jayebug

Oh, no, by BPD, I meant bipolar disorder-guess that's what happens when u make ur own abbreviations :)

I have ADD (inattentive type), and I lost my job for being, well, inattentive (don't worry nobody died, actually in my 11 yr career, no one has ever experienced any harm under my care which even some "normal" nurses can't claim) I wasn't taking my meds because my insurance company sides with the DEA in thinking they are evil and I'm gonna start selling them to naive college kids. I tried to shelter myself from that stigma. But I say, no more! Maybe I'm a little late here, but after losing my job I did some soul searching, got back on meds and with some investigating, I realized Florence Nightingale herself was reported to have BPD. The mother of modern nursing! I wonder how many employers would have given her a pink slip? Anyway, it just reinforces everything I always thought about mental illness or disabilities. We are the innovators and the inventors-without us, life on earth would pretty much suck. I'm not saying that it's not my responsibility to treat my disorder or take my meds so that I can keep my patients safe. I guess I'm just hoping to communicate to others, who are experiencing self-doubt in this modern job market that still shames mental illness, that, when appropriately harnessed, your mind can do beautiful and wonderful things! I'm glad to know that people like Charles Darwin, Winston Churchill and Abraham Lincoln all had the proverbial monkey of mental illness riding on their backs! In my opinion, I'd rather be like them than normal or boring!

I have ADD (inattentive type), and I lost my job for being, well, inattentive (don't worry nobody died, actually in my 11 yr career, no one has ever experienced any harm under my care which even some "normal" nurses can't claim) I wasn't taking my meds because my insurance company sides with the DEA in thinking they are evil and I'm gonna start selling them to naieve college kids.I tried to shelter myself from that stigma. But I say, no more! Maybe I'm a little late here, but after losing my job I did some soul searching, got back on meds and with some investigating, I realized Florence Nightingale herself was reported to have OCD! The mother of modern nursing! I wonder how many employers would have given her a pink slip? Anyway, it just reinforces everything I always thought about mental illness or disabilities.We are the innovators and the inventors-without us, life on earth would pretty much suck. I'm not saying that it's not my responsibility to treat my disorder or take my meds so that I can keep my patients safe. I guess I'm just hoping to communicate to others,who are experiencing self doubt in this modern job market that still shames mental illness, that, when appropriately harnessed, your mind can do beautiful and wonderful things! I'm glad to know that people like Charles Darwin, Winston Churchill and Abraham Lincoln all had the proverbial monkey of mental illness riding on their backs! In my opinion, I'd rather be like them than normal or boring!

Thanks :)

Hey, Viva, How did you come back from being fired? All the jobs I've applied for have asked me for info on my last place of employment. I'm so afraid they're gonna call my boss whose last words to me were "I have to put the safety of the patients first." (Now that's a downer if I ever heard one!) I've done a lot of soul searching lately and have been applying to jobs in other specialities, like psych. I worked at a drug and alcohol place a couple times through an agency and LOVED it. Problem is, is that I have no psych experience other than the 3 or 4 shifts I did at the D n A place, and that was 2 yrs ago, so I doubt if anyone remembers me. There was also a lot of agency people cycling through there at the time, so that doesn't help, but I got feedback that they liked me and thought I did a good job. How do I fill out apps in the wake of a termination? I feel like my career could possibly be over

Ugh, this site won't let me PM, but I am interested. My son has ADD as well

Thanks for your reply, I guess I just get a lot of feedback from my friends and family that 1.ADD doesn't really exist, like my best friend, who has a tendency to be a little judgemental at times, really because she's so overwhelmed, who told me that my life started to unravel because of my meds, and that I don't need them because I'm not really "crazy" as she put it. Or 2. That amps are weird and evil and nobody should be on them because they make you act like Jesse on Breaking Bad after he snorted a boat load of crystal. Not that I ever behaved in that way (and it's not me just thinking I didn't, most people outside of my close circle don't even know I take them-like my co workers, and that's when I'm usually on them, when I'm at work). But there's a lot of stigma I've been battling. I think my condition requires the stability of a routine. The places I've worked at the longest were the places I didn't get fired from, and that was even before I was diagnosed with ADD. It's when I changed my routine that everything really started going crazy. I worked at one institution for over 10 years, so I was well aware of their policies and procedures, and we managed our own tele monitors. We also were required to check the monitors as part of our shift report.

Hi all, Just got fired from job #4 of an 11 yr nursing career! I'm startin to think maybe I'm tryin' to fit a square peg into a round hole w/this nursing thing. I'm on meds, but I haven't been taking them cuz they're just too expensive! (I have to pay outta pocket cuz my crappy insurance won't cover amps!). Anyway, during my career, I've had long stints where I didn't get fired, or even written up, esp. while working at a large university based hospital. But I left that job to try homecare (big mistake), and couldn't get back into the hospital. I worked travel assignments for a while and never got fired from any of those, but I took a per diem job where my best friend works in June. So, Mon. night I went into work and got report on an admit who just came up from the ER. The nurse who gave report told me the pt was on tele. The tele at this place is monitored by techs on another floor, and we don't check the monitors during hand off. The guy had a box on, so I stupidly believed he was being monitored. This place is also really, really busy. I got another admission, we had a code on the floor, I had 5 patients and 4 of them were completes. We had one nursing assistant, so I had to do most of my own vitals. Anyway, I noticed at 6am, when I finally got the chance to sit down to chart, that the pt wasn't on the monitor. He hadn't been all night. I know this is my fault, but I'm so sad that I was inattentive. My manager was so ****** at me. She asked me (and I love this question) "what the hell were you thinking?" I said "I don't know". What I really wanted to say was "You don't even wanna know! If you could experience my brain for one second, you'd probably be wondering how I eat, walk, or even tie my shoes it's sooo fast and cluttered!" Maybe I'm not cut out for this, what do you guys think?

Yeah, ok, making bullying a sentinel event could be viewed as going a bit overboard, but honestly, I haven't seen much of an improvement lately. So, maybe they need to be ridiculous to get their point across. I'm a traveler, so I'm like a bully magnet. Especially considering that most of the places I've been sent to need to sub contract staff because of some sort of dysfunction going on somewhere, which usually results in this kind of "pack" mentality among the nurses. I haven't been a regular staff member for a while, but I have seen it when I was, and regardless of whether the target is the convenient outsider or a regular who's just a bit different, it's still ugly none the less. I think a lot of times this behavior comes about for several reasons, but I think the most apparent is that we are innately trained to look for any possible problems that exist in a multitude of different delivery systems, so, some eventually turn this form of auto examination on their colleagues. The benefit to this type of thinking is that many will find some way to rationalize the exclusion of themselves in the process.There always seem to be those amongst our peers who are looking for "the weakest link" because they think it benefits patient care. Unfortunately, when too much time is spent searching for the flaws of one's colleauges and reporting those findings to management, the ability to be there for the patient is removed. Honestly, when I'm at work, I feel like I'm too busy to be paying attention to what everyone else is doing, so unless they're stumbling drunk down the hallway, I've been answering their call lights all night, or their patients seem to end up coding a lot, I just keep to my business. Maybe that's why this charge nurse has been placed under the microscope as well as the MIA supervisor. The charge nurse has just made it a point to soil the reputation of her co workers too may times, to the extent that management is just sick of hearing it. In that case, I say good for them.

I guess, since it's nurses week, I've been reflecting on my career choice, and regardless of whether or not anyone wants to be subjected to any of my revelations, I thought it was necessary to share them. Lately, I've been thinking about what it means to be a nurse. In nursing school, I had an instructor who stated that nursing, as a career choice, is "a calling rather than a profession." I think her words stuck with me because it really defined how I view nursing practice. To me, a nurse is an educated professional who incorporates their continuously acquired knowledge and skill into the action of providing care and guidance to each specific patient in order to assure a more desirable health outcome. Wordy, I know, but let's just say that it's difficult to touch on every facet of nursing in one sentence, so I'm trying to describe here, what I view are the most important aspects. These are : education, patient instruction, implementation of a finely tuned skill set, and overall planning and collaboration. I purposefully did not include the execution of tasks or documentation of events here so much because I honestly don't believe that these are MOST important parts of nursing practice. And I never will. Of course, this always seems to cause an uproar amongst my colleagues. I think mostly because they're missing my point. I won't say that task completion or documentation isn't important. It is. But I find that, in the course of any given shift, nurses are so inundated with tasks and documentation that, really, in an attempt to deliver excellent patient care, one must really prioritize their actions. I'll give you an example. I recently had a patient who was admitted to my unit around midnight on a night shift with a diagnosis of pnuemonia and pancreatits. If you think about all those nursing diagnosis you learned in school, then I'm sure you understand that inadequate oxygen exchange, pain control, and fluid and electrolyte imbalance (secondary to vomiting) were the priorities when developing a care plan for this particular patient. So, I got report from the ambulance crew, and, after I insured the patient was well oxygenated via nasal cannula, I brought the bedside computer (or WOW) into the patient's room and completed the admission. I drew and sent his labs, reviewed the doctor's orders, checking specifically for pain medications and antibiotics, prepared for him to be sent for various scans and tests, and, after verifying his name and date of birth via ID band administered the appropriate medications. The patient had come to the unit via the health system owned ambulance company from a subsidiary hospital. The ID band that he had on was from that hospital, unfortunately, in all the hustle and bustle of his admission, I forgot to apply a new ID band. OK, not good. I admit my mistake. The ID band he had on looked identical to the ones that were specific to the hospital where I was working, because it was the same health system, but it didn't have the correct institution written on it. Upon discovering this, the day shift nurse alerted, I think, every possible disciplinary figure she could think of and, subsequently I had to answer to my nurse manager who described this as "a very serious issue". The upside, however, to my meeting with the nurse manager was that she emphasized the importance of bedside hand off in order to review anything that has been missed by the previous shift. I firmly believe in bedside report, although, many times I get a lot of resistance because I think that the other nurse feels as though I'm looking for things to bring to the attention of management, but honestly, I'm thinking of the patient and providing a smooth continuum of care. I can tell you that in the course of my 11 yr career, I have only "written up" two people and that was when patient safety had been seriously threatened or compromised. This goes back to my statement of what I think the most important aspects of nursing practice are in that I cannot prioritize the disciplinary action of another nurse over delivering patient care unless their actions are serious enough to merit this and/or are further unresolved by simply speaking to that person. The importance of appropriately prioritizing patient care related tasks and documentation is something that I feel is missing in the nursing profession. I use the above example as an illustration of this. My point being that with the recent*increase in litigation that has been occuring over the years, it seems that nurses are forced to view every minute detail of our interaction with patients as being especially relevant to their overall care. In all of the what was going on in the specific scenario I just described, I can really see how I missed the ID band because it was really at the bottom of my list of prioritized tasks that I'm certain would have been completed in entirety should I have had the time. I know. It's the age old "24 hr job" thought. Am I negating it's importance? No. I'm just saying it wasn't AS important as some of the other tasks that I actually did complete during my provision of care to this particular patient. I'm also concerned by, what I have seen in many facilities and would describe as, an emphasis on overdocumentation. The truth is, many facilities are keenly aware of the legal ramifications of providing an inadquate timeline of services rendered to the patient. The initial introduction of the nursing flowsheet was one way of establishing a "blow by blow" record of patient care services, status of a patient's condition, and reaction to treatment. However, it seems that a lot of nurses fail to view it as such, placing their emphasis on the written narrative instead. This quote is from a recent article I was reading from the American Hospital Association that stated: "One strong advantage is that flow sheet design can incorporate clearly defined expectations for the type of patients cared for on each unit and in each care setting. A standardization of forms process within each facility allows caregivers to provide consistency in patient assessment and documentation. The CBE system still requires POMR documentation of significant or abnormal findings yet does not require narrative noting when expected outcomes are achieved by nursing interventions. Charting by exception can reduce the amount of time spent on documentation.Charting by exception has the potential to be a great asset to electronic medical records documentation. The use of quickly scored checklists that document routine matters complement at-the-bedside computerized data entry. By shifting the emphasis from descriptive, discursive narrative paragraphs for every routine and expected event, CBE uses minimal narrative notes for only unexpected or highly significant events. CBE may be the cutting edge of medical documentation (Stansfield, K., Yetman, L., & Renwick, C., 2009). " In short, I'm not a note writer. I never will be. I guess my question, here, is if we are being provided with technology that allows for us to spend more time at the bedside, then why are we not using it appropriately? I also completely agree with decreasing the nurse to patient ratio, but I disagree with the idea of spending the extra time that this allows for by excessively documenting on those 4-5 patients. The article I quoted before also stated: "If it wasn't Charted, it wasn't Done"*is inaccurate and misleading,according to Dan Small of the legal firm Holland & Knight and Launa Rutherford of the firm Grower, Ketcham, Rutherford, Bronsor, Eide & Telan.Good documentation is important, they continue, but documentation is not care. "Nothing in the law requires health professionals to document everything they do or say. That would be impossible."*Charting should be "a way of trying to record things that give a fuller picture of the care", along with specific key elements essential for documentation." I worked at a very prestigious facility recently where the manager of my unit boasted about adequate ratios and the recent introduction of a paperless EMR system, but I still found that the staff was placing priority on written notes even when nothing untoward had occured during their shift. They justified this by saying that "it only takes a few minutes to write a note", but, as I stated before, why are we allowing for this to become just as crucial as caring for the patient at the bedside? I was under the impression that one of the reasons EMRs are becoming so popular in facilities was, not only, to standardize documentation but to make it less time consuming to meet the required standards for describing what happens to a patient during any given shift. I think that viewing the EMR as means to increase the volume of progress notes in a patients' chart is sadly erroneous and it keeps nurses away from their patients. In conclusion, I just wanted to share some of my thoughts and concerns about our practice during nurses' week. I agree that my views may be seen as non traditional, but I believe nursing is a professional occupation that should be open to evidence based actions. I tend to disagree with a non reflective, "just stick the pill in the cup" modality that still seems to be so popular, even amongst new nurses. I really think it's okay to not be an automaton!

I'm a RN in the Phila area with 11 yrs of telemetry /stepdown experience at UPENN. I tried homecare for a while, because, as a single parent, I thought it would help me have a normal schedule. But I ended up working 60 hrs/week, and I was only being paid for 40. I tried to go back to the hospital but was turned down for jobs (and even invitation only job fairs) left and right (shortage....what shortage?). I'm now a traveler because I can't find work. It seems like I'm in the same boat as the new grads because the hospitals prefer nurses who have between 2-5 yrs experience. Am I losing my mind, or is this a correct assessment? Anyone else in the same predicament?

Hi, I just finished an assignment there. At first I thought everyone was really nice. I have to say that they aren't outwardly hostile towards travel nurses. They seem to accept you as regular staff. Towards the end of my assignment, however, I really felt bullied by some (not all of the staff), and was being reported on a regular basis for simple petty stuff that other people were also doing but somehow managed to dodge any kind of reprimand. I haven't worked in Maryland before, so I didn't know the culture, but from what I have heard from the clinical resource team at my company, the RN is responsible for everything, and I mean everything from stripping a room after discharge, to drawing all AM labs, to monitoring the equiptment for malfunctions, to transporting a patient to and from a test and staying with them if they aren't allowed to leave the floor off tele. If anything untowards occurs during the patient's care, it all falls on you. For instance, I was off the floor twice during one 12 hr shift. During this time, the nursing asst did a fingerstick on my patient and the result was low. Of course when I got back, I had to catch up on everything and it made my day totally hectic. The patient remained vompletely asymptomatic. The NA never informed me or the charge nurse about the blood sugar. When this was realized in report later on, I got nailed for it. Sure, it's ultimately my responsibility but if you're swamped (which it seems to me to be the purpose of a having a nursing asst) and the techs help you, just know that they are not responsible for the care they deliver because they don't document it in the system, and they are not obligated to report anything of the ordinary to you. If the phlebotomist agrees to draw a lab for you, they aren't obligated to actually do it. If it doesn't get done, it's your fault. I'm just telling you this so you know upfront. The acuity is high, and the patients are needy, so just get your documentation done very early in the shift so that you can prepare for stuff that might come up later on. Parking sucks. Make sure you get your parkibg form into the transportation office early to get the 8 dollar rate. The staff is a younger set-mid to late 20s who have about 2-3 yrs of experience. They seem to prefer similar people. Hope that helps.

I realized, rather recently, that I have been bullied for most of my life. The only place I didn't feel bullied was when I worked in California. That was what kinda clued me in. I was bullied all through high school, but not so much in college because I didn't live on campus and attended classes part time. I've even been bullied by my own family. I know it sounds crazy, but I think my past treatment caused me to become a target, like I have this personality that bullies seem to gravitate towards, and I just accepted it because I felt like it was the norm. I'm a travel/agency nurse too, so that doesn't help. I'm automatically the outsider. At my last assignment, I was in my manager's office every week. Sometimes for things that weren't even my fault, like they told me my documentation was incorrect on a patient I had never been assigned to. And it was mostly petty stuff too, like not specifying a Heparin drip on the I and O section of the flow sheet when I had documented it in the IV med section, and in my computer charting. I admit I missed some things, and I own that, but it was never anything that placed a patient in imminent danger, like once I forgot to place an ID band on a patient who had been transferred from another facility within the same health system. It was so horrifically busy that night, and at change of shift the patient still had on the ID band from the other facility (it's not like he had NO patient identifier whatsoever, and he was even transferred from the other facility via the health system's own ambulance). They made me feel like this horribly incompetent nurse. And I realized that other people were making the same mistakes, or even worse ones, but somehow they managed to stay out of the manager's office. I guess my biggest fault was that I would take their complaints and mull them over, wondering if they were correct in their assumptions before I defended myself. Once they see they've shaken your confidence, I think it's more difficult to keep yourself from becoming a permanent target.

Hey all, I have temporal lobe ADD (no hyperactivity) secondary to a polymorphism of dopamine beta hydroxylase defienciency. In other words, I have behavioral symptoms and autonomic nervous system defecits that effect my blood pressure, blood sugar, lactation, temperature control etc. I do have a lot of trouble sitting still, and often fidget or shift my position, although my doctor thinks this could also be because sitting causes my blood pressure to drop and I'm naturally compelled to move because of this. I've been a nurse for 10 yrs, but my symptoms have been getting worse as I get older, which is common with this disorder, and now that I'm in my 40s, I find it hard to keep up with acute care nursing. I have trouble focusing, which is one of my biggest symptoms. I could literally space out for hours on end, which is what my brain seems to be comfortable doing because forcing myself to focus for extended periods leads to mental exhaustion. I wish I could have a series of small 5 minute breaks througout the day (nothing excessive, just totalling like 30 minutes or so) just to sit and let my mind rest. I'm on a hypoglycemic diet, which means I eat small, constant, high protein snacks throughout the day instead of 3 large meals which maintains my blood sugar, but also combats any post prandial drop in blood pressure (food coma). I'm also very sensitive to dehydration, so I have to drink a lot of water, so I'm also running to the bathroom a lot. I have mood swings too, which are also effected by low blood sugar or the fatigue associated with my low blood pressure. I take medication. Actually, I take Adderall IR (the extended release didn't seem to work all that well) 3 times a day when I'm working, and twice a day when I'm off. I tried Vyvanse, but the D amphetamines make me agitated. I can't take the sympathommetics because they don't control the behavioral symptoms. Adderall controls all of my symptoms to a certain extent. It actually calms me, allows me to focus, while at the same time supports my blood pressure, fatigue, and hypoglycemia. Acute care nursing doesn't seem to allow me to take care of myself in the way I need to in order to be at the top of my game. I realize a desk job would be perfect for me, but with the job market being so tight lately, it's hard to change specialties without any experience. I probably shouldn't have gotten into acute care in the first place, but I was only properly diagnosed with this disorder 2 years ago, and like I said, my symptoms get worse with age, so I've really only been feeling this way recently. I realize I could ask for accomodations but I'm very wary of revealing my disorder to my superiors because nursing seems to be such a disability phobic profession, and I know they can really find something to fire you for if they are uncomfortable. Has anybody had these issues? Any tips or tricks, or ways to talk to management that I haven't thought of? I'd love some input, thanks

Maybe psychiatric nursing isn't such a bad idea. I know you don't want to be reminded of your illness, but there's another side to that-one that maybe you're not considering. With all the stigma against people with mental illness, wouldn't it be great if your patients could see you working and contributing to society? If we hide ourselves away from the public at large, we're only conceding to the idea that mental illness is something that should be cloaked in secrecy. That we should be ashamed of ourselves, and drastically removing the mentally ill from the rest of the population is what perpetuates the stigma. Yes, maybe our direct managers should be made aware of our limitations, but that goes for anyone who has a chronic illness. Would you be ashamed of having diabetes, or cancer, or MS? OK, so maybe acute care in your case is like trying to fit a square peg into a round hole. But who wants to feel sub par every day, which is what working in that enviroment might do to you. You might be a mediocre acute care nurse, but an excellent psych nurse. And don't ya just want to be that-an excellent nurse?