NicStrRN

There is a difference between can you and should you. Keep in mind that, while travel agencies are requiring only a year of experience, they ARE NOT there to protect your license. Not sure where you practice, but our LDR residency program is for an entire year for new to practice, and even fellows get a 12 week orientation before being able to cement on their own, REGARDLESS of prior med/surg, critical care or other nursing experience. Keep in mind that obstetrics has a higher rate of litigation than most other specialties and not one single other entity is concerned with your continued licensure more than yourself. So can you you travel with just a year of experience in LDR? Yes, it appears you can given the requirements agencies have. Should you though? I’d think hard about the risks and not knowing what you don’t know after just one year in a specialty with a learning curve unlike any other. If you’re stressed on a unit where you presumably at least are familiar with workflows, policies and procedures, imagine how unsettling it will be to walk into units where you get like 12hr orientation to those workflows, policies and procedures. Only you can decide what’s right for you, but proceed with caution.

This sounds like a very frustrating situation. One that we all encounter in our years. Demanding, needy, abusive, they come in all forms and nursing school does little (if nothing) to prepare you for The level of abuse we sustain in this job. As a point of advice, just as patients “fire” staff so to can we ask to be reassigned. As a previous charge myself, I was sure to “spread the love” with these types of patients because they really wear on the staff. Also, a good Charge RN can step in and have the hard conversation, to model how the setting of boundaries can occur. There have been times where I’ve had staff say they can’t go in room A one more time or they’ll lose their cool, so I’d answer the next one and go in and set boundaries. I’ve had some of the toughest ones ask for new nursing staff and I’ve told them “you’ve fired everyone we’ve assigned and the rest have specifically asked not to be assigned to you” often that puts into perspective the fact that we have rights and I will enforce them. Period.

Obstetric patients (both pregnant and postpartum) absolutely trigger intervention at this range. We have protocols for provider notification and IV hypertensives for 160/110, they are at risk of severe morbidity, with a recommendation to treat within 1hr (CMQCC toolkit supports this). Just a heads up, as we see a bit of a lack of recognition that this is a severe range BP in our population outside of our OB departments, for example when they present to ED where this is not always a severe range BP (absent symptoms) in the rest of the adult population. To the original question, I do not agree that the approach the oncoming nurse used to give critical feedback was very collegial. Having said that, increasing pressures to the range described should warrant a provider call to update about patient condition, and clarification with notification parameters. If the patient had experienced a complication of a sustained high BP, the nurse’s judgement could be called into question. Take as a learning opportunity, but certainly provide feedback in a professional manner to the nurse who berated you in front of a patient.

In an environment of increasing pressure to pursue BSN degrees, many forums and threads seem to include comments regarding the increased aspirations of younger nurses entering the field. There seems to be a perception that bedside nursing is being used as a "stepping stool" to management or leadership, or advanced practice nursing. In some of the comments, there is a sense of condemnation and wonder about why this change seems to be occurring, with many nurses somewhat put off by a perception that younger nurses don't value the bedside anymore. Just a pondering, but could it also be that an increase in pursuit of degrees above an ADN is also relative to a perception that bedside work is not realistic as a lifetime career choice? When considering the vast changes in nursing care, is it possible that increasing acuities, comorbidities, larger body habitus of the population, and increased violence against health care workers contribute to a conclusion that the physical ability to perform the work will be limited over time? When I personally consider how many coworkers have been injured moving patients, or as a result of patient violence/behaviors, it seems fairly reasonable to believe that sustaining a career at the bedside for 30 years in today's environment may be very difficult. That's not to say it was ever easy, but certainly things have, and will continue to change.