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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.

I think it's pretty clear that the public education system has failed this nation by turning out poorly educated graduates for at least the past two decades. According to the Nation's Report Card, published by the US government, 78% of high school seniors are not proficient for grade level in science, 76% of high school seniors are not proficient for grade level in civics, 88% of high school seniors are not proficient in history, and 63% of high school seniors can't read at grade level. Guess what; they still get the diploma. This was not an isolated fluke of a year (2019 data) but an ongoing trend. It is no wonder that these same adults can't think critically or evaluate evidence. Our society considers reading internet memes, forums, and news comments "research." Health literacy statistics are shameful. Culturally, we have promoted the lie that feelings and opinions are as valid as objective truths. Dumb people down enough and they'll believe what the loudest voices tell them. The loudest voices tend to come from those with extremist beliefs (both ends of the spectrum) and plenty of time on their hands. Voila! Sitting ducks for misinformation!

Instead of graciously accepting the feedback you've received in this thread, you continue to challenge all responses. Your instructor's replies sound gentle and kind, not defensive. I would encourage you to evaluate your own defensiveness. You are an adult in a professional program and still felt it necessary to point out that someone else made more mistakes than you, even though you lost a total of 2 points. Yes, it absolutely appears competitive. Let this go. -Your peer's grade is not your concern. Your peer's performance is not your concern. -How your faculty grades a peer is not your concern. Sometimes, failing to identify or recall errors isn't because your instructor is unfair or showing partiality. Sometimes it's the result of briefly zoning out after having watched the same exact health assessment 45 times in a row. I'm not saying that's a good thing, but your instructors are human. Since this was in no way to your detriment, it doesn't concern you. -Sometimes your peers might have their skills graded by an "easy" instructor who doesn't really know the procedural steps and overlooks errors as a result. Sometimes you might have the "hard" perfectionist instructor who knows a skill well and catches every error. This isn't unfair. It's just the luck of the draw. Sometimes you'll be the one with good luck. -If I received a message from Student A about why she thought Student B's performance warranted additional deductions, my response would simply say "Please let me know if you have any questions about your deductions." Yours. Your own. Discussing Student B with Student A is not appropriate. Additionally, as an experienced nurse with a graduate degree and decade of working in academia, I would not welcome grading assistance from a second semester nursing student. -Your instructor has already replied twice. Why would you send additional messages about the same issue? It's time to move on, especially if you don't want her to dread working with you at clinicals.

She holds a doctoral degree, and, therefore, she has earned the title of doctor. As long as she isn't presenting herself as a medical doctor, I don't see the problem. Her title is academic, not clinical.

I don't recommend a year of Med-Surg for anyone, in any year, except nurses who would like to work in Med-Surg and gain that experience. Think about diabetes. The way a diabetic is treated in a family practice clinic, labor and delivery, ER, ICU, and Med-Surg might vary. Each unit has different goals and a different patient focus. It isn't necessarily a huge deal that the diabetic with a broken thumb in the ER has a 260 glucose; he's going home and lives that way. In my experience, the glucose wouldn't be treated at the hospital. It isn't necessarily a huge deal that the non-compliant diabetic in Med-Surg has a glucose of 260 as he drinks a soda and tells you he has no plans to stop. He will take some meds to lower his glucose, but there's no real sense of urgency. On the other hand, it would matter quite a bit if an OB patient or the post-ROSC ICU patient had a glucose of 260. For this reason, I feel it's important for all nurses to be competent in their chosen practice areas- not in floor nursing.

The clinical rationale isn't routinely part of a physician's order (barring exceptions like PRN meds, sliding scale, etc.). This is why nurses must ask themselves if an order is safe and makes sense for a patient before carrying it out. The medication/diagnosis requirement, while helpful, sounds more like an organizational policy by your employer. I'd bring your concerns to admin, letting them know that it's not within your scope to assign medical diagnoses in the chart. Sometimes there isn't an obvious diagnosis for a medication; it may have an off-label use or be an adjunct. Sometimes meds are strictly preventive and not the result of an existing medical diagnosis. Sometimes orders are just related to a procedure, not a diagnosis. I would request an option for the diagnosis of "Unknown" or "Not Provided." If your administration isn't willing to make this allowance, and providers are upset with how things are done (after failing to enter their orders in accordance with your facility's policy), I'd start calling the doctor every single time. Why is Mrs. Jones getting vitamin D? Why is Mrs. Jones getting albuterol? The squeaky wheel gets the grease, and I imagine the providers would get squeaky pretty quickly.

I find this comment so off-putting, especially by someone who is theoretically FMP and PMHNP certified. If you're employed in either of those capacities, you've seen the long term fall out of COVID. I don't think people are "freaking out" over the mortality rate. I think they're hoping to avoid lasting lung damage with new chronic diagnoses, heart damage with new chronic diagnoses, kidney failure with associated new diagnoses, strokes, clots, the sensation of drowning in their own lungs, weeks of air hunger, months on supplemental oxygen, losing the ability to smell, months of food tasting like battery acid, brain fog, the inability to remember words and complete sentences, chronic debilitating fatigue, severe headaches, PTSD, depression, anxiety, lasting changes noted on brain scans, potentially low sperm count and male fertility issues, losing loved ones in a horrendous and separated way, etc. People don't want their young children exposed to these possibilities. People don't want their older relatives dying just because they're old. The number of patients experiencing long hauler symptoms is significant. Many COVID-is-a-hoax folks ask "How can we say the damage is permanent on a novel virus?" All you should need to do is ask yourself as a provider how often areas of brain atrophy reverse themselves, or how often scarred, fibrous lungs suddenly turn healthy again. It is so dismissive at this point, knowing what we clinically know, to imply that people shouldn't have concerns about COVID since they're likely to live. Additionally, not all people fall into the category of likely to survive. One of my local mom friends with children ranging from toddlerhood to high school has leukemia and absolutely no immune system right now. Combined with her comorbidities, COVID would almost certainly be a death sentence. Let's not accuse people of "freaking out" because they'd like to see their children grow up. It's really just tacky.

Legally, as an RN providing (even limited) patient care, you'd be held to the standards of your RN license. It would be a good idea to renew your BLS regardless of your organization's policy.

Documenting the transfer of care itself is not redundant. It shows the time you are no longer responsible for the patient's care and that you properly transferred the care to another nurse (no period of abandonment). This is not information that can be found elsewhere in the chart, nor can it be assumed that it aligns with shift changes (mid shift assignments, nurses running late, nurses staying 2 hours after, nurses continuing to work after clocking out despite policy, etc.). It's also a prudent practice when heading to and returning from your lunch break. If your patient experiences a complication, fall, meds were given late, etc., you don't want to be the one taking the fall. Many hospitals require hourly nurses to clock out at lunch, so this note shows the patient was never left without a covering RN. Personally, I don't care to take the fall for someone else's negligence when I'm off the clock and not physically in the unit. I can remember going to the cafeteria with a nurse friend when I worked L&D. When we got back to the break room with our lunches, the monitors showed her patient's FHR had been dangerously low for several minutes with no indication of interventions on the strip. My friend went flying down the hall, and it turns out the covering nurse had been distracted in someone else's room. (As for why no one else ran to help from nurses station, who knows?) I do feel like documenting patient status in a handoff note is redundant. The status is readily available throughout the chart, assuming documentation is current. "1908: Patient's care transferred to Jill, RN. Beside handoff report given. Oncoming RN had opportunity to ask questions. All questions answered."

I told myself I wouldn't answer these baiting posts anymore, but I am genuinely curious about something. Based on your own posts, you, your peers, your patients and their families all acknowledge you are incompetent at managing and leading a clinical team and a poor fit for your job. Why/how do you continue to hold a management position? Also, can it actually be considered a management position when you lack the authority to discipline staff members and are still responsible for floor nursing? Aren't you technically more of a charge nurse? I'm curious about your actual job title (while also wanting to kick myself in the shins for getting roped into another one of these unlikely/fake posts).

It really just depends! You probably won't find that pay is negotiable. -I made $9,000 for the semester at one job (16 weeks, 9 hours per week). That amounted to $62.50 per hour, which was unusually high pay for clinical faculty and was only possible because of a program grant. -I worked full time for a program that paid its adjunct clinical faculty $30/hr. Years of experience and teaching weren't considerations, and graduate degrees were required. If you're thinking "wow, that's really low," you're correct. Adjunct nursing faculty are typically paid poorly. -I made significantly more money as a hospital-based educator than I ever have in academia. Working as a hospital-based educator was also a very fun job that brought a lot of value to the organization. If you're interested in teaching but want to make a living wage, look into staff development positions at hospitals. If you're interested in teaching just because it's something you'd enjoy and would provide some extra pocket money, working as clinical faculty can be a great opportunity.