You worked hard for you credentials. Don't give up on nursing.. just because your first job is not so hot. Please see the first year of nursing forum here on AN.
You are a nurse! Many opportunities await you.
The first year of nursing sucks, wherever you work. Please don't give up so soon. It's best if you can get a year in on your first job, but if you truly can't stand it, feel free to explore other areas of the profession. There are so many things to try! Hospital, skilled nursing/rehab, assisted living, psych, LDRP, school nursing, hospice, home care...there's a lot of variety. Best of luck to you. Viva
Being a nurse leader is challenging. You might often feel like you are performing an impossible balancing act between management and the staff in your department. You want staff to respect you and bring concerns to you first. You hope your hard work and dedication is noticed by your supervisors, peers, and employees. You work to seize opportunities, rally the troops, and achieve or even exceed company expectations for safe and quality care.
All of this pressure, whether part of the job or self-imposed, can place you right in the middle of difficult to navigate circumstances. Maybe you said too much or not enough. You might be in a situation you’ve never been in before, and you aren’t quite sure how to handle it. Or - and, we’ve all been here - you stuck your foot in your mouth in a big way. These are times that call for a few phrases that need to be on your “speed-dial” of things you need to learn to say when you work in leadership. And, they can be used regardless of your nursing leadership style.
Apologies restore relationships. However, no one ever said that apologizing is easy. You might even consider apologies as a sign of weakness or fear that saying “sorry” will shine a bright light on your own imperfections. But, saying you’re sorry (and actually meaning it) is a sign of strength and character.
When you apologize, it starts the process of bringing the matter to an end. It demonstrates your own humility, transparency, and humanness. No one wants to work for someone who can’t admit that they make mistakes. When you allow those who report to you to see you at your worst, they will respect you even more when you’re at your best.
How Can I Help You?
It’s critical that nurse leaders remember their humble beginnings. You might have a fancy office with a shiny nameplate on the door, but your first role in the hospital was that of a nurse or maybe a nurse aide. So, when the you-know-what hits the fan, it’s essential that you head out on the unit and ask your staff if they need help.
Even when life is good, and everyone showed up for their shift, stopping by the nurse’s station to check on the crew just means a lot. If you have new staff or nurses in new roles, schedule one-on-one meetings with them at 30, 60, and 90 days to see how things are going and ask them how you can help. If you have a nurse that’s struggling with a particular skill, patient, or even life at home - take five minutes to ask this question. It shows you care and will encourage employees to come to you when they need help.
What Do You Need From Me as a Leader?
This is my personal favorite. When I was working in leadership, I used this phrase often. I always used this as an interview question. I was fascinated by the answers. Some individuals would say “nothing,” but most people could give great insight into how they worked when they answered this question honestly. Typical responses ranged from clear expectations to independence to specific equipment or workspace considerations.
When an employee tells you what they need - listen. This is an excellent time for you to engage and elicit more information from those on your team. They will likely provide more insight into what motivates them to do a good job than what they even realize.
No one wants to be given the “because I said so” answer, especially not adults. Being a nurse leader isn’t a dictatorship. It’s called leadership because you have qualities that make others want to follow you.
One of your most important functions is to educate staff on why things are done a particular way. Give them the rationale behind big decisions, especially unpopular ones. They might not like the answer, but if they know that you will always provide the “why” they can probably come to live with the solution a little quicker.
This phrase should come out of your mouth lots! Again, be sure you mean it and that you give it the space that it needs. Don’t say “thanks” on the fly. Fully engage with the person that has done something that you noticed or went above and beyond. Keep blank notecards in your desk drawer and write a note of thanks to one staff person each week. This works well if you work in a facility with multiple shifts that you don’t always see. However, the best way to show gratitude is to say it directly to the person.
Everyone likes to receive praise. They might not want trinkets, cake, or a party to make over them for every single accomplishment, but they will enjoy an honest acknowledgment of when they did a good job. If you’re feeling a little adventurous, you can even combine “Great Job” with “Thank You” and watch staff members flourish.
Being a nurse leader isn’t always easy. However, if you invest in those around you by using these phrases and matching your actions to your words, you will likely be successful.
Do you have other phrases you use as a leader? Or, maybe you’ve worked with a leader who is exceptional and isn’t afraid to say they’re sorry or use other phrases like these. Share your experiences in the comments below.
The definitions for each unit must be used.
By definition a "Telemetry" patient must be stable.
Patients moderately unstable or potentially severely unstable must be staffed at three or fewer patients per nurse at all times because they fit the definition of "Step Down".
Clearly a patient requiring such "Technical Support as an arterial line, mechanical ventilation, titrated IV vasoactive drips or insulin are unstable requiring 1:3 or better RN staffing.
A tip related to my first question, which I've found in this forum recently:
Be good and ready to quit or be fired if bosses demand you take an unsafe assignment (how to always know what might unexpectedly become unsafe without enough experience, I'm not sure). This is difficult to do when you rely on a job. It's also difficult to do when you've had a high work ethic your whole life and then find yourself in a profession where you absolutely must say no to your boss even while they nearly convince you that you can handle it. More tips related to this -- in fact, a whole class in nursing school devoted to this very topic -- would be helpful in keeping patients safer.
This is something useful that's new to me (copied from homicide thread):
I cannot believe that there is anyone who has "worked many moons" who has not made a mistake. Who follows the rules EVERY SINGLE TIME and never gets distracted, or puts down a vial to open a syringe and then picks up the vial right next to it, who notices every single time the pharmacy puts the nitride in the nitroglycerine slot or an order is written incorrectly or a patient, who has willfully removed their wristband and cannot remember their own name or birthdate is on the wrong side of the room. I cannot believe there is any one of us who is absolutely perfect.
I try very hard, I follow the rules every single time -- until there's a situation that falls outside the rules, that the policies haven't accounted for and we have to make things up as we go along. Sometimes, the rules don't keep up with changes in medicine. Sometimes, I have a brain fart. I have made mistakes.
The difference between me and you is that I KNOW I have made mistakes and I know I'm capable of making more mistakes in the future. I will recognize my mistakes because I am allowing for the possibility and double-checking yet again. You don't know how many mistakes you've made and won't be willing to consider the possibility that you might make one or HAVE made one. So you won't recognize your mistakes, won't set about to mitigate the harm to the patient.
I'd much rather be cared for by the nurse who has made mistakes and learned from them. Really.
Being a good nurse and a good employee are not necessarily one and the same. I used to take pride in the fact that I was a good nurse, but I sometimes clashed with bosses who called me "slow" and demanded I take more patients than I was comfortable with, or wanted me to work OT when I was exhausted from my three 12s. I was also one who protested having non-nursing tasks dumped in our laps (like housekeeping and laundry). And of course, I was alone in much of this because other nurses were too terrified of management to stand with me. So I often found myself quitting, or in several cases being terminated.
I wasn't perfect as a nurse, and I made a few minor med errors, but I was good at what I did and always did my best, even if that meant going slower than some of the other nurses and finding the time to fluff pillows and let patients talk if they needed to. I would never make it in a hospital today. But then, I seriously doubt I would have omitted not one, but several safety checks before giving a drug I wasn't familiar with, no matter how rushed I was. That nurse was negligent and should lose her license IMHO, although I don't agree that she should've been charged with a crime. She has to live with this for the rest of her life no matter what happens...that and losing her license should be sufficient punishment.
CALPERS is 1 trillion dollars in a hole for pensioners.
SF just instituted a new tax....another one....on top of the city tax if you work there and the highest income taxes in the country.
This has nothing to do with "discriminating against foreign nurses". They raised the licensure by endorsement for US TRAINED NURSES as well.
So are you saying they're discriminating against us too?
No. It's and easy revenue generator. The fires in California have wreaked havoc, the rents and property taxes are at the upper limit for the poor schmucks living there and stuck--
do your homework on California before you say something as inflammatory and ignorant of the facts as this. Race and nationality baiting is not cool.
When I worked in CA as a traveler....the nurses who were licensed there are the ones who are willing to pay the licensing fee. That included Philipino, Chinese, Indian---all nationalities and ethnicities were included.
ANA is urging all nurses to contact their Senators to co-sponsor and support Title VIII nursing education and workforce funding reauthorization.
ANA is currently urging lawmakers to suppot the bipartisan Title VIII Nursing Workforce Reauthorization Act, which would reauthorize nursing workforce development programs through fiscal year 2021. Title VIII provides the largest source of federal funding for nursing education. These programs are invaluable to institutions that educate registered nurses for practice in rural and medically underserved communities.
The House has already approved this legislation: H.R. 728: Title VIII Nursing Workforce Reauthorization Act of 2019
Nursing Workforce Development has more info re legislation
Easy to complete letter available at ANA's Action center: Tell your Senators: Support Nursing Education
Found at Medscape.com
February 05, 2019
Nurses Union to Back Medicare for All With Week of Action
National Nurses United (NNU) is sponsoring the National Medicare for All Week of Action from February 9 to 13, which will include 130 barnstorms across the country where activists will "learn the ins and outs of organizing our communities" and how to "persuade additional legislators to sign onto the bill," according to an NNU news release....
...The barnstorming events come as Rep. Pramila Jayapal (D-Wash) prepares to introduce an "updated version" of a House Medicare for All bill, along with her fellow representatives Keith Ellison (D-Minn) and Debbie Dingell (D-Mich). As many as 70% of Americans support Medicare for All, according to the nurses union.
Each union is different. They are not all the same.
My union has a political action committee. No one is required to give to it.
Most nurses I know have signed up to have $5.00 or $10.00 a pay-period sent to the PAC.
The reporting makes it seem as though there were no donations over $200.00, but the donors who give ten dollars a pay period donate $240.00 a year in ten dollar increments.
Most of the money is for transportation for nurses to lobby and/or rally for a cause or candidate.
When we were working for safe staffing ratios in California we sent a questionnaire to all statewide candidates of ll parties.
After a short presentation we asked them all the same question, "If elected will you vote for this bill?"
Those who said, "Yes." we worked on their campaigns.
We lost twice, but gained votes each time.
Finally after several elections we got it through the legislature. The governor vetoed it.
Before the next election we asked gubernatorial candidates the same question. All said "No" or refused to promise. Gray Davis said he probably would, "But I may try to tweak it a little."
Then after it passed nurses held rallys and demonstrations at places where we though we'd get press. By then most people were educated enough to want safe staffing ratios for their hospitals.
Then it took four years of other activities to get the ratios implemented.
We supported candidates that would vote for what we wanted so our patients could have the best care we can provide.
Here is the text of the law:
My 2 cents; I am currently a union RN but I am currently in a non-healthcare union. I am a Merchant Mariner and I am represented by the largest US union for Merchant Mariners, and I will say that being a union sailor has WITHOUT A DOUBT allowed myself and other sailors to perform our duty without fear of management messing with us like I have read here. I am well-paid, have amazing benefits, dues are not expensive at all, and the equivalent pay of non-union sailors is about 2/3 what union sailors get. I work in the medical department on military ships as a civilian RN.
I have no idea why people dislike unions so much. Without unions I would not have such a plethora of benefits and the protections that a union ensures. I had pay issues recently and because there is a union backing me those were solved quickly. Are there bad apples people can point to? Absolutely, we are all humans and thus there are 'bad' ones out there in the workforce no matter the industry. However those bad apples usually do not last long when management does what it is supposed to and documents that and begins the process of termination. As we all know, if it wasn't documented it didn't happen. That is why there are processes for terminating those bad apples, and even a union cannot protect the absolutely incompetent. What a union CAN do is find out what exactly that person is doing wrong and provide them the required training/education so that they no longer are so incompetent and that is another benefit of unions; they protect your job and allow you to grow. If you need training a good union will identify that and provide it. My union has a school built just for sailors to fly in and train for certain things for example.
Unions are a good thing! It's funny to me when people seem to think employers will listen and negotiate with you. Unless you are an executive in a critical position THEN they will listen. We as RN's are easily replacable in the eyes of many employers and thus our concerns don't mean much to them. Now add the power of collective bargaining which ensures that those RN's have a strong voice, it is then employers will listen and accommodate. Like maintaining 1:4 or 1:1 ratios when patient safety requires is. Or allowing breaks/lunches as required by law when most employers will blatantly ignore those requirements, or giving promised raises/benefits and following thru with them, and so forth. Unions gave us so much, and as a current union RN sailor I would happily work in a hospital which has union representation.
If you have ever cared for a patient with shingles, you probably hope you never have the shingles experience- intense itching and pain. Unfortunately, according to the Center for Disease Control (CDC), 1 in 3 people in the United States will be diagnosed with shingles. This is a surprising 1 million cases diagnosed each year. Shingles, also known as herpes zoster, is caused by the varicella zoster virus- the same virus that causes chickenpox. Those at greater risk for shingles include the following individuals:
With medical conditions that weaken the immune system
Receiving immunosuppressive medications
Over the age of 50
Recent illness or trauma
Despite the high rate of occurrence, there are still common myths and misconceptions associated with shingles. Do you still believe any of these myths?
It is all about the rash.
Fact: The shingles rash is usually a group of small blisters that eventually dry and scab over in about a month. This itchy rash is one of the tell-tale characteristics of shingles but pain often causes the most discomfort. The pain can be severe and may occur as early as 2 to 4 days before the rash. Unfortunately, the nerve pain caused by shingles can also continue long after the rash disappears.
Shingles only occur on one side of the back.
Fact: It is true shingles often occur on one side of the body, is linear and follows a nerve pathway (dermatome). However, shingles can occur anywhere on the body, including eyes and ears. Approximately 2% of cases are disseminated (shingles on both sides of the body) and occur along multiple dermatomes.
Only older adults get shingles.
Fact: It is true that as you age, your risk of shingles increases and about 50% of shingle cases are in the over 60 age group. However, shingles can occur in anyone at any age. Individuals with compromised immune systems, due to illness, medications, trauma or stress, are at greater risk.
Shingles and Chickenpox are the same disease.
Fact: Shingles is caused by varicella zoster- the same virus that causes chickenpox. However, shingles and chickenpox are not the same illness. Here are key differences:
Chickenpox is milder and usually affects children under 10 years of age
Once you have chickenpox, the varicella zoster virus lies dormant in the body. People get shingles when varicella zoster is reactivated in the body.
Shingles is not spread from person to person. However, if someone has not had chickenpox (or the chickenpox vaccine) they can contract chickenpox from direct contact with fluid from shingle blisters.
There is no treatment for shingles, you just have to suffer through it.
Fact: It is possible to reduce the severity of shingles by starting antivirals (acyclovir, famciclovir and valacyclovir) within the first three days of an outbreak. The nerve pain associated with shingles can be treated at early onset and with persistent nerve pain after the outbreak has resolved. Treatment to treat pain may include:
Topical capsaicin and numbing agents (i.e. lidocaine)
Oral analgesic and narcotics
There is nothing you can do to avoid the shingles.
Fact: Two vaccinations against shingles are currently available- Shingrix and Zostavax. Zostavax has been used since 2006 and is a live vaccine. The newer Shingrix (a recombinant zoster vaccine) is recommended over Zostavax by the Center for Disease Control. The CDC recommends healthy adults, 50 years or older, receive Shingrix in two doses, separated by 2 to 6 months. Shingrix has proven to be up to 90% effective in preventing shingles compared to Zostavax 65% effectiveness rate. Shingrix is available to individuals who have had shingles or have received Zostavax in the past. Studies have shown 99% of individuals over the age of 50 have had chickenpox and Shingrix is recommended even if you don’t remember having chickenpox.
**Note: Zostavax may still be given to individuals that prefer Zostavax, are allergic to Shingrix or prefer vaccination with only one injection.
Prevention of Complications
The shingles vaccine is the only way to prevent shingles and the complications of shingles. The most common complication is a condition called postherpetic neuralgia (PHN). People with PHN have severe pain in the areas where they had the shingles rash, even after the rash clears up. The pain from PHN may be severe and debilitating, but it usually resolves in a few weeks or months. Some people can have pain from PHN for years and it can interfere with daily life. About 10 to 13% of people who get shingles will experience PHN, although it is rare among people under 40 years of age. Shingles may also lead to serious complications involving the eye such as vision loss. Although rare, shingles can also lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death.
What are your thoughts on the shingles vaccine? Has your geographical area experienced shortages of the vaccination?
For additional Information:
Center for Disease Control, Shingles Vaccine: What You Should Know
Thanks for the empathy, Flare.
That area of my anatomy has recently taken quite a beating, as I had a routine checkup with my PMD last Wednesday:
On 1/30/2019 at 4:59 PM, Davey Do said:
good ol' Doc Fat Fingers pushed around on my prostate like he was playing a game of Wac-A-Mole.
In most states, LPN/LVN is a technical certificate, not a degree program. After you obtain your education (ASN/ADN, BSN, and in some cases MSN), you sit for those boards, so I'm not sure how this works, especially if you ever want to advance to RN. For most state BONs your education must be recent, within a certain time frame to do so. How would you update your education?
There is a pay difference sometimes $10-$20/hr from LPN/LVN vs RN with same years of experience and levels of experience. I just don't fathom paying for an RN education, and being reimbursed (paid) for that at a lower rate (LPN/LVN).
I also found your post hard to follow. It may just be me, but in places, it doesn't make a lot of sense. It may be your wording.
What state are you licensed?
Research states that for every patient above 4:1 there is a 7%greater risk of death for each patient. I'll go hunting for the reference when I have a minute, but 6:1 is not ideal.
https://jamanetwork.com/journals/jama/fullarticle/195438?version=meter at null&module=meter-Links&pgtype=article&contentId=&mediaId=&referrer=&priority=true&action=click&contentCollection=meter-links-click