Really, there aren’t two topics of more importance, so why not lump them together. Since I’m sort of between teams right now (oh, the heck with it, Go Raiders!!!) it will be fun to work through this flowchart, since I hate thinking for myself!
On another note, I’m attaching the shift routine worksheet I’ve made to keep on track at work, and prevent charting deficiencies. It really helps me remember to order labs when I’ve got patients on protocols (e.g.; K+ replacement, etc.), to identify Core Measures (thanks, Jay-Co and CMS!) and mind my p’s and q’s. I’m attaching it should it be useful to others on the internets. Here you go: Shift Routine for Med-Surg
So, as a new graduate RN at a hospital, one may expect to experience a thing called “Orientation.”
During the first few days of this ritual, new members of the tribe are welcomed by the elders with offerings of continental breakfast, free coffee (the good stuff, not that whatever-it-is-that-gets-served-on-a-hospital-unit-stuff), swag bearing the facility logo, and are treated to campfire stories concerning lean hospitals, corporate integrity and benefits. All too soon, children, it is time to buckle down and get to work, larnin’ stuff like electronic charting and code procedures – the tasty, gratis edibles vanish, ever so slowly (they wean us from the oh-so-sweet baked goods like there’s a CIWA protocol for it. . .first it’s just cookies at the back of the room with coffee, then just cookies with water. . .and then, NOTHING) and like baby dolphins, the newbies are eased into the shark-filled waters of. . .computer-based training!
Mostly, it’s been fun, although I do need to turn myself Q1 hours for fear of developing a pressure ulcer or two. There are, however, bright points, like when the instructors, seasoned nurses, try to drum some common sense into the wee, thick skulls of the students.
During a sprightly discussion of scope of practice and delegation, the role of the CNA was discussed. A quiz about what a CNA might be delegated to do ensued (discontinue a Foley catheter? Yes! Insert a Foley catheter? NO!!!!), and when the instructor sensed some superiority complexes in the room concerning the RN-CNA relationship, she pounced like a lion on a limping gazelle during dry season on the savannah. “Your CNAs work hard. . .they are a great asset, and you need to treat them with RESPECT! They can make you or break you. . .and they talk! So don’t develop the wrong reputation off the bat! If you’re sitting at the desk doing nothing (not to be confused with charting) while your CNA is running after seven call lights, and you ask them to get the patient in the room across from your desk a glass of water, that’s probably not going to go well! Work as partners with our valued CNAs, and you’ll do great!”
Speaking for this now former CNA, and the other folks who started their medical careers on the wrong end of lots of Code Browns – thank you, Wise One. And don’t let me forget to consider the feelings, goals and frustrations of everyone on the health team with me. Please, don’t let me forget my roots.
I was going to write some awesome posts about ICU beauty tips (the BEST way to get dried blood out of hair, for example) but weirdly combining summer/post-school/post-NCLEX meh with job-seeker anxiety has served to completely eliminate my blogging drive (kind of like overdoing the oxygen flow on a COPD-er – over time that minimizes the respiratory drive).
So, after all but giving up hope of an RN position where I currently work (the only interview I had was for the OR – some of my nurse coworkers flat out laughed at the thought of me in the OR because I LOVE patient interaction, hate to stand still, and almost never shut up) and that didn’t really go anywhere. But when the hospital made a last minute decision to hire more new grad RN’s, a classmate did me a solid and gave my name to her manager. 4.5 days later, I had a job offer.
This is good, because I was contemplating keeping my CNA job for the health insurance and internal applicant status for future new grad opportunities later this year or early next, and combining it with an RN position somewhere else so I could start acquiring experience, all while starting work on the RN-BSN. (Stress! Stress! Stress!) I was listening pretty hard to all the current wisdom that says “you don’t want to be an inexperienced “old” new grad!” Combine that with the spouse saying “Hon, you’ve really been through the wringer this last two years, it’s OK if you just take it easy for a bit. You’re wonderful and some place will see that and hire you. Please, here is some chocolate, now stop freaking out!” and you’ve got the recipe for a somewhat schizophrenic outlook (“I’m OK, I’m OK, I’m Ok! No, I’m not OK! I’m OK! No, I’m pretty sure I’m not OK!“).
So, now I have just four shifts left to go as a CNA. I’ve ordered my new scrubs in the appropriate nursey colors (PS: I love Koi Warehouse – they sometimes blow out separates for under $10 each! They are awesome, check them out if you wear Koi.) My oldies (but goodies) have new homes waiting (I hate waste!) and I’m completely (well, mostly) excited but also more than a bit terrified about how I’ll do in the new job. One of my coworkers said it took a year before he felt like he wasn’t really in danger of killing anyone! Help!
I’m bringing treats to celebrate my coworkers (Cookies for breakfast? Why not?) and celebrate that things worked out after all. They were all pulling for me, RNs and CNAs alike. Because they are filled with so, so much awesome. And I’m so glad I get to keep coming to work at the same facility, still on night shift, so I won’t lose touch with them. They are my work family.
So, wish me luck! In the mean time, I’ll figure out what my next blogging adventure comes next. I might just bequeath this blog to my son (Son of DisorderlyCNA) as he enters into his own CNA adventures!
I’ve earned the RN pin. . .the culmination of five years of hard work, lost sleep and intense caffeine consumption. Our critical care director, probably one of the kindest docs around, and much beloved by our hospital’s nurses for the respect and admiration he has for the nursing profession, spoke eloquently, with just the right touch of humor. A Nightingale ceremony, with an appearance from Flo herself (reincarnated), really capped things off.
So, one set of busted pumps, several beers, and a couple of deadly Fireball/beer cider dunkers consumed (imaging a cinnamon apple that makes one extremely tipsy), plus one barbeque (huh, who knew my classmates’ talents included keg stands? Impressive!), I’m contemplating the future to come. There’s an NCLEX review class at my community college (a good deal at $200), plus some interviews (critical care and surgical units at my hospital). . .but what I really wonder is, what’s next? Will I gain employment at a hospital without a BSN in my grasp? Can I hope for a critical care job? Can I hope for any acute care job? Does it really matter?
After a gut check (after the weight gain of nursing school/working full-time night shift, there’s plenty to check), I find that, no, it really doesn’t, as long as I have the privilege of caring for patients, in any care setting. Long-term care, long-term acute care, acute care, community-based care, home care – I think any of them would work out, as long as I have the right attitude and the willingness to continue blooming where I’ve been planted. Til’ then, I’ll be happy to continue walking in circles for 12 hours a night, caring for patients within my scope. The path will be there, I just have to take it when it appears.
Geehosiphat! My final term – and nursingpreceptorship – are flying by. I realized it was time to update the ol’ resume, start putting in some job applications for when I’m all grown up and a real nurse, and to finish up some scholarship applications that I’ve been cheerfully ignoring.
I realize, the job market being what it is, that choosing a nursing specialty might not be my option, but that it will instead choose me. I personally think I’d make a hell of a med-surg nurse – I actually enjoy meeting new friends all the time (but not at the turbo pace of the ER). I realized that getting people excited about eating hospital food, getting them their meds on time, and making sure they are safe actually makes me happy. Let me tell you about our pudding and jello options, folks!
Don’t get me wrong. . .I have loved my time in the ICU, and if I landed a critical-care job or new graduate internship I’d be wildly happy. . .but at the same time, the ICU doesn’t always afford a lot of chances to be joyful. Every day, bottom line, you are guaranteed to be surrounded by people who are having a crappy time (at a minimum) and are possibly dying. Yeah, yeah, I know death is part of life, blah blah blah. Try telling that to little kids who just lost their mom or dad because they couldn’t sustain life and the grownups had to let go and turn off the pressors and the machines. Tweakers who OD’ed trying to get out of bed and painting themselves with their own offal. People who may never get out of bed again, period. The sad, sad, futile sadness of some of it. There’s just a lot, and it’s hard to describe it until one’s wallowed in a large ICU for some time. Yeah, the machines that go ping! are pretty neat, and I know they save lives, but sometimes it’s a bit much. (The ice cream parties for the staff, courtesy of the organ transplant coordination agency aint bad, either.)
My coworkers tease me sometimes. . .”Oh disorderlyCNA, sounds like a long-term care nurse in the making!” So it’s not like there’s a betting pool, but some of my coworkers are starting to put down bets one where I’ll end up. I will end up somewhere! I’ve told them that if I’m still there as a CNA six months from now to kick me squarely in the ass!
Some think I’d be great in peds (they are insane!) or in the NICU (yeah, right. . .tiny sized critically ill patients sound so much better than adult critically ill patients!). One of my managers thought I’d be a great psych nurse. Really? (Are you mad at me? Writing me up? Glaaahhhh. . .)
So, I guess it remains to be seen where I’ll end up. So for the time being, I’m enjoying the learning opportunities afforded to me by my preceptorship, and acquiring the rest of the RN role. Long way to go, though.
I can’t believe it took me so long to figure this one out. Was a sitter for an unhappy, withdrawing ETOH-er and things weren’t exactly therapeutic.
Patient: I wanna go home.
Me: Everyone here wants to go home, including all the staff.
Patient: I’m gonna hit you!
Me: No you’re not, that’s not OK.
Patient: I can kick your girlie ass!
Me: Uh-uh…I wouldn’t try. I outweigh most NFL linebackers. I got moves.
Patient: F— you!
Me: No one gets to say the f— word here, except for me, silently, in my head.
Patient: (Sulks silently.)
Me: You want to watch TV?
Patient: F— you.
I turn on the TV, with the objective of distracting the patient. Network news? Ugh, that crap makes me feel agitated…and it isn’t helping the patient. Infomercials? Ugh. (Patient continues to squirm and attempt bed exit maneuvers.)
…What’s this?? C-SPAN! Worth a try…sure enough the melodic, droning sound of the political voices draws Mr. Twitchy’s attention…hey, looks like he’s falling asleep! Whaddya know?
Yet another reason to love this great country! Our unfettered access to the political machinations in our Capitol not only enlightens, but calms.
Remember C-SPAN the next time someone squirmy is trying to clock you…it’s the cat’s pajamas for inducing sleepytime! (Maybe Ativan should be renamed C-SPAN!)
Many times, I’ve had cause to question just what the heck I was thinking when I decided to work full-time nights as a hospital CNA while going to nursing school. I stumble/limp into lecture after a shift, feebly clutching a giant latte, hoping to stay awake for most of the lecture. I would be lost during this second year without my trusty digital recorder, although I’m currently avoiding becoming the class bee-yotch (no, I will not post all the lectures so the rest of you can leech off my effort – the nice guy who did that for y’all last term failed out, so I’m leery of following in his steps). Yes, health insurance is a nice thing to have, but I still question my choices – especially when my grades are not on a par with those of those that don’t work (except at school, which is hard work enough).
So the other night at work, one of my nurses asked me to help her student RN (from a distinguished local BSN program) with a bed bath on a vented patient. The experience went well, as I like to teach (although I have a hard time keeping my hands in my pockets so the person learning actually has time to learn). The student was careful, and seemed to treat the experience seriously.
So where was the problem? The student said that she had taken a CNA class, but that she never really wanted to do “that kind of work.” (‘Scuse me? I mean, I didn’t know that the work many choose as a long-term career was on a par with pole dancing, or something. No disrespect meant to the dancers out there. . .I’ve seen your tax returns, ladies, and you sure have to spend a lot on shoes. Noamsayne?) I bit back on my hair-trigger response, and asked the student what she meant (because I prefer not to second-guess people). The student said “well, they are such different jobs, and the CNA job doesn’t really have that much to do with the RN role, so I didn’t want to get confused.”
Fair enough – I’ve sometimes had difficulty trying to step beyond the CNA mindset at my own clinical shifts – which is task-based, because it has to be, or you’ll drown/cry after every shift/get fired. But it’s not impossible, as evidenced by the many RNs I work with who were CNAs first.
I would argue that students should not be allowed into nursing school until they have worked in some clinical situation – medical assistant, EMT, ED tech, CNA, assisted living aide, whatever – because the practical experience gained is invaluable. As a grunt, one is in a unique position to observe and learn in many situations – particularly in critical care or the ED. I’ve been a helper/fly on the wall during codes, new admissions, transfers, road trips to CT, etc. Each experience has taught me things I need to know as a nurse, in any situation where I find myself after graduation.
I asked one of my coworkers if lack of clinical experience and skill displayed by this BSN student, compared to the students in my community college ADN program, was typical in our geographic area. She responded that in her experience, that was generally the case, if the student had not worked in the medical field before. I have heard – not just from this coworker, but also from others, that BSN programs prioritize teaching the leadership aspects of nursing over skill development, telling their students “you’ll learn your skills on the job.”
I wonder to what extent this has contributed to the woes new graduate nurses experience when trying to get jobs in the current tight nursing job market? Is nursing education shooting itself in the foot in the effort to “professionalize” nursing? The statistics would seem to indicate that BSN program graduates are successful in being hired. Are the educators attempting to shift clinical training back to the hospitals, where nurses used to be educated and trained, not colleges and universities?
Even though this student’s opinion of the value of CNA work caused me to have an indignant knee-jerk reaction, I am glad she shared it, because it’s helped me do some thinking about the future of nursing education in this country.
Sometimes, patients are unable to control the impulse to pull at their various lines, ET tubes, telemetry leads, or (gasp!) Foley catheters.
Restraints may not be in the best interest of the patient’s safety, and sometimes serve to agitate the patient further. Using a CNA as a sitter is a great restraint alternative choice, but let’s face it, sometimes keeping a patient from pulling at their lines is like trying to put a cat in a box to go to the vet!
So, here’s where mitts can be the BFF you’ve been waiting for! Several manufacturers produce washable “hand protectors” (yeah right, more like dressing/Foley/IV/nurse sanity protectors). In general, these protectors feature a generously pillowed palm, and lace-up or Velcro closures. The patient can move his/her arms freely, but cannot grasp lines to remove them.
So, you ask, how do I keep the patient from removing the mitts by using their teeth/other hand/legs? The hidden secret (when using lace-up mitts) is to cut a small hole in the top of the tongue (of the mitts, NOT the patient! This is important!). Lace up the mitts, and thread the top laces (furthest from the fingers) through this hole, then tie the laces in a bow to secure the mitt. This one small modification makes a world of difference when it comes to keeping the mitts ON your patient!
So, this interesting study explores the efficacy of LTACs in the post-hospitalization survival rates of ICU patients. Essentially, the gist of the matter is that older patients with lots of comorbids don’t have a very high survival rate a year after hospital discharge, despite LTAC utilization. Probably not too surprising, given the acuity level of the patients studied. The study did not include patients coming from non-ICU care, although such patients are cared for in LTACs.
However, the question of whether LTACs serve as a more cost-effective method of delivering care to patients and families not ready to give up and die is asked, but not well explored. It would be interesting to see a study delineating survival rates only for non-DNR/DNI patients utilizing LTACs.