Ariesbsn

Years ago, yes. Per the lady at the employment agency that arranged the interview, the interviewer wanted people to show how much they wanted the job by contradicting his negative responses with positive information about themselves. He also wanted people who would be assertive. I threw a wrench in his interview when he pulled the "I don't think you will be a good fit" out of his bag of obnoxiousness, I said "You are absolutely correct. Thank you for your time," and walked out. His jaw dropped and he was speechless. In my humble opinion, life is complicated enough without the games.

Dude! That just plain sucks! No wonder you said in another post that you didn't want to bring your golf clubs to work. What if they took your wallet AND your clubs? So, did you give the family the name and phone # of your manager? As in: Pt: "I'm gonna complain!" Tom:"Let me get a piece of paper. Here is the name of the person you need to call and their phone #. They are usually in the office by 0900." I am really sorry that happened.

Sorry you had a stressful bunch of firsts all in a row. The first thing you need to do is put yourself in your patients shoes. He is hungry. Hunger and pain will drive a person to do things that don't make sense to someone who has a full belly and doesn't hurt. Being frustrated and angry are natural, but also be sympathetic. Just for kicks and giggles, on your off time put yourself NPO, get in bed, and do nothing but lie there and watch TV or read. See how long you can go before you have to eat. One of the things that may surprise you is that if you have nothing to do but watch lousy TV, you may find yourself unable to concentrate on anything but how hungry and thirsty you are. OK, now on to the patient situation. The first thing I would have done was to ask the patient to explain to me his understanding of why he wasn't suppose to eat and the consequences of that behavior. Then, if he knew why he wasn't suppose to eat and what could happen if he did, I would ask why he had someone sneak in food. Next, I would turn to the attorney and the medical doctor, look at them with the biggest, most innocent eyes, smile and say: "I'm so glad to meet you both! So you are a medical doctor. How wonderful! Are you on staff here? Mr. X you do know that since Ms. T isn't 1. a staff doctor here and 2. not your doctor, I can't legally follow her orders, don't you? However, Ms. T, since you are a medical doctor, maybe you can do a better job of explaining to Mr. X how hunger never caused physical harm to a patient, but eating with symptoms such as his has. Oh, can you also explain to him how as a nurse, although I do sympathize with him being hungry, as long as one of our doctors writes orders that are safe, I am bound by law to carry out those orders. If he isn't totally bored with the conversation by this point, could both of you discuss the legal ramifications to the nurse and doctor of allowing a patient to do something harmful? While you all are having your discussion, I need to go report this to the charge nurse, the nursing supervisor, and the doctor." Then I would talk it over with your charge nurse, I would also look up the results of his tests that morning, and then page the doc. What happens next kind of depends on your facility. In ours, I could tell the visitors to leave and that they weren't welcome back. I could also institute the rule that unless he is receiving care, his curtain is to remain open at all times. I would also fill out an incident report. One of the things you will learn, in time, is to use that kind of b.s. of "my friend is a lawyer/doctor" to help you.

In the 42 years that my mother practiced as a nurse, she always talked about how busy she was and how physically demanding the work was, but not about being short staffed or worrying about safety issues and her license. It really is good advice.

How about: Longer orientation. Preceptors who like to precept. An on-going relationship with a mentor who likes to mentor. Smaller assignments to start with. A no tolerance stance on lateral violence.

Thank you all for the kind words and thoughts. My hope is that another nurse at some point in their career will think "If she did it, I can do it." It is rather neat to move from a position of feeling trapped and frustrated to feeling rather liberated. I can also say that I loved the expression on the charge nurse's face when I told her at 2100 that I noticed we only had 4 nurses on the schedule at 0300 and that I wanted to let her know in plenty of time that I would be happy to take an assignment that fell within the ENA recommended staffing ratios or clock out and go home; which ever she felt would be the most helpful thing for me to do was fine with me. I truly do believe in giving people as many choices as possible, ya know?

You did the right thing. It is so much easier to vent about the idiots than to pray that the person who had a reaction doesn't sue you because you didn't follow policy and gave the shot without the epi pen.

Thanks to the wise advice of the people at allnurses.com, I took a stand at work and started refusing to take assignments that were more than double the ENA recommendations for staffing because it wasn't safe for my patients for me to have 5 shock room patients or 9 exam patients. I have been very vocal at work about how unsafe it is to have all 28 beds full with only 5 nurses in the department. I have also been quoting the quarterly publication that the board puts out regarding how a nurse should handle an unsafe assignment. The icing on the cake was having to put a trans-venous pacer in a woman with a heart rate of 20 and not enough nurses to cover the little things such as recording (we paper chart) and someone to be the "go-fer" for the sterile nurse setting up for the pacer. Yes, I was smart enough to start looking for another job BEFORE I did this and have accepted a position in a different hospital. It is a good thing too because this went over like a lead balloon. I was told last week by the assistant manager that I was not allowed to say at work that I was going to call the board and find out if the article from 2005 was still in effect, or if I needed to do something different to protect my license. I was also told that my negativity was undermining "all of the positive changes" that they had implemented. Now, at the time of this conversation, the changes that had taken place were that all of the agency nurses (30-40% of our "staff") were cut from the schedule, additionally, the number of nurses allowed for every 4 hour time block was decreased by 1, in-house registry (IHR) staff were allowed to bump a regular staff off the schedule because IHR never gets put on call, the exam beds were going to be staffed at a 1 nurse to 7 room ratio, and there was the addition of 12+ tasks to the list of things that we already don't have enough time to do. My immediate supervisor has been very supportive of me and my stand. She confirms that I haven't missed any positive changes. She also confirms that no, I am not negative, I am realistic and the reality is that it is dangerous here. She was told by the assistant manager to stop mentioning the ENA recommendations because we weren't going to staff by them and the assistant manager was tired of hearing about them. There are 10 people that are trying to find a way out of this department. I am one of the lucky 2 that so far have. It is bad enough in our department that one of that people with 15-35 years of ED experience are saying it is unsafe an looking for jobs. One day, after reading something here about staffing ratios what popped into my head was "Shame on them for putting me in a position where my patients and my license aren't safe, but shame on me for allowing them to do it day in, and day out." So, thank you to everyone who has ever contributed to threads about staffing ratios since I found allnurses.com in March. If it hadn't been for this site, I would have never gotten up the courage to take a stand. I would have bought into the philosophy that 1) Staffing was like this all over so I just needed to suck it up. 2) If I didn't take the extra rooms, I would be making more work for everyone else. 3) A good nurse would be able to handle this and not even complain.

Even though it seems like your heart is breaking, think of the gift you give each family by taking care of their loved one and helping them have the best death possible given the circumstances. They are so fortunate to have you there to explain things to them and to support them with whatever decision they make. I would be honored to have a nurse who cared enough to cry take care of my family any day. Big hugs to you, and I hope you find peace.

We have the walkies with the ear piece in the ED that I work at. I HATE IT!!!! They have 2 volumes regardless of where you have the volume dial set; loud and inaudible. The other problem is that sometimes they transmit, sometimes they don't. So, I frequently have to track someone down the old fashioned way.

Wow! We had a half day lecture about it, but were never tested on the material. Say, can you use "energy field disturbance" as a diagnosis for a person who repeatedly causes light bulbs to not only become unusable, but also issue a loud pop, and, many times shatter, when they flip the switch? I am not talking about every so often they flip a light switch and the light bulb doesn't work. I am talking about phases that last for days.

This is one of those things where I feel if you are interested in the idea, have $400.00 left over after you meet all of your financial obligations and have nothing else that you need or want to do with the time the class takes, why not? You may learn something. I also feel that you shouldn't use this on your patients. Since it wasn't part of Kaplan's NCLEX preparation class, I would wager that energy manipulation is out of our scope of practice.

The sound of retching gets to me too. I am fine if the person vomits silently, and I don't wig out if I wear someone else's vomit. However, the loudly yakking person 7 rooms away gets to me.

Don't ever feel bad for practicing within your scope of practice and against policy! The minute you do something that is outside of your scope of practice/against policy and something goes wrong, it is your butt and license that are on the line. Not only will the charge nurse not back you up, neither will the hospital.

A live chicken? Cause that would almost be worth watching just to see how!

Would you care to share those skills?

I am so sorry that you had to go through this. While what you went through is traumatic and horrible, it did not happen in vain. When you become a nurse, you will never let your patients or families go through the same experience.

Hi Coolpeach, I have never worked hospice, however I watched both of my parents die from cancer. My father died in a hospital when I was 10. My mother died in a hospice facility 8 years ago. I have also worked in ICU. I think the best place to die is somewhere that makes sure your pain is managed and that encourages your family to be as involved as you, and they, want to be. Sometimes that can happen in the hospital. It just depends on the nurses:nurse: . When my father died in 1977, my access to him was restricted because of my age. I was allowed 15 minutes a day with him until the last week of his life. At that point someone decided he was too sick and I wasn't allowed to visit him any more. I didn't get to say good bye or tell him one last time that I loved him. When my mother died in 1999, she was in a hospice. The experience was very different. The energy was different. It felt like you were walking into a giant hug. It was also very comforting to have people around who specialized in end of life issues. My mother had a much more peaceful and pain free death than my father. When I was working in ICU, I had a 55 year old patient who was a DNR. He was approaching his celestial transfer on my shift. His wife had been sitting in the chair next to the bed all day. People had come and gone and at around 0200 she asked me if she could put down the side rail because it was hard for her to hold his hand with the rail up. I said sure, not a problem. I told her that if she would like, I could reposition her husband in the bed and she could get in the bed and snuggle with him. She took me up on my offer. I pointed the video camera in the room at the ceiling (for privacy), repositioned her husband, got her comfortable in the bed with him, pulled the curtain and left. He died in his wife's arms at 0337. As she was leaving she thanked me for allowing her to have one last cuddle. I guess in my mind, it isn't so much the place, as it is the people who are caring for you. I don't care where I die. I just hope that it is sudden and that there isn't a lot of pain.

Tom, people don't enable the bullies. Enabling implies that the target is helping the bully be a bully. I don't think any of us who have experienced the things the OP listed have jumped up and down yelling "Pick me, Pick me," or "Hey, after I leave, when you are telling everyone at the nurses station what a s#!++y nurse I am, you should include that I turned my patients every 2.25 hours tonight instead of every 2 hours." I have never given anyone any power in that sense. I am pretty mellow, don't have a know it all attitude (cause I don't know it all) and rarely do you find me sitting during a shift. I know what I know, and most importantly, I know what I don't know and am not afraid of asking questions. I do my best to know what the policies are and follow them. I also advocate for my patients. I'm also a pretty good nurse. Several of the ICU nurses that I worked with who had been nurses for decades said I could take care of them any time. That being said, there were several nurses in ICU who came after me time and time again. It didn't matter what I did, it wasn't right. EVEN when I followed the policy I was told I did the wrong thing . Confronting the people didn't help. Quoting and or handing them the policy didn't help. One of the nurses would make it a point of coming into my room before report and telling me every thing I did wrong all night on patients that weren't on her assignment. This same nurse got on my case for taking a patient's blood pressure every 15 minutes. My rationale was that I was giving Precedex for the first time and wasn't sure what it was going to do to the patient's blood pressure. Neither was the pharmacist. He stayed in the room for the first 45 minutes to be sure the patient was OK. He thought the q 15 minute blood pressure was a good thing. She said I was taking the pressure too often and could have caused the patient irreversible damage. I'm not saying I didn't make some mistakes. There was the time that I didn't label the line with NS. However I did label the levo, the insulin, the calcium gluconate, the versed, and the fentanyl. Every so often, I would forget to empty a nearly empty suction canister. I didn't do anything horribly wrong and nobody died on my watch who wasn't suppose to. My patients were clean and looked comfortable, my rooms were always clean, trash and linens were emptied, and I stocked my rooms so my replacement wasn't left short of supplies like I was. It didn't matter. The response from my charge nurse, shift supervisor, and the manager of the department was that was the way those nurses were and nothing was going to change it. I was also told to remember that "nurses eat their young." As far as why some people and not others, there is great site, http://www.bullyonline.org/ that discusses the whys. There was also another site http://www.worktrauma.org/ that stated females are more often the target. I think that in order to put an end to it, management is going to have to take a huge stand and not tolerate the bullying. Unfortunately, I think a few people are going to have to be fired before anything changes.

Thank you traumaRUs and RNcDreams.

Thanks a bunch for your replies. Management has cut our staffing to the point where it is dangerous. Last Thursday I had the following 5 patients by myself and all at the same time. There was a pt with a hemoglobin of 7 with a bleeding mass in his abdomen, a pt whose defibrillator was firing, a pt with a blood pressure of 214/158 with chest pain and a headache (imagine that), a pt s/p parathyroidectomy who was experiencing tingling all over and turned out having both a low calcium and a low magnesium, and a pt who would desat into the mid to low 80's when he talked or moved even though he had supplemental O2. The patients in this area have q 1 hr vitals and assessments. I spent the night praying that nobody would die. I am in the process of writing a letter to the manager and telling her that the patient to nurse ratio is unsafe and that I feel my license is on the line. I want to be able to say that the ENA recommends the following ratios and I will not accept assignments that exceed those ratios. BTW, I am looking for a new job. They aren't worth my license.

I joined the ENA, but don't know where to find the patient to nurse recommendations?

I graduated from a BSN program and we had to pass math tests with a 90%. I calculate dosages frequently. I always do the calculation twice. If I am dealing with a peds med calculation, I always ask someone to check my math.

OK, true story that happened when I worked on Thursday. I was in the ED and had a pt come in because his defibrillator fired. At 2314 the tech room called to tell me that the pt's defibrillator had fired again. I checked the time frame that they were referencing, saw something different, odd even, and then went in to talk to the pt. He stated that no, he didn't feel the pacer fire. I reviewed the strip and the situation with a more seasoned nurse. We decided it wasn't anything to report to the doc. A couple of hours later, I took the patient up to his room and was in the process of disconnecting the monitor leads. When I got to the red lead, the electrode was not on the lower left side of his chest. I followed the wire and found that the wire and electrode were in his pants. I gave a gentle pull on the lead and met resistance. Since he was getting into bed anyhow, he took off his jeans. The electrode and wire were in his underpants and the electrode was attached to his member! Apparently, it wasn't his defibrillator that fired earlier. Somehow, when he was going to the bathroom, things got rearranged. I still am chuckling about it. The nurse I reviewed the strip with passed pop through her nose when I told her. My question to the OP is, do you know all sides of what happened in your examples? Maybe the nurses weren't incompetent, just inexperienced and relying on the advice of a seasoned nurse. Maybe they thought they were doing the right thing. Maybe in the past, the monitor room people have not been that accurate with their interpretations. Don't judge the nurses, help them overcome their knowledge deficit.

We were told in ICU that the number of people who were clocking out using the "worked through lunch" option was excessive because there were 2 people who used it in a 3 month period.