Nurse Bully, please protect your young: "Don't eat them"

[Leonardo Del Toro]

I believe nurses are very special individuals. Think about it. They are professionals who take care of others in their dire moments. They patiently heal the putrid wounds of some; calm the fear and hopelessness of others; tolerate ingratitude and hostility daily; endure day after day of toiling around the sick and dying. Is only natural you'll find compassionate and warm hearted beings among nurses. I have been in other professions and the contrast is clear to me.

But because nursing is a tough job; some of us develop a thick skin. In a way, is a protection mechanism some develop to survive - you either get tough or you die. Although there is nothing wrong with being tough, some nurses can become quite aggressive and hostile to other nurses. We all have met them at some point, I surely did. But even being aggressive and assertive, nurses cannot match the aggressiveness of some bosses. Oh yes, let's talk about them bosses.

But bosses are people too. Yes, there are reasons why nurse bosses are sometimes so bossy. But bosses also have their though fights to fight. They too must develop an even tougher skin to survive the trials and tribulations of health care. Sometimes bosses are just nurses who left the floor because they simply couldn't take it anymore. Then to find even more stress in management.

Nurses are usually between a rock and a hard place. They have lots of responsibility, but lack the power to make decisions on their own. Doctors have much more say so in regards to their professional lay out. They call the shots, they can fire patients and are respected by most. Nurses on the other hand need to make decisions but always filtered by a set of rules created by others. Nurses must endure whatever BS is thrown at them. If you have an abusive patient, all you can do is to write a note and hope for the best. Most nurses can't simply fire a patient or they'll get fired.

Nurses run the show but are told how things should run. Often by someone who is deciding for them from an office chair; people who never worked on a floor or have not worked in years and can't remember anything. So, nurses are in a pressure cooker situation. Pressure from all sides and not an outlet in sight.

Well actually there is: and that is to relief the pressure on the least dangerous and inconsequential outlet - the young and vulnerable ones. The perplexed and scared nurslings are the recipient of a lot of pent-up anger. But why older nurses engage in this predatory and coward behavior?

It must be their inability to change the system and claim their power. Their extreme frustration lead them to eat their young. The ones they should be nourishing, protecting and grooming to take nursing to the next level just got eaten for lunch. Just like scared animals - they step on their own eggs. This is unfortunate.

If young nurses were well groomed and nurtured they would be the ones able to take nursing to the next level. Instead nurses create a culture of perpetuating the errors inflicted in them by transferring it to the young.

Protecting the young

Again, if you want to bully someone bully the oppressor and not the oppressed. Bully your problems and not the people who are here to learn. The bully energy is good energy but wasted and pointed in the wrong direction.

The alternative to bullying is to preserve and protect the young: because teaching the young the right ways is the only viable way to change nursing culture. It changes things because the young always will change the world. But instead we teach them the culture of bullying. We create perfect students in the art of bullying others. Nothing changes.

So, Mr. Bully next time you decide to torture the young, think of why you went into nursing back in the day. Bullying the young will only perpetuate the culture of abusiveness you were ounce, and continues to be a victim of.

[Susie2310]

The students did not get assignments ahead of time - they were expected to be proficient enough with SBAR and charting *before* entering the hospital environment and attended report on time, in uniform, and got their assignments with everyone else.

The model you used sounds much less rigorous for students.

The students are beginners, so I'm not sure how they could be proficient with using SBARS and charting if they have never practiced this in the hospital setting, having only done this in the classroom/skills lab.

When I was a student we had to prepare well researched care plans, including our patients disease process, and medication sheets, the night before we set foot in clinical. If they weren't prepared satisfactorily we weren't allowed to set foot on the floor. How/when did you prepare care plans and medication sheets for your patients - I assume you did this?

[AliNajaCat]

You can't teach a student that developing a plan of care depends on assessment data and then require her to write it before she lays eyes (or hands or stethoscope) on the patient.

I used to have my students generally prepare for their patients with as much data as they were able to glean from the chart the night before. But they didn't write their complete plan of care until after the last clinical day of the week. (Before that, they relied on the existing plan of care, supplementing it as they learned/collaborated/assessed). Their learning proceeded apace as they started to see similarities and anticipate possibilities, sorta like the way nurses do when they come in to work and get their assignments.

[sickonXmas]

the nurse who walks out on report does this often... to almost all the newbies actually. so i shouldn't take it personally.

she stopped walking out on me when i told her my charge nurse wanted me to write her up for not removing a foley (per hospital policy AND MD order) she deliberately disobeyed. i didn't ... i should've? i'm not sure... oh well. she's friendlier nowadays.

i can't edit my post... but i forgot to add something.

it shouldn't matter that i didn't write her up, right? though i'm not sure why this nurse doesn't walk out on me anymore. i've changed nothing. give report the same exact way. odd, no?

[Susie2310]

You can't teach a student that developing a plan of care depends on assessment data and then require her to write it before she lays eyes (or hands or stethoscope) on the patient.

I used to have my students generally prepare for their patients with as much data as they were able to glean from the chart the night before. But they didn't write their complete plan of care until after the last clinical day of the week. (Before that, they relied on the existing plan of care, supplementing it as they learned/collaborated/assessed). Their learning proceeded apace as they started to see similarities and anticipate possibilities, sorta like the way nurses do when they come in to work and get their assignments.

No-one is suggesting that the whole care plan would be written before the students provided care for their patients. The care plan/s would be started the night before, after the students had researched their patient/s at the facility based on the information available from the medical records, and after meeting the patient/s if possible. There was usually no shortage of information available. We would prepare our nursing diagnoses and plan of care based on this information. The care plan would be completed after providing care on the clinical days. Sometimes it would be necessary to start new care plans if new patients were assigned.

[srercg6]

because often new nurses are not given that chance. They are gossiped about until they are out the door. Its a very very uncomfortable work environment when you hear your superiors making fun of another new nurse -knowing they do the same to you.

[kalycat, BSN, RN]

The model you used sounds much less rigorous for students.

The students are beginners, so I'm not sure how they could be proficient with using SBARS and charting if they have never practiced this in the hospital setting, having only done this in the classroom/skills lab.

When I was a student we had to prepare well researched care plans, including our patients disease process, and medication sheets, the night before we set foot in clinical. If they weren't prepared satisfactorily we weren't allowed to set foot on the floor. How/when did you prepare care plans and medication sheets for your patients - I assume you did this?

i will attempt to address your questions. We were not prepared in the skills lab only. The program was 55 hours per week between classroom and clinical for all for semesters.

For preparation to enter acute care, first semester, our clinical experiences were three 8 hour days per week in the skilled nursing, assisted living, memory care, and LTACH-type units. While in this setting, medication prep was done ahead of time. There were three medication quizzes throughout the semester that needed to be passed at 100%. And extensive education on polypharmacy and common issues w/the geriatric population. SBAR testing and role play was also conducted both in the clinical setting with nurses and faculty, as well as in the classroom. We also had a short stint in the community doing outpatient head to toe assessments, vitals, and vaccinations on pediatric patients and practicing reporting our findings. Were we SBAR experts? No. Could we call a provider and give a serviceable hand off by the end of that semester? Yes. We had strong emphasis on SBAR from day 1 and it was integrated in to multiple facets of the program that term. This competency had to be met or you would not progress.

I wont get in to all of it due to length, but there were extensive benchmarks that had to be completed before you were allowed to progress to next semester and enter the acute care clinical environment. Assuming the student was successful, the first two weeks were spent in what was called "boot camp" that was all clinical preparation and refresher - no classroom didactic other than what specifically related to our focus - med surg 1/basics, for example. We had an extensive list of commonly used medications for the unit we were on provided by the hospital - a combo Med/onc and onc surgery unit for the first clinical focus area. Again, there were Med exams - you needed to know all the meds beforehand and be able to respond to your clinical instructor and participate in "surprise" assessments (w/faculty) while at the clinical site. The Socratic method was heavily utilized.

Students received report w/nurses. The pre-work and orientation/scavenger hunt and equipment training were conducted during boot camp so it was expected that the student was comfortable enough to function as a novice student in a clearly defined role on the first day of clinical. If you were not prepared, you were dismissed. You needed to know where everything was, test Pyxis and charting access, and certain other things before the first clinical day.

Care plans: expectations for care plans were lined out in advance and used the same format for the entire semester. Data was gathered for care planning during the clinical experience (respecting privacy.) Since the students were there three days (typically toward the end of the week) care plans were due by Sunday at midnight and feedback was given by clinical faculty well ahead of the next clinical so that the student could focus on certain remediation if needed. Nursing dx, prioritization and the nursing process were key benchmarks that were scored during the first two semesters. The whole progression of the program was to have mastery over the content as much as possible before entering clinical so that the students could develop a deeper understanding of the pathophys at work and co-morbidities. Again, Socratic method.

Each semester's curriculum was tailored to the clinical units we were visiting and patients of increasing complexity. In that way, pathophys and medications for the most commonly seen diagnoses for that unit were engrained via repetition. Units became more specialized while still remaining Med/surg but with increasing acuity. One limitation was that specialty areas such as L&D were shorter and considerably less hands-on than core areas. Pediatrics was represented over multiple semesters with increasing complexity and students who wished a practicum in a peds unit needed to meet benchmarks and put in some extra work. There were multiple clinical faculty. All skills had to be first checked off in skills lab and then performed for the first time at the hospital with the clinical faculty who either then chose to have the student move forward with his/her nurse preceptor supervising or who told the student that they must remediate the skill in lab and clinical and were held back in progress with their nurse preceptor.

As the students approached practicum, the majority of skills had been checked off if the student was still in the program. The skills should have been performed multiple times, ideally. By Med Surg II, the student was expected to carry a patient load typical for the unit for either 8 or 12 hour shifts. (with supervision) If the student chose to complete practicum in a highly specialized area such as nicu, there were further proficiency processes in place as well as faculty leads that were trained and practicing in that specialty (employees of the University). The only classroom time in the final semester was for NCLEX prep and career planning. 4 days per week were spent in clinical and in the community health setting.

We did not have "post conference". Once each week, usually Friday afternoon or Sat AM for four hours, all the nursing students in the program were required to pick a recent case and care plan and participate in nursing student "grand rounds". The care plan was presented and we received questions and feedback from faculty, clinical instructors, and other students both ahead and behind us in the program. This vastly improved our ability to communicate about our patients using the verbiage of our profession and to become comfortable being on the spot (somewhat).

i am no expert on the rigor of nursing programs as I am hampered by my own experiences in a limited geographic region with a large teaching facility. As far as night before prep and Med research goes, I have had these students with me for clinical. I am sorry but I truly feel that whatever benefit is gained by looking up meds the night before is offset by the extreme fatigue these students seem to exhibit since they come in wth a half finished care plan on 2 hrs sleep and I don't see much improvement in preparation. I know this was a very traditional method but for whatever reason, it seems another barrier to getting a portion of students to actively engage in clinical (a multi faceted problem)

Obviously my programs method cannot prepare for every unit or illness or every single med ever given. That was why before giving a med, the student must verbally demonstrate adequate knowledge of the med, why it was being given, etc. OR properly state they WERE NOT familiar with the med and utilize the hospital resources they had been trained on to look it up. As far as charting, our school had the EHR software installed in skills lab and we had 2 eight hour days with a certified trainer before ever going to clinical.. All simulations were video taped and a huge part of the scoring was how well you documented.

This program has its issues as any other,but I feel I was well educated and we had excellent nclex stats and employment stats. So, in my opinion, there were fewer issues than what I've read here and most students had excellent, engaged preceptors. Can't guarantee all the students were perfect or made it through, but since I'm now employed and work alongside the nurses and managers who precepted my cohort, I know I've heard positive feedback from them regarding the experience.

I know I have some typos in this but my computer is sick and editing on my phone is a challenge w/the app gone! I apologize for the sloppy editing and grammar.

[emilly.lynn]

Very Informative and useful.

[twinsmom788]

Oh good Lord. Disagreeing with you is not bashing or bullying you. By the way, I still think a diploma nurse on her first day has far superior "skills" to a BSN new grad, especially in the SICU. But that would be a difference of opinion, not an example of me bullying youl

Here's the link to the "bashing" you were complaining about. https://allnurses.com/critical-care-nursing/baby-rns-running-962880-page4.html

No bashing; just disagreement. I wonder how many years you would hold a grudge if I did bash you.

Yes, you did bash me, and you were not there in the SICU to witness either of our skills... I do look at your posts at random...BTW learn how to spell the word bitter it is not biter....I am retired now FWIW.

[Wuzzie]

Yes, you did bash me, and you were not there in the SICU to witness either of our skills... I do look at your posts at random...BTW learn how to spell the word bitter it is not biter....I am retired now FWIW.

For the record spelling bitter as "biter" is a reference to an old post which is frequently referred to when people start getting all butt hurt about responses to their posts. It's a long-standing joke around here. As such your insult is probably not going to reflect on you the way you'd like it to. You might want to just edit that out...or not. Up to you.

[Ruby Vee, BSN]

Yes, you did bash me, and you were not there in the SICU to witness either of our skills... I do look at your posts at random...BTW learn how to spell the word bitter it is not biter....I am retired now FWIW.

I am sad for you if you cannot distinguish a differing opinion from "bashing". No, I wasn't there in SICU to witness your skills. In general, a brand new grad diploma nurse runs rings around a new grad BSN nurse -- so either you were an honest to goodness superstar or the diploma nurse in questions was woefully lacking what her classmates had learned. I will say, however, that many people over-estimate their skills, and over-estimating skills goes hand-in-hand with feeling persecuted when one is not actually the victim of persecution.

As for "bitter vs. biter" -- I wrote what I meant. Long standing inside AN joke.

What the heck is "FWIW"?

[Horseshoe, BSN, RN]

What the heck is "FWIW"?

For what it's worth.

[Ruby Vee, BSN]

For what it's worth.

Thanks.