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?

In reference to those of you who are debating BSN vs. RN, I would look very closely at the BSN programs. A lot of places, at least here on the E. Coast, are making it a requirement. I worked with one nurse who left the facility because she moved to Chicago. When she returned, she reapplied to get her old job back, and they wouldn't hire her because she didn't have her BSN, even though she had 10 years of service at the institution

Thanks for the support.(Did ya notice the criticism I got for my format? Geez, it's like I'm pourin' my heart out here, but that's exactly what I'm talking about) I think I just needed to hear someone say what you said because, really, I work most of the time until my feet swell and I've had no lunch, and no break for 12 hrs, and I rotate from days to nights. I think to myself, sometimes, that I should go back to school, and maybe further my career, but when it's like this, I just cringe at the thought of pouring more money into this especially when I'm still paying off my undergrad loans. I may sound whiny, but really, all I want is to go to work and feel like I've accomplished something. I don't need someone to tell me that all day, every day, or be nominated for nurse of the year. Just every couple of weeks or so, if someone from the facility (cuz I get thank yous from my patients all the time) would say to me," hey, I really liked that you did (fill in the blank)." It would seriously make my millenium. I think that's what anyone wants from a job-any job. I would get that more from the jobs I had before I became a nurse. To me, that's really sad.

I've been a RN for 10 years, and I have to say I'm at a bit of a crossroads. I realize that it's very rare when someone totally looooves their job. I had a professor at college once tell me that it's not absolutely necessary to love your profession, but if it's something that gives you the ability to do what you really love in your spare time, then it's worth it. However, I often find that nursing is so totally mentally and physically exhausting that I spend most of my spare time recovering and/or preparing for the next onslaught. Don't get me wrong, I love taking care of people. I love spending time with them, making them comfortable, giving them the emotional support they need, and providing them with the information that, most often, they didn't have before. That's the part of nursing I truly love-the patients. I find it difficult to recall a patient I didn't like, or at least relate to on some level (and I work at a large, inner city metropolitan hospital, so I take care of all kinds of patients). It's so rewarding, to me, to provide them with even the smallest of comforts like an extra blanket from the warmer, or actually going down to the kitchen to get the lunch tray that was ordered too late, but they were just allowed to eat after a week of being NPO. Like, I get it. It sucks being a patient. Being trapped in the hospital, with every contact you have from any of it's employees being rushed and cold. Being awakened at all hours of the night for vital signs and blood draws, or to be whisked off to some test at 3 in the morning without really getting a grasp of exactly what's going on. I'm so flustered by nurses who can literally walk away from a patient who just burst out in tears, or label someone as a drug seeker who asks for more pain meds, simply because they asked, without even a thought of calling the doc or the pain management team to say, hey, this guy keeps asking for pain meds, do you think their pain is well controlled? Not that I haven't had a patient who really just wanted to get high, but even with those people, I ask for a psych or social work referral (often to be looked at like I have 10 heads). I've come to this understanding that the nurses who seem to excel in the field or be a favorite of management are those who distance themselves from the patient and remain fixed at the nurses station glued to a computer or a chart. I guess that's where I falter. My documentation is, well, adequate. I was also trained (actually by an Ivy leauge, level one trauma center) to document only what is absolutely necessary because of studies that indicated that a lot of litigation where the ruling didn't favor the medical institution was often decided from info derived from abberations found in the nurses' notes. I find, in a lot of cases, that documentation differs greatly from facility to facility based on the type of institution and the existing nursing culture therein. For example, when I worked in California, the particular hospital I was employed at insisted that when you documented info about a patient's PICC line, that you included arm circumference, as well as the measurement of the actual PICC line itself from the tip of insertion to the hub. When I worked in PA, the hospital I was at didn't require those particular measurements, but, guaranteed, you would be called into the manager's office if you didn't change the caps every 3 days and document that you did so. The hospital where I work now as a travel nurse, doesn't seem to care about any of those things, or even if the dressing is changed every seven days, but I was disciplined because I didn't specify every type of IV med in the I &O section of my flow sheet, even though I did in my computer charting. Of course, it doesn't help that I'm a travel nurse and I get an abbreviated orientation. Travel nursing is not really my choice of venue right now, but the area of the country that I call home is saturated with nurses right now and the job market is too competetive (esp. seeing as many hospitals are cutting costs and don't want to pay for a nurse with 10 yrs of experience). OK, so you may say, well, just take the criticism as it is, acknowledge the input gracefully, and move on-don't stress too much. I used to think like that until I was asked to not return from 2 different facilities because at one place, I was pulled to 3 different units in one day, and when I was transferring my last patient out of the short stay area where I had been assigned so that I could work the last four hours on another floor, the doc wrote (as I was wheeling the patient out the door, because I checked the time the order was placed) for a change in IV fluids, so I showed up on the other unit with "100 ccs left in a bag of incorrect fluids", and I couldn't give them the Plavix that was ordered post cath because it was a new unit that didn't have it's own Pyxis and the Pyxis in the neighboring units didn't stock it. I was instructed by pharmacy and the charge nurse (who was on a different floor, I manned this particular unit by myself) to wait until pharmacy hand delivered it. I called the supervisor and discussed the situation with her, she said she would call me back, but when she finally did, it was only to tell me that I had to move the patient out of the unit, and fast, because in ten minutes, I had to report to this other floor. So, not only did I transfer the patient with "the incorrect fluids", but I failed to give an ordered medication, and the nurse who received the patient gave me hell for that, even though I explained the situation, and offered to walk down to pharmacy and get the med myself. She also complained that my notes were scant but only because I documented that I received the patient from the cath lab whose vitals were stable and that I was unable to obtain the Plavix that was ordered, which I had discussed with the physician and he was aware. I pointed out that I documented hourly rounds and vitals directly on the flow sheet in the comment section next to the vitals, but they wanted this documented on the back of the flow sheet in the nurses' notes. The other facility that didn't want me back stated I refused to give an ordered anti seizure medication. (In both of these cases, nothing untowards happened to either patient.) This particular patient was NPO, had horrible veins, and had a PICC placed because of this, but both lines were clotted (I couldn't flush or draw back on either port). I called the doc and asked her to put an order in the computer for antistreplase because we were not allowed to take verbal orders for this med. She was very abrupt with me saying she had several patients in the ER that she hadn't even seen yet, and she would put the order in when "she got around to it". I documented that the med was not given, that I informed the doc, and that I even stuck the patient 3 times for a peripheral IV, which I couldn't get, before he refused any more IV attempts. I passed on to the nurse for the next shift, when she asked why the 10p seizure med wasn't given (my shift ended at 11) that I was waiting for the antistreplase. She asked me if I tried flushing the patient's line, and I replied, of course I did, but I was trained not to force it to avoid pushing a clot into the patient's right atria. I even explained this to the nurse manager, who asked me about it the next day and seemed satisfied with my answer, and I was even allowed to work 3 shifts after the fact which seemed uneventful (i.e no one complained to me about anything). When my recruiter said I was listed as a DNR (do not return) by the facility and I asked why, she said the facility stated the reason was because I failed to give the ordered anti seizure medication. I asked if there were any other reasons, she said no. I worked as staff at three different facilities for 2 years a piece and never had an issue or a complaint filed against me. I won an award two years in a row at one facility for having received the most positive feedback from patients via the patient comment box. I gotta say, being reprimanded, and even fired, for such minor misunderstandings has left such a bad taste in my mouth as far as nursing goes. Now, every time someone even looks at me cross eyed I think I'm going to lose my job, which I desperately need as a single parent who doesn't receive child support. I wish my career choice hadn't led me to this point. I wish I could one of those nurses who everyone likes so much and speaks of with so much respect. I don't have an especially bubbly personality. I'm not usually "popular" (but not unpopular either) amongst my nursing colleauges because oftentimes, they're a much younger crowd (I'm 40), and I'm friendly, cordial, but not overly so. I usually keep to myself, but I work very hard. I rarely hear comments nowadays about anything I'm doing right. I almost feel like nursing has become like a beauty pageant and I'm killing myself to have perfect makeup, a flawless dress, and super white teeth. I guess it's sort of because I don't have a regular job, and I'm only at these places for a short time, and I keep to myself so that the staff doesn't really get to know me well enough to know that if I'm not a fixture at the nurses' station with my nose in the chart, it's only because I spend most of my time at the patient's bedside. Any advice? I think I need it because I'm starting to get depressed. Thanks

Hi all, I've been a nurse for 10 yrs. Currently, I 'm a travel nurse on assignment at a university based medical center, which is a nice facility, and the people are generally pretty personable. Up to this point, I 've been comfortable. I'm experienced in the specialty where I've been placed, and I was trained in a university based metro hospital, so, I thought this assignment was a good fit. The other day, when I finished my shift, I was giving my patients back to the person I got report from. I received a direct admit overnight, and I hadn't done a direct admit before, so I was a little slow on the uptake, and it seemed to take all night to get all the stuff I needed for the patient, who required antiboitics, pain meds, a CPAP, etc. The doc on duty seemed overwhelmed and argued with me about prescribing pain meds for the patient who had pancreatitis. She said she couldn't prescribe anything until I entered the patient's home meds into the computer (huh?). I told her the pt. just got pain meds during the ambulance ride to the hospital and tolerated them, so why not just give more of the same. After 2 hours, she finally prescribed him something oral that he was allergic to. So, back to the drawing board. That's how the night went. It was like pulling teeth to get anything done. I had to wait for everything, and make multiple phone calls to follow up. Plus, he was a hard stick, and I had to call phlebotomy to get his labs cuz I stuck him 3 times with no luck. Meanwhile, I had started a Heparin drip on my other pt. @10p, so I knew I needed to follow up with a PTT with am labs. That pt. was pretty grumpy (understandably so, because most sick people are) so I had to talk him into the blood draw. After our discussion, I was running about a half hour late from the time the PTT was ordered, and just as I was rushing up to bag the labs and then go to the unit next door to tube them, a co worker stopped me in the hallway, frustrated that her pt.'s PICC line was clogged. I looked around for someone else to help, but of course the hallway was vacant, and I felt bad for her because her pt. was pretty difficult and I could see she was at her wit's end. A half hour later (one hour after the PTT was due) I finally sent the labs. So, by the time the results were posted, I was already giving report. The person I was giving report to was this new grad with a very flat affect, who was actually reading the chart and looking at the computer the whole time I was talking to her (I hate that, I always feel like, what do you need me for ??) And she bashed me the whole time cuz "this wasn't done, and this wasn't done, etc. etc., and so on". I felt like saying, hey, it's a 24 hr job, but I did manage to hold my tounge. She had actually given me report on my new admit, and told me he was in this one rhythm that he wasn't in upon arrival, and when we were talking about his cardiac status, I said (and not even to be smart, really, I just wanted to know) , who told you that? The nurse who gave report from the OSH (wondering if maybe she had heard it elsewhere, like one of our docs or something). Yeah, she didn't like that. Anyway, I came back into work after her shift, and of course, got more of the same bullying, but this time she was upset cuz my new admit didn't have a wristband from our facility (he still had the old one from the OSH, and I still asked him his name and birth date, etc, I mean, I had to to complete the admission paperwork), and the PTT for my other pt. was late (even though she told me he had been discharged to home). I was bothered by her attitude, cuz, I mean really, it wasn't like I had been sitting on my butt the night before, but tried not to l let it get to me, cuz really, I needed to focus on my job. That's when I went to see one of the other pt.s we shared, only to find her stinking to high heaven, covered by sheets with dried urine stains, call light hanging over the IV pump outta reach, with a symptomatic syst. BP in the 60s. I hate to say it, but I did have the thought "talk about stuff being overlooked, have you even seen this person in the past six hours?" I dealt with the situation, the pt had a raging UTI, borderline septic, and dehydrated. I wrote a note, but didn't report her cuz I thought I'd talk to her first and ask what happened. She didn't relieve me in the morning, but that whole day I had management from my agency and the hospital blowing up my phone (which I didn't even realize because I was sleeping so I could come back into work) because of the whole wrist band/PTT incident. Really? So, you can basically kill someone, but God forbid, you forget a wristband. In all fairness, management doesn't know about the UTI/sepsis pt., and I have to meet with them next week, but I'm afraid if I say anything, it will appear to be in retaliation. Any thoughts? (Sorry for the long post)

I'm also looking for a low stress nursing job, and although my co-workers and I have had many conversations about what type of speciality could provide such an enviornment, I honestly don't know where to start. My Mom was an RNAC for a long time in a long term care facility, and said that that job wasn't really stressful, but I don't know if that's the ticket because of the paperwork. Paperwork is one of the things about this job that stresses me out the most. I've been a nurse for almost six years now, and, although I started out in critical care, I have been working pretty much the whole time in med-surg acute care. Right now, I live in CA, but I got my education and worked for four years on the East Coast. I woked on a predominantly cardiac floor-like post caths and ablations and stuff, and I didn't realize how good I had it. Back there, I wasn't even doing half the hard labor I'm doing now working on a med surg/tele/renal floor. I'm not saying that it's really geography, as much as it is the types of patients you work with (renal pts I think are the most diffcult in the acute care setting because they usually have soooo many co-morbidities that they are rendered virtually helpless, and I used to think you were doomed when your had heart problems-oh no, it's your kidneys!!) But since I've been a travel nurse (that's how I got to Cali), I'm also realizing that your stress level also has a lot to do with co workers, and bosses, and the actual facility itself. It seems to me that no place is perfect, and it almost scares me into thinking that no matter where you go, or where you work, every job has it's drawbacks, so what's the point of trying new things? I know-really negative huh?! I got into this because I really wanted to help people, but I'm finding it difficult to help when I'm buried under mountains of paperwork, feeling pressure from mgmt to worry about a budget that I know nothing about, and dealing with patients who are mentally ill who, via external circumstances, do not have the resources or the education to help themselves so the hospital just becomes another institution with a revolving door. Aaaah!!! And I do have to say that all this stress makes us turn on one another to boot. There's always somebody in my bosses' office complaining about another co worker, and from what I see, these complaints rarely have anything to do with patient outcome, but are more about petty little things like how you turn your hospital corners, or whether or not the patient has had a bath on a daily basis. I kid you not-one of my co workers got written up for eating cookies that were left out and unlabeled in the break room. Another nurse who witnessed this alleged cookie incident was apparently appalled that someone would eat cookies that were not specifically designated as their own. (what the heck???) Honestly, I'm sooo busy I can't figure out where anyone would have the time to pay attention to things like cookies, let alone write a note to the boss about it. And it also makes wonder what's NOT being done for their patient while this person is perseverating about baked goods. I was thinking that maybe if I got my master's (I have my bachelor's now) things would get better, but I was a CNA for 7 years before I got my BSN, thinking that once I had a degree I would feel much happier and more fufilled. So do I want to incur more student loans just to find out that no matter what you do, it's all really stressful? I'm even starting to think that I'm not cut out for this, which makes me sort of sad because I realize that I do have a BSN which is helpful, and I received some really top notch training, so I do have a lot to contribute, plus I really enjoy science-A and P was my favorite class-I thought it was so cool. . I just think I'd be able to serve my patients better if I wasn't so stressed out. Even if it's boring, I would like a job that's 9-5 (or some variation of it) where I could clock in and clock out and feel like I've actually done something for someone, and that I'm not going to take my work home with me and worry about it until I have to return in the morning. Does that job exist-or is it just a pipe dream?