nurseshepherd

Our small OB/MOBA unit does team nursing, but only on nights. We take report on everyone, the charge nurse makes assignments, but if someone needs something the nurse at the desk takes care of it whether it is her patient or not. Same thing when we get an outpatient in, one nurse writes while the other nurse does the hands-on part of the assessment so we are done very quickly and efficiently. Our day shift does the opposite, spending 5 minutes to find 'that patient's nurse' in order to refill their water pitcher or some other task that would take just a minute of their time. Team nursing works and keeps individuals from feeling too overwhelmed, IMHO.

When I worked as a tech in nursing school, there were some horrible nurses who were verbally abusive to techs who didn't stand up for themselves. I was not a timid person, but nursing was a career change and I was unsure of myself. These seasoned nurses knew more than me, I realized that, but they lost the very essence of being a nurse somewhere along the way and became merely technicians performing tasks. They had no compassion at all, and it made the 2 shifts a week something to dread. Yes, there were some good nurses, and they were the ones who made up for these sad individuals. I needed the experience to strengthen my clinical skills, and the money was a Godsend. All but one of these nurses straightened up after the first 6 months, but only after a controlled verbal confrontation where I let them know their behavior and attitude were unprofessional and would not be tolerated any longer. When it was time to interview with the VP of nursing for job placement, I told her I would work any unit except the one with the hateful nurse. Without elaborating or naming anyone, I told her the experience had been a trial by fire that I wouldn't wish on anyone. She was shocked, evidently no one else said anything about the hospital's nursing staff before. Speak up, but do it to the supervisors and in a calm and professional manner. Learn this now as a tech, it is a skill you will need the rest of your nursing career!

The idea and practice is sound, according to studies that have been done showing improved patient satisfaction, reduced pain levels, etc. The problem comes in when nurses have too many patients and not enough help to do hourly rounds, address needs (pain medication, food, drink, blanket, pillow, etc.), and chart without feeling overwhelmed. Right now I work in a small unit and with 2 - 4 patients and the hourly rounding from 7 - 11p takes up all my time, but it is doable. When we first started hourly rounds a couple years ago, most of us would just keep our notes in our pocket and jot down what we did, then we would chart everything at the 11p full assessment. Now we have computers at the bedside which makes it easy and convenient to jot down a note and that pleases management because they don't like having to explain 4 - 5 hour old charting when the JCAHO comes to survey our hospital. I personally cannot fathom working on some of the med/surg units (like in our system) and trying to do hourly rounds on the 8 - 12 patients they usually have each shift, it has to be nightmarish!

Our facility is proud to support the continuing educational efforts of it's employees. However, some of our folks interpret this as permission to do most (if not all) of thier school work on the clock regardless of patient load. The charge nurse needs to bring them back to the reality that they are there and being paid to work, and their patients are counting on them. Night shifts are great for folks going back to school because there is often down time after finishing 11p rounds, but they don't need to depend on that time to get assignments done. As an instructor I was given that excuse more than once!

Thanks to all who have replied. Interesting that many included administrative cutbacks; to date we have not seen that at our not-for-profit hospital system. Our local nursing programs are still taking as many students as they have desks for and I worry about those getting out in the next year or two expecting (and needing) to find a job in the current climate. Thanks again!:)

Our area hospital system (rural TN) has cut all nurses and non management employees to 32 hours a week, allowing those with personal time to use it to make up the hours. They have also cut all education and travel funds, reduced each departments budget by 10%, and have instituted a hiring freeze. Departments with secretaries and techs will not replace any who leave (increasing the workload on nursing staff) and our PRN nurses are not being utilized unless absolutely necessary. Additionally, if the department census does not support the number of staff scheduled, nurses are sent home low census (using even more personal time if they have it or try to get by on 20 hours that week). What is going on in your area and are you rural or urban?

Management has not mentioned anything but we are in the rural South so I doubt seriously it would be an issue here. Agree with PP, micromanagment!

I work with several women on herbals but they are going to a local MD who was an internist until the stress of the hospital led him to partner with a local herbalist and they have a thriving alternative medicine practice. So far I haven't heard of any untoward outcomes.:wink2:

Our hospital has a policy that all positions have to be formally posted, even though they already have it promised to someone. That could have been what happened with the posting.

Sounds like a really good unit! We run into this quite a bit with 'change-of-shift' deliveries and it is funny how different it is depending on whether it is AM or PM. If it is at 6:45 AM, some of the day folks will stall around because they have to get report and sometimes act annoyed that there is anything left undone, anything. However if it is 6:45 PM, they are yelling at us to come in and take over so they can get out on time, finish their charting, whatever, and they don't mind leaving a laundry list of stuff they couldn't get to.

We need a lot more like this!!!

I agree with the PP that simply asking politely and keeping the visitors informed works well with most folks. As far as having people at bedside during procedures, that really depends. In OB we almost alway insist on having the woman come back sans partner so we can discuss health care issues one-on-one. It is amazing how many women tell their partners they quit smoking but really haven't, have herpes and haven't informed their partner, have taken drugs and their partner is clueless, etc. We also need to discuss her relationship to see if there are issues with domestic violence and provide her with resources without the partner at bedside. One issue we run into quite often is family members who are CERTAIN they are wanted in the room for everything and if you haven't asked the patient while you have them alone you won't find out until it is too late that she only wanted her partner in the room and not the whole clan.

During nursing school I thought I wouldn't have any money worries once I graduated because I would make so much more than I had before. A hard lesson was learned about the financial backlash of nursing school (when you keep robbing Peter to pay Paul, Peter eventually gets wise) so I spent the better part of the first year trying to get myself out of debt and put a little in savings. My first RN check was awesome though, it was 3 times what I had been used to making and the idea of being paid that well for doing what I loved was just the best feeling. For motivation I kept a copy of the house plans I intended to build after graduation in the front of my notebook and every time things got rough I would flip to it. Find your motivation, tough it out. God bless.:wink2:

I try to keep an unstructured PRN job to help with situations like that and for addition income when I have a project or financial need. Working in another area of nursing is always a challenge and helps you grow as a health care professional. Having said that, my primary issue is the hourly rate and safe working conditions. Good luck to you and God bless.:wink2:

'Buzzing' a fetus in utero in order to get it to move/turn is an example of noxious stimulation (uses a device similar to an artificial larynx) which does not hurt the baby but certainly gets a reaction which is the goal. Sternal rubs usually do hurt and I would put them in the painful stimuli category......

Totally agree with PPs, RESIGN now and do it in writting giving proper notice so your HR record is good. Many places will pay you for your PTO if you resign which could give you some breathing room until you secure another job. I have one family member who was fired from a nursing job and even though it was a personality conflict with her manager, she has had that to deal with every time she fills out a job application.....most will ask if you have ever been terminated. Good luck, better things await you!:wink2:

Speaking generally, NO!

This is another example of the tail wagging the dog. We are changing things in our department trying to get better scores and we already were doing great but no, we have to do something. The biggest thing so far is that our Maternity Center has thrown out the visiting rules and regs b/c a couple folks were upset that they couldn't have all 18 of their friends and family members with their children in their room at one time. We have just thrown infection control and patient safety out the window here for a POSSIBLE increase in our score. Dietary, who historically gets the LOWEST rating of all in our system, has not been required to change a thing. Nothing. Their dismal ratings are figured in with our department patient satisfaction rating (typically really good) as well as all of med/surg (who are working very hard to make changes to get their scores up) and we are being told the hospital reimbursement will be based on these scores as will be our raises. The whole things stinks.

Don't forget, you can always file a grievance if you feel you have been wronged. You may not want to do this initially, but if this matter is not resolved, you may want to consider it. Lots of folks are uncomfortable with this but is is a necessary tool sometimes. You would need to send a letter to your NM stating your case and send a copy to her supervisor. A formal typed letter would be best, but handwritten will work too. I only know of 2 people who have ever done this, both involved poor evaluations from vindictive NMs and both were given better evaluations after administration told them to redo the evals (1 was leaving anyway and just wanted his eval to reflect his level of performance and the other is still employed by the hospital - over a decade). I'm sure there will be others who didn't fare as well, but grievances are made for situations when you have done all you can do. Good luck and God bless.:)

I totally agree with Chatsdale, you need to go in prepared with a written statement of facts to safeguard yourself. I would not sign a thing until I hand wrote my statement on the write up. You can hand them your typed version of what happened (in detail), but I'd write on the write up form as well to make sure my side of the story doesn't get misplaced. It does not sound like any PHI was shared and the NM probably got raked over the coals for the lab snafu and is taking it out on you. Good luck!

A lot of nurses leave because of their nurse managers, not their job. They may list other reasons officially, but when you talk with nurses who are switching units or hospitals it usually has more to do with how they were managed (or mismanaged). Playing favorites is sadly, too common among managers and brown-nosing does appear to grease the advancement gears. If your NM is great but walks all over you, then she isn't respecting you and she isn't great. I have seen NM's do this to senior nurses on a shift (bring in someone from another shift) and when they went to the NM and asked if it was a mistake the NM corrected it on the ones she wanted to and didn't on the others....no mistake, it is what she intended for whatever reason. If you have tried to discuss this with the NM and haven't gotten anywhere, save your breath. Do what you need to do to grow professionally (additional education, certifications, classes, etc.) so you are ready for bigger and better things when they come along. Focus on yourself and doing your very best (which has obviously been noticed by at least one of your patients) so others will see you in a positive light. Good luck and God bless. One more thing, does your hospital have an EAP? Most Employee Assistance Programs give you the opportunity to talk with someone about your work difficulties and it is usually a free service for employees. Just a thought.:)

Most of the ER nurses I have known thrived on the excitement level and would be bored to tears with the pace of med/surg. They also like the focused aspect of ER care rather than the holistic (speaking only of the ones I have known folks, not generally) and would fuss that we (non-ER nurses coming in to help triage) took too long looking at everything. Most of the time they can see a pretty immediate improvement in their patients when they turn an arrythmia around or take care of a diabetics unconcious state and watch their eyes open. That is pretty potent stuff, really makes the rewards on med/surg pale in comparison. As the PP pointed out, lots of specialty nurses wouldn't want to work anywhere else. Our adrenaline junkie co-workers in the ER don't appreciate a good precipitous delivery in their ER, evidently the wrong kind of adrenaline rush for them!:chuckle

A nurse I worked with years ago had 3 ultrasounds during her last pregnancy and the last 2 she was told it was a female and the radiologist even wrote that on the report. She was named Suzanne after a beloved aunt and all clothes and decor were pink and frilly and waiting on the big day. Thank God she was fully awake and unmedicated when her son was born because everyone in the room was shocked! And no, he was 'well armed' so microphallus (or micro anything) was not an issue.:)

Probably because it's not dealing with a true emergency or a laboring patient. It is still shameful but the hospitals put up with it.

There are no absolutes with this and cultural sensitivity certainly recognizes that not everyone within an ethnic group is the same. Teaching students and nurses to be more aware of their patient's needs from a cultural standpoint is enhancing their ability to care for patients from all cultures. No, not all Hispanic women defer decisions to their husbands, but a lot of them do and as a health care professional I know that and give him opportunities to make decisions in keeping with what the wife wants. She should not have to deal with his displeasure over being usurped or feeling dishonored. We provide the same nursing care to everyone, just tailor it a bit to accomodate special needs whether it is cultural, disability, age, gender, etc.