CathyRN06

Thanks all for responding and I appreciate your comments. Unfortunately, I've had a relapse and will have to start all over again. Guess I'll never learn to accept my limitations! Thanks again!

A wait of 15 to 30 minutes isn't a long time, it's not unheard of and most will do it if you ask - once you have a working relationship with the other units. Granted, it takes time to get that kind of relationship but it can be done. Furthermore, that kind of relationship is necessary and worth working toward IMHO. It also goes both ways. I was ER and ICU so I'm not advocating for med-surg specifically but advocating for safe patient care - which I had a reputation for. I don't mean to be argumentative but I would read that policy again - and also your floor policies. Many times we are so busy the actual policies that regulate our behavior are the last thing we are able to become familiar with. Policies have a way of being transmitted through conversations and not verified by the very people they effect. It wouldn't be such a big deal if in fact the supervisor was there to help, staffing was adequate and the nursing mix was right but accommodations have to be made for the increased acuity and staffing problems. I'm not saying it's going to be easy or readily accepted, especially by the other units at first. It's an option for optimal patient care. What's the alternative? This is becoming quite the discussion, isn't it?

LOL.......just had to chuckle!

If they do send the patient anyway, then you write an incident report if the relationships have deteriorated that far. Usually there is a space on the incident report for explanation and you can explain your rationale, putting the patients needs over yours in your explanation. Words fail me here but I think you get the jist. Eventually the "norm" will change but you may have to be the one to initiate it, and also the one that takes the crap for it in the beginning. Just be professional, listen patiently to their tantrum and tell them you don't like it either but that's the way it has to be on your end. Tactfully and patiently is the key here. Expect it because it's going to happen but know that you'll be giving the best care that you can and remember it's your responsibility to act as patient advocate. Also, I was thinking - regarding the 20mg of morphine given. PACU rarely keeps them over an hour and if that patient were going to ICU or step down, that dose would be acceptable but to send a patient to a med-surg floor after given that much in such a short time is not kosher. Just because it's on the protocol list does not mean it should be given taking into consideration where the pt. would be transfered to. Of course respiratory depression would happen. I'm not saying the patient didn't need it, just that the transfer should have been to another unit for monitoring even for a few hours. There are different acuity levels in hospitals - one ICU or step-down isn't like another. Some ICU's in rural or community hospitals would be equal to a step-down(or even med-surg) in a trauma 1 center. Yet we become accostomed to a 1:2 or 1:3 ratio when in fact, it isn't necessary. Therefore, the nurses resist. I've been there also so can understand. Mind you, it might take 6 months to 12 but the sooner you change things, the sooner you won't feel this way at the end of the shift. One last thought - I'm not advocating refusing patients just because you are busy or.....just because. You're still running your butt off but you're following the protocol for new surgical patients. You could also start keeping track of the time it takes you to do each of these tasks for these patients and then ask management where the extra man hours are coming from....again, hard to put into words but hope you understand what I'm trying to say. All of this is based on safe patient care - remember that. It's not how the nurses are feeling so stressed (which you definitely would be) or that you're running your butt off (and you are) because in their eyes, that's what you're suppose to be doing. All explanations have to relate to safe patient care. Kapish? Don't feel bad though about that shift. Sounds like you handled it fantastically. Sometimes we don't know the alternatives open to us and this is one good reason this board is so important. Just one more thought - do you ever get direct admits? That is one admit you can't "schedule" for lack of a better word at the moment. ER nurses (who I was) always keep the unknown in mind - what would happen if you had one (a direct admit) at the same time? Happens and there is nothing you can do about it at the time because they're coming regardless. Would have been even more of a disaster and another reason to be assertive and an advocate. Good luck to you

thanks nursecat64! that was my first thought too and to be honest, I don't want anyone to know. I found I either received sympathy or apathy as a response and I want neither. I feel a little dishonest but I read an article once the mentioned that everything is on a need to know basis and if they don't need to know then you don't have to tell. I've become better through the years being "honest but evasive" but sometimes it's still difficult. It doesn't come naturally. Thanks, you gave me validation - shouldn't need it but I did.

I'll tell you what I would do. You work with the nurse who has the transfer and inform her of WHEN you can take the patient. You're right, you are responsible and if you can't give safe patient care then you can't accept that patient at that time. You are allowed to schedule and prioritize care so that the essential assessments get done in a timely manner for these patients. Sorry that your supervisor didn't answer your page - have you talked to your manager about it? The more you tolerate it, the worse it becomes. By the way, you can do this in a spirit of cooperation, "what's best for the patient" kind of attitude. Tact goes a long way especially if this is not the norm in your hospital. Think of it this way: if you had refused the patient at that time, your supervisor might have made an appearance to your unit! :) I'm assuming here that it isn't the norm in your hospital and I ran into that once. When we first started "scheduling" our transfers and admissions, there was a bit of an attitude from other units. Eventually they respected us and it did become the norm in the hospital. It's part of professionalism and perhaps you'll have to be the one to start it in your hospital.

What a hard question to answer, at least without qualifiers. Given the circumstances I was in at the time I went to school, I would definitely do it again. I had always wanted to be an ER nurse but was married right out of high school and it wasn't in the cards at that time. While my children were growing up, I tried numerous times to go back to school but I found that working and taking care of small children in addition to education was just too difficult. I finally graduated from one of the last diploma programs just before I turned 40. I had reached that goal! Unfortunately, my husband died a week after I had my first job. I'm sure my opinion of nursing was biased because of that. Sometimes I still grieve. I worked for many years doing ER, ICU, critical care float then traveled for three years. I had my CEN, ACLS, Trauma and PALS certifications and was proud of my accomplishments but I made career mistakes along the way that affected my happiness in retrospect. In 2006 I was burned out, dissatisfied and miserable or so I thought! I went from working in a busy ER to being flat on my back within a month. I spent a year in bed, another in a wheelchair and am now, almost six years later, readying myself to go back to work. As burned out as I was, it was such a part of my self-esteem that the depression was unbelievable. I didn't consider going back to nursing for quite some time. Physically I am doing better now and am preparing to go back but not into critical care. If I had to do it all over again? I would probably go into physical therapy if I were young and without children, but I had a family to take care of and nursing was the way for me to do that - and as I said before, I had always wanted to be a nurse. The mistakes I made? Like others on this board, I job hopped. I always thought it was better at another facility but it wasn't. Sometimes it was worse. My attitude became bad quickly after graduating. I wasn't prepared for the reality of nursing and I'm not sure how a school could prepare you! I think something is wrong with nursing education but I certainly have no answers. Another mistake I made was not taking care of myself well enough. Even given all the above, I am eager to get back into nursing at this stage in my life. I feel excited at the possibility and am looking forward to it. Do I have mixed feelings about the profession of nursing? You betcha.

Good luck to you! I'm pullin' for ya!

I was severely ill and am happy to report that I am now doing better and am preparing to go back to work. Question: When I interview, I can anticipate the managers will have concerns because of the gap in employment. I look "fine" and do not appear disabled. I really don't want to go into much detail during the interview, how can I minimize this? Can I? They will want to know why I was out for so long. Is there a diplocatic way to answer questions that is truthful, without giving too much detail? Do you have any tips for me regarding the interview?

I've used Medscape for my CEU's for years, a very good site - thanks. I just want something that will increase my confidence and make me feel competent. Right now there are holes in my memory but I'm good at independent study. Thanks so much everyone for all your ideas. It's been very helpful and I'll let you know how the big job hunt goes! Again, much gratitude!

:) no, I meant dry....as in technical, facts and figures, rationale's, meds. Maybe I should have clarified that statement. I don't want to take the time for fluff!

dry's what I'm looking for..........glad you mentioned it!

Had to abbreviate that a bit to make it fit! I'm going to be returning to the workforce after an illness that has lasted over five years. I previously had never applied for a job that I hadn't received an offer for but unfortunately, I don't expect the same regard given my circumstances. I don't plan on telling anyone unless I have to that I have been ill and I don't anticipate problems in doing the job. I'm only going to accept and apply for positions that I'm sure will cause me no problems. I'm going to prepare for re-entering by independent study to assure competence and it will also give me confidence. This is the question I have for you: What are your biggest concerns about someone returning to work after being out for that long? I'm 58 but look younger but not as young as someone 40. I understand that discrimination is against the law but I also know that age has an impact on hiring. Not so naive to think otherwise. How can I downplay that fact and what would make you feel most comfortable considering my circumstances - both the lack of recent work experience and age? Thanks in advance for your responses.

I know this thread was started quite a while ago but I wanted to lend some encouragement to those of you who have failed the test repeatedly. First of all, if you can complete nursing school, you can pass the NCLEX. Remember how many people didn't make it through? The instructors have a way of weeding out the ones that will not make it but you did. Remember what it took to do all that studying? The sacrifices you made? The determination to do this alone should give you encouragement and motivation. You made it! Remember that. Two, considering you did make it through, there must be another reason you aren't passing the test. Consider all the reasons this might be happening. Are you having an exhorbitant amount of test anxiety? Remember that we all had some form of anxiety but for certain people it can inhibit memory and critical thinking skills. There is help for test anxiety. The questions on the NCLEX are worded in such a way as to be confusing and you'll have to use critical thinking to choose the right one out of the final two. Ask yourself what would happen if you did each, and which one would take care of the problem they are addressing in the question. Analyze it if you really are having a problem choosing otherwise go with your first instinct if you have prepared well. That's the key though. When I graduated in 1993, I had to wait two months to take the NCLEX. I spent those two months reviewing and preparing for it. When I tell you that, I'm talking about studying as much as I had when I was in school. Hours per day - not simply one or two. I made a list of what I thought I was deficient in and although I reviewed everything, I paid special attention to my personal needs. Lastly, and this is meant in the best way, there may be nurses or family that discourage you from taking it again. Don't let that happen. You may experience attitudes about the number of times you have had to take it but again, don't let anything discourage you from doing what you have to do. I admire your determination. I once worked with a nurse who had to take the NCLEX repeatedly to pass. Know what? We didn't know and she was a very good nurse. I think the fact that she did have a hard time may have even helped her in the end. She was very systematical and organized which in retrospect, I think she may have partially learned because she did have to take it so many times. So, just do what you have to do. If you work, spend your entire evening hours studying. Get someone to help with the kids. Buy as many books as you have to, borrow the money if you have to. Take as many courses as needed. Just don't give up. If you need extra time, study for a few months, schedule the exam and then continue to study. Just do it...........and get er done! :)

Thanks again all! I found this wonderful flash card site. Has almost anything you would want to look up: lMedical Flashcards Great for a review.