ShiphrahPuah 3,332 Views
Joined Dec 5, '07.
Posts: 92 (52% Liked)
I am wondering how many other clinic nurses end up working late nights. I left the hospital so I could have more work/life balance and work 8-5. I worked for a really great clinic for a few years where the nurses each had one late night (until about 6:30) but usually worked until 5 or 5:30 the rest of the week.
Then I took a job MUCH closer to home in family practice office where I was told the hours were 8-5 with one or two nights per week until 6, but reality is that we usually stay until 7:30 to 8:30 pm most nights. The schedule is always so overbooked that even when the docs are only scheduled until 5, they are not done seeing patients until about 7:00. THEN they get to answering their phone messages, and we have to stay until everyone is called with reponses. With these hours, I might as well work 12 hour shifts in the hospital and make more pay and only work 3 days per week instead of 5.
I am thinking of trying to get back into my previous clinic where I usually got out at 5:00, but I hate leaving a job when I have only been there for a few months (the employees who have been there a long time say it has always been like this).
I was wondering if any other clinic nurses are experiencing neverending hours -- I don't see this complaint very often. Since I have only worked in 2 clinics since leaving the hospital, I don't know if I was just extremely lucky with the first one or if these hours at the second one are pure insanity. I want to be home in the evenings with my kids.
I work in the OB/Gyn department of a large multi-site clinic that has pretty much any specialty you can think of (we have a lot of HMO patients). I give way more injections at the clinic than I ever gave in the hospital (in my dept, depo provera for contraception, weekly progesterone for moms at risk for preterm labor, Rhogam for neg Rh mothers, various vaccines like flu and TDAP). Also do blood draws. Some departments in my clinic do IV therapy (walk-in care, oncology) but we pretty much send pregnant women who need fluids to L&D so they can also have long-term monitoring. I do nonstress tests (electronic fetal monitoring) weekly or biweekly on pts with conditions that warrant it toward the end of their pregnancy. Of course what you do depends on what type of specialty you work in. You get to know the meds you work with, and those will be different for different departments. I look up those that I don't give all the time. I also spend a LOT of time on the phone triaging, answering questions, doing Rx refills, notifying patients of lab or ultrasound results.
The phone is my least favorite part of the job, but I do really like working in a clinic better than in a hospital for several reason only some of which are that I like the 8-5 (although I do work one evening late), no weekends, no holidays, plus I get an hour for lunch and actually get to eat and pee during my day which often was a very difficult thing to do at the hospital.
As for community oriented, I am not sure of your exact meaning. Clinics like the VNA (Visiting Nurse Association) take uninsured and public aid patients,and that might be what you are getting at. My clinic used to take public aid before I started working there, but now it is only on a case-by-case basis (preg mom who lost insurance will be treated throughout, sometimes a longtime pt of a doctor will be authorized by the MD to see the doctor). I do like that I see some of the same pts over and over and really get to know them.
A lot of people will say you should work in a hospital first (just like they say you should work in med surg before going anywhere else in the hospital). I did work in a hospital for 2 years and think it does help, but I also know my clinic has hired new grads in the past who have worked out really well. It's a very different workflow than the hospital, and nursing school pretty much trains you for hospital work. I had a lot to learn when I made the switch, but I am very happy I did.
Hospital is hell, ambulatory care rocks
Completely agree with Klone. I have worked with a few doulas who were amazing and provided great support to the patients and worked WITH the nurse to make laobr the most positive experience possible for the pt. These doulas were a blessing and made my job easier when I was juggling multiple labor patients. However, there are other doulas who make everyone who works for the hospital out to be an enemy so there is constant conflict and the pt does not trust anything the nurse tries to do. Labor and delivery is one of the places where lawsuits are most common. So, yes, my hospital had pretty strict rules about the certain things we had to do (i.e. continuous fetal monitoring with some breaks allowed under specific circumstances). Some doulas can be very obnoxious and leave the hospital staff wishing the pt and the doula just stayed home for the birth.
There is huge potential for a doula to be a great asset to the team. And to be honest, I do think due to liability, hospitals can have sort of a factory approach to laboring women, and this is where a doula can really be a great help to the pt. Plenty of L&D nurses WISH they could spend more time with their pts but are unable to due to pt load, and this is where the doula is a great team member.
I just made the switch from the hospital to a doctor's office a month ago, and I LOVE it! Because my clinic is part of a large organization of clinics associated with a hospital group, I only took a $1 cut in pay. A whole hour off for lunch where I can run errands or just get away, no weekends, no holidays, the day is busy and goes quick but it is not super stressful and I don't have multiple critical patients at once....wonderful!
I know a nurse who is missing a hand (since birth) and another one who has a shortened forearm and incomplete hand, and both are awesome nurses. They have had to learn how to adjust in doing things like giving injections and starting IVs, but they have adjusted to doing everything else in life and have adjusted in those areas as well. You can do it.
I have loved your posts over the years and have learned so much from you, from nursing school and now into my third year of working as an RN (even though I don't know that we have ever communicated other than me reading your posts). You have a wonderful talent as a writer, and I wonder if that is part of God's plan for you. I will certainly be following your story. I am 46 and rapidly approaching the same age range you are writing about, but I have far less experience in this field since it is my second career. I think nurses with decades of experience are extremely important to our healthcare system and hope that soon that will be obvious to all. I too just made a job move since I couldn't afford to lose all my hours to being put on call all the time for low census -- crazy times.
I am glad your hope is in God and that you are resting in him to see what comes next in your life.
Working in a hospital was worse than I thought it would be. I came from another career (information systems) and was used to professionalism and corporate culture. I think the conditions in many hospitals are miserable, and nurses are seen as disposable. I did not enjoy 12 hour shifts that often turned into 14 hour shifts with very rare opportunity to eat or even pee in those 14 hours -- VERY unhealthy lifestyle.
HOWEVER, there are lots of options in nursing (well, this economy has limited that, but that is true in every career right now). I now work in a clinic and LOVE it -- 8 hour shifts, a whole hour off for lunch, nice people, and work that is busy but I am not juggling multiple critical patients and thinking my license is at risk every day like I did when I was in the hospital.
Nursing is great because there are lots of places to land eventually. AND, you may end up liking working in a hospital....I am not an adrenaline rush person, and I never really dreamed of working in a hospital in the first place. You might be wired completely differently than I am. If you really want to be a nurse, you will find your niche. I am very happy now in my current position, but I did question my decision to become a nurse when I was in the hospital. Read the "first year in nursing" threads for more feedback, but also go with who you are and what your desires are.
Work in a hospital during nursing school to get your foot in the door. Often it can be difficult to get into L&D as a new grad, but it is not impossible. My department has hired new grads who worked in the department as OB techs or as a unit clerk during school. I got hired in as a new grad and didn't work in the department, but I did work for the hospital in ER registration and got a great review from my director which really helped me get into L&D.
A lot nursing schools will tell you NOT to work during school, but in this economy it is a wise thing to get your foot in the door of a hospital. In my graduating class in May 2008, those who worked in hospitals as techs or even in clerical positions got jobs first, and I think it has gotten significantly more difficult to get hired in general as a new grad now than when I graduated. Yes, grades are important, but I think work experience and a foot in the door (with the reputation of being a hard worker) are even more important. I was psycho about grades and got through with straight A's, but I really think that working in a hospital was the key to getting into the specialty I wanted. Nobody cares any more how I did in school, only how good I am as a nurse. And some of the best nurses I know were some who graduated with me and struggled all the way through to maintain a C average (on a scale where below 80% was failing). The academics are important, but experience weighs in pretty strong.
You seem awfully defensive and easily angered.
The fact of the matter is that the system is broken. I had a few really good clinical experiences in nursing school due to a couple of phenomenol nurses who took the time to teach. I also had way more negative clinical experiences. I swore I would always go out of my way to help nursing students when I became a nurse, and I have had several nursing instructors and students go out of their way to tell me they appreciate how I work with the students.
That being said, it's a messed up system. I love to take students, but often my patient load is overwhelming and I feel like I am doing the bare minimum to get by (NOT the kind of nurse I want to be). Certain students certainly are a huge help because they are able to check in with the patients and let me know the patient needed something right away and it was something that they were able to take care of on their own or with their instructor.
The problem is that we get students from multiple schools, and honestly, some of those instructors completely disappear and the students become fully my responsibility. I would love to be a nursing instructor in the future (a GOOD one), but as floor nurses we do not get anything extra for taking on students -- as one other poster put it, we put in the work but the instructor gets the pay and credit which is a problem if they are one of those disappearing instructors. The floor nurses don't even get a choice if they are getting students. I like getting students, but I know some of my fellow nurses really hate it and are bad with students. I notice when I am working with those nurses who really are not good with students and often go out of my way to talk to the nursing instructor about changing assignments, or I just grab one of those abandoned students when I am about to do a procedure and ask if they want to watch or do it if they are OK'ed for that procedure.
As much as I like teaching, some days I really don't have time to do it like I want to due to my patient load (just like I am very often not able to listen to the patient and give the care I want to as a nurse due to my load ---my BIGGEST disappointment with nursing). Some days I can barely keep my own head above water, and teaching someone else to swim in those moments is impossible.
I wish the system could get fixed. I thought it stunk when I was in school, I think the students deserve more now, and I think staff nurses should somehow be rewarded when they do go out of their way with students (even if it isn't financial but a specific positive comment on an annual review or SOMETHING).
I have been an nurse for 2 years, and I can remember how horrible some clinical days were due to nurses who hated having students. Because of that experience, I have tried to go out of my way to be especially nice to students. I love teaching, so it fits with what I like to do anyway. However, there are some days that it is very tricky to have students on the floor.
We get students from several different colleges on different days, and each instructor sets the expectations for the students. There are certain schools that I know that the students will be a huge help because their instructor is very involved. With other schools (unfortunately like the school I went to) the instructor sort of disappears, and the nurses are left to do ALL the teaching to the students....which can be OK, but on really busy days it is a drain. In the end, the RN is ultimately responsible, and as other posters have noted, we can't just defer to the fact that a student had the patient. It is our license on the line, so often things have to be done twice.
Also, occasionally we get "know-it-all" students who are out to prove the RNs are doing things wrong. The most obnoxious one I remember was a guy who was working as a tech in an ER and thought he knew more than EVERYONE else (all of us felt he deserved to be humbled, and as it turned out he did not do well enough on the exams to pass that specific course...only it meant we had him on our floor again the next semester, and he seemed undaunted by having to repeat the course.) Real-life nursing is often different than what you learn in school because you have to balance so many patients and priorities. Yes, I know there is a way to do it in an ideal hospital, but since the nurses who stay too many hours late are reprimanded for "poor time management," we have to find ways to get a lot done in a short amount of time. Of course, you never want to sacrifice patient safety, so there are certain things you never want to take short-cuts on. However, we sometimes are just doing our best to handle a full load of patients, and adding multiple students to our responsibilities sometimes is the tipping factor in the day.
As a student, do your best to read when something is critical and very time-dependent, and be willing to stand back and watch if the RN really needs to get something done in a hurry. Most nurses are willing to give you as many opportunities as possible, but sometimes things just need to be done STAT.
One final thing is that sometimes the students completely take over all of the computers, and it is nearly impossible to get our charting done. Obviously you need to chart and get info for your careplans, but be aware that the RNs are carrying a heavier patient load and really need to get stuff done on the computer. Ask if a nurse needs to use your computer if she is obviously frantically looking for one. Usually on the days we have students, I know I will be stuck at work much longer than usual because I can't get to the tools I need to get my job done. I'm all for helping, but I have kids and band concerts and soccer practices and family life to get to as well, just like many of you do. However, I can't just leave when my shift is over if my charting is not done.
School is hard, and clinicals can be brutal when you have a crabby nurse. Some nurses really are just plain crabby, but some might be crabby on a given day because they feel overloaded with responsibility.
Your AKC Kennel Club reply is hilarious (even if you don't really use it.)
As an L&D/postpartum nurse, I would agree that you should expect your nurses to be helping patients. Yes, we do want them to become independent, but I always figure I'd rather err on the side of being too helpful than not helpful enough. Women who have had c-sections or a large perineal tear especially can be moving slowly and really do need the help. I like to take every opportunity to turn things into a teaching moment, especially for those who are very nervous about baby care. I have been told by coworkers that I am "too nice," and to be honest on super busy days I spend a lot of time in patient's rooms and may not discharge patients fast enough, but I think the postpartum teaching is very important. I was not a nurse when my kids were born, and I almost hemorrhaged at home after leaving the hospital with little teaching (and very few fundal checks while I was there).
To be honest, in this economy, there are plenty of nurses who would like the jobs of lazy nurses. To be fair though, there are times that our patient-to-nurse ratios make it very difficult to be the kind of nurse I like to be. I am not sure if that is the case on your unit, but you are correct in thinking the PP nurses should be assisting patients. Some of them might do well to float to a med-surg floor on occasion!
Yes, the idea of having a minute in the bathroom without the portable phone ringing sounds wonderful. Also, the opportunity to GO to the bathroom! I can't believe the number of 12 hour shifts I have worked without EVER going! (or eating). I know plenty of people say it's time management, but there are occasional days in the hospital where everything is a crisis and there really is no time for even a few minutes of a break. That doesn't happen on most of my shifts, but the times it does happen, I think "this is NOT a healthy job!"
Thanks for taking the time to respond! I had my first interview and am still optimistic!
Ok, so I have been hesistant to bring this up, but here goes. I am all for "to each his/her own," and if people want to groom down there, it's all good by me as long as they are not getting coerced or manipulated into doing it. I do have a few questions about logistics though for those of you who prefer that. I mean, what about 5 o'clock shadow? Stubble on a face is one thing, but there, uh....ouch. In our younger days, my husband shaved there ONCE. Stubble...tortuous and not at all pleasant, especially the more vigorous things get. I told him NEVER again. So that's on the other person. On yourself, how do you deal with the insane itching? Many of us have experienced that post-delivery and in summer just when trimming up for swimsuit season. All in all, the whole thing sounds very unpleasant to me unless you are a slave to shaving twice a day just in case the mood strikes -- not so good for spontenaity. I'd rather not worry about stubble and having to go at it gingerly. FREEDOM!
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