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Oh'Ello 5,093 Views

Joined: Jul 24, '14; Posts: 228 (68% Liked) ; Likes: 935
Specialty: Heme Onc

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  • Mar 3

    I may be in the minority, but I think it actually helps to be thoroughly prepared for the lateral violence towards new nurses. I just posted in another thread about how I see it all the time on my unit - and how I could think of five people off the top of my head I've seen written up for things everyone else gets away with, and forced out just because the "in crowd" didn't like them. And they were all new grads with the exception of one. If you have the wrong preceptor - someone who's not in the clique - it's going to be harder to get started on my unit because the help is not going to be there when you need it. If you also happen to need to ask a lot of questions because, you know, you're a new nurse and my unit is crazy high acuity - that's it for you.

    I'm pretty sure the only reason I didn't get axed right out of orientation myself is I came in with experience and they couldn't find anything to write me up for. I covered my butt extensively, because believe me, they looked. It got better after about a year. After that period, I finally had one of them tell me, "I thought you were annoying as **** when you first started, but I can tolerate you better now" which was funny because she had probably spoken less than 20 words total to me while I was on orientation, but it is what it is.

    Not only is it the attitude and exclusion, many of my coworkers like to haze the new hires by giving them the worst assignments on the unit every shift they work. I experienced that myself the first four months out of orientation. It was so bad that the only reason I didn't leave is I kept repeating to myself, "You don't want to look like a job hopper, you need to stay at least a year" over and over again in my head every time I felt like I was being treated unfairly. Now that I'm charge a lot of the shifts I work, I try to rotate the bad assignments and I try not to give them to the new people at all unless every assignment is a bad one. It's hard enough to learn how to do your job on my unit without having the worst assignments on the floor every shift. You need some down time to look up unfamiliar medications and review the protocols when you're new, and there's no time to learn if it's balls to the wall every shift every night.

    It's exhausting dealing with other nurses. I'd held five other jobs before going into nursing, and nursing by far has the pettiest people in it. I swear to God I'd take going back to middle school over dealing with some specific coworkers some days.

  • Mar 3

    Quote from chiromed0
    I think part of the reason "new" nurses quit isn't any different than any other occupation. They just simply have that option b/c they can find work. If the job market is tight-they will stay. Some are just young and don't know the value of patience. Some get scared and hate it so that justifies quitting until they find out they will "hate" every new job for a while then might like it--that's just called "work". Others do what we all do and take the anything until what we really want comes along. Either way there is a high turnover and it even extends to mid-levels and physicians in big cities. Health care saturated markets just see a lot of moving around. Hard to turn down the next employer giving you $10/20/30K or more a year just for quitting one job and starting another. I never understood why they just don't make tiered salary bands for nurses vs just hourly rate...get a contract, give them a high salary and make them stay.
    I agree, but there are a lot of other reasons I am leaving after my residency is through. Not Nursing per se, but definitely the department I oriented to, the "hospital life" and the geographical area (see Chiro's response for this one)

    NETY is alive and well, and I think everyone here knows it. Whether you PRACTICE it, that's not the issue. I had an exceptionally lengthy orientation, 6 months. After one month, it was clear that my preceptor was in it to get his CNIII and climb the ladder, nothing else. He set me loose and would literally leave the unit without saying a word (I'm ED), getting his co-workers to "watch over" me.

    (80+ bed ED here, folks. just putting a little context out there)

    When I was asking to get some trauma experience, which is what my preceptor was supposed to be teaching me---I LITERALLY was told (by preceptor) "Well, get in there!"

    Oh. <slaps forehead> THAT'S all I had to do? Just "get in there"?! I know I truly would trust a trauma RN that had that kind of teaching under her belt!

    How about a girl who graduated a cohort behind me, who had the CNIV come to her 2 days after she got off of precepting, he sat down, crossed his legs, and slid a piece of paper across the desk to her.

    They had "studied" her first self schedule as a brand new "on your own" RN...and determined that she had not opted to take >2 days of OT per week....and on that slip of paper were the dates/shifts (some not her regular shift of 2p-2a) that THEY decided that she should take.

    That same CNIV, who told me that I was not permitted to take any classes on my off time---even if they had everything to do with Nursing---because if I had "spare time", I should be using that towards chipping away at the short shifts in the dept.

    And that is just an everyday run-down. The pay sucks. That's geographical, and I am doing something about that at 1 year. I don't get lunches or pee breaks (common), but I also don't ever get a single word of guidance.

    Know why? Because the "senior RNs" feel that since I will "probably" be gone after a year, like all the others, they aren't investing in me fully.

    It's not a marriage, folks. It's a job. Putting your "heart and soul" into training someone? That's nonsense. It's a job. If you are precepting by choice, then it's a job YOU signed up for. Do it. And act as if that person you are precepting may be taking care of your parents or your kids. If you are being tapped to precept against your will? Still do the best you can. Again...that RN may be in a position that they're taking care of YOUR loved ones.

    It's a JOB. Not a popularity contest--your personal opinion of any other employee is irrelevant. If their skills are up to par, then you need to keep your "personal" opinions of them to yourself. That's where the "lateral violence" comes in.

    One of my cohort made a simple mistake in putting a foley cath in a female pt and inserted the catheter into the wrong orifice. <snicker snicker> yeah wasn't that just hilarious? especially being the patient, i'll be she thought that was just so funny to have her hoo-haw out there for the senior RN to snicker at the new grad.....and then, not to be outdone by her disgusting behavior at bedside embarrassing the NG, senior RN goes and spreads the story around. Classless and gauche.

    Oh, but dark humor! No. It's lateral violence, and it's showing your butt to the patients as well. I wouldn't EVER allow that RN, senior or EVER touch one of my family or friends.

    There's just no line with some RNs. Oh, but I'm senior and I'm having a bad day. Well, I'm an NG and I'm having a bad day. We're even. I don't get to act like a classless jerk, neither should you.

    Respecting each other in the workplace isn't a function of how LONG you've been there. THAT is what NETY is all about. Senior RNs feeling that they have "earned the right" to act like jerks.

    I wasn't told in nursing school that I would get a preceptor that sits on his phone all day while I do his pt load, and when I ask a patho question I get, LITERALLY, a dumb stare and a comment like, "i have no idea. i don't keep those things in my head." To complain to management....preceptor's longtime friends? LOL. Yeah. I'll do that.

    Which is why I am of the Robert Downey Jr school of thought..."Listen, smile and agree...then do whatever the **** you were gonna do anyway." Which is learn what I can, read everything....and then bail. Go to someplace where the pay is 3x what I make now (same experience level)...there is a union that protects my rights and my pee breaks....and let the NETY senior nurses sit around and wonder "why oh why" the NGs aren't interested in staying.

  • Mar 15 '17

    It's because the monitors calculate the MAP and THEN extrapolate the systolic/diastolic using proprietary calculations not based on what we use when doing manual pressures. Automatic cuffs do it by measuring oscillation to determine the MAP while direct-measure devices (a-lines) measure the wave form. Blew my mind when I found this out.

  • Feb 27 '17

    Quote from Oh'Ello
    with all that said

    none of that **** makes any sense for use in an ER
    YES. This right here.

  • Feb 26 '17

    The questions that come to my mind are
    Is this a new behavior? Did he help previously or have you traditionally done all of these things?

    is it that he doesn't want to do them because he has never had to? He sees it as women's work? Or is he afraid of your new independence? You have a new presumably well paying job and this threatens him in some way?

    I would spend some time thinking about your relationship dynamics to determine if it is a new behavior.

    In my experience people that have always helped will be supportive but some people are just lazy, threatened, or believe in traditional gender roles.

    Once you you figure out which it is you can approach him and based on his response decide if you can live with the situation or if you need to move on.

    ps I missed the fact he is working 7 days a week. Another explanation is that he is also tired and burnt out. Maybe discuss a cleaning lady as well. After all now you have two incomes.

  • Feb 26 '17

    Neither of my husbands (term used loosely) stuck around for the career. They bailed at each degree-seeking pursuit. Ask me if I care. More rewards left for me.

  • Feb 23 '17

    If it is ordered and there is no medical reason not to give it, you give it. Period.

    I have not read through the entirety of this thread so forgive me if I am repetitive or off topic by now.

    I found once I quit trying to dictate the morality of others and just did my job, my life became much more peaceful and my opportunities to be therapeutic to my patients increased.

    If you want to take the patient out of it and just address your own well being, just save your sanity. Put on their white board when things are due and reassure them you will give them what is due, when it is due...not 15 min before, not 15 min after (when you can help it), but when due, they will receive, provided vitals are all WNL. Calms them down. Makes your shift easier.

  • Feb 23 '17

    Quote from Thankgodforativan
    Thanks to everyone who replied, but I'm done with this thread. I hoped to actually have a reasonable discussion, but I can see that just isn't possible here.
    This is actually a surprisingly reasonable discussion.

    The subject comes up frequently, and often elicits emotional responses.

    In this case, several folks have explained your responsibilities and your options. Some have sympathized, some have been critical. That would be a reasonable discussion.

    Was it a real question? I see you are new to nursing, but did you really not know the answer?

    Were you expecting: "Yes- you have the right to disregard MD orders on admitted patients under your care. Just make a list, let administration know, and somebody will come in and take care of any orders to which you have moral objections".

    Do some searching on this site, and you will see that this issue frustrates many of us, including me. But, I like my job in the ER, and this is one of the aspects that keeps it from being perfect.

  • Feb 23 '17

    I've been hesitant to add this because I totally respect some of the members who write these things and a few of the topics are interesting enough but I believe posts on a message board are and should be identified as nothing more than posts on a message board.

    Elevating something to "Article" status adds credibility that has not been professionally vetted and the ones I have opened have been fairly light based on, if nothing else, the limited amount of space available. They seem to vary between an interesting commentary with a few relevant references and total self-serving grandstanding many of the latter which if I were a moderator I'd be tempted to censor rather than post with a fancy banner dignifying it as an "Article".

    My ideal solution, so I don't get again bashed for just venting, is to select actual peer reviewed articles that are within the public realm and post a link to them in an effort to engage us in scholarly conversation. None of these topics are reinventing the wheel so why not utilize the actual comprehensive data that exists as a starting point?

  • Feb 13 '17

    At this point in the game, you have to prioritize. Like some previous posters have stated tylenol is protocol for many places when using post-code hypothermia. IMO i would 100% give the tylenol to help achieve appropriate hypothermia status in hopes that we are able to regain neurological status. Although the liver is very important, i would call it secondary in this situation.

  • Feb 13 '17

    I think in general, night shifters would like to get to bed as soon as possible, preferably before the sun comes up, the bigger question is how many day shifters would want to start at 3 AM?

  • Feb 13 '17

    slow paced nursing jobs

    hmmm, is that an oxymoron, like jumbo shrimp?

  • Jan 8 '17

    Seems like you have pretty much done it all. and honestly I can't offer you any advice other than, stick with it or do something else.

  • Oct 11 '16

    Well - ok here is the thing:
    People do not read the stuff thoroughly and to make it more dramatic say something like "CMS says the BSN is equivalent to the BS biology or Chemistry" and try to make it even more dramatic by suggesting the nurses will be flocking to the labs - take them over - and what not.
    I wish people would reflect on the issue before getting all upset.

    CMS does not really say that the BSN and the BS Bio or so are equivalent meaning they are the same. Of course they are not. Though there is the word "science" in BSN .... CMS put out that they view the BSN as a science for the purpose of lab testing , which would mean that nurses are technically allowed to perform certain tests in certain categories that were limited to staff the has studied a science science and have the lab experience.
    The detail is important though - it could open up the possibility for nurses to also supervisory for labs especially if they are advanced practice nurses.
    Does that make much sense? It depends. If you ask the laboratory personnel lobby - they are highly upset because they feel that nurses are moving into their arena and probably feel de-valued by this move from CMS. They are lobbying hard against this - there are some links below. But is it like many other things in healthcare - things change over time. Look for example at the "medication aids" in some states and facilities. Nurses were upset about it because they go to school and now a medication aid with minimal training can pass out certain medication (not they are really doing the same as nurses but for arguments sake). So for the purpose of passing out medication that is established and routine without high risk the CNA medication aid education is equivalent to the nursing education for this specific population and case. It does not mean that they are really "the same" So both are able and allowed to pass out let's say a cholesterol pill. But of course we know that the "education" is not really the same.
    Is it a safety risk to allow nurses technical and theoretical to qualify per their BSN to perform moderate testing? That probably needs to be determined and looked it. I guess it also depends on the test. If you are a BSN and perform the moderate testing but have actually not passed the competency you are not qualified - with or without BSN.

    I can not really see nurses running with wide open arms to the labs and perform moderate testing. It is probably less $$ and why would you go to nursing school if you wanted to do lab work???

    I feel it is mostly about protecting their jobs and and attempt to draw some more boundaries around their profession. But again - nobody really said the the BSN and the BS Bio are the same meaning you have the total same knowledge. I honestly do not know a single nurse who would want to sit in a lab and waste their education on performing moderate testing or supervising a lab....

    Internal Warning

    "The American Society for Clinical Pathology (ASCP) is urging laboratory professionals and other interested individuals to sign a petition urging Centers for Medicare & Medicaid Services (CMS) to reconsider its position that nursing is a biological science for purposes of performing laboratory testing."

    Press Start: Lead an Empowered Life as a Clinical Laboratorian : CMS Says Nurses Can Perform High Complexity Tests

    Clinical Laboratory Management Association : Blogs : Tell CMS Nursing is NOT a Biological Science

    "It also appears that CMS’s position could allow individuals with as little as a bachelor’s degree in nursing to direct a CLIA moderate complexity laboratory and/or serve in senior supervisory roles within a CLIA high complexity laboratory. Since the Clinical Laboratory Improvement Amendments (CLIA) of 1988 doesn’t specifically require clinical training of individuals with a degree in biological sciences, CMS’s new policy exempts individuals with a bachelor’s degree in nursing from any specific training requirement prior to performing high complexity testing for diagnostic purposes."

  • May 25 '16

    Good lord, people. CNA scope is defined by the state, just like RN practice, so there are bound to be differences from state to state. OP was pretty accurate when they said everyone responds essentially the same: "in MY state/facility/whatever that would never be allowed." This same topic has come up at least a half dozen times, and it blows people away every time. Just because you've never seen or heard of something doesn't mean it doesn't exist or can't happen. Mind your own practice and assume that OP's facility and coworkers who are licensed in the same state probably know more about what's legal for OP to do than you do. Get over it. Please. Just let it go.

    Further, regarding the "you can't control how people respond" thing... This is true, but isn't there some rule - applied kind of unevenly - about keeping threads on topic? The thread is about OP wanting to shave their patients' pubic hair. How is that not rife for conversation?

    On that topic... you probably shouldn't shave a patient for your convenience. You could ask the patient, "Listen, Mr. Bear, you have a blackberry thicket down there that I'd like to trim back to more of a grassy knoll. Awkward, I know, but in the long run it'll mean my hand is in your butt crack less, which seems like a win-win, am I right?" If there's an infection risk (skin break down, wound, etc), then it may be indicated... send it up the chain. Also, for the love of god, as a PP said, go get the clippers from the cath lab. They shave groins on the regular. I don't want to shave some dude's forearm with clippers that were just down your patient's pants.