake of telling someone I was going to do something, and then forgetting to tell someone that I had changed my mind about my decision to do something.

I could do two things differently.

  1. Not agree that I will do something if I am not 100% sure that I will be able to complete it (This is a little difficult for me because unfortunately, I am a ‘people pleaser”. I have to know my limitations and be able to say “I have to think about it more” or “no” to some requests.).
  2. If I had already agreed but later could not make that commitment, then contact the other party as soon as possible. A later time is not a good time. The best time is as soon as I know that I can’t make that commitment. Even if it initially upsets the other person, it is much better for me to contact him first, than for him to contact me first.

When is the best time to do something?

When you think you ought to do something, the best time to do it is right away.

Especially when it comes to notifying someone with bad news. I don’t know if there is a good time to tell bad news. The bad time to tell bad news is when it is too late.