TessLJ

I think that's a cute style and can't imagine it would be an issue, as it's up and clean. What I hate to see are these young women with their long hair hanging down. Yes, your hair is beautiful, but it's also touching my mother when you lean over her hospital bed, which means your hair has been touching all the other patients too. Gross!

I think you need to start with your preceptor and have a clearing of the air discussion. I think going above her to speak with the supervisor about where the accusation came from is only going to widen the chasm between the two of you. I whole-heartedly agree with everyone who has said you need to communicate. When someone is trying to explain things to you, to change the subject or look away would convey the message that you're not at all interested in what they are telling you. Also, you're on orientation, so assuming you already know what she's telling you could be dangerous. One time I had a patient who was in respiratory failure with very high pressures on the vent, and had gotten a pneumothorax. He was still running high pressures on the vent and I was afraid he would "pop" the other lung, so I had all the chest tube equipment available in the room to be ready. I was trying to go over the clinical signs of pneumothorax with the new nurse who was taking him for the next shift, to which he responded, "Yea, yea, I know, I know," and walked away from me while I was talking. I was furious at how rude he was. Imagine how much more furious I was when I came in the next morning to find that the gentleman did indeed "pop" the other lung overnight, but in looking through the charting, the clinical signs were documented by this nurse, and not only ignored, but resulted in the patient coding before they realized he had a 2nd pneumothorax and got the chest tube in place. This nurse's unwillingness to take my advice almost killed someone. So please don't think you already know things; take some time to listen and you may learn something.

I'll just say with 26 years of nursing under my belt, many days aren't met with passion, but I do think you shouldn't stay in a job you truly hate. It will show in your performance at some point. That said, you've got some good education and experience under your belt. I'm not going to repeat the great suggestions by the others but you probably need to get maybe another year or so of clinical experience before applying for case management or utilization management, or for anything in insurance. Most places prefer at least 3 years of clinical experience. But clinical doesn't have to mean bedside. Home health or office/clinic nursing, for instance.

Just curious, why nursing? But I 100% agree with the people who recommend going the ADN route. It's the fastest way to bringing in a decent paycheck, and there are a lot of ADN to BSN programs that are geared to accommodate working nurses' needs.

I manage a team of case managers. I honestly think at my age I couldn't physically do it anymore, on my feet for 12-13 hours, lifting heavy patients, that on average are now about 100lb heavier than when I left the bedside. I don't miss walking into patient rooms to family members glaring at me, when this was the first time we'd laid eyes on each other, and already they're ready to get angry about something, anything, you know those people. They like to mention the word "lawyer" a lot when you're in the room, and you can tell from looking at them they don't have a pot to pee in, much less an attorney on retainer. I don't miss the smell of poop, nor do I miss cleaning it up. I certainly don't miss working weekends and holidays.

I've never been asked and as a hiring manager, have never asked. I have noticed it showing up as well as high school dates in resumes.

Since it's for Aetna, which is health insurance, it is around measuring and monitoring quality standards within the company. Some possible responsibilities of quality management could be around making sure that quality measures for health insurance plan accrediting agencies (URAC, NCQA) are being met, tracking performance expectations for customer groups (such as compliance with clinical care, HEDIS scores), providing consultation to the case management and disease management areas for audits. There is also the provider end, which could involve provider credentialing and investigating complaints about providers' quality of care delivery.

You have the right to be given specific pinpointed behaviors that need corrected. All the generalizations are not helpful and it's setting up an environment of mistrust. Not very good management happening where you are.

"The whole deal was very startling. I thought of myself as being a least well-liked among the staff I usually work with, as I'm a very jokey, light hearted person who enjoys good food and hard work. But now I'm not sure how people feel about me and I don't know what impact it will have on me. One staff mentioned that the administration would be asking staff members how they feel about having me in this new position, and it was mentioned in a way that very heavily implied that quite a few of the staff would not be okay with that." This is evidently a blind spot for you, if your perception of staff opinions are so far off base from what they are saying. Stop trying to "manage" their perception and try to be a leader. You may benefit from reading, "Leading from the Middle," By W Robinson. Also, "The 5 Dysfunctions of a Team," is another good one. Are you trying to be a 1 person show with all these plans you have to straighten out the organizational turmoil? One of the best ways to get staff buy-in and involvement is to include them; as for the input. You're concerned about what they think of you, but have you made sure that they feel valued? If not, what can you do to help them know they are valued? Sticking to policy...does the policy make sense, or is it part of the turmoil? There is nothing wrong with re-evaluating policies to see if they are still relevant or should be changed. What do the staff think? Have you solicited their feedback on the policies and what they think needs to be done?

I live and work in Alabama, and while I can't say it never happens, I have never seen discrimination against homosexuals in my 25 years of nursing experience here.

THIS!!! Our upper management is made up of non-clinical people, and it's like we get no respect from them. They' keep re-purposing the nursing staff positions to hire more business people. Wonder what they're going to do when there is no one left to do the work?

Since you say you need structure and routine, have you considered home health care?

"He's failing at the best thing I excel at, which is science, with a D+. I don't know what assignments are due or when they are due because he is expected to write them down in his agenda. I just emailed the principal and teacher with a request to meet for a parent teacher/principal conference." Question: is he failing due to not applying himself, or is he genuinely struggling with the subject? Yelling won't help, and he will learn to tune you out. I know you are already busy, but you may want to read a bit about performance management. It's something I learned regarding how to reinforce desired behavior and extinguish undesired behavior in the workplace, and I brought it home and used it with my children. In a nutshell, you apply consistent consequences for behavior, reward the good with positive reinforcement, and try to extinguish the bad with negative reinforcement. So he loves to play Fortnite. I recommend not deleting it just yet. You said you only let him play on weekends. How about changing tactics, and allowing him to play it for a certain amount of time on weeknights once he completes his homework? Bring home a bad grade on a test, Fortnight goes away completely for X number of weeks. Earn it back by making a good grade on the next test. Let him understand that his own actions drive his consequences, and mom stops yelling. Motherhood is difficult, being a nurse is difficult, school is difficult, and marriage is difficult. Mr. needs to understand you need his help and support. I hope you can make him see the light. Hang in there!

What is your relationship with your supervisor? Do you feel comfortable talking to him/her about this? I think, if anything, there is at the very least a lack of cultural competency with regard to the physician dismissing the patient's symptoms as just being too emotional. I personally think you should continue to provide translation services, not for the sake of the other hospital staff, but as an advocate for the Hispanic patients. Think about it from their perspective, sick, likely frightened, and surrounded by people they can't understand and who can't understand them. Honestly, if I was the the manager on the floor and a Spanish language only patient was admitted, I would probably want to assign them to you too, just thinking common sense. Now if that bothers you, then you need to take a step back and think about why that is. However you decide to handle this, please don't go with the "not my job to translate" route, because ultimately it will only hurt those patients. You might also consider sharing some key Spanish terms and phrases to help your coworkers learn to communicate with these patients. I agree the doctor's comments are garbage, and you have a right to find them offensive. Nothing wrong with you mentioning that in the moment, or maybe at some point recommending to your HR personnel that some cultural training would benefit the hospital staff. I hope you get your raise.

"I'm asking for guidance in how to approach this nurse, from a management standpoint. I was thinking about just asking her what was going on in the way of being able to change his dressings because we have noticed them not being done regularly." Are the nurses expected to date and time the dressings on the bandage? Are they expected to document in the chart the date and time of the dressing and their observation of the wound appearance? I would try to collect more concrete information than one previous shift nurse's complaint. If you have information that supports the other nurse's complaint, then I would recommend having a meeting with her and her shift manager in which you provide her with the information showing that she isn't following the wound care orders, and educate her on the importance of following the orders, with clear explanation of the consequences going forward, whether that leads up to termination.