boxofrain

Okay, total tangent, but I laughed out loud at this. I hate the term "self-care." It sounds so touchy-feely (and almost a little bit Mediaographic.) Whenever someone asks me what I do for self-care, I'm tempted to say "heroin." Not appropriate for healthcare setting though, especially when I worked the detox unit.

Thanks! I'm focusing efforts on outpatient and research right now, but I'll see where the road takes me. With regard to the stress nurses endure, I'll say this. One of my last conversations with the nurses at my former facility was completely about our anxiety, insomnia and how we manage it. One takes 5HTP and 20 (yes, you read right) 20 mg of melatonin per night. The other one takes something else, can't remember what. Both of these women are young and both have more than two years' experience. Again, this is a rehab facility, not ICU or even acute care. Point being that the problem goes pretty deep into the culture and environment and will likely take time and ingenuity to fix.

I think you hit the nail on the head. This has become such a "hot topic" that anyone who even raises a (very valid) question about safety and efficacy is swiftly labeled a wacky anti-vaxxer, which itself has become a perjorative term. Even before I became a nurse, I didn't post my concerns on social media. Now, there's no way I would do so for fear of being shunned by the nursing community. This is unfortunate. Good science is grounded in skepticism. Skepticism starts with questions.

Thank you for your kind words. Yes, I've found that the nurses I've worked with have not been particularly kind. In fact, they've been pretty nasty at times. They're also very stressed and anxious. I think that's the key to the whole "nurses eating their young" atmosphere. Everyone is feeling overwhelmed with having to do more with less and everyone is concerned with keeping their own jobs. It's not a very healthy environment for anyone.

Somewhat far afield from the original post, but this was on Medscape a few days ago. https://www.medscape.com/viewarticle/918026

The first part of your post describes me exactly. At least in the role of floor nurse. Judging from the string of letters after your name, you've thrived as a nurse, so that gives me hope. Since I originally posted, I've been focusing on outpatient and research jobs. I think I'd really love research as I tend toward the academic and I'm inquisitive by nature. RE: your comment about my writing skills. First, thank you. Second, I would love to write, at least as a side gig, but I feel like I need to get some experience so that I have something to write about.

So, newbie (kinda) nurse here with a quick question...what's the point? If you woke me up every hour of every night, I'd be A&OX0 by the second night. If you wake someone out of REM sleep, you won't get any kind of accurate picture of their mental status. Sounds like CYA to me. At one floor during nursing school, we woke patients up every four hours for vitals...including the ones on tele! Where's the logic there?

Many, many thanks for all of your thoughtful suggestions and insights. In answer to the question about clinical rotations, again, my education was woefully inadequate. Technically, the number of required hours was attained, it's what passed as "clinical" hours that is lacking. I think I stated earlier that I only actually went to the hospital three times during my OB rotation. One of those times we were sent home earlier because there was nothing going on. That rotation was supplemented with sim lab hours. In peds, the entire rotation was more like observation since we weren't allowed to pass meds. This was at one of the top hospitals in my area (also in the entire nation.) I was determined to make the most of it, so I attached myself to the preceptors hip and spent much time chasing her down when she disappeared. I was actually very proactive in all of my placements in this regard. At one point, I asked another preceptor if I could observe a procedure. The instructor happened to be there and she yelled at me, saying, "you don't ask her; you ask me." I just apologized and said it wouldn't happen again, when I knew full well it would happen again. There's no way I would have gotten even the small experience I did without being assertive on the floor. One more thing I will say about clinicals. I know that the school needs some kind of metric on which to grade students, but I feel that way too much time is spent on care plans. The time I spent copying information, since I couldn't print anything out, was precious floor time I could have spent honing my skills. I did voice my concerns when I was still in school, saying that I didn't feel like I knew what I was doing. My instructors told me "oh, those are things you'll learn on the floor." Not sure if I believed them even then. Regardless of what got me here, I have to press forward with what skills and knowledge (and hopefully, at least a little wisdom) I do have. I'm trying to pursue some ambulatory care positions and considering school nursing. Also wondering if the universe is telling me it's time to pursue my NP. Again, many, many thanks for all of your thoughts. Keep them coming if so inclined.

I tried to delegate and was told that I wasn't helping the PCTs enough, so I went back to doing all the patient care myself. I really felt like I could not get a break at this facility. Every move I made was wrong...

I really hope not. Yes, I was focusing on certain tasks that needed to be mastered, while trying to keep the big picture in mind. "Task-y" is almost the worst thing anyone could ever say about me, in my world. And to be perfectly honest, yes, I've always thought myself to be a critical thinker, but this whole experience has left me questioning my abilities in that area. Here's an example. A preceptor admonished me for not taking a patient's bp before passing meds that included beta blockers and Ca+-channel blockers. My reasoning: 1. There were no call or hold orders. 2. BP had been taken a few hours earlier and was w/in baseline for pt. 3. I had never seen any other nurse taking vitals before med pass. In my past experience, a doctor would have thrown a fit if I called w/a bp and there were no orders. This only happened once, and I took bps every time I passed meds after that. Of course, again, kind of a time suck....

This is something else I've learned. My school (and others, from what I've heard) does not prepare students for nursing jobs. It prepares students to pass the NCLEX. That's a piece of advice that I've given people considering nursing school...beware the school that touts their NCLEX pass rate. Maslow's hierarchy of needs and Erickson's stages of development count for zero on the floor. Oh yeah, and that Peplau person...

Yes and yes. I know I have at least moderate anxiety and I'm pretty sure I have ADHD (my son, brother, a niece and a nephew have all been diagnosed too.) I have considered medicating for the ADHD and will at least consult w/someone about it. I'm very leery of anxiety meds. I used xanax about 10 years ago as a "rescue" drug when I was going through extreme stress. It did the job at the time, but it was awful. I felt groggy, slow-moving. The benzo route is a can of worms I really don't want to open. Maybe ADHD meds can help w/anxiety too...or exacerbate. I'm willing to try at this point.

This is such a fine line. I've dealt with situations like this before. A parent of one of my psych patients actually asked me to give her child a placebo and tell him he was getting medication. I did not comply and she understood. Does your facility have a bioethics department? If so, they can get involved in addition to docs and psych. I never worked w/Parkinson's patients, but my understanding is that muscle relaxants (is she on baclofen?) not only relieve discomfort from dystonia, but delay or prevent contractures, which are difficult, if not impossible to treat once they occur. Assuming she's on neurontin for pain? If she doesn't get that, she's probably going to be less mobile, miss or not participate in therapy and thus begins an ugly cycle. I'm sure I'm not telling you anything you don't already know and I really don't like medical professionals who seem to know what's best for everyone. I'm thinking if you ask her what are her reasons for not wanting to take all of the meds, you might be able to come to a compromise, as others have posted above. Finally, you say she's not completely oriented, but is she actively hallucinating or delusional? If so, that adds a whole new wrinkle to the conversation... Hope this helps.

Hmmm...trying to remember almost two years ago now. Role transition was on a general med surg floor with a few tele pts thrown in. Want to say maybe three or four? I don't remember what the regular patient load was for those nurses. Probably four or five. Standard pt load on my most recent floor was six, which I understand is true of most rehab facilities. One nurse who had been there for more than 30 years told me it had changed a lot. Patients are sicker; much more like a med surg floor. RE: Accelerated program. I agree. As I state above, probably fine for people with previous medical experience or even people transferring in after two years of university, but for me, out of college for 20+ years, not a good way to go.

Aw, thanks! Something I needed to hear...

I would welcome an opportunity like a new grad residency and some of my friends have suggested it as well. Although technically not a new grad, I guess it can't hurt to try. Thank you so much for your response.

Just, fyi, I left the psych facility of my own accord to take this most recent job, which I thought was my dream job. And it was, in many ways. This is why the loss of the job is so difficult for me. I think the earlier part of the post may be one component of the problem. Applying knowledge to real life situations. Hence, the comment from the preceptor about not "making connections." So, now I'm trying to figure out how to get there from here.

I did an accelerated BSN program (16 months) with no prior medical experience. That was probably my first mistake. A program like this is fine for the student who previously worked as a PCT or EMT, but not so much for someone like me. Because the program was accelerated, the rotations were only seven weeks, sometimes not even that long. For my community health rotation, I went to a senior housing complex and sat around waiting for residents to wander in. I got really good at manual blood pressures and accuchecks though. Wondering if a nursing refresher course (like one for nurses reentering the field after hiatus) would be helpful or if I just lack some basic quality needed for the bedside.

First, thank you for taking the time to put together this response. I know the questions are meant to elicit personal reflection, but thought I'd throw the answers out there: 1. YES! I had trouble with the med scanner, getting med packages open, coordinating movements when suctioning, etc. These were the things that I practiced at home. Also, time sucks like dropping meds on the floor (and having to go back and replace them) really seemed to sabotage my time management. 2. My assessment skills were actually pretty good. Biggest problem (I know this will come as a shock) was that I did tend to overthink (and thus overcomplicate) some of the cases. 3. This is a good question. As stated above, I did very well establishing rapport w/patients and families. I thought I was doing okay w/peers, but in retrospect, starting to wonder. In all honest, I've never really fit into big groups of women, but I felt I was doing okay here. 4. YES. Probably my biggest problem, therefore, I put together a number of "cheat sheets" and practiced procedures at home. I was making much progress at these things, but apparently not enough. 5. YES. I had every day planned in advance, but the things I mention above reared their ugly heads. Additionally, I'd get sucked into a patient room (say to take them to the bathroom) and end up spending 15-20 minutes there since they couldn't be left alone. With regard to this, it's not like I just went blindly into each day...I had a definite plan, but was seemingly thwarted. I was racked with anxiety every day, in a constant race with the clock to get everything done. I still don't understand how the other nurses did it. I was often told, "that comes with experience." 6. I probably do lack confidence, but I never hesitated. I always asked to do the things I needed work on. For example, I let the PCTs know that I wanted to do all of the lift transfers or all of the straight caths just to get the experience. Having lost two jobs before the end of orientation has been very demoralizing. I know it must be something I'm doing wrong. Admittedly, the school I went to was sadly lacking in skills education. It was an accelerated BSN program that was only 16 months start to finish. Many of clinical experiences were either abbreviated or barely qualified as clinical (ie had to supplement short Peds rotation w/observation at a day care center.) So I guess my question is, do I try for another bedside position (which would probably be pretty difficult to obtain) and continue to hone my skills (which had come a long way; I'd hate to lose all the ground I gained...) or look elsewhere, like research? Research appeals to me, but most of the jobs I've seen require bedside experience. Also considering ambulatory or school nursing. On the upside, all of these have great hours. On the flip side, I really loved direct care. Thanks for listening.

Actually, that was another piece of positive feedback that I received. I was told that I was very good at developing relationships with patients and family. And, yes, probably most people would describe me as "book smart."

Long, sad story. I graduated from BSN program as a second-career nurse in December, 2017. Passed NCLEX in 75 questions in Feb. of 2018; secured first job in ICU at a Level I trauma unit in a residency program summer 2018. Was asked to leave program after 2.5 months on that job, with management saying that ICU is too difficult for a new grad nurse. Took psych job at small, poorly run standalone facility and worked 50+ hours/week, was assaulted, had 20+ patients at times. Was offered and accepted dream job at a highly reputable rehab hospital in the specialty I've always wanted. Did not make it through orientation here either. Manager and one of the preceptors stated that maybe I'm just not cut out for floor nursing. I came into this job with almost no bedside experience. I arrived for 6:30 a.m. shift at 6:00 a.m. every day. I lived, ate and breathed this job, spending all non-working time reading about disease pathophysiology, watching YouTube videos on suctioning and IVs (just to name two, there are many skills with which I had no experience) designing shift report form and tightening up med pass procedure. For many of these, I actually acted out the processes just to get some muscle memory. All to no avail. One preceptor remarked that I was "passionate" and "the most hard-working person I ever met," but, something just wasn't "clicking" and I wasn't "making connections." She also said that she loved my inquisitive nature, hinting maybe I should try research. Here's my question. Are there really some people who just can't do bedside nursing? I don't want to appear as bitter arrogant, but, come on, this isn't rocket science. This most recent dismissal happened a week ago and I'm working hard to gain some perspective and insight. I would definitely look to other areas of nursing, but it seems most want at least 1-3 years bedside experience. Where do I go if I can't manage that? Any guidance would be much appreciated.