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Content That Barnstormin' PMHNP Likes

Barnstormin' PMHNP 8,522 Views

Joined Mar 8, '12. Posts: 352 (66% Liked) Likes: 970

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  • Sep 18

    It doesn't offend me. I refer to myself as a nurse practitioner. i care that I am treated with respect and the paycheck is made out to the correct person.

  • Sep 18

    None of the above. How about "nurse practitioner?"

  • Sep 18

    I'm not one to get upset over semantics. As long as I'm valued by my practice, compensated well and respected...those are the important things. Don't sweat the small stuff.

  • Sep 17

    Beachcomber. But the career advancement is limited as is the pay

  • Sep 17

    I've said it before, I'll say it again:

    Exotic dancer

  • Sep 11

    I cannot discuss you work intelligently. My background is oncology, ICU and CCU. I didn't want to let your post pass, though, without thanking you for being willing to provide safe and legal abortions. There are too many who choose not to, and our freedom of choice is being curtailed. So thank you. You are a genuine hero.

  • Sep 11

    I think the ones who are crummy patients are probably those who are judgmental, self-righteous coworkers.

    Being ill is often a test of ones character. Some people believe it an excuse to become demanding, bottomless pits of need. They think their social obligations are suspended because of their suffering.

  • Sep 9

    They're not being ridiculous.

    Part of being new is reviewing the common meds you see as well as classes that you anticipate seeing and your facilities P&P pretty much everyday after work and days off until you become functional. There isn't realistically enough time to become competent by learning only on the job. Seroquel is a common med and you should be familiar.

    "I don't know" is rarely an acceptable answer. Everyone is looking for signs of being teachable and possessing ability to critically think. Answer with anything other than "I don't know, I didn't look".

  • Sep 9

    So, let's see: You went to your charge nurse, asking for meds, she asked didn't you have those in your cart, and your response was, "I don't know, I didn't bother looking." Your charge nurse gave you some meds and asked (told) you to scan them into the system and you didn't do it. Passed the task on to the next nurse and never followed up to see that it wasn't done. Administered an opioid without an order. Got questioned by the APRN and admitted that you don't know your client's diagnoses or the medications you are administering.

    I'm v. surprised you're not getting more than "attitude" -- like, a verbal or written warning about your errors and attitude. To me, the problem is not so much that you don't know this stuff, as it is your apparent lack of awareness that you're making serious errors and feel that you're being unjustly criticized. They're not wrong, and their concerns are definitely not "kind of ridiculous."

    I understand that you are a new grad and have a lot to learn. I hope that you will take advantage of this wake-up call, instead of blowing it off as the other nurses being "ridiculous," and start taking your practice seriously and being open to learning what you need to learn, before there is a bad outcome with one of your clients. Best wishes!

  • Sep 9

    I'll tell you this. Telling someone that you don't know and you didn't bother checking tells that person all they need to know about you. And the responses you get are a direct result of that interaction.

  • Sep 9

    I'm actually headed out the door in the next few minutes to a going-away, but here's a quick and dirty synopsis. I had to type it out in Word.

    "One was a new admit and had no meds in the cart, so I asked her to pull them for me from the electronic med dispenser. She says "You don't have any of these in your cart?" I replied with "I don't know I didn't bother looking."

    Why didn’t you look in the cart to see if the meds were there before asking her to pull them?

    "I ALSO mentioned to her that I needed help with scanning in some meds.... Two days ago she handed me meds and told me that I would need to scan them into the computer. I never scanned them in but the next nurse said that she would take care of it."

    Why didn’t you scan them in when the RN asked you to? I'm sure someone else could've helped you. Or you could've approached her and reminded her you needed help.

    "Two days ago she handed me meds and told me that I would need to scan them into the computer. I never scanned them in but the next nurse said that she would take care of it. Well today I noticed that it's been almost 3 days and the box of Fentanyl patches for one of my residents has been untouched. So I asked her about it and she said that it has been a few days and she has been starting to feel a lot of pain. So I go to check the date on it.... but can't find it. We strip her down to her bra and there is no Fentanyl patch to be found. So I go ahead and slap one on her. Partially because it just made the most sense to me and partially because I believed that she hadn't received one yet because I never scanned in the meds. After explaining all this she acted as if I made a huge mistake for placing the Fentanyl patch on without seeing an order in the computer. AGAIN... i thought the order wasn't in the computer because I hadn't scanned in the med... silly, I know... So the charge nurse does some digging.... turns out that resident had a patch placed less than 72 hours ago.... (around 60 lol). I didn't see an order for it because it wasn't going to pop up to be changed until the next day.”

    This is a bit hard to follow, but it sounds as though you didn’t check backwards in the MAR to see if one had been placed within the last 72 hours, another one was put on the patient, and then when you were corrected on placing a medication (a NARC, nonetheless) without an order, you thought the charge RN was out of line for telling you the order needs to be rewritten? In my world that’s a med error and a PSR gets written – not punative but definitely a learning experience. THIS IS A HUGE MISTAKE. And you’ve said “i thought the order wasn't in the computer because I hadn't scanned in the med” so it sounds as though you have indeed admitted fault here.

    one of my coworkers who has been there (and a nurse) a lot longer than the charge nurse, helped me to call the doctor, left him a message and he never called back”

    Then YOU call back until you get the correct order.

    "At the end of the night the next nurse who took over for me just D/Cd and rewrote the order for me... Saying that it really wasn't a big deal or something to bother calling the doctor for. Basically what I've gathered is that she made a big fuss over nothing. I did the right thing by giving the resident her pain medication.”

    If I’m reading this right, someone else told you that asking for an order for a narc from an MD wasn’t something you needed to do, and that the charge RN made a huge fuss over nothing. Absolutely. WRONG. Rewriting a narc order isn’t something I’d touch with a ten foot pole – no nurse should. And if you gave a med incorrectly, you didn’t do the right thing.

    "I only had for the first time yesterday. She replies with well "He's layingn in his room passed out." So I go to his room and I see him being stirred awake by the CNA. Obviously she exaggerated a little bit.”

    If he was being “stirred awake”, he wasn’t exactly awake and alert.

    “So I go back to my med cart. I read to her what I have for him on my report she and admit that I don't know what "CKD" is.”

    You should’ve asked when you got report or looked it up in a medical dictionary.
    I pull up his MAR and attempt to pronounce what I now know is the generic name for Seroquel. She asks me what its for and I read it straight from the computer that it's for Dementia. She starts telling me that if she was State that I'd get a tag and that Seroquel is not for dementia.... that I'm supposed to question orders... bla bla bla. She asks me what I'm supposed to look for with antipsychotic meds? What is psychosis? ..... It was crazy.... And she kept trying to say that she's not trying to give me a hard time that she's advocating for me... I call bull.”

    I don’t. She’s trying to educate you, help you, instruct you. Seroquel (quetiapine) is for depression, schizophrenia, and bipolar disorder. It’s also sometimes used off-label as a sleep aid but it’s not a recommended use. It’s also used for Parkinson’s psychosis – which is where I believe the NP was going with that. If you’re able to pass meds, and you don’t know what you’re passing, look it up. I’ve been at this for ten years and I look up meds all the time. You shouldn’t pass a med unless you know what it is and what it does and what it can cause.

    There's more, I'm sure...but suffice to say you have a lot to learn - and that's okay, but think about what I've pointed out and how you could've handled each situation differently

  • Sep 6

    I've experienced bullying as an RN and as an NP. When I was a younger, it used to bother me a lot and had such an impact on my self esteem. I later realized as I got older and had more experience, bullying stems from insecurities.

    As an RN, I was bullied by older nurses but I learned that it was mostly because they're just sick and tired of their work. That coupled with the cynicism is bound to manifest on someone else. funny thing was one of the nurses who bullied me started telling people we were best friends when turned NP. Of course I don't rub it in her face but in the back of my mind, I wonder how can she think I'd easily forget all the things she's done to me?!?

    ive been bullied by office managers and MAs when I worked in the clinic. Often times I had to stand my ground and stand up for myself. I've been bullied by some ICU nurses and one doctor in the hospital where I work now but it doesn't bother me so much.

    Life has a way of making things right. What comes around goes around.

  • Sep 6

    I love the grammar threads

  • Sep 6

    Case studies about unique conditions

  • Sep 6

    I enjoy when we discuss puzzling patient cases. Especially when the OP gives little details at a time, allowing us to figure it out together.
    I like to help students when they come prepared.
    I enjoy most of the articles.