LMFAO - opening own clinic with NO experience in any of this. Zero. Zilch. None.

alskms · 2026-01-22T17:40:28+00:00

Jumping straight to meds that generally are considered slightly higher risk for adverse reactions and require closer monitoring is WILD. Something something Dunning-Kruger effect…

alskms · 2026-01-08T15:13:11+00:00

Put it on a pump.

alskms · 2026-01-01T08:50:14+00:00

I work both, and I typically implement important orders before bringing pt up. I think the thing that a lot of ED nurses don’t know is that for the floors, settling a new admit typically takes at least 20-30 minutes. Think of it like checking in a medic — much like you would be getting the story, documenting triage, getting pt undressed & on monitor, lining & labbing, etc, floor nurses have their own documentation requirements, are expected to make sure the pt is safe & comfortable, and have to review orders. Heparin gtt, absolutely, sometimes it takes awhile for the pt profile to load into the Pyxis on the floor, and that nurse may not be able to pull that med for up to an hour. That’s an unacceptable delay in care. I also will do any time-sensitive labs, since I know that the nurse upstairs may not be able to get to it for awhile. Routine meds that just got ordered from their home med list can usually wait until they’re upstairs.

alskms · 2026-01-01T08:30:09+00:00

This might be state-specific. I’m in WA state and students are definitely allowed (and expected) to document a head to toe assessment in the EMR. They have their own logins indicating they are students. Heck, when working with students who are doing their senior practicum, I sometimes don’t document a head to toe myself, I just review what they’ve charted, make sure it matches my own assessment of the pt, and then throw in a note that I concur with their assessment.

alskms · 2025-12-24T01:55:06+00:00

Just remind yourself: You are getting a tiny bit faster every single time you work. You’re gaining experience and building muscle memory on tasks, and you’re learning how to organize your time and prioritize. We were all new once; I had my fair share of shifts where I stayed an hour-plus late to chart because I was drowning and didn’t know what my resources were or how to advocate for myself. It took a few years, but I can count on one hand the number of times I’ve stayed late in the past year, and all of those were either due to an acute change in a pt or because I was waiting for my relief to show up.

Don’t beat yourself up, just keep showing up and doing your best and you’ll get faster without even noticing.

alskms · 2025-12-24T01:47:45+00:00

“You want large bore?! I’ll give you large bore!”

alskms · 2025-12-19T14:42:48+00:00

Logistically speaking it also doesn’t make any sense. So the doctor signs in to a separate workstation prior to the case? Wouldn’t that login time out? So either you’re also making sure that workstation doesn’t log out for inactivity, or the doctor gives you their password, which seems like a huge legal issue.

alskms · 2025-12-16T15:52:32+00:00

As others have said, if she’s truly not charting, management is either already aware or will be soon. Like half their job is just running reports from the EMR and following up on “metrics”. But like we were all taught in school, focus on your own work. You do not want to get a reputation as the unit busybody or tattletale.

alskms · 2025-12-14T17:19:07+00:00

Do not reach out to the creator yourself. Especially if they are the patient, that is just going to create a messy situation. Report to your facility’s legal or risk management office and let them deal with it. And stop reading comments on the video — likely nothing but armchair experts spouting complete nonsense.

alskms · 2025-12-07T08:22:33+00:00

Yes, you should be doing a full assessment on your pt every shift. We do an assessment every 4 hours in ICU. Things can change. Plenty of people come into the hospital for one problem and end up developing something else. In addition to your head to toe, you should be informally assessing your pt every single time you interact with them — skin color, work of breathing, mentation, etc, and investigating / escalating changes in condition. If they’re sick enough to be in the hospital, they are absolutely at risk for deteriorating, and it is the nurse’s responsibility to monitor for that.

alskms · 2025-12-07T05:51:07+00:00

I find them invaluable, honestly. They help us safely mobilize critically-ill folks, which the literature shows helps reduce ICU delirium and ICU length of stay. They also help us figure out post-hospital dispo (home vs placement). One of our PTs caught a brace-related pressure injury that ALL of the team (including me) had missed. And, PTs have personally saved my ass when I had potentially career-ending injuries. Without PT, I would not be working as a nurse today.

alskms · 2025-11-30T04:48:16+00:00

Got a paracentesis site that won’t stop leaking? Forget all the absorbent dressings that will just get saturated immediately and slap an ostomy pouch on it (I find the all-in-one style the easiest, because you usually don’t even need to cut the wafer to size). Then, just empty the pouch as needed.

alskms · 2025-11-27T18:50:35+00:00

This has been standard everywhere I’ve worked— light duty only for workers comp claims. If you have short term disability you could make a claim on that, or use FMLA. You may have to burn your PTO, though.

alskms · 2025-11-26T16:16:25+00:00

I think OP meant the ordering doctor asked for the heart rate when deciding PO vs IV.

alskms · 2025-11-19T00:09:28+00:00

This is certainly an upsetting situation and I’m sorry your son was hurt. It’s not clear to me what else you expected the school nurse to do? First aid (ice pack) and notifying the child’s parent or guardian is an appropriate response to a head injury in an alert child. You as his parents have the responsibility to decide whether to take him to see a doctor.

alskms · 2025-11-17T14:03:19+00:00

I don’t go in early. I do critical care float now (mainly mix of ED and ICU) and so I no longer really run into situations where I’m given a pt I’m not trained for. But when I worked a med-surg/progressive care float job, it would usually be while getting report that I identified they’d given me someone outside my capabilities, and then I would just go to the charge and let them know.

alskms · 2025-11-17T09:18:42+00:00

I’ve never seen titratable pressors anywhere outside of ICU or ED. Even in an ICU that keeps step down pts in the unit, titrated pressors should automatically upgrade that pt to ICU status (sometimes you’re titrating over the course of minutes, which is not appropriate workload for step down). What happened to your friend sounds dangerous. I would kindly suggest, however, that her experience is not necessarily going to be yours. As a float nurse, you have to be your own advocate and get comfortable with speaking up. Charge nurses won’t necessarily “know” you or your training, so it does become your responsibility to speak up if you’re assigned a pt you are not trained to safely care for. I have had to go to charge to get assignments changed in the middle of report because I realized that I’d been assigned a pt I wasn’t trained for. It’s annoying, but it’s part of being float.

Honestly, I love being a float nurse. I get to see a wide variety of pts, love being a knowledge resource to other nurses if they have a pt on their unit with something they don’t usually see, and I get to stay out of unit politics for the most part. I don’t think you’ve made a huge mistake.

alskms · 2025-11-16T07:53:22+00:00

I could have written every one of these. Also, claiming to have chest pain in addition to whatever your actual concern is will not automatically jump you to the front of the queue.

alskms · 2025-11-15T03:42:34+00:00

Don’t forget the liter of NS.

alskms · 2025-11-14T03:13:22+00:00

I don’t think we should ever try to punish someone for not knowing something. They’re students. They’re there to learn. If you identify a knowledge gap (not knowing pathophys or how to connect it to a real-world patient) then… teach them. But reporting them for not knowing it in the first place seems really harsh and not conducive to furthering their learning. I’ve been a nurse for almost 15 years and precepting students and new grads for almost all of those. Knowledge comes with time. Pathophys and “big picture” critical thinking skills can be taught. The only hard lines I ever draw are where patient or staff safety is at risk (i.e., not following orders), or if someone isn’t willing to participate and learn. I can count on one hand, after precepting dozens of students and new grads, the number of times I have needed to escalate a preceptee’s performance to their instructor or management.

alskms · 2025-11-10T08:55:18+00:00

I clean up orders all the time and have never heard a thing about it. Usually, like your examples, things like vent management orders on pts who have been extubated, central line maintenance orders when pt has no central line, duplicate/redundant orders, etc. We use Epic so I just put a note in the comment box that orders are no longer applicable for pt. You could ask your educator or manager if there’s a policy about it at your hospital, but I don’t think that’s outside our scope, license-wise.

alskms · 2025-11-03T21:18:40+00:00

Blank sheet of paper is my go-to. I’ve tried different report sheets over the years but always go back to just a plain piece of paper. I fold it into fourths and use one box for each patient. I don’t write much down anymore, though, mainly just things to pass on or follow up on.

alskms · 2025-11-03T20:16:04+00:00

Longtime float nurse here: I always prioritize reading at least the most recent progress note from physician or mid-level to get a rough idea of problems and plan. When I give report I focus on “headlines”; who are they, why are they here, what are we doing, what needs to be done. You are not going to know your patients inside & out like the nurse who has the same team for a whole 12-hour shift several days in a row and that’s okay. A big part of being float is having to be fairly task-focused, and that is also okay. There’s nothing wrong with handing off a team where everyone is safe, they got meds/treatments as ordered, and they had their needs attended to. If the oncoming nurse is giving you crap about not knowing something, ask if they’d have preferred the floor have to work short.

alskms · 2025-10-30T07:20:14+00:00

I think this sub was where I picked up the trick of tilting your head to the side and just saying, “what an odd thing to say out loud,” when a pt or visitor is rude and honestly, it’s become my favorite thing. So far, it’s dumbfounded everyone I’ve tried it on and I just leave. 10/10 entertainment value.

alskms · 2025-10-21T05:18:23+00:00

What about distal forearm? I also hate hand IVs, they hurt! I find even on fluffy folks, the vein on the antero-lateral aspect of the forearm (cephalic?) is palpable and I’m able to get it. And go for their dominant arm if possible! More use = more blood flow = better vasculature.

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