Zookeeper3

I''m finding this as well in my Florida hospital. My unit has... get ready... a 68% of staff with 2 years exp. or less in our ICU. I'm exhausted from precepting, exhausted from my name being called thirty times an hour in every direction, and I left and went to rapid response The changes in health care... no foley's or central lines in my vented and sedated patient?? Really? Open visitation, families sleeping in recliners when I can't get to either the vent or IV pumps (all allowed), pharmacy that makes me count their pyxis meds, central supply that acts dumb and takes forever... lab that looses labs, then takes two hours to process stats, ..... .... and then I'm going to round hourly, use scripting, fetch coffee and blankets... fill out six extra forms to prove I did my work, while never being allotted the real time to do so.... THEN I can't make the frequent flier DKA'er happy who is NPO, they score me low on patient satisfaction survey... and I NEED remediation?? These are a few reasons why... patients are going to have increased morbidity and mortaility rates, but administration wants to make dang sure they are happy in the process.... Those who know better are leaving.

Dartmouth is hiring....

Thank you so much. I'm an ICU and ER nurse. I had no idea about AA, great information, thank you! Normally social work sets these things up, but we are doing more and more without resources lately. I really appreciate your time!

Hey all, I am working in an inner city ER with frequent flyers. THere is this middle aged man always found passed out on the road. We admit him, he goes through detox and starts to drink right after discharge. I've really started to bond with him. He says that AA doesn't work for him because he is a quiet loner and three meetings a day plus sponser calls turns him away from the program. I had suggested the program for general addicts, is it allanon? Can't recall, social work had set it up. Well he's back again. Now I know I can't help everyone, expecially until they are ready. But ARE there alternatives to sobriety instead of a super structured environment such as AA? Thanks

Depends upon the type of nursing. In the ICU, we do a full body system SBAR, with labs, the almighty wish list from the doc, family issues and general patient needs... like social work. A small ICU I've just worked at prints a kardex for the patients and both nurses review at the same time (computerized charting), it's redundant, but that's what they do. In the ER where I work, computerized charting completely, we pull up each patient and go through a SBAR format, while looking at what orders need to be completed. My issue with the kardex, is that the chart is generally not referenced and you only get a he said/ she said, and I miss orders that are pending until midnight chart checks and it is dangerous. If the kardex is used with a review of the paper chart and signed off in a shift change than I think this works just fine. I have little to no floor or nursing home experience so take my points with a grain of salt if the ICU/step down/ER doesn't apply to your situation, you may have other methods that work best and I respect that.

One more suggestion.. when a preceptee and I are having a difficult relationship, I make a contract to meet with them after report and allow them to give feedback as to how the shift went and what I was expected to do different. If it was reasonable, and usually always is, I would listen until they were done and pointed out three things that needed to be worked on the next shift and asked them to pick one. We agreed on it. The next shift I would reaffirm our teaching plan and adjust my praise, correction based upon the feedback. Not every preceptor has the people skills to do this, but you should DEMAND it upon your next hire. Make a contract with your next preceptor and give feedback. All too often, preceptors are chosen for their excellent clinical, NOT people skills. We need you newbies to give us feeback in an appropriate setting to teach us too! We are always evolving and learning. Give your next preceptor the chance to adjust to your needs, BUT you NEED to STATE them, as well as how you like to learn for us to know!

THe hard truth is that you will come across people like this your ENTIRE career and you just can't keep quitting!!!! I have told my kids and all those I have precepted for 17 years, that you DON'T have to like the person educating them, as long as they are competent and you can learn from them. THis is precious advice. I learned skills from hard nosed nasty nurses, I learned how to interact with the caring ones. I learned how to stand toe to toe with a screaming doctor from those nasty nurses. I learned how to drop everything and hold a hand and just listen from the caring ones. Each peer you encounter in your career has the potential to teach you something each and every shift. You can't run from the hard ones, but you can figure out what you need from them and what they need from you. ex. the hard a$$ nurse gets assigned the difficult needy on the call buzzer patient. I offer to take that one from them, and tell them I need the patient experience. The trade off is that my lab draw skills stink and I want her to help me improve my skills with the morning lab draws. This is about knowing how to work and work with people. It is a skill to be learned that will serve you well as you slowly become proficient in dealing with a wide breth of patients. It starts with our peers, please don't let ANYONE drive you out of a job, unless you are going to be fired, there is always wiggle room to work out a compromise. May I finally suggest, in the future, you immediately pull this nurse away in private and discuss how you prefer these situations be handled. It sure as heck is uncomfortable, but I've been pulled in for doing a few of the things you mentioned and quickly adjusted my precepting verbage and actions... ... we all learn from each other, you need to put in the difficult actions by stating what you need, like and dislike. I wish you well.

If you do a search here, you will find some strong opinions and some excellent advice that mirrors your thoughts, though not everyone is that social network savy. Once it's posted, it's there forever! I never ever post any specifics, but I do have pics of me drinking a beer or a frozen foo foo here and there. I might say," sure as all get out, it was a full moon and the crazies were out in full force". Now it didn't say I was at work, where I work, what type of work I do anywhere on my site. I could be working flipping burgers for all the public knows. I know enough to call my nurse friends and have a private complaint session... a public forum is NOT the place. In fact I am VERY careful here as well, as some need to heed that and give less details too!

You did great! Now management may speak to you and that is their role to investigate conflicts/complaints. Just remember though, there is a time to act instead of react. It's hard when someone is so RUDE! It took tons of practice, but I get quieter, and smile deeper (my devious smile) with these folks. - "I would have happily been here sooner if only you had hit your call bell to alert me of your needs..." -"your tone of voice is offensive, I will be happy to come back in a few minutes if you need to calm your tone of voice " -"did you mean ""please get me a smaller cup""?" -MY PERSONAL FAVORITE "I'm sorry, but your verbal abuse of calling me lazy will not be tolerated, I am stepping out to get the charge nurse to speak to you. If you want a new nurse I understand, we have many new nurses on staff tonight whom lack the years of experience that I posess, that you may find more suiting to your needs" I drive management simply crazy because my hands are folded infront of me, my smile strong, my voice oh so sweet. When you can master that, the sweet sweet words that you use to stand your ground protect you and leave your patient looking like the butt that they are. And that blanket thing, or "feed me" or any demand meant to be demeaning for me to serve them instead of facilitate independence is met with "oh, no sir, I am here to help you get strong, recover and return home as quickly as possible. So you do what you can yourself first and I'll do what you can't. Thank you for understanding I am here to provide EXCELLENT care to you" Choke on that press gainey!

no good deed goes unpunished :uhoh21:

My facility has it in the policy that lockers are hospital property and are subject to search without notice. Two staff members must be present, one must be security, one the manager or assistant manager of the unit. Everything found, is written down in a detailed report by security. Now in fairness, this is in MY policy, not yours and a professional manager will ask any gawkers to excuse themselves to provide privacy to their search, but we all know which lockers belong to our peers! My old management would wisely search several locker to prevent the team from knowing the true "suspect". This does stink, and I'm ticked off simply by a nurse educator going through my work mailbox looking for papers. I know in my head it's company property, but still feel violated. So I understand how you feel. THis does protect you from errant co-workers who stash things like insulin, drugs like haldol and benadryl to be dispensed to patients without orders...( don't ask), let alone a narcotic diverter. I'm glad that nurse weeded herself out. You still should consider a sit down with the manager and an HR rep. to discuss how the search went down and was poorly handled.

Its a medical floor that may or may not take surgical patients. The primary doctors are in a residency program. They have a MD license, but need their training as intern, resident and specialty. They have supervising docs whom I assure you, you will be speaking to as these docs are in a learning phase. I have taught these guys a ton only to have to re-teach them three years later not to dare get an attitude with me. Its great because there is always a doctor in house. Its a struggle because they are slow to make decisions, check with the resident for everything and you have to spoon feed them sometimes.

Hmn, this is a wild card. I too had a DWAI, driving while under the influence, not intoxicated... three beers in three hours and was underage. This didn't prevent any employment, although I still have to disclose I have a conviction dating back to 1990 on my license and most times I apply. Because these charges are pending and not final, I would simply call HR and alert them to this on Monday, as well as get a lawyer to get it reduced. If conviced, even if you feel you were wrongly accused, any felony or misdomener must be reported if asked in the future. just know it automatically doesn't bar you in most states, although OHIO BON refused me because of my DWAI, even though it was 12 years ago.

Back in 1995 in a huge nursing shortage, yeah right... in Buffalo, I had to take a geriatric psyc position at $10/hr. I was dang pleased to get it, sick I know. That launched my career. I litterally applied to every single facility in an hours drive. Nursing homes wouldn't even take me. (no disrespect for my nursing home peers). Point is I had to take anything, anything no matter what the hours and it was 3-11 with three school aged kids, was hell on my marriage. After a year, and months of looking and begging recruiters (I think I wore down one who gave up and hired me into a long term vent dependent floor). From there I wanted ICU. I had to move my family 600 miles out of state to do this. I never would have though we were able to just up and leave, it was inconceivable, but we did. Now 17 years later, I've done everything from managed two ICU's, done EP/cath lab, precepted almost all of it and now my kids are grown and I'm a travel nurse. Things are not that different now, only if you are in a tight market like I was, know that I put in applications to every single facility every 30 days, called each HR person weekly and got on a first name basis with them. It WAS my full time job to get a job. Heck, I even brought in donuts to severat HR people that I had gotten close with from so many calls, just to thank them. I worked my hind end off, for the crappiest job and celebrated it. It really, really took that much work. Reconsider your efforts and compare them to mine and see if anything I did to succeed can assist you in your search. Constant pleasant follow up calls is what I firmly believe made the difference. I wasn't pushy, but friendly, asked for advice and stayed in contact with EVERY recruiter. I either wore them down, or they respected my drive to be hired, I'll never know.

One more point, thanks for putting up with me on my rant. I'm abit hot on this topic, as I've just changed my own BP meds, to more affordable ones with more side effects that drive me nuts, to save money so I can afford to pay for my daughters co-pays. My cupboard are stocked with ramen noodles. I'm an RN, my husband is an engineer and we do this to pay off the debt and not loose our house. At some point soon, my daughters health will be affected, as will ours, with our financial challenges and our quality of life will suffer. People don't realize, it happens to the educated, hard working and insured. It I happen to live with, every single day.