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.

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!

What Do Registered Nurses Do?

What Do Registered Nurses Do?

My sister keeps asking me what I do as a nurse. In a nutshell, I assess, teach, provide medication and treatments, monitor conditions, communicate my findings, and coordinate care (are referrals needed? Consults? Who else should know about the issue?). Taken from the Bureau of Labor Statistics, here is the differences among things that Registered Nurses, Licensed Practical Nurse, and Nursing Aides do.

Registered Nurses (RN)

  • Record patients’ medical histories and symptoms
  • Give patients medicines and treatments
  • Set up plans for patients’ care or contribute to existing plans
  • Observe patients and record the observations
  • Consult with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze results
  • Teach patients and their families how to manage their illnesses or injuries
  • Explain what to do at home after treatment

Licensed Practical Nurse (LPN)

  • Monitor patients’ health—for example, by checking their blood pressure
  • Administer basic nursing care, including changing bandages and inserting catheters
  • Provide for the basic comfort of patients, such as helping them bathe or dress
  • Discuss health care with patients and listen to their concerns
  • Report patients’ status to registered nurses and doctors
  • Keep records on patients’ health

Certified Nursing Aide (CNA)

  • Clean and bathe patients or residents
  • Help patients use the toilet and dress
  • Turn, reposition, and transfer patients between beds and wheelchairs
  • Listen to and record patients’ health concerns and report that information to nurses
  • Measure patients’ vital signs, such as blood pressure and temperature
  • Serve meals and help patients eat

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.

I have a cold and I don’t want to take meds

The other day, my friend said that he had a cold and suddenly remembered that I am a nurse. He asked what he should do. Naturally, I said “take some medication.”

But then he asked what he could do without taking medication. Mostly because medication makes him feel bad. I mean, personally, I try not to take medication either unless I’ve been sick for at least a week and symptoms haven’t let up yet.

The “natural” way to treat a cold is sleep, vitamin C, vitamin B complex, and maybe some lemon tea.

I think that most people prefer not to take medication if they can, mostly due to the side effects. I just watched the movie Silver Linings Playbook. The characters discuss how the medication (specifically psych meds) dull their thinking, cause some to bloat, and makes them ‘non-functioning’. These side effects really suck and I can see why someone would not want to take them.

There has to be other ways to treat the root of the problem without taking medication.

Don’t be afraid of advancing

My orientation nurse instructor told me (and the four other people on orientation) to always say yes to a promotion.

She said that some people are afraid of advancing, or more precisely, more responsibilities and suddenly out of the comfort zone again.

While it is nice to feel comfortable, you learn the most when you’re just beyond it.

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.

Nurses are Observers

One of the major reasons why I like to watch the new NBC show Elementary — a New York based Sherlock Holmes, is because Mr. Holmes is a great observer and can deduce so many things from his observations. I’m not sure if it is possible to be as finely in-tuned as him, but I do know that first, you have to completely aware of what you are looking at. Second, once you realize what you are observing, you have the obligation to take action.

One of things that I will face is having the courage to take action after observing something that I see is performed incorrectly. But I believe that if I base my reasoning for making a change on the fact that I truly care about the care provided for the resident — then I believe that I can do it. I have to think, “If she was my grandma, how would my grandma want to be treated? How would I want her to look?”