Effie, RN

re: FMLA, it applies to illness or providing care for an immediate family member and sister/brother in law would qualify. There are some conditions, i.e.: FT employment for one year, but after that it's pretty open and if you've qualified you have 12 weeks to take in any increments you need to...one day at a time or weeks at a time. For an employer not to offer this option to an employee in this situation is not just immoral it is against federal law and prosecutable!

Re: Case Manager 1 getting fired: This situation is why FMLA exists...it is illegal for them to do this, you just have to go about it the right way!

the key here is knowing the knowledge level of the practitioners and everyone working as a team! it's not supposed to be about egos or letters after your name, it's about using everything you know and everything everyone else knows to make sure the patient gets the appropriate level of care.

i have never thought this was a good idea. in missouri we have certified medication technicians who can also get insulin certified so they not only do the fingersticks but give the insulin too, all with training that is measured in hours not months or years. in the same vein, i am totally opposed to "patient care techs" removing indwelling urinary catheters and iv lines. who in the world came up with these moronic ideas???

i'm also one of those baby boomer nurses. been doing this for 32 years and have seen the job gluts come and go but the need for nurses does not change. i personally do not plan to continue working until i'm in my dotage and want to be sure that there will be some younger yet experienced nurses there to take care of me when i need it. i agree that there may be less facility based care for us but believe that the home-base care will sky-rocket for economic and comfort reasons. having worked as a vna nurse, i know that this kind of care requires experienced rns because you are out there on your own so please students...study hard, work in acute care to get that great experience, and be there when we all need you. (and can we all play nicely together?)

been a nurse for 32 years, seen the ease of getting a job ebb and flow but one thing is for sure there will always be a need. every estimate i have seen in the literature says that unless there is some major miracle there is likely to be a shortage of nurses in 2020 of up to 1 million!!! from your posts, it sounds like you are going about it the right way and for the right reasons. good luck!

all the more reason for you to get involved!

until we all realize that the politics of nursing is important then nothing is going to change. the docs, the hospitals, the insurance companies have each had a powerful lobby in dc and the state capitols for years speaking for them and getting the public to see things their way. we nurses on the other hand have been at the bedside providing care, working our tails off, and then complaining about how no one gets it. if we don't all speak with one voice through our professional organizations no one ever will get it. only very recently have nurses gotten "a place at the table." ajn is just one professional journal, one of several that i personally subscribe to from one of several professional organizations general and specific that i belong to. every one of us has the professional responsibility to stand up and be heard through our professional organizations to make things better for our patients and for all of us too!

it makes me very afraid when a bedside nurse is not interested in finding out about research based nursing care. this is evidence based practice in action. if you don't think it is pertinent, you should contribute something that is.

for anyone who cares to read it there is a very timely article in the current issue of ajn on this very topic. i would encourage anyone who has strong feelings to read it. i would also refer all nurses to the standards and scope of practice for nurses and the code of ethics for nurses with interpretive statements. these two documents, which were originally begun many years ago and have been revised and honed many times, are the basis by which we all should practice. upon those, i rest my case.

i do understand. but things were no better "way back when", just different. we had more patients jammed into smaller spaces plus family members camped out in chairs. we were trying to manage iv pumps and any other equipment we could squeeze in behind all that. when i was first out of school, i worked on a primary care neuro floor. that meant we nurses each had 6 patients for whom we did absolutely everything. if we were lucky there was a na or an orderly who could help us lift or do a bath but that was 1 for the entire floor not 1 per nurse. we didn't have computers, we did everything on paper which meant of course trying to read a dozen or more different different mds hand- written notes and orders. there was no pyxis, meds had to be brought up from the pharmacy individually when needed. we mixed most of our own ivs and antibiotic drips. getting the picture? so yes, i understand. and staffing issues with administration has always been an issue. back then the difference was that most hospital administrators were business people or mds. no chance that a "mere nurse" would ever reach that pinacle of success so it was pretty rare to have anyone topside who had ever had boots on the ground no matter how long ago. the more things change, the more they stay the same. the only way that anything will improve is if we can all just believe that we all have hard jobs but no matter what the patient comes first...that is, the person patient, not the patient as dysfunctional medical machine.

this is not a personal criticism of you but my own experience with nurses on all shifts, all days in the hospital i was in. thankfully i did not personally need a cardizem drip. what i did desperately need and did not receive was adequate pain control after major abdominal surgery. i also needed my lungs assessed and appropriate intervention taken but that didn't happen without strenuous intervention on the part of me and my family. i am quite sure that we were all labeled as difficult by the nurses who were not doing their jobs and that doesn't hurt my feelings one little bit. a patient should not have to threaten to call the jcaho in order to get an individualized pain control plan, rather than being told "it's not in our policy" when there is a physician order in the chart to give a medication immediately post-op. these same "professionals" also told me a great deal of hipaa protected information about my roommate. what frightens me is that there are many patients every day who do not have the benefit of many years of experience in the heathcare environment, do not know their rights or what should be happening and so do not know how to protect or advocate for themselves as i did for myself and my family did for me. this is why family members want to stay in the hospital, because they have heard the same horror stories on 48 hours and 60 minutes that we have. what truely saddens me is that there seem to be so many nurses who resent these family members who are only trying to care for their loved ones the best way that they know how. a big part of our job as nurses has always been and continues to be to advocate for the patient and their support system. florence nightengale wrote about this in her book "notes on nursing" which, by the way, is still very pertinent in 2009 if you read past the part about chamberpots!

in fact it is what my family members did, in addition to monitoring my medications, my respiratory status, my pain status, and making sure my iv didn't run dry. oh wait, isn't that all what my nurses were supposed to be doing?

wow. i guess i am just some kind of dinosaur or something. i too remember doing pm care and giving backrubs but i remember it a bit differently. i remember how much all of my patients appreciated it. i remember how much more relaxed they were, how much better they seemed to sleep, how much better their pain meds worked. no, i'm not a massage therapist, i'm a nurse. on my license it says that i am a "registered professional nurse" and that's how i see myself. that includes doing whatever kind of personal care will help my patients get better...not just the high tech stuff though that is certainly important. i'll share something else too: when i was a patient last summer i would have loved having one, just one, nurse who care enough about my wellbeing to even offer to do something simple like give me a backrub. unfortunately, the nurses who "cared" for me were much too busy looking after my iv pumps, etc. so busy in fact that they failed to ever assess my lungs adequately. they also managed to make several major medication errors and did not control my post-op pain. btw, this was in a hospital that is "one of the top 5 in the us" according to recent news reports.

catherine- brava, well said. i've been where you've been (na to rn, started as an na in '71) and you are right on! it is all about professionalism, something that seems to be in very short supply these days in many professions, nursing included. customer service, to our patients, families, and outside providers (external customers) and to our coworkers (internal customers) is not a new concept, just new language to nursing. formerly it was called common courtesy and respect for others. we would all benefit from more of it.

if more of us in the nursing and medical professions behaved that professionally, there would be far fewer unhappy patients/family members! (imho)

as with any other patient, someone with alzheimer's must be assessed for pain. just because they cannot tell you with words about their pain does not mean you cannot assess them for heaven's sake. would you give a placebo to all children? sorry, the example just rubbed me the wrong way. i personally would hesitate to give a placebo. in the circumstances as described, i would not give it because there is not enough info. my other question is why is there no instructor present? in my state, an instructor is required at every clinical site for just this reason.

wow...i don't have time to read through all the responses but what strikes me is the negativity here. have none of you been in the hospital? have you never had a loved one in the hospital? each of us as nurses knows intimately the kinds of mistakes that can happen so we of all people should be understanding when family members want to be around. i am personally very grateful that when i was hospitalized i had a family member with me 24 hrs/day because it ended up preventing several serious errors and facilitated my pain control which, unfortunately, the rns did not seem interested in taking charge of. of course we have a responsibility to educate and yes, in my 32 years i have run into many challenging family situations. but isn't that one of the things we are trained for? our job is to provide holistic care and the family is part of the package. who do you think will be assisting that patient when they leave us? and bravo to the writer who pointed out that we are not medicine, we are nursing and we are our own profession...be proud of it!

:igtsyt:imo, this is mostly speaking to a larger issue. if you look at any survey of "trusted professionals" including the latest, nurses are right up there at the top. yet it is only now becoming generally recognized around the world that violence (physical and verbal) against healthcare workers is a huge problem. to my knowledge, only two countries have addressed this issue legislatively: great britain and australia. we as nurses all need to join our professional organizations and work hard to get this problem addressed in this country too. it is a travesty that something which would be recognized as assault if it happened in the street is not even reported if it happens to a nurse in a healthcare facility. (stepping down off the soapbox now.)

i would absolutely recommend you go into nursing if you have experienced what it is about and know that it is something that will be rewarding to you for reasons other than just money. this has been a thread subject at other times and imo this is one big reason why people get out of nursing: if you are only in it for the $$, you will not put up with the bad days. i've been doing it full time for 32 years and yep, i've had bad days. yep, i've been hit, spit on, etc, etc, etc. but the mental challenge and rewards far outweigh all that stuff. there are so many directions you can go with a nursing degree and if you continue your education you just continue to grow. my cup of tea has never been management so i try to stay away from that but if you like that kind of stuff you can get a ms in healthcare managment and go in any number of directions. if you find you really like the or/anesthesia stuff, get your msn/crna. i could go on and on. but the poster who recommended that you shadow a nurse was right or you could work as a cna for a while. back in the dark ages when i did it, nas weren't certified. i did that in high school and all thru nursing school and always felt that i was better prepared than the students in my class who never set foot in a hospital except for clinicals. good luck to you, whatever you choose. we need more nurses, but only if they want to be nurses!

i really believe that you have missed ruby's original point here. she isn't attacking anyone, she is just saying that the preceptor/new grad relationship is just that: two sided. both parties have to work at it equally hard. i don't personally know ruby but what i gleaned from her multiple postings is that she is a responsive and responsible preceptor (and, btw, not even sal's actual preceptor!) who participates in a program that worked hard to help sal be successful. but, unfortunately, sal doesn't seem to have been willing to carry her weight as the preceptee. she did not want to continue learning or even to put into practice the things that she presumably learned in school. because of this, she not only failed as a new nurse at this institution but more importantly she endangered the lives of multiple patients. this is, after all, the reason we are all doing what we are doing is it not? yes, without a doubt there are less than perfect preceptors and all of us have bad days or even just bad moments. but because nearly all of us have experienced an "eat their young" moment at some point in our career, most of us don't want to perpetuate that negative stereotype. some of the posts on here, unfortunately, seem to be doing just that, imho.

Congratulations!

ok johnny, good to know that you think so much of yourself. personally, speaking as a female nurse with a little experience in the field, i've never felt i had anything to prove to other nurses male or female. and whether i was single or married made absolutely no difference in how i related to the male nurses i worked with...nor any of the other nurses i knew. did you ever consider that it might have a little to do with your own attitude to them? just wondering...

sorry but i don't think that a nurse who can't get "it" with all that help is safe in any setting in which she is recognized as a nurse. if you are practicing as a nurse, you are expected to exhibit critical thinking skills that this woman clearly has not got. consider the clinic setting: a patient has an inr drawn and the results of 9 are called to the clinic. the physician should be immediately notified so that the patient can be called and steps taken but judging by what the op wrote that would not happen. i certainly wouldn't want this woman working in my doctor's office.

I am a long term care educator and I would definitely say that A is the most correct answer. D could also be correct with some clarification. The rationale for this has already been well defined by previous posters. I hope that your instructors would be open to discussion on this question since their intent was obviously not well communicated, i.e.: the test question was poorly worded.