HiddencatBSN

Yep. Regardless of how safe we think we practice and how we’re not making mistakes like Vaught, this is a bad precedent for us and for Just Culture.

Your mileage may vary but my anxiety improved on stimulants for ADHD: struggling and then feeling bad about struggling with “easy” things for others was a huge contributor for me. I’ve started multiple new jobs on ADHD meds. Make sure you are compliant with your prescriber and have an active RX while you take them. When you get called by the drug testing company they will want your RX number. And as an aside, I’ve found med surg and inpatient nursing in general to be terrible fits for ADHD, at least mine. ED is where it’s at- a specialty couldn’t be more tailor-made for ADHD.

#1 You answered your own question, it’s to verify ID. #2 The “one clinic at a time PIN” sounds like an absolute disaster LOL. How is the patient identified to give out the PIN in the first place? With a decentralized “PIN” system how many PINs is a patient going to have to remember? What happens if they forget their PIN? #3 When a patient collapses unconscious on the floor, the priority is going to be BLS measures. But then yeah, having the patient’s identity is going to be pretty helpful in treating their unresponsiveness: medical hx, medications, course of tx in facility….in the ED we treat patients with unverified IDs and no hx or ability to give hx all the time but it’s not ideal. #4 You want the people taking care of you to be “obsessed” with your safety. #5 Looking forward to the post questioning timeouts: “we all know what we’re here it’s not like they’re going to do surgery on the wrong person” ?

And I just want to add, that people with genuine medical exemptions is why I feel it is so important for those who are medically able to be vaccinated to provide a larger vaccinated population for herd immunity. I totally appreciate the hesitation to get vaccinated if you’ve had a bad reaction. I work with a nurse who had hd Guillane Barre (sp?) from the flu shot. She did get the COVID vaccine but was closely monitored by her provider during the process and had a lot of anxiety around it. The folks who just don’t wanna…well. You can see my post history for my thoughts on that. With the staffing crisis it will be interesting to see if the CMS requirement changes. We didn’t lose a lot of staff over the mandate but between the staff we did lose to that plus the staff we’re losing to burnout or travel contracts and our patient volume….it’s a pretty bad situation here. Mandating to stay an extra 4 hours is a daily occurrence and that fixes things in the immediate moment but contributes to burnout and staff leaving so ultimately accelerates the crisis.

Oh goodness, that would suck LOL. No, they came to the peds ED in the morning when we were (in theory) slower. They got registered as patients and hooked up to full monitoring (cardiac, respiratory, pox, NIBP) and got 1/4 of the dose every 15 minutes and then were monitored after for a while and if needed we had the anaphylaxis treatment ready. I work evening/nights so most I did was triage and settle them in at the end of my shift but it was pretty successful. I didn’t hear of any excitement mostly just complaints that with our staffing and things picking up census-wise it was a pain in the butt for the day shift nurses, but I know we got a lot of high risk people fully vaccinated. They were all really grateful, friendly patients to settle in.

My hospital had a program that gave second doses slowly over an hour and monitored closely for reactions for those who had a reaction to the first dose but wanted to be fully vaccinated. I’m surprised that wasn’t more widespread.

Imagine being a nursing instructor and not knowing how stuttering works ? Or that it’s a disability covered under the ADA.

Rather than peer groups we should be organizing. Unionizing where we’re not unionized and making the unions more active where we are. Working together as a group is how we change systems. The language of self care and coping mechanisms is implicitly individualizing. You didn’t say “individual nurses are to blame” but you highlighted the importance of self care and coping which is just as much a shift of responsibility. This isn’t your fault- self care and coping mechanisms have been heavily sold to us by entities that benefit from individualizing societal problems rather than making systemic changes. We don’t need help coping we need to band together to demand systemic changes. Peer support is a helmet/seatbelt that we’re responsible for designing, manufacturing, distributing for free while trying to keep the car hurtling down the hill under control.

Yes. ? down to calling this a bandaid to a systemic issue. These studies were also all conducted in 2020. We’ve since had another full year of the same or worsening conditions. The support and friendships I have at work are definitely beneficial to me but that benefit has waned significantly as the pandemic has dragged in. What has helped my coping ability was dropping my FTE from 1.0 to 0.75. I am still working close to 1.0 with mandatory overtime requirements to stay- I have had frequent weeks where I am mandated every shift I work and it’s becoming more frequent for staff to refuse mandation. My hospital has over 400 vacant RN postings and my hospital and others in the region were recently featured in the NYTimes for our staffing crises. How is the identified compassionate nurse supposed to cope with the additional responsibilities of being a peer counselor? How are psychiatrists and psych residents supposed to find time for peer groups when our EDs are already boarding a high load of psych holds waiting for placement for over a week? How are we supposed to resist making 4 times as much in travel assignments to stay in our communities? Our ED wait times are 4-6 times what they typically are during our busiest months. We’ve stopped elective surgeries and have reduced available beds in the hospital which means the ED is 50-75% full of boarders. This is not a personal resiliency problem and coping mechanisms and peer support groups are yet another shifting of responsibility for a societal issue to already tapped out individuals. I’m a huge believer in the benefits of therapy but self care is increasingly going to look like reducing hours and leaving the profession.

I worked at a hospital with a point system and it was highly punitive but also weirdly encouraging of longer callouts: for example, consecutive absences were counted as one event, and leaving a shift early for illness was less points than calling out, so it was common for people to go home (sick or otherwise) and then call out the next day to get fewer points from that, and if you were out sick one day you might as well be out sick 3 days which was the max before needing a doctor's note to come back and "cost" the same number of points as 1 day. Lateness was scored in steps so if say you were going to be more than x minutes late (I can't remember but there were 3 lateness levels) due to car issues or traffic or weather, it was the same number of points as calling out and there was no reason to try to get to work. The only callouts that didn't give you points were from FMLA and it was really, really easy to have your points sit in the "in danger of being fired soon for points" zone if you had a bad few months with illness/family emergencies/etc that didn't qualify you for intermittent FMLA. IDK about that being industry standard, but I've worked at 5 hospitals and it was the only one that used the point system.

Getting a kidney stone and having it surgically removed is a pretty intense way to game the system to get a fix. How’d they fake the stone? Or the procedure?

Yeah as a peds nurse I want to know how many kg the patient was because 2mg is an appropriate dose for a 20kg child. 4mg is our standard adult dose. And for surgical pain we use PO opioids with IV for breakthrough….at standard dosing.

Yeah I'm side-eyeing the comment about wanting narcan on hand for 2 norco and 4 mg of morphine that were spaced out. For a kidney stone that's not all that exciting and it sounds like the patient was under-treated for pain. The MD should have come to assess the patient and if the 2mg of morphine helped, more is reasonable but if it did nothing a different narcotic would make sense. And if the 2mg needed to be repeated, I wouldn't wait to administer because that's the point of titrating to effect. People with chronic pain learn the names of meds that work for them too, not just "drug seekers.” Heck after a few doses of each post surgery I know that the fentanyl helped a ton and the dilaudid left me in a lot of pain. I know that addicts and people with opioid tolerance have pain and deserve it to be treated so with a known painful condition and report of pain, it's not really my job to decide if the patient is faking it or not. The risk-benefit of doing that in an acute care setting doesn't really justify it- like on the one hand I prevent an addict from getting a fix but on the other I've left a patient in excruciating pain. There's a ton of research out there on how our implicit biases impact pain control (in particular for black women).

There's a difference between creating a work environment that allows this (which I fully support, but I haven't had adequate coverage for a lunch break in like, ever, so clustered nap breaks for night shift definitely isn't the current situation) and just peace-ing out and sleeping while your overloaded coworkers are forced to step in and try to cover for you as best as they can (coworkers who are also working the night shift and also having to manage sleeping and being awake on schedules that contradict our body's rhythm). Honestly, you sound very inexperienced and like you don't have a good grasp of what's at stake OR nursing culture. This site is FULL of tips and advice and commiseration on the difficulties staying awake and alert during night shifts, sleeping during the day, managing home life when the rest of our friends and families (and doctors and grocery stores and post offices and restaurants etc etc) are awake and active when we need to be sleeping. Nurses eating their young has to do with not educating, supporting, encouraging, being understanding of new nurses as they learn. When a nurse is doing something that is dangerous and a risk to their license, blunt and direct IS A KINDNESS. Staffing so night shift can have a midshift nap would be awesome. You don't make that happen by just taking those naps (from the OP's description too, long naps beyond a lunch break) while your patients and fellow nurses struggle to cover for you. And I've worked nights for years. And been recognized by my orientees, inexperienced nurses, charge nurses, and managers for my precepting and mentorship. I still think the behavior the OP described is dangerous (and still think a private duty nurse without relief should not leave their patient unmonitored for a nap).

It doesn’t need to be a competition with other professions tho. The working class is, as a whole, underpaid and over exploited. That includes nursing. That includes other jobs that are less immediately life or death but are still essential to societal functioning and survival. We don’t and shouldn’t need to advocate for ourselves by arguments for how we are more valuable than other workers. It’s totally fair game though to question the value and cost of CEOs. But arguing with other workers about who should be paid fairly and who is valuable and who is most important just directs attention away from the fact that there’s a small class of wealthy and powerful elite whose “contribution” to society is minimizing our wages and maximizing the labor they extract from us.

No, this is not "nurses eating their young.” What this nurse is doing is horribly unsafe and irresponsible. Most hospitals it's an immediate fireable offense. I think you should consider why knowing that your naps are grounds for termination wasn't enough to discourage you from taking them. You're the only one there with the patient as well, it's not like you have a coworker who can keep an eye on things for you. When you a rule and a consequence don't make sense to you, you really should seek to understand why the rule is in place and why the consequence is what it is.

I want to add that bone disorders are usually not something immediately diagnosed. We recently admitted a patient and the results and diagnosis took several days to come back. We still had to file a report pending the outcome. Everywhere I’ve worked has taken a team approach to filing the reports and I appreciate that because it gives you the opportunity to discuss concerns and talk with people who might recognize specific abuse-mimics you might not know about. Knowing your facility’s policy and the requirements of being a mandated reporter are essential too. It is a really hard thing to be involves in- on the one hand abuse is under-recognized and under-intervened with and on the other, it’s a scary and disruptive process for families and children, there are class and race inequities in the system, and alternative placements are not always safe and healthy either.

I agree- I worked in PA and when I got a job in Allentown after working in Philly I took a huge paycut that the hospital justified as being due to the lower cost of living but the decreased COL wasn't nearly close to the decreased pay. The city itself might have been cheaper but the surrounding suburbs and rural areas were still pretty $$$ because it was still within commuting distance to Philadelphia. They also offered a whopping $0.50 night shift differential and had to hire on to night shift only for some reason. Food and housing and gas and all the others only vary so much outside of major metropolitan areas.

It's about $100 a year, not a month. I agree $100 a month would be tough but yearly it's much more affordable.

For $100 a year I'd rather know there's no conflict of interest or that I'm not going to be judged to be worth the loss for the benefit of the org which is the whole point of having your own insurance.

Two things: as a profession that’s got a good job outlook and is somewhat accessible (although there are still tons of barriers rt our educational system in the US) it’s definitely (in general) decently paying compared to professions with similar educational requirements. I made more as a first year nurse with a BSN than my mother made at the height of her career as a private school teacher with a Master’s degree. BUT. Wages in general suck in the US so that’s a really low bar. Wages have been stagnate and dropping compared to inflation and rising healthcare costs for decades. Not to mention the cost of education and the burden student loans place on people. Millennials have a lower standard of living than previous generations. So in this sense, no, nurses are not paid enough for what they do. The working class isn’t paid enough for what they do. We are absolutely justified in demanding better compensation especially when the top tier of healthcare is profiting so massively off of our labor. And it shouldn’t be a competition against other professions and jobs but part of a larger push for workers’ rights.

Email and give notice now and start your new job. With staffing concerns a lot of staff are being reassigned BUT: 1. They didn’t think to explain the situation to you until you asked 2. You’re a new grad and aren’t being given an orientation 3. It seems like that’s standard practice there. I’d tell you to run but you already did so don’t give them more of your time than necessary. Don’t feel guilty, don’t feel like you’re letting them down or being unprofessional or whatever. Two weeks notice is more than they deserve and oh well you’re in quarantine most of that time. Everywhere I’ve worked the policy is two weeks.

And I apologize that I wasn’t more clear about it being a unit gift when I said “packaged and delivered in a way that gets to them [night shift] too”.

Yes, unit gifts is what I am wanting to do. Personal letters for individuals directly involved but I want to thank the units as a whole.

I want to thank the teams that took care of a family member and know what I’ve really appreciated from families but am looking for more ideas. And don’t worry, as a night shift nurse I am making sure it’s packaged and delivered in a way that gets to them too!