mclennan, BSN 20,497 Views
Joined: Sep 25, '06;
Posts: 747 (58% Liked)
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Yep. I was assaulted by a patient on the job. He kicked me in the chest and sprained my wrist. Security was called and never showed up. The patient continued to assault other staff, and I called the cops. My supervisor came back from a meeting to see the patient being dragged screaming from the unit. She wanted to *write me up* for calling the cops because it wasn't "protocol." She showed zero concern for or even asked us 3 injured nurses anything. A huge argument in her office ensued - the manager agreed and wanted to write all of us up for calling the police.
A resident doctor, another RN and I handed over our badges and keys and walked out of that place right then and there. The resident had tried to restrain the patient as well and gotten his head bashed against a wall. The other nurse had a door opened forcefully over her shoes that broke 6 bones in one foot.
I had no problem finding 2 jobs after that. I just say the job wasn't a good fit and I left to pursue other opportunities. The HR office there only provides my dates of service. I think lots of nurses have walked off at least one bad job in their career.
No. She is talking about the State of CA PHN license, not ANCC board certification. And yes, as a CA PHN RN of 6 years who started in this state as a new grad it IS worth it. Get it. ANYTHING you can get to help you in this tight market, do it.
Be ready to answer questions about the current immunization schedules, modified schedules, and schedules for children, adults and elderly. Make sure you study the current CDC recs inside and out.
Be ready to speak to scenarios involving parents who are resistant to immunizations and what you would say in those instances.
Be ready to show cultural competence by being knowledgable about how different cultures perceive health care, immunizations and how language barriers can affect preventative care.
Be ready to show them you understand how immunizations work, and how you'd explain their mechanism to patients.
Know your Hep shots well, know the difference between DTAP and TDAP, and available combos for kids. Know what gauge needles to use, and what other delivery routes are available (nasal sprays, PO).
Have some answers ready for scenarios like a huge man fainting; a combative child; an allergic reaction; needlesticking yourself; consent, VIS and documentation (study up on what your state requires, if there is a state immunization database and if you know how to use it) and how to provide verified documentation to schools and employers.
CRUCIAL: know your storage and transport protocols! Be able to talk about rotating stock by exp. date; temperature control, calibration and logging; the cold chain & how to maintain it; backup systems and plans if power fails. Losing stock due to temp maintenance failure can cost THOUSANDS of dollars.
I was a PHN for 4 years and was in charge of my clinic's immunization program and these are things I'd ask about! Good luck and keep us posted!!!!
I am a case manager RN. I also have a good relationship with my hiring manager and know why she hired me so here ya go:
1. BSN. Most medical groups, insurance co.s, hospitals get better reimbursement and accreditation if CMs have BSN.
2. Some experience in Public Health, health teaching, discharge planning, chronic condition management or something along those lines. Lots of states offer PHN licensure to BSNs whose program curriculum included community/public health that meets requirements. If you can get it, get it. My hiring manager, and 3 or 4 other CMs in my department were PHNs for some years before becoming CMs - she says that pretty much nailed why they hired me. Highlight any nursing experience in which you developed therapeutic, long term relationships with patients and followed them through chronic illness. Any telephone triage expertise or training is valuable too.
3. Get certified as a CM either by the Commission for Case Manager Certification or the ANCC Case Manager Board Certification. I cannot emphasize this enough.
4. Be prepared to sit in a cubicle all day calling patients, to wear business clothes, to earn salary instead of hourly, and go to lots of meetings. It is a far cry from working the floor, the clinic, or 12 hours in scrubs. And it's not always better, it can be just as crazy busy, complicated, stressful and the grind of 9-5, M-F isn't the paradise you might think. We have had a couple of CMs who came straight from inpatient, bedside shift work nursing leave after 5 or 6 months because they missed working with patients and having those 3 or 4 days off a week. And, they missed overtime pay.
5. On the upside, it's very autonomous, independent work that actually uses nursing theory heavily, and really sharpens your critical thinking skills. Docs love us. Patients love that they don't have to come to as many appointments and have a go-to advocate. Case management is gonna be a big thing, it saves everyone money and increases patient satisfaction scores big time. And, the pay is great IF you have the experience and certification!
Hope that helps and good luck!
I say DO IT. Take the risk. Money is dumb. Happiness rules. Keep your RN license and pick up 5 or 6 shifts a month per diem if you really think you're gonna starve. But you won't. Not if you resist the mainstream expectations that you're "supposed" to have a new car, own a home, and breed. RESIST!!!!!
I wish I'd taken bigger risks when I was your age, and done what makes me happy instead of listening to everyone tell me what I "should" do. ROCK the poorhouse and your parent's house. Screw nursing and help the animals. Don't be on your deathbed listing your regrets. Do these things NOW while it's easy for you. Every minute that goes by while you sit on your butt soul-searching, it gets harder and harder to change careers, move home, go to school, and take a pay cut. Money is NOTHING. Happiness is EVERYTHING. You sound like you have a good head on your shoulders, and a better situation to support your dream than most. GO FOR IT.
Thumbs up to you and a high five, OP. I have been a BSN/RN for 6 years now, and done bedside, case management and public health. I HATE all of it. The last 3 years I've really spiraled downward into total hatred for the job. I'm cursed with being really good at it - I'm always a patient favorite, and have never received a bad review. But I'm so over it.
I'm starting a new job in two weeks doing case management, and have already decided if this doesn't re-ignite some hope and passion for this profession I'm done. I'm gonna try for a year, and if I still hate it, I'm headed for grad school to teach nursing. I had an awful nursing school experience -and if I can do anything, at least I can help avenge my experience by being a good teacher.
Why do I hate it?
1. The obvious: the health care system is broken. Horribly. And I'm sick of being a part of it.
2. The bubble is going to burst, folks. Nursing salaries are going to take a nosedive. Of this I am certain.
3. The quality of schooling and therefore quality of nurses is in the gutter. I can't believe some of the people I have worked with. How the hell do half these dopes graduate? They can't spell and can't speak clear English. I don't get it. I don't want to be lumped in with people like that.
4. I have worked with "under-served" populations for way too much of my nursing career, and their sense of entitlement and demanding services they don't need has embittered me and ruined my faith in this profession forever.
5. I like animals and machines more than people.
One other thing. It's so sad how we who hate nursing & want to leave have to keep that such a secret, or that ANYONE is shocked by something like that. Nursing is just a vocation, an occupation, a profession. No profession should completely define a person. YOU ARE NOT YOUR JOB. You are a human being, first and foremost. Nursing is not the noble, altruistic, self-sacrificing job it used to be. Sorry, Charlie. Florence Nightingale is DEAD.
Some people end up hating it, just like some accountants end up hating their job. A nurse leaving the profession really should not be judged so harshly, it doesn't mean she's an uncaring, cold, uncompassionate person. In fact, it's probably the opposite. Too many nurses who hate it STAY in the field and make everyone's lives - their co-workers, bosses, patients, and their own - MISERABLE. So kudos to those who bail when they know they need to. I wish you all the best of luck.
I definitely agree with #7. I was a successful student for a lot of reasons, but looking back, I know a big part of it was the fact I didn't have kids or pets, only worked VERY part time, (a few shifts a month) and generally accepted the fact the nursing school was my "life." I watched many classmates who tried to work, who had children, who got married & had weddings to plan, who got pregnant, who had drama going on in their personal lives or were always partying FAIL.
I'm not saying it can't be done if you have family obligations or a job but it's 100000X harder. Too many people (especially females) are led to believe we're supposed to be SUPERWOMEN who must be 100% successful at everything and overachieving perfectionists every minute. There is no better recipe for failure than believing that. Just set your life up so you can focus exclusively on nursing school. Don't whine about it, because it is what it is.
Also, figure out what works for YOU. Lots of people say don't cram, don't procrastinate. Well, some of my best A grade papers were written all night before the 8am deadline, smashed on vodka & Red Bull. Cramming worked for me. Figure out your quirks and don't always follow the rules.
Hey. Watch it. We nurses who "work in offices" make HUGE DIFFERENCES in people's lives. Just as much, if not more than nurses in clinical settings. You might have pushed meds through an IV, hung blood or suctioned trachs, but nurses who "work in offices" made sure your patients got their procedures approved by their insurance companies ahead of time, fought for more follow up with specialists, ordered their DME, arranged for post discharge care at home, educated their families, helped them determine DNR status, coordinated referrals with their PCP, facilitated communication between hospitalists, specialists, PCPs, the insurance company and the patient/family, hooked them up with social workers and transportation resources, got them their meds delivered to their door for cheap, consoled and counseled the family about end of life issues, mailed out tons of info on disease management and local agencies, met with the patient in the office to give them salt substitutes, a scale, a BP cuff, a glucometer and strips, and spent 2 hours showing them how to use these things correctly, and spent HOURS documenting all this within compliance, and sitting in endless meetings with doctors, management and other nurses "who work in offices" trying to provide the best care for patients for the most important time in their health care.....OUTSIDE that hospital room. GOT IT? Good.
Honestly, if you have the experience in ambulatory that is required to sit for the ANCC cert exam, you can pass the test without dropping $ on prep materials.
I had 4 years of full time clinic nursing serving a very diverse population. I didn't study at all - and passed it on the first try. Much of the exam is common sense, basic nursing theory (like Maslow), and some cultural competence stuff (which everyone should know by now unless you've been living in a cave the last 20 years). Seriously. Check out sample exam questions. Purchase a prep book if you must, but really and truly, if you've been in ambulatory and have a basic grasp of the concepts you'll ace it.
Oh, dear fellow introvert. Please don't be bamboozled into thinking case management is the answer! I've worked in CM off and on for the last 6 years and let me tell you, even though some CM jobs don't require face-to-face, you will have more contacts per day with dreaded PEOPLE than you ever will in an entire week in a direct care job! There are no patient ratio laws to protect nurse case managers, and with so much EBP directed toward outcomes affecting reimbursement now, case managers are DOGPILED with panels of 100+ patients to manage, often with no help. It varies wildly employer to employer, but it is my theory that because CM as a specialty is so under-developed in terms of standards of practice, each company just makes up their protocols as they go. There are even 3 specialty certifications available for CM - that is how fractured it is. I'm tired of hearing CM advised as some golden ticket out of bedside nursing when often it's just as much a nightmare as the floor, sometimes worse. Maybe it will get better as CM is spotlighted for a lot of new developments, but as with any nursing practice standards, improvements will take a VERY long time to come to fruition.
Look into utilization management instead!
A lot of my nurse friends seem to have "project" boyfriends, failing marriages or are single/divorced. My marriage fell apart shortly after I graduated BSN school. He just couldn't tolerate how nursing school turned me into such a mess (stress, anxiety, depression, constantly sick and losing weight, insomnia) then we moved across the country for a job for me, and that was the nail in the coffin.
2 years after that debacle I met the boyfriend I've been with now for 3 years. He teaches special Ed in a public elementary school. It's working pretty well - we're both in helping professions that get crapped on a lot, we're both in our late 30s and have learned a thing or two by now, and are together because we want to be and not because we NEED to be.
Also, neither of us wants marriage, kids, to share money or own a home. I am thoroughly convinced those things put people and relationships under way too much pressure. People think they need these things that represent happiness. They usually don't. These things are just conventional expectations that we've been conditioned to believe represent achievement and adulthood. So many relationships fail because of the pressure to be married, to have kids, to own a house, etc.,etc., blah blah blah. Women ESPECIALLY fall into this trap.
I encourage all youngins' to keep their minds wide open and enjoy their youth. And nurses, don't take on "project" boyfriends you think you can "fix" like your patients!!!
Thanks Commuter for an excellent article.
I've made decent middle class income in my 6 years of nursing - but after all the co-pays for anti depressants, talk therapy, psychiatrists and chiropractors due to work related stress, culmulatively I'm probably just above the poverty line. Ha.
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