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LadysSolo 4,781 Views

Joined Dec 17, '06. Posts: 215 (70% Liked) Likes: 554

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  • 11:45 am

    Having been in the nursing field for over 25 years, I have seen it change drastically, and not for the better. However, I can say that nurses have always been at the bottom of the "s*** roles downhill" positions. It seems that anything that goes wrong, whether a toilet overflows or a med is missing because pharmacy screwed up or a patient falls out of the bed or a physician f***s up an order or the computers freeze up, the nurse is the one who has to fix it. That's how it has ALWAYS been, so it's not a new thing.

    Having said that, there are so many worthless things that the government has piled onto healthcare---like the smoking cessation stuff. That is a HUGE WASTE OF TIME. In this day and age of televisions, computers, cell phones, etc., anyone that smokes is well aware of the health dangers of smoking and if they decide to continue smoking, that's their own fault. There are smoking cessation programs everywhere---all you have to do is ask. The documentation has become so heavy that it takes up more time than actual patient care does. Back in the pre-computer days, I remember everyone saying that when computers come into healthcare, it will make pen & paper charting obsolete and much easier. HA! Now, nurses have to do pen & paper charting as well as entering the stuff into the computer because "What if the system fails and we lose all the information in the computer system?" Well, get rid of the computers and keep doing the pen & paper charting then!!! It is our illustrious government that mandated electronic medical records.

    Nurses have become glorified servers, especially on med-surg/tele units. In the ICU or ER or OR, nurses have a more specialized role and aren't relied upon to deliver a hot cup of coffee to an already demanding patient. But, I do not envy the med-surg/tele nurses at all. They're overloaded with work, can't give patients the attention they deserve, are treated like dirt, take the blame for poor Press Ganey surveys, get "spoken to" by management if they come back from their meal break 5 minutes late, and have to tolerate the B.S. they get if they are not absolutely perfect. It's not worth it.

    Hospitals make me laugh. They act as though hiring nurses is like hiring C-level, Fortune 500 people----they make nurses go through 2 or 3 interviews, ask questions in interviews that are completely irrelevant, they want to know exactly how much experience you have & what you're able to handle, etc. My first job 25+ years ago was at a private major metropolitan medical center in NYC---I got hired over the phone by the nursing office in May of my senior year in college. I had a telephone interview, they asked me what unit I'd like to work on, and they told me what day to show up for my employee physical & what was my starting day. I had a great orientation and stayed there for quite a while. I had no experience whatsoever, and you know what? They taught me how to be a nurse. Now, nurses need certifications for everything (I recently saw a job listing that required nurses have EpiPen certification----*****?) like IV, PICC lines, etc. (You can either start an IV or you can't---why do you need to be "certified"? Hospitals don't want to teach new nurses----they want nurses with "recent" hospital experience so they don't have to spend any money or time training them. And then we hear about how hospitals are short staffed "because there are no nurses out there". It's all a farce, which is representative of the entire healthcare system we have now. Healthcare used to be run by people with clinical experience----physicians, nurses, etc. When the MBA's in their tailored suit & shiny leather shoes are on the scene, it was the beginning of the end. They'll do whatever they have to do to ensure their own salaries & bonuses, and to hell with the nurses. Hospitals want the public to believe that their hiring practices are "better" than other places, that they only hire the "best & brightest" of the nurses---this is a product of the "Magnet" program. I can tell you what the root problem is in all of this---instead of focusing on the REAL issues in nursing, which is mainly related to too many patients per nurse & short staffing issues, lots of smoke & mirrors were instituted to hide the real truth. Hospitals don't need this "Magnet" B.S. All hospitals need is to hire enough nurses to give QUALITY care to patients, with enough per diems and float nurses to cover the sick calls & holes in the schedules. That's how it used to be done, and it worked great. But, as with all things, they take something that worked fine & change it up so it becomes a disaster. Instead of hiring per diems & float nurses, hospitals expect nurses to stay another 4 or 8 hours after their shift is over to cover the holes in the schedule----yeah, that's real safe. And then if something goes wrong, they'll the the first one to throw the nurse under the bus, change staffing schedules if they get sued to make it look like more nurses were working than there actually was, and blackball the nurse. Nurses have NO SUPPORT. (I've done legal nurse consulting where I have personally seen hospitals actually change the master staffing schedules to make it look like there were more nurses on duty than there actually were. The truth comes out when the nurses are deposed, it makes the managers & administrators look like complete idiots and then many years later, the hospital settles the lawsuit because it was their fault that there were 2 nurses taking care of 45 patients.)

    I don't blame you for wanting to leave. The reason employees don't leave Costco is because they're treated well, Costco is loyal (they don't all of a sudden have a huge layoff of employees), they pay their employees well & give them good benefits----they appreciate their employees. That's where the difference lies between Costco and hospitals. Costco is a very well run business overall----they have excellent buyers, their prices are great, they run every store the same. You don't see 15 year old kids working there, pulling their cell phones out every 3 minutes to check their text messages & Facebook accounts. People that are shopping in Costco are generally happy and the banter between employees & shoppers is generally happy (except at the return desk----but Costco has such a great return policy that most people don't get mad). You won't go home upset or worried. Maybe healthcare should take a few pointers from Costco.

  • Oct 15

    I don't buy it, and I don't mean it with disrespect to you personally, but the sole reason me leaving bedside was because of "them". It's easy to say things behind a desk, walking on high heels eating corporate served bagels and coffee while my ER colleagues struggled to even have proper staffing let alone be served a cup of kool-aid. Then I see "them" walking with a smile and making comments about "we care about patients and our staff", I laugh at this. No one becomes an administrator to "affect the community in bigger impactful way", you get out because life is less stressful and less demeaning at the desk in a suit compared to working with short staffed department all day long and get chastised because you didn't meet sepsis bolus time or patients complain because they didn't get their pain med or a retarded second pillow. It's easier to set goals and policies when you don't really have to abide by them physically. They are the reason I will never work at a bedside or hospital ever again unless I am "them." all I gotta do is act like a give a crap but just rake in my bonus and cut corners for all the other cronies to make more bonuses, if you can't beat them you gotta join them.

  • Oct 15

    'They' are the clueless managers who cut staffing to dangerously low levels and then continue to slam the floor with admissions. 'They' are the ones so far removed from direct care that they don't think adding one more thing to the to do list is a big deal. 'They'are the ones who turned healthcare from being about the best possible patient outcomes to being all about the customer service survey.

  • Oct 15

    What he said! "They" are those who are not us. "They" have a different agenda. "They" have different loyalties and priorities. It is "They" whose job it is to do make "us" do more with less. "They" have to do it or be replaced with those who will. Make no mistake. Once you are "They" you become part of the problem and can no longer be part of the solution,....and keep your cushy, no poop on my hands, job. It is "They" who keep nurses, the real reason people stay in a hospital, at a disadvantage. It behoves "They" to keep nurses disorganized so no uniform improvements in patient care and working conditions ever come to fruition.
    I bet if reimbursement is radically restructured in a way that nurses can bill for their services and finally become an asset to hospitals instead of a financial liability, conditions will dramatically change,......of course, I live in a delusional world where this might actually happen.

  • Oct 15

    When "they" give "us" large bonuses and generous stock options and golden parachutes and facilitated lateral movement from one company owned hospital to another, despite exibiting no managerial or people skills, only then will I buy into your thesis.
    Until then I will continue to live with my, just to name a few, issues involving intractable back pain, stagnant wages, staffing shortages, crappy high deductable, ever more expensive health insurance, arbitration agreements upon condition of employment robbing me of my day in court, and BS ice cream social blow-smoke-up-my-derriere disingenuous attempts at kumbaya.
    And still some wonder who let the devil unions through the front door.

  • Oct 8

    Quote from NurseGirl525
    Why do so many of you mix it with NS ahead of time? I push a flush behind it to make sure it all goes in, but why would you dilute it ahead of time? We only do that on medications that can be a vesicant. I want to hear the rationale from somebody first. I think I know what people are thinking, but I need to know for sure. I think that rationale is wrong.

    To me, unless specifically instructed to mix a med in NS, it is a med error and should not be done. All of our orders specifically state when to mix a med with NS. And how much. And the most we ever mix with is 3mL, not 10mL. That is for vesicants. I will have instructions for reconstructions to mix 10mL.

    I think i understand the thought process, but, it's misguided for several reasons.

    You can't make somebody a drug addict by administering some fentanyl or hydromorphone for a few days. That's not how it works. You are not contributing to the drug problem by giving meds IVP. We in the medical community especially should grasp addiction better.
    In some locations its taught and customary to dilute. The biggest advantage I can think of it that it allows the actual drug to be pushed closer to its safe administration rate. It's difficult to push 0.5ml over three minutes, for example.

    There is a segment of the population that can become addicted to these drugs very quickly, although certainly not everybody.

  • Oct 8

    Quote from Emergent

    2) I only do a slow IV push for opiate naive pts. For the seasoned user, a faster push gives them the little rush that assures them they are getting the drug they want/need. I do this to instill confidence in the pt that I'm not stealing their med.
    That's a minor pet peeve of mine. I'm constantly having to explain to patients that they are not supposed to feel a rush ....and that if they have been feeling one, that means their medication has been being administered too quickly.

  • Oct 8

    "My head hurts. I think my pigtails are too tight."

    10th grade girl. Neither one of us could keep a straight face as I shooed her back to class.

  • Oct 8

    Quote from elysRN
    A new grad, young nurse landed her DREAM job. Or what she thought would be her dream job in ICU. After orientation and on her own, she quit and said she thought she was dangerous and could kill a patient. The training was poor and the bullying was second to worst I have seen. That day she went home and gave up her life. Later, her parents notified the floor/ unit.

    Now, obviously not every nurse under these circumstances has the same outcome. But, what can be done to change the (mean-girl- middle school) culture on floor? Who do you complain to? Who recognizes this as an issue with not just that nurse but many whom have left the floor for the same reasons?

    How do you cope, who should be there to help nurses cope? Has this happened where you work?
    Too many assumptions here.

    1) That the ICU staffers were mean girls. Many new grads think there's bullying when they don't get unconditional affirmation for everything they do, or when a preceptor or charge nurse asks their rationale for doing something, or gives them feedback that suggests another course of action/better assessment skills/better time management would have been better.

    2) That she killed herself because of work relationships, solely. Most people who suicide have long-standing many-faceted difficulties. Insecurity, overdeveloped sense of responsibility, inability to seek help or self-actualize, no other life outside work, weak ego strength... You will never know.

    3) That this has to be fixed fast. The way you, as an individual, change a culture is one day, one person at a time. The next new person who orients, you explain #1 in detail. If there's really unnecessary harshness, stand beside her and say something like, "Maybe we could restate that more softly." Offer to be the preceptor for the new person, and work out with that new person how they want to hear constructive criticism, because they are going to need it as sure as the goddess made little green apples. Next year, both of you do it. This will NOT happen rapidly, or even in a few months. This is a years-long process, but once it gets better it will not g0 back.

  • Oct 8

    The trend I am seeing in my own community where I live is that students generally speaking seems to suffer from high stress, crazy expectations from other people, a lack of positive outlook into the future ("you will not find a job", "the world is dying and global warming will kill us", "the world will be destroyed in 50 years" and so on).
    The pressure is huge! There have been more High school students in my "high performing" community than over who struggle with depression, anxiety, and self-harm, attempted suicide and completed suicide. Sadly enough, last week another student took his life. The expectations that parents , school, and colleges have are literally crazy in my community. They are teenagers and supposed to grow up and go through all those stages and at the same time there is so much pressure in my town to be in honor's classes and keep the GPA close to 4.0, athletics - at least 2 - several extra curricular activities (some kids have 10 on their resume by the time they apply for college and those are often longstanding commitments), and we expect them also to socialize and develop into a mature young adult.
    My oldest who has left for college pointed out the other day that there is a common feeling among students that they "are not good enough" and are not "worth anything unless they achieve high grades, high test scores, and get admitted to a prestige college".
    Parents are a huge part of this problem - they are the ones who pushing them and instill this kind of idea that your value and worth is based on achievements only and you as a person do not matter.
    That is clearly a trend in my community and as far as I have learned, also in other communities that are similarly structured.
    The other piece is that coping with stress is something that people need to learn but I think that is not happening much either. As a parent I had discussions with my child and said that "your personal happiness and satisfaction is very important, you are not a machine. There is nothing wrong with dropping down from an AP course, it is not making you a failure. It is a learning experience". But according to both my children it is not the norm that parents understand the stress and problems that this generation faces.
    And when a person has anxiety or "depression", which seems to be a common side effect of "growing up" , the general ability to cope with stress is greatly reduced - leading to more problems in a society that defines itself through test scores, GPA and such.

    There is some research about suicide and which professions seem to be the ones that are involved. Healthcare workers including nurses and physicians come up - but also farmers.
    I think it is not a trend the "new nurses" commit suicide but it is a trend that students in High School already face challenges and stress that previous generations did not have in the same way and it extends into nursing school and after that into the first job - those are all high stress situations plus when a nurse has pushed through HS to get competitive grades to get into nursing school, they have to continue to work hard through nursing school. By the time they start the first job they are already anxiety ridden. The reality shock does not help when a person starts working. If reality does not align with expectations and emotional / personal investment it can bring on huge disappointment and potentially that person questions their whole life based on that.

  • Oct 8

    Quote from elysRN
    I am am seeing a trend. That's why I asked. Colleges are offering classes to teach hope to cope. Google it
    Thats not the same thing. What you are seeing is an increasing trend of depression among college kids. The depression rate among college freshman is around 60% these.

    There is a reason for this. Helicopter parenting. Parents incessant need to fix their child's life and control it so they won't ever experience failure, disappointment, or hurt feelings. Now, kids have no idea how to deal with it in college and become depressed and suicidal at their first failure or disappointment. They don't have the coping skills they should have learned 10 years earlier. These people don't see that a failure is not the end of the world.

    When a person first experiences this they should be around 8. Remember your first failure? To you, as a kid, it was the end of the world. Even as a dramatic teenager it was the end of the world. But you learn it's not bad you will get through with the support of your family or friends. These adults don't have that capability and the end of the world, literally becomes the end of the world.

    These parents, think they are helping, but are doing the biggest disservice in the world to their kids.

  • Sep 29

    Since this thread is still going somewhat strong, I thought I would add an interesting tidbit from an insightful physician who specializes in obesity medicine. He argues that nobody is ever cured of obesity.

    We can also cure many forms of cancer, where surgery or a bout of chemotherapy removes the tumour forever. Those conditions we can “cure” – obesity we cannot!

    For all practical purposes, obesity behaves exactly like every other chronic disease – yes, we can modify the course or even ameliorate the condition with the help of behavioural, medical or surgical treatments to the point that it may no longer pose a health threat, but it is at best in “remission” – when the treatment stops, the weight comes back – sometimes with a vengeance.

    And yes, behavioural treatments are treatments, because the behaviours we are talking about that lead to ‘remission’ are far more intense than the behaviours that non-obese people have to adopt to not gain weight in the first place.

    This is how I explained this to someone, who recently told me that about five years ago he had lost a substantial amount of weight (over 50 pounds) simply by watching what he eats and maintaining a regular exercise program. He argued that he had “conquered” his obesity and would now consider himself “cured”. I explained to him, that I would at best consider him in “remission”, because his biology is still that of someone living with obesity.

    And this is how I would prove my point.

    Imagine he and I tried to put on 50 pounds in the next 6 weeks – I would face a real upward battle and may not be able to put on that weight at all – he, in contrast, would have absolutely no problem putting the weight back on. In fact, if he were to simply live the way I do, eating the amount of food I do, those 50 lbs would be back before he knows it.

    His body is just waiting to put the weight back on whereas my biology will actually make it difficult for me simply put that weight on. This is because his “set-point”, even 5 years after losing the weight, is still 50 lbs higher than my “set-point”, which is around my current weight (the heaviest I have ever been).

    Whereas, he is currently working hard against his set-point, by doing what he is doing (watching what he eats, following a strict exercise routine), I would be working against my set-point by having to force myself to eat substantially more than my body needs or wants.

    That is the difference! By virtue of having had 50 lb heavier, his biology has been permanently altered in that it now defends a weight that is substantially higher than mine. His post-weight loss biology is very different from mine, although we are currently at about the same weight. This is what I mean by saying he is in “remission”, thanks to his ongoing behavioural therapy.

    Today, we understand much of this biology. We understand what happens when people try to lose weight and how hard the body fights to resist weight loss and to put the weight back on. This is why, for all practical purposes, obesity behaves just like every other chronic disease and requires ongoing treatment to control – no one is ever “cured” of their obesity.
    Arguments For Calling Obesity A Disease #3: Once Established It Becomes A Lifelong Problem | Dr. Sharma's Obesity Notes

  • Sep 28


    How do I say this nicely? The only nurse I ever worked with who said she went into it for the money (after years of bartending, which can actually be quite lucrative in the right setting) was a fairly lousy nurse. Not to impugn your character, Aliens, but all the people telling you that nursing is more than a way to pay the bills aren't blowing smoke up your rear end.

    You have to understand that nursing is stressful because nurses, for the most part, care. They are there for the patients, not the paycheck. It's why you know aren't going to get out on time but you spend the extra 20 minutes comforting or explaining or trying to lip-read your trached patient anyway; it's why you miss lunch or pee breaks, because every time you try to get a few minutes to yourself you find someone on the way down the hall who needs something. OK, sometimes it feels like self-interest--fine, I'll put the whiny old prune on the bedpan, because if I don't she'll jump over the side rails and land on her face and I'll have to fill out tons of paperwork and listen to her daughter scream at me on the phone and the supervisor scream at me in person. But really it's because you care. If you didn't care, it wouldn't bother you that you're spread too thin; you put in your time and go home. If you do care, you can get stressed out in any setting when things aren't going well or you just don't have the time to do what you know you should. I've worked numerous areas, mainly because I spent several years working for an agency; all of them had stress--even private duty home health (the stress of being bored out of my skull--I would rather work L&D, and I hate L&D with a passion).

    I'd love to cruise around in fast cars and travel all the time, too. I too wanted a job that didn't get in the way of my playtime. But I was too scared to deal drugs and too proud to be a gold-digger. It's not about stress--it's about loving the kind of stress you'll have. Find out what setting and what pace you enjoy, and make your decisions based on what works for you.

  • Sep 24

    Being happy in your career and being happy in your personal life aren't mutually exclusive.

  • Sep 24

    Quote from blondy2061h
    I feel like you're setting yourself up for a negative self fulfilling prophecy if before you even start you're expecting not to be able to love your job and your personal life. Like it or not, if you work full time you're going to spend nearly a third of your life at work. Low stress jobs can tend to be dull jobs. My job isn't low stress, but I work with a great group of people and get some fantastic stories out of it. You might as well aim for more than tolerable.

    Love this!!!