Tom123

With just a year of experience you hit the nail on the head. Keep up the good work. I hope you continue with your education.

I believe that a BSN graduate will gain more, and contribute more to his/her graduate program if he/she has about 5 years of experience. My reasoning is based on the fact that the clinical experience we had while in our BSN program did not give us a true picture of what clinical experience is all about. I also think that having the 5 years of experience will allow the graduate student to assertain what he/she wants to concentrate in at the graduate level. I had 10 years of experience between my BSN and MSN, and I had 18 more years of experience between my MSN and PhD. I must admit that I am glad that I did have the experience. I do not believe that anyone needs as much as I had, but experience really counts. You need to get your hands dirty. Learn what the basic RN is doing. You will never understand it, unless you have experienced it. Good Luck. :wink2:

Thank you for telling us your story. It really shows how important it is to have malpractice insurance. God Bless and Keep you.

That may be true. Depending on the state where you practice, your employer may have the right to collect any damages attributed to you, in a lawsuit. I know that is true in Florida.

I have malpractice insurance, and fortunately I have never had to use it. However, I do know of nurses who have used their insurance to defend them in court. Malpractice insurance does not defend you against the Board of Nursing. That is an Administrative Hearing. Malpractice insurance defends you when you are sued for malpractice -- negligence, wrongful medication that caused damage to a pratient, etc. These are defended in a Court of Law. However, you can be called to the BON for an administrative hearing on the same issures. Your malpractice insurance does not help you there. Keep your insurance. I remember a nursing student who stated "it is silly having that insurance, you are never going to be sued." She is the only nurse out of my graduating class that was sued within the first 5 years, and she had NO insurance. She lost everything, including her licenses to practice. YOU NEED MALPRACTICE INSURANCE. The hospital or facility says it will defend you. Who are the lawyers working for whe the hospital is sued or the nursing home, etc, and you are named in the law suit? The hospital is defended. You are out there on a limb, and the limb is ready to break. That attorney is only going to defend the hospital. They will let you sink or swim on your on. Hope this helps.

Nursing Educators do have a speciality. It is called Nursing Professional Development. I am certified in the field. A BSN is required to siit for the examination, plus other basic requirements must be met. If you pass the examination, offered by the ANCC, you become certified in Nursing Professional Development for a period of 5 years. The examination covers the following areas. Principles of Practice Educator Role Leader Role Consultant, Facilitator, and Change Agent Roles Researcher Role After 5 years you are required to renew your certification. In order to renew you must: Option A: Professional Development plus Practice Hours > Hold a current, active RN license in a state or territory of the United States or the professional, legally-recognized equivalent in another country; > Hold a current ANCC certification; > Complete the professional development requirements for your certification specialty which are: For this specialty only, professional development Category 1 equals 37.5 contact hours. If you double this category, then submit 75 contact hours. > Professional Development Categories 3 (presentations) and 4 (publications/research) cannot be doubled. Category 3 Presentations Present five different topics related to your certification specialty. Presentations that are a requirement of your employment are disqualified from this category. If you double this category, then you must present 10 different topics related to your certification specialty. These specialties may not double Category 3: Adult Health Clinical Nurse Specialist, Gerontological Nurse Practitioner, Gerontological Clinical Nurse Specialist, Nursing Professional Development. Audit: If your certification record is selected for audit, you will be required to submit supporting documents such as a copy of the presentation outline, abstract, letter accepting your abstract, or a letter inviting you to speak, and evidence that you actually presented the topic e.g. thank you letter on official letterhead. Category 4 Publication or Research Publication: Publish an article in a peer reviewed journal or a book chapter or develop education materials (such as a CD or web-based materials. Articles that are not yet published may not be used.) If you double this category, then you must have published two different articles in peer reviewed journals or developed two different education materials. Research: Serve as the primary investigator in an IRB-approved research project related to your certification specialty and completed during your five year certification period, or complete a master's thesis or doctoral dissertation in your certification specialty. You can double this category by competing two IRB-approved research projects as the principleinvestigator. You can also double this category by completing one publication and one research project. Nursing Professional Development may not double Category 4. Audit: If your record is selected for an audit, you will be required to submit supporting documents to include either a copy of the table of contents and a copy of the entire article or chapter journal name with the date and your name or the copy of the IRB approval letter or IRB letter of exemption and a one-page abstract, no more than 250 words, describing the research study and findings, and the period the research was conducted. Category > Practice Hour Requirement: Completed 2,000 hours of practice in which your primary responsibilities included teaching, managing, or consulting in continuing education and/or staff development. > Complete a minimum of 1,000 practice hours in your certification role and specialty; > Pay the renewal fee. Option B: Professional Development plus Testing if you do not have practice hours in your certification specialty. This option only applies to those certifications in which an exam is available. > Hold a current, active RN license in a state or territory of the United States or the professional, legally-recognized equivalent in another country; > Hold a current ANCC certification; > Complete the professional development requirements for your specific certification, as identified above. > Pay the renewal fee; > Pass the exam I am the author of the Ethics and Legal section in the Core Curriculum Text, 3rd ed. In my opinion, certification in Nursing Professional Development definitely qualifies as an Advanced Nursing Practioner. I definitely support placing this as the 5th Advance Nursing Practice Level speciality.

GoTo, What do you mean that this is on your license? I have never seen an application for a nursing position asking if I have a mental condition. The only thing you are required to report to a prospective employer is if you are on probation from the BON. It is non of their business. I thought I understood what you were going through, but I am now confused.

Hi Goto, I understand you are in a "Right to Work State," so am I. In Florida there have been cases like yours brought into court on a Wrongful Termination Lawsuit, and the employee won. I am sure your attorney has asked for and received everything from your previous hospital. They need grounds to terminate, even in a right to work state. Your co-worker who was told that if she became involved she would face disclipinary action -- THAT IS INTEMIDATION, and it is ILLEGAL. She can also bring a lawsuit, but she has to understand that they will probably find some MINOR thing in order to terminate her. Your situation does SUCK, but I still think there is a legal way to get back at the hospital for firing you. Ask your attorney what the actual laws are regarding wrongful termination. I bet there is some law that you can hang this hospital out to dry. This really makes me mad. I have been a nursing executive in a right to work state, and our policies required that evidence of policy violations be documented, and that the following steps be taken. 1. Verbal counciling 2. written warning (if for the same offense -- if for a different offense, you have to start over with #1). 3. 2nd written warning with supension up to three days, and documentation that employee has been notified that another infraction will result in termination. 4. Termination. I continue to hold you in my prayers. I wish there was more that I could do, because it is unfair to you. Please check out the Federal Laws regarding wrongful termination also. They apply in a right to work state. God Bless, Tom

RandeeN, I am sorry to hear about your burnout, but from what you describe, I can definitely understand. I am confussed. Is your nurse manager requiring you to have a note from your physician to return to work? I thnk the answer to that is yes. Also, who is refusing to let you see the available positions in the hospital? If it is your NM, then make an appointment with the Vice President. She cannot refuse to let you see what is available. That is illegal. I gather that you have been at this hospital for several years. You have probably gained a reputation as a good or excellent nurse. If that is the case, USE IT. Take your last few evaluations and see the VP. Having been in the VP position, I would much rather see one of my best nurses, go to another unit -- with less stress that loose him/her. As you have undoubtly heared the old saying, "Nurses eat their young." Well, regretfully, in many cases, Nurses try to eat other experienced nurses as well. The Best to You, and please keep me informed.

I am currently in the process of gathering research for a Nursing Book I wish to write. As you can see from my bio, I have been in nursing for over 40 years, and have seen drastic changes in nursing care, nursing judgment, and just how nurses feel about delivering patient care. I would appreciate every nurse's input on how you feel nursing has changed, or "Where Has Nursing Gone?" Thank you for your assistance in this project.

I am very sorry to hear that you are going through all of this. I know you do not have any drug/alcohol issues. Did you ever tell a fellow nurse, etc., that you were seeing a psychiatrist? If so, that is where the complaint stems from. I must ask, did you sign the consent agreement? You need to appear in front of the Board of Nursing and explain to them what has been happening in your life, etc. This will let the Board know that you are tired, because of everything you have to do, including work. Also, and please do not take this the wrong way, if your state has an IPN (impaired nurse program) seek them out. They will be able to assist you. I am from Florida, and the IPN program in this state is very helpful, not only for nurses with drug/alcohol problems, but also for nurses who are facing a trememdous amount of stress. This allows the Board to know what is going on with you, but also protects your license. As far as I am concerned, your supervisor acted too hastily. He/she should have come up to your unit, and spoken to you in private, to assertain what was going on. She could then have asked you if you would be willing to submit to a drug/acohol test. It is probably mandatory in that hospital. You may also have a case in wrongful terminiation. They forced you to resign or be terminated. They used pressure, without any evidence of wrong doing. Ask your attorney about that possibility. Please keep me informed of what is going on. I have dealt with several cases involving the BON. You and your family are in my prayers. God Bless

All IVs are gtts/min. I know we use a pump and schedule it to go over X number of minutes, hours, etc. But, when you boil it down iit all comes up as gtts/min. I know you are asking about other drugs, but are you having a problem with calculating gtts/min?

THANK YOU CUBBY777 This behavior must stop. I have been in nursing for 44 years. In the ancient days, we had to stand up and give our seat to the doctor, when he (very few female doctors) came to the nurses' station and was going to write his progress notes, orders, etc. Doctors got away with yelling at the nurses. Then I reentered the U.S. Navy as a Nurse as a Nurse Corps Officer, and rose in rank to LT, and Lcdr (Lieutenent Commander). I then out ranked the doctors. So when one started this type of behavior, I disciplined the doctor. I would not stand for the behavior. After leaving the Navy, and returning to civilian practice, I continued NOT to tolerate the behavior. In some hospitals I was supported, and in others, I was not supported. When I climbed the ladder and became a Nurse Administrator, I definitely would not tolerate the behavior. My nurses knew I would back them. Now, if the nurse was getting ready to do something that could be harmful to the patient, yelling might be in order. Otherwise, it is not. If a doctor has a problem with a nurse, he/she should go to the Nurse Manager and let them know. The Nurse Manager investigates the complaint to see if it is valid. If so, the nurse is counseled. If not, the doctor is informed that the nurse used proper nursing judgment, and the complaint was invalid. Nurses, seek out the Nurse Administrator. Have your Nurse Manager invite him/her to the next staff meeting to discuss this problem. I really think that in today's environment, the Nurse Administrator/Executive will support the nurses. Again, Cubby, thanks for your response. I agree completely. Tom

I must ask the question -- Was an experienced RN available for consultation -- or how about the Nursing Supervisor? I agree whole heartedly, NO physician has the right to yell at a nurse. It is actual hospital policy to call a physician for medication reconcilation, on admission, then the young nurse had no choice. But due to the hour, maybe some critical thinking is needed. My experience has been that ALL medications are cancelled upon admission. Therefore, new orders must be written. I know I have only been in the business for 44 years, but what physician is responsible for writing the admission orders? Is there a hospitalist in the house? There has to be some other course of action that could have been taken. I would love for the young nurse to copy the policy for all of us to see. That would clarify most of the questions everyone has, and also let us know the diagnosis, why was the patient admitted? Answers can be given more appropriately if all of the facts are on the table.

I would not have called the physician at that time, based only on the need to know the dosage of a med, that was not taken. I think you probably had orders for other antibiotics, IV probably. It is like calling the doctor at 1 AM for a sleeping pill or a laxative. Don't do it. But about yelling doctors. This physician would have yelled if he were the admitting physician, and the patient was in a crisis. I handle this a couple of ways. 1. I hang up the phone and page the doctor again. I then tell him/her how sorry I am for having been cut off. If he starts yelling again, I just make comment that I am quoting him in the nursing notes. If he does not wish to address these issues, I will contact my supervisor, and have him/her handle the situation. In these cases, I have usually called to Chief of the Service. If that does not help, I call the Chief of Staff. That usually gets results. I do this as the supervisor. 2. If the physician gives me a minute to speak, I try to explain the necessity of why I had to call him/her. I even let them know that it is hospital policy. I am bound by hospital policy. If he/she continues not to listen, I return to option #1, and work my way up the chain of command. Hopefully you have a very supportive Nurse Manager, and a supportive Nurse Executive. That always helps.

You listen for the "muffled" sound, and list that as the diastolic pressure. We actually have three reading for BP. ie -- 120/60/0. Hope this helps.

Nurses must learn that they can not meet every need of every patient. That is what Critical Thinking is all about. We must organize our work load as much as possible, realizing that something is going to happen to screw it up. How do we get out of this guilt? 1. List the major needs of your patients, and attend to those. 2. List the medium needs of your patients, and attend to those you have time for. 3. List the lowest needs of your patients, and you can probably forget about those. PLEASE, when you go home, do not think about what you have not been able to do. That is a setup for failure. Instead, think about what you were able to accomplish. However, and we have all seen this type of nurse, who does the least amount possible, tries to get other nurses to do it for him/her. That nurse needs to be guilty, and really removed from the profession. From when I entered nursing -- I carried the lamp for Florence -- until today, nursing has changed dramatically. I must say that I wonder if it has been for the better, but I am old. Patients are more seriously ill that when I first started. We had patients come in for the yearly exam. They were perfectly healthy. Now we have almost, if not, every patient being monitored. That means that every unit in the hospital is at least a step down unit. You cannot meet all of the needs. Some of the basic needs that must be met, is making sure the patient has a bath and that the linen is changed. It is amazing at how much this small item helps patients feel better. If the RN has enough time, and I am one who believes we can make that time, help the aide bath the patient. You learn so much. It is a perfect time for assessment of the skin, range of motion, wound healing, etc. You have really accomplished a total body assessment, along with AM care at the same time. I digress. Just keep the priorities straight. Ask yourself if you meet those needs that must be met. I bet the answer will be yes.

I am assuming that you are a physician, based on your screen name. I agree with your assessment of Ultram. What continues to baffle me is why physicians will not refer their chronic pain patients to a Board Certified Pain Management Physician. I have chronic back pain, post 3 spinal surgeries. My pain physician is a Board Certified Anestheologist and Board Certified in Pain Management. Chris is fantastic. He constantly monitors my pain, to ensure that I am receiving the best relief possible -- that is reducing my pain to a tolerable level. As to the point about depression. Many people do not want to admit depression, because of the stigma. Regretfully, ALL chronic pain patients have depression -- from the pain. Again, this is a great teachable moment for the physician to explain to the patient about depression. Of course, we all know that it will be the nurse doing the explaining. I hope everyone involved in the care of pain patients do this type of education. In most states education by the RN is mandated in the Nurse Practice Act.

This is a difficult problem. I would really have to know the patient's history before I made the decision. I would hope the physician discussed it with the patient. I would ask if there is anything in the chart showing the patient is really drug seeking. What is the patient's diagnosis? I would really like to see a physician, who is not sure about pain medication, to seek a pain management referral for the patient. Regretfully, there are doctors who think the patient is faking. I always fall back to this: If the patient says he/she has pain -- he/she does. The pain is as bad as the patient tells me. On the other side -- While I was a Navy Nurse, I saw the use of placebos used in amputee patients, well past the post-operative phase. They were usually given for phantom pain, and it worked the majority of time. The doctor then told the patient what we had been giving him, and that he - the patient - had been controlling the pain all along. Some patients think that a pain med should completely eliminate the pain. That is not the purpose of a pain med. The pain med, brings the pain down to a tolerable level. Hope this helps.

I like the way you think. I have read a couple of your responses, and from what I can gather, you entered nursing for the right reasons -- to care for patients. It is refreshing to see a young nurse look at the "team" and the patient. Keep up the good work.

The decision to remove the NG tube has been made by the family. The patient, himself, may have made the decision prior to having a stroke. That is the purpose of a Living Will. It allows us to make those decisions, so the family will not be stuck with it. It allows children to follow the parent's wishes, rather than have the guilt. They are doing what mom/dad wants to have done. Death and Dying is a difficult topic for some nursing students. It needs to be discussed openly. One day you may find yourself in the position of removing life support systems from a patient. The patient will have made these decisions, or there NOK, or designated surrogate will made the decisions. Before you can help a patient face death, you must first face your on death. I have taught BioMedical Ethics for several years. I would recommend that you write your own obituary. This sounds rather morbid, but it does put you in the position of facing your death. Once we understand, and really understand, that all of us will die, then we can help a patient, family member, friend, face their death, or the death of a loved one. Read Kubler-Rose's book On Death and Dying. It will help you understand more. Keep up the good work, and best wishes.

Thank you for your response. I asked the question about assisting with baths, because we have 5 major hospitals in the area. Of those, 3 do not use aides/techs. I had major spinal surgery 2 years ago, and was not even asked if I needed any assistance with a bath, nor was my bed changed. That is one reason why I ask, Where has nursing gone? Thanks again

I am currently doing some research on "Where Has Nursing Gone?" I am looking over the past 45 - 50 years of nursing, and wanting to look at how we delivered patient care, and how are we delivering patient care today. What are the differences? How much impact is the nursing shortage? How much impact has the 12/12 shift had on patient care? Why do nurses no longer give bed baths, or assist patients with a bath, when needed (ie., post surgery)? Any suggestions on books on the same topic would be greatly appreciated. I would also encourage your on responses. If you do give me personal responses, please include: Age bracket: 20-30; 30-40; 40-50; 50-60; 60 and over. Years of practice:

I have been in nursing 40+ years. I must agree with the nurses who recommend a Med/Surg unit. You will learn how to manage a patient load on this unit. You will refine your basic skills, and learn more. Before going to the "high tech" units, get your feet wet and hands dirty on Med/Surg. PLEASE, do not be afraid of "getting your hands dirty." This will make you a much more valuable nurse. Remember, we go into nursing to care for patients' needs. That includes the dirty work. Empty the bedpan, Please bath the patient, be with the patient when he/she vomits, and then clean it up. You will gain the respect of all of the Aids, and the majority of your colleagues. There will be some nurses, hopefully not a lot, who believe they are to good, or to high on the ladder, to do the dirty work. That is where we learn.

It is GREAT to see a Hospital Corpsman Second Class in this forum. I too was a HM2, prior to receiving my commission as a Nurse Corps Officer. Wish you the best