I Need some kind of RN Career Counselor

Nurses General Nursing

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Specializes in tele,med/surg.

Hello, from another thread that was deleted I will recap... started May15 and I

got fired on June11 2014 because of my "way of handling frustration in the work place" and I guess my "inability to connect with patients emotionally" per my former manager

(But I did meet every other competency very well and can do everything else an RN career entails)

My first incident, I got mad at the vital signs machine because it wasnt giving me a blood pressure...then I took it out on questioning a medication I didnt understand why the patient was getting. A substitute preceptor and the clinical education lady were present when I took out my frustration on the medication on the screen. I wasnt cursing or anything crazy, just saying " Why am I giving this med??? Im not going to give this, no where in the reference manual does the patient meet criteria of why hes getting Risperdone" I guess it was that big of a deal my manager heard about it. They thought I was 'going out of my scope of practice saying I wanted to hold the med'. I dont know..

Next I had 2 drug user patients that gave me a hard time. One made up some story saying "She doesnt have passion, she just takes it like a job"....My manager and I spoke over this incident, we agreed that Im very task oriented and that the patient took it as I didnt care or have passion. But the other side is this patient is stuck on the floor for 48 day, has a manipulative history thats been documented,the rest of the nurses cant stand him and no one really liked working with this patient etc., I never really had a problem with the guy, I actually thought he wasnt so bad. So that incident through me off completely... whatever, nothing I could really do about that one.

The last patient on my last day there, to make it short..was VERY difficult. She was cocaine drug user, from the hood, recently released from prison etc etc the whole 9 yards. This patient was KNOWN on the floor, history of physically fighting staff:blackeye: (I wasnt warned by my preceptor, it was whispered to me by the PCA's). I had to do her admission right at shift change, she was an angel and cooperative with my preceptor. The minute I was left alone with her to do the admission she did a 360 on me, telling me "Man Shut up, I dont know, I dont care, why are you asking me this stuff, Man put whatever you want, get out" etc all while shifting violently and thrashing sheet and smacking pillows. Had to go to my preceptor 2x and get her to finish the admission form with me. Of course the patient was perfect and we both knew this was all an act.

Im not going to lie I did everything I could and in the end the patient got under my skin, I even felt in my gut she was being racial towards me but w.e, I voiced and vented to my preceptor and I guess it was too much Im not sure. I also asked for her expertise and how can I handle this better next time, tips, phrases etc.

I get a voicemail the next day on my day off from my manager saying dont come n, we need to sit down with the other manager and discuss some things that happened over the weekend. I did some homework on how to handle difficult patients, had some articles printed and brought them with me. Found out that same day of the meeting on Friday I was fired.

They did it very well and professionally, was honestly the best 'You're fired' sit down Ive ever experienced. They gave me good feedback and constructive and positive details and well. Suggested that other branches of nursing might work better for me, it really resonated and had me thinking. It just came down to what I mentioned above; my "way of handling frustration in the work place" and I guess my "inability to connect with patients emotionally". Im going to write them a thank you letter for giving me the opportunity and the time I spent at their facility, I really did learn ALOT. (it was a tele, step down, surgical, med surg, psycho, etc kind of floor, we got everything)

I basically need some expertise, I wanted to know what other avenues of nursing I can take that require much less emotional connection and less family centered care. I would like to do something thats fast paced but not so much customer service oriented. Im great at DOING, the manager emphasized I was VERY intelligent and it kinda blew them away at first............................I guess...lol.

So any ideas will help, I tried looking up odd jobs and very different positions nurses cant take. I was thinking correctional nursing maybe? My dream would be the ER but I need experience and thats my other obstacle, Im a new grad... so I NEED experience regardless what avenue I take :banghead: all I have is about a month or less experience, handled up to 3 patient at a time.

Any ideas or where I can find an RN career counselor??? Thanks..:nurse:

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Specializes in Pediatrics, Emergency, Trauma.

Well, most nursing jobs ARE pt:/family/client centered; there is no way around that...learning how to approach the job at hand an how to home your practice appropriately will help you transcend many areas of nursing...getting a foundation is they key.

You also need to step back in terms of how your response to stressful situations affect you and others and give red flags-getting mad a vital sign machine?? Do you fly off the handle easily? Is your personality aggressive to a fault?

Learning how to practice mindfulness in terms of "I have a concern/question", "I need greater feedback" is a good way to question pt/nursing issues; you also need to understand that people also take medications for atypical/off-label uses for optimal treatment; I learned that in pharmacology. Not everything is nursing is black and white, all or nothing absolutes...you have to remain fluid to what is presented in front of you, use your knowledge base, THEN apply your nursing judgement.

As far as interaction with people in their most vulnerable, down in the gutter movements; use those skills that were learned in mental health on how to deal with personalities; the BEST thing about mental health was learning how to therapeutically communicate with pts/family/peers very effectively, regardless of how they approached me; and trust me, I had people that didn't like me because of race, "age" assumption, etc...it didn't to bother me because it was less skin off my back; there were plenty of other patients that enjoy my advocacy more than that one person-I treatment my pts all the same...I let th know 8 am a "healing manager" almost like life coaching-in this space and time that we have together-what is the plan? I tell them my plan and rationale of what Is needed for their benefit, if we need to tweak it, as long as it will not adversely affect anything or if it's going to affect their health, they need to realize that it may not be in their control...pts feel out of control and may be out of control...YOU cannot be out of control when engaging with such challenging behaviors... :no:

Never let them see you sweat...take a step back and let someone know what's going on; team up with personnel when doing patient care.

Also, google "learning how to deal with challenging behaviors" most of the literature will be about children, but what I've learned is it transcends age groups.

Stepping back and addressing what you need FIRST will help with engaging in communicating with the public; if you need assistance in communicating effectively, get help with that; that "blood pressure machine incident" gives me the assumption that you may need assistance in handling frustration and there's help for that too.

I'm curious as to what your manager suggested what areas of nursing to get in to; regardless, you must be able to handle interacting with people appropriately and professionally.

Best wishes.

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You think you have a problem with drug users, psych patients, and manipulative people? Ummm, corrections nursing is NOT for you.

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Specializes in tele,med/surg.

Well I thought of CN (corrections nursing) because maybe its not so customer service oriented. I dont know maybe Im wrong. When im on the floor I have to make every effort possible to appease the patients and thier family. I cant just tell them flat out " I cant do all of your demands, I have other patients I need to see. Ill get you your juice if I get a chance" vs if its a jail I possibly could...

That difficult patient was ridiculous. If it wasnt for our "customer first" attitude I would have definitely been firm and told her out front Im not going to deal with this attitude, Im going to ask you again to calm down or Ill get security/manager etc. Like I said I could be very wrong. But Ive read some articles on CN and no where did it say anything about customer service or getting an emotional/personal bond with patients..... I dont know you tell me... Im not a violent curse out person when Im frustrated, all I do is get a more assertive tone and then Ill vent about it in the med room or Nurse lounge...But I guess even that was too much. I guess it just shows more on my face when Im frustrated. But I learned now...big time.

Can you tell me or about it?...

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There's a whole forum for corrections nursing on AN. Go to the yellow band at the top of the page, click "Specialties," and go there. Those folks will know a whole lot more than I do.

PS: If you equate "customer service" with "decent manners," you're not going to find much in nursing. Even if you ended up as a forensic nurse dealing with dead people :), you would still have to control yourself better with coworkers and frustrations.

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Specializes in tele,med/surg.

Thank you, I appreciate your response. I did look up various articles on how to deal with difficult patients, I brought them with me to the meeting to show them Im trying my best effort to better myself and my practice/skills. Unfortunately it didnt matter, their mind was made up.

Im not an out of control person when Im frustrated, I just think that, truthfully, it might show on my face a little more and possibly my sentences get short and brief when I speak. I NEVER lashed out a patient or came close to such thing. I guess I just have to shut my mouth and vent outside the workplace. In the end I learned big time from this experience...that hard way.

But your right I need a foundation...so I suppose if I want to move around later in nursing Im going to have to bite the bullet and learn to work on a family centered floor...I m good at doing, but being all touchy feely.....Thats why Im trying to look into various "other" branches of nursing...

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Specializes in ICU.
You think you have a problem with drug users, psych patients, and manipulative people? Ummm, corrections nursing is NOT for you.

Quoted for truth.

And I don't think you would much like ER nursing either - plenty of people treat the ER like their own personal drug supplier and come in with all kinds of BS complaints to try to get pain medicine. And, of course, they are "allergic" to everything but Dilaudid and when you ask them what happens when they take morphine/fentanyl/ibuprofen/aspirin/tylenol they always say anaphylaxis for every single one because they know how to work the system.

The thing is, I don't think you're going to find something that is less family centered and less customer service like you want. Hospital reimbursement is now tied to patient satisfaction. Whatever unit you work in, if your patients don't like you, the hospital will lose money because of you and you will be a liability. It sucks. You might not get fired for your patients not liking you at every job, but if you get consistently bad reviews from your patients, I imagine you won't ever get a raise or you will just get the minimum amount. I thought I was getting out of awful customer service jobs when I went into nursing, but it's just not the case. Nursing is now just a better-paid bottom of the totem pole customer service job that also happens to deal with people's health. I think you just have to accept that you are now a customer service professional because you went into nursing.

Maybe if you work in the OR you won't have to worry quite as much about customer service. I can't imagine you would really affect patient satisfaction much if your biggest interaction with the patients is waving at them while anesthesia puts them under... but I have also never worked in the OR so I don't know if that's an accurate reflection of nurse/patient interaction there.

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Specializes in tele,med/surg.

Oh no no I totally get you, I can definitely handle myself with coworkers managers etc. I have NO problems with that, everyone worked great with me and liked me. It was just those incidents...and my "frustration" at that moment with the situation...never the staff. Im a team player and ALWAYS offer help.

I can do customer service...for the most part...just not emotional connection stuff..

I have read various articles on CN on AN, I did that while looking for a job for 7 months before this one. Like I said...I didnt ever see anything that had to with customer service...But Im going to look again and post a thread on there.

What other areas in nursing can you point me to??

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Specializes in tele,med/surg.

I thought of OR too! That mask though...is horrid and uncomfortable :***:

But I agree with you, how much can I really affect their satisfaction of they are dead on the table or waving goodbye to them undergoing anesthesia.

Hmmm.....I think that could work for me...Ill have to get used to that mask though ahaha.

What other ideas do you have??

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Specializes in Pediatrics, Emergency, Trauma.
I dont know maybe Im wrong. When im on the floor I have to make every effort possible to appease the patients and thier family. I cant just tell them flat out " I cant do all of your demands, I have other patients I need to see. Ill get you your juice if I get a chance" vs if its a jail I possibly could...

The issue is HOW you say it...no one can't possibly please and appease everyone, :no:, however at least having an approach of "I'm/we're working on it" in terms of difficult questions, even for something that may be a low priority may work-being able to engage in assertively (not passive-aggressive, or passive then aggressively assertive) setting the tone for the time you spend with the pt makes a HUGE difference. I learned that in my acute rehab days where most of my pts were male, in their 20s (I got teens as well) and had SCI and TBIs, not always in the best, some ended up there because of their paths and demons, so a lot of reaction formation and projection was attempted, but firm and polite and upfront on what we are going to do in the time period of the shift...arguing and going back and forth was not an option, however discussing what can be done and what was possible realistically made for a better shift.

That difficult patient was ridiculous. If it wasnt for our "customer first" attitude I would have definitely been firm and told her out front Im not going to deal with this attitude, Im going to ask you again to calm down or Ill get security/manager etc. Like I said I could be very wrong. But Ive read some articles on CN and no where did it say anything about customer service or getting an emotional/personal bond with patients..... I dont know you tell me... Im not a violent curse out person when Im frustrated, all I do is get a more assertive tone and then Ill vent about it in the med room or Nurse lounge...But I guess even that was too much. I guess it just shows more on my face when Im frustrated. But I learned now...big time.

Can you tell me or about it?...

Again, see response above, and exercise mindfulness...when you get frustrated, start to feel how your face, how your body responds, the words you use, you may not have realize that your "venting" may have been the words you used, and you may have not been cognizant of what you may have said, especially if you got visibly upset or used profanity or exhibited unprofessional behavior that was not conducive to being professional; I don't know because I'm not your ex-manager or your ex-coworker and based on your OP, there were issues raised even from the start of your OP, which makes me question how you cope with frustration.

You still need to step back and self inventory how you respond to frustrating and high stress...what we do and the skill set that we possess calls for being able to respond appropriately most of the time to frustrating and high stress situations; to have the IQ and EQ to remain professional in this business.

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Specializes in Pediatrics, Emergency, Trauma.
Thank you, I appreciate your response. I did look up various articles on how to deal with difficult patients, I brought them with me to the meeting to show them Im trying my best effort to better myself and my practice/skills. Unfortunately it didnt matter, their mind was made up.

Im not an out of control person when Im frustrated, I just think that, truthfully, it might show on my face a little more and possibly my sentences get short and brief when I speak. I NEVER lashed out a patient or came close to such thing. I guess I just have to shut my mouth and vent outside the workplace. In the end I learned big time from this experience...that hard way.

But your right I need a foundation...so I suppose if I want to move around later in nursing Im going to have to bite the bullet and learn to work on a family centered floor...I m good at doing, ***but being all touchy feely***.....Thats why Im trying to look into various "other" branches of nursing...

***Most nurses I know, including myself are not "touchy feely"; again, that has nothing to do with your own admission that "possibly" your sentences get short and brief, which to the average person can be construed as anger, and possibly rudeness; it also breaks down therapeutic communication-that's mental health and nursing 101.

I'm going to suggest a book that I used as a PN student, BSN student, and have used as a LPN and RN; I read the book again when the start of my RN stage of my nursing career started out rocky and had my own hackles up: Critical Thinking and Nursing Judgement-available on Amazon, get it used:

http://www.amazon.com/gp/aw/d/0721697291/ref=mp_s_a_1_3?qid=1402859890&sr=8-3&pi=SY200_QL40

In all my 14 years of healthcare, which I entered when the corporate touches were planted in healthcare and what we have today exists, I have learned to remain committed to the pts and yet assertive in terms of my nursing practice and realizing how we are "healing managers", attempting to coach pts during their acute and chronic illnesses; I've also learned that I have power on my practice, I also have power on how someone makes me feel; I am going to always have power over that; as well as being comfortable with remaining objective when I approach pts families and peers has had less issues and burnout; I recognize that I have power in my practice and have a skill set; having that foundation and trial and error to hone ones practice is key-reflecting and tweaking helps and will help you go far and survive in this business. :yes:

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Specializes in tele,med/surg.

I do need to, Im definitely going to work on it. I dont use profanity at all, I know thats NOT ACCEPTABLE and is an instant fire. I dont raise my voice at all either, I dont cross my arms when Im upset either. I remember vividly the situation that day and I know I was consistent with my body language, but my face might have been a little off...like just direct and bland. Not aggressive glares or anything, I wast angry at her just frustrated and kind of bewildered why was I getting such treatment.

I already just realized its not worth venting in the workplace and just to shut my mouth but you are very right I still should and need to work on it so that I maintain it.

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