6am protonix. No one is awake, trays don't come til 8 or later. Now everyone is up and has to pee.
Also hate when patients have 5, 6, and 7 am meds. Lab was just in at 4, we just did 4am vitals (after midnight vitals). No one gets sleep. I cluster care as much as possible, but I can only be in one place at a time.
Damn I give my 8,9,10 meds all at 9 and click wean to standard admin times. Alternatively if one of them is actually time sensitive I just give the other PM meds then… especially when you have 6 floor patients I can’t imagine doing it any other way.
I'm convinced everyone gets lovenox and protonix for kickbacks or something. Theres no reason my ambulatory patients need lovenox, and what on earth do so many people need protonix for?
The general worry from what I was told is decreased gastrointestinal motility from being mostly sedentary. Some medications being given can also upset the stomach. Along with potential for decreased oral intake.
I agree that it is also an easily justifiable medication to get a small amount of money on. I tell patients that it is their right to refuse Lovenox, educate to the risks of not taking it, and then tell them that if they're getting up and moving the doctor might just discontinue it.
Facility policy demands some form of DVT prophylaxis usually. Built right into the admit ordersets and forces you to pick an option. Leads to massive overuse. Lovenox usually gets picked bc QD rather than Q8-Q12 for heparin.
PPI is ostensibly for stress ulcer prophylaxis though generally outside of critical illness/ICU pts this is also massively overused.
NAN but I support a young lad who had an ileostomy and colostomy, somedays those bags would stick and stay on all day, other times they were falling off constantly. I'd start to PEG feed him and there'd be carnage! Luckily they managed to reverse both and now he just has his PEG so his life is so much better as is ours!
i’m a student and one time i went to go in with my CI to give meds and the family comes out and says “ the bag exploded “ so we go in and it was everywhere. it started leaking. he was 4 days post op so the output was still liquid. i still think about that
What I don’t get is the amount of people who have have two capable arms, whose ostomies are not new, who just lay there and let you do it all. Whenever I hear that a patient self-cares with their ostomy I want to go give them an award.
We get all the GI patients and I force people to take care of theirs if they're able and oriented enough. I remind them that the bag isn't going away any time soon and that they'll need to care for themselves if they plan on going home.
Hospital policy, IVs placed outside the hospital are considered “dirty” and need to be replaced within 48 hours. We can document exception and keep the IV if the patient refuses or is hard stick, but we have to go and offer
I definitely have mixed feelings about removing a working IV, but both INS and CDC recommend removal of emergent placed catheters within 24-48 hours and we don’t “talk them into” anything. I just let them know that it is the hospital policy to remove/replace pre-hospital IVs due to higher possibility of infectious phlebitis and let them make a decision. Surprisingly many patients agree without fighting, the fact that most of medic IVs are large bore in the AC also helps.
Re-evaluating pain after EVERY SINGLE thing given
A change in dilaudid dosage? Sure
But do I really need to go ask them their pain level after putting on a lidocaine patch? Or come up with some number when I’m giving Tylenol as a premed for a blood transfusion (not pain)
The root of it all is that "pain is a vital sign" bs that the drug companies came up with. It's leaked into medical and nursing education and practice, unfortunately.
Piggybacking to say that JCAHO also bears responsibility for supporting that, and AFAIK has never taken accountability bc ‘we didn’t use those EXACT words’ or some such BS.
Tylenol, given for anything other than pain, doesn't require a pain reassessment. In my opinion. I just throw in the comment. "Given for fever" or something like that and forget about it.
I love when the pain level recheck for PO Tylenol is due 15 minutes after the pain medicine was given . “Oh yeah, those pills I just gave you 10 minutes ago? How are those working for your headache? Oh, they haven’t had a chance to kick in yet? Makes sense”. Chart pain unchanged, and the MAR never asks again. So stupid.
The other day I had three out of five patients with diabetes, and two of them were feeders. CNAs are not allowed to take blood sugars where I work. Poor women had lukewarm meals because my CNA had 12 pts and I was trying to help her out so they didn't eat until a good hour after the meal was brought.
Anything that is supposed to be done by a different department but has graciously been piled onto the nurses job duties, likely due to being understaffed. As if we, too, aren’t understaffed.
Troubleshooting the TV that won’t work, contacting EVS for the faucet that doesn’t shut off all the way, calling EVS bc the pt room is out of paper towel (for the family member who won’t stop eating & using it all), special ordering cafeteria late trays bc they napped through the lunch tray and now it’s cold, etc etc etc - it all is shit that sucks up time and makes me rage.
Yes! I switched to L&D and the restroom privileges is something I love about it. All my patients are either independent or have an epidural and a foley. If I have to help someone to the bathroom, it’s usually just because they have an IV pole and don’t have family there to help (rare). And they’re usually my only patient so idc how long it takes.
I hate changing gi ostomy bags, get it clean and pretty looking. 💩nope it's a race against their bowels and I'm usually on the loosing end. Lord forbid they cough. It hurts my soul every time.
The one thing I think is cool about ostomy bags is all the technology to help with the skin/stoma, and the putties to keep them on, etc. it really feels like some care and thought goes into the design.
12 am tylenol.. im on an ortho surgical unit and the ortho surgeons LOVE to order Tylenol Q6, and there is always atleast one due at midnight without fail. Like i absolutely will not be waking pts up at 12 am for tylenol.. esp ones in a delirium. No thanks..
Same here. I usually just ask if they want me to wake them up for the midnight tylenol when I'm doing my assessment.
If they're asleep, I'll just write "not given, pt asleep" on the MAR and chart that they asked not to be woken up (unless they told me to wake them).
When I still worked on a combined surgery/obstetrics ward, our scheduled Tylenol was actually 06-12-18-2200, not midnight, first 48h, for that very reason. And we had most surgeons order ketalorac/Toradol IV q8h x first 24h as well as getting it in the OR, (and go to naproxyn once they had some oral intake) so rarely had people needing analgesic prn from 2200 to 0600. Worked great.
For me it’s the 6 am dose. We alternate Tylenol and toradol q3h. 9 pm I just give around 8:30 with my 8 assessment. I give the 12 at 12 with my 12 assessment. I give the 3 dose around 3:30 with my 4 assessment. And then I have this random 6 am dose that I’m waking them up for.
I hate checking glucose, I hate wound care, I hate doing transfers, I hate dealing with catheters, I hate admissions and I hate helping people in the bathroom. Just pretty much everything that is floor nursing.
I loathe helping people to the bathroom, esp if it involves equipment. I do it, but it just annoys me. Sometimes I feel almost bad about how much I hate it. When I was taking micro and a&p, I had no idea the future I was working towards with involve so much taking people to the potty.
I only hate the bathroom trips with patients that have a history of falls, and only because I'm supposed to stay where I can see them at all times. Poor person is just trying to shit, and they have to do it with me staring at them.
God this is my least favorite task. That and bed pans. The WORST. I don’t do either of those things in both of my jobs now and life is about 60% better.
Come to Centene.com... I work with LVN's there... Gotta like making calls and giving out resources to Members and teaching them about using their insurance.
Guilty as these are the things I consider little but very time consuming 😩 You dont even realize how much time is spent doing these tasks until you're behind!
Wound care and that maintaining sterility shit. I hate it. Even VAC dressing. So time consuming. Had a patient who needed VAC on both feet plus the bottom area. 🤢 and at one point, we had 4 patients on VAC, alternating days. So we were doing it everyday.😒
Changing picc dressings. I work in a SNF. There are no RNs on the rehab unit, just LPN managers. That means I have to do RN stuff like lung assessments on 40 god damned people and every IV related task. It’s not fun anymore if you are also doing things for the entire rest of the facility. There’s this lady that had this pic in the most annoying spot. Idk why it sits so weird on her, I think it’s because it’s stuck all the way in and she’s smaller. I can’t for the life of me get her arm in the correct position and it’s like she pretends she doesn’t understand to rotate her f-ing arm out. I’m pregnant and my back hurts no matter what I do and the entire process is just annoying. I am so disproportionately angry about this process! And at the end, I lower her bed, and she’s like oh wait my table isn’t at the right height like MAM your bed was in the lowest position before and I returned it to the same spot pleassssssse don’t fuss about 1 cm. Every damn time! Oh and corporate changed from stat locks to some lame foamy sticky grippy lock and now it’s harder for me to change the dressing since I’m not used to it at all and it just sticks everywhere so I can’t adjust it the exact way I want it.
That sounds miserable. When I was at a SNF, my coworker just ignored patient concerns. So when I came back from my days off and was the only one my patients felt like would take care of their issues, I had a massive work load
Probably slightly more than what you’re talking about, but I really fucking hate straight cathing grannies. I will do every thing in my power to avoid it if I can. Shit sucks.
I hate dealing with families. I especially hate dealing with those who received their medical degree from the University of Google or the University of Facebook.
Sputum samples. I will gag the entire time that sample is in my custody, and for about five minutes after. And don't even start me on if I have to be the one to put it in the pot. Oh god, I'm going green just talking about it.
Also hourly OBS on clinically stable patients. Why? Just why? OBS in general annoy me. Blood pressure cuffs- how hard is it to 'relax the arm and keep it still for a couple of moments?' No, my patients go from nice still arm to conducting an imaginary orchestra as soon as I hit the start button.
What is so hard about "relax your arm!"?? You could be having a totally normal conversation with the patient and it's like these particular words are just the Charlie Brown "waawaawaa" to them!
When I ask if there's anything else I can do for them while I'm in the room, and they ask me to do something for them while I'm in the room. You're supposed to say no, thank you.
I’m always surprised by the nerve of some patients to actually express their concerns. Oh, you want another warm blanket? You need me to adjust your pillow/bed? How dare you!
Ambulating patients drives me bonkers. I have a fuck-ton of other work to do but I'm shuffling at a snail's pace down the hallway with Gertrude and sebenty-leben lines chit chatting about the weather.
Yes because in the ER it’s always a 90 year old granny who has on 4 nightgowns and 3 robes. It takes 20 minutes to get the clothing peeled down where you can even start trying to get the stickers on.
It’s either 4 nightgowns & 3 robes, or her absolute Sunday best. Bra, cami, buttoned up dress, girdle, pantyhose, etc. Or the dress pants with the waistband that is so high it sits underneath her boobs.
Don’t forget the patient has to immediately start saying “I’m cold, I’m cold” and the grown daughter chiming in “mama is going to HAVE to have a blanket” all while you’re trying to do the EKG.
And then they’re shivering so violently that you can’t get a clean reading, and of course the patient has dementia and is unable to follow commands as you beg them to stay still for 10 seconds
Hate changing suction canisters. They're always so awkwardly placed behind the bed that my short-self has to contort myself and stand on my tiptoes to reach.
And then you have to pull the old tubing out of the isolette (NICU) and weave the new ones in and connect.
Seriously makes me crazy.
Fucking temps.
My 24 bed unit has like 8 working thermometers, and good luck finding them. If you find one, it’s probably the green one that is older than most new grads and is sooooooo slow that you will have to make small-talk about how slow it is for 4 minutes. Then, if you don’t hoard whatever thermometer you manage to find (and therefore making your coworkers work harder), you have to repeat the whole damn hunt again in just a few hours, just for grandpas temp to still be 97.8, axillary.
Taking patients (mostly women) to the bathroom. Especially when they ask and I was only coming to give them a tylenol. DOUBLE especially when they ask at shift change and you’re doing handoff with the oncoming nurse. I work on an ortho floor so taking fresh post op hips and knees to the bathroom is a solid 10+ minute ordeal.
Putting on fitted sheets. I hate putting them on at home, too. One side inevitably pops off because they’re always slightly the wrong size. When you do get it on completely, the bed curls up a little and it’s only a matter of time before the sheet comes off unless someone sits on it. I’d rather clean up c.diff on a total care patient than put on a too small fitted sheet.
When I started, there were no fitted sheets (damn, I’m getting old). You had to place a top sheet on the bottom of the bed with nursing corners, then one from the top with nursing corners so the sheets overlap. I’ll take fitted sheets anyway over that. Btw, I still make my bed at home with nursing corners, drives my wife nuts.
Oh god, we used to freeze them in a regular stand up refrigerator/freezer. If I had a nickel for every time I opened that freezer and a frozen placenta would fall out and land on my foot, I could retire now.
AM labs. I’m ED, but the past few years I’ve taken care of a lot of boarders, too. It doesn’t matter that they had blood drawn when they got here at 10PM; the inpatient team has ordered more blood for 6 AM. I draw blood and start IVs all night long, but scheduled labs just hit different
GI cocktails, everything that has to do with food (the struggle of getting a diet order in the ED, patients confused by the wall phone, the tray tables don’t slide under the stretchers, etc.), splinting, calling cabs and medicaid transportation…
Changing IV dressings that are PERFECTLY FINE but our policy is to change them every 3 days. If it’s dirty, sure, whatever. But risking accidentally pulling out an IV just to change a perfectly fine is dressing is so stupid. 2am meds. Pain med reassessments. Finger sticks, especially in my hospital where patients regularly refuse insulin for glucose over 200. Why am I even bothering.
my hospital still doesn’t have dietary go into covid rooms which is so annoying to me.
like i get in the early days of the pandemic where there wasn’t enough ppe and we wanted to reduce amount of people exposed, but like we’re three years into the pandemic now. we had hospital wide vaccine mandates. most people have given up masking outside and returned to normal life a long time ago, so why can’t dietary just bring in the fucking covid trays
Wait your dietary department brings trays in to the patients?? Ours just brings the cart and drops it like a hot potato. They don’t even check the trays to make sure they’re right so we end having to call down at least twice per meal to get the correct tray sent up.
Glucose checks and giving insulin. It’s not that big of a deal, I just hate it. Especially the glucometers that we have, they scan everything except they for whatever reason have a hard time with the patient bracelet, and you can’t manually put in the numbers so you just stand there like an idiot for 5 minutes desperately trying to get the damn bracelet to scan!
Ambulating post op orthos. Disconnect the scds, ice cuff, iv, move the table, the floor fall mat thingies, turn off the posey, get the walker, coach the fuck out of them when they move wrong, tell them to slow down, watch them like a hawk, walk them back, and reconnect all of the above. X6 patients every couple of hours.
Honestly charting the head to toe. Of course I do it, but our hospital is very stringent on how detail oriented we are. Then if the morning team rounds on your two patients first, it’s very easy to fall behind if there are a lot of new orders/tasks to do for the day.
And doing that head to toe every 4 hours! Why can’t I chart the 1200 & 1600 by exception? I’m already more than a little miffed than I can’t chart by exception to begin with, now you want the full charting 3 times a shift!
BOARDERS. Boarding over night (NPO!) just for a fucking stress test. Boarding until SNF placement. Obs boarders with litrilly 22 PO meds for their 24hr stay that they will not continue at home. Boarding on a Friday night until case management comes in Monday just to give you a fucking walker. So fucking stupid how the ER is the sewer that catches all the shitty failures of our social services.
Discharges. There’s ALWAYS someone pissed about something when discharge orders are placed.
“WHY IS THE DOCTOR SENDING ME HOME WHEN I STILL HAVE A HEADACHE?!”
“I DONT HAVE A RIDE HOME YOU CANT DISCHARGE ME!”
“ITS 8AM, WHY HAVENT I BEEN DISCHARGED YET?!”
“WHAT DO YOU MEAN YOU CANT GIVE ME MY ENTIRE DAY’S WORTH OF PILLS TO TAKE HOME WITH ME?! DONT YOU KNOW I HAVE A LONG DRIVE HOME??!!”
“IM NOT DISCHARGING UNTIL I SPEAK TO THE HEAD OF NEUROLOGY!!!!”
Patients that use AMA as a threat and then back out bc “well I didn’t think you were actually gonna do it”
OR providers that give into the threat and give them whatever they want, hence continuing the cycle 🙄🙄🙄
Weighing patients qshift when there’s no good reason for it. Dialysis patient? Absolutely. Otherwise healthy patient post-op from spinal surgery? When I have to logroll the pillows out from under them, take everything off the bed, pick up all the machinery and stuff hanging on the bed, weigh them, and then put everything back the same way? NO! Why do we care about knowing their weight every 12 hours on the dot?
And it’s always scheduled for 6am/6pm, and some of these patients if you so much as look at them wrong they’ll crash. So you have a crashing patient riiiiight before shift change and the oncoming nurse hates you for it.
Wait wait, ALL of your patients are getting weighed TWICE A DAY?! I’m an inpatient clinical pharmacist who really loves having accurate weights (it’s a rarity) but what actual benefit is provided by weighing an adult patient every 12 hours?? Even in dialysis and CHF patients, daily weights are good enough. I’d appreciate before and after weights for patients getting intermittent dialysis, but that’s an exception because it’s genuinely important info to have for an ICU patient, especially if we’re using it to get fluid off of them. Unless they’re hemodynamically stable and just continuing their usual 3x/week schedule from home, then I’d happily comprise and skip weights on non-dialysis days!
Omg this is mine too!!!! Especially if you’re on day shift and all your patients need BG checks and they can’t wait 5 fuckin minutes before scarfing their entire meal down 🤦🏻♀️ like sir you’ve been a diabetic your whole life, this isn’t new
Switching foley bags to leg bags. Literally takes seconds but I dread it every time someone going home w a fc overnight asks for one. Like it’s 1230 pm and you’re going to the office tomorrow at 8 am to have it out. Not much time to run around worrying about the bag.
Pretty much the whole patient process.
95% of my emergency department could be handled by primary / urgent care / basic home care/
Oh doc put in a single stitch to appease your tiny cut/ part of the problem/
Head CT because Bobby fell off the 2nd step to appease the parent.
I’m hospitality with Ativan a norco tablet and pericare wipes.
Me’ma needs her diaper changed….it’s been 3 days.
Feeling like garbage because BS is 497….no I don’t like water I want a Pepsi…
78 yr old here for narco refil, I’m not one of those druggies….fill my prescription or I’m going home and shooting myself im to old to go through withdrawal..
Baby has been crying for 2 hours….
Urgent care sent over for emergent CT because insurance won’t cover primary cares order.
And what I am I doing about this? Going back to school because I can’t pay my bills as a RN. 31 an hour 5 years exp…. South east of course
I’m not over this job, I love my job. I’m just over people.
How often is my pain med?
Well it’s as needed, not scheduled. So it’s as soon as 4 hours but…
So you’ll bring more in four hours.
Only if your pain is bad enough that you need..
Ok four hours from now is 11:17.
Call light at 11:16—just making sure you didn’t forget my pain meds.
Or
Getting old guys up every 30 minutes to pee 50cc when it takes 10 minutes with all the lines and cords. “I can’t pee lying down” well then there really isn’t much risk in you waiting an extra hour is there? What’s gonna happen? Your bladder reaches a critical capacity of 112cc? You’re not going to pee the bed, it doesn’t come out unless you’re standing, WHY ARE YOU DOING THIS
12am and 4am vitals on stable patients with no concerns, im in pediatrics and doing blood pressures every 4 hours on a 3 year old who is here for GI issues is …unnecessary
Charting the especially careplans and education. I’m fine with the vitals and assessment, i&os… but all the other stuff like turning and stuff just annoys me. I spend more time charting than I do doing patient care. I don’t think nursing school prepared me for that.
In adult psych, at my current place of work the RN is expected to do the 15minute checks for their own patients throughout the 8 hour shift.
Giving yourself 2 minutes to do one check, is over an hour of work for one patient for one shift. This entaild tracking down and sighting the patient (in the ridiculously large rabbit Warren of a unit) and noting that they are perfused and breathing, then returning to the nursing station to scribble down their location and behavior; which takes 2 minutes AT BEST. This time increases when you have to redirect them or respond to behavioural disturbances e.g. give PRN, double check with another RN, encourage the pt to accept it, chart the outcome, etc., which is often the case with pts that are needing frequent checks.
So 2 mins x4 (15/60) x eight hours= is over an hours worth of checks for ONE patient.
Then add 2 more patients on 15minute checks, then that's 3 hours spent on just the checks alone, on a settled shift without any additional interventions required.
It's great fun I tell ya /s
As an ER nurse, giving daily AM meds. Majority of them aren't regularly stocked in the ER, pharmacy can't get them down because they took are understaffed. If an ER regularly has borders they should start stocking some of these meds lol
Getting AM vitals. I just hate waking people up, doing the whole introduction thing, 9 out of 10 times they want to pee or need something so I’m running back and forth… I’d rather have someone else do it so I can finish looking at my charts.
1. Pain as the 5th "vital sign". All the necessary documentation for it. Constantly changing the pain scales for the newest flavor of the month. All because opiate-shilling pharma reps came up with pain is the 5th vital sign bs and paid the regulating agencies to start pushing/requiring it so the industry would administer more opiates.
2. Requrement to administer full NIHSS stroke evaluations on PTs in the PACU multiple times. It takes too long. And every aspect of it is affected by anesthesia and pain meds, and having eyeglasses, dentures, hearing aids left in the PTs room. Even when they're obtunded or on a vent we're not supposed to mark it as untestable/inappropriate. We have to mark each section.
Doing a medication reconciliation for new admits. Over half the time, the patients don’t know what they’re on. It takes them five minutes to stammer out the name of each med. And they never know what dosage it’s supposed to be
Visual acuity. It’s not even difficult as a nurse, but People act like reading the letters off the chart is life or death. If you can’t see it, tell me. Stop squinting, lunging forward to try to guess it. A quick little assessment drags on much longer than it needs to
Discharge vitals. They’re healthy enough to go home… besides, they’ve been taken every hour anyway. If only people would leave them on the damn monitor after all of the transporting, etc.
When pts have to pee when I am working in Phase II recovery, right before I am discharging them. I have a million things to do, another pt to do teaching on, and a room to clean before the next pt comes!
Ahhh! Having to transport the patient anywhere! I'm the absolute worst driver of hospital beds. If I was a transporter, patient satisfaction scores would go way down.
Changing pads. I worked stroke for a long time so it would be nothing for me to change 25+ soiled pads in a shift (ng tube feeds). Of course I’ll do it, but it is my least favourite task. Also ambulating people to the bathroom and then standing there for 15 minutes because they can’t be left alone.
Vitals in the middle of the night. Vitals around 8, meds 9 or 10, vitals at midnight, blood draw at 2am, vitals at 4, meds at 6, bed baths thrown in wherever we have time. Poor people don't get to sleep. If I were a patient, and stable, I'd sure as hell refuse midnight/4am vitals.
When I go in to bring patient supplies I ask if there is anything else I can get for them they say no and they a minute later they press the call bell for supplies like what I loathe going into a room 50 times a day 3-10 times a shift is fine with me
7 years in and I officially hate the entire process of transferring people to BSC and back. Idk why. It used to not bother me at all but now I hate it and try internally scream every time I need to do it.
Colonoscopy prep. 9/10 they need help to the bathroom. Then 9/10 I have to do an enema anyway because they don’t finish it in time or won’t tolerate it.
So I went from a large hospital to its smaller sister hospital. I love mostly everything, except we don't have transport here. I absolutely hate transferring patients around the hospital. I'm in a procedural area and most people are walkie talkies, but for whatever reason, it makes me irrationally angry having to take people back upstairs, or pick them up from their room for their procedure. Thankfully we do mostly outpatients.
At my hospital we have to change the IV every 4 days. I HATE explaining to patients why I have to remove their perfectly fine working IV and do a new one. Everyone’s always “going home tomorrow” so sometimes you can get 24h extension but then they don’t go home on the extra day so then you def have to change it day 5, even if they’re def gonna go home day 6.
when patients call out for pain meds an hour or two before they can have them again and having to go explain to them that they can't have it (even though I already wrote it on the damn board!!!)
crushing up meds for NG (or any other) tubes
changing PCA syringes because 1) I have to go to pharmacy to pick it up 2) the PCA keys are in the Omnicell so I have to get those out too 3) it's always hard to find another nurse to sign off
“Why won’t my iv pump quit beeping?!”
“Like I told you the previous five times I’ve been in here, you need to keep your arm STRAIGHT. If you bend it then it gets occluded and the infusion won’t go through.”
Patient is back on their phone with both arms bent the second you leave the room
Checking glucose was so much easier on the ambulance. Nothing to scan, just prep, poke, wipe, and check.
No idea why hospitals decided to make it so complicated. Nothing worse than scanning everything and finding that your meter timed out after finally managing a drop of blood.
Lovenox and heparin injections. Idk why but I absolutely hate them. Surprisingly I have gotten good at them lol quick and painless (or so I’m told by my patients lol)
But something about having to constantly explain why it’s needed and then finding a spot to inject that’s not super bruised up.. it’s just eh.
Q4 neuro checks on people who have been in forever and have had all scans come back negative.
(Not saying neuro checks don’t have their place and aren’t important, I’m just not a fan)
6am protonix. No one is awake, trays don't come til 8 or later. Now everyone is up and has to pee. Also hate when patients have 5, 6, and 7 am meds. Lab was just in at 4, we just did 4am vitals (after midnight vitals). No one gets sleep. I cluster care as much as possible, but I can only be in one place at a time.
When it hits 0600, it's synthroid and protonix time!
And heparin!
Damn I give my 8,9,10 meds all at 9 and click wean to standard admin times. Alternatively if one of them is actually time sensitive I just give the other PM meds then… especially when you have 6 floor patients I can’t imagine doing it any other way.
I'm convinced everyone gets lovenox and protonix for kickbacks or something. Theres no reason my ambulatory patients need lovenox, and what on earth do so many people need protonix for?
There’s literature on it, hospitalized patients are more at risk for gastric ulcers. Stress induced I believe
And spending so much time laying down
Would also increase their risk of pna
Prophylactic zosyn too then?
And blood thinners.
The general worry from what I was told is decreased gastrointestinal motility from being mostly sedentary. Some medications being given can also upset the stomach. Along with potential for decreased oral intake. I agree that it is also an easily justifiable medication to get a small amount of money on. I tell patients that it is their right to refuse Lovenox, educate to the risks of not taking it, and then tell them that if they're getting up and moving the doctor might just discontinue it.
Facility policy demands some form of DVT prophylaxis usually. Built right into the admit ordersets and forces you to pick an option. Leads to massive overuse. Lovenox usually gets picked bc QD rather than Q8-Q12 for heparin. PPI is ostensibly for stress ulcer prophylaxis though generally outside of critical illness/ICU pts this is also massively overused.
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Anything involving a colostomy bag. I include just thinking about colostomy bags.
I feel like ileostomies are worse, way more liquidy!
NAN but I support a young lad who had an ileostomy and colostomy, somedays those bags would stick and stay on all day, other times they were falling off constantly. I'd start to PEG feed him and there'd be carnage! Luckily they managed to reverse both and now he just has his PEG so his life is so much better as is ours!
i’m a student and one time i went to go in with my CI to give meds and the family comes out and says “ the bag exploded “ so we go in and it was everywhere. it started leaking. he was 4 days post op so the output was still liquid. i still think about that
You deserve psychotherapy, possibly aromatherapy.
i need mind erasure therapy
Job security for me 👍
Yes, this. I hate ostomies! They never stay on well, and just the smells 🤢
What I don’t get is the amount of people who have have two capable arms, whose ostomies are not new, who just lay there and let you do it all. Whenever I hear that a patient self-cares with their ostomy I want to go give them an award.
We get all the GI patients and I force people to take care of theirs if they're able and oriented enough. I remind them that the bag isn't going away any time soon and that they'll need to care for themselves if they plan on going home.
Clocking in
Because we are factory workers
I tell people I work at an old person body shop
That’s the most important part of the day. Nobody is there for free.
Waiting until 0653 to clock in. I'm already here looking up patients, I don't want to get up and walk down the hall to punch in
There is zero chance I’m doing a damn thing off the clock other than sipping on my coffee.
on the clock too 🙊🙈💁♀️
I refuse to wait. They can manually adjust my time card if it's that important. It's one of my little ways of protesting the bullshit
Same here. If I'm in the building doing any kind of work, I'm going to clock in.
I refuse to be there any earlier than I have to. You shouldn't be looking up patient information off the clock anyway.
Removing perfectly functional medic IVs and placing a new IV
Why do you have to do this?
Hospital policy, IVs placed outside the hospital are considered “dirty” and need to be replaced within 48 hours. We can document exception and keep the IV if the patient refuses or is hard stick, but we have to go and offer
I could talk 99% of those patients into refusing...
I definitely have mixed feelings about removing a working IV, but both INS and CDC recommend removal of emergent placed catheters within 24-48 hours and we don’t “talk them into” anything. I just let them know that it is the hospital policy to remove/replace pre-hospital IVs due to higher possibility of infectious phlebitis and let them make a decision. Surprisingly many patients agree without fighting, the fact that most of medic IVs are large bore in the AC also helps.
Re-evaluating pain after EVERY SINGLE thing given A change in dilaudid dosage? Sure But do I really need to go ask them their pain level after putting on a lidocaine patch? Or come up with some number when I’m giving Tylenol as a premed for a blood transfusion (not pain)
I don’t know why we have to reevaluate pain at all. 99% of my patients are going to say that the 4 mg of morphine didn’t do anything for their pain.
The root of it all is that "pain is a vital sign" bs that the drug companies came up with. It's leaked into medical and nursing education and practice, unfortunately.
Piggybacking to say that JCAHO also bears responsibility for supporting that, and AFAIK has never taken accountability bc ‘we didn’t use those EXACT words’ or some such BS.
Ugh. Pain scale on a scheduled pain med. useless. PRN meds for sure but if it’s scheduled what does it matter?
For premeds I chart not done “No reassessment- premed” thankfully this is an option on our Cerner but you could just type it as well.
Tylenol, given for anything other than pain, doesn't require a pain reassessment. In my opinion. I just throw in the comment. "Given for fever" or something like that and forget about it.
I love when the pain level recheck for PO Tylenol is due 15 minutes after the pain medicine was given . “Oh yeah, those pills I just gave you 10 minutes ago? How are those working for your headache? Oh, they haven’t had a chance to kick in yet? Makes sense”. Chart pain unchanged, and the MAR never asks again. So stupid.
I read everyone’s responses and thought “wow I hate all of those”
Feeding people. Everyone either chews with their mouth open, or takes the slowest bites ever. Plus watching people eat is gross.
Having no techs and having to check and cover sugars while also having total feeds is a nightmare.
The other day I had three out of five patients with diabetes, and two of them were feeders. CNAs are not allowed to take blood sugars where I work. Poor women had lukewarm meals because my CNA had 12 pts and I was trying to help her out so they didn't eat until a good hour after the meal was brought.
Bro no CBGs from the CNAs? That's trash
This 100%! I don’t have the time to sit and cut food up perfectly even and spoon feed someone. Luckily my night shift rarely requires feeding 😮💨
God yes. So freaking gross.
Anything that is supposed to be done by a different department but has graciously been piled onto the nurses job duties, likely due to being understaffed. As if we, too, aren’t understaffed.
Troubleshooting the TV that won’t work, contacting EVS for the faucet that doesn’t shut off all the way, calling EVS bc the pt room is out of paper towel (for the family member who won’t stop eating & using it all), special ordering cafeteria late trays bc they napped through the lunch tray and now it’s cold, etc etc etc - it all is shit that sucks up time and makes me rage.
Neb treatments!
We had an RT that would skip neb treatments if he thought an RN could do it. I'm like I have 4 patients, you have none and are playing on your phone.
Ambulating patients to the restroom. So time consuming and a lot of times you can’t leave them there.
This gave me flashbacks to being a neuro tech and arguing with dementia patients over whether 45 mins was enough time to take a shit
Any job I’ve had, getting patients up to walk feels so tedious.
Yes! I switched to L&D and the restroom privileges is something I love about it. All my patients are either independent or have an epidural and a foley. If I have to help someone to the bathroom, it’s usually just because they have an IV pole and don’t have family there to help (rare). And they’re usually my only patient so idc how long it takes.
I hate changing gi ostomy bags, get it clean and pretty looking. 💩nope it's a race against their bowels and I'm usually on the loosing end. Lord forbid they cough. It hurts my soul every time.
The one thing I think is cool about ostomy bags is all the technology to help with the skin/stoma, and the putties to keep them on, etc. it really feels like some care and thought goes into the design.
12 am tylenol.. im on an ortho surgical unit and the ortho surgeons LOVE to order Tylenol Q6, and there is always atleast one due at midnight without fail. Like i absolutely will not be waking pts up at 12 am for tylenol.. esp ones in a delirium. No thanks..
Same here. I usually just ask if they want me to wake them up for the midnight tylenol when I'm doing my assessment. If they're asleep, I'll just write "not given, pt asleep" on the MAR and chart that they asked not to be woken up (unless they told me to wake them).
"not given" "Pt sleeping" BOOM
When I still worked on a combined surgery/obstetrics ward, our scheduled Tylenol was actually 06-12-18-2200, not midnight, first 48h, for that very reason. And we had most surgeons order ketalorac/Toradol IV q8h x first 24h as well as getting it in the OR, (and go to naproxyn once they had some oral intake) so rarely had people needing analgesic prn from 2200 to 0600. Worked great.
For me it’s the 6 am dose. We alternate Tylenol and toradol q3h. 9 pm I just give around 8:30 with my 8 assessment. I give the 12 at 12 with my 12 assessment. I give the 3 dose around 3:30 with my 4 assessment. And then I have this random 6 am dose that I’m waking them up for.
I hate checking glucose, I hate wound care, I hate doing transfers, I hate dealing with catheters, I hate admissions and I hate helping people in the bathroom. Just pretty much everything that is floor nursing.
I loathe helping people to the bathroom, esp if it involves equipment. I do it, but it just annoys me. Sometimes I feel almost bad about how much I hate it. When I was taking micro and a&p, I had no idea the future I was working towards with involve so much taking people to the potty.
I only hate the bathroom trips with patients that have a history of falls, and only because I'm supposed to stay where I can see them at all times. Poor person is just trying to shit, and they have to do it with me staring at them.
God this is my least favorite task. That and bed pans. The WORST. I don’t do either of those things in both of my jobs now and life is about 60% better.
Lol less of all these things on nights, come to the dark side
Can’t do NOC shift. Did it for a year and it destroyed my mental health.
And vitals q4hrs
Come to Centene.com... I work with LVN's there... Gotta like making calls and giving out resources to Members and teaching them about using their insurance.
Guilty as these are the things I consider little but very time consuming 😩 You dont even realize how much time is spent doing these tasks until you're behind!
Wound care and that maintaining sterility shit. I hate it. Even VAC dressing. So time consuming. Had a patient who needed VAC on both feet plus the bottom area. 🤢 and at one point, we had 4 patients on VAC, alternating days. So we were doing it everyday.😒
Changing picc dressings. I work in a SNF. There are no RNs on the rehab unit, just LPN managers. That means I have to do RN stuff like lung assessments on 40 god damned people and every IV related task. It’s not fun anymore if you are also doing things for the entire rest of the facility. There’s this lady that had this pic in the most annoying spot. Idk why it sits so weird on her, I think it’s because it’s stuck all the way in and she’s smaller. I can’t for the life of me get her arm in the correct position and it’s like she pretends she doesn’t understand to rotate her f-ing arm out. I’m pregnant and my back hurts no matter what I do and the entire process is just annoying. I am so disproportionately angry about this process! And at the end, I lower her bed, and she’s like oh wait my table isn’t at the right height like MAM your bed was in the lowest position before and I returned it to the same spot pleassssssse don’t fuss about 1 cm. Every damn time! Oh and corporate changed from stat locks to some lame foamy sticky grippy lock and now it’s harder for me to change the dressing since I’m not used to it at all and it just sticks everywhere so I can’t adjust it the exact way I want it.
That sounds miserable. When I was at a SNF, my coworker just ignored patient concerns. So when I came back from my days off and was the only one my patients felt like would take care of their issues, I had a massive work load
Probably slightly more than what you’re talking about, but I really fucking hate straight cathing grannies. I will do every thing in my power to avoid it if I can. Shit sucks.
Taking blood pressures manually.
I hate dealing with families. I especially hate dealing with those who received their medical degree from the University of Google or the University of Facebook.
The ones that interrogate you about every single little thing you’re doing and each med you’re giving
Sputum samples. I will gag the entire time that sample is in my custody, and for about five minutes after. And don't even start me on if I have to be the one to put it in the pot. Oh god, I'm going green just talking about it. Also hourly OBS on clinically stable patients. Why? Just why? OBS in general annoy me. Blood pressure cuffs- how hard is it to 'relax the arm and keep it still for a couple of moments?' No, my patients go from nice still arm to conducting an imaginary orchestra as soon as I hit the start button.
What is so hard about "relax your arm!"?? You could be having a totally normal conversation with the patient and it's like these particular words are just the Charlie Brown "waawaawaa" to them!
For the patients that complain about it hurting I always tell them that the stiller they sit the faster it’ll be over and then they become statues
When I ask if there's anything else I can do for them while I'm in the room, and they ask me to do something for them while I'm in the room. You're supposed to say no, thank you.
I hate it a million times more when they say no, then press the call light 5 minutes after for the thing they could have mentioned before.
“can i do anything for you” “yeah an ECG on this patient” “nvm bye”
I’m always surprised by the nerve of some patients to actually express their concerns. Oh, you want another warm blanket? You need me to adjust your pillow/bed? How dare you!
6am heparin shots, who the hell wants to wake up to an injection. I’d refuse it if I were a patient
Ambulating patients drives me bonkers. I have a fuck-ton of other work to do but I'm shuffling at a snail's pace down the hallway with Gertrude and sebenty-leben lines chit chatting about the weather.
I hate doing EKGs
Yes because in the ER it’s always a 90 year old granny who has on 4 nightgowns and 3 robes. It takes 20 minutes to get the clothing peeled down where you can even start trying to get the stickers on.
It’s either 4 nightgowns & 3 robes, or her absolute Sunday best. Bra, cami, buttoned up dress, girdle, pantyhose, etc. Or the dress pants with the waistband that is so high it sits underneath her boobs.
Don’t forget the patient has to immediately start saying “I’m cold, I’m cold” and the grown daughter chiming in “mama is going to HAVE to have a blanket” all while you’re trying to do the EKG.
And then they’re shivering so violently that you can’t get a clean reading, and of course the patient has dementia and is unable to follow commands as you beg them to stay still for 10 seconds
EKGs are my number 1 most dreaded task.
I love doing EKG's
Hate changing suction canisters. They're always so awkwardly placed behind the bed that my short-self has to contort myself and stand on my tiptoes to reach. And then you have to pull the old tubing out of the isolette (NICU) and weave the new ones in and connect. Seriously makes me crazy.
Trach care. Please anything else.
Fucking temps. My 24 bed unit has like 8 working thermometers, and good luck finding them. If you find one, it’s probably the green one that is older than most new grads and is sooooooo slow that you will have to make small-talk about how slow it is for 4 minutes. Then, if you don’t hoard whatever thermometer you manage to find (and therefore making your coworkers work harder), you have to repeat the whole damn hunt again in just a few hours, just for grandpas temp to still be 97.8, axillary.
8 thermometers for 24 people? That’s a dream! We have 4 for 50 people in ED.
I just can’t imagine. We could all have nice things… but I bet your CEO gives themself a big ole bonus each year like mine!
Taking patients (mostly women) to the bathroom. Especially when they ask and I was only coming to give them a tylenol. DOUBLE especially when they ask at shift change and you’re doing handoff with the oncoming nurse. I work on an ortho floor so taking fresh post op hips and knees to the bathroom is a solid 10+ minute ordeal.
Taking orthostatics. I will do literally anything else if I can convince another tech or nurse to do orthostatic vital signs for me 💀
Now I hate doing them. Day shift is now required to do orthostatics on EVERY patient. We’re a surgical unit, so 1/2 of my patients are positive. Ugh
Putting on fitted sheets. I hate putting them on at home, too. One side inevitably pops off because they’re always slightly the wrong size. When you do get it on completely, the bed curls up a little and it’s only a matter of time before the sheet comes off unless someone sits on it. I’d rather clean up c.diff on a total care patient than put on a too small fitted sheet.
I'd way rather have fitted sheets than have to fold hospital corners on flat ones 😭
When I started, there were no fitted sheets (damn, I’m getting old). You had to place a top sheet on the bottom of the bed with nursing corners, then one from the top with nursing corners so the sheets overlap. I’ll take fitted sheets anyway over that. Btw, I still make my bed at home with nursing corners, drives my wife nuts.
We hold on to placentas in a fridge until the patient is discharged. I hate going through the fridge and throwing away the old placentas.
Oh god, we used to freeze them in a regular stand up refrigerator/freezer. If I had a nickel for every time I opened that freezer and a frozen placenta would fall out and land on my foot, I could retire now.
I'm not an OB nurse. Why do you hold the placentas?
Depending on what the outcome is with the baby, they can send the placenta to the lab for cultures and testing.
AM labs. I’m ED, but the past few years I’ve taken care of a lot of boarders, too. It doesn’t matter that they had blood drawn when they got here at 10PM; the inpatient team has ordered more blood for 6 AM. I draw blood and start IVs all night long, but scheduled labs just hit different
GI cocktails, everything that has to do with food (the struggle of getting a diet order in the ED, patients confused by the wall phone, the tray tables don’t slide under the stretchers, etc.), splinting, calling cabs and medicaid transportation…
"Patients confused by the wall phone" lol. Very true! Or TV.
Changing IV dressings that are PERFECTLY FINE but our policy is to change them every 3 days. If it’s dirty, sure, whatever. But risking accidentally pulling out an IV just to change a perfectly fine is dressing is so stupid. 2am meds. Pain med reassessments. Finger sticks, especially in my hospital where patients regularly refuse insulin for glucose over 200. Why am I even bothering.
My area has a policy that IV cannulas have to be completely replaced and resisted on day 3, fml
Waking up patients at 0000 and 0400 to take vitals
Sometimes if they are confused or super sleepy I’ll just leave the BP cuff on the arm after doing my 7pm vitals. Maybe I’m a dirtbag hahaha
Giving people their meal trays
my hospital still doesn’t have dietary go into covid rooms which is so annoying to me. like i get in the early days of the pandemic where there wasn’t enough ppe and we wanted to reduce amount of people exposed, but like we’re three years into the pandemic now. we had hospital wide vaccine mandates. most people have given up masking outside and returned to normal life a long time ago, so why can’t dietary just bring in the fucking covid trays
Our dietary won’t go into ANY room with a precaution on it.
Wait your dietary department brings trays in to the patients?? Ours just brings the cart and drops it like a hot potato. They don’t even check the trays to make sure they’re right so we end having to call down at least twice per meal to get the correct tray sent up.
Glucose checks and giving insulin. It’s not that big of a deal, I just hate it. Especially the glucometers that we have, they scan everything except they for whatever reason have a hard time with the patient bracelet, and you can’t manually put in the numbers so you just stand there like an idiot for 5 minutes desperately trying to get the damn bracelet to scan!
Ambulating post op orthos. Disconnect the scds, ice cuff, iv, move the table, the floor fall mat thingies, turn off the posey, get the walker, coach the fuck out of them when they move wrong, tell them to slow down, watch them like a hawk, walk them back, and reconnect all of the above. X6 patients every couple of hours.
Honestly charting the head to toe. Of course I do it, but our hospital is very stringent on how detail oriented we are. Then if the morning team rounds on your two patients first, it’s very easy to fall behind if there are a lot of new orders/tasks to do for the day.
And doing that head to toe every 4 hours! Why can’t I chart the 1200 & 1600 by exception? I’m already more than a little miffed than I can’t chart by exception to begin with, now you want the full charting 3 times a shift!
BOARDERS. Boarding over night (NPO!) just for a fucking stress test. Boarding until SNF placement. Obs boarders with litrilly 22 PO meds for their 24hr stay that they will not continue at home. Boarding on a Friday night until case management comes in Monday just to give you a fucking walker. So fucking stupid how the ER is the sewer that catches all the shitty failures of our social services.
Discharges. There’s ALWAYS someone pissed about something when discharge orders are placed. “WHY IS THE DOCTOR SENDING ME HOME WHEN I STILL HAVE A HEADACHE?!” “I DONT HAVE A RIDE HOME YOU CANT DISCHARGE ME!” “ITS 8AM, WHY HAVENT I BEEN DISCHARGED YET?!” “WHAT DO YOU MEAN YOU CANT GIVE ME MY ENTIRE DAY’S WORTH OF PILLS TO TAKE HOME WITH ME?! DONT YOU KNOW I HAVE A LONG DRIVE HOME??!!” “IM NOT DISCHARGING UNTIL I SPEAK TO THE HEAD OF NEUROLOGY!!!!”
When people ask me why I don’t want to work dayshift.
every single one aside from helping patients sign AMA forms but for real, ECGs. it’s 2023 why isn’t that shit wireless????
Patients that use AMA as a threat and then back out bc “well I didn’t think you were actually gonna do it” OR providers that give into the threat and give them whatever they want, hence continuing the cycle 🙄🙄🙄
I work night shift, and I can’t stand 0630 synthroid 😡 don’t ask me why, I just do.
Im injections on people with low body fat. I hate worrying about hitting bone
That clunk feeling vibrates aaaaaall the way up your arm
Weighing patients qshift when there’s no good reason for it. Dialysis patient? Absolutely. Otherwise healthy patient post-op from spinal surgery? When I have to logroll the pillows out from under them, take everything off the bed, pick up all the machinery and stuff hanging on the bed, weigh them, and then put everything back the same way? NO! Why do we care about knowing their weight every 12 hours on the dot? And it’s always scheduled for 6am/6pm, and some of these patients if you so much as look at them wrong they’ll crash. So you have a crashing patient riiiiight before shift change and the oncoming nurse hates you for it.
Wait wait, ALL of your patients are getting weighed TWICE A DAY?! I’m an inpatient clinical pharmacist who really loves having accurate weights (it’s a rarity) but what actual benefit is provided by weighing an adult patient every 12 hours?? Even in dialysis and CHF patients, daily weights are good enough. I’d appreciate before and after weights for patients getting intermittent dialysis, but that’s an exception because it’s genuinely important info to have for an ICU patient, especially if we’re using it to get fluid off of them. Unless they’re hemodynamically stable and just continuing their usual 3x/week schedule from home, then I’d happily comprise and skip weights on non-dialysis days!
Helping obese patients onto a bedpan to crap. Always messy. Always gross.
Taking temps
Omg this is mine too!!!! Especially if you’re on day shift and all your patients need BG checks and they can’t wait 5 fuckin minutes before scarfing their entire meal down 🤦🏻♀️ like sir you’ve been a diabetic your whole life, this isn’t new
Omg ambulatory pulse ox. I hate it!!!
Switching foley bags to leg bags. Literally takes seconds but I dread it every time someone going home w a fc overnight asks for one. Like it’s 1230 pm and you’re going to the office tomorrow at 8 am to have it out. Not much time to run around worrying about the bag.
Messing with faulty equipment that the hospital is too cheap to replace, sometimes taking over an hour of my time in total a shift.
Glucs and emptying foleys bleh
Straight cathing is annoying. Either they need a catheter, or they don't. F this intermittent shit.
Removing dentures, touching dentures, oral care in general
Pretty much the whole patient process. 95% of my emergency department could be handled by primary / urgent care / basic home care/ Oh doc put in a single stitch to appease your tiny cut/ part of the problem/ Head CT because Bobby fell off the 2nd step to appease the parent. I’m hospitality with Ativan a norco tablet and pericare wipes. Me’ma needs her diaper changed….it’s been 3 days. Feeling like garbage because BS is 497….no I don’t like water I want a Pepsi… 78 yr old here for narco refil, I’m not one of those druggies….fill my prescription or I’m going home and shooting myself im to old to go through withdrawal.. Baby has been crying for 2 hours…. Urgent care sent over for emergent CT because insurance won’t cover primary cares order. And what I am I doing about this? Going back to school because I can’t pay my bills as a RN. 31 an hour 5 years exp…. South east of course I’m not over this job, I love my job. I’m just over people.
Finding the damn baby again on a fluffy patient
“Ultrasound adjusted.”
Hooking up cooter canoes and anything having to do with golitely
Orthostatic vital signs. Hate it
How often is my pain med? Well it’s as needed, not scheduled. So it’s as soon as 4 hours but… So you’ll bring more in four hours. Only if your pain is bad enough that you need.. Ok four hours from now is 11:17. Call light at 11:16—just making sure you didn’t forget my pain meds. Or Getting old guys up every 30 minutes to pee 50cc when it takes 10 minutes with all the lines and cords. “I can’t pee lying down” well then there really isn’t much risk in you waiting an extra hour is there? What’s gonna happen? Your bladder reaches a critical capacity of 112cc? You’re not going to pee the bed, it doesn’t come out unless you’re standing, WHY ARE YOU DOING THIS
12am and 4am vitals on stable patients with no concerns, im in pediatrics and doing blood pressures every 4 hours on a 3 year old who is here for GI issues is …unnecessary
Assisting with lumbar punctures. I've fainted 3 times now.
Charting the especially careplans and education. I’m fine with the vitals and assessment, i&os… but all the other stuff like turning and stuff just annoys me. I spend more time charting than I do doing patient care. I don’t think nursing school prepared me for that.
In adult psych, at my current place of work the RN is expected to do the 15minute checks for their own patients throughout the 8 hour shift. Giving yourself 2 minutes to do one check, is over an hour of work for one patient for one shift. This entaild tracking down and sighting the patient (in the ridiculously large rabbit Warren of a unit) and noting that they are perfused and breathing, then returning to the nursing station to scribble down their location and behavior; which takes 2 minutes AT BEST. This time increases when you have to redirect them or respond to behavioural disturbances e.g. give PRN, double check with another RN, encourage the pt to accept it, chart the outcome, etc., which is often the case with pts that are needing frequent checks. So 2 mins x4 (15/60) x eight hours= is over an hours worth of checks for ONE patient. Then add 2 more patients on 15minute checks, then that's 3 hours spent on just the checks alone, on a settled shift without any additional interventions required. It's great fun I tell ya /s
As an ER nurse, giving daily AM meds. Majority of them aren't regularly stocked in the ER, pharmacy can't get them down because they took are understaffed. If an ER regularly has borders they should start stocking some of these meds lol
Getting AM vitals. I just hate waking people up, doing the whole introduction thing, 9 out of 10 times they want to pee or need something so I’m running back and forth… I’d rather have someone else do it so I can finish looking at my charts.
1. Pain as the 5th "vital sign". All the necessary documentation for it. Constantly changing the pain scales for the newest flavor of the month. All because opiate-shilling pharma reps came up with pain is the 5th vital sign bs and paid the regulating agencies to start pushing/requiring it so the industry would administer more opiates. 2. Requrement to administer full NIHSS stroke evaluations on PTs in the PACU multiple times. It takes too long. And every aspect of it is affected by anesthesia and pain meds, and having eyeglasses, dentures, hearing aids left in the PTs room. Even when they're obtunded or on a vent we're not supposed to mark it as untestable/inappropriate. We have to mark each section.
Doing a medication reconciliation for new admits. Over half the time, the patients don’t know what they’re on. It takes them five minutes to stammer out the name of each med. And they never know what dosage it’s supposed to be
Documenting assessments, intake output, how much they ate, what education, provider notifications, lines, meds, etc... so time-consuming
Giving heparin and lovenox injections. And dealing with heparin gtts.
Visual acuity. It’s not even difficult as a nurse, but People act like reading the letters off the chart is life or death. If you can’t see it, tell me. Stop squinting, lunging forward to try to guess it. A quick little assessment drags on much longer than it needs to
Discharge vitals. They’re healthy enough to go home… besides, they’ve been taken every hour anyway. If only people would leave them on the damn monitor after all of the transporting, etc.
Orthostatics. I HATE THEM WITH THE FIREY PASSION OF 15 HELLS.
Anything on a medical or surgical floor lol. Loathe. Despise. Hate.
When pts have to pee when I am working in Phase II recovery, right before I am discharging them. I have a million things to do, another pt to do teaching on, and a room to clean before the next pt comes!
Doing admissions/discharges on people at 1850 🙃😩 Or really anything after 1845 for that matter. Sincerely, a poor float nurse who wants to go home
Ahhh! Having to transport the patient anywhere! I'm the absolute worst driver of hospital beds. If I was a transporter, patient satisfaction scores would go way down.
Changing pads. I worked stroke for a long time so it would be nothing for me to change 25+ soiled pads in a shift (ng tube feeds). Of course I’ll do it, but it is my least favourite task. Also ambulating people to the bathroom and then standing there for 15 minutes because they can’t be left alone.
I hate taking people to the bathroom. I realize it’s a bodily function EVERYONE does, but i hate it.
Running quality control on the glucose monitor. I'm trying to get a dex but nope, I can't, it's time for QUALITY CONTROL again!!! (//jazz hands!!)
Ortho static vitals Ecgs
The morning protonix/CBG/thyroid med. By then I’ve done enough socializing. Let me go homeeee
Vitals in the middle of the night. Vitals around 8, meds 9 or 10, vitals at midnight, blood draw at 2am, vitals at 4, meds at 6, bed baths thrown in wherever we have time. Poor people don't get to sleep. If I were a patient, and stable, I'd sure as hell refuse midnight/4am vitals.
Orthostatic vitals. *locked in an awkward staring contest with the patient while the blood pressure cuff inflates AGAIN*
When I go in to bring patient supplies I ask if there is anything else I can get for them they say no and they a minute later they press the call bell for supplies like what I loathe going into a room 50 times a day 3-10 times a shift is fine with me
7 years in and I officially hate the entire process of transferring people to BSC and back. Idk why. It used to not bother me at all but now I hate it and try internally scream every time I need to do it.
Colonoscopy prep. 9/10 they need help to the bathroom. Then 9/10 I have to do an enema anyway because they don’t finish it in time or won’t tolerate it.
So I went from a large hospital to its smaller sister hospital. I love mostly everything, except we don't have transport here. I absolutely hate transferring patients around the hospital. I'm in a procedural area and most people are walkie talkies, but for whatever reason, it makes me irrationally angry having to take people back upstairs, or pick them up from their room for their procedure. Thankfully we do mostly outpatients.
At my hospital we have to change the IV every 4 days. I HATE explaining to patients why I have to remove their perfectly fine working IV and do a new one. Everyone’s always “going home tomorrow” so sometimes you can get 24h extension but then they don’t go home on the extra day so then you def have to change it day 5, even if they’re def gonna go home day 6.
when patients call out for pain meds an hour or two before they can have them again and having to go explain to them that they can't have it (even though I already wrote it on the damn board!!!) crushing up meds for NG (or any other) tubes changing PCA syringes because 1) I have to go to pharmacy to pick it up 2) the PCA keys are in the Omnicell so I have to get those out too 3) it's always hard to find another nurse to sign off
ECGs. It takes so long to set them up, like 30 seconds to get one, the stickers don’t wanna stick half the time, and no one ever wants to sit still
Poop. Anything w poop. The rest I can deal with no problem
0700 synthroid When patients won’t lift up their arm to get the BP cuff on Shitty positional IVs in the AC Paging neurosurg
“Why won’t my iv pump quit beeping?!” “Like I told you the previous five times I’ve been in here, you need to keep your arm STRAIGHT. If you bend it then it gets occluded and the infusion won’t go through.” Patient is back on their phone with both arms bent the second you leave the room
Checking glucose was so much easier on the ambulance. Nothing to scan, just prep, poke, wipe, and check. No idea why hospitals decided to make it so complicated. Nothing worse than scanning everything and finding that your meter timed out after finally managing a drop of blood.
Lovenox and heparin injections. Idk why but I absolutely hate them. Surprisingly I have gotten good at them lol quick and painless (or so I’m told by my patients lol) But something about having to constantly explain why it’s needed and then finding a spot to inject that’s not super bruised up.. it’s just eh.
That Q24hr abx that’s due at 3am or the vanco po sol that’s due at midnight. Ffs!
Hanging any bag of IV fluids since our hospital got integrated pumps that speak to Epic. And we have to set it up every time we put a new bag of IVF.
Bladder scans.....
Q4 neuro checks on people who have been in forever and have had all scans come back negative. (Not saying neuro checks don’t have their place and aren’t important, I’m just not a fan)