How to spot a bad nurse

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Specializes in Med nurse in med-surg., float, HH, and PDN.
3 minutes ago, CommunityRNBSN said:

I'm a little testy because I had a situation at work today.  And that's why #4, "ignoring protocols," annoyed me.  Who was it telling me to ignore protocols today?  Hint: it wasn't a nurse...

Would the one who told you to 'ignore protocols' be willing to go before the BON and stand up for you? Or would that person be willing to put that in writing, on record as a Dr's order? Not likely.

I don't blame you for being irked! 

 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
20 hours ago, CommunityRNBSN said:

And that's why #4, "ignoring protocols," annoyed me.  Who was it telling me to ignore protocols today?  Hint: it wasn't a nurse...

Our current problem like this is midline IVs. They've just started being placed in the past few months in our hospital and our policy states they may not be used for pressors. (Or TPN or central line dedicated infusions, obviously). However, because there's some sort of incentive out there for providers to have less central lines, they're resistant to consulting to have a central line placed. Instead, we get nursing communication orders "may infuse pressor through midline". Well, we had our first levophed infiltrate through a midline and it caused some major damage to this person's arm, apparently required a surgical intervention. And who was getting blamed? The nurse. Even though there was a order, because it's "not policy". Such BS that we're trying to do what's best for the patients, but everyone else is looking at a different bottom line. 

Sorry you had a frustrating day. 

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4 hours ago, JBMmom said:

Well, we had our first levophed infiltrate through a midline and it caused some major damage to this person's arm, apparently required a surgical intervention. And who was getting blamed? The nurse. Even though there was a order, because it's "not policy". 

This sucks big time!

Im curious, Did the order say okay to use the midline?

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On 4/11/2022 at 8:49 AM, Emergent said:

How to spot a bad nurse before it's too late

Bad nurses are usually mouthy, to staff and to patients. They bad mouth staff and patients and also will skip out on orders.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
17 hours ago, HiddenAngels said:

Im curious, Did the order say okay to use the midline

Yes, the provider's nursing communication order said "may infuse pressor through midline".  Which meant they weren't going to request a consult for a central line. We also have an order that says okay to use midline (which was already there), but that would not cover the pressor specifically. This particular patient had horrible access, so there wasn't even the option to use a peripheral because those had been lost earlier in the admission. The nurse literally had no choice if she was going to get the pressor hung. Other people even tried to get an ultrasound guided peripheral and the patient was so edematous it just wasn't possible. Super frustrating. 

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On 4/11/2022 at 5:31 PM, ThePrincessBride said:

Job hopping nowadays is an absolute necessity to keep your raises above inflation. 

My man was at a job for a little over a year and got another job that instantly increased his pay by about 25 percent. His previous job prior to that was about 2.5 to 3 years (not sure of the raise, but got a decent bump). 

Stayed at that job for not quite five years and hopped again recently (and once you get to a certain level, 5 years or less is more or less job hopping) and got a 40k year raise with 20 percent bonus potential (so all and all, 80k/year raise).

Me? I have been in my field for seven years and my pay barely kept up with inflation and I only make $9 and some change more than I did seven years ago. I should have job hopped MORE.

I work for the government and salaries are posted...it is amazing how screwed over some people are, they don't even realize it. 

And others have little and inadequate ability to manage, lead, develop staff.  Yet they are promoted.  Old friends in high places?

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Specializes in Med-Surg.
On 4/14/2022 at 6:06 PM, JBMmom said:

Our current problem like this is midline IVs. They've just started being placed in the past few months in our hospital and our policy states they may not be used for pressors. (Or TPN or central line dedicated infusions, obviously). However, because there's some sort of incentive out there for providers to have less central lines, they're resistant to consulting to have a central line placed. Instead, we get nursing communication orders "may infuse pressor through midline". Well, we had our first levophed infiltrate through a midline and it caused some major damage to this person's arm, apparently required a surgical intervention. And who was getting blamed? The nurse. Even though there was a order, because it's "not policy". Such BS that we're trying to do what's best for the patients, but everyone else is looking at a different bottom line. 

Sorry you had a frustrating day. 

I was in a similar situation once. A doctor wanted to infuse a med through a peripheral IV that the policy said central line. I refused and went back and forth for hours. Part of the reason why I refused was because I had 6 patients and there was no way I could give the patient extra attention. Guess who coded on the next shift?

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Specializes in Pediatric Critical Care.
On 4/11/2022 at 10:30 AM, JBMmom said:

I'm not sure where this doctor works, I went back through a couple articles he wrote and it didn't specify his position.

From his bio page:

"Ryan Gray, MD, is a former Air Force Flight Surgeon. He is now helping premed students overcome obstacles on their journey to become physicians at the Medical School Headquarters."

A Google for "Medical School Headquarters" turns this up:

"Ryan [Grey] is a former Flight Surgeon in the United States Air Force. Ryan graduated from the University of Florida (GO GATORS!) with a B.S. in Exercise and Sports Sciences, and received his M.D. from New York Medical College. After graduating from medical school, Ryan completed his internship through a Tufts Medical Center transitional medicine program at Lemuel Shattuck Hospital.

Ryan is the publisher of MedicalSchoolHQ.net and OldPreMeds.org and the podcast host of several podcasts on the Meded Media network. He is also the Director of the National Society of Nontraditional Premedical and Medical Students."


I am struck by the fact that his bio does not mention a residency, fellowship, or work experience as an attending -- just an internship.  Interesting.

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Specializes in Pediatric Critical Care.
On 4/12/2022 at 2:51 AM, Googlenurse said:

In his article on what makes a nurse good, he said nurses must have an extroverted nature. I disagree with that one.

It also says that a good nurse needs to have a good memory.  But it's not just to help them remember their patient's condition and medical history.  A good nurse also remembers their patient's favorite sports team and favorite food.

I also read his article on how a good nurse makes a doctor's job easier.  One item on the list was that nurses take care of the "little things."  What little things you ask?  Well, some of them were smiling, talking, answering questions, and being kind to family members.  Funny, I thought those were all things that a good doctor did, too.

To his credit, none of his articles seem disparaging to nurses, and he seems to appreciate them as a valuable part of the health care team.  But some of the stuff in his articles just sounds...kinda dumb.

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18 minutes ago, Julius Seizure said:

From his bio page:

"Ryan Gray, MD, is a former Air Force Flight Surgeon. He is now helping premed students overcome obstacles on their journey to become physicians at the Medical School Headquarters."

 

Obstacles such as bad nurses? ?

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Specializes in CVICU.

You can tell this isn't written by a nurse without checking who the author is. This is why nurses manage and hire nurses, not doctors. As nurses, we do not work for physicians, we work with them (typical inpatient units). We work for the hospital and our nurse managers.

That said, many of these attributes are certainly qualities of a bad nurse, but they also are qualities of an overworked, understaffed, under appreciated, abused (by patients and employers), underpaid, and high liability profession. And people job hop to make more money and find better working conditions. I got a $0.27 raise at one job. Promptly left for a $9.50 pay increase after that. My manager's response? "Well that's what you gotta do to get more money." 

The attitudes and actions of employees is often times a direct reflection of the way they are treated by their employer.

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Specializes in Med-Surg.

I think most of what the article rings true, even if it was written by a doctor, even if we can point the other finger.

About job hopping, I think like the writer says to listen carefully to the reasons.  If the reasons were to advance career opportunities and salary, that's not a red flag as history of problems with coworkers, management and badmouthing multiple employers with anger.  

 

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