"The last place I worked, we did things differently!" (and correctly)

hogan4736, BSN, RN · Mar 5, 2007

...I think a new employee should be at his/her job a minimum of three months before the suggestions start. Before that I don't feel the person knows the job or the facility well enough to start offering ways to improve.

Unless you are from a big city, and move to a rural area (why did I leave, to raise my kids in a small town), and the ONLY hospital in said rural area:

1) routinely uses nipride gtts, and has NO cyanide tox box

2) has no pharmacist in house after 2200, and the ER runs out of stuff

3) has never heard of Cerebyx, and uses dilantin without a filter, in hand IV sites

4) allows the "old school" docs to berate the nursing staff with NO accountability on their part ("That's how it's always been")

5) has NO ER triage protocols, with waiting room waits of up to 4 hours ("We don't like our nurses ordering labs" (see previous post)

6) doesn't encourage nursing judgement/discretion, call MD on EVERYTHING

7) has no hospitalist coverage (that knows the pt) after 1700...We have to call a doc in the box for orders after 5p...

8) ER doc is responsible for ICU pts after 1700...YIPPEE

I could go on and on...

I try and keep these to myself, as I am a house sup...

The point is that in a small town with only one hospital, the mantra is "but that's how we've always done it"

They definitely need to get out more...

GardenDove · Mar 5, 2007

hogan, you'd better get used to it and many other things if you want to live in a small town. You sound small town naive to me. Small hospitals and small towns have much in common.

AshestoBeauty · Mar 5, 2007

Introducing new ideas is all well and good, but the wise person uses discretion in the time and manner that she chooses to do so. Walking into a new job and presenting a laundry list of all the things that your new facility is doing wrong just isn't going to endear you to your new co-workers.

Just wanted to ditto on that. Why not first learn new facility's policies and if something doesn't jive with you, go to the DON about it. By telling me and all the other nurses on the floor is suppose to accomplish what? In the end, its the supervisor who changes policy so go directly to her. I'm not going to do it for you. There is a time to talk and a time to just be quiet, look, listen and learn. If my wound nurse says to use a dry dressing, I'm going to do it her way. S/he has reasons for it. If a new nurse disagrees, go to the wound nurse and express what changes need to be made, don't complain to me about it.

Ashes

GardenDove · Mar 5, 2007

Just wanted to ditto on that. Why not first learn new facility's policies and if something doesn't jive with you, go to the DON about it. By telling me and all the other nurses on the floor is suppose to accomplish what? In the end, its the supervisor who changes policy so go directly to her. I'm not going to do it for you. There is a time to talk and a time to just be quiet, look, listen and learn. If my wound nurse says to use a dry dressing, I'm going to do it her way. S/he has reasons for it. If a new nurse disagrees, go to the wound nurse and express what changes need to be made, don't complain to me about it.
Ashes

Well said! :yeahthat:

mamason · Mar 5, 2007

Well, I can relate to this. I just started a new job and we did things differently at my old place of work. We were doing them wrong and a sloppy job at that. So, I'm pretty receptive to how things are done at the new place. I am willing to learn mainly because I respect the facility for holding us nurses to a higher standard. I feel as if they are promoting professionalism which was seriously lacking at my old place of employment.

hogan4736, BSN, RN · Mar 5, 2007

actually mercy, I've lived in small towns most of my life (40 years)

I've just nursed in a big city...

that being said, if you are excusing docs that berate nurses on the small town mentality, then shame on you (or anyone)

and just because we live in small towns, that doesn't mean pts don't deserve the same standard of care as in the big city...dilantin without a filter????

drug advancements (Cerebyx) apply to everywhere, not just big cities...

I do agree w/ using discretion, but when you have one community college, and 90% of the graduates work in the ONE hospital, and always have, that can lead to a one sided view of the (nursing) world

and my old big city jobs could have learned a thing or two from the small town...so it definitely does go both ways

LydiaNN · Mar 5, 2007

actually mercy, I've lived in small towns most of my life (40 years)
I've just nursed in a big city...
that being said, if you are excusing docs that berate nurses on the small town mentality, then shame on you (or anyone)
and just because we live in small towns, that doesn't mean pts don't deserve the same standard of care as in the big city...dilantin without a filter????
drug advancements (Cerebyx) apply to everywhere, not just big cities...
I do agree w/ using discretion, but when you have one community college, and 90% of the graduates work in the ONE hospital, and always have, that can lead to a one sided view of the (nursing) world
and my old big city jobs could have learned a thing or two from the small town...so it definitely does go both ways

I hope I'm not the mercy to whom you're referring, because I don't have the slightest idea what you're talking about. Big city? Small town? Dilantin? I didn't say anything about any of those... :confused:

GardenDove · Mar 5, 2007

I hope I'm not the mercy to whom you're referring, because I don't have the slightest idea what you're talking about. Big city? Small town? Dilantin? I didn't say anything about any of those...

I think that might have been my post.:smilecoffeecup:

hogan4736, BSN, RN · Mar 5, 2007

:stone my sicerest apologies mercy, I meant gardendove...I was confused

the message remains the same garden...cyanide toxicity happens ANYWHERE, regardless of the town size...

pts deserve better than a "doc in the box" when they're on a levophed drip, and the nurse has some questions at 0200...

I'm not sure of your defense...

medicine and nursing should (for the pt's sake) be held to the same standards everywhere...

plantiff's attorney to Pharmacist: "Why is there no cyanide toxicity kit available after 2200 for your ICU pts on a nipride infusion"

pharmacist: "uhh, because it's expensive, and we're a small hospital"

jury back in 10 minutes with a huge cash award for the plantiff...

we didn't use Cerebyx when I got here...now we do...(an infiltration on a kid in a hand vein, no filter...none of the ED nurses had even heard of Cerebyx)

I raised hell, pissed off the pharmacist (who actually told me we didn't use it b/c it was too expensive)...6 months later I reminded him of our conversation 6 months prior...He also said "doctors are the ones that make those suggestions around here"

NOT ANYMORE

Pts deserve the best that's out there, no matter where you live...

caliotter3 · Mar 6, 2007

Am in agreement with what mamason said. It would be such a pleasant occurrence to encounter a group that holds to high standards. High standards never hurt a patient's care nor the morale of a worker.

fultzymom · Mar 6, 2007

What about nurses who come from other facilities, who constantly critisize the way things are done where you work? They are always talking about where they previously worked, as if it were the gold standard.

I'd tell them they should go back there if it was so great! :lol2:

NurseShelly · Mar 8, 2007

I think also, sometimes it's a way of saying, "This is what I'm used to, please tell me how it's different here so I don't do it wrong...." It's a way of saying, this is who I am, this is what I know.... not necessarily a criticism.

I'm moving to another state. I have only been an RN for one year, and the above quote is exactly how I'm feeling already. I'm just planning on keeping an open mind and remaining humble.