NuGuyNurse2b 8,596 Views
Joined: Nov 23, '13;
Posts: 913 (61% Liked)
; Likes: 2,395
You didn't get her into trouble. You told her what the policy is. The trouble is that your facility has a written policy that they expect you to circumvent. That's bad news for all of you.
Yes, you should speak up in order to clarify the policy. If you've been teaching it wrong and doing it wrong yourself, you want to know. So should everyone else.
I first read the title of your post as "getting it on with other staff". So, the actual post left me disappointed.
I'll move on. Good luck!
Why would you feel morally obligated to say anything? if I'm reading correctly, you had a meeting where you were told to hold medications that you simply don't have on premise. I'm assuming this is the policy if it was spoken about during this meeting? The borrowing of medication from other residents' medication bins is an unofficial way of going around that. So why would she get in trouble for NOT doing that and doing what is (supposedly) the facility's policy...which is to document and hold any medications that are not supplied.
I think the experience is invaluable. I can't tell you how many nurses I've come across who truly don't know how to give basic pt. care. Sure, they could figure it out in a pinch, but its really helpful to everyone if nurses know how to properly pull someone up in bed, how to change them, turn them, transfer them, etc.
I think it helps with getting a foot in the door, as many new grads get hired into a hospital setting because they worked as CNA's on their respective units. I don't think it necessarily gives them a leg up on the non-CNA competition for jobs - in fact, it might be a turn off for hiring managers as I've known a few CNA's who graduated and were not hired as new grads because the managers knew how awful their work ethics were as CNA's. I've never worked as a CNA prior to becoming a nurse, and I do not look down on CNA's, but I do detect when there are those who simply aren't doing their jobs.; nor do I need to have worked as a CNA in order to appreciate their hard work. If anything, you often see a thread here started by a CNA complaining of how "easy" it is for nurses and how "lazy" they are by not helping CNA's when they are not cognizant of how nurses need to delegate and set priorities that sometimes the CNA are not aware of.
Maybe these people shouldn't be in the healthcare biz with luck like that.
At my hospital you mostly see these contracts with the ICU - what happens is that people get their ICU experience (and they're not necessarily new nurses, btw), get their NP or CNA, then bounce. So those floors have at max 2 years from those hires, which is not a very good return in investment. So it is not necessarily to do with any "desperation" to hire since the applicant pool is actually pretty competitive for the ICU but it's just they want to make sure people stay. New grad contracts are for the same reason - maybe people want ER or ICU or any other specialty but as a new grad with 0 experience, some places don't hire those, so the new grads get in where they can, get their 1 year and then move.
We print and mount Q2hrs in our ED. Well...we're supposed to, at least. It makes sense, though, cause I've had pt's who I've gotten in report that they were RSR and then I go in, look at the monitor and see brady. So if the strips were there from the prior shifts, I could see where the pt was in that RSR spectrum - was the pt borderline RSR/brady or were they absolutely just RSR like 80's and 90's and suddenly is now in the 50's. But Q2hrs is really not feasible in the work environment that is our ED. You get a pt who crashes and that pt becomes the priority, and maybe you won't get to even see your other pts in the next 2 hrs let alone print and mount their tele strips.
Most of our ER pts who malinger usually walk out once we made it clear they're not getting any narcotics, they're not going to be seen any further and we're busing sick people all around them left and right and just plain ignoring them. We've had a few faking seizures on us....load up 1mL normal saline...tell them it's Ativan...administer...seizing stopped.
Honestly, I wouldn't walk away from a no weekend/no nights/no calls job...
With the exception of adenosine, I push everything slowly, even narcan. people in the ER slam it and then you get someone bolting straight up like in pulp fiction, or worse, vomiting all over the place. I had another nurse try to tell me to push it fast, and I said where's the policy. she never came back with the policy. I knew the policy cause as part of our orientation we had to do the e-learnings and in fact per policy we are supposed to even dilute the narcan, which no one ever does.
I'm not going to repeat the same thing cause as you can see the consensus is that you should've called the MD. But this is a teachable moment and I can tell you as a new grad nurse 2 years ago I was in the same shoes, but something in me told me to call anyway. I had the same reservations as you because it was late in the evening, the patient wasn't doing too bad, she was alert/oriented, vitals aside from the BP were normal. I was on the fence but thank God my fellow workers were some of the most experienced nurses in the whole hospital. The MD dismissed my concerns, my fellow experienced nurses urged me to chart everything. I come in the next day, found out the patient was transferred to ICU during the night shift. Sepsis. Her BP tanked during the night, she had a fever, she became diaphoretic. I did get a side talk with the director and the only reason I wasn't written up was because I documented that I called the MD and they didn't do anything about it. I should've monitored her more closely, taken repeat vitals, called the house coverage just to say hey come look at this patient cause I called Dr Joe Schmoe and he's not bothered by it. But it was a lesson I learned and you only need one of those to never repeat it again.
And your point is?
Man, you Yanks get paid a lot better than us Brits.
The very first time I did CPR the patient woke up and immediately grabbed me while I was doing compressions. I was so shocked the only reason I didn't fall off the bed was because the chief resident was standing next to me and had a hand on my back to steady me (I was kneeling on the bed). Patient went unresponsive as soon as I stopped compressing and we couldn't get a pulse, so CPR was resumed. Again, patient woke up and stared straight at me as I did CPR. Ended up calling it after 30 minutes. I will definitely never forget that experience.
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