drmorton2b

I have been a Nurse for 2 Years now been involved in healthcare for 8 years in some capacity now. I am going to attempt to come up with a list of 3 types of nursing practices that some may find humorous. 1. The Laid Back/I Can't Make a Mistake/I don't care Pay me so I can go home type practice: This kind of nurse can be any age and of any experience level. Most are newer grads, however some are older nurses who have just had enough or have always "done it that way". They approach you in 2 ways. One they are very negative and simply don't want to do anything more then they have too. Second they don't care about what management wants (I don't mean this in a Union Collective Bargaining way). Example the Nursing Administration will issue a Memo saying DO NOT DO THIS or DO THIS. Usually its something simple. They ignore it completely. Their Documention is poor, incomplete or non existant. They also are very quick to blame others when a problem arises. Acountability is not a word they learned. Common presenting problems are excessive cell phone and face book use (with younger nurses). With middle aged nurses it usually Magazines and plain old telephone chat which is observed as you walk in the door and they say "We had no time to do anything tonight". The Union is on speed dial for The I don't care nurse. 2. The I want to be the Perfect Nurse type: I have news for you. You will NEVER be a perfect nurse. Well you will be when you retire or if you decide to leave nursing all together because you have gone nuts trying to be perfect. The Perfect nurse documents EVERYTHING (and I mean EVERYTHING... things thats have 0 to do with nursing). Might as well ask the Patient what kind of car they drive and how many MPG it gets and note in the nursing note. The Perfect Nurse all though they mean well also reports EVERYTHING to administration. Acting like they will get a cookie or something. Yes there are things that should be reported to administration we all know that. But we need to not "Call the DON" over every little thing. The Perfect Nurse usually is someone who has never worked in a healthcare setting and in past jobs a huge brown noser and helps management which may or may not be competant push their agenda. Which in reality usually creates more duplicative work in the name of safety due to problems causes by the "Laid Back Nurse" not doing their job. Little does the Perfect Nurse Know they are not perfect at all. They view this as a job (yes Nursing is a Job just like any other job.) You go into Nursing because you can't picture yourself doing anything else. You know your limitations as a nurse and your scope. These nurses tend to go into it for the money alone after multiple failed degrees in Art History and other useless things. 3. The Defensive Nurse: I admit I am one of these types. I Document EVERYTHING not too little not too much. If something happens I write what probably amounts to a well written press release of a nursing note. I make sure my written orders make sense. I just don't scribble crap down so the other nurses can YELLOW it out later because they have to repost the order. I avoid management at all costs unless it involves a patient safety issues that they should be in the loop on. Not petty things. I constantly want to learn and I try to teach what I know to younger/new to the floor nurses. I also shut up and listen when an experience older nurse is teaching me something. Most of the time the older nurse is correct but I don't take what they say as gospel. I work everyday like its my last day on the job. I know I am going to take flak (military term for when Anti-Aircraft guns are trying to shoot down the plane). daily and get dinged occasonally. I cover myself as much as reasonably possible. I try to never leave loose ends. I do what management wants (once again this has NOTHING to do with Collective Bargaining) and If I don't know something I ask. Even if it means going to the Nurse Managers office and asking is this what you mean by that memo and bring up a hypothetical example. The Defensive nurse is always on the alert for any other nurse trying to fly into their airspace and cause problems. Besides Police Work I can't think of no other job where the public doesn't support you and has no idea that not all male nurses are homosexual and not all female nurses sleep with the doctors and unless a Doctor is maybe at a Triage Site or in the field Doctors NEVER routinely draw their own labs, start IVs. You are constantly under the microscope and being Judged by patients, families, other nurses and if that doesn't get to you Judge by Management. The public thinks you make way too much money. At one end of the spectrum you spend time dealing with #1 Nurses issues who worked before you while the Perfect Nurse turned you into Management because you didn't cross you T. Nursing also the only profession where people are constantly trying to take your job either directly through Business Means (dreaded word cut backs), You are also constantly judged. Everyday your are fighting for your job. One error here, or one mistake there and you could be done for. There are not excuses. You are supposed to be everywhere all at once. That being said I provide the best patient care I can in 8 hours. I try to follow the polices and procedures of my facility the best I can. I don't gossip about other nurses or even talk about them unless it involves patient care. After the 8 hours or when my shift is over I go home sit on my couch and watch TV and relax or work out. Then I repeat until a day off or vacation comes.

As a male nurse I always thought I was immune to this. I am starting to feel it and become a gossiper myself. My goal is to stop this habit I am developing. Especially since I am now at a new facility and as always I am constantly reassessing my own nursing practice. I know people aren't perfect.. But when a few nurses are totally missing pages of forms and not signing it ticks me off because Information I need it totally missing. Because my job encompasses updating things (Kardexs, etc.). And I'm not writing a med or treatment without seeing the order. I don't care if you said you called the Doctor.. I need to see it in writing. This problem is starting to go away thankfully. Unless its standard admission or protocol order (example Epipen or Tylenol).. I need the written order... No writing it in the MAR or in your Nurses Note or verbally telling me doesn't count. Because if its not written so the doctor can sign it if something goes wrong every nurse who gave that med or treatment will get blamed for that error. You better believe in a higher power too if you don't have a written order and you do a med or treatment and the patient has a reaction to the treatment. Since you never wrote out the order. The Doctor who is much more likely to get sued and have a long drawn out medical malpractice trial will quickly deny he or she gave such order. I've been on 2 medical malpractice juries. One case took TEN years to go to trial! The Nurse will always be the first kicked out the door if it came down to a Doctor being fired and you being fired. They will always chose you. I no longer can get mad at these nurses anymore and bash their practice openly anymore..this leads to gossip (its so hard not to sometimes..) I have to figure a way to say no comment. I know I can't hire a spokesperson to be with me 24/7. Horizontal Violence exists in Nursing big time. I can see why they have done studies on this. A lot may have to do with the fact that its a bunch of women (sorry but its true go to any Scrub Store and looks in the mens section). and men of various cultures and backgrounds who deal and view with things differently under stressful circumstances that can be literally life or death. Also in some cases Doctors. Doctors sometimes get Doctor Rage when things aren't working out with their patient. I have never seen it happen but read about it and its similar to road rage. Its in some of the Suzanne Gordon books. I have done better at keeping my private affairs private. But I am sick and tired of this... I do my job the best I can for 8 hours and I go home. I don't care if I get a compliment or not. I don't care if you don't like working with me. I saved the same nurses who put me down behind my back quite a few times while they were asleep (I work nights always have and always will). Yellowing out a Med Order that if it was given would have probably ended your career. Or calling the insurance company waiting for hours for them to call back because you either forgot or were to busy fiddling around online and mismanaging your time. If I didn't get that auth we wouldn't have gotten paid losing the company $$$ and NO COMPANY likes when they lose $$ because someone didn't do a simple task to prevent this. I order all of your supplies. Filing your paperwork in the right chart. Find allergies you miss that are life threatening. I make your job easier. On top of this I do the same Nursing Duties you do. I come to work to work. They don't pay me to gossip or sit online all night. Just because I work 11-7 doesn't make me any less of a nurse. This is the solution to the problem I have been having with gossip. I try to ignore it and as long as it doesn't involve danger to my patients or lose of my job or my license I try not to care: -My goal is to provide the safest nursing care I can provide reasonably in 8 hours while protecting my nursing license at all costs. -To NOT gossip I need to stop. It isn't who is screwing who kind of gossip it mostly involves me bashing other nurses poor practices and it needs to stop. But I need to stop unless it involves a pertinent patient care issues (example Nurse A didn't get or do this then fine so I will tell Nurse A when they come back in the AM or try to rectify the problem on my own or with the oncoming 7-3 shift). Other then that I don't care how I was treated by another nurse. I need to learn ways to SHUT IT DOWN and prevent it from happening and snowballing. On a scale of Low-High I rate this a medium threat. I'm going to start going no comment mode and start saying so and so isn't here and it didn't happen on our time. I am just amazed at the lack of oversight and horizontal violence that occurs in Nursing. Its like I don't really care. No one can be trusted... Its like I'm a police officer at times and I have to worry if a suspect is going to try to do me harm (to my reputation). -Remember the 3 rules. 1. Does it affect patient safety? 2. Is my license on the line? 3. Is my job on the line/discliplinary action going to happen? If I answer no to all 3 questions then there is no reason to discuss it. Unless that other nurse did something that will affect patient safety on my time/into next shift I don't care. Lets talk about anything else except other people, politics, religion and sex. -I need to learn that I am no longer in administration/planning position like I was in my past job. I need to do my 8 hours tie up any lose ends before I leave and go home. I wasn't hired to be Miss America (or Mr.) and be everyone's friend. I will treat you with respect but I am tired of these games. I'm no longer sending out the Calvary to defend anyone via gossip except myself. Its always misconstrued and I'm tired of it all. So I need a Patriot Missile way to avoid gossiping a way to detect it coming towards me and redirect it and make it inert. Also go into no comment mode when it involves an issue that doesn't involve me. I don't really care that so and so nurse got eves instead of days. I have often wondered how Military Nurses handle things and I bet there is gossip. But they have a core mission saving lives of service members. Plain and simple. Plus pride people lack pride in their job with the exception of one older nurse no one has pride at my place. I never really cared that certain people don't like working with me. If you don't like working with me then well tough. I really don't care. My goal is to avoid drama and do goal # 1. I know I will always take flak as a Nurse or in any job. That being said there is no other job on earth I'd rather do. If I think of all the little things I have done for my patients just the last week alone that have produced positive results it far outweighs the gossip which I need to avoid. It needs to become a habit like exercising or meditation.

My union sucks because it is not a nursing union. Sure it's better then nothing. They get a a 2% raise then the union raises it's dues by 6.5%... and then non nursing disciplines totally tie up the bargaining. Some union is better then non. I am glad we can't strike... I can't live off of $50 a week.

What can you offer them? I was a speciality hospital pharmacy tech before being a nurse. I work in detox/psych. Which I love the only thing better would be being a Psych NP. But Getting the RN is key one day at a time. I'm an LPN also a nurse,

$125 an hour for a contract Psych NP here in New England. I will be an NP someday, as long as I have a steady nursing job to plan $ wise. I think nursing wages will go down slowly for the average floor nurse. We won't notice the pay cuts because they will come in the form of no raises and heavier workloads. Also I am tired of people confusing me the LPN as a NP, just like people think that because I am male I must be the doctor.

Wrong... nurses are being laid off left and right. However, if you like nursing and it clicks for you go for it! Plus it is very geographic but for the most part nurses are not in demand.. not saying you won't find a job. The OP is young I would go to a BSN program and by 4 years things should open up again. That is if Medicare and Medicaid isn't destroyed. Also remember not all nurses work in the Hospital.

In community health centers, public health service, etc. Congrats. I hope to be in your shoes one day. Check with the VA also

11.1% Medicare cut for SNFs google it. The outcomes are not going to be good. This is a CMS ruling

First of all places have to hire... and interview this topic is a waste of time. With medicare reimbursement cuts 11.1%!!!!!! For SNFs, this sounds like 1994 all over again.. If your in nursing school get your BSN maybe in 4 years more jobs will be available. We are screwed simply put. It's only a matter of time before something effects the agency any nurse works for. I thank god everyday for my FT job. I love nursing... I do not know what else I would do. But one day at a time and Worry about it if it happens. As we say in addiction nursing.

I agree with all the above especially since it's a high priority med. We are not talking Colace here!

It's a union.

Good for you nothing like that first job feeling. Give it a few months and you will have a system in place.

I find it shocking that their is no law requiring a federal balanced budget. I agree cuts have to be made, but why not look at all foreign aid first? I think a deal will be reached softening these proposed cuts. The thing is the past 2 weeks one person says we have a deal the other says I don't know and the other says no! Now is not the time to become a nurse. If I get laid off it probably won't happen for a year or so. Truck Driving or plumbing here I come!

Medicaid reimbursements and Medicare reimbursements look as if they will get even lower! The debt ceiling plan may cause Medicaid to be mostly funded by the states and more cuts to Medicare. I doubt the sky is falling but it's pretty close.....Does anyone know of another time in Nursing history cuts were this bad? Keep in mind the plan needs to be ironed out by the house and senate but either way their will probably be more Medicare and medicaid cuts resulting in more job problems for nurses in the forms of hiring freezes and lay offs. And to think the NNU and Mass Nurses Association supported Obamacare which cut $500 Million from Medicare over the next 10 years. LTC and Homecare will be hit hard. Hospitals that are safety net hospitals or are located to close to other hospitals will probably close. I'm staying where I am at as long as possible and possibly thinking about a back-up career. I recall something similar with Medicare or Medicaid cuts happening in 2004ish with Bush and some LTC s closed mostly ones in low income areas and or had to do major facility updates. The other huge issue is Medicaid it does not pay enough and if the states have to pay more it will spell disaster. On the other hand things never seem as bad but then again people thought Obamacare would never pass.

I like the idea of prioritizing the diabetics first. Maybe if possible mix that in with the patients on Digioxin and HTN meds also.. get their apical/vitals. Also have a list of the residents and room numbers and use that as your report sheet. Some places don't use report sheets if not develop your own. Make a blank one with the room numbers or just something to write the pt name. diabetic Yes/NO, etc. other notes. Prepouring meds is foolish unless you have 1 patient which wouldn't happen in any setting.