seenitallERnurse

I could have written this letter !!!! All areas are true. Intimidation about job security, staff reduction, liability for the entire unit if one patient falls...................jobs are restructured and re-aligned (it's cost-effective). After 30 years, my job doesn't exist. I have no choice but to move on.

did have a gentleman try to "tip" me $5.00 (but yet he couldn't pay his own cab fare and i had to provide a cab voucher:confused:.) i firmly and gently declined the offer but suggested he could write my name (and others) on the follow-up pt survey he would be receiving in the mail in a few weeks. i always tell verbally-appreciative pts/families they may drop a note for administration praising our staff/dept. we always seem to hear all the negative feedback--it's nice to get positive feedback that the "suits" hear also.

wow, this info is really helpful. my hubby is a teacher and i've considered year to year walking away from hospital nsg to start school nsg. the hr info is great but i have some other questions re: experiences as a school nurse. 1) are you confronted w/ social issues? how often? and what is the chain of follow-up? (i.e. if a child confides to you that they are the victim of abuse in their home, they may be pregnant, they are suicidal, they need information on abortion, they seek treatment for an std . . . ) how far reaching is the scope of a school nurse expected to be to deal w/ these types of issues? 2) do school nurses regularly "take heat" from disgruntled parents like many teachers receive? 3) do school nurses have a significant, daily role in the care of dev. delayed students? do nurses give tube feeds & meds or does the 1:1 assigned "caregiver" accompanying the child do those tasks? 4) is documentation in the school setting as horrendous, or even more horrendous, than most institutional settings? thanks for any experiences . . .

popular thought used to be work at least one year on a med-surg floor -- provides for a variety of educational experiences. might consider a single-focus area though--you'd have fewer protocols, etc. to have to keep up on. you might learn less skills but you'd be solid in the skills you learn in that area. also, consider shifts; all of them have positives and negatives. nights = more patients per nurse probably; less ancillary help available; but, also, fewer procedures, interruptions. but don't think that all pt's sleep all night--it's very difficult for many adults to sleep well anywhere besides their own bed. dayshift = probably better staffing ratio; more interruptions from other departments (scheduled tests, surgeries, meals, therapy). plus, head-to-toe assessments on everybody, pass meds am, mid-morning, noon, mid-day, suppertime. and, as you said, it depends on hospital management and floor management. follow something you find most fascinating during college--wherever your interest lies, you'll be willing to excel. best of luck to you !

originally posted by "lucretiamott i had a hard time paring down my list but to summarize: i was asked to do the following as an nurse practitioner under managed care planning: {# 1 - 8 }" wow, shaking my head in disbelief.

nurse4years; "i have seen these scripted sayings posted in the staff restroom- directly across from the toilet. talk about a new spin on subliminal messages." lol :yeah:

omg ! i just had this meeting yesterday at my employer. yup, had to come in on a pleasant summer afternoon for an hour, watch a suit make three attempts to start a pre-taped video, endure audio out of sync w/ the video, and then be told there will be eight more topics to be covered in the coming months. the staff in the lounge afterwards (20+ years service nurses) are so insulted. our point, we were raised w/ the character we need by our parents and probably had all the instruction we needed before age seven or twelve. one said, "if you don't already have this, i'm not sure you can teach this." but i get weekly e-mails from the top suit re: pt satisfaction scores. (i would block those e-mails if i could figure out how to do so w/ our new program.) i agree: if you trust me to give safe, complete care to whomever chooses our institution--putting their lives in my hands--don't you think i know how to give outstanding customer service as part of that care? er is a tense, sometimes fast-paced, intimidating setting for many pts and their families. i am always striving to set pts at ease, reassure families of the best care our "team" can offer, and facilitate their return home, transfer for further treatment, or admission to our own facility. i've been verbally thanked, enthusiastically hugged, kissed (by someone recently released after incarceration--a very hyper little person--thankfully did not land anywhere above my neck:eek:). other times, the appreciation may not be spoken, but i know it's there. i don't sweat dissatisfied customer's report to a survey questionnaire. i do my job to the best of my ability--always have, always will--and when i hit a point where i no longer would--i'll change occupation.

point made !

"i just don't understand how this can be proven-unless you are under quarantine influenza can be brought in by visitors and vendors,not just direct care staff...." you have echoed my thoughts. the infxn control staffer said " i know of a case . . ." implicating a physician or pa in passing flu to a pt under their care. i'm just thinkin' ... "ok, maybe it came from the hcp or maybe, just maybe, it came from any number of visitors--who didn't know they had flu symptoms yet or they would have refrained from coming." when these studies are carried out, why are hcp implicated as links? did the "studies" examine the non-professional staff as part of their data.? were ancillary staff also evaluated as to possibly being linked to passing a flu virus around? it seems nsg staff and docs are at fault, but there are any number of personnel that a pt can come in contact with throughout their day, and any employee could be coughing, sneezing, touching surfaces and passing along a germ. i just wonder how extensive such "studies" are when conclusions are disseminated to employees and the public. and, yes, how does the working man find out what truth there is to challenges being received from medicare re: lowering reimbursement? thank you, nrskarenrn, for your references. i appreciate all the responses. it seems a mixed bag--some plan to accept the vaccine; others will decline. i'll continue researching influenza vaccine effectiveness over various flu seasons. and i'll review your references for joint commission, etc. it figures they would impose in the area of employee compliance for vaccinations. i'll keep researching. . . who knows, i might change my mind and go for it.

i just heard this last week and want to know what anyone else has heard. the infection control person at my employer let us know that we will be expected to accept the flu vaccine for the upcoming 08-09 flu season. i don't plan to accept the vaccine but i was incredulous that this edict would be passed around. i believe we were warned that we would have to "sign a form of declination?":eek:--never heard of such a thing. the justification for attempting to mandate such action was : "medicare will be lowering reimbursement for institutions that don't have a high-enough percentage of compliance." has anyone else heard any of this yet?

I saw this guy dithering to Robin Givens on the morning news show. Had a lot of trouble following him. However, I think someone 1) overmedicated and 2) erred in allowing him to go home, if in fact he didn't stay overnight the night of surgery. As a profession, I know doctors "underprescribe", nurses "undermedicate", and patients "under request," so I try to be non-judgemental about pain as reported by patient's--even if I don't actually believe the report. I would still medicate. But, it'd ridiculous to send someone home with all the different sedating meds on board. It also sounds as if he was seriously uninformed--and that fault lies with him and his surgeon(s).

great question! i feel for the newbies out there but you gotta keep plugging away. in er, i actually do learn something new everyday--and i love it! i'm so tired of "floor nsg" simply because i think nurses have so much responsibility, little help, and less time to get everything accomplished--not to mention the unforeseen interruptions from well-intentioned family members or just a change in the pt's condition. in my unit now, nurse/pt ratio is clearly defined but, being an er, we also have lots of teamwork. i'm not sure floor nurses have that luxury with their nurse/pt ratios set higher. mistakes? i've made a few. but know this, you do have safeguards in most hospitals--especially if jcaho comes through your institution. pharmacies are as careful as they can be packaging/labeling, the nurse has to check all the "rights" (time, pt, medicine, dose, route), and always stop and re-check orders if a pt legitimately questions a medicine you are offering them--trust them to flag an error, in other words. i think it took a couple of years for me to feel "comfortable" but as hectic as nursing units are today, who could blame you for feeling so harried or overwhelmed? keep plugging--and don't be afraid to ask questions.

hey, not-so-jolly holly, don't give up on the profession. after i graduated, i interviewed for a busy med-surg unit. the interviewer assured me that it would be very busy (3-11 shift--lots of post-ops coming back after am surgeries). she scared me enough that i waited six months and hired in on another unit. i graduated may and hired in the next february. not a good idea, but my pedi unit mgr was generous and gave me eight weeks orientation (usually allowed six weeks). through a twist of fate beyond my control, i was on the very med-surg floor a year later. of course, by then i did have some experience and confidence but yes, it was busy! i agree with the suggestion to consider returning to the same employer but see if they could re-assign you to another unit. or, just consider another employer and avoid med-surg. if you could find a single-focus unit (neuro, oncology), you would still have to learn specific new things but maybe not as hectic as med-surg can be. we need nurses--you, your skills, and your knowledge are in high-demand. don't walk away from it. something will work out just for what you need!

Really enjoyed Timothy's comments re: Ivory Tower. Consider this. In my experience, all the information I needed was taught in two years and I received an ADN--qualified to deliver nursing care. When any ADN returns/continues on for BSN--what can they teach that you use on your job that you don't already know? Oh, well, let's see. THEORY, maybe?????????????? As I see it, the academic institutions must find a way to bring in revenue. Since third and fourth year students are already qualified and have all necessary knowledge to be licensed by state boards, institutions decide "We'll teach nursing theory--oooooooh, yeah, that'll work. It sounds real humanities- and arts-like and it'll look good on transcripts for those desiring Masters degrees. But, NO, I don't know of any theory used in bedside nursing or charting. When I hired in, care plans were brand new. I never knew of a doctor that read one (to approve or gain enlightment)--they were kept in the nurses' paperwork--not the chart. The floor nurses never had time to review them, so care plans were of no benefit to MDs nor nurses. Nursing (ER and otherwise) is very much gut-instinct at times. You have a "gut" feeling that something has changed or will change. I don't see how any theory can teach you that. I do believe foundational academic courses and bedside experience will help. So, NO, I don't see practical application of theory in my years of bedside nursing.