heathIam

Thanks for your responses. We have already implemented actions along the lines of what has been suggested. The emerging concern is the apparent inability to transfer learning from one situation to another. As a previous RR nurse I would expect an understanding of the importance of having certain medications easily available for urgent intubations, yet this learning from previous work and from recent similar events within the picu does not seem to be translated. It is almost as if each day's learning must be analyzed with the nurse and key points identified. As part of our education/orientation quality improvement I have asked for there to be an exit interview as well as several along the way check-in interviews with new staff. There is never just one way to prepare staff and we need to be continually learning from our staff to make it a better work environment, but I am also concerned about being too willing to accomodate. Co-workers must feel safe and able to depend on new staff at a certain level of competence.

I am astounded at this AND that it was allowed to continue over years! Where the hell was this resident's supervisor? Succinycholine isn't even pain medication, it's paralysis! Why was this not brought forward the very first time she uttered this? This isn't mechanically responding this is complete and total incompetence and dangerous disregard by the rest of the hospital staff who allowed this to continue! A dangerous order needs to be not only not followed but also followed up on to ensure it doesn't occurr again

Looking for some suggestions and ideas of what is a reasonable expectation here...in the past the picu I work in had a fairly unforgiving attitude that if you didn't get it within a short period of time you were out. Now, we have made attempts to recognize that everyone adapts in different time frames and in different ways, but we are wondering how long is reasonable to give someone to develop the competence to care for a basic intubated picu patient. Our query is around a nurse who has been working in our unit for about a year. She is not a new grad but has worked for many years prior to this in a recovery room and newborn nursery. How do we determine whether she really gets it or whether she needs something else?

No, not too old, but I would be concerned about your willingness to be swayed by the opinions of others so easily. You also need to realize there are hundreds of different kinds of nursing, so just because you don't like cleaning up vomit doesn't mean nursing is not for you (just for the record, No one likes cleaning up vomit - but that doesn't make any of the rest of us bad nurses) Nursing is one of the few careers you can train for and do a complete change of fields several times in a career without massive retraining. But seriously, I would worry about how suggestible you might be - you need to develop an inner strength and willingness to persevere to get through nursing school and continue as a nurse

There's an old adage in nursing - you can't fix stupid. Facebook, twitter and all the other social networking sites prove the adage true. People are willfully stupid about what they post online and who they share information with. Just because someone you work with wants to friend you does not mean you have to accept. Privacy seems to be a poorly understood concept in our current culture. It's ok to *nudge, nudge, wink wink* about what happens in Vegas stays in Vegas, but how about developing a personal practice policy of what happens at work stays at work? I post as little real personal information online as I can get away with and I have no contacts from work on my social networks - it's only for family and is set with the highest leel of security filters the site allows. I don't post anything about a patient or family - and here's the thing this nurse didn't understand - you don't have to give specifics to violate confidentiality, all you have to do is indicate you care (or didn'\t) for the person as a patient. Really nurses, learn to zip it!

Cultural sensitivity gone amuck. I find it hard to understand how a manager would even suggest such a thing to the staff. I like the idea of asking for a behavioural policy for this. Dare them to make it policy. In my country (Canada) when we run up against this type of cultural difficulty it is the job of the chief of medicine to explain to the physician that this is an unacceptable behaviour in this country.

Absolutely no right to know this extermely private information. Our culture has gone way too far in thinking exveryone's private life is within thier shere of 'right to know'. Just because we can know what Lindsey Lohan's favourite sexual perversion is and what she cried out in her sleep in jail does not mean we actually have a right to that knowledge. s nurses we stradle the line even closer. We often know intimate details of our patient's lives as part of our work. As a result of this intimacy there can be a sharing of our personal selves with co-workers that is inappropriate. Just because you admire and respect someone at work and get along well with them as a co-worker does not make you a close personal friend and privy to private information that can be gossiped about a break time. Besides, if she wants you to know, she will tell you. When I started my most recent job the unit manager quit, was fired or let go (I don't know the story) shortly after I was hired. Only she told all her friends on the unit she was terminated for no reason. She told her friends on the unit that it was all the new director's fault and whipped them into a fury of indignation. The physicians got involved, staff were in an uproar about this beloved individual who was terminated unjustly. Meetings were held, people were crying and yelling and acting very unprofessionally. Comments came out during patient care...truly it was awful. The Director finally quit as she din't have the support of the medical director any longer and I was frequently targeted by the old guard of the nurses as part of the problem (I was hired to provide guidance and direction on patient safety and quality care initiatives). It has taken two years to recover from the damage she created by sharing why she was terminated/fired/quit. And of course, management could never even respond to her accusations or the questions of her outraged co-workers. If she and her friends had just kept their mouths shut it would have blown over and done less damage.

Oh yes please, close it down so that words that might disturb the so called positive encouragement won't have to be viewed. Or thought about, or considered. Very sad and disturbing that raising questions is seen as negative and discouraging. When did questioning become negative? When did identifying problems become discouraging?

Thanks to kty1, at the very least I know that there are others out there who see the problems and are concerned enough to speak up.

See, all those who posted at what a mean, negative person I was to attack those poor, dedicated people who keep writing their exams are perhaps a good part of what is wrong with nursing. I didn't attack the first poster, nor did I suggest anything about any other responder's personality or intelligence. Yet, because I suggest that this symptom of multiple attempts to pass an exam is an indication of a problem within our profession, MY intelligence and my nursing compassion is ridiculed and slammed. The problem is not those of us who question, it it those of you who blindly, fanatically keep insisting 'we're ok, we're ok, we're good people because we want to nurse' This symptom, and judging by the number of responsers who also had to write multiple times, is a more and more common one. If you start seeing a symptom repeated over and over in a population do you just ignore it and tell people to keep trying and they will get better, or do you look at the environment, situation, population and potential causes of the symptom and the illness it is spawning? There is something seriously wrong with a profession that takes 3-6 years of your life, and money and then does not prepare you to pass the licencing exam. If you have to study and teach yourself everything you need to know to pass the exam, what was the schooling doing for you? Teaching you to not queston?

My kind of judgement? Wow! talk about judgement. You know nothing about me other than that I have posted I fear for the profession, the patients and the staff due to the dumbing down of nursing. Let me tell you of how far I have come in nursing. I started in 1974. Perhaps you were even alive then? I worked 15 years as an LPN. I worked my way through university to get a BScN and support my children as a single parent. I spent 25 years in PICU where the most devestating tragedy is a daily occurrance. I went to school and worked full time, at the same time to get a MSN and I spend my work hours now focusing on patient safety, quality of care and reducing the risks to patients from health care providers who can't integrate all that is needed to be a safe practioner. Yes, taking 10 tries to get your credentials IS an indication of a problem. We need to understand and accept our profession is in deppe deep trouble instead of sweeping it under the rug and pretending that it is OK to be unable to pass the exam certifying your competence to practice nursing. This is not professional, or acceptable. I have spent 36 years in this profession and I have seen it slide into a mediocracy that is sad and frightening.

Ok, first off I want to say here that I am in no way casting aspersions on teh author of this thread, but I just need to ask...Is anyone else but me concerned that nurses are practicing who had difficulty passing the licencing exam? I'm not at all comfortable with the idea that the nurse who brings me my medication may have had to write 6 times in order to finally pass. Or even 3 times. This means the education they are getting is not preparing them to understand the practice...which we all know from expereince, but this inability to pass the credential portion of the training is very worrisome. I fear for our profession. I fear for our patients. I fear for ourselves.

First born female but second born in the family. My older brother is a doctor (does that count?) but my father never drank. So that blows that theory. Just to add to the statistics, my mother, also a nurse was the second born daughter of a father that did drink, but I don't think was an alcoholic and my first born child, a daught of twin girls is a nurse and her father never drank either...

Oh yeah, that reminds me of the liver transfusion method favoured in PICU - another sign things are going badly with your patient

When your HR, SBP, PAP, sats, RR and innotrop infusion rates all equal 50 (actually, this is the celestial traige sign; they have already GONE bad!) When you hear the words ECMO and TRANSPORT in the same sentence from the doc arranging the transport When the number of IV pumps attached to the patient is greater than the patient's age X number of staff standing at the bedside When the number of white coats standing around your bedside equals the number of IV pumps coefficient in above calculation When a senior nurse drops by your bedside to ask you "everything OK? Do you need help with anything?" more than once in the previous 2 hours, then next time by brings the crash cart and says, "I'm just going to bring this here, just in case" When the blood is dripping through the bed and creating a puddle while you have been pushing blood continuously for the past 12 hours as the CV surgeon INSISTS that cannulas to the IVAD are intact. They weren't. This little guy survived! When the same CV surgeon pulls your ETT because the patient's sats have dropped - and she can't intubate.