People think I am stupid

Guest372004 · Jan 4, 2013

Interesting. I will wait to see if we do this. So what happens if they need more piggy backs during this 4 hour period? They are always coming up with something new that takes more time.

Guest343211 · Jan 5, 2013

Reading your original post, my advice is to not "be that person". You have developed a reputation and you need to improve your practice by being consistent and trustworthy. To do this as a new nurse especially, you need to come to work up to an hour prior to your shift and gather information regarding your assigned patients, i.e. hx, iv, tele, tests, labs, Dr notes, etc. Know your patients thoroughly before you step into the room. You may receive this info in report but with your reputation and being a new nurse you need to be prepare yourself accordingly. The goal is to strengthen your reputation by showing that you are putting in the time. Your coworkers will see improved effort and develop respect for you. If you are not prepared to leave your current position you need to develop an action plan. Being a new nurse is very difficult; you are learning so much information on the job and on the go. The first year is the most difficult you need to be proactive in your approach. Ask lots of questions, you will find your peers respect you for being thorough. Find the coworkers you can trust and develop a bond with them and they may be able to mentor you through this tough time. You can do it!

I hear what you are saying, and I have seen nurses do this, and also I have done this. In the places and units I am referring to, it is very easy for assignments to get changed--preceptor situation or not-- so unless the nurse on orientation wants to research all the patients in the unit at that time (also not knowing what's in the ED or what's moving in from emergent ORs or the like, and then who can be moved and who can't--information that the charge nurse and the supervisor know), well unless than an exercise in academics (which may not be without merit) is what he or she will likely encounter.

In hospital areas, people are moved around quite a lot. Some charge nurses are not that supportive of newbies coming in early for the 411, when they haven't figured out how things are going to roll. Finally, some units have policy where the on-coming charge nurse makes the assignments. They may or may not come in early enough. I think coming in early to learn about the different players in the unit, is a good academic experience, but it may or may not help some poor newly hired nurse "precepting" in a particular unit. In fact, in just about every unit I have ever worked, patient assignments were very dynamic, whether there were people on orientation or not. You are expected to roll with it. So then this really comes down to the quality and effectiveness or the preceptor, nurse educator, and the manager.

I say your idea is a great one, but it doesn't always work in certain areas of units, b/c the flow of movement can be dynamic.

I have seen very few places that have worked diligently at developing comprehensive, objective systems for precepting. And too many times, being a preceptor is either thrusted upon a nurse, or he or she really is far from the best precepting material by progressively and objectively evaluated systems of measurement. By that I mean to say, X amount of newbies know how to play the right political games, and they give lip service to their preceptors, b/c they want to be accepted and not weeded out. IOW, the preceptors' and the systems' evaluations are not objective. So then preceptors are praised and past on by these standards rather than more truly objective ones. Same thing with the evaluation of the preceptee. The patience required to precept as well as the evaluations often comes down preceptor/nurse educator/other staff/and nurse manager biases. This is not right. So it way too often comes down to predominate likeability, which may be a factor, but is given way too much weight and isn't put together with the big picture, in balance. Nursing is often doing things just plain WRONG when it comes to the whole preceptor/preceptee process.

Of course the newbies should be open and accountable; but I am talking about a much bigger, more pervasive problem.

I don't know what the OP means by lazy or stupid. I wish she would expound upon these subjective terms. That doesn't help in any kind of solid evaluation process.

Guest343211 · Jan 5, 2013

New guidelines are for Zozyn to run over 4 hours, it has been found to be more effective. We just recently started this timing.

This > also:

[h=4]Renal Insufficiency[/h]In patients with renal insufficiency (Creatinine Clearance ≤ 40 mL/min), the intravenous dose of ZOSYN (piperacillin and tazobactam for injection, USP) should be adjusted to the degree of actual renal function impairment. In patients with nosocomial pneumonia receiving concomitant aminoglycoside therapy, the aminoglycoside dosage should be adjusted according to the recommendations of the manufacturer. The recommended daily doses of ZOSYN for patients with renal insufficiency are as follows:

Recommended Dosing of ZOSYN in Patients with Normal Renal Function and Renal Insufficiency (As total grams piperacillin/tazobactam)

[TABLE=class: blacktbl]

[TR]

[TD=class: EmphTd, width: 30%]Renal Function (Creatinine Clearance, mL/min)[/TD]

[TD=class: EmphTd, width: 35%]All Indications (except nosocomial pneumonia)[/TD]

[TD=class: EmphTd, width: 35%]Nosocomial Pneumonia[/TD]

[/TR]

[TR]

[TD] > 40 mL/min[/TD]

[TD=align: center]3.375 q 6 h[/TD]

[TD=align: center]4.5 q 6 h[/TD]

[/TR]

[TR]

[TD]20-40 mL/min*[/TD]

[TD=align: center]2.25 q 6 h[/TD]

[TD=align: center]3.375 q 6 h[/TD]

[/TR]

[TR]

[TD]

[TD=align: center]2.25 q 8 h[/TD]

[TD=align: center]2.25 q 6 h[/TD]

[/TR]

[TR]

[TD]Hemodialysis**[/TD]

[TD=align: center]2.25 q 12 h[/TD]

[TD=align: center]2.25 q 8 h[/TD]

[/TR]

[TR]

[TD]CAPD[/TD]

[TD=align: center]2.25 q 12 h[/TD]

[TD=align: center]2.25 q 8 h[/TD]

[/TR]

[TR]

[TD=class: source, colspan: 3]* Creatinine clearance for patients not receivinghemodialysis

** 0.75 g should be administered following each hemodialysis session onhemodialysis days[/TD]

[/TR]

[/TABLE]

For patients on hemodialysis, the maximum dose is 2.25 g every twelve hours for all indications other than nosocomial pneumonia and 2.25 g every eight hours for nosocomial pneumonia. Since hemodialysis removes 30% to 40% of the administered dose, an additional dose of 0.75 g ZOSYN should be administered following each dialysis period on hemodialysis days. No additional dosage of ZOSYN is necessary for CAPD patients.

Zosyn (Piperacillin and Tazobactam Injection) Drug Information: Indications, Dosage and How Supplied - Prescribing Information at RxList

livefully · Jan 5, 2013

Sometimes when you've (general) been working at a particular place, you tend to gloss over P&Ps and figure you "know" a procedure since you've seen it done countless times.

I think you should forget about making freinds for now and just try to learn as much as possible. Even if you think you know, listen to your preceptors. Even if one of them shows you a different way, nod and pay attention. Never bad mouth another preceptor or co-worker.

At the end of every shift or during downtime, sincerely ask for criticism. Even if you don't agree, you probably will not change the preceptors opinion of you, so nod, apologize and never repeat that mistake again.

Unless the pt is CLEARLY in danger, let the preceptor do things her way, and once out of earshot of the pt, compliment her on her way and ask for rationale.

Come in early, go over charts, offer to help others.

It's easier to destroy someone's reputation than it is to restore it, so don't expect people to forget everything in a week.

*****You made it through nursing school, passed NCLEX and got hired at the same facility so you must be doing some things right.

Ruby Vee, BSN · Jan 5, 2013

I am a new nurse who just got off orientation a few weeks ago. I have worked at the hospital where I am for more than a year and was hired from a tech position to a nurse once I passed my boards. I thought everything would go smoothly once I got off orientation, but I've been wrong so far. During orientation, I managed to make a lot of really stupid mistakes that I should have known better than to make, had numerous personality clashes with a couple of my preceptors, and got on my nurse educator's bad side. I know that people at work talk about me. I have heard it first hand and get the sense that people do not like me. Although some of it is unwarranted bullying, I realize that some of it is my fault as well. I take the blame because my problems with coworkers seem to follow me wherever I go. I have never had an easy time making friends at work and have always gotten the reputation for being stupid, lazy, etc... I guess what I am asking for is help. I realize that I can control how I present to other people. I am tired of being "that person." I need some tips on how to better my reputation and gain friends at work. I also need some words of encouragement. There is a girl at work who I know has spoke poorly about me to various people and I feel like as a result, these people now have a very negative opinion of me. I can tell by the knowing looks, sideways glances, and hushed whispers in the hall. I realize that I cannot control what other adults do, but these things have really put a beating on my self esteem. Any advice on how to not **** other nurses off, how not to look stupid, and how to overcome a bad reputation? Thanks!

Everyone makes stupid mistakes during orientation; that's why we have orientation instead of just throwing you into the job to sink or swim. Kudos to you for taking responsibility for your mistakes, though. That shows evidence of maturity and integrity.

If you have had difficulties getting along with co-workers wherever you go, you are right to accept the blame in this situation. Again, kudos. You're way ahead of the game if you've done a self-assessment ant realize that you need to change some of your ways of interacting with others. Making friends at work, however, is different from getting a reputation for being stupid and/or lazy.

Overcoming a negative impression is very difficult, but it can be done and you've already done the first steps by doing some good, hard thinking about the issue, accepting some of the blame and seeking advice.

Here's the difficult part of the whole process: You need to initiate interactions with others. For someone who isn't social, that's very, very difficult. At first, it need not be much -- just make sure to have a pleasant greeting for each of your co-workers as you come on-shift, encounter them in the med room, or whatever. If you have downtime and someone else looks busy, approach them and ask them "You look busy. Can I give room 2 his dinner tray for you?" If you just ask them if they need help, most people will say no because they don't want to appear incompetent, or because they're so overwhelmed they don't know what to ask for. But if you approach with a specific plan for helping them, it's easier for them to say either "Yes, thanks." Or "No, thank you, but could you help me take Mr. Y to the bathroom in a few minutes?"

We expect new nurses to need a lot of help, so don't be down on yourself if you need to ask questions or ask for help. Being willing to help others does a lot toward mitigating a reputation for laziness. When you have to ask questions, be sure to ask them in a way that makes it clear you've done some work on the issue. Instead of asking "should I give the coumadin?", ask "Mr. Bleedsalot's INR is 4.4 and his urine is cherry red. He has some new bruises on his arm, and I'm wondering if I should hold his coumadin tonight, and if so should I call the doctor or wait until someone else needs to call him for something?" The first is just a lazy way to get someone else to do the work for you. The second shows evidence of critical thinking and knowledge of what coumadin is/does.

There isn't much you can do about your colleagues gossiping about you . . . but you're ahead of the game because you know why they're gossiping about you and you can refute that gossip through your future actions. It's a tough road, but it can be done. I wish you the very best of luck with it.

Garethaus · Jan 5, 2013

One of the nicest, caring individuals that I know has expressed your thoughts in nearly exactly the same manner in the past to me. Is it possible you are being too critical of yourself? Everybody makes mistakes.

Some people you can never please anyway. Separate the constructive professional criticism from negativism meant to break you down. Concentrate on doing your job correctly and **** the whingers who personally don't like you, you can never please an *******.

CherylRNBSN · Jan 5, 2013

Please help me figure this out. What antibiotic is run at 12.5 ml/hr? I have been doing this job for tons of years and have never seen this. I have never run anything at 12.5 ml/hr. Yes, we will titrate morphine drips for example but antibiotics? If it is 50ml of zozyn it is run in 30 minutes. If 100ml of Zozyn, it is run in one hour. Unless it is a specific special antibiotic which the pharmacist will decide upon rate, or if it is some special circumstance, then please tell me what is run at that odd rate?

Our institution has recently implemented this protocol, as it "works better"; rec'd note from pharmacy about mainainting blood levels...can't recall specifics, but it a more effective way to fight infection. But if you have a pt w fluid needs, you would need to pump Zosyn in to primary fluid line and maintain primary fluid infusion. It's different from a 30-60 min. infusion of antibiotic.

CherylRNBSN · Jan 5, 2013

I am a new nurse who just got off orientation a few weeks ago. I have worked at the hospital where I am for more than a year and was hired from a tech position to a nurse once I passed my boards. I thought everything would go smoothly once I got off orientation, but I've been wrong so far. During orientation, I managed to make a lot of really stupid mistakes that I should have known better than to make, had numerous personality clashes with a couple of my preceptors, and got on my nurse educator's bad side. I know that people at work talk about me. I have heard it first hand and get the sense that people do not like me. Although some of it is unwarranted bullying, I realize that some of it is my fault as well. I take the blame because my problems with coworkers seem to follow me wherever I go. I have never had an easy time making friends at work and have always gotten the reputation for being stupid, lazy, etc... I guess what I am asking for is help. I realize that I can control how I present to other people. I am tired of being "that person." I need some tips on how to better my reputation and gain friends at work. I also need some words of encouragement. There is a girl at work who I know has spoke poorly about me to various people and I feel like as a result, these people now have a very negative opinion of me. I can tell by the knowing looks, sideways glances, and hushed whispers in the hall. I realize that I cannot control what other adults do, but these things have really put a beating on my self esteem. Any advice on how to not **** other nurses off, how not to look stupid, and how to overcome a bad reputation? Thanks!

To a great degree, you CAN control how you present yourself to others at work.

Since you have just gotten off orientation, I would say you should focus on a couple of things:

1.) ALWAYS seek out someone you respect and ASK questions. There is no shame in saying "I'm not sure what to do here, I was thinking blah blah blah, but I am concerned about blah blah." You always want to ask a question in a way that shows HOW you are confused; i.e., I know this, but that confuses me. Show them what you DO know, and then ask them what you don't know. B/c if your co-workers can see your thought process, they will be more understanding about what is tripping you up.

2.) Be sure and THANK those who offer you help or advice. "Joe, I really appreciated you taking the time to help me with my PCA. Thanks!" That goes a long way. I thanked the desk nurse, who did my chart checks, the aid who called me in to look at a reddened sacral area. BUILD TEAMWORK.

3.) Don't ever be afraid to apologize when you feel the need (no matter how slight). When I was on orientation, I snapped at my preceptor, b/c I felt I'd been thrown to the wolves prematurely. It was awkward. While I meant what I said, I apologized, b/c we are both human. It was awkward for both of us, but we totally worked it out. We get along great, and respect each other now. (I could give you many other examples like this...treat others would like to be as you would like to be treated. A sincere apology can work wonders.)

4.) As you progress, remember to ask your co-workers who are drowning if there is something you can do for them. Can I do your accuchecks? Let me answer that call light, since I see you are way busy right now. This demonstrates team work! And it is SO easy, and generates such good will. Only takes a few minutes, too. And you can do it when you are able. Always be on the lookout for those moments when you have a moment to lend a hand.

5.) Finally, realize that entering an established "group" takes a little time. As you progress in your role, the things I am recommending will become easier. (Except numbers One, Two, Three, which need to happen from day one.)

6.) Go to work and be FRIENDLY. Simple courtesy. A "Hi, how are you?" "Good morning!" "How was your night", etc. Don't be afraid to laugh, joke, and show who you are. Loosen up! Lighten up! Talk to your charge nurse! Don't be afraid to ask her "How should I handled this?" etc.

7.)Finally, don't be too paranoid. Yes, you are new. Yes, people are going to discuss your performance and attitude. Focus on improving both to the best of your ability. JUST DO THE BEST YOU CAN. Try to grow, or add something, every day.

8.) I have found, in my many yrs of practice, it takes me about 6 mos. to integrate a new position. The first 6 mos. are by far the hardest.

Take a deep breath, let go what is in the past, and focus on what you can do TODAY to make it better.

You WILL grow, and it will gt better.

Best,

Cheryl

wanderlust99 · Jan 5, 2013

If they think you are lazy, some suggestions to not appear lazy include:

-don't sit down for long periods of time, even if you are charting, try to do some of it standing up, it makes you appear busier

-walk fast

-ask fellow nurses for help

-answer call lights within 10 seconds

-be quick

-say "I'll do that!!" with a smile on your face if something interesting comes up

-don't look at your phone the entire shift

-never complain about your workload

-act excited when you are about to get an admit

Sometimes you gotta fake it if you're a naturally lazy person. I also recommend never arguing or questioning any advice given by your preceptor. Kiss a little ass. Go the extra mile. And try to stay on top of your game.

Sorry you're in a bad situation. I wish I could precept you and show you what a supportive preceptor looks like. Best of luck to you!

N.U.R.S.E. · Jan 5, 2013

I have had the same problems that you mentioned and still struggle sometimes. I have learned myself and work very hard at self improvement. Some people have that look of being timid and some formidable. Are you normally passive, learn to be assertive, and if possible reflect and learn to get better for the second round. One former boss said I have this blank look on my face all the time. You know when you first arrived at work people already sized you up and others join in the chime when they hear others gossip. The best way to dispel their belief system. Glean where you can, be cordial, respectful and professional at alll times. It's work not a social club, and be self taught and proactive in your learning look up the meds you normally deal with since you stated been there 1 year and what procedures and kinds of patients you deal with learn contingencies and pre/post op s/s to be aware of and pay attention especially before giving new meds of allergies before writing an order have all needed info for the pcp when a call is needed right in front of you. And if you think you need some support or counseling by all means seek it out. Pray and ask God to build you up and to build your self-esteem. Prepare your self for success. And should you hear something that is true or not work on making it better and then move on.

chrisrn24 · Jan 5, 2013

If they think you are lazy, some suggestions to not appear lazy include:
-don't sit down for long periods of time, even if you are charting, try to do some of it standing up, it makes you appear busier
-walk fast
-ask fellow nurses for help
-answer call lights within 10 seconds
-be quick
-say "I'll do that!!" with a smile on your face if something interesting comes up
-don't look at your phone the entire shift
-never complain about your workload
-act excited when you are about to get an admit
Sometimes you gotta fake it if you're a naturally lazy person. I also recommend never arguing or questioning any advice given by your preceptor. Kiss a little ass. Go the extra mile. And try to stay on top of your game.
Sorry you're in a bad situation. I wish I could precept you and show you what a supportive preceptor looks like. Best of luck to you!

These are all good tips. I will add:

- Ask for help nicely. For example, "when you have a second, would you mind helping me with so and so?"

- nursing aides are awesome. Treat them with respect. Although you are technically leading them, make them feel like equals. When you're a nurse you are a nurse and an aide. Don't forget that.

- do what you can for the sake of the place. If a patient needs water, get it yourself. But realize that in some situations if you're busy you can delegate.

- when you are new, no gossiping. Just respond "hmm" "okay." You don't want it to get around that you are a gossip.

- take initiative. If you have a minute, clean or ask your aides or preceptor "what can I do to help you?" If you see something that needs to be faxed or entered in do it. Clean. Answer the phone. Before I leave for the day I ask the nurses, "is there anything I can do to help?"

redhead_NURSE98!, ADN, BSN · Jan 5, 2013

Interesting. I will wait to see if we do this. So what happens if they need more piggy backs during this 4 hour period? They are always coming up with something new that takes more time.

You piggyback a piggyback onto the fluids, as long as its compatible with Zosyn. If not its timed in between the Zosyn infusions. I can't believe I didn't look it up at work. I think it's 4hours on 2 hours off? I don't remember but it's not really continuous, just feels that way!