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FacultyRN has 12 years experience.

FacultyRN's Latest Activity

  1. FacultyRN

    New protocol - No report from ER to floor...

    I have several thoughts on this. 1. Know your Board's definition of patient abandonment. In my state, care must be transferred to a receiving RN. However, dumping a patient in an RN's assigned room, and this certainly is dumping, doesn't constitute a transfer of care. The receiving RN must be given an opportunity to accept/decline care of a new patient assignment. A facility's policy can't lower the standard of abandonment. Let's say the receiving nurse is at lunch when a patient is dropped off in her room. The transferring nurse doesn't notify the charge nurse or nurse providing break coverage. Three hours later, the floor nurse realizes there's someone in a room she thought was empty. The patient is in the floor with a head injury. The responsibility lies fully with the nurse who dropped and ran without safe communication. 2. Joint Commission states "A handoff is a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another." Joint Commission notes that handoff allows for discussion between the sending and receiving nurse; the receiving nurse must have the opportunity to ask questions and have them answered to determine if he/she is willing to accept the patient's care. Rolling a patient into one of my assigned empty rooms doesn't mean I've accepted that patient's care. Providing me with a detailed beside report doesn't mean I've accepted a patient's care. It is my responsibility to determine, based on the report received, whether or not I can safely accept a new patient's care. That is when my duty to the new patient begins. Now, might saying "I don't accept this patient's care at this time" result in employer repercussions (barring Texas Safe Harbor situations)? Maybe. You're going to end up with an angry ED nurse and manager, maybe an angry charge nurse and floor manager. You could be written up; your job could be threatened. However, I'm more concerned with protecting patient safety (and my license) than I am with protecting my job or people pleasing. The reality is that some patients require care beyond my scope of practice. The reality is that a receiving Med Surg nurse may already have 5 other patients, 2 of whom are going downhill fast, 2 of whom are fresh post-op patients, and 1 of whom has dementia and keeps trying to climb out of bed. Can this nurse safely accept a new patient with respiratory distress and a glucose of 400 from the ED when she knows the patient next door is about to code? No, she can't, and she has a right to say so. Accepting the new patient's care at that point endangers the well-being of her existing patients and the new patient. It means she almost certainly can't meet the standards of practice in the care she is providing. I was an ER nurse; I understand the importance of opening beds to serve the greatest number of patients. There are certainly floor nurses who drag their feet on new admissions for a variety of illegitimate reasons, including convenience. That is a leadership problem that should be addressed in their unit. There are also plenty of legitimate reasons to decline a new admit. Ultimately, it is the unit manager's responsibility to ensure adequate staffing of the unit based on patient acuity and safe ratios. That way there's always someone available to accept a new patient if a room is available. 3. Medical records existed prior to modern patient handoff standards. There's a reason handoff was created. The majority of sentinel events are related to communication failures. Yes, the information is available in the chart. When does the M/S nurse described in bullet point #2 have time to review the new patient's chart? Thankfully, most EMRs provide a patient summary/e-Kardex that can be reviewed in about 1 minute... but the nurse still needs the opportunity to ask the sending nurse questions before deciding if she will accept the new patient. When I worked in the ED, we called the receiving unit to say "Will you let the nurse receiving John Doe know that we're coming up in 10 minutes? I sent a copy of the patient summary, and I can be reached at extension 1234 if she has any questions before transfer." That system worked well because a) it didn't waste time providing a lengthy report; b) it gave the receiving nurse a chance to ask questions or decline the admission; c) it gave the receiving nurse a heads up that I was coming so she could meet me in the room if possible. If the receiving nurse wasn't available to review the faxed summary, the unit secretary was required to give it to the charge nurse instead, and she would temporarily accept the patient. The ED nurses were instructed to document report provided, transport to the floor, AND "Patient care accepted by ____." That's when our own responsibility for the patients ended. 4. First, I would have a sit down conversation with your manager. Present factual information and objectively list your concerns. Hopefully, the two of you can work together to find a suitable solution. If nothing is resolved, and you're truly having patients dumped on you without receiving a proper handoff, you should complete an incident report for each patient dumping occurrence at the end of your shift. Copy and paste Joint Commission's requirements for patient handoff into your report. Copy and paste your Board's definition of abandonment, if it's relevant. List any patient concerns that arose during the shift that would've been prevented if you'd received report. Do it every time. Make risk management aware of this dangerous process, and make it known that you're not willing to take the fall when a patient is harmed as a result.
  2. This isn't legal advice, but if I were in your shoes, I would personally... -Avoid any signs of remembering the patient, even if you do. I wouldn't say "Oh yeah, I remember this case." -Avoid any self-blaming words, I.e. "I would normally do XYZ, but that night we were swamped and short staffed." "I should've documented ABC, too," etc. -Avoid adding a single thing verbally to my documentation. I would not expand upon what I'd written by guessing about the situation, my thought process while charting, etc. I'd say "I consistently document the care I provide and pertinent findings. However, I have cared for so many people that I can't accurately speak about the nursing care I've provided to past patients beyond what I've already documented in writing." I'd happily answer questions like: "Is a BP of 184/102 normal?" "What does edema mean?" "What are crackles?" "Why would this patient have Lasix ordered?" I would decline answering questions like: "Is there a reason you didn't call Dr. Smith when your patient had a BP of 184/102 and a headache?" Keep in mind that your employer's defense attorney is NOT your defense attorney. Their job is to free your employer from liability, not protect individual nurses. If you can tell things are taking a questionable turn, I'd say "I'm not comfortable with this conversation. I am done talking unless I receive a subpoena and have my own attorney present." Shut that right on down if you need. Don't fall for something like "Innocent people don't need representation."
  3. FacultyRN

    How to deal with Nosy Co-Workers?

    Yes, gladly! If you go to Google, or the search engine of your choice, you'll find a blank box where you can enter your search. Type the words "relational skills" (quotation marks optional), and you will find abundant sources explaining what they are. You will even discover sources discussing relational skills as a professional nursing competency. As you can guess by my screen name, I love education, so I'm happy I could help you learn something new! Our society is terribly broken and disconnected right now, so I can only hope that you're incorrect. I hope that people work to maintain connection and relationship, each of which requires a genuine curiosity and care for others. I think the ability to converse with others effectively is very much an adult skill, not a toddler skill. As I said in my initial post, that doesn't mean dropping all boundaries. Well, at least there is one point from your post that we can agree on! Asking someone their panty size at work would be sexual harassment. Asking someone about their new car is making casual conversation. I tried making the mental leap you did that asking a coworker about their new car is on par with asking for a stranger's social security number, but yeah... I just can't get there. All I know is that I am SO glad that throughout my nursing career I've been able to openly converse with my peers about common, everyday topics. It has benefited me personally AND professionally. I think if I were easily offended by people who ask about my public life, or openly hostile towards them, I would feel incredibly isolated. I hurt for people who lack connection with others.
  4. FacultyRN

    How to deal with Nosy Co-Workers?

    We work in a profession centered on human interactions. How would a coworker you aren't close to possibly know that you dislike friendly conversation? To me, someone you work with showing an interest in your life is not offensive. Many people spend more time at work than at home, and being in relationship with coworkers and enjoying the people around you can make that much more tolerable. If someone oversteps a boundary by asking about something you feel is private, like faith, relationships, or political views, there's no problem with kindly saying "You know, I'm a rather private person, so I don't like to discuss these things at work" and changing the subject. She brought up a topic you'd discussed with other peers. I'm guessing your new car was in the work parking lot. I just can't wrap my head around being offended that someone acknowledged your accomplishment. I think your reaction sounds immature, lacking in relational skills and defensive. Like I said, there is an appropriate way to redirect what you personally feel is a boundary crossing. Re-read your words, and I imagine you can see how your reaction could've improved. In fact, I think it was so over the top, that next time you see this person, it'd be good to say "Hey, last time we talked was kind of weird. I am a very private person, so I'm not really open to discussing my personal life at work, but I wanted to apologize for being so snappy. I was just caught off guard and prefer to focus on work-related topics at work." Based on the wording and tone in your post, as well as your RN v PSW differentiation with an air of superiority, I'm inclined to believe that your attitude and aggressive manner are why your co-workers have considered reporting you for bullying. I doubt it has anything to do with your cake eating preferences. Congratulations on the new car (if I'm allowed to say that).
  5. FacultyRN

    Moving. Can I keep license?

    Yes! When I moved out of state, I notified the Texas BON, so they converted my license to single state, and I maintained its active status while away. I also had a single state license where I lived. When I returned to Texas, I updated my address with TBON and sent an email, and they automatically converted me back to a multistate license.
  6. FacultyRN

    I can't believe this - wearing a mask during the test?

    I'm glad to see that you have accepted the idea of wearing a mask during your exam. It is a fair and level playing field, as private businesses are entitled to have a dress code. I think a greater number of people's testing performance would be impacted if masks were not required. Imagine trying to focus on the NCLEX if the person at the next station over kept coughing, and you realized their aerosolized droplets would be suspended in the air you would be breathing for the next few hours. Constantly worrying that you were being exposed to COVID would be a much bigger distraction than wearing common PPE, in my opinion. I think it's considerate of Pearson VUE to protect its employees and testing candidates by asking people to keep their droplets self-contained. You've chosen nursing as a profession. It's a good rule of thumb as you begin your career not to compare it to unrelated professions, like "law, medicine, and accounting" mentioned in your original post. Each of these is a unique profession, so it would be silly to think the same set of requirements/guidelines/expectations should be equally applied across the board. It's 100% acceptable for a standard to apply to a nurse, but not an accountant, and vice versa. If you think another profession's requirements/guidelines/expectations are better aligned with your personal value set, it's never too late to pursue a new path. I don't mean that in an ugly way... just that, factually, comparing nursing with law, medicine, or accounting is like comparing apples and oranges. Hopefully you'll enjoy the nursing path you've chosen, and I wish you the best on your exam.
  7. FacultyRN

    Difficulty with respiratory issues as a new grad?

    I love the advicd you've received above about seeking a second nursing opinion, but I want to add that you should not let this RT run you down. If he gives you a hard time in the future, you follow him out of the room, and say "Excuse me, but do not speak to me like that in front of a patient again. You were really unprofessional in there. I'm a new nurse and still learning, so sometimes I might call when you don't think treatment is necessary. It's my duty to keep my patient safe, which includes making a referral to RT if I'm concerned about my patient's respiratory status. I'm going to continue calling when I think it's necessary, even if it turns out I'm wrong. It's OK if you disagree with my judgment once you evaluate the patient, but I expect you to treat me with professionalism and respect in front of the patient and my peers. Now, can you explain to me why this patient doesn't warrant a treatment at this time, and what would need to change with his status for me to call you again? I'd like to learn from you and improve my clinical judgment, but I can only do that if we work together as the team we're supposed to be." In my opinion, it's OK for people to be jerks in their personal lives. It's not OK for people to be jerks at work, so "That's just how he is" should never fly. Speak up for yourself. You'd be surprised how that will earn respect from some people with jerk personalities who just need to be called out.
  8. I would recommend reviewing the NCSBN materials on professional boundaries, reviewing the ethical principle of justice, and perhaps ANA's Code of Ethics. This is no longer a patient-centered professional relationship, even if you tell yourself it's for the patient. If she is receiving inadequate care, you need to speak up to management. If she is receiving appropriate care, just not to *your* personalized preference, you need to distance yourself. If I were her nurse, I'd be asking why you were in my patient's room repeatedly throughout the day, and I'd have no problem letting you know it was inappropriate and needed to stop. Your frequent presence could be a hindrance in other staff forming the therapeutic relationship needed for her to trust them with her care. If you have extra time to visit with someone, use that extra time to go above and beyond for those in *your* care.
  9. FacultyRN

    School Nurse told not to follow DNR order

    This really irks me. Parents have the right to make medical decisions for their children. School principals can't override parental rights, protected by law, to make their own medical decisions for children... in this case, not even considering the best interest of the child with the DNR, but feelings of others. Children belong to their families, not to a school. Additionally, school policies can't override that a nurse's primary duty is to her patient. A school administrator does not have the authority to override that duty, nor guide nursing practice. I'd be making it very clear that my nursing duty, as a requirement of my license, was to serve this child according to his/her needs and parents' legally presented wishes. My duty is also to practice according to my license's scope and standards, as well as according to the best practice education I've received in nursing. Someone with a degree in education doesn't get to make my nursing decisions. Even nurse co-workers don't get to make my nursing decisions, although their feedback and ideas are well-received. A duty to protect the general student body's feelings doesn't exist. And this principal has clearly never observed a resuscitation scene, which can be much more traumatic to witnesses than a peaceful passing. Thankful for school nurses and what they do!
  10. FacultyRN

    Proper Way to Display Credentials

    In order: Highest degree, highest licensure, specialty certifications
  11. FacultyRN

    What should I do?

    An acutely hypoglycemic patient, whether yours or not, is a higher priority than a dressing change. For that reason, I'd communicate to the manager "OK, I'll go get that patient. Will you let her nurse know I'll have her back in a few minutes so she can be ready to help when we're back in the unit? Dr. Smith wanted me to get Other Patient's dressing change done right away, so if you see him, please let him know it'll be a little longer." That way, if the doctor makes a fuss, your manager is already aware of the delay and on your side.
  12. FacultyRN

    Nurse with mental issues?

    Since you haven't enjoyed nursing in your first two years, I would not recommend investing any more time or money into nursing education at this time. It's OK to take a pause. Take care of your mental health, and see if that changes how you view nursing. If not, it's OK to jump ship and find something that fits your lifestyle and needs! Your RN pre-reqs could likely apply to other degree programs, too- surgical technology, sonography, dental hygiene, etc. If you don't think healthcare is a good fit, the world is your oyster since you're willing to pursue more education. Once your mental health and your personal situation are better managed, consider meeting with a career counselor who can help point you in the right direction based on your experience, strengths, interests and personality. (Your local community college likely offers this kind of service for free!)
  13. FacultyRN

    What is your "favorite" procedure?

    IVs for the win!
  14. FacultyRN

    Having a hard time choosing first job!

    Here's the other good thing about starting in ICU. If you find it's too much for you as a new grad, it's not the end of the world. You can always transfer if needed. MANY new grads are successful in ICU. Many ICU nurses are happy to work with and mold new grads. Since the hospital offers an ICU internship, it's bound to have at least some new grad-friendly ICU folks. There are some people who will always adamantly oppose new grads in the ICU setting without considering the individual nurse and training opportunities, and there will always be some nurses who enjoy making newbies miserable... You'll never change those people's opinions/actions, so decide in advance to let that negativity roll off your shoulders. Have strong work ethic, positive attitude, and be professional even if you find yourself struggling. Be kind, avoid gossip, and don't be the person who cries or shuts down if someone gives you corrective feedback. Don't call in because you had a tough shift; get yourself to work and learn a little more each day. Communicate with your preceptor. Let them know if you need more feedback. Ask them to narrate rationales for their actions so you can better understand why things are done. Let them know if there's a skill you're struggling with and that you'd like to practice it more when an opportunity arises in your unit. Plan to succeed in this position. Internship, great pay, no contract... Go for it!
  15. FacultyRN

    Expired License Nurse

    I believe nurses have a duty to report if we suspect someone is practicing without a valid license, which is fraudulent and criminal. You've done your due diligence by checking the state BON and NURSYS pages to verify your suspicion. Six years is 3 license renewals; I seriously doubt the state BON and NURSYS have somehow forgotten to update this nurse's information 3 cycles in a row. I think contacting the BON is the right thing to do, but you must know your "close friend" may no longer be a friend.
  16. FacultyRN

    Would this look like job hopping?

    I think as long as you keep the new job for a year and a half or so, it'd look OK. Once you move, you could list "lack of available shifts due to COVID" as your reason for leaving PICU, which most managers will certainly understand, and "long distance move" as your reason for leaving the new gig. Both are reasonable explanations. If your goal is to work pedi CVICU, I think your history of trauma, PICU, and cardiac ICU will be great.

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