Plan of Action

Back in the day, when I managed restaurants, we always had to have a plan of action.  Depending on what area you were a manager of depended on your plan.  A plan to lower food costs, labor costs, etc, etc, etc.

I have started my plan of action.  I filled out my financial aid information (FAFSA).  Yup, sure did!  I’ve been in contact with UCA and UAMS, and getting advice on whether I should get my BSN or go right into my MSN.  I’m excited, but afraid of the cost!  UCA tuition is $206 for undergraduate and $245.50 for graduate – Per credit hour!  ACK!  UAMS is $198 and $281, respectively.  WOW.  Just WOW.

I’m hoping to start this fall, if not January at the latest.    Wish me luck!  (OMG, what the heck am I thinking, going back to school!!!!!!!)

 

10 Reasons To Love A Nurse

 

Primary Care Nursing

The hospital I work at has been on “team” nursing for many many years.  A unit has 30 beds, during the day there are 3 RNs, 3 LPNs, and 3 Techs (CNAs), and each group has 10 patients.  Of course there is a support nurse, and a charge, and the unit manager on the floor.  At night, ideally, there would be 3 RNs, 2 LPNs, and 2 Techs, but at times there might only be 2 RNs.  The RN’s primary duty is to assess, teach, intervene, etc.  LPN is meds and dressing changes, and the tech would be vital signs, feeding, and bed, toileting,  and bath care.

Recently, they’ve tried to go to primary nursing on one floor, with hopes to move the entire hospital to this (and get Magnet status).  During the day, there would be 6 nurses (5 RNs and an LPN).  According to state law, the patient needs to be assessed by an RN at least once in a 24 hour period.  So the charge nurse would assess the LPNs patients, then the LPN could take over and chart from there.  Everyone else would assess and chart, and do their meds, etc.  At night, there would be the charge nurse, and 4 RNs and 1 LPN, and the same concept would follow.

I’ve had no problem when I’ve gone to this floor to work, it’s been great, no problems.  Last week they changed the staffing grid.  So last night, I had 8 patients primary care.  Me.  Me to do meds, assessment, interventions, Dr calling, and so on.  It’s crazy.  How do they except us to give good patient care?  My license, my livelihood is on the line.  If this is what is expected, I will move to the ER, or even another institution.  I really do enjoy my job, but this is not a safe practice IMO.

I understand the nursing shortage, I understand the need for money cuts, but didn’t all take a pledge to do no harm (beneficence) when we entered the field of nursing?

I do plan to make my thoughts known to my supervisor, hopefully my voice will be heard!

 

Being a Nurse

So I’ve been on my own for a month now.  A few things I’ve come to realize:

1.  I love my job.

2.  Yes there is a nursing shortage.

3.  I have great organizational skills and time management skills.

4.  I need to say no.

Let me explain.

1.  I really do love my job.  Being able to teach people, talk to them, change a dressing or two, it’s great.  My paychecks are wonderful!  Better than I had planned.  I love only working 3 days a week.  I really do love it.

2.  Let’s skip this, I’ll hit this one on number 4.

3.  I’ve always been this way.  One of my first jobs was a waitress at Shari’s, which is like an IHOP.   We would have 7-12 table sections, do our own drinks, taking orders, salads, service, etc, and even bussing/cleaning our own table, and many times seating our own guests.  I was really good at it.  I’ve worked as a server and a bartender for many years and am really good at it!  As a manager, I’d be able to to the money count, inventory count, or whatever much faster than others, because I was more organized.  Now that has carried over to my Nursing job, which is really helpful when you have 15 patients.  Sigh, number 4.

4.  Most of our hospital is team nursing, meaning 1 RN, 1 LPN, and 1 PCT (CNA) take care of a group of 10 (sometimes 15) patients.  It works ok, if you have a good and helpful team, and if the other team is also helpful.  One floor does primary nursing, which during the day time they have 5 RNs and 1 LPNs (making 5 patients each) and a charge nurse, and at night it’s 4 RNs, 1 LPN, (6 patients each)and a charge.  The charge nurse opens the charts for the LPNs.  Meaning, they do the assessment and documentation for the first of the shift.  Any other thing that needs to be documented can be done by the LPN.  Of course ER and ICU are all their own entities, so I’m including those units here.

In the last month we have lost our travel nurses.  I believe there is one left on the cardiac unit.  The hospital spent so much money on them, they decided not to renew their contracts.  One bad thing about them, is that most of them live within an hour or two drive and still get paid travel nurse wages.  Well, being in a rural area, most of our nurses travel to get to work anyhow.  So many of them have signed up with travel companies, and we have lost nurses.

So one night, I was put on the primary care unit, and made charge nurse.  Ok, fine.  But due to a shortage of nurses, staffing pieced a staff together.  Which meant there were 2 LPNs, 1 experienced RN, and 2 new RNs (one of which graduated with me).  Ok, fine.  So I had to chart on 12 patients, plus deal with any other issues.  Ok, fine.  But I had to do it all by 11 P.M.  when I would be moved to the oncology floor.  Ok, fine.  I managed to chart on 11, helping a newer LPN with some skills she hadn’t done yet, calling the doctor for the new grad, among other things.  At 11, I went upstairs and received 15 new patients.  The nurse leaving had charted on 5 of them.  One room was empty, and two patients were new and needed to be admitted. That left 7 patients to see.  This is where I began to think it’s crazy.  Thankfully, another nurse (the 3pm to 11pm charge) stayed until 2 am admitting the two new patients.  I had another who was really ill, and had to have his bed changed every 30-45 minutes (not to mention he was in isolation), and be given three units of platelets and some chemo.  Thankfully I did not have any blood to give.  I ended up seeing my last patient at 6am, right before shift change.  Crazy!  I also had to draw the morning lab and get two patients ready for surgery.  Thankfully I had a good LPN and PCT, who were experienced and knew how to get a job done.

Good ol’ hindsight says I should’ve said no.  It’s my license to protect.  My job line.  My family’s income.  I am not superwoman, and I need to say no.

Oh, the week before the night above, I worked on the senior behavioral health unit.  I’ve worked there many times and a PCT, but never a RN.  The paper work is COMPLETELY different, including the three times more paper admission packet.  So two weeks out of orientation, I was sent to the pysch unit.  No problemo.  Except that I had three new admits.  UGH.  Now in this unit, there are 14 patients, 1 RN, 1 LPN, and 2 PCTs.  Great.  So the day RN stayed and did one admission, leaving me two.  I managed to get them 90% complete.  Again, thankfully my team was experieced and worked on that unit, so I didn’t have to follow up on them very much.  The day after the charge nurse/oncology floor experience, I was put back on the psych unit (no, not as a patient), again, with 3 admits.

This past week, I worked on the pysch unit (again).  Except, now they opened 4 more beds.  18 patients, TWO RNs, ONE LPN, and 2 PCTs.  IMO, still not enough staff.  These patients have schizoprenic disorders, depression, combative agression, dementia, etc, etc, etc.  So after a rough start, and somewhat quiet middle, around 4 am, the most ambulatory patient on the unit fell and broke her hip.  Of course she was my patient.  Nice.  I had to call doctors, the house supervisor, get her transferred to the med/surg floor.  What a mess.  Now, I’m not saying that wouldn’t happen with more nurses, but I do think that once again, I should have said no.  NO, NO, NO!

I’m learning, I do love it, we’ll see what the next three nights have in store for me!

 

EEK!

 

So since I graduated, I of course had to go through orientation at work.  I have been an LPN on the cardiac floor, which has become home to me.  But for my greedy little hands, I decided to go to the float pool when I graduated (more money an hour!).  So during normal float pool orientation (as my memory serves me when I was a PCP/CNA in float), you spend maybe a week or so in each floor/unit, so you know the basics of how that unit runs.  Great idea huh?  For my RN float orientation, they put my on the cardiac floor for FOUR WEEKS!  Yes four. Quatro!  Piece.  Of.  Cake.  By the end I was easily able to handle the sometimes necessary 15 patients that we had.  Like I said, piece of cake!

So we go camping, take my boards, diddle daddle, so I’m off for almost two weeks.  I think, hmmm when I go back, I’ll take JUST  ten patients.  Yeah.  Uh huh.  10.  So I spend my first week back on the Oncology unit.  Cancer.  Yuck.  My wonderful father in law died on that floor two years ago.  I hate working there.  I won’t go on about the nurses that work there, because that’s another entire post in itself. 

As I’m sitting in report, listening about patient’s external vaginal tumors, FU5, loads and loads of morphine, cancer here, there, being “ate all up”, I’m thinking WTF?  Where are the post cath, check your groin site, vitals good, pedal pulses good patients?  These people are freaking S-I-C-K.  Ten my ass.  Maybe TWO!

I did have a great very experienced nurse that taught many things.  Our night started with me just following her, since I wasn’t certified to handle any chemo (Thank GOD).  But between having to give 5 units of blood, the chemo, the morphine, and one patient living out his last moments, Ten o’clock came and we had only seen three patients!  I took the last 6 patients, who were the “healthier” ones in the bunch.  Our blood finished, we changed the chemo, our patient passed away, and I somehow survived.  The next two nights were easier, if that’s what you want to call it.

The next week, I went with another float nurse.  We spent our first night in my 2nd love, the ER.   I love it there.  Last year when I was suppose to graduate, that’s where I had a job at.   They offered me a spot again this year, but for some strange reason I opted to stay on the floor.  Most of the night we had level four stuff, you know, the school nurse role.  Cut fingers, bitten off toe nails, headaches, etc.  Pretty simple stuff.  The second night we were on rehab.  Lots of post knee and hips.  Pretty simple despite the bigger load of patients.  And the third night was on our primary nursing floor, neuro.  Again five patients, pretty simple.  Lots of turning and neuro checks.  Again, I survived.

But tonight, alas, my time has come.  I enter the world of nursing by myself.  I will shine my stethoscope and press my whites.  My orientation time has come.  I will have my own group of patients to tend to.  I will wipe the brow of the weary, care for the sick, and love the weak ones.

Ok, wtf!  Really now!  I know that I will forever be in orientation and learning, and I know that I will have other nurses and staff around to ask and get help from.  But holy heck!  I’m kinda scared!  Which if you know me, the know it all, that’s a pretty big thing for me to say.  I wish they’d stick me on the cardiac floor!

Twelve hours!  Ack!  Wish me luck!

 

Graduation May 17th

Just some more pics of this, and some of lunch and lake time with Grandpa!

 

 

 

The pic above and below, you can see Popo and Z sharing coin tricks!

 

I’m Graduating!!!!!!!! I’m A Registered NURSE! I’m Getting PINNED!

 

 

 

 

 

 

 

Ok, I KID about that last pic!  HA!  WOOOHOOOOOOOO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

Really? That’s what you are going with?

Travel nurses.  What a bitter taste it brings to some RN’s mouth.  They often ask, if they can pay THEM that much, why can’t they pay US that much?  Of course during this nursing shortage, travel nurses can be a life saver to the already worn out, overworked staff.

So after those lovely thoughts, last night was my first experience with a travel nurse.  Our group had 10 patients on a med-surg floor.  Quick run down of clients  (very vague-HIPAA!):  A mix of 1, 2, 3 day post op clients, most with PCAs, one  DNR on a 100% non-rebreather.

One client is suppose to go home, but wants to stay until the morning so he can get the results of a certain test.  One is still in surgery, may or may not come to the floor (vs ICU).   The DNR has O2 sats in the 70s.  After asking me several times if she needed to pass any of my meds (and me declining several times), she still passed meds to one client (couple of POs).  In passing I tell her that one clients IV has gone bad and I’ll fix it later.   In the meantime, the charge nurse was dealing with the one wanting to go home (calling all the doctors, making sure the client could stay), with the DNR client’s family, and with one client who was throwing things (calling their doctor).  The surgery client comes to the floor, the travel RN goes and assesses him.  Next thing I know, she’s is leaving.  Like leaving to go home and not finish her shift, or the remainder of her seven (of eight) weeks.  WOW.  Just WOW.

Her reasoning was that it wasn’t safe practice, she was having to give meds (really now?) and it was too much to deal with.  She had charted on not one client at 10PM, only really dealt with the post op client, and the one to be discharged for a few minutes.  There were two other strong RN’s on the floor (plus the charge), three LPNs (experienced) and the two PCTs.

Really, I just would think that this would be considered abandonment, but since she gave report to the other RNs, I was told it was not considered as such.  Is this what we are to expect from travel nurses?  This is the first time in the 100 year history of the hospital that we have brought in travel nurses.   This is my only hospital I’ve worked in, and like I said, my only experience with travel .  Am I missing something?  Are we expecting too much of the RN?  Yes, our ideal modality would be 5-6 clients, but right now, because of the nursing shortage, it’s not a possibility.

Two words:  Not Impressed