SarHat17

Is he looking to leave bedside/direct patient care nursing or just healthcare in general? There are so many non-direct patient care options that with his experience could be available to him. If he has any kind of career guidance/support options at his employer, I'd recommend connecting with them for information. I scheduled an appointment with one at my health system prior to making the change from inpatient bedside to outpatient clinic nursing, and it was really helpful to gather more information about my options. For example, I currently have my ADN. I want to stay in my current health system, as I have a lot of time/retirement/etc invested here. 1. If I was to pursue a more advanced degree program, would it be worthwhile to get BSN vs MSN (since I would already be going back to school). There were, essentially, 3 MSN tracks open to me- Education, Leadership, Informatics- the only one I was interested in was Informatics and the only Quality-type positions that require that degree are few and far between in the current system at that time, so planning to get that specific degree and staying in this health system may not be a realistic goal. 2. If I move out of the inpatient side of things into an outpatient role, coming back to the inpatient side may be difficult, due to the focus on Magnet/BSN preference. So moving out of that position may "require" me to complete my BSN prior to being eligible to "come back." She wasn't discouraging at all and it was really helpful; just helped lay out some options and information that I needed to consider with my available options at that time. She had information on all the different "positions" that I could consider in the health system, which helped me focus in on my priorities, etc, and make a decision. Even if he is not planning to stay at his current employer, it may be helpful to have a conversation like this with someone like that as a more hypothetical, "What are my options" kind of information-gathering opportunity. Best of luck to all of you!

Is your highschool in a different state than your college/nursing school by any chance? I took AP English in highschool in Florida, and that "counted" when I was attending college in Florida, but when we moved to a different state, I had to take English 101 at the college to meet that requirement. Missouri didn't accept Florida AP highschool credit for that class. (I didn't finish a degree program in Florida prior to moving.) This was also about 20 years ago, but just a thought if it applies to your situation.

How else can you remove a gown that doesn't have sleeves that snap together? The ED gowns at our hospital are just regular sleeves, so there is no other way to remove the gown without pausing the infusion, safely securing the line (we have green Curos caps for lines) when you unhook it, and wiping the IV port before reattaching the line to restart the infusion. 100% agree CNAs should not be doing this though (it is considered outside their scope at our hospital), it should be a RN.

^^This! When I started, we had a "brain/SBAR" sheet for each patient. I used that for notes/etc on each patient, but made a sheet that had very basic boxes for each of the potential 6 patients I would have overnight. (Called it "My Brain Sheet" I think.) Each box had a box or line to be checked off for: (let's see if I remember it all!) Assessment, Neuro Checks (2000, 0000, 0400) Education, Care Plan, Tele (2000, 0000, 0400), AM labs/Check Elytes, I&Os, and space for anything else that needed to generally be done each shift. ((I would keep specific med lists, what/where IV is, history, assessment information, etc, from report on the individual patient pages, and use the "My Brain Sheet" for general tracking of shift requirements. Then I could check tasks, etc, off as I go through the shift and use it to make sure I did it all. I made a stash of copies of "My Brain Sheet" and pulled one out for each shift, stapled it to the top of my other patient pages. Multi-colored pens (don't need to get crazy, red and black are fine, or get the BIC multi-pen- it has 4 colors. Then write in a color or circle some stuff in a color to make it stand out. You may have to add/tweak/adjust as time goes on, but you WILL develop a rhythm that works. Hang in there!!

Other people visiting in the room would possibly have questions/responses to sensitive information (not to mention that it would be inappropriate to share this information to whoever else besides the patient is in the room in the majority of situations if the patient had not consented), and the time spent requesting everyone leave, then the time used while everyone does leave, etc, all eats into the 30 minutes for report between shifts. On my unit, I would be giving bedside report on 3-4 patients, usually to 2-4 nurses, who are taking 4-5 patients at night, so that could leave approximately 6-7 minutes for report on each patient for the oncoming nurse. Asking/explaining/moving family/visitors, etc, to the hall for each report could probably cut actual report time to approximately 3-5 minutes per patient, if we are aiming to stay within the 30 minute report time. (luckily, MOST of the time, there are not visitors present at report times.) The time spent is the part of bedside report I get stuck on. We are trying to implement it consistently at my hospital, and the culture of my unit, plus the actual time logistics/time crunch seem to be the biggest obstacles. I'm game to start doing it, but I am so over having to go find someone, "drag" them (if unwilling) to the room, and then start report. The response from management when I shared that scenario was to wait outside the room for the oncoming nurse to come to the room, which will prolong MY waiting time, and ultimately prolong the whole process. I'm hopeful it will get easier with practice; I am on a committee that is working to address all the roadblocks that come up, but truthfully, I think the general feeling on our unit is just so tired of all the issues and short-staffing, there is a real lack of engagement and initiative to start something that so many people are already uncomfortable/annoyed with. I fully support report outside the room and then both nurses go to the bedside to check/introduce/quick update to the patient the POC for the day.

I think Steve was one of the "bouncers" on the Jerry Springer shows and then spun off to do his own. ? It's such awful television! ?‍♀️

Here's my recent situation to consider if it's helpful! I have my ADN (and the program was definitely not easy or less stressful) and have been researching/considering going back for BSN vs MSN. My future opportunities are hugely opened up with BSN, in and out of my current health system. Long story short, I was considering moving from a 3 12s bedside position to a M-Th or M-F office/clinic/other position late this year, but: 1. Moving off my 3 day/week schedule will decrease my school available time (Both kids will be in school M-F starting in the fall.) and could impact how successful and/or how quickly I can move through either BSN or MSN program. I've been looking at the WGU program vs the more "traditional" schools with semesters, etc. 2. My personal goal is to stay within my health system, and the positions open to someone with a MSN in Informatics are about 3 people at this time, so my odds of moving into those roles are extremely limited. 3. If I wanted to return from a clinic position to the floor (to get back that more flexible schedule) before I achieve my BSN, I would likely find it much more difficult as I would be an ADN competing with BSN applicants. (Our system doesn't "grandfather in" or consider experience in some situations; we are really moving toward Magnet, etc.) I encourage everyone to move toward the BSN as soon as possible (for them) if they are in an ADN program. I wish I had worked for a year, and then started a BSN bridge program, and then this whole situation would be a fairly distant memory haha!

We recently had a process/policy change at our hospital. The RD explained that their practice and policy changed (at the national/international level) to cover water used in PEG tubes, etc, because while tap water may be appropriate and safe in one country/location, in other places it is not. Our facility uses bottled water. If your facility can't or doesn't provide bottled water, sterile water may be the next acceptable option. (Maybe it's cheaper to purchase it in bulk that way for the hospital?)

IMO, I agree with waiting on further schooling for now. It sounds like you are interested in working, just trying to figure out how to juggle family activities and childcare with a job. Depending on how long your husband is away with his job, you will be "single-parenting" during that time. 1. Look at childcare options. (Not necessarily putting the kids in school/daycare fulltime, but who will be available consistently to keep them when you are working.) If you have a friend/family/situation available MWF, for example, then that opens up your availability to MWF for a job. Also- working overnights is not an "easy" solution to childcare, etc. You MUST prioritize quality sleep periods during the day to compensate for no sleep at night, for the health and safety of all of you, AND to keep that job! You wouldn't want to jeopardize your license and the lives of your patients because you aren't sleeping and are making dangerous decisions. I had a former coworker try this, and would find her 3yo had been into/done unsafe things while she just "rested her eyes" on the couch. You would need to consider some sort of "childcare" for 6-8 hours during the day, just so YOU can sleep. Looking at it that way, is an overnight position really a solution? 2. If you are adamant about not using outside childcare, then you could consider a work-from-home position. This might be difficult when you don't have experience yet, but there could be a lot of options when you start looking! Also consider that most work-from-home positions do expect and require periods of undivided attention to get your work done; will having the kids at home/balancing their needs really allow you to be successful in your work position? If you have to hire in-home help with childcare, while you are "away" at your job in the other room, is that really meeting your desire to stay home with the kids? 3. I would not invest in further schooling until you have a real direction to head. I've been considering/researching whether to go back to school for my MSN vs BSN, and looking at finances and my "real-life activities (like family life, kids, etc)," it is looking like the most realistic and smart choice is to get my BSN while continuing to work my full-time job (3 12s). I also can take advantage of educational reimbursement through my employer and I have flexibility with time due to only working 3 days a week and kids are in school/daycare (both will be in elementary this fall and I plan to start the BSN program then). Something to consider! Good luck! You are balancing a lot already with husbands new job changing the home-life rhythms; don't forget to give all of you time to adjust and find what works well for you.

I'm not sure it is everywhere (in my experience). Depending on how critical or high acuity patients are on your unit, it definitely makes a difference in your ratios. When we changed to a lower ratio Intermediate floor, it noticeably affected my feelings about my job, and my ability to take really good care of my patients! When I've floated to other units that take 4-5 patients instead of 3-4, not only is it a little harder because I need to adjust my time management, it can also be legitimately harder depending on how sick/high needs my patient team is. I have utmost respect for our MedSurg staff at my hospital; they are 4-5 during the day with 5-6 at night, and these are very busy fresh post-op patients! Lots of discharges/admissions. When I've worked shifts up there, I am exhausted, mentally and physically. My advice would be to talk with your manager about your concerns and how you are feeling. (The more documentation/information they have about the high acuity of the current situation and how your patients would be better served with a change to Intermediate ratios the better!) If there isn't a light at the end of the tunnel, so to speak, like ratio change IS actually happening soon, then consider transferring to a different unit. 3 years experience will really work in your favor, and you might find a more comfortable fit! Good luck!

@MunoRN I think this could get sticky, depending on the context and interpretation. (I'm not referring to current treatment trends of BP in the hospital.) Using my clinical judgement to call on a patient with an "elevated" BP to let the Dr evaluate whether treatment is warranted or not is completely appropriate within my scope of care and policies/standards on my unit/at my hospital, especially if there are no parameters or PRNs ordered. Your statement almost reads like nurses are the ones overtreating the patient, which isn't how it works. If there are ordered parameters and PRNs, they are ordered by a Dr for a reason. If I ask for more clarification regarding WHY we are using those parameters, etc, that would be appropriate, but to put the "blame" on nurses who are calling to update the Dr on the current VS and status of their patient and then administering the medications ordered is inappropriate. Maybe just the way it was worded, but your post didn't sit right with me. If I misread, please help me understand!

Consider a longer orientation as a bonus, instead of a "punishment?" (I HOPE your hospital doesn't present that as punitive!) It's really difficult to switch back and forth in such a short time; it's really strange they are doing it all mixed in this way. We usually do the first 2-3 weeks on days, then switch to all nights for remainder of orientation for new night hires. Maybe approach the UBE with, "I am finding flipping back and forth between days/nights to be a really difficult way to get into a rhythm and utilize all my resources and time effectively because days and nights are definitely different. I'd really like to focus on my nightshift orientation experience while I have the time and support; can we adjust my schedule to consistently be night shifts?" They might really appreciate the feedback, especially for future new hires. Also- having started out on a neuro floor at night as a brand new RN, neuro patients at night are a whole different kettle of fish than days! Hang in there!!

Are you on-call or expected to be available to address these needs on Saturday and Sunday? It's likely a yes/no question. Ask your supervisor or HR for confirmation. If no, then every single call needs to be re-directed to the on-call person assigned to cover weekend needs. Hard stop. ✋ You can answer all the calls and texts to satisfy your own need for knowing everything that is going on, and continue to be taken advantage of, stress yourself out, and lose your downtime. If this is your "guilty pleasure" or preference, then accept it, own it, continue to give up your personal time, and don't engage further on this thread. ?‍♀️ Every time you address a weekend issue, the person who is supposed to be handling that is left out of "their loop," and are unable to handle the issues when they come up. They are either getting frustrated or upset you are doing their job, or they are taking advantage of you. Or, you can send out a unit/department-wide email and post a flyer with specific weekend coverage information. Then, take other's advice, set up a Do Not Disturb on your phone and enjoy your time! Really soak in the downtime and breathe, so that come Monday, you will be refreshed, ready, and motivated for the week! Re: nurses not liking managers for :insert any and all reasons here: Are you the manager or a coworker? The manager position can be a hard role, but you are not a peer. Your job (in either role, actually) is to do your job, not make sure everyone likes you. It's hard to not be a people-pleaser, but in a professional role, you have to handle your assigned responsibilities and others have to handle theirs. If something isn't getting done, it needs to be escalated/handled in the proper manner, not you taking on all the things to do the best job, from your perspective. Consider this, by not holding your staff accountable for their actions or non-actions, you are doing them a disservice and in some ways, actively preventing consequences and results from happening. It seems like you are struggling to separate yourself from other staff members in the "supervisor" role, not a coworker or peer. ** Just read the above post; I hadn't realized this had gone on so long.

I started on that unit as a new grad, and (before we moved into a remodeled tower) the EMU generally was staffed by one more experienced RN and a newer RN, plus a CNA. Once we moved into the new tower, the EMU was one whole floor, and staffed just as any other unit would be, new and experienced RNs, etc; we just had some extra Neuro education hour/class requirements. I'd suggest calling over to HR at one of the hospitals with that unit and asking if you could shadow for half a shift or something like that? Or just ask if you could get in touch with the manager. Sometimes the hardest step is the first step! (I know that sounds hokey, but it's true!)

My first reaction to previous posts was 1. every reply is negative, and 2. I agree with most of it. We were all asked for similar ideas regarding morale and resiliency recently, and while I am more in the Susie Sunshine camp, I know they were asking for little bits like food days and co-worker compliments, when really, CONSISTENTLY staffing the unit fully is one of the best ways to boost morale/show respect for our work I can think of. (There has been major turnover on my unit, with significant change from cardiac/CVRU focus to ICU stepdown with BiPap/AirVo Covid patients. We have 10 rooms that often have those patients in every part of their journey from crashing and moving up to the ICU, transitioning to comfort care and passing on our unit, and long-haulers that are waiting for a spot in a LTACH to open because they can't go anywhere else with the amount of O2 they need. Honestly, it's emotionally and physically exhausting. And angering. But that's a rant against Covid for another post. ) Add together the staff turnover, (which necessitates much of the shift staffed with float and agency staff instead of a more consistent core team), high acuity/high emotional stress of and from our patients, multiple orientees, AND 1st year nursing students twice a week, sometimes 2 to a RN, because they can't take Covid. Sigh. *I'm not against/negative about orienting or students, but as one of the only qualified preceptors for my unit, we are tapped to precept a lot, and students on the floor change the dynamic of the shift a little as well. It all adds up. Some things that help morale in my opinion are smiles and acknowledging each other throughout the day. Everyone pitching in to help. Cleaning up around the nursing station/supply/break rooms. Peep your head in to isolation rooms when you see another staff member in there and ask if they need anything. Say Thank You and Please! Grab the VS/BG on your patients when you have time, instead of waiting for the CNA to do it. Best of Luck!