outcomesfirst

Thirty years later, same sad story - but not every place is like this. You can do something about this. First - nurture yourself. When you are off work - be off. Go to the gym, read novels, fish, hike, swim, watch TV. Eat healthy. Have a variety of friends and interests outside healthcare. Next, every shift - have a smile and have a plan. Outline your priorities/must do's. Who is getting discharged? What time are meds? Dressings? Feedings? Be as organized as you can. Plan in time to chart - DO NOT MAKE A HABIT OF PUTTING IT OFF UNTIL THE END OF THE DAY - know what must be charted versus fluff - read hospital SOP. Start work on time and leave work on time - Everytime, unless you are in the middle of a code. Round on every patient at the beginning - eyes on, if only for a minute. Let the patients know you will do your best to see them every hour. Stay flexible, your plan will be constantly changing - based on needs. But know what you will be doing every hour - rounds, turning, meds, bath, what ever - plan it out as best you can. Plan in lunch/a break/ a drink of water/the bathroom. Most Med SOPs allow 30 minutes before/30 after, so if meds are due at 09/12/14/16, your window is 0830 - 0930, 1130 - 1230 etc. - read your SOP and make this work for you and your patients. Find something to appreciate every shift you work. A patient discharge (finally), a smile, a thank you, a sucessful foley insert, an IV start - anything that makes you feel good and productive. Always be honest. You do not have to buy in to the manipulation/complaining, but you do have to deal with the fallout. Do not join your co-workers coping/cover with laughing off issues - You do not have to participate, and you do not have to comment - smile and walk away, you are too busy and your patients need you, you do not have time to participate. Do help your co-workers when they need it, see one struggle to transfer a patient - help, do not wait to be asked, and ask for help when you need it - can't get the IV? Start asking for help now. It does not sound as if this culture is a new/recent event on your unit - you can be sure that the people who have been there for awhile have reasons for staying, and you can be sure the management/HR are aware of everything - complaining/anoynmous messages will not help you or your patients - and this behavior and the drama it will create will make it worse for you. Remember, you are part of the problem or part of the solution, you cannot have it both ways.Start planning your next move - where do you want to be? What is your interest? How will you get there? Research opportunities. Use this experience as a learning time/ladder out. You can do this for a year, be a great nurse and plan your next move. This time is invaluable and will serve you, and your patients, for the rest of your career no matter where you go. Chin up!

i urge you to continue looking hard in ca. i was a grad there and worked a few years before leaving - it really cemented who i am as a nurse today - and i do plan to return to ca. as a military spouse i have worked all over the states and out of the country - california nursing continues to lead the way in professional clinical practice. also born and raised in ca, no other state is the same... because you hold a california license, all boards will accept your credentials - you will just have to pay the fees. if and when you must accept a position in another state, your employer will not be held up if you tell them you have applied. turn around is much quicker these days. good luck!

For the first time I noticed 14 people viewing "research" thread at the same time. Where are you and what's up?

I am also curious. My spouse is getting ready to retire from the army after 26 years. Our last child enters college next fall. I am 48 y/o, an RN MSN with (OMG) 28 years experience (with the army life, you name it, I have done it.) Certified CCRN, CEN, CCRP, CNAA ....eligible for a few others. Love research at present. In shape, think I can pass physical no problem. Could I get in? What rank? What bonus? We have enjoyed the military life, too young to retire - maybe time to change life roles..............any thoughts?

Consider strongly a MSN with a major in leadership. CNO roles are now being redefined. Magnet now requires DONs/CNOs to hold a masters in nursing. MBAs came up in the 80s-90s, when hospitals became profit driven - yes a MSN will get you what you need to understand enough about business tools capital/direct/indirect, but for the most part every hospital now has sophisticated accounting departments to do this level of work, not to mention COOs and CFOs - hospitals need innovative leaders, particulary for nursing (which at this level incorporates all patient care areas...) Also, you want to set yourself up to expand as our health care system evolves. Good Luck!

Thirty plus years and the rhetoric has not changed..........when will nursing get a grip on this? Innovate, redesign, think out of the box, and change this self destruct pattern.

Breathe. Be kind. Be quiet. Get a small journal and carry it with you - write notes to yourself about issues/problems/change. Identify the top 3 priorities of your leader and contemplate how you can influence them to the good for everyone. Identify your top 3 goals in the role and how you can acheive them. No changes for 90 days. Think before you respond. Do not make promises you cannot deliver on. Catagorize the immediate/emergent from the might be good. Put your critical thinking cap on and hang tough - it is a right of passage.

A 'Research Coordinator' may mean many things. Read the job description carefully and research those you will be working for. A physician? A Site Managment Organization (SMO)? A Hospital? Acadamia? Look at each institution - how long have they been in business? Doing research? What kind of research - medical/pharma/device/operations/outcomes/epidemiology? What is the primary and secondary goal of the institution/individual? (Financial/Outcomes/Knowledge/Publication)? Do they have any warning letters? (Search FDA Website). What kind of training is provided? Human Subject Protection? ICF Process? Regulatory Requirements? Do they offer support for certification? What is the environment - is it a clean, organized, well lit offices with access to needed equipment and supplies? Is it a mess - paper everywhere, phones ringing, people moving quickly? Is there a library? Computers? Internet? Copier/Fax? Pens? Will you have to drive to see subjects? How many other people will you work with? Will you be completing all regulatory documents? Will you have suport staff? Will you assess/complete/propose Budgets? Will you be screening, enrolling, and managing subjects? (Think part sales/part medical knowledge/administrative/organizational skill set) How many studies will you work on at any given time? What is the therapeutic area? Acute Care? Field Based? Outpatient? Will you be completing case report forms? How is your time accounted for? And, if you are not a fan of documentation/writing and rewriting this may not be for you - Research is all about perfection in the details - again as it should be -. Clinical Research/Study Coordinator/Research Assistant/Research Nurse all have many definitions. Be sure you know what is expected. There are may great internet sources and books - search clinical trials/ICH/FDA. Check them out. A word about sponsors - yes, many are happy to help you learn - that said - the clinical trials of today have been evolving for about 20 years now, expectations are climbing (think vioxx/haldol) the environment is becoming increasingly competitive (for the better) and sponsors want to work with sites that provide high quality data and timely turn around - they do not want to spend precious, expensive hours monitoring/mentoring document completion - and they will not hesitate to let a physician/SMO know if something is not working. Also, study coordinators are being held accountable by IRBs and the FDA - if you are working with a professional license - standards must be met (again, please read warning letters issued by the FDA). All this said - this is a terrific evolving nursing specialty that has a very bright future!

I hate to be negative, but this is the reality. Your physical problems are probably an issue already...I would not discuss them with anyone...You need to examine your physical issues, but that is another discussion - no employer is going to want to work through them with you....unless you have been there 20 years and are a star. Yes there are laws, etc. but that is not the way employment works. For whatever the reason, you are not viable in this institution. HR is not going to help and neither is recruiting...Someone (s) want you to leave. If they were going to help, you would not be in this position. Find a new job, outside of this facility - now, before you are teminated. It is much easier to get a job, when you have a job. Your reason to your new employer is - it is not a good fit for you - end of discussion. Good luck, please move forward and put this behind you.

You must leave this position. You are in a no win situation. You have talked to the manager and HR - if they were going to help, they would have. Now you are a target, and let me stress this, by everyone. I'm sorry, this is how it is. Be happy, do not struggle. It is up to you.

Pure nursing research is very difficult to find. In my experience, nursing research - i.e: intervention testing/evaluation, efficacy measurement, outcomes, theory...etc. is conducted by academic nurses - professors etc. in addition to their teaching duties, or by grad/PhD students, in addition to their studies; or by nurse executives, in addition to their other duties. Many academic researchers receive grant support through professional organizations (AACN, WIN, ANA, etc) and the NIH; and use the funds for tools, assistants, statiticians, document/poster preparation. I have never really found a position as a pure nurse researcher, as an a assistant - yes (many of my mentors came from this role). I now struggle to try to conduct independent research, and write, but find myself time strapped - full time nursing research in a paid position would be nirvana.

Also look at what references the author used in the article. Read those articles. Are they opinion leaders in the field? Has the work been validated? Is this a peer reviewed journal? Does the article answer questions or leave the reader wanting to know more? Does the article make sense? Are the conclusions understandable?

I would encourage every student seeking clarification on how to write a research problem, understanding qualitative versus quantitative, or searching for a research topic to speak with their instructor. You are paying for an education and if you are not grasping the material you need to speak up. That said: As much as I appreciate qualitative research, unfortunately it rarely translates well into sustainable practice. The ability to objectively quantify a practice, intervention, or a standard lends itself to creating an evidence based practice. I believe as the US moves forward into a health care environment that sincerely places emphasis and value on high quality, cost effective care, the demand for objective solutions will be great and the implementation easier. When choosing a subject to conduct research on I believe it must be something you feel passionate about. Research is time consuming, often tedious, sometimes dissappointing, and always labor intensive. There are no shortcuts. If you do not have a passion for the subject matter, you will not connect, much less enjoy the hard work. Think long and hard about what interest you. Surf the net on key words and see what comes up. Keep your focus narrow and realistic. For example if you are interested in improving nurse satisfaction, choose one area. Shifts. Pay. Stress. Nursing Model. Then drill down. A few examples: Pay - hospital versus outpatient; hospital versus academic; Intensive care versus med surg etc...Shifts - Day versus night; 8 versus 12 hours; rotation. Stress - patient care; family life; professional relationships. Nursing model - primary versus team; professional relationships; leadership style. Just keep it tight and focused and dig in for the long haul. It is all about identifying what you can measure and then measure it. Most importantly, after you have done the research share it....discuss with your peers, offer to present, publish!

The SOCRA website has some practice questions. http://www.socra.org/ I would not buy the book, but when you register for the exam they will send it. The same material is also available on line at the FDA and ICH The FDA CDER web has easy access to the relevent regulations 21 CFR 312, 50, 54, 56, 318. See: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm The ICH recommendations (esp E6/GCP) has all the information and easy access. See: http://www.ich.org/cache/compo/276-254-1.html The exam was very basic and if you are comfortable with the regulations, a medical back ground and some common sense you should easily pass the exam. Also any book on Clinical Trial Management will cover the basics of research as interpreted by the CCRP exam. Good luck!

I have worked in two union facilities and my conclusion is that union rules trump health care delivery. From the basics of who and when trash cans get emptied to the model of nursing care delivery and mandated overtime - unions (in my experience) hurt, not helped nurse and patients. Instead of one parent the nurse now has two - "Administration" and "Union". Unions are a step backwards for nurses. If a nurse cannot independently decide on what a safe, effective, quality, rewarding environment is...I am not sure if they should be a nurse today.

Nursing offers a world of opportunity. The wonderful thing about our education and experience is that it provides us with a unique skill set. Instead of thinking what can I do outside of nursing, ask yourself "what can I do that will let me apply my skills". Start thinking about areas of interest that may require a health care background, relationship skills, people managment, multi-tasking etc. Then search the internet, journals, newspapers and industry and see what is out there. Health advisor for a company? Team member for a software developer? Acadamia? Community Foundation? Legal consultant or researcher? Reviewer? Researcher? Pharma? Insurance - case manager, medical auditor, customer service, quality development, product development. Interview with companies just to seek information, you never know what will happen - I did this and it was a turning point in my life. These are just a few ideas. For all nurses struggling (and we all do at some point) with this issue, please consider a change of scenery - you may find a new and satisfying career, or develop a new skill set, or just re-charge your batteries. The bedside will always be there.

Possible solutions: (From my personal perspective) 1. Respect is both given and earned from within. I would not work in an environment that did not provide a level of respect to me and those around me. If I found myself in such a situation I would have to leave. 2. Nurses are always accountable for their actions - I do not believe there has been an "increase" in nurses being "held" accountable for their actions; I think nurses are being held (finally) accountable for things they should have always been doing...elevating heads of beds, safely and promptly giving medicine, teaching patients why they should not smoke, following orders, protecting patients (time out anyone?), and documenting why and when they can't. How much should a nurse be paid for doing the job? Nursing salaries are not a secret...nurses make what they always have...the myths out there about fantastic money have always been over blown. 3. Churning...not so much...passing licensure in record numbers...not so much...lack of qualified educators and facilities...yes...retiring in record numbers...yes. Please see http://www.cdc.gov/ncidod/eid/vol10no11/pdfs/04-0253.pdf 4. The general concensus I am aware of is of smart angels who work very hard. 5. Low moral versus unhappy people versus perception......career change? Work change? Why would a group of individuals so unhappy stay together? 6. Low self esteem is an individual assessment. Passive aggressive behavior is a sociological phenomena that is tolerated by too many bobble heads who do not speak up and confront this behavior. 7. I had to look into this one...see http://nursingworld.org/mods/mod440/lateralfull.htm some helpful ideas here and also please see response #1. 8. Who gives the public their perception? TV/Movies? Well there you go...if you buy into that, that is another discussion. My peers, colleugues, friends, family and extended family are very clear on what and who nurses are. 9. The age old argument...well my perspective is there are excellent CNAs, LPNs, 2 year RNs, BSNs, MSNs, and there are horrific CNAs, LPNs, 2 year RNs, BSNs, MSNs. There is room and need for all and this is not a clear cut issue. 10. Are there more females in nursing...yes. Is that changing...yes. 'Domination' is not good for anything, well except in protecting your life. Have females been traditional nurturers and caregivers...yes...are females hardwired for this behavior???? Is this a good thing????? Can there ever be equality???? Will men ever 'dominate' nursing? No, not so much. Hmmmmm, I will need many hours and lots of wine to resolve this one. 11. People are greedy every where. We are all guilty of this one. Some administrators are "greedy" in order to keep the doors open and some are greedy to get their bonus. Who is best served? The community without a hospital or the community with a hospital, but less than desired staffing? 12. The new always replaces the old, as they should, because the old dies. Are there bad, experienced, greedy nurses who need to be replaced? Sometimes. Does time served equal quality? Not in my experience. New grads do make less, but are there hospitals with quality problems and the same staff for 20 years? Yes. I, personnally, have never seen admin come in and get rid of high quality, experienced nurses just so they can hire less expensive new grads...so I reject the premise. 13. Nurses can do it all..that's what makes us so valuable. That said...if a nurse is working in an environment where they are expected to cook, clean, repair, scrounge and document at the same time, I suggest they get a new job. If a nurse feels overwhelmed by their work load, I suggest they discuss the situation wih a peer or boss and if they cannot resolve the issue...get a new job. Life is too short. 14. If a professional nurse is working in a situation where the admissions rep decides who gets admitted to the hospital, this nurse should get a new profession, because I cannot believe they are a nurse with a conscience. 15. Nurses are all of these things for patients who cannot care for themselves. There is nothing unexpected, demeaning or untoward in a nurse fluffing a pillow, hanging up pajamas, answering the phone, getting a dish of ice cream, calming a family member, or reading the mail. If there is abuse, nurses own some of it for allowing it to continue. I guess what I am trying to say is this. Nursing is a choice. If you do not like something in your situation...do something. Leave follow or get out of the way is never more true when applied to today's nurses. People who complain without action further drag down nurses. Worse, people who support and perpetuate bad situations through the - dare I say it - passive aggressive stand of "this is where I work, I can't move my family, I can't drive that far, there are no other jobs near me, I've already been here 10, 15, 20 years, I can't go back to school, I have bills, family, etc" are perhaps root causes of many of the issues nursing is facing. There are no surprises in money and I resent the continuing statements that nurses are not paid enough - Here me now- no one is ever paid enough in the serving - and yes you hear me - serving professions. Not nurses, cops, fireman, teachers, soldiers, social workers, burger flippers or the guy at 7-11. Nurse salary information is and always has been readily available. People confuse the ability to be gainfully employed with unrealistic expectations for incomes. Please see the post about an optomitrist who wants to be a nurse so he can make 100-120K per year- paleez. Finally, to the OP, I think additional research is needed and then extrapolated and applied into why nursing is chosen as a profession. Then the information should be honestly marketed and applied to individuals seeking to be a nurse. I also think additional research is needed on what defines quality nursing and what constitutes a high quality, cost effective care delivery model and then that should be implemented. Wow, do I feel better.....

It really depends what you want career wise, and where you want to work - 10, 20 years ago it was the MBA. It may still be MBA in rural areas. I think nursing leadership has developed into many skilled tasks (direct care, assessment, resource management, human resources, research, implementation, program planning and development, project management, customer service etc.) and the influence of the MBA leadership in health service delivery has not been viewed as positive in recent years. An example of this is the Magnet Certification process, I'm not sure of the exact time frame, but Magnet now requires nursing leadership to be MSN. I was taught in my MSN Healthcare Leadership program the basics of accounting and finance, but the emphasis was more on relationships, team building and organizational management. The sense was that as a leader, you need to understand finance (read an operational budget, a financial statement etc.), and a leadership program will expose you to the basics, but there will always be accounting and finance experts to provide you the information to make operational decisions. On the other hand there are many MSN, MBAs out there.....

Duke has an excellent program. I disagree with the pos re: CCRC is the same education as a Masters in Clinical Research - the program teaches everything from drug discovery, regulatory and global affairs to business management and people skills. The program is also an excellent network to career development...graduate and the recruiters come to you.

Actually, maybe the water in the river has a poison making the tree ill, or maybe there is a problem in the house or barn. My point was a sociological perspective considers factors outside of the obvious physical framework. I think seeking to understand the difference in perspective was the topic. Not a right or wrong answer for a paper. That is a different discussion :)

Life is about relationships. Nursing, Stock Brokers, Walmart, Fire Department, Teaching, Politics, husbands, wives, second cousins twice removed, and the homeless standing by the freeway. I would encourage everyone posting in this topic to think about that before "choosing sides". What is the impact or import of the relationship on the work? How do I or you fit in? What makes you or I or Sues. happy, valid, fullfilled, contributory? Are we nurses for money? Are we truly altruistic? Narcissistic? How does that feeling effect others? I think we as nurses tend to box ourselves into one thinking mode and do not see the big picture. Getting fired is hard and it hurts. Beyond that, what is the lesson? Where does it go? How do we use it in our relationships? Our future? Our fault? Their fault? Does it matter? Are we bitter and going to get the "man"? Who "deserves" what we offer? Why do we "deserve" better? What is better? We must, must own who we are and what we do. It is what hope and change is made of.

Think of the medical model as a tree with a trunk and many branches. Think of the sociological model as a tree, in a pasture with horses and sheep, with a river on one side and a house on the other, and a barn in a field, with a road.......

I think it is really dependent on the sponsor, complexity and type of trial. Currently I am working on a critical care trial. The sponsor is only approving sites with RN coordinators and is only using RN monitors. From what I have seen, there are three types of physicians involved in trial research: 1. only involved to make money = SC does all work and never works with the budget; 2. really interested in the research, only participates in research in their area of interest, collaborates with the SC, leaves trial details (budget) to SC or admin; 3. a bit of both, high professional standards, only works with staff who are competent and qualified. I like working with #3, they are pragmatic idealists, are personable and seem to provide the best data.

This sounds more like an assistant role - RNs are too valuable, knowledgable and expensive to pay to chat on a phone. Coordinators heaviest job is usually enrolling subjects and collecting data - maybe you make followup appointments after a visit,? That is more reasonable. Coordinators are really the people who keep a research project moving. Physicians do not make rounds in the hospital or wherever looking for potential subjects - coordinators do - that is why nurses work well, they know the environment, physiology, they can understand the inclusion and exclusion criteria and requirements of a protocol. Coordinators chase paper - consents, subjects, IRB docs and federal docs. The key is you must be motivated. Yes, there are a thousand tasks - a good study looks for high quality people who can deliver and multi task -and they pay for those people. Be wary of being offered PAR or slightly below what you made as a staff nurse. Never buy into the well you don't work shifts etc...routine.

Depends on the Sponsor, protocol and job description. CRA's usually review medical records, case report forms (data collection tools)regulatory documents, budgets and contracts. You write alot of reports, usually from a template of sorts. You will "track" processes - this means what is done, completed, next steps etc. Computer skills are a must. You will account for investigational products (study drug) or devices. Collaborate with multiple departments - pharmacy/lab/imaging etc. You will ensure regulations are followed - thus you must know them. You will evaluate physicians, nurse and facillities and make recommendations. You will teach - everything from disease process to how to mix a drug. You will often travel all over the country and possibly the world. Can be very rewarding and challenging for the right individual.