Sunbird21

Hi, I recently began a position as a clinical educator for a private home health agency. It's my first position in nursing education, which has been my goal (am also starting my MSN program in August)! My agency has had some long term difficulties with the quality of their private duty nurses/home health aides, hence the "creation" of my position. I realize between the novelty of my position as well as my inexperience that it is going to be challenging to initiate change in bad behaviors/poor performance. Recently, my manager has asked me to come up with some ideas to provide some form of short term, intense training JUST for the nurses to reinforce customer service, bag technique, and other basic skills. She asked me to write up a presentation for her and the director. I'm trying to think of ideas-I thought about doing a "skills fair" over a few days, but I know that they don't want to take a lot of time (re: pay for a lot of time) for the nurses to invest in it. So, I'm looking for any feedback on ideas to quickly evaluate and train approximately 40 nurses-field visits not feasible due to time constraints on my schedule (I do three days of inservice/orientation weekly and have other tasks that take up part of the other two days). Thanks for any help!

Hi, I am an associates degree RN(2 yrs college) looking to travel to Australia and work for a year. i am 33,so i know i dont qualify for the WH Visa. I called the AHPRA and asked if it was possible to be licensed in OZ with an ADN,and was directed to their website and the skills assessment process. I have four years of experience,2.5 in hospital,1.5 home care(current),all in pediatrics. (I was also an LPN for 2 yrs on med-surg). I have read all of the questions about how to apply for the license,and I think I am good with that,but I would like to hear from any other ADN's who have actually done the process to see how likely it is to be approved(as it looks the cost would be $800)? Also,if I do this and get approved,how hard is it to find a hospital that will accept a US nurse? How do you go about the interview process? Are there any travel nurse companies that will accept ADN's? If you get licensure,does that mean that getting a visa is pretty easy? Also,if possible,if anyone has done this,I would be interested in learning about the whole relocating aspect and what challenges were faced. This is a decision that i want to research fully since it will obviously be costly,(and probably crazy LOL) but if its possible,I am at a point in my life where I need a major change,and I absolutely loved Australia when I visited this spring. thanks for any info, Stacey

Thanks guys for your input. i will suggest the employment board thing to the mom. Cali,I understand what you mean about the responsibility...the family is capable of taking care of the child,thats not the issue...its just that they get stressed out with the gaps in staffing. AsAs I stated, ive done A LOT of OT and extras for them,but now Im kind of getting a gult trip for taking three mornings off for my program...part of it is my fault b/c Ive probably opened up too much to the mom abot things(we're basically the same age) and vice versa. SDALPN,youre right,it is private duty....I get the terms mixed up. Part of the agencies staffing problem is that the primary hours open are weekends,which are not easy to fill at any time-although Ive offered to adjust my schedule to open up other hrs for people. The other issue is that the child has some neuro issues that are a bit complex-dont want to break HIPPAA and say too much. But he is manageable and not bad to take care of,and the home is a safe,clean environment. Supposedly the other nurses who she found on CL took "easy" cases that were offered to them once they went to the agency. The reason that two agencies are involved is also prob my fault....I applied to two agencies around the same time,and was ironically offered the same case with both,but the agency that I chose offered benfits and higher pay. I was surprised that they both had the same case,and it was a little tricky to get set up,but I figured it was a no brainer on my part. Sorry for the extra vent...just under a LOT of pressure...but thanks for any tips!

Hi, I have no idea where I would post this,so trying here first.... Right now I am a pediatric homecare RN in CT,have been on this case for almost 7 months. I am happy with my job now,esp. after some of the drama I have been through at other jobs! My issue is sort of two pronged: the case that i am on requires more nursing. The family already works with two agencies,b/c of complication of case,and neither agency has been able to provide the staffing that they need. I work weekdays 9-5,the other agency supplies a night nurse 5 nts/week. The family has tried to recruit nursing via Craigslist after waiting months without result from the two agencies.eac time they find someone through CL,by the time they get to the agency,they are lured to other cases instead of theirs. I have tried to help out,I actually did 45-50 hr weeks for two months to help them out,also tried to network with another nurse from my agency and bring her in. Unfortunately,she trained three days and split. Now the issue is that I am sort of back to 40 hr weeks,but I have to decrease my hours slightly b/c I need to attend to some personal issues in my life. Even doing the 40 hrs though,Im still feeling a bit of a guilt trip for not helping out as much as I did before. And maybe its me,but I feel like if I am ever sick or need some personal time,I am leaving them stranded b/c there is no backup. Does anyone have any other ideas as to how to recruit other nurses?? I know that they can post on monster/careerbuilder/etc but it costs $$$. They are trying CL again,too. I would talk to the people at my agency but they are basically useless(another story). I do love the child and the case,and the family really is good to work for(my personal guilt aside). Any suggestions would be helpful!!!

Hi, I'm interested to know,for my own benefit,how many nurses are out there who have had pretty bad depression(either episodes or ongoing)and have had negative repercussions from it at work? I know that most places aren't going to out and out terminate someone for it,without covering their tracks VERY carefully,but has anyone received the undercurrent discrimination(comments,shift changes,subtly pushing you out,etc) from it? My story(very very briefly) was that I more or less was terminated b/c of it. I had an episode related to recent stressors in my life,and ended up in the hospital myself. At the time,my work appeared supportive,but soon began the comments of asking when i was leaving( I had planned to move out of state), low census-ing me at least once a pay period(it was somehow always my turn) and then finally creating a situation in which I made a medication error that gave them "cause" to fire me. I've investigated civil suits and tried to argue my case internally,but the place that I worked was very large,very well known,and very good at covering their *****. I just wondered if anything like this has happened to anyone else,and how they dealt with it. Others tell me to move on,but the confidence blow i took from it was hard and its affecting me at my new job. I feel like they got away with discrimination and won,and can never set the record straight. I know that depression is common in nursing,but am curious as to how a known case of depression is treated in this career.

Thanks for your reply. I am actually most recently from the peds med/surg unit,and i liked that,but I had been searching for a job in this particular state for more than 4 months(my boyfriend relocated) and I had to cast my net pretty wide after a while. I most enjoy the pediatric part of it,interacting with the kids and parents,and Im ok at most of the skills(meds,cath,NG,suctioning,etc).I eventually received two offers,one for this ED and another for a NICU(which I havent yet done) 45 minutes away. I didnt especially enjoy PICU,so i thought that the ED was a better choice for me. I understand what you say about the assessment piece,and I agree.As I said before,I have recieved so many mixed messages as to what to do first,not just the triage vs assess piece,but also the "dont waste too much time on vomiting/diarrhea kids" vs "make sure you really assess them for dehydration". I dont know what to do.As I said,I have a weekly meeting with my manager,educator and new preceptor tomorrow,and my stomach is churning thinking about it. I cant just quit,as I dont have anything else lined up,not sure how it would look,but Im afraid that theyll make the decision for me. How do you know when its not a good fit vs. just needing more time?

Hi, I recently moved out of state and started a new nursing job in a pediatric ER. I have app. 5 yrs nursing experience prior to this job-2 1/2 as an adult med/surg LPN,1 as a PICU RN, and 15 mos as a pediatric floor RN. I am currently three months into my orientation(they claim it takes 4-6 mos) and I am starting to have a really rough time. The first two months,I seemed to be doing ok,my primary preceptor(we'll call her Annie) was very thourough at explaining how the ER worked,was encouraging,gave positive feedback,etc. My secondary preceptor(lets call her Bonnie) was a bit more stressful-she moves at a fast pace and is all about getting everything done five minutes ago. I wasn't with Bonnie as much,but it came to a head at the beginning of February,when I approached my educator and asked for advice on how to approach her about the difference in our paces. From this point on,my orientation has gone DOWNHILL. The educator,whom I'll call Sally, gave me good advice at the time,but a week later in our regular meeting with Annie,stated that i was having a lot of trouble and needed not to work with Bonnie anymore.That was fine with me,but then Sally kept making vague remarks about how I needed to "take a step back," and go back to handling 2 patients with more efficiency. After the meeting,i asked sally for specifics-I had thought I was doing at least all right,I had never received any severely negative feedback. Sally kept saying "well,how do YOU think you are doing?" and "we've hit a setback,but we'll keep moving forward." I was puzzled,and asked Annie,who just said that Sally was just making general comments. Then I spent a day working with Sally to "evaluate" me,and at the end of the day,I asked for feedback,and she shugged,threw the question back at me,and said "well,speed definately needs to come up." I was starting to get a little frustrated,but still not sure how all of the sudden I was doing so badly. I spent a large chunk of Feb in required classes,my schedule was all over the place,but I thought I was improving on what time I managed to get on the floor.I went back up to three patients,and still got mostly positive feedback from Annie. Then,last week,everything fell completely apart. I had a patient come in with asthma via EMS. As one of the many,MANY mixed messages I've received in this orientation,I was told that we had to do the computer triage form for EMS patients "right away." I looked at the girl,put her on the monitor,and she was on O2.I started the form,and Annie came in asking me what she sounded like.i said I hadn't done the full assessment yet(again,I was told to to an "eyeball" assessment first,then triage,then come back for full).She hurried me off the computer,had me listen to the patient,then start on this standing protocol that they have. Later Annie told me that with respiratory kids,it was better to assess them first,get them the treatment,then do the form. OK,so I flubbed that one,I get it,but we talked and I figured it was resolved. But in the meeting a few days later with Sally,Annie(who had otherwise given me several positive remarks,and had been helpful in chaotic times) went on and on about the above patient,as well as mentioning that I "got flustered" when there were several orders on multiple patients at once. She admitted that I knew which one was the priority,but kept recalling how I was "stressed" and she had to tell me "one thing at a time." Sally kept shaking her head,saying that she wished the respiratory assessment piece had "clicked already" and that I had had several resp. patients,I should be better by now. The whole meeting was very discouraging,and left me feeling very down on myself,my nursing abilities,and my orientation. As the meeting was 30 minutes into our 12 hr shift,I spent the rest of the evening flustered,making stupid little mistakes and then the big one. I had a resp. kid at the end of the night,I could tell that she had some retractions but she was playful,squirming around,and was difficult to auscultate sounds and really assess her work of breathing. I thought she wasn't too bad off,told Annie so,and of course,when Annie went in,she was calmer and you could see that she was retracting heavily.I felt completely stupid,and even more so when Annie came out of the room,chewed me out,calling me "scary" and saying that she didnt know what to do with me anymore,and that she was told that I had experience,but it didnt seem like it. Needless to say,i ended the nigth in tears,although two other nurses talked to me afterwards trying to make me feel better. I spoke to my manager the next day,who suggested switching preceptors and starting fresh,and working extra to increase my resp. skills.I was agreeable. Then i spent the last two days with my new preceptor,Cindy.At first,she was nice,telling me that it was ok to start fresh,she had no preconceived notions,etc. The first day started out ok,but I know I made some small errors(wording in charting,not moving fast enough,having a little trouble with task prioritizing) and she seemed a little annoyed with me at the end of day one. Day two,I tried to do better,and I think i did,but we had a difference in pulse measurement,I used a different cath kit then i had been,thus messing up my sterile technique,and finally,one pt I assessed as not appearing as dehydrated as she thought(we had differing views on how dry his lips were,and how active he was-he was austistic and it was 11pm). I ended the day again feeling like a total screw up,going home in tears. I have another meeting Wedsnesday with my mgr,Sally,and Cindy.I'm scared that they are going to get rid of me because they think I am incompetent. I know that i have experience,but in my past jobs I wasn't diagnosing and mentally planning the treatments for each kid. I know that my resp. skills need work,as I am used to simply noticing a kid with difficulty breathing/wheezing,and calling RT or the MD and following through with treatment. I am not making excuses-I know that I need work. But after several weeks of so many mixed messages(take time with patients,but move faster;charting can wait,but hurry up and finish it;you can ask questions,but dont ask me,tell me what you want to do;etc etc etc) I dont know what to do. My boyfriend tells me that my lack of confidence is killing me but I dont know how to feel better when I'm being torn down so much. And after initially getting decent feedback to all of the sudden being ripped apart every day,I feel like I want to just crawl under a rock. I apologize for rambling,but if anyone has any advice as to what to say in the meeting,how to improve and get better,or if I'm in danger and should just run,please tell me. Thanks.

Thanks everyone,for their advice. I actually tried to sign up for PALS prior to starting my job,but it isnt available until September,and my CI told me that my supervisor actually prefers that we go through orientation before taking it,so that we have something to compare it to. Yesterday went ok,but again,my preceptor left me to figure out things such as a machine I hadn't used before,and stood there while I attempted to work it. Later this person continued to scold me for the almost med error the other day. I really feel like I am going nowhere with this person,that they either have already decided that Im useless,or that they would rather surf the Internet while Im running around instead of teach. I am going to write an email to my CI and try to explain whats been going on and ask for help. I really want to succeed on this unit,pediatrics has been my dream for many years. I dont know how/where to diplomatically start. Again,I dont want to make an enemy of this person or their buddies on the unit-I just want a fair chance. Any hints from anyone on what to say? Thanks again:)

Thank you Denise,for your quick reply :) We have a clinical instructor who oversees the orientation,and she has even said that the patient that I have had with the preceptor is not a typical one that I would get during my second week(which i just completed). The preceptor just said that he thought it would be good experience. I'm hesitant to go to the instructor,because I know how things work from my other unit. if I say something about my preceptor,then it gets around,and I become known as either being "slow" or a "troublemaker." Do you(or anyone) have any suggestions about how to handle this conversation w/o it turning into this? It's only been a couple of weeks,is it too soon for me to be saying anything? What is a typical orientation pattern for PICU as far as skills? I've read a few other posts on here where people have 5 or 6 months to orient!! My hospital gives us 10 weeks,and I'm going to nights(its a day/night rotation) in two weeks. I'm curious as to whats normal to have a grasp on,or what I should be proficient at first. Thank you again for your advice! ETA: Suanna,just saw your post as i posted this! Thank you for your tips-I will try them tomorrow when I go back!

Hi to all~ I'm new to this forum,so please be patient with me! I recently started in the PICU unit of the hospital that I work at,technically as a "new grad" RN. I had been employed as an LPN for three years on a med/surg floor at the same hospital before this,so I came to this job familiar with the hospital's policies,methods of charting,etc. I have always wanted to be a pediatric nurse,and it is very difficult to find a job in this area if you don't have experience already,at least at my hospital,and its main competitor in the city. So when a PICU job opened up shortly after I received my degree,I applied,interviewed and shadowed on the unit.Even though it was ICU,I felt like the variety of pts and pace would be similar to the floor that I was leaving,so I figured that it would be a good move. I assumed that i would have a lot to learn in the way of pediatric procedures,ICU equipment,etc,but that I was able to meet the challenge. Boy,was I wrong! I started on the unit a couple of weeks ago,and my first day with my primary preceptor went fairly smooth. She was patient,answered my questions,and even acknowledged that I wouldn't remember everything right away. However,she left for vacation,and I was placed with another preceptor for the next several days during the interim. This preceptor has been there for many years and is very experienced,and apparently well liked on the unit. I have to admit,the preceptor has been nothing but polite and nice to me. The first day with this person was ok,although i didnt feel as comfortable as i did with my initial preceptor. I told this person that i wanted to get experience with lines,drips,and vents,since these were all new to me. the next day, the preceptor chose a patient that was very complex,had 7 lines and 9 drips running,was on a vent,had two chest tubes, and was post-op from a complicated surgery. I felt overwhelmed,but figured,I had asked for it,so i might as well jump in and start swimming. Throughout the day,the preceptor would go over some things,but other questions were waved off. I asked specifics on titrating drips(something I'd never done before) and specifics about vents(ditto). The preceptor just said,"you just know what to look for." I came across a mental block when it came to calculating dosages,and maintenance fluids,and asked for help,but the preceptor was having trouble explaining,or I wasn't catching on ,I dont know. I since seeked help with these from the clinical instructor,and feel better about them. The next few days,I felt like I was improving,but the preceptor kind of took a backseat and watched me go through the shift completing tasks,from flowsheets to hanging IV meds to speaking with doctors/family members. I'd ask questions,but the preceptor seemed to be getting impatient with me.I'd be in the middle of one task,and the preceptor would jump in and suggest doing something for our other patient.I felt like I wasnt moving fast enough,or that it wasn't prioritizing right,or SOMETHING. I havent received much feedback from this person,other than "you're doing a lot." I asked if I was on track with other orients,and was told,"it's hard to compare-the experiences are different." Yesterday was the worst-all was going well until we had a procedure at bedside for one of the patients. The preceptor sent me for a medication,and I glanced at the MAR before I got it all,and was certain that I had the right dose. I drew it up,and the doctor stopped me,saying that it looked incorrect. Sure enough,it was. My preceptor gave me a scolding look,and I corrected the mistake,but the rest of the day I kept missing things I had done a thousand times before on my other unit.At report time,again my preceptor sat back and the oncoming nurse kept quizzing me about the exact concentrations of meds and what the vent settings were. I was so flustered,i couldnt recall the exact doses correctly,and the vent settings i had to admit I didnt know because I hadnt gone over them yet-when I asked,the preceptor told me before that I would be learning that when I oriented with respiratory. However,at report,the preceptor gave me another look. Afterwards,the preceptor asked me why I had made the medication error and told me that it was a day for me to learn. I left work in tears,and confided in my friends who work in other units. They keep reassuring me,saying it takes time,and that Im putting too much pressure on myself. One friend told me to find resources to learn about drips,meds,and other ICU info and teach myself. This is what prompted me to look on the Internet,and I found this site. So,my questions are these-Do I still have a chance at this unit or am I really in over my head? If not,where do I find books or info to help me learn about pediatric ICU nursing? Neither my LPN nor RN program covered this level,and my textbooks dont even review med calculations,let alone nipride drips. I've wanted this for so long,I dont want to give up now,but I dont know what to do at this point. I hate coming home and crying every night. Sorry for the length,but if anyone has any advice,I'd greatly appreciate it. ~Overwhelmed RN