Tait

I do want to say that, in relation to this comment: And Please let the staff know the guidelines. I had students rotate through surgery and I was told to tell them--they can only go to surgery ONCE at that hospital. Then the OR staff would ask them back and I had to tell them they could not go back...even with their assigned patient.. WOW! Unfortunately with the sheer number of students, we have this same situation. We can have undergrad nurses, surgical techs, residents, and EMTs all in OR in the same day, so we have to keep the rotations tight. Also our orientation takes into account that the schools and units will make sure policies are followed. My department works to create a connection between the unit and the faculty so they can get started in the best way ?

Sorry had some issues getting it to let me post! OK so I did manage to create a 30 minute Faculty Onboarding program. I resourced the handbooks of several of our partners and pulled that together with our hospital policies. We have had some great success since starting this. Overall it went like this: We had 61 current faculty meet with us, some one-on-one, some in groups to review the handbook and ask questions, and now we onboard new ones as they start. We also have the handbook in ACEMAPP for them to attest to. The meetings are 30 minutes or less. We go over the expectations of the students: No lab coats Where to park General appearance expectations Pass meds with your preceptor/faculty Be proactive No phones unless cleared (that was in most of the handbooks) Be aware of where your stuff is and don't leave it lying all over Be respectful Expectations of the faculty: Be with your students Get a tour of the unit each semester to ensure they are comfortable there Understand the process of students receiving EPIC access and which email they will receive that information to How to escalate problems (unit leadership, me, my boss) Who to report any incidents to (charge RN) for documenting Expectations of the unit (we presented at the monthly Nursing Education Council and recently at our new New Nurse Educator Residency meeting): Be nice Be welcoming Look for opportunities to support the students Remember this pipeline supports your future workforce Know how and who to escalate to (and in real time!) Be ready to offer preceptors several times per year Always reach out to us with questions So far it is going really well. I have work to do with EPIC, but that is a huge project in its own right (older instructors are nervous to let students document even though it is all co-signed, and other units don't like it etc). Sorry for the slow response! I really need to come here more often, I am just so burned out lately but life is getting better! Tait

Excellent answer. I need to clarify. I am a Coordinator for Education Affiliations for the hospital system. We are having issues with professionalism in terms instructors and students. This is one reason for needing a lit of professional expectations of these instructors and groups on the units.

I prefer scrubs with a nice embroidered lab coat. Approachable but with a bit of authority. Only issue would be patients confusing you for a doc but that will probably happen anyway. Congratulations on your new role!

Good afternoon fellow educators, I am working on a handbook for our clinical faculty/faculty liaisons for a four hospital system. Without getting bogged down in the details of what I am creating, I have a question for you all: 1. If you have clinical instructors coming to your unit, what are you expectations of them and what do you expect their role to be? 2. If you are a clinical instructor, how do you manage your day, and what have your educational institutions set as expectations for you when you are with a group of students? Thank you, Tait

I am an RN of going on 14 years. Five years bedside acute care cardiac specialty, three years off completing my MSN and making two beautiful minions (now 8 and 10 years old), and have been in education/new grad residency coordinator and now manager of professional practice for the last seven or so. My heart breaks every day for my nurses. I work in a middle management position that is supposed to help elevate nursing practice in my hospital, support shared leadership, and generally do lots of support for the nurses I work with. However lately I feel like I am screaming in to the void every day and honestly it is leaving me so exhausted and unhappy. My nursing leadership team is changing dramatically and I am afraid I am going to just be stuck running around lighting candles while someone blows them out behind me for the rest of my career (my analogy to trying to get shared leadership solidified). I have also realized there are ancillary departments that honestly would like to see nursing fail, and it is so frustrating to see. I am considering going back to patient care in an outpatient setting, where at least I know I will be making a difference in their lives. But I am also afraid. I have one spectacular CNL I mange and I am also the coordinator for the nurse residents that come through our facility. I know I am replaceable, but I have sunk a lot of my energy into making sure people have the best start they can. I am honestly at a loss of what to do. My mother keeps telling me not to "run back to the bedside" as though I am looking for a quick fix to all my problems. But seriously, just because I have the skills and ability to be in leadership, shouldn't mean I have to stay there if I am miserable. Sad Tait

I am going to agree too. Honestly if he is willing to sack his marriage over an absent sibling I wonder if he is just looking for an out...LOL?

Does anyone have a recommendation for a light weight lab coat? I need to get one for when I do rounds, but I can't stand the idea of some of the heavier coats, but I also need it to stand up to embroidery. Thanks in advance for any advice.

That seems to be the sentiment coming from those who feel threatened.

So most of us, I believe, are familiar with some form of "essential employee" letter that was given out during stay at home orders. This letter is a sort of "passport" to be out on the streets heading to work, in case you get pulled over. This week our system has released another essential employee letter for those travelling past curfew times two work. We had a discussion this morning that, with the unrest, a letter may not be enough. Are there any systems out there with more robust protections for their staff travelling to and from work during curfews? Thank you in advance.

Bumping this for more input.

Side note: Having spent the last 6+ years working directly with new graduate RNs I do not recommend switching units in the first year unless you are at risk from bullying or other toxic behaviors. There is a significant growth and reality shock curve that happens in that first year.

We spent several weeks trying to come up with a solution for all our nurses to have access to hospital scrubs. We went round and round about the cost, dispersion, people wearing them home and not having them properly cleaned, how to hand them out, alternatives like laundering personal scrubs in house, on and on. In the end our system didn't come up with anything, but my hospital moved ahead with getting the COVID unit and the ICU hospital scrubs if they wanted them. Now pretty much everyone in the hospital seems to be in them and I am waiting to hear how much we have lost in cleaning and missing sets. While I don't agree with the firing, I also don't agree with just "going and grabbing them anyway." It was an opportunity on both sides to come up with a plan to disperse scrubs, not lose a ton of money, and help the staff feel safer.

We went with paper bags, my mom's hospital went with plastic containers. Our rationale for paper I believe was due to the evidence at the time that COVID fell apart faster on paper than plastic.

I wrote a post on this a few years back, about the many rocks I tripped over on my way to and through nursing. Feel free to read, it might make you feel better. Also lots of great advice already in this thread. Feel free to PM me if you need more support.

It is OK to be scared right now. It is OK to be angry right now. It is OK to feel you aren't being heard right now. It is OK to feel anguish for your patients right now. It is OK to feel betrayed right now. It is OK to feel like you need to get out right now. It is important to ask for help right now. It is important to raise your voice with concerns right now. It is important to support those around you right now. It is important not to be angry with those who don't understand right now. It is important to manage incoming information right now. Self-care is deep breaths. Self-care is saying no to overtime this week. Self-care is talking to your therapist. Self-care is ordering your favorite cozy socks from Amazon. Self-care is hugging your furry loved ones and not so furry loved ones. Self-care is playing a game over Zoom with friends and family. Self-care is demanding a quiet space for a few hours a week. Self-care is buying the nerdiest fabric you can find and making bomb new masks. COVID-19 has a created a world in healthcare that some of us have never experienced. A world littered with new challenges, ever changing protocols, and new frustrations. But with it comes opportunities to unite. To crack open age old EMR issues and say "Do we really need to do this like this?" To look at PPE stock and process and think "How could we have done better, can we innovate, can we shape a better future?" To look at isolated patients and think "What can I do to help them stay connected?" Nursing is a profession of innovation, integrity, and action. Don't ever forget that. Tell me, what are your oks, importants, and self-cares. What innovations are you thinking about? How are you staying connected with your patients when they need you most, even garbed like a yellow banana with bright pink goggles, and a sweaty N95? Tait

We have been doing this for about a month at our facility. Are you talking about N95s or surgical masks? For N95s they are to be used for three days, stored in paper bags in a centralized location (to keep them from being in lockers and floating around the unit counters) and then thrown out. Some of our larger hospitals are investing in UVC cleaning rooms and reusable masks with filters. For surgical masks you get one for the shift if you work with patients, and one for the work week (five days) for non patient care areas (again stored in a paper bag in a centralized area). All come with stipulation to replace if they become soiled, wet, or ill fitting. It is not a perfect situation by any stretch of the imagination, but at this point it is what we are doing to make sure we have gear at all. We have not at this point had any significant outbreaks among staff and we are metropolitan hospital.

While the cost of healthcare is a mess, it is not solely on the hospitals where the current prices are at. This being said, we are hemorrhaging money due to the just the short shut down on elective surgeries and outpatient clinics we went though in March and April. While federal funding will help us recoup some of the lost revenue (I work for a not-for-profit system) it will barely bring back 1/6th of what we will lose. Hence the furloughs, and the FTE reductions, and system C-Suite taking a 60% pay cut through the end of the year. I would love to pin everything we are seeing on pure hospital greed, but it isn't nearly as simple as that. These systems are large and complex and are reliant on even more complex government and insurance industry steam trains that cannot be stopped on a dime, if people even wanted to try. This crisis is cracking open, even further, the absolutely startling gaps in our social systems, yet people are spitting in retail workers faces for being asked to wear a mask. An Infectious Disease doctor once told me "Never get swabbed for MRSA because you will be out of work for a year." We know some of us are carriers. Many of us maybe, but without us working people will die for sure. If the infection rate is 20%, as some studies have suggested, that means risking sending home 20 of every 100 employees on a shift for two weeks. Testing will only be effective when it becomes systemic, and that can't just be on a hospital level. That has to be you, me, my DoorDash driver, my safe-at-home mom, and our children going back to school in the fall.

We don't have the PPE to support that kind of increase (we are already in cohort reuse of isolation gowns and gloves). In general the more PPE you put on people, the greater the sense of false security. People will self infect with poor donning and doffing practices and walk around with inappropriate and possibly infected gear in public spaces. Testing is a double edged sword.

That is exactly what I am doing. Working hard and by the sides of those who need it most, my nurses. I actually had seasoned RN come up to me last week. She is one of TWO wound care RNs for the whole hospital, yet her history in the ICU is long and dates back long before I started there. I asked her, genuinely, how she was fairing with her partner furloughed. She shrugged and said she would handle it, it wasn't ideal, but she would deal. I told her I had survived the furlough, but was anticipating a pay cut at some point. She then told me that she hoped not because she felt I was "essential" to the hospital and should be left in peace. That meant a lot to me, because she knows me well, and told me I was a value to her. ❤️

I was just talking to my CNO yesterday about stress management. Apparently my hospital is reporting the highest levels of moral distress in our hospital system. I recently started exploring our resources and found classes on leadership in COVID, 4 am zooms with yoga, HIIT, and Barre trainers. So I am planning a week long mental health resources push for the first week of June. I am going to get out there and let our staff know what is available.

In a nutshell yes. But I also understand the level of stress our staff are under and my role only became official at the end of last year, though I had been doing it informally for nearly a year.

Furloughs are rolling out, departments are being shut down, and the pressure is high. Having been an educator for over six years now I am used to being seen as "necessary but disposable". In my new role as a Manager of Professional Practice (nursing strategic planning/recognition/professional development planning) I was definitely feeling that vibe again yesterday as I walked amongst the units dropping off some self-care donations we had gotten. When COVID hit I was given the hospital educators to "direct", I am interim coordinator (which is looking like it will be more and more permanent every day) over the new grad nurses, I have organized and rolled out all education (with the educators) for cross-training, PPE changes, vetted innovations, helped modify policy after policy, reworked Code Blue, and sat on endless calls about everything under my umbrella and then some. I guess this is more of a vent than anything else. I am grateful my leadership team feels I add value to the team above the cost of my salary (I did discuss my willingness to furlough if it was felt to be the best choice, as well as recognized I may see a pay cut at some point) but I often don't know what to say to frustrated folks on the floor who just see their managers being furloughed and them being fed back to the hospital. Thanks for listening.

Thank you so much for all the responses!

My first job was four years on a complex med/surg floor (non-titrated cardiac drips, insulin drips, whipples, pre-open heart, post cath etc). When I went to a new hospital after two years out with kiddos and school, and before I got my first education job, I was dropped onto day shift where I just followed the other nurse around, and then went into night shift. My first night my preceptor got pulled to charge on the cardiac PCU they planned to transfer me to later, and I got someone who did precept. She abandoned me until 6am when I was treating a hypoglycemic patient with juice and crackers and started railing on me for not using glucose gel. I was like "well I guess you should have been here to make sure I knew the appropriate protocols for this hospital." Take the time to make sure you vet out all the kinks in what works for this hospital, but I agree the swapping teams part way through the shift is not useful.