Jolie 25,706 Views
Joined Oct 17, '01.
Posts: 9,455 (48% Liked)
There is absolutely nothing wrong with attempting to negotiate the conditions of one's future employment. It will either work, or it won't. But as long as you do so politely and professionally, the worst that will happen is an equally polite and professional answer of "no."
Good luck in your job search.
I formed my opinion when I read the second to last paragraph of your post, "but the workflow is so slow, I don't think there was enough to prove myself, only enough to make mistakes, which are my fault, I know. I was so bored there. It was supposed to be my preceptorship and me "being the nurse" but it just wasn't like that. On average, I probably did about 1 or 2 hours of actual work, if that. The rest was sitting around doing nothing or walking around aimlessly. And trust me, there was NOTHING to do.
I feel like I was set up to fail for sure. Why wasn't this stuff brought up to me earlier? But I also get soo anxious, especially if I make mistakes. I live in them. If I don't do good at first, I sometimes get anxiety to the point where I can't think at all. It's like I can feel my IQ just plummet. So here I am, wondering where the hell to go from here."
Where should you go from here? I suggest that you go back to the unit and apologize for your laziness and poor attitude during your preceptorship. Then meet with your academic advisor and find out if you will be permitted to repeat the preceptorship next semester.
You were given a gift. The opportunity to do an unconventional preceptorship in a highly specialized area of interest to you. A unit offering both detox and in-patient rehab offers a wealth of experiences with patients in various physical, mental and emotional conditions, and could be used as a springboard for a job search in virtually any aspect of adult behavioral health, substance abuse, out patient clinics, inpatient med/surg, community health, case management, etc. I remember all too well the pressure to "cram" every possible learning experience into a limited number of clinical days, and can't begin to imagine how there could possibly have been absolutely nothing to do, especially since you have identified a number of performance concerns from your early days on the unit.
I suspect that your failure had little to do with small mistakes and everything to do with a lack of self responsibility, self direction, initiative, effort, etc.
Of course you can appeal. I doubt that will be successful. I highly suggest taking the time to do an honest appraisal of your performance and developing a serious plan for improvement should you be allowed to repeat this clinical experience. It might represent your best chance of persuading the program director that you can be trusted with another opportunity.
Kimberly Hiatt was a very experienced nurse.
Was there a deficit in this patient's care? Yes.
Did you find it and get it addressed? Yes.
Might it have been better for the patient to have received alternate IV fluids sooner? Perhaps.
But you DID use critical thinking to determine that the patient's nutritional needs were not being met. Apparently that put you miles ahead of the physician writing the orders, and the pharmacist filling them. If you view this as your error, please help me understand why. I think you should be applauded.
You are 100% correct that he used you as a pawn to avoid directing his concerns to anesthesia. He did that because he is weak and unsure of himself. Most bullies are, and compensate by acting tough toward anyone they believe they can manipulate. You have unfortunately become that "anyone." It won't stop until you stand up to him, and in a somewhat public way. By the sound of your post, I believe that you are up to this challenge, but you have to be smart about how it is done so he can't claim that you have acted inappropriately towards him.
Please seek the support of your manager and/or a respected nurse on your unit. Once you have their back-up, be ready for your next interaction with Dr. Jerkface. If he says or does anything inappropriate or threatens you, remain calm and inform him that you will continue your conversation at the nurse's station, then walk away. Once there, and with your mentor present as a witness, firmly but politely state that you will not be spoken to in a threatening manner. Suggest that he take some time to re-word his message to you. He will either get the message and knock it off, or he will explode in front of witnesses who saw you acting professionally. Either way, you win.
As tempting as it may be to ask someone to intervene on your behalf, in my experience, that shows the bully that you are afraid, and the behavior grows worse. If you stand up for yourself, he will either give up or explode. Either works to prove your point. And as long as you have witnesses to confirm that you acted professionally, you will be able to defend any claim he might make that you incited his behavior.
Personally, I prefer to get them in private and tell them to go to hell, but that's risky Good luck! You have a good head on your shoulders and are an asset to your unit.
All I can say is "I'm sorry for your situation, Tweety." I wish I had sage advice. I don't.
About 25 years ago, I was working in a prominent Midwestern Children's Hospital when it became known that the new graduate RN pay rate was being increased substantially, making their salaries higher than some nurses with decades of seniority. The senior nurses went to administration with a well-thought-out proposal asking for an increase. They were told to go pound sand. Seems our wise administrators were certain of a few things: 1.) We were the only pediatric facility in the area, so there was no where else for dedicated pediatric RNs to go. 2.) Working in such a renowned facility was a "privilege" in and of itself, making wages unimportant. 3.) Money needed to be directed to new employees who would allow the facility to grow.
Turns out the wizards of smart got it a teensy bit wrong. A competing hospital opened a new maternal-child health wing, offering many of the services that had previously been exclusive to the Children's Hospital. They recruited heavily from the Children's Hospital staff, draining not only their numbers, but also their expertise. The Children's Hospital got precisely what they deserved.
I commend your loyalty to your manager. S/he is lucky to have you. I feel for your unit once you are both gone, as I suspect that you will take at least 50 years' experience with you. Unfortunately, most administrators don't understand the value of that. I started in the NICU in the mid 1980's. About every 10-15 years there is a sad story in the national news about a heparin overdose death or infant monitor-related death. I don't need to read them any more. I know the details without having to look. And they always involve the same errors made by new or inexperienced staff practicing in units without sufficient guidance from the previous generation. We've all moved on because of unwillingness of administration to adequately compensate our contribution to safe and effective care.
I won't pretend to know the financial particulars of Pfizer's offer, nor do I know the morals, values or ethics that guide their leadership's decision making processes.
But I suggest that we all examine our attitudes towards businesses. We tend to disdain those that make a profit in the healthcare industry, often implying that such profitmaking is immoral when people's lives depend upon healthcare services. At the same time, WE all profit from the healthcare industry. I doubt that many (if any one) of us would go to work everyday unless we received a paycheck for doing so. Granted, we tend not to be "rich," because we use our earnings to pay living expenses and hopefully invest in our families' futures. In reality, that's not much different than what most businesses do. They use their income to pay their bills and invest in future research, medications and treatments, without which we would see no advances in healthcare.
If and when circumstances come to light that demonstrate illegal or unethical management of pharmaceutical, equipment manufacturers or other healthcare businesses, they should be held responsible and are deserving of our utter disdain. But please don't assume that profit automatically warrants scorn, unless the same is true for nurses as we deposit our paychecks every 2 weeks.
I'm glad to read a few posts reassuring you that your experience on this unit is not normal or acceptable.
As some posters have indicated, "dark humor" is not unusual in healthcare, or any high-stress occupation. It is a coping mechanism, and as long as it is utilized in private, with trustworthy co-workers, it harms no one and serves to protect our mental health. But I don't think that is really the issue here. I think what you are overhearing represents an extremely poor attitude towards a patient population that is not respected by many of your co-workers, along with abysmal leadership that tolerates all kinds of unprofessional behavior in the name of staffing a unit with a horrible reputation that can't attract or keep quality staff.
I can imagine that you were excited to be hired into L&D as a new grad. It represents a "dream job" that few are able to find without experience or connections. I can only imagine what you were promised in terms of orientation, mentoring and support, especially since most nursing education programs offer limited L&D clinical experience. It appears that promised training won't be forthcoming unless you clearly and firmly demand it, and even then, maybe not.
I've been out of the hospital setting for almost 20 years, but even back in the dark ages of the 1990's, national standards of care (per NAACOG and per NRP) called for 2 fully independent RNs in the delivery room at the time of birth, one dedicated to mom one to baby. Someone will correct me if I am wrong, but I doubt that those standards have loosened with time. So, leaving you to attend a newborn by yourself was wholly inappropriate and in violation (I believe) of accepted standards of care.
I suspect that this was not simply a matter of a single bad day of staffing, but rather a long-standing pattern of slipshod training, care and standards that is not likely improve, nor is it a setting that will ever be conducive to your learning. Please have a pointed conversation with your manager and decide for yourself if this is an environment in which you can grow.
I have no experience with this, but imagine that insurance comes into play.
If a student is covered by an insurance plan and the pharmacy is submitting prescriptions for reimbursement, I would guess that the name on the prescription must match the name on the insurance policy. I doubt that insurance reflect companies accept name changes without legal documentation.
Yikes! It gets complicated.
Calls to both mom and doctor are needed.
I shake my head when parents provide doctor's orders and then ask us not to follow them. My response is always this: I have a legal and professional obligation to follow a provider's order that is forwarded to me. If I believe the order to be inappropriate, I will clarify it. If parents believe an order to be inappropriate they have 2 choices: they can clarify it, or they can ignore it. I don't have that second option, so if the parents don't want an order followed, they need to assist in getting it changed or they need to come in and provide care to their own child.
I didn't know about your husband's illness and passing. I'm deeply sorry for your loss and for the added pain of inappropriate care in his final days. Thank you for sharing so that we will all be better equipped and empowered to provide for the needs of our patients and families. Your unfortunate suffering will spare the same to countless others. God bless.
I'm sorry if this has already been said. I had little desire to read 9 pages of posts about kids, seniority and unfair scheduling.
To the OP: If you have not already done so, please sit down with your manager and politely suggest to her that she misunderstood your previous conversation. Let her know that you were willing to cover Monday night ONCE as long as you did not return to work until Thursday day shift, at soonest, to allow for adequate recovery from sleep deprivation, necessary for safe performance.
No need to drag children, fellow employees, conspiracy theories or any other hot button topics into the conversation, which would only serve to inflame the situation and cause her to become defensive. Nor is it necessary to begin job hunting over a one-time slight.
Unless your manager has proven over time to be incompetent or vindictive, please allow her the courtesy of making a bone-headed error once in a while.
As a manager who makes mistakes (shocker!), I always appreciate it when they are calmly called to my attention.
Do you have the peds residency job lined up, or is that something you are hoping to be hired for?
Some institutions designate nursing residencies specifically for newly licensed RNs who have not been previously employed. If that is the case with your future job, working as a home health RN would disqualify you from such a position.
Also, unless you have extensive experience in peds and/or critical care, I would suggest against taking home health cases that involve the level of care you describe. Trachs, vents, home IV therapy, etc. are services provided to medically fragile children, often preemies, whose care requires an extensive knowledge base and experience provided by a fully independent nurse. It is not likely that you will possess those qualities as a new graduate.
I understand the desire to begin earning a professional salary ASAP, but would suggest that doing so in the manner you describe may not be best for you professionally at this time. Accepting a job that you don't intend to keep for the sake of a few weeks' pay is likely to harm your future prospects.
Best of luck to you.
Consult with a reputable plumber or home inspector. How to best manage your septic system will depend on the specifics of how it was built, how it is positioned on your property, how old it is, etc.
With care and maintenance, it will function just fine.
Which of these sites has the best vascular perfusion? The most limited?
That's your answer
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