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You're clearly not the NP in this scenario. If a nurse practitioner co-worker has accessed your protected health information without consent or clinical cause within a provider-patient relationship, it should be reported to HR immediately. It is an egregious HIPAA violation, and the civil penalties for intentional HIPAA violations are significantly more costly to an organization than true accidents. I'm hoping this is just a hypothetical nursing school question about patient privacy since every licensed NP should understand how inappropriate this action is.

Keep in mind that there is no real clinical difference between 125/79 vs 125/78, so it's kind of a non-issue. The last sound you hear is separated from silence by 1 mmHg. ?

Your reaction was inappropriate and unprofessional. You chose to make another nurse uncomfortable, and possibly intimidated, just for the sake of being rude. Your conversation served no productive clinical purpose, nor did it help improve the work environment. I would not be surprised if you end up counseled or disciplined by your manager or HR for your response, and really, I hope that's the outcome. This type of toxic behavior shouldn't be tolerated. Would I personally write an incident report about this? No. However, the nurse had a legitimate patient care/safety concern. As a float nurse, she might not have had the opportunity to bring it to your attention personally. As a preceptor, she walked her orientee through your facility's process for reporting patient care/safety concerns. I'm not seeing the problem. Nursing 101: If it wasn't charted, it wasn't done. You're no longer employed at your previous job, so that isn't a factor here. Take accountability for your clinical errors. Learn from them. Then learn how to professionally interact with peers. Creating an incident report for a genuine concern isn't toxic. Verbally accosting someone for doing so is toxic.

"Thanks for offering to help, but I've worked in the ER 15 years and am known as one of the better sticks around here. I'm not looking for new techniques when mine works so well!" I think that would actually be a good conversation to have the next time you see her before even entering a patient's room.

This is an awfully strong judgment of someone you've never personally observed in the clinical setting. Since your primary source for this opinion is previous students who didn't do well under this instructor, you should consider that it's one-sided and likely biased. Just because an instructor isn't all smiles doesn't mean she's rude. Just because she's considered a "hard" instructor isn't bad. Perhaps she takes her job seriously and wants students to become safe, competent nurses. Perhaps that's because she genuinely cares for her students. Would you want an instructor who doesn't care about quality? To answer your question, no, asking her to switch groups would not be a good idea. If your program wants or needs to adjust clinical groups, they will do that. If they want volunteers, they'll ask. Letting someone know that you're eager to leave their clinical group probably isn't an ideal first impression. Show maturity, be respectful to everyone you encounter in clinicals (nurses, peers, instructors), and learn what you can from this rotation.

I love learning, and I enjoy helping others learn. Teaching others to be safe, competent, caring nurses leads to improved patient outcomes. If every student I teach ends up being a little better of a nurse than they would have been without my influence, I'm positively impacting a far greater number of patients than I ever could as one individual bedside nurse. I also feel like patients deserve competent nurses, and that requires invested faculty who really care and have high, but reasonable, expectations. I don't like the us versus them mentality that some nursing faculty and students hold towards each other. The best academic and clinical outcomes occur when it's us (faculty and students working together) FOR them (patients).

1. Paying tuition and fees to an institute of higher education doesn't mean that *you* become the faculty's employer. 2. Paying tuition and fees doesn't mean you get to make policies or determine what clinicals should look like. 3. You absolutely can, politely, respectfully, and professionally, share concerns with your clinical instructor. Instructors can't be physically present with all students at once, so good communication is key. It doesn't mean there will be a target on your back. I'd recommend finding a better way to voice your concerns than accusations of lying though. 4. The purpose of evaluations is to evaluate. I think students prefer explanations of *why* they lost points on their evaluations to simply receiving low scores without feedback. Your instructor has every right to record why he or she assigned the grade provided. I've never once retaliated against a student who had questions about a grade or comment, and I imagine the vast majority of instructors are willing to have these discussions without retaliation. 5. Your posts in this thread appear argumentative, aggressive, defensive, etc. while lacking self reflection. That attitude/approach isn't ideal for school nor working as a nurse.

Yes! https://www.BON.texas.gov/education_continuing_education.asp

My job is not even messy, and to this day, I still strip down before entering my house. Work shoes permanently stay in the garage. Work purse permanently stays in the garage. Used scrubs stay in the garage until I'm ready to wash them. I go directly to the shower and don't even greet my family until I'm clean. I don't think of this as an OCD routine. I think it's just good infection control.

If I, as a patient, learned that my body was exposed to and clinically cared for by a non-employee, without a background check, with pending charges, without required HIPAA training, without a verification of certs/licenses, without an orientation to facility policies and equipment, and without anyone having verified his clinical competence first, I think I'd come unglued. Frankly, I would feel completely violated. Patients consent to receive care by employees- not random people who are unknown to the organization and have no business assuming their care. Healthcare is a profession of trust. If I found out my Foley had been removed by Joe From the Street, I'd want to pursue assault and battery charges. I would report any licensed staff who delegated my care to you to their licensing agencies. I would report the facility for a HIPAA violation for allowing a random person to view my records. It is one thing to have non-employees shadow staff, with full disclosure to patients of their role and patient consent. It is quite another to turn patients over to someone who could've caused harm and who certainly took advantage of patients' trust, even if they were unaware of the violation. Shame on the manager and staff for entrusting vulnerable patients to your care without any precautions. Congratulations on landing the job.

1) Not a protected class 2) Think of the impact on patients with sensitive respiratory systems when cared for by someone who comes in reeking of smoke. Being around anything remotely smokey results in airway problems for me- even just being around someone who just smells like it. (For those who don't physically react to being around smokers with smokey clothes, there's still a general unpleasantness to being cared for by someone whose clothing and breath smell foul.) 3) Higher insurance costs, more sick days, statistically take more breaks during work day

Have you verified that it is within the scope of RNs in your state to pronounce deaths?

Any time one patient is offered preferential treatment over another, or any time your personal life is blended with your patient's personal life, a violation of professional boundaries has occurred. -Hiring a patient for a commission is preferential treatment. -Your role in this patient's care is as professional nurse. The patient's role is to receive clinical care. The roles should not shift to employer (you)/employee (patient). If you like this patient's artwork, find an artist with a similar style.

I can't speak to your performance to give feedback, but I can say this as a parent. If I were ever in the horrible situation of my newborn child being critically ill and heading towards a code, I would choose for the experienced NICU nurse to step in and take over care every single time. The best orientee is still an orientee, and from a parental standpoint, I wouldn't care what an orientee learned during that shift. I'd care that my baby had the best nurse possible and survived. Maybe try to think of it from that perspective. Your preceptor might have realized how dire the situation was and realized what was coming. While operating at that stress level, her communication and teaching skills probably weren't ideal. She may not have mentally been in a place to debrief you appropriately or discuss your performance after she'd just had a newborn baby die on her and gone through the adrenaline rush and trauma of trying to reverse that death. Could she voice her concerns in a more kind, clear, and tactful manner? Of course! But I'd give her grace for that night because she had just experienced the same trauma you had. Hang in there. Remind yourself of the positive feedback you've received along the way, and remind yourself that a micromanaging preceptor isn't necessarily a reflection of your performance or abilities. It might just be her style. If you have down time on your next shift, ask her to walk you through her thought processes and actions from the critically ill/coding baby so that you'll be better prepared for similar situations in the future.

Each state has its own Nurse Practice Act, so this will be unique to where you live. It should be accessible on your Board of Nursing's website. As a starting place, read about your state's standards of practice and scope of practice. Outside of your practice act, familiarize yourself with nursing process, SBAR communication, professional boundaries (NCSBN), nursing ethics (ANA), your unit's clinical policies and procedures, and regulatory requirements (Joint Commission, CMS). Is your struggle with "not knowing what to do" regarding clinical skills? Speak with your unit's educator. Observe experienced nurses performing the skills. Refer to your organization's P&P and clinical resources that offer guidance. Familiarize yourself with the equipment in your unit. Most importantly, speak up when you don't know how to do something and feel you'd be unsafe without supervision.