Latest Comments by ThePrincessBride

ThePrincessBride, BSN, RN 41,756 Views

Joined Jun 13, '10 - from 'Somewhere'. She has '1 RN, 3 tech' year(s) of experience and specializes in 'Med-Surg, NICU'. Posts: 2,079 (60% Liked) Likes: 5,637

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  • 1
    grad2012RN likes this.

    Slay the GRE, get great letters of recommendation and kick ass on your essays. I'm sure you can and will get accepted to an FNP school.

  • 1
    TriciaJ likes this.


    No. It was not heparin. It was not insulin. It was not chemo. Nor was it a cardiac drip, a PCA pump or blood. I wish I could go into more detail into what it was.

    She reminded me of the policy and I thought that that was that, but literally, two minutes later, management comes to me while I was caring for a patient to tell me that they were going to put this incident in my file.

  • 1
    TriciaJ likes this.

    Quote from Boston RN
    So you made a mistake, we have all been there and that's how we learn. It appears this mistake was not severe because you only received a "note" from management. What is most disturbing for me, is that it appears you somehow got your co-workers involved. This has escalated to them sharing with you that "informant" had been partially responsible for a patient losing a limb (c'mon). Now it appears you are repeating this information about "informant" based on hear-say and now you want to confront "informant." This is exactly the type of behavior that needs to be STOPPED in nursing.

    If you want to be a trusted/respected nurse - do what you are supposed to do and don't feed into the sewing circle. If you are reprimanded, keep it to yourself, correct it and keep it moving. If you stay out of gossip-central, there is a good chance you may win over some of these "informants", If not, who cares?!
    I am definitely not going to confront her.

    I asked a couple of coworkers who I consider mentors insight as I really didn't know what to think of this. It was then they told me the information about her. I knew this incident had happened, but I didn't know she was the one behind it.

    Not sure what the "c'mon" was about, but again, if you knew her error (and were familiar with the specialty I work in and the equipment I work with) you would know it was definitely negligence. I don't want to go into too much detail about that.

    I do agree that I should stay out of the drama, and I do when it doesn't involve me. And I shouldn't stoop to her level, but it is hard. However, if someone is going to run to management over pettiness, that person better have her/his stuff down pat.

  • 1
    TriciaJ likes this.

    Double helix, if you knew what happened, you would know it was directly a result from negligence. Trust was really bad.

    But you're right. It doesn't excuse my mistake and as I said before, I take full responsibility.However, I am just not the kind of person who believes in running to management for something that my mentors agree was trivial. My first reaction was anger towards myself and shocked towards her but I hoped she had reported it because policy. But then I hear about her history and among other things and I realize that her intentions were out of malice and pettiness...and that is what gets me.

    And no, I'm not making this up to justify my anger. I want to believe she didn't do it to out of spite seems unlikely. To quote one of my mentors, the girl is not well-liked.

  • 2
    NottaSpringChik and TriciaJ like this.

    Thanks for all the replies and putting it in perspective for me.

    You are right, Ruby. It is about my practice and I do want to be the best nurse possible as I love bedside care and helping patients. I would be devastated if I harmed a patient, and I need to own up to my mistakes.

    I agree with everyone who has said she probably has a guilty conscious, especially since this patient died soon after this sentinel event (for something else). I am trying to come from a place of understanding and not anger and revenge (because that will make things worse).

    After she reported me, she wouldn't even look at my direction all day. My inner five-year old wanted to let her have it!

  • 1
    TriciaJ likes this.

    I've heard both.

    I know I should look at it that way but I can't help but be pissed. This kind of behavior is what makes some nurses keep quiet and are reluctant to work as a team.

    In the future, I will avoid this nurse.

  • 1
    xoemmylouox likes this.

    So, I get a "note" from management. Yes, the policy was technically broken and I take full responsibility (and it had been my first time doing this procedure since starting my new shift). It had to do with dual sign offs (I'll leave it at that). To get some perspective, I asked ta couple more seasoned nurses/mentors for their insight because I was flabbergasted. They are shocked that this coworker went up to management about this issue and have even stated that they couldn't believe this coworker went to management over something extremely petty.

    And then I find out that she was apart of a really bad sentinel event (d/t negligence) not too long ago (think loss of limb). APN confronted her and she took a blase attitude over what happened and even defended her actions (in front of someone she was training!) and that is when APN took it up the chain.

    It kills me. I admit that I am not perfect, but to have someone with a stye in their eye complain about the speck in mine gets me. She not only made this mistake, but she didn't care. She reminded me of the policy (which, at the time, totally left my mind) and I thought it would be left at that.

    To seasoned nurses, how does one deal with a person like this? I am fighting the immature urge to confront her...but how do you deal with someone who throws people under the bus not for patient safety (b/c her sentinel event was enough to get her license tossed), but to make themselves look better? I have never had any negative instances with her before and I wasn't aware of her history, but this has thrown me off guard and ticked.

    I take responsibility for my actions and going forward will not make the same mistake again and will keep my distance away from this one.

  • 0

    I have worked day shift med/surg with seven patients. Five is pretty awesome.

  • 12

    Hmmm...where to start.

    1. LTC (and home health) nurses are the wave of the future. Baby Boomers are getting older and within the next 20 or so years, we will be seeing a surge of people needing to live in LTC facilities. LTC nurses are DESPERATELY needed and are HIGHLY valuable. Get a few years in an unimpressive LTC and soon, you will be able to write your ticket to better facilities with better pay and working conditions.

    2. I work in both med/surg and neonatal ICU. To be honest, I find my work in med/surg (which is often looked down about in similar fashion) FAR harder and more impressive than my oftentimes "cushy" NICU job...and yet, I receive far more appreciation in the NICU. When people find out that I "still" work in med/surg, their noses wrinkle and their eyes bulge out of their sockets in complete shock. "I could never work in med/surg." Yeah..they couldn't. Not with that attitude, at least.

    You tell future NMs that you are able to juggle the care of 20+ patients and watch their reactions. Don't say anything....just observe.

    3. ER and ICU nurses aren't constantly doing life-saving or adrenaline-rushing stuff. Oftentimes, our days are long and uneventful with a sprinkle of action here and there. Many ER nurses feel burnt out d/t lack of actual emergencies and seeing abuse of the ER system. ICU nurses aren't always coding patients, but monitoring, assessing and keeping the MDs/NPs up-to-date on patient status. It isn't all action.

    I have more to add, but I have got to go. I do find starting this thread to be very tasteless and attention-seeking.

  • 0

    Quote from Stepney
    What's in a name? What's in a level? There are many institutions calling themselves level this or that, that do not actually meet the criteria for that designation. Level IV is really about cardiac service. Everything else can be done in level III. Also, it is more efficient to send cardiac babies to one institution which has a lot of experience, regardless of your own insitution level. An nurse or NP in one state can get experience that another nurse or NP would not get in another, even when both hospitals have the same level designation. All the level IIs that I have been in have ventilators, drips, and keep micro-preemies that do not need surgical intervention. I have worked in a level III that did not have ECMO and transferred babies down the street to another "level 3" with ECMO. There are level IIs that do not keep anything under 32 weeks gestation, while others think nothing of the 23-weeker. It all depends on the state and hospital.

    I have seen young nurses graduate from college, start working, and go straight into NP school. They worked and trained at the same hospital and completed their programs in about 2-1/2 years. After completion, they did very well. One NP came from a level II which did not keep anything remotely complicated.

    There are NICUs that are like a club, excluding those who want to move ahead, while others are eager for you to progress. Even if you feel shut out, nothing stops you from reading, going to conferences, picking the brains of the seasoned nurses, etc. And sometimes, you really do get to do more in a scaled-down setting. Your knowledge needs to be top-notch and you get to develop skills that you might not have the opportunity for if there are a million residents, fellows and interns running around in an academic setting.
    To me, Level IV not only includes cardiac care, but anything surgical/more intensive. My unit takes baies under 23 weeks (and I was fortunate to have received that experience), but the minute the perf/nec/show signs of needing a specialist surgeon, they are shipped, and I feel like I am missing a huge part of the NICU by not having that hands-on surgical experience.

    Or do NNPs not deal with anything surgical?

    Club is definitely an apt description to describe NICUs, and it really isn't safe, in my opinion.

  • 0

    Quote from babyNP.
    It's interesting to hear your thoughts about Level IV academic jobs being the cream of the crop. That has not been my experience at all. Now that I've worked in both settings as a NNP, here is my perspective based on my own anecdotal experience that seems to follow with other folks with whom I've had this type of discussion:

    Academic pros:

    Sick kids. Odd kids. Kids that you'll see once in your career and never again. Access to lots of good education in the form of grand rounds, morning reports, and every specialty imaginable and being able to pick their brains. Being at the forefront of the latest and greatest in evidence based practice. If we're being honest, somewhat of an ego to say that yes you work at a certain facility. Salary is hit or miss, depending on the institution.

    Academic cons:

    Generally in big cities and so has all the inconveniences of living in a city including high cost of living, terrible parking (NPs don't generally rank high enough to park on campus except for night shift unlike at many community hospitals), less "perks." Generally 12 hour shifts, no 24s (depends on your outlook whether or not this is a pro or a con).

    Much less opportunity for procedures and if you are- having 23935498 people in the wings waiting just in case (competing for who gets to do the procedure is a thing, largely due to lack of availability). Generally no deliveries (this isn't always the case, but overall majority). Chronic babies that are 6 months upwards of a year old with a million problems that most NNPs don't want to really manage (as this isn't our skill set and not what we learn in grad school) that also come along with parents who are sick and tired of the NICU and resist the medical inevitability (not all of course, but the number of times we've spent months and months trying to convince a parent that yes a trach really is the way to go, eep).

    And...sick kids. All the time. Not much room for a break. It's different kind of stress being the provider in charge as a provider versus the nurse. Managing a baby on ECMO even despite everyone (surgery, heme, fellows, attendings, etc etc) right there helping you is a completely different experience than when I was the bedside ECMO nurse. Then you have the kids dying on a fairly regular basis. And giving "the talk" to parents and being the one to tell them that yes, their child is dying and no there is nothing I can do about it.

    Many NNPs don't want any part of the above...

    Thanks for the reply.

    I was always under the impression that academic jobs were held in such high regard because there are usually more resources, better staffing and more educational opportunities than a non-teaching hospital.

    But it is interesting (and sad) to hear that NPs aren't treated with much respect in an academic facility, but I find that this is a case in many areas, unfortunately, especially when dealing with Neos, residents, etc. However, I do think working three 12s is much more preferable to a couple of 24-hour shifts (that sounds brutal). Also, aren't benefits usually better?

    My concern is that as a (wannabe) NNP, I want to be able to handle any and everything that comes through the door (within my scope of practice, of course). I don't want to be stuck in lower acuity NICUs and not feel confident in my ability to manage a very sick baby's care. For now, I am stuck with more stable babies and Level IVs are so few in my area.

    Oh, and I have absolutely NO experience working with ECMO patients whatsoever.

    Quote from babyNP.
    Community sites are generally the opposite. For example, I've done more procedures in 1 month than I would do in 6 months at my previous job. I only work 6-7 days a month. True, my babies are not very sick, but I like to call them my "rainbows and sunshine" babies. They're pretty nice. And I am still learning- learning how to manage "regular" acute babies that don't go to Level IVs but still need specialized care that I didn't treat in my other role.

    I've also had to stand more on my own; my attending leaves by the mid-afternoon and while they are always just a phone call away, I'm otherwise it for the NICU and any delivery in the hospital. There is something to be said for being more autonomous and becoming a stronger provider because of it. One of my favorite parts of my new role is doing prenatal consults with families that expect to delivery prematurely.

    Overall, I am glad I have the experience I do and wouldn't change a single thing. Perhaps I'll change my mind in a few years and go back to Level IV, but it's nice to be a more rounded NP for now with a better lifestyle.
    Do you think you would have fared well with just level III experience?

  • 2
    not.done.yet and RN-dancer like this.

    Quote from 2mint
    From aanp [dot] org/all-about-nps/np-fact-sheet

    220K+ NP's in the US
    7.7% in Acute Care
    1.7% in Neonatal
    (for argument's sake, let's exclude CRNA since they require ICU exp)

    Majority are in primary care (i.e. preventative medicine).

    Specifically for FNP's, I think 0-1 yr MS/ER experience is good enough--some nurses here "seem" to think that an MD would let a brand spanking new FNP run wild day one, as if a hospital would let a new grad RN run wild day one

    I personally will have about 9 months MS; 12 months ER; X months parttime ER while doing FNP program. (ER is something I always wanted to do--will I use my ER experience in my future FNP job? Possibly, but ER nursing is about stabilization, not prevention).

    RN is an entry-level position (that happens to pay very well here in California).

    Bottom line: roughly 90% of APN's do not work in hospital setting.
    New grad FNP managing DM/HTN vs New grad FNP with 5 yr RN exp managing DM/HTN...
    ER is good mainly because you see just about everything and it provides an incredible range of experience. You also see what happens when a chronic illness is not being well-managed (either via lack of resources, pt non-compliance or provider incompetence).

    It is good that you plan to work while going to school. It may help solidify concepts you are learning and make it easier for you to retain information and see the big picture.

  • 4
    Irish_Mist, Zyprexa, Here.I.Stand, and 1 other like this.

    Quote from Zyprexa
    I agree with you, however, coming from someone who has worked in both med-surg/tele and now psych, there is a big difference between having a psych patient on a medical floor and a psych patient on a psych floor. You will definitely see LOTS of psych patients on the medical floors, but you won't really learn about their psychiatric diagnosis, medications, or treatments to the extent that you would on a psych floor. On the medical floors, the goal is to treat the medical issue, the underlying psych problem is still there but is often not the reason for admission. Now there will be ETOH withdrawals, suicide attempts/OD that require medical clearance prior to admission to psych, but again, the medical issue is the priority. For psych NP school, I would recommend getting some initial experience in med-surg or ED, and then a few years on an inpatient psych unit. Understanding the psych diagnoses and manifestations, interventions, managing difficult behaviors, assessing for SI/HI, safety, pharmacology, deescalation, and recognizing medication side effects, among other things, is very important. Psych is not for everyone, and that goes for Psych NP as well
    That is also a good point. Thanks for pointing it out! Yes, I think for psych NP, inpatient psych experience would be the most optimal. Unfortunately, I know some people jump into psych NP programs thinking they will be "easy" who have never ever dealt with a psych patient in crisis.

  • 12
    Jules A, Nurse Leigh, caliotter3, and 9 others like this.

    Everyone and their dog seems to be going to school these days.

    Not only do I have a problem with nurses with little to no bedside experience becoming NPs, I have a problem with nurses applying to specialty NP programs where their nursing experience is completely irrelevant and unhelpful. I work in both med/surg (adult) and NICU. I know many NICU nurses who have zero adult experience going to school to become FNPs. Funny thing is, the only population an FNP can't work with is the NICU population. The idea of NICU RNs becoming FNPs and caring for adults without any adult experience is frightening, much like a person with only adult experience deciding to become a NNP without any NICU experience.

    I believe we should not only require bedside experience, but experience that pertains to the graduate program in mind. Psych NP- a few years in psych ward/or med-surg (where you will see a LOT of psych patients), Pediatric NP-a few years working in peds, Adult Acute Care NP-work a few years in Adult ICU or step down, CNM- a few years in L/D, NNP- a few years in NICU, FNP- a broad program that should require broad (not super-specialized) experience, such as ER nursing, med/surg and maybe even ICU. Clinic/public health nursing may also be relevant for FNP work.

  • 0

    Med-surg is perhaps one of the best specialties in preparing for FNP school, followed by adult ICU and ER. Going to OB would be a huge mistake.

    I say this as both a med-surg and a NICU nurse. I see NICU nurses going back to schooland they are struggling