KrustyTheNurse

I know it's been a few months since my interview, but I wanted to let you know that I did get the job, and started on October 4. I've been crazy busy learning the job, and I started on the cusp of a go-live for the hospital's perinatal department. I'm just loving this new job and have received some great feedback from staff. Thank you so much for your advice. I put together a PowerPoint and demonstrated the training I used at the prior job. The interview panel loved the presentation and liked the job aids I brought along. Thank you again for your sage advice and wisdom in assisting me with my career goal.

Great pep talk! :) I do have the confidence to show in the interview I can do this job and that I will be a valuable member of their team. I do have hope but I know I'll be a terrific informaticist.

Thanks so much for the great advice. The job description encompasses Epic Care training and I have experience training end-users in PACU with Cerner. I believe I will use my time to simulate a training session for a recent enhancement. I have pocket guide cards I developed for my staff, which has been helpful for them to remember the steps. I plan to make duplicates for the audience at the interview, too. I want to convey I can manage the classroom environment, and focus the training and meet objectives for the lesson. I will be able to use PowerPoint, and I will be taking screen shots from the training domain for each step the nurses need to take in order to utilize the application. Thanks for the advice and I hope this goes well enough for a job offer.

:) Thanks for your ideas and input. This will give me something to think about. BTW, you mentioned you're not an informatics nurse yet? It sounds like you have a goal to enter this specialty. If you are, good luck. I've found it a little challenging to find openings, especially in this economy where some hospitals are decreasing their workforce due to decreased volumes, revenues, and increased charity care. Again, thank you and good luck to you!

I'm very excited about an interview I have scheduled for an Informatics Educator this coming week. I've been wanting to move into informatics for a long time and I don't want to blow this opportunity. I've been asked to give a 15 minute training presentation to the interview panel. This needs to be technology-related. I have asked if I will be able to use a computer or what other resources will be available to use but am not sure if I will have this available to me. I have done informatics training with my staff as a unit-based clinical educator, and could utilize some of the handouts and other written content I developed and used with our recent "go-live". I thought there may be some better ideas out there from those of you who may have had to do this in your interview, or what you've seen if you've been involved in the interview process of a new applicant. I want to show that I understand how to address the learner's needs, that I have the ability to train within the informatics domain, in addition to my ability to use only 15 minutes allotted to me. Thanks to anyone who might throw some advice my way.

Good luck!!

That's a very sad story. I think, from a patient safety perspective, you are going to have to make some decisions as to whether you should be working in this environment due to your limited physical abilities, and if you should even continue working in this organization. Patient safety should be the most important piece and if there are clear violations of accepted guidelines from AWHONN and ASPAN that are clearly being breached you need to think twice about devoting anymore time, energy or emotion into this job. I'm sure there is a policy from HR that indicates what type of work you would be allowed to do taking into consideration the limitations you list. Have you been cleared by Employee Health to return to 100% function? It doesn't sound like you meet the physical requirements of the RN job description. If your injuries were related to work then it falls into the Workman's Comp arena and it's the obligation of the hospital to give you work that you could due with your specific limitations. Your manager, her administrative supervisor and the hospital are leaving your case wide open for any liability related to limitations you have where you are being required to function as if you were free of any injury. This is purely a patient safety issue and that is where I'd start with your documentation. You might have to decide this situation is too dangerous for patients and yourself and that you need to get out of there. Policies are also a wonderful thing if you can correlate how your situation is in violation of any organizational employee health and work injury policies. As a nurse manager I'm constantly making sure I apply established policies fairly to all employees and patient situations. I don't know what type of hospital you work in or what her budgeted P/I (productivity index) has been established. It's sometimes feels like you're being squeezed in this role - from my supervisor at the top and from staff and patient issues from the bottom. Staff sometimes don't have that bigger picture that the manager has. I usually tell my staff that I'm the Reality Officer for the department. I have to define reality daily to them and perhaps this is how your manager is defining reality for you in your department. Take care and good luck!

The reason to prewarm patients to to maintain a normothermic temperature which will, therefore, decrease the risk of post-op infections. One of the patient safety goals set by the IHI (Saving 100,000 Lives Campaign) was to decrease post-op infections - preop antibiotics, discontinuing them within 24 hours, maintaining normothermic temperature, etc. Research has shown that if a patient is prewarmed for at least 30 minutes preop, temperature is maintained throughout surgery and they continue to be warmed in PACU, the incidence of post-op infections are decreased. Leukocytes can not work properly in a cold environment so, therefore, keeping a patient's body temperature closer to normal will help to decrease their susceptibility to infection. It also helps to decrease cardiac events. http://jama.ama-assn.org/cgi/content/abstract/277/14/1127?view=abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11395840&dopt=Abstract http://www.bairpaws.com/arizanthealthcare/bp_pro_warming.shtml In our PACU we use the Bair Paws gowns and the patients love it. Also the staff isn't running for warmed blankets all the time. The warmed blankets only stay warm a couple of minutes and do not maintain a patient's body temp.

ASPAN postion statement is a guideline - guidelines are suggested modes of practice. This guideline states "requires two licensed nurses, one of whom is a Registered Nurse competent in postanesthesia nursing, be present in the Phase I PACU whenever a patient is recovering from anesthesia." The other licensed nurse can be an LPN. Anesthesia means general, spinal por epidural anesthesia. Please visit the ASPAN website for more info http://www.aspan.org. Is there a staffing committee at the hospital you are referring to that could be of assistance? Are there state mandated nurse/patient ratios that need to be addressed? Do you know the name of the nurse manager of this department where you could discuss this with? Are you familiar with nursing administration at this hospital where you could voice your concerns? Good luck!

One thing you'll learn after you become an RN is that patients have specific rights and are responsibile to take accountability for their care. You have to respect her wishes to "come home from surgery and take her meds and sleep and heal and doesn't want anyone there." Every outpatient surgery settings require a responsible adult to accompany the patient home and whoever is going to be staying with your mother will receive her post-op instructions with patient care and contact numbers for the surgeon. We require the patient to agree to have a responsible adult with them for the first 24 hours. I'm sure this will hold true in your mother's case. Part of the pre-operative process is patient teaching from either her surgeon or his nursing staff. Many patients are not open to teaching and react in various ways to the information presented to them. Processing this information may be difficult for her due to the fact she will be undergoing a life-changing event (look up "Alteration in self image" from your nursing texts). You don't mention her age but from your description of the situation it sounds as if you mother doesn't need a mother and may feel threatened somehow by your comments to her or how you may be treating her - as a child. As difficult as it may seem, she is looking for support and isn't ready to relinquist the parenting role to her daughter. You can't stop patients from being in denial, whether their family members or the patients you care for. It's a process patients have to experience, process and deal with themselves. Be as supportive to her as you can and let her know you'll be available if she needs you. You don't mention her age or your age, or whether she's more comfortable discussing this and getting support from one of her friends, etc. You mention she has a fiance . . . imagine what loosing both her breasts means to their relationship. This is a lot to handle and the possibility that she may eventually succumb to this disease process. As frustrating as it is, you're going to have to back off and give her space but still let her know your love for her and that you're there is she needs anything.

I'm glad you're asking these questions. From my perspective as a nurse manager I might be of some help and guidance. I manage an 18 bay PACU within a 400+ bed, level I trauma center. Our job descriptions and requirements call for critical care nursing experience, either from ICU, NICU, ER or a telemetry unit. At least two years experience is required within the last four years. I view PACU as an acute care ICU and, in fact, ICU is considered a step-down unit from the PACU. Every patient that comes into our PACU is a potential ICU admit depending on how well they recover from their anesthesia. We receive patients at the most vulnerable and unstable status a patient can experience - immediately after anesthesia - where there are so many potential problems that need immediate and seasoned experience (airway and respiratory instability, hemodynamic and cardiac implications, emergence from anesthesia with complex pain management). For new grads to succeed in this setting you must possess thorough critical thinking skills and have done well in any critical care classes from nursing school. Understanding fluid management, vasoactive drugs, narcotics, antiemetics is essential. All this needs to be done expertly and safely in a very fast paced environment (it's not unusual for my nurses to take care of 6 to 7 patients, some requiring 1:1 care, within an 8 hour shift). The ADN programs do not offer these types of experiences for their graduates due to the short duration of the nursing program. Even BSN grads may not have a good opportunity to have exposure to the experiences required to orient to PACU. New nurses to our PACU must have a broad understanding of A&P, be familiar with various types of surgical procedures and expectations from those surgeries, be quick to pick up on problems that a solid background in critical care will give you. I also require ACLS and PALS certification - patients do code in the PACU. Unless you apply to a hospital with an extensive (4 to 6 month) critical care class with didactic and practical instruction/experience, it may be difficult for a new grad to successfully orient to PACU. I wouldn't give up on eventually working in PACU but any nurse working in this area needs a solid background in critical care. Working in ICU is a great beginning as you have 1 or 2 patients for the entire shift and would have time to digest and understand their disease process, learn EKG monitoring and interpretation, become familiar with vasoactive drugs, be part of airway management with intubation and ventillator management. Good luck in your future nursing career. If you truly want to move toward PACU, secure a job in ICU or ER, get some experience and then see what PACU can offer to you. The major concern as a nurse manager is whether the nurses I hire are safe and experienced practitioners. Perhaps you can find a hospital that will provide an extensive training program in order for you to work in PACU sooner.

Thanks Lace-RN. That's a great suggestion. I planned to do just that. I will be making an appointment with our Employee Relations Specialist tomorrow for more guidance and to help me with development of their action plan.

To feistynurse, thanks for your advice; it's very helpful. I don't want to be played, which I think has been their agenda and I could sort of see that while we met. Both of them said they'd never received such a bad evaluation in the past and that if they'd known any of this it would have given them a chance to improve instead of just hearing this at this annual review. What's disappointing is that one of these nurses is my day charge nurse, they are both stellar with patient care but how they treat others in the department is the sad part. I hate feeling like a parent or that situation like an 8th grade girl's gym class. I don't want to sound like Judge Roy Bean but their attitudes and behaviors are incidious and undermining which are affecting the operation of our department. This has to stop if I'm going to be able to lead and make our department respected and my nurses well thought of. With everyone's evaluation I gave them all a copy of the hospital's Code of Conduct policy as groundwork and explained my expectation of all employees in the department was to follow this. I felt it was important to set the tone that I was serious and it wasn't excluding one person over the other. 98% of my staff took this and was glad I'm addressing this with everyone (they all know who the bad players are) so I didn't really have to expand on my reasons further. With this policy as common knowledge from me, I feel it will be easier to move toward discipline with those who choose not to comply. Again, thanks for the input and encouragement.

I think I really messed up. This is my first nurse management job (8 months out) and I just finished giving yearly evaluations to my staff. Two nurses in particular have had interpersonal behavioral problems that have been present for years. I unloaded on them an unsatisfactory evaluation in this yearly appraisal when I should have been meeting with them and counseling them throughout the year to help them work on these things. It probably could be viewed as an "ambush". While we were talking I realized they had no inkling of any of these serious behavioral problems. I indicated to them that I should have let them know these things all along but they still did not meet the standards set by the hospital - violations of code of conduct, personal accountabilities, etc. These two nurses are very senior - at least 20 years for both of them within the same department and at least 10 more within the hospital. Both are passive-aggressive, manipulative and I believe that other managers before me have either been afraid to confront them or were sold a "bill of goods" by each of them. I have other staff who report to me that they "dread" coming to work when they know this nurse is working. Maybe because they are so senior they are just tired and unhappy at this part of their career and they are just beginning to exhibit this where it wasn't a problem in the past. I prefaced our conversation by saying that I viewed myself as a mirror to them as to what I see and what others who work with them have told me and my job is to let them know these problems and to help them find ways to improve. After these evaluations I began to feel really terrible in how I handled this whole process. Employees should know going into an evaluation what their evaluation will be since they would have had a clue all along. I have spoken with one of them intermittently about problems but I haven't done that in almost 3 months. I know I need more management leadership training and this is a good example of this. I feel I want to make amends somehow without diminishing the problems they both have in how they treat others and how their personal demeanor is affecting the smooth running of my department. And I don't want this to turn into my problem related to their behavior when it's their problem to solve. I'm sure someone out there has some advice for me in how to deal with this. I did set an action plan with one of them to meet weekly to "work" on her behaviors and I promised both of them I would come to them immediately when I observe or am told by other staff of these problems. I thought I'd contact our Employee Relations Specialist on Monday and see if they have any advice or can be of assistance. Thanks for your thoughts and suggestions. Thanks!

What is voice care report? Is it the same as SBAR?