Scared.....No Nursing?

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staple1027

25 Posts

Thanks. Currently LTC. But I don't want to stay here. I want to go back to the hospital or perhaps something like an outpatient infusion center...... just nervous it's going to be the same thing over and over. Two hospitals and now even my LTC are questioning my nursing abilities. REALLY hard to trust/gain confidence that I can actually do bedside when it's the same song and dance

Nursing has a whole lot of cattiness that goes on. Ever hear of the expression "nurses eat their young"...its a conundrum that has existed in this profession for decades. My best guess is because you are a BSN (LTC generally has fewer BSNs and more ADNs) you are seen as a threat to whomever is in management ...maybe that or those people are not BSNs....maybe not. But for me its been 20 years, and I'd be lying if I said that there were not at least a few rotten apples in every single place. Women angry because they are supporting their entire households, angry because they got dumped from their last job, angry because their husband left them, angry for any reason or no reason, jealousy, bitterness, obesity (thats a big one) , etc...I think I've seen it all. Another tactic I've seen is that the facility prefers constant turnover to long standing employees. When there is constant turnover, no one is getting any benefits at all, b/c by the time they accrue, the person is long gone (much less expensive). So there are some places that literally try to force the staff to quit. Not sure of your exact fiancial situation, but quitting without another job hurts alot (yep, I've done it) , should be avoided whenever possible, (its harder to collect unemployment) but ya gotta do what ya gotta do. If the situation is so toxic that you are unable to function at your job, then maybe your time would be better spent at home hitting the job ads from your computer. Like I said before, people who try to strip a person of their confidence do not belong in this industry, yet they exist, and even find their way into management. I have a management degree from a former career, and always take note of how poorly prepared many of the "nurse managers, DONS, etc" really are, and I doubt they have ever taken even one management class.

Davey Do

10,476 Posts

Specializes in Psych (25 years), Medical (15 years).
Nursing has a whole lot of cattiness that goes on. Ever hear of the expression "nurses eat their young"...

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Just-floored

29 Posts

That is a starting place then. Any time I need to call the physician and notify them of something I will do an assessment, run through what could be causing the problem and be ready to answer their questions. Think of the nursing process it all starts with assessment!

beekee

839 Posts

You hit the nail on the head for black and white.... it's causing a lot of problems for my "critical thinking skills" which is a problem theme among my previous and current employers....

I'm pretty black and white too. In addition to my basic head-to-toe, I have a list of ten or so questions I ask everyone. If I get a positive response, I keep asking questions and do a more focused assessment.

1. Are you in any pain or discomfort? If yes, further pain assessment, PQRST. Offer heat, cold, pain meds.

2. How's your breathing? Any shortness of breath? If yes, assess lung sounds, effort of breathing and oxygen saturation, respiratory rate, edema. Consider supplemental oxygen, inhaler, nebulizer, diuretic.

3. Any nausea/vomiting? If yes, assess bowel sounds, distension, tenderness. Consider ginger ale and crackers, anti-emetics.

4. Any diarrhea or constipation? When was your last bowel movement? If yes, assess bowel sounds, distension, tenderness. Consider prune juice, ambulation, bowel meds.

5. Any light-headedness or dizziness when you stand up? Orthostatic vitals. Fall precautions.

6. Any numbness, tingling, burning or pain in your feet? Fall precautions.

7. Anything else going on that I should know about? Anything new? Open ended questions are great for getting them to tell you about anything they are concerned about. A lot of people don't want to complain, so this gives them permission.

I'm sure I'm forgetting some, but I basically follow a flow sheet. It can all be done pretty quickly. You will also learn to "go backwards." If a patient starts voiding more frequently, ask if it burns when they void and bladder scan them. It might be a UTI or retention. And you'll watch for a temperature, increased confusion, a fall/unsteadiness, elevated WBC, all signs of a UTI. Or maybe you notice increased confusion, and then you'd look for all the other signs/symptoms of a UTI, but also consider other possibilities.

It takes time and practice. Ask questions of the providers, coworkers and patients. "Hey, Mary seems more confused, I did x, y and z. Anything else I should do?" When you come across an abnormal finding, research the heck out of it so you know what that finding could mean, what other assessments would be useful, what meds might be appropriate and what nursing interventions could be implemented.

I know you can do this. If you get any abnormal finding, you need to keep digging. If you report your findings and the provider asks "what about x?" Make sure you know x next time! You will get better with practice and experience.

Specializes in Hospice.
PLEASE, familiarize yourself with giving a good SBAR. Write it down, and read from a script to the provider if necessary.

THIS! A thousand times this! Having all of the information in front of you BEFORE calling the provider will help you more than anything!

Thanks everyone for your support and encouragement. I am feeling hopeful again, I know that I have a long way to go. Today I had the first of I believe several one on one meetings with one of my managers. They seem to have a really good plan to support me and help me regain some confidence. I am pretty excited to see where I can go with this. While I definatly don't plan on making LTC my career, I am going to plan on staying here and "bloom where I am planted" coupled with the support that they seem to be providing and see where this takes me. Keep the encouragement and advice coming!

Julius Seizure

1 Article; 2,282 Posts

Specializes in Pediatric Critical Care.
Women angry because they are supporting their entire households, angry because they got dumped from their last job, angry because their husband left them, angry for any reason or no reason, jealousy, bitterness, obesity (thats a big one) , etc...I think I've seen it all.

And then there's this angry guy, too. :facepalm:

klone, MSN, RN

14,790 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Staple sounds like a South Pole Elf.

anewsns

437 Posts

Specializes in Neurosciences, stepdown, acute rehab, LTC.
Thanks everyone for your support and encouragement. I am feeling hopeful again, I know that I have a long way to go. Today I had the first of I believe several one on one meetings with one of my managers. They seem to have a really good plan to support me and help me regain some confidence. I am pretty excited to see where I can go with this. While I definatly don't plan on making LTC my career, I am going to plan on staying here and "bloom where I am planted" coupled with the support that they seem to be providing and see where this takes me. Keep the encouragement and advice coming!

Oh good! If you love the bedside despite everything I'm glad you're staying there! I'm sure you'll be so good at it in the end. A lot of people don't like it so we need people who do!

Wlaurie, RN

170 Posts

A lot of your story sounds familiar to me. I'm a black and white thinker, worked ltc. I would make a suggestion that you might want to try private duty care. I'm not sure if your dead set on hospital setting but you might want to try a different venue. When I started doing private duty I felt like I'd found my niche. Working with one patient built up my confidence with my nursing skills. Many times you're able to do certain skills like caths, vents, gtubes over and over. This population is fragile medically but you only have one patient to deal with. A lot less pressure but you will make less money accordingly. Might be a good place to try for awhile as you sort things out.

Davey Do

10,476 Posts

Specializes in Psych (25 years), Medical (15 years).
Staple sounds like a South Pole Elf.

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This and remember SBAR from school. It should help you frame your conversations. I'm new myself and just made my first call to a doctor this week. I wrote it all out with a co-worker and well it was Situation, Background, Assessment and Recommendation. I hadn't realized I'd done it until I looked at it. If you have a few minutes maybe try and write out what you're going to say. Have the vitals. Baseline should be in their binder/file.

It's tough to get your sea legs, so to speak. You're not alone. Chin up and nurse on!

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