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Kooky Korky 26,652 Views

Joined Feb 12, '10. Posts: 3,690 (53% Liked) Likes: 5,039

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  • Dec 10

    Quote from AutumnApple
    I used to supervise on night shift at a nursing home. I saw charting deficits that would make most alert&oriented nurses facepalm. One nurse felt "Pt. coded, sent to hospital" and absolutely nothing else was perfectly fine documentation after a patient went into respiratory distress and 911 was called. I'm so grateful I was not working that night. The patient did not make it and, well, you can imagine the outcome after management saw her documentation.

    On the other hand, as has been stated already, there are those who love to hide behind the computer and (cough) document all day. I don't know what they were documenting because they never left the nurses station to do anything. And of course we had the ones who'd spin around in their chair after report and start documenting their pt assessments. Never saw such detailed assessments as those done by the ones who never left the nurses station.

    Point is, documenting is a part of what you do. Like everything else, it must be prioritized into the day. Over documenting, lacking in documentation, it's all the same thing. *But*, the problem is rarely the documentation itself per se.

    You said you do so much work that when the time comes to document, you end up leaving late. I'm going to disagree with my peers here and say your problem isn't likely to be over documenting. I'm more inclined to believe it's time management and taking control of your assignment during the day that is your problem.

    I see it like this. If it takes an hour per day to document properly, but you're running in circles with other things and leave yourself only 15 minutes to do it, you'll get out late. Most of the time when I see people getting out late, yes, they are sitting at the nurses station documenting. But it's not the documenting that made them stay late. It was mismanaging the med pass and/or other things that caused them to put off documenting until the very last minute.

    Unfortunately, there is no magic wand to wave to make you suddenly able to improve here. For all I know, you may be a speed queen in completing your tasks and manage your assignment beautifully. Often, problems like yours are the result of poor staffing and over sized assignment loads. So there really is no place to improve on to fix the problem unless you are willing to sacrifice quality care for speed.

    Welcome to nursing.

    I did Med/surg my first five years in nursing. I faced this problem as well. As time passes, your view on what is a "priority" and what is not will change and how you manage your assignment will change. It will also start to include you getting out on time as a priority. But this part of the journey in nursing can't be "taught". It's very zen like. You experience it and you find your way.
    time mismanagement is not always the problem.

    There's only so much that can be managed in a given amount of time.

    OP, chart shorter narratives if you chart narratives at all.
    Chart only for problems.

    For example: pt c/o SOB; wheezing and rhonchi noted bilat LL; resp 30/min, O2 Sat 84%; Dr. Smith notified, orders rec'd; chart the temp and whatever other VS you obtained.

    After you have carried out the new orders and rechecked the pt, write:

    CXR done, shows pneumonia per hospitalist Dr. Andrews; antibiotic started, chest PT done, (add whatever O2 supplement pt is now on, type of mask or whatever); resp 22, less labored and other VS, like a temp; family (name) notified, says will visit tonight; (This is for LTC, where families are notified for changes).

    I used to be the last one out, staying late to chart, not having taken any breaks. I checked my CNA's charting of I&O's, wts, etc. The other nurses had not only meal breaks but smoke breaks. Guess what - they didn't check their aides' charting and they barely did their own charting. They also never called a doctor for problems unless someone was literally dying. If you noted problems and didn't leave them for a doctor to see the next day, you got behind. Never mind that the pt was suffering with a sore throat or something painful but not life-threatening. It takes time to get orders for gargles, lozenges, sprays. Not getting the orders means your pt will be uncomfortable. Can you live with that? If you want to get out on time, you might have to just pass that stuff on in report and hope it gets addressed on the next Rounds. ( If it was a decent hour, I would call for stuff like that.
    Late evening, midnights - let Docs sleep.

    Their key was to make sure the med and treatment carts were restocked so the nurse following them couldn't c/o that. They charted their meds and did the minimal charting required. They got out on time.

    Good luck. You should read some of your colleagues' notes to see how they chart. You can learn.

  • Dec 10

    I'm so sorry about your father, MHDNurse.

    Even thought we expect to lose our parents, we suffer when they pass.

    I pray that you find strength and comfort in the days and weeks ahead.

    Try not to overdo. Take time to grieve and to rest, fortify yourself in whatever way is best for you.

    Thank you for sharing your loss with us.

    KK

  • Dec 10

    Quote from EGspirit
    Then what are you going to do? Ruffle feathers by spouting "opinions" and forcing your personality on others? Remember, it's YOU who wants to work with them. It's you who put in the application. If it was the other way around, if you had skills so rare and in demand that they simply had no choice but to do whatever they could to retain you, then you'd be able to ruffle feathers and give your daily opinions without fear of consequence. Without that, what are your choices? Either you will ruffle feathers or you will stifle you desire to do so. Neither is a good option. But what if you just had no desire to ruffle feathers or give your opinion or express your unique personality in the workplace.

    And I'm not talking about giving your opinion when it's part of your job to do so. I'm talking about all the other times in the nurses station when its really just part of the chatter that goes on.
    Stop chatting in the nurses' station. Stop expressing your unique personality at work. just do your job and go home. It's a job, you go there to work. you do not go there for social fulfillment, rather for the paycheck. Hopefully, you can enjoy the patients, certain tasks and aspects of the job, and some of the coworkers, but mostly it's about the work.

    I am so glad I'm not in it full time any more.

    Good luck.

  • Dec 9

    Quote from EGspirit
    Then what are you going to do? Ruffle feathers by spouting "opinions" and forcing your personality on others? Remember, it's YOU who wants to work with them. It's you who put in the application. If it was the other way around, if you had skills so rare and in demand that they simply had no choice but to do whatever they could to retain you, then you'd be able to ruffle feathers and give your daily opinions without fear of consequence. Without that, what are your choices? Either you will ruffle feathers or you will stifle you desire to do so. Neither is a good option. But what if you just had no desire to ruffle feathers or give your opinion or express your unique personality in the workplace.

    And I'm not talking about giving your opinion when it's part of your job to do so. I'm talking about all the other times in the nurses station when its really just part of the chatter that goes on.
    Stop chatting in the nurses' station. Stop expressing your unique personality at work. just do your job and go home. It's a job, you go there to work. you do not go there for social fulfillment, rather for the paycheck. Hopefully, you can enjoy the patients, certain tasks and aspects of the job, and some of the coworkers, but mostly it's about the work.

    I am so glad I'm not in it full time any more.

    Good luck.

  • Dec 9

    Quote from SpankedInPittsburgh
    I think the real question here should be "why do I care about what this yippy pack of dogs think"? Nursing is many things to many nurses but what it is for all of us is a paycheck. If you have a direction to go in your life then get there. If this place will help pay for you to become an NP let them (I'm working on my DNP now and it gets expensive but as important as financial support can you work around your clinical hours). Anyway, this isn't high school and I see no reason to leave a good job because you don't fit into a cliché of rude hags.
    Are we sure they are a clique of rude hags? Or a yippy pack of dogs? LOLOLOLOLOLOL

    All we really can tell is that OP feels she doesn't fit in with some coworkers and is sad because some she does get along with are possibly retiring or leaving.

  • Dec 9

    Quote from EGspirit
    No, of course not. But if you are going to report a colleague or supervisor, or facility for that matter, it better be for something really serious.

    And even then, you may have to realize that you will fall on your sword for doing it. And when all is said and done, all your next job is going to know is that you might report them, that you go behind your bosses back and report him or her, that you think you're better than others, that you will be spying on others, and that you have trouble working as a team.

    Because here's a fact: in any given day at work there will be medication errors, neglectful care, ignorance, failure to call a doctor, doctors who don't call back to give an order, etc., etc., ad nasueum--every single shift. So, what sword are you going to fall on? Because you can only do it once.

    And no, they can't fire a whistleblower, but you will make mistakes--every single shift, I guarantee it. And they will just start looking at them. And that's how they will get rid of you.

    I know this sounds negative, but I really don't see it that way myself. It's definitely Machiavellian, but it's neither negative or positive. It's just the way things are, and nurses burn out all the time for not understanding it. That's all I'm trying to say.
    Whistle blowers can be fired - just not necessarily openly. If the boss wants you gone, you will be gone sooner or later.

    I have worked with many people for the last few decades. Some were awful and some were wonderful. I don't think that college or the lack of it makes a person pleasant or not.

    I do know that particular personalities tend to end up in particular specialties, although there are certainly exceptions.

    Just try to keep a low profile. Do not be unfriendly but do not talk to people if you can help it. That is, don't gossip, don't gripe, don't chart in anger.

    If you expect trouble, you will likely find it, so try to keep a positive attitude. Don't let this be too well known, as someone will likely want to rain on your parade.

    Good luck.

  • Dec 9

    Quote from ThePrincessBride
    If I go for my NNP, I will stick it out, but upon graduation, would transfer. They don't respect me now as a person...why would they respect me as a NNP?
    Why do you think they don't respect you as a person?

  • Dec 9

    Quote from ThePrincessBride
    I know there have been a thousand or more threads on this subject, but hear me out:

    I have been working on a neonatal ICU unit for almost two years now. Prior to that, I worked in adult med-surg and still work there casually.

    I love working with the babies and their families but socially, I feel like an outcast. Some coworkers refuse to acknowledge my presence and ignore me even when they are assigned to be my patient's secondary nurse (for when I need to use the restroom or go on break). Just today, I was happening to go the cafeteria at the same time as a group of my coworkers. They all waited for everyone else to get their food...except for me. No "see you later" or anything. They just walked away.

    They are constantly talking about stuff they do with each other outside of work and to events that I haven't been invited to. When I try to join a conversation, sometimes I am ignored or given a quick response and then they go back to talking among themselves.

    There are some coworkers who are wonderful. They are older and more experienced, but they are slowly leaving the unit, leaving me with a clique of younger nurses. I am an island of a person.

    Should I start looking elsewhere? I am planning on going back to school next year (FNP or NNP, not sure which yet). The place has good tuition reimbursement (though not astounding or anything).

    What is the rational thing for me to do? I have been bottling this in and keeping my nose down and working, but I think it might be time to leave.
    How do they get by with ignoring you when they are your secondary nurse? How do they demonstrate that they are ignoring you in this situation?

    Do they refuse to relieve you if you ask them to?

    Do they ask someone to relieve them if they need relief? (instead of asking you to relieve them)

  • Dec 9

    Quote from FPNP
    Find an ally. Go out of your way to befriend someone on your shift. Find out about who they are, people love to talk about themselves. Then slowly start doing coffee or social events together. You don't need to be friends with everyone, or even most people, just start with one person.

    Yes. One at a time. Rome wasn't built in a day. And do be a great listener.

    I have been in your situation and it does hurt. But I didn't leave a job I loved just because I felt not much a part of the group. Anyway, is there really a group?

    You might be surprised to find that the ones with kids about the same age might get together once in a while. If their kids are in school or extracurricular activities together, two nurses might see each other outside of work because of that.

    Some might be related or have another friend in common, go to church together, whatever. Maybe they live near each other and are in the same Home Owners' Association.

    I wonder if you are just a naturally quiet, shy person while some of the others are more extroverted. No matter. I think you should try to just be yourself and make peace as best you can with the situation. Don't leave if you're not sure you are ready to do so. If you like the work, get along with Management and others, and have at least some peers you are comfortable with, it seems to me you should just be nice, help if someone asks for help and you are able to do so.

    Maybe they are at somewhat of a loss about how to relate to someone who is going to go to NP school.

    Might they envy your childless freedom? As much as people love their kids, kids do sort of clip our wings for a few years.

    Best wishes.

  • Dec 8

    "Work with me, Doc, Let's stay out of Court".

    I guess when you're new, it's natural to be scared and take to heart all the trash your coworkers tell you. But try to be calm, be prepared as others here have advised, and just do your job.

    I've rarely had to deal with this and never more than once with any particular doctor because I let them know, nicely but firmly, that we are a team trying to care for our patient.

  • Dec 6

    Quote from klone
    Gone are the days when nurses are physicians' handmaidens and we blindly follow orders. You need to know much of what the physician knows so you know whether or not it's an appropriate med/treatment/intervention. If you carry out an inappropriate order, YOUR license is on the line.

    And yes, pathophysiology is incredibly important to know. Nursing is not tasks.
    Isn't Nursing tasks plus knowledge? Certainly there are tasks to learn, to master.

    Nursing professionally includes understanding why we do what we do, why the docs order certain meds and procedures.

    The nurse if the backstop, the last person who can catch wrong med orders, wrong or incomplete various other orders. So there is a great deal you must learn.

    Best wishes.

  • Dec 6

    I'm so sorry about your father, MHDNurse.

    Even thought we expect to lose our parents, we suffer when they pass.

    I pray that you find strength and comfort in the days and weeks ahead.

    Try not to overdo. Take time to grieve and to rest, fortify yourself in whatever way is best for you.

    Thank you for sharing your loss with us.

    KK

  • Dec 6

    Quote from AutumnApple
    I used to supervise on night shift at a nursing home. I saw charting deficits that would make most alert&oriented nurses facepalm. One nurse felt "Pt. coded, sent to hospital" and absolutely nothing else was perfectly fine documentation after a patient went into respiratory distress and 911 was called. I'm so grateful I was not working that night. The patient did not make it and, well, you can imagine the outcome after management saw her documentation.

    On the other hand, as has been stated already, there are those who love to hide behind the computer and (cough) document all day. I don't know what they were documenting because they never left the nurses station to do anything. And of course we had the ones who'd spin around in their chair after report and start documenting their pt assessments. Never saw such detailed assessments as those done by the ones who never left the nurses station.

    Point is, documenting is a part of what you do. Like everything else, it must be prioritized into the day. Over documenting, lacking in documentation, it's all the same thing. *But*, the problem is rarely the documentation itself per se.

    You said you do so much work that when the time comes to document, you end up leaving late. I'm going to disagree with my peers here and say your problem isn't likely to be over documenting. I'm more inclined to believe it's time management and taking control of your assignment during the day that is your problem.

    I see it like this. If it takes an hour per day to document properly, but you're running in circles with other things and leave yourself only 15 minutes to do it, you'll get out late. Most of the time when I see people getting out late, yes, they are sitting at the nurses station documenting. But it's not the documenting that made them stay late. It was mismanaging the med pass and/or other things that caused them to put off documenting until the very last minute.

    Unfortunately, there is no magic wand to wave to make you suddenly able to improve here. For all I know, you may be a speed queen in completing your tasks and manage your assignment beautifully. Often, problems like yours are the result of poor staffing and over sized assignment loads. So there really is no place to improve on to fix the problem unless you are willing to sacrifice quality care for speed.

    Welcome to nursing.

    I did Med/surg my first five years in nursing. I faced this problem as well. As time passes, your view on what is a "priority" and what is not will change and how you manage your assignment will change. It will also start to include you getting out on time as a priority. But this part of the journey in nursing can't be "taught". It's very zen like. You experience it and you find your way.
    time mismanagement is not always the problem.

    There's only so much that can be managed in a given amount of time.

    OP, chart shorter narratives if you chart narratives at all.
    Chart only for problems.

    For example: pt c/o SOB; wheezing and rhonchi noted bilat LL; resp 30/min, O2 Sat 84%; Dr. Smith notified, orders rec'd; chart the temp and whatever other VS you obtained.

    After you have carried out the new orders and rechecked the pt, write:

    CXR done, shows pneumonia per hospitalist Dr. Andrews; antibiotic started, chest PT done, (add whatever O2 supplement pt is now on, type of mask or whatever); resp 22, less labored and other VS, like a temp; family (name) notified, says will visit tonight; (This is for LTC, where families are notified for changes).

    I used to be the last one out, staying late to chart, not having taken any breaks. I checked my CNA's charting of I&O's, wts, etc. The other nurses had not only meal breaks but smoke breaks. Guess what - they didn't check their aides' charting and they barely did their own charting. They also never called a doctor for problems unless someone was literally dying. If you noted problems and didn't leave them for a doctor to see the next day, you got behind. Never mind that the pt was suffering with a sore throat or something painful but not life-threatening. It takes time to get orders for gargles, lozenges, sprays. Not getting the orders means your pt will be uncomfortable. Can you live with that? If you want to get out on time, you might have to just pass that stuff on in report and hope it gets addressed on the next Rounds. ( If it was a decent hour, I would call for stuff like that.
    Late evening, midnights - let Docs sleep.

    Their key was to make sure the med and treatment carts were restocked so the nurse following them couldn't c/o that. They charted their meds and did the minimal charting required. They got out on time.

    Good luck. You should read some of your colleagues' notes to see how they chart. You can learn.

  • Dec 5

    Quote from hodgieRN
    I'll tell you the main reason why flu shots are now becoming mandatory. Reimbursement. Hospitals are under enormous pressure. Pts that cycle back through the hospital cost billions. A recurrent congestive heart failure pt is a huge thorn in the side of hospitals because it's an endless cycled-disease. So, hospital adopted national standards to help pts live better with the disease. It cost less money and pt have better outcomes. Those of you who are getting BSNs will learn the importance of cost analysis and productivity. Our effect on the healthcare system reaches far beyond the clinical aspect at the bedside. Pts who contract the flu can become deathly ill and they stay a longggggg time. Many hospitals rely on reimbursement from the government to pay for admissions....especially medicare reimbursement. That is why electronic records are now becoming the standard. Hospitals received a huge reimbursement if they switched to EMR's (millions per hospital). It was based on better patient care, etc, etc. If nurses don't get the flu shot and a pt gets sick, it's costs the hospital money...lots of money....thousands a day, on top of the other diseases they have to pay for. And the shot reduces the risk of flu and pneumonia (especially medicare pts). So, if one nurse doesn't want to get a flu shot b/c of personal reasons, that one person is not worth the risk of millions of dollars per hospital per floor. If you had to pick up the bill for a pt who got sick from you, you would get the flu shot on day one of the flu season. New health care laws are basing reimbursement on these standards. A congestive heart failure pt who isn't given CHF education at discharge, or not given standardized meds (ace-inhibitors, diuretics, beta-blockers) will come back to the hospital multiple times. Just occupying a bed in the ICU, on day one, can equal what you will make as an RN in a month. Hospitals that don't meet satisfaction guidelines can even be denied reimbursement. Plus, if a nurse or student doesn't want the flu shot, there are dozens and dozens of others who are chomping at the bit to swoop into that position....and they are more than willing to get the flu shot and donate a kidney. The supply has now out numbered the demand. They can let a nurse go from a position b/c no one is that important. And, no one is worth more than reimbursement. The cost of our health system is broken and every chance must be taken to ensure patient safety and proper health care guidelines. We are one of the many vital positions in the hospital, but our worth does not compare to the safety of our patients. A life cannot be reimbursed, so we must either adapt or move along.
    How can a pt's illness be traced to a particular nurse?

    Dopes anyone believe in organized resistance, revolutions? Does everyone just think like sheep?

    I understand about money being the king, far more important than people, I just understand that change requires someone to stand up to tyranny.

  • Dec 5

    Quote from 45whenimdone
    It didn't dawn on me until just right now, don't ask me why, that my choice of NOT getting a flu shot will NOT get me into a nursing program. The director at my school of choice basically stated "it is a requirement that you receive one, however you can sign a declaration that you do not wish to receive one." Then I asked, "would that inhibit my chances of getting into the program?" She replied, "well, the facilities in which we work with it is required due to you working with elderly clients; If you do not wish to get the flu shot perhaps you should look into another career."

    *****?? (excuse the language) I have worked in nursing homes, health centers, private duty, home health agencies, visiting nurses association, hospice AND THEY NEVER REQUIRED me to ever receive or even ASKED if I have obtained a flu shot!!! (mid 90's)

    So, anyone please tell me my dream of becoming a nurse is already dead because I REFUSE to get a flu shot???!!! seriously??? I am so upset right now!!!
    Go into Health Care Administration or some other business management. It pays better and might not require vaccinations.

    Most people don't want to believe or even investigate the dangers of vaccinations or their efficacy. It always amazes me that a flu virus knows to come out into the open every Autumn.

    This obstacle might be God's way of guiding you to a better life situation, one that you can't envision right now. Wishing you all the best.


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