Latest Comments by JKL33

JKL33 15,578 Views

Joined: Oct 2, '08; Posts: 1,718 (85% Liked) ; Likes: 8,227

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  • 0

    I would mind my own business whenever humanly possible. Half the things that people report involve an attempt to distinguish oneself on the part of the reporter. I don't remember the last time I participated in "unprofessional conduct" reporting; it's too subjective and is usually one-sided and I utterly despise the related drama. I'm neither a paid peer-evaluator nor a professional tattle-tale.

    Not nitpicking your post, but I'll use your example of clearing pumps - - where would you say that something like clearing pumps registers on a priority list on any given busy day? I'd say it's toward the bottom, all things considered - - wouldn't you?

    Let these things go. There's "safety concern" and then there's unsafe/dangerous. Learn to distinguish the two. If there is any question how/why I say this - - it's because I have seen a few real, serious safety issues. Without fail they are either 1) A direct, predictable result of changes enacted knowingly by management because they serve some business purpose or 2) A result of failure to terminate seriously harmful employees in a timely manner.

    All this other malarkey you're talking about stems from too many people trying to fulfill emotional needs while at work. It's not a social scene; these aren't BFFs.

    My goal would be to not interact with this woman except to smile and appear pleasant if I run across her. I would take myself off her radar and out of her path.

  • 0

    Quote from Ilovenursing3
    If you don't mind me asking,why wouldn't you want to comment again? Your replies have been very helpful.
    Because I wasn't sure if the comment was useful or not; didn't want to be overbearing. I decided it might be food for thought though.

    Learning to not let people get the best of us can be a process sometimes. These experiences you've had can be turned to good if you put your mind to it.

  • 1
    CityofAngelsRN likes this.

    Unfortunate. May be burnout, maybe not. There are posts here not infrequently that represent the same basic mistake in thinking, which is failure to separate self and other.

    Lots of other people would've been able to appropriately dispo this in 5-10 minutes while remaining perfectly pleasant.

  • 0

    ilovenursing3,

    What's done is done; put this behind you.

    I probably shouldn't comment again but since you have put the time and effort into becoming a nurse I will encourage you to review all of this carefully. You are going to need to know how to accomplish your goals despite others' inappropriateness because that is something that almost everyone (within and outside of nursing) will have to deal with at some point. It's a long shot to think one's personal goals can be accomplished while fixating on someone else - particularly someone who doesn't do what's right and who may be somewhat malicious.

    You chose to fixate on this woman and her inappropriateness. And the instant you noticed that she wasn't SuperNurse the downhill trajectory ensued.

    I will say all of this more succinctly: Do you realize what has happened here? Someone you neither liked nor respected, whom you felt was entirely inappropriate, just dictated your life.

    I think you've gotta buckle down in this interim and set your mind to making good decisions and comporting yourself professionally. For your own good, you must concern yourself primarily with your patients and your own self. When you agree to participate in someone else's ridiculous drama, you create more problems, you become part of the problem, and you fairly well sabotage yourself. Please think about it.

    Take care

  • 1
    Kitiger likes this.

    ilovenursing3,

    Looking at your previous posts I can see now that it's very possible this particular preceptor is not someone you want to emulate. Maybe she isn't that great. Maybe she's awful. But I still think it would be best if you re-focus. You don't need to read an article about good vs. ineffective training - you can worry about that when you need to prepare to train someone.

    You are in the thick of the process of realizing the differences between what you were taught and what can reasonably be accomplished. Over time you will be able to reconcile these two things according to your own sense of what's right and wrong, and then you will feel more comfortable.

    Unfortunately, part of what is making you feel extra-pressured right now is the fact that you have a short orientation on a unit where you will be the sole RN on your shifts. It's really imperative that you re-focus. You aren't going to have to worry about her (and you aren't going to have anyone to check your insulin, etc.) when you are the only RN on shift.

    You could ask your preceptor if the two of you could make out a basic routine that might be helpful in prioritizing your tasks. Continue interacting and asking appropriate questions even though you don't care for her manner and methods. For your own sake, be pleasant with her in attempt to cover the basics during the remainder of your orientation.

    Good wishes ~

  • 2
    psu_213 and brownbook like this.

    Quote from PeakRN
    I typically give injections in the arm a patient injured, they are going to be sore regardless and why make both arms sore if it can be just one? That being said I also give patients the option and it doesn't really make a big difference
    Me too. For the same reason.

    Every once in awhile someone's really freaked out by the idea of being poked on the injured side (not so much once the local takes effect and they aren't experiencing pain any more).

    I'm sure my lack of EBP here should bring great shame upon me. Alas, I do it this way because it makes good sense to me and I can't find anything that says it matters.

  • 3
    amzyRN, Kallie3006, and broughden like this.

    Quote from offlabel
    Part of the ER is routine care and that should take as much priority as "code 3" traffic because nothing is routine in the ER. A sore throat can turn into a full blown resuscitation while you're off getting coffee and "code 3" traffic can be utter BS....your obligations are the things that are in front of you at the moment. They are not to be discharged because of what "might" be on the way...
    I get how you're looking at this offlabel, but you are imagining situations that weren't the case here. In this scenario we were not told what "routine med" was ordered, but we can reasonably assume that, since the patient has already been examined, the OP wouldn't have used the word "routine" to describe the urgency of the order if there were also other orders for that patient that conveyed an increased acuity.

    A known patient who has already been assessed to not have an urgency/emergency will never outright trump a reported incoming Code 3. Code 3s are routine in the ED due to three basic things: 1) they happen often enough 2) we are well-trained to handle them and 3) the setting is prepared for them accordingly - both as a matter of long-standing preparation and immediate preparation. They wouldn't be routine at all if they were nothing more than unprepared sh*tshows every time one rolled in and people were scurrying for basic supplies when they should be performing immediate interventions. Everyone needs to know the limitations of their own environment and prepare accordingly as much as possible. That's the basic tenet underlying the radio report to begin with; that we can't control the accuracy of the report is neither here nor there.

    Now, if the OP had said that the first patient was having some sort of problem and she needed to decide what to do first - attend to the first patient or get the room ready for the second - that's an entirely different matter and yes, the one who is already present and is having a problem is obviously the priority.

  • 5

    Now why would you leave nursing instead of:

    1) Reviewing these instances to see categorically how you went wrong. In the first instance you did not ensure the 5 Rights which is a basic nursing principle that must be observed in any setting and in every instance of administering a medication or other prescribed treatment. I don't know what you mean when you say the parents said it was their child when it wasn't, but it seems like asking them to state the child's name and BD would've revealed whether you had the correct patient or not. This is an easy fix: Ask for the information itself, not for confirmation of non-specific information. "Are you John?" = Wrong. "I need your (child's) full name, please" = Right. The second situation, by your description, sounds like you also did not take note of available information (I say that only because you said you overlooked it. It would be different if it were some unwritten protocol that you had no way of knowing).

    2) Considering whether this is the right setting and employment situation.

    You can get past all of this by being proactive. I think you can make a couple of tweaks with the potential for great improvement! You have to slow down, practice the basics, review things carefully, and ask questions. If there is literally no one with whom you can double-check your practices as you get up to speed, then you do need to look for a workplace situation that is more friendly/appropriate for the novice stage of your career. What you can't do is anxiously sequester yourself away and feel so pressured that you can't think things through.

    I really do think you can do it.

  • 5
    Quota, Kitiger, AJJKRN, and 2 others like this.

    Quote from Ilovenursing3
    Hi all

    if I am wrong about this situation please let me know. I am a brand new nurse and I started my first job two weeks ago. My first week I noticed my preceptor was harsh on one of the nursing aides. She would gossip about her, and get frustrated with her over little stuff.

    So, on my third or fourth shift, a bed alarm went off and I went running to make sure the patient wasn't about to fall. The nursing aide according to my preceptor does not get up fast enough. Which, okay I can for sure understand that. My preceptor told me she intentionally tried to push the nursing aide out of the way to prove a point to get up faster. Instead of pushing a nursing aide out of the way to prove a point-wouldn't it have been better to discuss it in person?

    I like cristism, but I feel there is a certain way it should be said. She told me she will tell me "everything I'm doing wrong because that is what will make me a good nurse". I'm sorry if I'm wrong, but dealing with someone constantly putting me down I think would be a sign I should find a new job or maybe nursing isn't for me. I appreciate any feedback. Thanks so much.
    You're not on a good track, I'll just tell you that right up front.

    1. The situation you describe between the NA and your preceptor is one of (likely) laziness and/or incompetence that is being handled in a very unprofessional and childish manner, and no I certainly would not handle it as your preceptor is. I would try to develop a rapport with the NA and see if we could get a little teamwork going. If that fails there isn't much else to do besides plan on doing one's own work and not relying on that NA for anything. In just a few short weeks or months you can talk with that NA and help her learn how to move faster.

    2. Your last paragraph is the most concerning. Did your preceptor tell you she is going to put you down? You've chosen to get hurt by words she used to tell you how she is going to help you. You would feel better if she had chosen her words slightly more carefully and said, "You'll do great and I'll let you know what you need to know and where to improve." You know what - pretend that's what she said, because I'm about 99% sure that's what she meant. You are working with someone who at least has a mind toward helping you become a good nurse. She didn't say she plans to rip you up for entertainment and make you hate life itself.

    Since when is hearing what one did wrong the same as "constantly putting me down?"

    [Serenity now!!!]

  • 1
    Dormi93 likes this.

    Quote from Dormi93
    They said they are budgeted to be staffed for 22 beds (they are a 35 or 36 bed unit). On nights there is 1 PCT and no PCTs on Sunday, I was told I would be expected to have usually about 6 patients.

    Well, the ortho floor would be excellent for building your general knowledge base. But there is obvious potential for it being downright brutal at night in this scenario you pose. That they said they are budgeted to staff 22 beds was a bit of a clever statement. In your four years working in the hospital, you may have heard that the money people despise open beds, and that nurses being "maxed out" is a ludicrous excuse for not filling beds - not acceptable at all. Secondly, 1 PCT for 22+ patients on an ortho floor (or practically any acute care floor) will make you cry real tears and come here to write about how you're second-guessing your decision to become a nurse.

    So my advice is that you need more information about this ortho staffing.

    Congrats on your two offers!

  • 2
    deeCNA2013 and Emergent like this.

    Hard work and loyalty were spoken and unspoken themes with which I was raised. They are important to me and are probably the reason I've never had any employment-related difficulty.

    Loyalty is a bit like trust in that some people think it is owed, others think it is earned. In reality they are both things that only work out when both given and earned. Otherwise they're just someone's demand or someone's unearned goodwill. If one party's agenda doesn't involve earning and cultivating loyalty, then the idea that any loyalty is owed is not legitimate.

    The laundry list of business-of-healthcare practices that are not consistent with the idea of anyone being very concerned about loyalty grows every day. Although I've never required an employer to fill an emotional role in my life, at some point they have to either pretend they care about decent treatment of people or else roll with the natural consequences, which is nothing more than what they expect from employees!

    Priorities clarified. Life is good. Usually-picky conscience is silent.

  • 2
    psu_213 and Penelope_Pitstop like this.

    Could we please.

    Licenses are probably very rarely in jeopardy (of revocation) when people imagine they might be.

    Just the same, stressed-out nurses didn't come up with the license-snatching boogey-man all on their own. It is a product of real things said (and threats made and incorrect information taught) to real students and real nurses, by instructors, managers, DoNs/CNOs, business people, lawyers, etc.

    There's "This patient became so angry about not getting his turkey sandwich on time, he swore at me and called me the most vile names and reported me and my manager was not happy and I got written up. I'm not putting my license at risk for stuff like this, I'm outta there!!!"

    ...and then there are situations where things seem to skirt legal or ethical rules to the point that one would be stupid to not take into consideration their own professional well-being.

    That's what we're talking about.

    Nurses should know what kind of things put their license at risk because that is empowering.

    Nurses should not feel obligated to remain in situations where there is a reasonable likelihood they won't come out professionally unscathed. And when they say, "my license is at risk" it'd be perfectly fine to say, "You know, it's probably not, but since this portends other badness your overall concern about remaining in that position is reasonable."

  • 0

    Quote from topdoc
    Hi all, we were recently cited by CMS for forcing behavioral ED patients into scrubs. We were placed in immediate jeopardy. Once we stopped forcing patients into scrubs, the immediate jeopardy was removed. We were recently told we will be receiving a full CMS survey any time now. They will be looking at use of seclusion/restraint, forcing scrubs, etc. Bottom line is that you cannot use force to get a patient into scrubs as the use of force is the trigger for a violent situation, that can lead to harm to staff or patients. More to come.....
    Hello topdoc -

    I do think you should ask a few more questions about the citation.

    It would surprise me to hear that CMS expects you to leave dangerous materials and/or weapons in the patient's possession - which would be an occasional effect of not having a routine gowning policy - - unless you're saying CMS's idea is that frisking/searching every patient and then allowing them to remain in their own clothing is preferred. Rather, I suspect there were other/additional issues besides the idea of gowning and that your rates of requiring force and restraint were out of line in ways not solely related to gowns. That I can believe; either that or CMS received a specific complaint and found concerning circumstances upon investigation. Too many HCWs have behaved aggressively like some sort of rogue posse when dealing with these very volatile and sensitive situations, even displaying a personal-appearing aggression sometimes. Not at all acceptable. Helping a patient follow a safe protocol in the course of getting help they need is not meant to be today's sporting event or adrenaline release or camaraderie activity.

    If you were placed in immediate jeopardy then CMS has other concerns besides psych patients wearing gowns or even the occasional and appropriate use of team effort for conflict resolution/unsafe behavior management. One way or another your place is an outlier.

  • 2
    amzyRN and meanmaryjean like this.

    Hello, SDKRN -

    Without offering medical advice or giving empty reassurances - - no. You should not stress endlessly for the next 6 months. Regardless of anything else it simply would not be good for you and you kind of need to take an active role in making your mind be reasonable about this.

    My suggestion would be to contact employee health services now (I assume you were referred to your organization's version of employee health following your ED visit) rather than assuming you won't be interacting with them until it's time for your interval assessment. See if you can make an appointment to speak with them; it's okay to let them know you are scared and struggling and are hoping someone could help you gain a little perspective.

    You probably haven't had much time to think about it, but will you be seeking OB care with one of the physicians/practices familiar to you? If so, they/their office might be willing to do an early pregnancy visit, not because there's a medical need but because I think you could benefit emotionally from having a support network.

    As far as your coworkers knowing about this, please don't make yourself crazy about it - people are understanding, compassionate, etc. Things happen and they know that.

    Things are going to work themselves out! It would be sad for you to struggle needlessly.

  • 7

    Quote from cyc0sys
    I've seen this time and time again. The tech must observe the chain of command while exercising a very limited scope of practice which does not include prioritization as Cowboyardee mentions above. Even if the PA didn't do the splint as ordered by Doc, regardless of protocol, it will ultimately fall on the tech because she received the initial order. It is not the tech's responsibility to inform the Charge of your need to re-prioritize tasks, that's your job.

    Let's also not forget, floor transfers can be a quite a debacle for the tech in this situation because no one wants to own something left undone.

    ABC's are limited to Basic Live Saving Measure. If your patient wasn't coding or choking, it did not warrant working out of task order because the tech was still performing under the direction of the Doc.

    That being said, Techs can get out of control with insubordination and passive-aggressive behaviors. I've found it's usually because they feel underappreciated and disrespected. With a little one on one face time, off line, I've been able to resolve these types of issues.

    The team building process requires mutual respect and emotional investment. Insincere apologies are cheap, its easier just to acknowledge someone else's feelings. All people respond better to the carrot than the stick. Though it may be effective short term.

    Bottom line, the task was completed in a timely manner and did not result in an unfavorable outcome for your patient.
    Although I appreciate the idea of not exaggerating the situation, the retrospectoscope does not provide a legitimate assessment of a situation that someone else had to handle in real time. The tech was not doing anything for the doc, she was twitting out worrying about being accused of something dumb. Instead she needed to do her assigned role in the process of ruling out "ABC"-related things in a situation where there was at least some potential for badness. This incident did not cause her to have to choose between two similar priorities whatsoever - and when that does happen, her role is to tell the two staff/providers to choose the priority for her, not to tell those whose role it is to decide priority what she is or isn't going to do.

    ABC-related concerns are given priority assessment in every ED patient. Every single one. And the principles of the PAT are assessed as a priority first look @ every unwell pediatric patient. The basics may be completed/cleared within seconds in most cases, but that doesn't mean no one took account of them. If they can't be cleared (such as in this case) - - they remain the priority. That means they bump every other thing that is not of equal or higher priority.

    A 30-minute EKG is not considered a timely manner for a STAT EKG in any ED in this country.


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