PintheD

I don't have any advice for you. Just want to say I am sorry that this has been your experience. Keep your head up! Any wise COB's have any advice for our fellow nurse?

Study Healthcare Policy. A nursing degree would not be the most advantageous for your goals.

CNA as your only clinical experience to an advanced nursing degree? Reputable program? Who is going to hire you? I am afraid for your patients. Im afraid to get old.

I walked away from the bedside in 2011 after coming to the realization that this insufferable Patient Satisfaction nonsense wasn't going away. After fourteen years as an ICU nurse from New York to San Francisco I had learned a thing or two. All that experience now benefits no one, neither the critically ill patient or the less experienced nurses. Think of how many, like me, who walked away from the dysfunction. What a tragedy. So, OP, while I agree that maximizing reimbursement and playing to the patient satisfaction scores are the rules of the game, we don't have to play by those rules. Some of us have chosen to walk away. There is life after bedside nursing!

Not surprised at all, OP, to read that you are a Nursing Director. I knew that before I finished your post. How? Your voice is so out of touch with a nurses reality. The disconnect hurts my head.

I am a second degree/second career nurse. Next year it will be 20 years since I graduated from nursing school, seventeen of which were spent at the bedside. I wish I could get those years back. Nursing crushed me emotionally and has practically destroyed my self esteem. I always worked in very high acuity, challenging environments because I did thrive on the intensity, for a while. Some years ago I had a patient found dead on the floor next to his bed when his alarms registered asystole. I have worked very few shifts since that day as I suffer from PTSD related to that patient's death. Even after all this time I remain emotional, feel responsible and feel as though a part of me has died. All of this never would have happened if I had been, say, working in a department store at the mall. I have friends that are also second degree/second career nurses and have enjoyed very fulfilling careers. I am not the rule. My intention here is to give you food for thought. The potential for unfortunate consequences for a bedside nurse are very much reality. A day in the life of a nurse can impact that nurses life tremendously and for a very long time. Good luck to you.

I have seen the same. Enough of being treated like a naughty child while shouldering the huge responsibility of fellow human beings' welfare. How did this happen? The current acceptable treatment of nurses in the US is healthcare's dirty little secret. Overburdened nurses who are denied autonomy equate to patients' overexposure to harm. Nurses and their patients have become pawns in the business of healthcare. I respect myself and my abilities too much to be a part of this sickness. Off to graduate school in a non nursing major.

A lot of patients suffer from "comprehension" issues. Could be the stress of illness or could be a general inability to process information. The trouble (clearly stated in my post) stemmed from me sharing with a patient what the MD should have explained. Hence, the physician is the one who "skim(med) by on the job". This patient was not receptive to any explanation, and was quite hostile toward me in his demeanor. As nurses we are faced with, on a daily basis, the intellectually challenged, those who are just plain angry, and those with no self control. Often it is all of the above. Good luck to you in your pursuit of a nursing career.

Congratulations!!

No interest. I'm done, totally defeated. It's been a long time coming, now I am a nursing cautionary tale. I'm going to concentrate my energy on finding a job outside of the hospital and ideally out of nursing altogether. Sorry everyone for spewing negativity. I appreciate all the comments and interesting discussion.

Why do you teach them this? In the real world I have never seen this done and we were taught the same nonsense in nursing school. I'm not going to waste time fiddling around with a poop filled washcloth - it's disgusting, unnecessary, and a colossal time waster. I, too, like those hot pack peri wipes.

Oh, Altra, I read the first sentence of your reply and started feeling all warm and fuzzy. Then I read the paragragh that followed... Why are you offended by my mindset in approaching my job? Are you a bedside nurse? Specifically do you work med/surg, tele currently? The reason I ask is the job is all about tasks. In fact, the EMR generates a "TASK LIST" for each patient strictly for nursing use. By the time one completes all those tasks, passes meds and puts out a few fires guess what? It's time to go home. My background is ICU where the nurse must have a clear clinical picture of his/her patients in order to do their job safely and effectively. Not so in this environment. Time does not allow and no one expects the nurse to think critically. The expectation begins and ends with completion of tasks - expectation of management, MD's, and based on my experience yesterday, I'm lumping patient's in there too. I have not arrived at this mindset out of apathy. It's survival. Does that make sense? Anyway, apology accepted. I, too, am sorry for my rude reply.

"It just makes me cringe to hear someone say that they will stop communicating and reduce him/herself to a task monkey." - ALTRA AllNurses GUIDE Monkey? Who said anything about being a monkey? Oh, you did. The cheerleader for communication is a name caller! Perfect. You might want to subscribe to my limited communication approach because you suck at communicating.

Be the bigger person, move your stuff. We're blue collar shift workers. Some of us have awful manners.

Pinkfluffybunny i agree. This is why I'm going forward as the nurse who smiles and nods, as if I can't read or understand English. Limited communication is my new motto. Here is my new work model: safety, complete charting, figure it out/that's not my job/I'll call someone who can help you mentality all while saying as little as possible RN.

Don't know. Patient didn't want to communicate with me (nor I with him) regarding dx, however subsequent unrelated interaction with said patient was pleasant. Actually my impression was he was a bit sheepish.

Actually, I'm going forward with this mindset, with the exception of patient care. Here is my new dictate: Keep your emotional energy for those in your personal life, give your patients your utmost clinical judgement. When time does not permit, cover your ass. In addition to this I will add; I am a bright, educated human being. I will not be abused by people or systems. Nursing is not rocket science. I am over qualified for this job.

Guttercat - I think there is a lot of power in playing dumb. Think about it. You still do your job to the best of your abilities and move on. Unless management wants to blame you for the rain or a snow storm, no harm - no fowl. Thats what I'm looking for. 350 pound diabetic looking for pie? OK. Don't care because if I try and "teach you" you will be offended and I will be screwed. I'm ok with that. Again, task oriented. If I can complete my tasks as dictated by my computer oriented list then I have successfully completed my shift. It's the dumbing down of nursing. I'm good with that but don't make me accountable when the crap hits the fan because it's convenient and you can.

Yes, Beckster, I agree. However in this specific clinical environment there is no face to face report. I'm dependent on the written word. Now in a perfect world I would have read all the ecare (CERNER) notes and would have a clear picture. Not so here. I learned years ago A&Ox3 people want to see and speak to a nurse at change of shift. I try to get a few minutes of face time right away to negate those feelings. In hindsight, I agree if the admitting dx does not affect plan of care to skip it. Yes, lesson learned. As an ICU nurse that was a given. My current job doesn't permit such initial perspective. It didn't help, in an environment that is already time constricted, that I was called late cover this shift. Dixieredhead - Took a long time. The less one expects of themselves in a dysfunctional environment the more one can achieve the tasks at hand. Sorry state of affairs but being task oriented is the only way to survive. Yes, I said it nursing purists, in a med/surg, tele environment the task is king (or queen), not the patient. Let's accept that this is a job and not a calling. That was predicated by religious that historically nursed. Let's all move on. The healthcare systems we work for have and are banking on the fact that we've not figured it out.

I posted on this thread earlier and it was negative. Went back to work today as a prn nurse in a hospital after 3 months and it was awful!!! An attending "ordered" me to change a patients admitting diagnosis. Totally out of the scope of nursing, but he was steadfast. Now, of course, I didn't and couldn't, but my point is where will this end? You want to be a nurse? Fine, just know you will be healthcare's b*tch until you can figure a way out. Yes, the sky's the limit for options but initially you have to suck it up hard. And I have been a nurse for 15 years. My advice - get away from the bedside ASAP. Let the flames fly!! Don't care. If I can save one person from this soul sucking life, I have done my job. Get in then GET OUT! Good luck and always be looking forward.

Different day, different crap. Today I was screamed at by a patient for mentioning one of his admitting dx; syncope, GI bleed, acute renal failure. No one had mentioned the ARF, he assumed I had the wrong patient info. I didn't. Proceeded to explain that ARF is a common result of dehydration, a byproduct of his GI bleed. Said I would review chart for plan of care and clarify ARF dx. Patient (hysterically) not receptive to communication so I offered to contact MD to clarify. Exit. Paged admitting doc x2 in a half hour - no call back in an hour. Got house MD who graciously came to talk with patient. He claimed patient requested nurses to come in and say "hi" and leave the "medicine speak" to the MD... Prior to the house MD being involved I paged the nursing sup to talk with upset patient, as I couldn't get an MD to call back (I've learned the hard way crap can be kicked up too). After doing so, her sage advice: page the doctor.... This is where it's gets good. Attending shows up late morning and wants to know why the patient, and 5 of his family members at the bedside, are under the impression that the patient has a diagnosis of ARF. Explain exchange with patient, show MD ER note enumerating ARF as part of DX and recite supporting lab values. (BTW he did return the page, as confirmed with his iphone, one hour later. No clerk to answer his call. I was blamed for that too.) His response: "YOU need to fix THIS"!!! REALLY? (THIS being the component of DX on record reflecting ARF.) When will it end? Now the nurse is responsible for the diagnosis too (FWIW admitting lab values did support ARF)? No, No, No! Never been one to doctor bash as I have the utmost respect for anyone who puts themselves through that process, regardless of the motivation. Now I'm changing my tune. NO - can't change a diagnosis. NO- won't support the fact that you, MD, didn't explain adequately to your A&Ox3 patient what was happening to him physiologically. NO - don't subscribe to the harassment mentality predicated on nurses today. Learned my lesson. Keep a smile on my face, speak when spoken to, it's a task oriented job, play dumb. Got it. Take heed new nurses.

It's a learning curve, workingharder. I believe you're a second degree nurse? I assume you left a job where you had a achieved a level of proficiency. Now you're starting over. Give yourself a break. First off, change your thinking. You know you're intelligent, you don't "suck". Remind yourself frequently while at work that you are a bright, capable professional. You must believe in yourself! It's ok if you're not perfect as long as you're trying. Make a list of the things that cause you angst, then tackle them. One day you'll round the corner and know what it feels like to be more confident in your abilities. If you really feel your job is in jeopardy show your NM your list. I'm sure he/she will respect your proactive approach. You may find, even after feeling more confident, that the type of nursing you're doing presently isn't for you. That, too, is ok. "Graduate" and move on. That's what a career is all about. Right now you are priming yourself for that next great thing. Nursing is very task oriented, it's not rocket science. You can do this!

It's all a bunch of nonsense. What is the worst case scenario for the staff RN if patient satisfaction scores aren't top notch? We will be denied a raise, likely 2%. That's much less than $1000.00 annual after tax dollars. Not the end of the world and not worth the added stress in my book. Here's some perspective: If patient satisfaction results in a 2% raise than I say make patient satisfaction nonsense 2% of my time and effort on the job. That's 14.4 minutes in a 12 hour shift. Very doable. These scores are just another manipulation tactic, manipulation of staff and the customer's (read patient) perception of care. Who says manipulation has to be one sided? I say learn all the proper buzz words and repeat them in front of those that care. Then go about your work prioritizing in the way you feel is appropriate for quality nursing care. And keep your hidden agenda hidden! I'm not saying that patients shouldn't feel they had a satisfactory hospital experience. I just feel it's ridiculous for nursing to shoulder the responsibility. If there are issues with food service fix them! If hospitals want to extend the "hotel experience" to patients hire a concierge for each unit, all shifts! For minimum wage NM's could have an extra body on the floor and free up valuable nursing and nursing assistant time to do nursing. It's a relatively small investment that will pay huge dividends in increased customer satisfaction and employee morale. OK, I know this will never happen. In the meantime let's keep things in perspective. Administration is counting on us to make them look good. I, personally, don't care to add a huge bonus to their already huge paychecks. Well, maybe I care a little, just enough to keep my job. That equates to 14.4 minutes every 12 hour shift, the perception of a "can-do" attitude and smiles, smiles, smiles!

Marie, please know what you are experiencing is an awful introduction to nursing. Reminds me of the joke: What do you call a medical student who graduates top of his class? Doctor. What do you call a medical student who graduates at the bottom of his class? Doctor. Same applies to nursing. Some "bad" nurses find facilities where they can hide out and still collect a pay check. Generally this attitude is top down. Get out of there. You deserve better. In the meantime tell the powers-that-be that you need orientation on the paperwork aspect of your job. Do it repeatedly until you get what you need! This will make your life easier. Document patient findings as appropriate to cover yourself and look for another job. You can't fix this. If your supervisor is sloppy then just assume it's a top down mentality. Having said that, I am sure there are valuable clinical learning experiences to be had where you are currently. Soak those up, don't compromise yourself as a professional and reach out to more experienced nurses (here or face-to-face) for support and feedback. This is a temporary blip in your career and bigger, better things are waiting for you. Good luck and keep us posted.

CapeCodMermaid I'm assuming you're a Nurse Manager based on the above. I can't understand your position here. You want your staff nurses to hold each other accountable for attendance? That's rich! I would love to see the cat fights that would ensue when nursing peers start playing "attendance police" with one another. Attendance is a management issue. An employee abusing an attendance policy needs to be managed. No, it's not your fault, it's your job! And don't even get me started on your derogatory comment regarding agency nurses.