marylou5 764 Views
Joined: Jul 1, '15;
Posts: 45 (78% Liked)
; Likes: 113
If you didn't chart/document it....you didn't do it! Count on it!
That's what your charting reveals to everyone ...especially the Courts!
Keep charting as you have been, while critiquing yourself whether or not you are long winded and how to make your comments more concise. If you follow through on an MD's order..chart it..ie IV started or discontinued. Don't short-change yourself or your pts.
Clear, concise charting documenting what you did/observed etc will never get you in trouble. CYA!!!!
I/O, Vital signs, bed sore descriptions/measurements, RXs etc etc etc...not charted are considered by courts as not done!
Like you I left late to document what I did...it is what it is! Documenting what you did is mandatory..just do it!
I've called too many nurses, when a patient had an emergency and needed info for an MD, and nothing was charted...and yet the nurse had witnessed events/ symptoms she did not bother/forgot/was going to chart a late entry tomorrow! Shame on them (and now I have to write an incident report as well as everything else..because the MD is livid the info was not available!)
Most hospitals would be more inclined to consider employing you if you took a refresher course to show your motivation.
Many hospitals insist on a refresher course after a five year hiatus!
In fact many hospitals would consider a 16 yr hiatus means you are totally unqualified simply because of the tremendous changes
in most aspects of nursing in that period of time.
The cost involved to get you up to speed, unless they are desperate for help, would be prohibitive.
At age 62 a hospital training you would not be cost effective....and hospitals always consider the bottom line..
Most hospitals would prefer younger nurses who would have a longer work span to recoup the cost of training.
You may have better luck taking a refresher course in Telemetry, Dialysis or applying to Skilled Nsg, Assisted Living facilities, Walk in Clinics or Out Patient
The vast drug changes, medication procedures, machines you'd have to learn etc etc will be overwhelming in a hospital setting.
Good luck on your journey and don't get discouraged if that's what you really want to do.
Stay off of Facebook is the absolute best advice.... as well as never discussing patient issues with friends or strangers...funny or otherwise!
You won't ever be guilty of a HIPPA Violation which is a serious offense and could have license consequences.
Surely you can find something else to talk about on FB without involving those whose privacy you are obligated to protect!
Trust me it has nothing to do with jealousy! That's a huge stretch. You don't really believe that??
It has everything to do with safety of the patients.
As a new Grad, you are at a distinct disadvantage because you haven't a clue what you don't know.
You haven't had enough experience to realize that fact yet...you'll has a light bulb moment one day and realize how little you knew!
You feel you are carrying your weight...trust me you are not.
You haven't had enough experience to quickly assess and react to symptoms of 'downturns' before they become acute emergencies.
ICU is a fast moving environment with immediate life and death consequences.
This comes with nursing experience, of which you've had very little, although I'm sure you feel otherwise and quite competent.
All members of an ICU team have to trust one another's judgement...a trust that is earned through experience.
ICU nurses know what consequences an inexperienced nurse missing a sign or symptom creates.
It increases the stress level double fold
I personally feel that experienced nurses, not new inexperienced untested Grads belong in ICU....imho!
More often than not...verbal communication is the best measure of pain...esp. with younger children.
The child wants to get it right..to them it's just another anxiety producing 'test' they have to pass and not really high on their priority list.
Charades, simple explanations, a little humor and acting out the faces helps the child to relax and focus, in a non-threatening manner.
I don't think which test you use is as important as how well the child is prepared and understands why you are asking the questions as well as how it is presented.
Pain is a combination of the nurse's objective observation and the pt's subjective comments..but most important, when all is said and done.... pain is what the patient says it is. Therefore we have to help the patient articulate it as best we can.
I prefer to pick my battles..that doesn't sound like one worth fighting.
You'll come up on the short end, no matter how you phrase it.
You are telling your manager that her behavior was rude...not a win win for either for a relatively trivial event!
Yes, the manager was rude..but you didn't handle it as well as you could have, to diffuse the situation.
It was up to you to turn to the MD...smile, and politely state your intent,
"Sorry, sir, can you give me 10 seconds to sign this off...xray/lab/surgery etc. needed this pt 10 min. ago?"
Now you've put the ball in his court! The decision is his..not yours..not the manager's.
If the MD is an @$$ ....or is on his way to an emergency...and insists....so be it.
Most MDs will acquiesce, refrain from flexing 'ego muscle', and accept the short wait.
My staff always knew that if a patient was in jeopardy..they should interrupt! Otherwise I put up a 'wait one' finger or lightly touch their arm to let them know I'm aware they need my attention. More often than not, if it can wait they leave a note... or return later. If I have time I find them, apologize and ask what they needed. Interruptions are the bane of nursing...always was...always will be...how you handle them makes the difference.
I guess I don't understand your comment. You ARE working for him and the patient, at that moment.
Anything you can do to expedite the pelvic exam is a win, win!
He may be making comments to distract the patient.
Be completely set up, swabs open, speculum lubricated..(2 sizes of speculums handy if needed)
You are there to chaperone... AND ASSIST. Why would you not?
If he is impatient, are you too slow getting him what he needs when he needs it.
Everything he needs is set up 'behind' him/her. Why would you not assist and give him what he needs,
because if you are 'witnessing', you know what he'll need next.
Sounds like much ado about nothing ...or I missed the salient point of your question??
My concern is that you did nothing to relieve that patient's distress at the time that you felt he was being abused. You did not speak up. You did not get help for that individual whose dignity and treatment you objected to so intensely in your post.
That leaves room for people to question your motive for not getting 'immediate' help...and waiting to 'discuss' with the instructor what you considered elder abuse.
Sorry, but I don't get if that you left a pt. in distress, watched and listened, and then later documented a day's worth of elder abuse for us in your comment, but did not once step up to confront the abuser or mitigate the abuse as it occurred.
I'm sure you can understand why that leaves your comments suspect of being over dramatization. Your actions were not in the immediate best interest of the patients...but you later documented a litany of abuse which you did not address as it happened. That is very disturbing.
Every nurse, doctor, aide etc is a mandated reporter when it comes to elder abuse and that goes without saying. If you are aware of abuse and don't report it, you are negligent and complicit. I'm sure that was covered in your class work.
You are your patients' advocate..you observed what you considered abuse and allowed it happen in your presence...
No offense, and I'm sincerely not trying to be judgmental or put you down,(I wasn't there) but if you knew you were on solid ground and witnessing elder abuse, I'm curious why didn't you step up immediately and address the individual as it was happening?
This was your first clinical ..and you want to be a tattle tail? Careful...you have 5 more to go.
(I'm not excusing or accepting the behavior..it's obscene..... if you are not being overdramatic!)
It's not your job to criticize, squeal, or report, but to learn the basics and decide what kind of CNA/Nurse you want to emulate...Unless there is a safety issue that needs immediate attention..your job is to observe!
Did you offer to help take the patient to the bathroom ..or get him a urinal....did he have a catheter...is he on bladder training...can he walk..or does he think he can...does he have dementia and ask everyone 99 x a day to be toiletted...is he a falls risk etc etc etc
No matter where you go, you'll run into coworkers with less than admirable qualities..it is what it is...
I hate it!
Abusive behavior, as bad as you describe, has surely not gone unnoticed by others and they are aware and monitoring it...or not. But that is not your purpose for being there. Do your job and let the facility do theirs.
You will have a group opportunity to discuss your clinical experience with your instructor and coworkers.
Maybe they'll back you up with the same observations..or not!
That's the time and place to discuss your observations..what you liked, didn't like, what bothered you and what your responsibility entails and how to handle what you observed.
If you decide that you did not overreact..so be it! Nursing is called a 'practice' and we learn by others' mistakes and try to keep our own to a minimum!
New nurses are targets..(and I've changed jobs enough, because of relocations, to know that is true in most places).
I don't 'make friends', join in personal conversations or cliques...there are always the princesses... and the followers!
I just do my job...professionally....keeping personal chat and contact to a minimum...and smile a lot!
You are always a threat if you do your job well, and heaven forbid if a pt tells them how much they like you!
I'm polite to a fault, thank everyone who answers my questions, try not to ask the same nurse too many questions.
I dumb down instead of showing off..and if someone tells me I'm doing something wrong, or I didn't do ,
or I should have done, I simply say 'Thanks for the heads up..appreciate that!" Even if I know it's a bullying tactic to put the new nurse down!
I tell the Manager/Charge nurse how much I appreciate the help/hints everyone gave me..made the day easier!
I don't complain or put down anyone...you're the 'newbie'...and you have to prove yourself every time you change jobs!
You play the game! Not fair, not nice..it is what it is.
You can cop an attitude and make enemies, or go about your business. They usually come around if you don't make waves!!!
Sometimes you do what your gut tells you to do...because it helps the family deal with their grief (and it is not illegal... just hospital policy)
...and worry about the consequences later. We've all done it...because we are human and it's the right thing to do.
Communicate, communicate, communicate..the first rule we all forget in the heat of a struggle!!
I had a 21 year old drug overdose/ auto accident pt/ in a coma for two months in LTC, not expected to recover, who had dozens of treatments/suctioning/messy dsg changes plus he was on isolation...took an hour or more, a couple times a shift plus quick in and outs. As a rule coma pts creep me out, sorry! I hate the silence. I explained what I was doing, why I was doing it and how his wounds looked etc etc. Especially this one because he was so young. I always said 'Nurse Marylou" at your service today.'.. I chatted constantly, asking questions he couldn't answer, why he did drugs, college too hard, bored etc. lectured him on the danger of drug abuse. Told him what the weather was and the headlines, world and local news, politics etc., what I had planned for the week and even sang when I ran out of small talk. He did come out of his coma! Told his Mom that "Nurse Marylou" was the only one who always talked to him like he was a real person. I admitted that I did it for myself because I hated the silence...and she said..so did he! How sad. Communication is key!! Lesson learned.
Yuk..that would set me off!!.
Don't recognize his bullying. Ignore it!!!
Don't criticize his behavior...say nothing!
Go about your business.
Turn off your mouth and your ears!
Let him rant....remember the adage...sticks and stones etc etc
Do what you have to do...(or leave quietly, if he won't allow it and say you'll be back in 10 min, period.)
Ask if he needs anything right now?
Sounds like you may be trying to change his behavior...ain't going to happen...!
He enjoys antagonizing you because you react/engage....what fun!
Bullies want you to engage..they want an audience. Don't engage! Don't argue.
I resent entitled individuals taking my time from other patients.
I offer the RX/Med. etc. If they refuse..I calmly state why MD ordered it, possible consequence, CYA,
... and that they of course have the right to refuse.
I simply walk away/chart incident/report to Supervisor and MD.
I am too busy to argue/engage with bullying patients, who expect special concessions.
If they touch me, spit, throw things etc making my environment, and theirs, unsafe, I call Security.
It is no longer my problem.
Hospital rules/regs are in place for the safety of everyone.
If bullying is addressed properly the first time, it usually ends or at least becomes manageable.
Violent, uncontrollable bullies should be transferred to a Psych unit....they are not safe in the general population.
We all experience loud, nasty, argumentative, entitled individuals....
Don't engage. Don't bend the rules and jeopardize your license.
Walk away/report/ and go on to the next patient.
I've reserved a special place in H*ll for Charge nurses who abuse Part time/ Agency/ or Travel nurses by always giving them a full load of the most difficult patients...shame on them!
I always call them on it and calmly suggest a modification of an impossible assignment ;-)
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