Content That blueheaven Likes

Juan,

thank you for responding. A more in depth review of Critical Care Fundamentals sounds like something that I would enjoy and use every day. Maggie

None of you will like what I have to say. But let me kick the hard truth to you. Honestly about 50% of people I talk to are in nursing school or are taking pre reqs for nursing school. This is a major red flag for several reasons. If you have not noticed, nursing wages/benefits have been on the down trend.

Pension?? goodbye.

Crud 401k 403b plans hello. Raise? LOL "sorry hospital is working out financial issues, maybe next year".

Nevermind if you work for a community/SNF agency. But yet insurance companies, medicare derived/gov agencies, and anyone else from the top 1% will continue to blast the RN as "shortage" in order to drive drones of students into nursing schools pulling each others hair out on the way to land a seat. Proof of this is lets see (ABSN ***** ADN, BSN, diploma, LPN/LVN bridge to RN programs, RN to BSN) why do these different routes exist? To flood the RN market as fast as possible to drive the wage, need, and profession into the ground.

Lets look at our oh so loyal CNA's. If you can find one that isn't in nursing school to be a nurse, ask them how much they make?

Look at LPN's 20-30 years ago and look at them today??

Surely the ANA and other organizations treated them with respect. The RN is next, so make sure to support your local nursing agency so they can do nothing for you. So they can be paid off by organizations so powerful that no one can say no and "not have the power to stop a bill". So they can continue to cry nursing shortage when this is not true.

RNs today are treated like children and are required to demonstrate fundamental task and other skills in inservices which were designed for nothing else but cut throat. To place blame of UTI's and poor patient satisfaction on the nurse.

If you are an RN today, your only safety net iS to become an APRN if you want to live comfortably. But in several decades the APRN will be under attack just like the LPN had been an RNs currently are. "OH the aging population is going to need nurses" you really think so.

Nursing homes are shutting down and now elderly people live at home with "24 hour care takers" that get paid **** wages and do things only an RN should be doing. You don't think so? Wake up.

None of this is to say that i hate nursing. I love helping people who are mentally ill, suffering from dementia, sick, or on their death beds. It is when we do great things for them that my love for nursing shines. There aren't other people standing around to reward you for your great deeds.

When the family comes in the next day complaining about everything, they never had a chance to see how well their dieing love one was cared for. Your good deeds will never be rewarded, but in a safe place in your heart.

I am just here to open the eyes of people who are intelligent and looking for a new career. I think you may find better job security else where. Invest your time in classes and money else where. Nursing is honestly under great attack right now and the future is black.

Work Cited
The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025

It really doesn't matter what line of work you are in, saying that you were fired is a bad idea. Always go with the "don't ask, don't tell policy". Just because you were fired, doesn't mean that you aren't entitled to ever hold a job again. It's a personal choice, but I say what happens between you and your previous employer is between you and them.

I worked with a nurse who had some weird misunderstanding with the wife of one of our frequent flyers (an oncology unit) for chemo. It got blown way up, and she had to go to HR with the manager over it. Frankly I didn't want to know why, you never hear the whole story anyway. But I remember how terrified this nurse was that she would be canned over it. The nursing culture in that hospital was very lenient and nurse centered, but even so, when the rubber hits the road, we are held responsible for 'customer service' which translates into 'the customer is always right'.

It put me on my toes, let something similar happen to me. I'm pretty easy going, but still. Often the first time you realize you've had a complaint is from your manager. The nurse above was shocked, she herself didn't know there was a conflict in the first place, the patient's wife didn't confront her or argue with her at all.

I agree with the others, no need to tell on yourself. If you have professional references, use those. Anymore, when you call HR you find out the person was 'terminated' whether they resigned or were fired. Some states have very strict human resource laws about what the previous employer can disclose. One of my previous bosses only said "Yes she worked here between such and such dates" and nothing else! He wouldn't talk to them, I had to call an HR lady I knew well and have her send me copies of my four years of evaluations lol. This previous boss was a stickler for HR rules, perhaps he'd been burned before? Hard to say.

That said it's worthwhile to learn every way possible to avoid triggering trigger happy people. For your own sake. An outspoken person is more likely to get it than a quiet one, so it pays to go self-preservation all the way. It's not worth doing otherwise, as you can well say Best of luck, you'll get snapped right up, I'm sure.

You mention that you are a 14 year nurse. In this same facility?

Bottom line--They can hire 3 nurses for the wage that they are paying you--as a specialty nurse with 14 years of experience. So usually, management will find some sort of something to immediately let you go for. Plus, the 3 nurses that they can hire to take your place can be well trained to use "key terms" and scripting, run around appeasing patients and families--new nurses have no point of reference, therefore, do what they are told to do--which has little to do with practice, and everything to do with "customer service".

Unfortunately, it is not about skilled specialty care of patients. It is about dollars, reimbursements and scores on surveys.

I am sorry that this happened to you. I would certainly contact my malpractice insurance, speak to a union rep.--you need to preserve your right to seek unemployment, you need to get whatever benefits you have coming (ie: un-used PTO) that type of thing.

Finding ways to pick off the most seasoned nurses is not a new thing, and most managers will be in tune to that moving forward. You may find, however, that your pay will decrease significantly. As a complete aside, it just stinks that nurses with such a long history of quality care in such a complex specialty as critical care are pushed aside to be replaced by inexperienced, sometimes moonbat nuts nurses.

But Op, remember, you may or may not have been firm with a family, but that patient was given the best foot forward for function as feasible. Like any 14 year veteran of critical care would do.

Let us know how it goes.

I belive my first 'message board' WAS Allnurses maybe in 2002 or so?

And I remember one particular post reply (I want to say it was in regards to nurses and tattoos) I made that caused an epic stool storm. It was an innocent enough post but it was taken the wrong way. That being said, I pushed the keyboard away and just read posts. After a few weeks I stopped visiting. When I returned in 2006 I lurked as a guest (as I could not remember my previous signon name and email) and it took me about a year of watching, reading and understanding the workings of this board before i got up the guts to register again and begin participating.

It's valid to me, as I am not offended. I once weighed 200 pounds---something my small frame couldn't handle--after pregnancy and eating myself to that weight, I felt horrid.

But I persisted and got rid of it...it wasn't easy and it wasn't fast, but I did it.

So...having been that weight and everyone having told me for about two years "what happened to you?" Eh, I got fat.

It's the truth. Was I hurt? Not really.....I was fat. . And I was a glutton...and I embraced it...

Whatever...

And I wasn't in a hurry to lose the weight no matter what anyone said, especially MY MODEL THINK MOTHER.

So...

I tuned everyone out and lived my life.

According to MY standards and according to MY timeline.

Eventually I lost it--got kudos for it. I didn't care so much for the kudos.

I "ku-doed" myself the whole time--fat or thin. I think it has to do with really liking who I am---whatever my size.

J

Yeah, if you want privacy, a teaching hospital is not the place.

I guess I was referring more to the attitude and behavior of the attending described in the OP rather than the descending hoards (which is one reason I prefer working nights).

On the other hand, the patient certainly could ask to speak to only one physician, rather than a room full of people, and many of the attendings and chiefs that I know would comply.

Interesting that people believe that. I live within an hour's drive of the medical mecca of the world with many teaching hospitals and three medical schools (including House of God's BMS), and recent research indicates that patient care is better, complications and infections less common, outcomes better, patient satisfaction better, and costs lower at the community hospitals outside of town. This is still true when you adjust for acuity, age, and premorbid conditions. Across the board.

The BMS and its partners get all the ink, but you'll never catch me going there for care.

True, but you can still refuse anyone's care and attention, including house staff, and if it's a teaching hospital, it's important to realize that some things you learn aren't in the syllabus. All names changed...

My child was in a nationally-famous children's hospital after van-vs-bicycle trauma (thankfully no permanent disability, but it was a lousy couple of months). She had, among other painful things, a couple of JP drains in her leg. Her second post-op morning the Chief Resident in plastics, Robert, came in at 0645 with the retinue of residents and students, pulled down her covers, yanked off her dressing to look at her wounds, whanged the JPs around a bit, slapped it back on haphazardly while calling for a nurse to replace it, and walked out without a word to her (by now in tears) or to me, who was right there in the room. I was speechless, but mad. So the next day, I said, it would be different.

0645 again. Crowd enters noisily in the door. Chief Resident reaches for covers. "Good morning, Susie. Is it ok if I look at your dressing?" That was me speaking. His hand froze. I spoke again. "'Good morning, Susie. Is it ok if I look at your dressing?' That's what YOU say." He got very red, and the crowd behind his back looked sideways at each other.

Then he spoke. "Good morning, Susie. Is it ok if I look at your dressing?""
She said, "Yes, but please be careful not to move those tubes around so much because that really hurts."
He was noticeably more careful, put things back together nicely, and left without a word. A few of the retinue cast a glance backwards at us as they followed him.

Later that day the Chief of Plastics, the attending, one of those lovely physicians for whom nurses would walk barefoot over broken glass, dropped in during naptime. He sat with me and we spoke quietly in the dim light. "Heard you had some words with Robert," he smiled.

I answered, "I guess word gets around. I am sure if he's your chief he's really good technically, but he has a helluva lot to learn about bedside manner." He nodded, and said the students took the lesson. I saw that man off and on in the course of my work for years afterwords, and he never failed to ask after her.

And Robert never entered the room again. I don't know if he rotated off the adolescent service or what, but never again.

Unfortunately, if someone is going to be upset about a parade of residents and medical students crowding into their room, or having to answer the same questions over and over again to different medical students, residents, nurses, and nursing students (a big complaint we get) -- than it kind of *is* the fault of how a teaching institution is set up.

You can go about it tactfully and some of our docs are great about introducing themselves and explaining the process but. /shrug

I just came back to this thread after perusing some of my other more recent posts, and I have to say WOW---the outreach from AN members has completely astounded me once again. I am SO grateful for each and every one of you!!!!!

And, I have some good news for a change: there is an oral chemotherapy medication that could possibly stop hubby's tumors from growing anymore! We saw a cancer surgery specialist at the big university hospital yesterday who helped developed this drug, and has patients WITH METS who are still alive after five years. This is incredibly promising, and since the drug manufacturer charges only a nominal fee to those without insurance and/or who can't afford it, we'll be able to get it (the stuff costs > $8000/mo.).

Not only that, there is no tumor obstructing his small bowel as had been feared, so the constipation and vomiting have responded to vigorous bowel care and he's now eating again and gaining strength. God really does hear our prayers, even if the answers come in some rather unspectacular (and inelegant) ways.

Thank you again, one and all. I love you!!

Can nursing programs graduate practice ready nurses?

Of course they can, diploma programs did so for decades before and after BSN and ADN programs came along.

Thing was diploma nursing programs were just about that, training/educating nurses. While the apprenticeship method is long out of fashion, the fact remains such programs turned out clinically competent grads that went from GN to RN often with ease and no more change of uniform/caps.

Old school hospital programs offered clinical experiences of two or more days per week with rotations in every area covered by nursing service. Contrary to popular belief many programs kept up with modern developments in the profession and were not merely producing automatons. Theory and rationale were covered along with incorporation of various other disciplines such as science and pharmacology.

Clinical competency is in no small way the result of doing, and doing, and doing things over and over again until one's brain becomes hardwired. Schools now seem to push this off and or hope it comes later at the hospital's expense during orientation, but the latter group is saying "not so fast".

Any person in possession of reasonable intelligence can study a nursing text book and after period of study know enough T&R and whatever to pass an exam; however you certainly wouldn't let them loose on a sick cat much less you and yours.

Problem today is college/university educated nursing students have many demands on their time. If they are to spend two or three full days per week at clinical rotations where does the time come from for classroom time? Not just nursing but the other subjects that are required by the college as a whole and or state for those seeking a degree. This is particularly a problem in the United States where students are used to ample and often long breaks in their school terms.

There are many, many hospitals that are phasing out more experienced nurses who hold a lesser degree than a BSN in favor of anyone who does. In some instances, new BSN's "training" newer BSN's. It is driven by dollars with little sense. With everything computerized checklists, scripting of patient interactions, reminder pop ups when meds are due--it has become less the art and science of nursing, and more the technical computer programming of nursing. Most want a nurse to just do, not think.

Nursing schools don't confirm nor deny that one is going to get a job out of the gate. Few colleges do. However, it seems like the trend is pointing to BSN only facilities. New grads = less pay, and they can shape them any way they wish.

With the healthcare reform, there is a huge push in keeping people in their homes longer. So home health would be were I would be looking.

What a powerful article! Thank you for telling your story of honesty and integrity at a time when there is precious little of either in public life. But I respectfully disagree with your last sentence, because you are much stronger than you realize and this IS a victory!