dclong 702 Views
Joined Sep 21, '12.
Posts: 5 (0% Liked)
"Hey, Flo! You're getting a new admit in 206-1," says Mel, the charge nurse. "ETOH, admitted for detox, alert and oriented times 1-2. He's got an IV but ER says it won't last long the way he's picking at it. He's coming up in five minutes---they've gotta get him outta there 'cause he's stinkin' up the place."
Flo, of course, has her hands full with six patients---three of whom are total care, two of whom are high-maintenance types who can't reach the water pitcher without an RN's help, and the other is merely a little needy. She explains this to Mel, who asks her friend Alice (with only five patients) to take the admit, while she runs off down the hall to see what 204-2 wants.....again.
"What'll you have, Mrs. A?" she asks in as cheerful a tone as she can manage. "It's about time for some pain meds, isn't it?"
"You're an hour late," growls the patient, a lady of indeterminate middle age with a bad dye job and an even worse attitude. "I want Dilaudid, right now!"
Flo scans the eMAR, finds only orders for Tylenol, ibuprofen, and Norco, and informs Mrs. A. "I'm sorry, ma'am, I can only give you one of those three. Which one would you like?"
"I said I want Dilaudid," insists Mrs. A, becoming somewhat agitated. "Now go get it, or I'll call someone who will!"
"Sorry, I don't have any to give you," Flo replies. "If you want Dilaudid, we have to ask the doctor for it. In the meantime, would you like Tylenol, ibuprofen, or Norco?" In a snit, Mrs. A refuses all three and tells Flo to get out of her room. Flo heads down the hall to her next patient, a COPD frequent flyer who is at least as endearing as he is annoying. "Hi there, Pete," she says cheerfully. "How are you doing today?"
He proceeds to give her a lengthy---and exquisitely detailed---description of the quality and character of his most recent sputum as she assesses him with a practiced eye. She's dealt with fellows like him all her working life, and she's as familiar with what really ails him as he is: it's loneliness. Right now, however, he needs nothing more than a cup of hot coffee and a breathing treatment, which she provides with a smile and a few kind words before she has to be on her way to her next "customer".
Before Flo knows it, it's time for her lunch break, and she asks Mel to cover her hall while she's in the lounge. It's crazy out there, as it is on every day shift, but the teamwork is good and she never has to worry about whether her patients are being taken care of. Unlike her previous hospital, the charge nurses here don't take patients, allowing them to cover for breaks and lunches as well as emergencies; this ensures that the nurses actually get time to eat (and even PEE---what a concept).
By the time she gets back, Mel has medicated everyone and even handled the brittle diabetic in 202 who'd cursed at her and the CNA earlier that morning about the "lousy service". As a matter of fact, he kicked the matter upstairs to Charlie, the department manager, who had promptly informed the patient that his behavior was unacceptable and he would be discharged if it continued.
"Charlie just handed him the AMA papers and showed him where to sign," says Mel, grinning. "He told the guy that this is a HOSPITAL, not a Shilo Inn, and said he was free to check into St. Elsewhere across town if he wants better 'service'. Charlie's got our backs---nobody gets to treat us like that and get away with it!"
Back on the floor, Flo and the aide turn and change two of their three total cares before Mrs. A's light comes on. This time, she tells Flo that she herself spoke to the doctor, and he'd ordered Dilaudid. Flo searches the computer records for the order, and of course, finds none. It's time for a little reality check.....but instead of taking it all on herself and risking a big ugly confrontation, Flo pages Dr. Awesomesauce to the floor.
He has to come from the ICU, but eventually he does get there and Flo can't resist the temptation to listen to the conversation from behind the door. Sure enough, he orders the Dilaudid, but not before he discontinues the Norco AND gives Mrs. A a little speech on how medication orders are carried out. "The nurses are the ones with the keys to the med dispenser," he reminds her, "and they check every order to make sure that it's right before they give a medication. It's in your best interests NOT to lie to them, or make them wish they didn't have to come in here."
(Remember, this is a fantasy!)
Eventually, the shift ends and Flo gives report to the oncoming nurse, a part-timer substituting for the regular night nurse who's ill with bronchitis and not allowed to come to work. (Administration doesn't like the bad PR that results when the staff make the "customers" sicker than they were when they came in.) As she drives home to her comfy apartment, she sighs with satisfaction, for although it's been a long, hard twelve hours she can sleep tonight knowing that she's done a good job, made people smile.......and earned some pretty decent money while doing it.
And tomorrow, she gets to wake up at 0500 and do it all over again. Some things NEVER change!
Don't you just love it when someone posts a "homework question"? Something like "Why are all doctors so obnoxious?" or "What do you do about lazy CNAs?", but with no context? If it's a real question, you would expect that there would at least be some context in the question. Instead of "Why are all doctors so obnoxious?", there could be an explanation of why the poster believes all doctors are obnoxious, complete with a story about being mistreated by a doctor. Or a story about a lazy CNA . . . with a bit of an explanation about what the CNA did to make the poster believe she or he is lazy. But not, just the bare bones question that could have been a header.
And then, when someone attempts to answer them, either to ask for context or to hint that this might be a homework question and that the poster should do some thinking for himself or herself, the poster goes on the attack.
"I hope me and my family NEVER encounter you as a nurse!"
"You have no empathy!"
"You shouldn't even BE a nurse."
Someone posting homework questions on a nursing forum with the obvious intent that we nurses do their homework for them has no idea what makes a good nurse. They have no idea what a nurse is or does. And they really don't know anything about the poster they're attacking, including whether or not that person is a competent nurse. So how can they be informed enough to conclude that the person they're attacking shouldn't be a nurse or couldn't be a good nurse?
I have no problem helping out new nurses, student nurses and wannabe nurses -- it's the main reason I participate on AN. (Well, OK, that and the funny stories I often find on the ER forum.) But I'm getting tired of spending my time and effort answering questions and then being attacked because the poster doesn't like my answer.
Either someone wrote a long tale of woe, expecting everyone who read it to jump on their bandwagon and is amazed, hurt and insulted that someone dared to suggest that some of their problems might be attributed to THEIR actions, someone posted a homework question and is incensed that other posters might expect them to do some thinking for themselves, or someone started a thread with no other interest than just stirring the pot.
If you keep having problems with your co-workers no matter how many times you change jobs, chances are it's not them, it's you. Blowing rainbows up your skirt isn't going to help you deal with that problem.
If you've been a nurse for a year and are on your third or fourth or fifth job, it's not the toxic workplaces you've encountered, it's you.
If you've flunked the NCLEX twice, taking it again without some remediation is not going to be any more successful than it was the first two times. You may have been a straight "A" student or gone to the world's best nursing school, but you still have to pass the test.
Nursing is not a calling, it's a career. When I'm sick, I'm not looking for Florence reincarnated; I'm looking for someone competent. If all you have to offer is compassion and a calling, no thanks. (And I'm sorry, but I would not want you to be my nurse. I don't care how compassionate you are or how certain you are that nursing is your calling . . . I'd be really concerned about how well you remembered your unit's protocols and whether or not you really know anything about the drugs you're handing me. (Especially if you're insisting that I take my anti-hypertensives when my systolic is 80, but I digress.))
Two mornings ago I received a distraught phone call from my mother telling me that my dad, who is suffering with end stage COPD, spine compression fractures, and a distinct lack of proper narcotic metabolism, became flighty, picky and squirrelly to such a point that he was assigned a sitter.
Look, I've been around. I know what can be said about sitters. I know that for every one that understands the amount of sheer effort and work that goes into trying to keep someone in bed, calm and intact, there are several more misguided individuals that think sitting is easy, requires little effort and even less work.
Obviously those individuals need to meet my dad when he is blitzed out of his brain on Fentanyl and Vicodin. Let's just say that when my family decides to lose it, we don't just misplace our minds, we straight up blast them into orbit never to be seen or heard from again.
Maybe it's the southern mentality: go big or go home.
We pride ourselves on hearing the blankets whisper, seeing shadows slip through the walls, and having full out conversations with no one physical. We sing with gossamer birds, swat at oily, ethereal spiders, undress, and boot scoot boogie down the hall, crumpled spine and inability to breathe be damned. We talk back at the television (even though it's off), recite bits of poetry, and try to lick our meatloaf. We load pills in the end of water straws and attempt to "tranq" the "elephants" in our room. And yes, the nurse would just so happen to be the elephant in question. Perhaps wearing grey scrubs in the presence of one no longer operating on this plane of reality was a mistake. Just sayin'.
But regardless of all the insanity, of the wandering, flitting hands that pluck at skin tears, scrape at desperately needed picc lines, and fidget with the oxygen in his nose, and never, ever rest, he is safe, cared for, and, although gently, patiently re-oriented again and again, he is even kept company in his joyful delusions.
I went to see him the other night only to walk up to the room to hear him murmuring, "The birds...do you hear them?"
"Yes, sir. I think they are canaries. Let's lay still and see if they come back to sing to you."
And there he was, staring at the upper corner of the ceiling as if watching a menagerie in the zoo, rapt, still, his hands resting lightly on his bedding. The sitter, Margaret, greeted me and explained everything he had been up to in a hushed whisper.
After all, we were waiting for the canaries to return.
And then last night, a half mad, partially naked Humpty Dumpty decided to have a great fall.
It would seem that someone decided to tap into their inner ninja and attempt to vault the bed rails and make a beeline for the room exit. The gown was apparently trying to rat him out, so it was discarded for the sake of security (thankfully, he didn't manage to totally disrobe).
Mission impossible music may or not have been involved.
The sitter only looked away for a second. And you know what? I totally believe her. I've seen my dad move when properly motivated.
But it is not because of any "blame" issues regarding his escape attempt that she caught my attention. No.
It is because she was fast behind him, and when his foot caught and his burst of strength gave, she swiftly, skillfully guided him safely to the floor, cushioning his head on the soft toe of her shoe.
Because of her knowledge, her quick thinking, fast reflexes and sure hands, I am not writing a grieved announcement of my dad's need for a crani or an intermedullary rodding of a femur.
Because of her, I get to watch him listen to the sweet chatter of the blankets and blow bubbles in his soda.
And although that may sound like the strangest thing you have ever heard, I could not, ever, be more grateful.
It may not be much, but thank you.
Thank you for giving him the same dedication you would give your own loved one. Thank you for never yelling, never losing your cool. Thank you for laughing with me because crying is not something built into my coping mechanism. Thank you for not laughing at him. Thank you for speaking calmly with my hysterical mother when I could not be reached.
Above all, thank you for "doing nothing".
If someone choked and threatened to kill me trust me I would call the police and press charges.
Sent from my iPhone using allnurses.com
Um, this article seems a bit over the top to me. Medical professionals are predatory, smell blood, etc.? I've been a nurse for over twenty years. That is way over the top.
As many other posters have said, the way you precept, and your attitude, your leadership style may be a great match for some orientees.
But not for me.
I don't think anyone needs to be "broken down" in order to reach their full potential.
And it's kind of condescending to think all new nurses need to be petted and coddled, and it is your job to toughen them up and show them how the real world is.
I, and many others, were well equipped with enough innate intelligence that we already possessed some pretty good critical thinking skills before we ever even started nursing school, and also realize we have an intrinsic responsibility for our own professional growth and development.
I look at new grads and nursing students as colleagues. I do not try to intimidate them. I get to know them as a person on some level; i.e., ask them when they are graduating, their future career goals, etc. I respect them, and they respect me. I freely tell them everything I know. I assure them there are no stupid questions. That knowing what one does not know is a cornerstone of safe practice.
Positive, healthy interactions with all coworkers go a long way in making tough shifts bearable, even enjoyable.
Support, teamwork, respect, sharing of knowledge, modeling leadership, and yes, KINDNESS. Despite whatever else is going on in my personal or work life.
So I don't worry about my orientees speaking about their experience with me as a preceptor with other staff.
Anyone who has ever reared a child or trained a dog understands that kindness works better than the hostility and anger you seem to value. I have mentored using kindness and I can assure you, the preceptee is educated BETTER than when having been beaten over the head with a stick. No, I don't discuss recipes or go for drinks, I am just plain kind to the learner.
This is certainly NOT my philosophy when precepting. Yes, nursing is difficult. Yes, we do deal with life and death situations. Still, there is little need for the level of drama you’ve inserted into your role.
Also, I must agree that you are perpetuating quite a few stereotypes.
I’m sure that this style of teaching will and has been successful with some new grads. We certainly would not have gotten along if you were my preceptor. However, I generally don’t respond well to militant personalities. Hence my abstinence from sororities/cliques/work gossip.
There is a difference between not understanding and not agreeing.
Wish I had the time to tally up the responses between those who get it and those who don't. Just reading responses over the course of the last 24 hours makes me think that those who do get the OP outnumber those who don't and consequently think that OP is an old battleax.
This is how precepting should be done, every time.
If you can't take it, be a candy stripper.
When did it become acceptable that "abuse" in nursing, is acceptable?
You can do all of the above without the hard nose and still help precept a great RN. Really, I see it all the time where I work.
I agree you shouldn't have to coddle folks, but you don't have to have a itch attitude either. Attitudes don't make the nurse, rather skill, hands-on experience, knowledge, critical thinking, etc does. What you foster is what you'll be breeding on the floor. I very much would dislike working with such hostile attitudes.
Nurses are such a diverse group. There are tons of nurses who become nurses later in life and plenty of 2nd or 3rd career nurses who have been successful in their professional and personal lives before nursing.
When I read the original post....it sounds like it's directed at a 20 year old kid who those kind of antics might work with.
However, if that kind of "breaking down" had been attempted on me or the majority of my classmates, I'm sure the preceptor would've been in for a surprise.
Little kid games don't work on grown ups.
so THAT'S why we say nurses eat their young.......they're "Predatory pack animals". Mystery solved.
A LOVE NOTE FROM THE PRECEPTOR FROM HELL
Memorandum from the desk of Your Friendly Neighborhood Sociopath~~
Because medical personnel are predatory pack animals. When you cry, they scent blood and bay for their pack mates to take notice. They watch. Stalking. Lurking. Marking you as weak, ready to cast you aside to larger predators, or, more readily, pick the psychological meat from your bones themselves.
Oh and as I go along and read more comments like the ones from who I already thanked...I want to thank you all too. I say "ENOUGH" to abusive, bully, and vicious behaviors in nursing.
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