Content That Tina, RN Likes

Tina, RN 13,631 Views

Joined: May 30, '09; Posts: 518 (55% Liked) ; Likes: 923

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  • Apr 8

    Quote from freckles23
    I have had this nurses district several times and it turns into a crappy load and I am on the verge of tears because of what is left behind for my shift. Am I being unreasonable?
    No, you are not being unreasonable but hear me out. First, I agree that genuine safety concerns need to be written up. Beyond that, you can make this situation more tolerable for yourself/your emotions by examining why you are on the verge of tears. When I have been in situations like this I felt similarly and it was because I was angry about me being dumped on. I took it very personally. But...since I ultimately can't control what others do, and even if I report them I can't control what will be done about it, I had to find a way to not send the whole shift south by being indignant about the situation in which I found myself.

    I got past that by utilizing a little bit of an "it is what it is" attitude, which put me more in the mode of making a plan to get things back on track step by step. Another related idea is not taking responsibility for the actions of others. For example, if an antibiotic is now going to be "late" because I've discovered yet another subq IV - - well, I can fix the IV; as for the lateness, it truly has nothing to do with me - therefore it's not worth getting more angry about. I don't need to take personal offense to finding a bad IV.

    Not getting emotional about others' shortcomings (or dumps, or laziness or ineptitude) is how you can make a plan and whittle away at it until things are back on track.

    None of it is "right." Should you have to do this? NO. But when you find yourself in the situation it's literally no use thinking in those terms.

    Staying calm also helps with being as objective as possible when it's time to discuss this with your manager.

    Good luck ~

  • Jun 30 '17

    Quote from ThePrincessBride
    Not all RN experience is equal.
    This is the crux of it. If APN programs want to start making relevant RN experience a requirement than I would support that. The question is for some APN program what should be considered relevant? And how much? There is very little data on this in the extant literature and what data there is suggests that RN experience doesn't seem to make a big impact. Historically, specialty APN tracks have been 2 years of directed RN experience. We should study it and find out what works and what doesn't.

    I will say from precepting lots of NP students, trying to do NP school while also trying to be a novice RN at a job (and novice for me is under 2 years) does nobody any favors: patients, the student, managers, etc.

    Quote from ThePrincessBride
    Coupled with the fact that so many low-quality NP schools are churning poorly-prepared NPs left and right and I am pretty convinced that even if I did go straight through, I would have regretted not getting the experience.
    We need to do away with the low-quality programs, we agree.

    As I have said many times previously, the person themselves (and their direct educators) is often the best judge of what is best for them in transitioning to advanced practice. It has been my experience that most student NPs never "regret" their RN experience.

    Quote from ThePrincessBride
    Yet they were taking the same classes as the undergrads and judging from some of the questions they were asking and their level of performance, it was a little scary to believe that many would take the NCLEX and start their NP portion after a handful of months. Even some of the graduate students complained that facilities didn't want to hire them.
    A few things here, for the record if nothing else:

    1. Students in pre-licensure RN programs are all the same regardless of the end degree: they all need to pass the same national standard board exams, doesn't matter if they are diploma, ASN, BSN, MSN, or DNP. The national bar is the same.

    2. What is the DE program's NCLEX pass rate? This is readily available on the BON website for most states. For instance my state has four programs, the NCLEX pass rate for all four programs is >96%.

    3. Facilities don't want to hire DE RNs. This happens here too, and would you blame them? Students trying to get RN jobs while going to school full-time for a different job? Again, benefits no one.

    Quote from ThePrincessBride
    And I wonder how many attendings would feel comfortable knowing there are MDs out there without a residency?

    Residents may be called "doctor" but being a doctor doesn't automatically make one an attending.

    If these "DE" programs require bedside experience, then they aren't truly "DE" as they couldn't go straight to the NP portion without any bedside experience. So that just proves my point even further.
    And you know why attendings think that? Most often: money. Most resident and fellow physicians practice with very little oversight. The nurses provide most of their real last line of defense. Residents are cheap labor.

    In a way this shows your misunderstanding of the NP curriculum, which I don't think is isolated to you by any means. For example, the program I work with requires DE student NPs complete 18 months of part-time RN work prior to graduation as an APN. To be completely honest, I'm not sure that does a whole lot of good, as above.

    Quote from ThePrincessBride
    No. But I bet you'll hear many NPs who value their bedside experience and are glad they didn't go straight through either. You seem to want to completely divorce NPs from RNs; you can't. Otherwise, an RN license wouldn't be required.
    Of course they do! No matter what experience an individual has they value it, that's what makes up the people (and as such, the providers) we are. I don't, by any means, want to divorce NPs from RNs, we are educated under the same model, and that is why NPs have fantastic outcomes data. An NP without RN experience does not make them any less a nurse.

    Quote from ThePrincessBride
    Yes, but I don't want an NP who is starting from ground zero diagnosing patients, and a Nurse Practitioner without any (relevant) RN experience is just that. As a NICU RN going on my second year of practice, I can say for sure that all of what I learned on the floor will help me see the "bigger picture."
    You don't, based on what, a year of RN experience? You are still learning yourself! I am sure what you have learned on the floor will help you, but at the end of the day, if I had the choice between a APN with two years of APN experience and an APN with no NP experience and two years of RN experience I would take the former. I didn't always think this way but after time in the role and working with students of different levels of experience, I do. If I had the option of RN experience plus APN experience in a specialty then that's ideal. A novice APN is a novice APN regardless of RN experience, at the end of the day, my two cents from having been down this road for many years.

    Quote from ThePrincessBride
    But I have a feeling that you have it in your mind that bedside RNs are clueless about the NP role and that bedside experience is overrated, so this feels like a waste of a post.
    That is not the case at all, but I will tell you that, having precepted many experience RNs in the APN role, that most are fairly humbled by the provider role, and the ones that aren't, are dangerous.

    In the end, I am very empirical, where is the data that shows how important bedside RN experience is to practice. Again, in my experience with both APN students and MD students, is that the variability between individuals far exceeds the variability in their experience and education, this is why population-level studies are really needed moving forward.

  • May 31 '17

    Dear New Cleaning Lady,

    You are super sweet and I sincerely appreciate what you do! HOWEVER, I am 2 days away from being on maternity leave and have yet to have a true emergency on my campus this year. If you could refrain from phrases such as "It sure is quiet in here today...", I would GREATLY appreciate it.



  • May 20 '17

    Quote from MrNurse(x2)
    Ask them for study sheets for your children and make them tutor for free.
    My kid's English essay is due tomorrow. I left it in your mailbox so you could glance it over for me! Just write any notes you have in pencil so we can erase it! Kthnxbye!!

  • May 13 '17

    Quote from VivaLasViejas
    "We're going to knock this one out of the park."

    "There is no 'I' in 'team'."

    "It is what it is."
    I like to say there is no "I" in team, but there are two "I"s in idiot.

  • May 13 '17

    "We're going to knock this one out of the park."

    "There is no 'I' in 'team'."

    "It is what it is."

  • May 13 '17

    That sounds toxic. I know what it's like to be in a horrible workplace, my last job was so awful that I would get panic attacks while I was there. One time I was in my car on a break, had to get out of there and just lost it. I couldn't move, called my parents to get me because I didn't know what else to do. I only worked two days a week there, yet it completely took over my life. Work was always on my mind. It changed who I was, lost all confidence, become so passive, anxious all the time.

    Getting out of there was the best thing I've ever done. I made a plan to handle being unemployed, started looking for other jobs and found people I could rely on for being a reference. Once everything was in order I gave one weeks notice, come in and did my shifts and was professional the whole time. As much as I wanted to f*** them over, I knew it would do me more harm in the long run.

    Get out of there before it damages your mental health. Just make a plan and stay professional.

  • May 13 '17

    Think of it this way:

    The first time it only took the adaptive testing 80 questions to know you weren't ready to get your license. The second time it took 265 questions before the computer was sure. The way I see it, you must have been much closer to passing on that second try. I bet with some focused studying and a review course like Kaplan, you will pass on #3. Good luck.

  • May 13 '17

    A BSN without licensure is worthless. Well, you could check off that you have a college/bachelor's degree on any job application, but that's about it.

    If you really want to be a nurse, roll up your sleeves and do some more hard work. You wouldn't be the first nurse to get licensed on attempt #3. Look at the reports, see where you've gone wrong, and attack. Consider using a course--some here have recommended Kaplan. Figure out what you were doing wrong or should have been doing, and make that change.

    This quote's made its way around AN quite a bit over the years, and since it kind of fits this situation, here it is:

    “The brick walls are there for a reason. The brick walls are not there to keep us out. The brick walls are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don’t want it badly enough. They’re there to stop the other people.” (Randy Pausch)

    You're at your brick wall. It's up to you to decide whether it is going to stop you.

    Best of luck.

  • May 13 '17

    Quote from EiEiO_55120
    Try Kaplan. It's expensive, but they teach a "decision tree" that I found very helpful. Also, if you don't pass, they offer further help. Another feature that I thought was useful was analyzing how I answered practice questions. For example, how long I spent thinking about a question or how often I changed an answer from correct to incorrect. (Usually because of over-thinking)
    I think there's a lot of value in practicing relaxation, too. Try to recognize when you're flustered and do what works for you to clear your mind. Deep breathing, meditation, visualization etc...
    You WILL pass. You just might have to change the way you prepare.
    Thank you so much for this! I think I will try Kaplan!

  • May 13 '17

    My daughter told me recently that she is anorexic. I watched her lose 50 lbs in 6 months. She said kids at school have been calling her fat. I remind her how pretty she is and how loved she is and she has been eating better. Some days are better than others, though.

  • May 11 '17

    I turned in my notice two weeks ago that I will not be returning to work as a school nurse in the fall. I have been presented with a great opportunity to return to mental health nursing, my absolute favorite field, and have decided to seize the chance to go back to psych.
    I have noticed a change in my demeanor since I turned my notice in....mainly, that I have more confidence, and I am not afraid to stand up to the teachers. I like the new me! It's normally not in my nature to be feisty; I like to be agreeable and keep the peace. However, since I know that I will not be back, I find myself making statements such as "I did a thorough head check and this child does not have head lice, just dandruff. I realize the teacher thought it was head lice and was terrified, but I am an RN, I know how to differentiate between head lice and dandruff, and I am sending her back to class. Have a good day." And this "A poison ivy rash is not likely to spread from one child to another in the classroom. I am not sending this student home. Have a good day."
    And this! "It is possible for a child to have a runny nose and not be contagious. This is allergy season and the pollen count is extremely high today. It's not appropriate for me to send this child home."
    Since I won't be back in the fall, I really don't care what the teachers think of me! I am the nurse, and I "call the shots," so to speak! I'm going to enjoy this bold new me, right up until I walk out the door for the last time!

  • May 11 '17

    sounds like that kid's not gettin' eye drops.

  • May 11 '17

    Oy. Perhaps an impertinent question but why the need for dosing at school?

    This is why I love high school nursing. They'll lie to you but they can put in their own eye drops!

  • May 11 '17

    We had testing week, and they wouldn't let the students see me unless it was a medically know, how it should always be