vivere

great advice!

Hey Ruby. I didn't get the impression that anyone had a grudge. I think people DO know if they have done their best, or not. Nursing is not just about the mechanics of nursing, to me. It is also about being a human being, making a connection with someone who needs your care, and trying to get along with the rest of the staff as well. I am a "senior" nurse, and I have also learned from new grads, about how to be compassionate to team members, how to go back and say "I think I came across a little harsh." I think new grads are already anxious enough, and trying to appear confident is part of it. Peace, Ruby Vee.

Note: To Kissunshine: I have seen this many times. Just remember to jot things down if you can, especially when you have a difficult day as you described. Be ready for management with your own accurate facts about what occurred and don't be intimidated by senior nurses. Sometimes we are just old hens, pecking at nothing in the dirt. You know if you did a good job. You have your head on straight. Let it go. Don't be surprised if the tables get turned one day and you have an opportunity to be the better person.

I'm glad you wrote....I understand what you are saying. Sometimes I have seen preceptors expecting the new nurse to completely take over the difficult patient...it gives them a break. I'm not saying it's right. Everyone learns at a different pace. Back in the stone age when I was new, we didn't have as difficult patients as we do now in ICU. It was still a lot to learn, and it took me a full year to feel comfortable, and even now, I am still learning. You cannot remember everything. Keep a notebook, or box of index cards that you can refer to, especially for the mechanics behind the equipment. If you have your information readily handy, you will become the resource person for others, even as you are learning. Nurses are greatful to the geeky among us who can pull out a policy, or a drug formula for reference. I still refer to our unit's "cookbook" when I am using a drip. I don't rely on my memory. We get busy, we could make a mistake. Always reference. Remember the basics. How does the patient look? You will learn to assess at a glance when you enter the room. How is their color? Does the breathing look peculiar to you? Don't rely on the shift nurses who came before you....when it is YOUR patient, it is YOURS, and even the most seasoned among us can make an error with IV pumps, rates, calculations. If you master the art of assessment, you will be amazed at how quickly you will succeed. I am grateful for your reminder. We do tend to get impatient, please forgive us, and don't let it stop you. The patient has a right to have the best care! So, don't feel frustrated with yourself. Turn it back on the preceptor....and then look it up yourself. You will be a fine nurse, I have no doubt.

Good answer above by Isabel. Sometimes this works, when it doesn't, I will usually just change the assignment. A fresh face will often make the patient feel as though they have some control, and often temperament has been dictated by an illness or situation in which the patient feels out of control.

This is a difficult problem in nursing. I personally see nothing wrong with what you did. Why are nurses so eager to be martyrs, allowing patients to be rude, curse, or in other ways "disrespect" them? I have had a few instances over the years in which patients who refused to be compliant with doctor's orders would ask for another nurse, i.e. one who would let them eat take-out food, not be hooked up to a monitor, and be on the call bell continuously for attention from staff. This is in an intensive care setting, no less! When the physician himself says to "have the AMA form ready" for the patient, there are probably going to be some issues. Hospital patients are just a cross section of our society. We are supposed to take care of all types of people, without regard for what kind of person lies in the bed. It remains a constant challenge, but if a patient is sane, and not suffering from an illness that affects the brain , I am just not willing to take any verbal abuse. Patient satisfaction is important, but if the nurse suffers a blow to her self respect, then what have we gained?

Great post, Jean Marie. Some things I hadn't thought of.....sometimes we are more cautious of new folks until they prove themselves to be "sane".....we have had more than one new employee come on board and welcomed them heartily, only to be faced with terminating them when they proved to be dishonest, or just plain cuckoo. It is great advice, just to hang in there....

Don't take it personally. If you ask a question and no one answers, it may be that they don't know the correct answer, and don't want to lead you wrong. It takes a good year to feel comfortable enough to think of yourself as a nurse, and it will be a lifetime of learning after that first year. You are right not to socialize much. Be polite, cordial, but I would caution you against becoming personal - I realize this may be an unpopular view, but in my experience, familiarity breeds contempt. Let them get to know you on the job and keep your personal life to yourself at this time. Old nurses .....I am one. I am frequently tired, have aches and pains in strange places and not much of a social life. Be happy. Continue to be nice, and use humour, it will serve you well in your career. And lastly, learn from these crones....LOL> As new people come on board, be the go-to girl. Be the one who they feel comfortable enough to go to for help, answers and assistance. I predict a great career for you.

I can SO relate to you, beeker. It is one of the biggest frustrations of my nursing career to have to deal with family members who either do not understand the visiting policy, or just don't want to! I had an intubated patient with pneumonia, and his girlfriend (who uses a wheelchair) had been allowed to sleep in the room for two nights before I took over his care. Our policy is open visitation during the daytime, and the unit closes at 9 pm for the night. After that, we do let visitors back by request, to check on the loved one or get updates, but we prefer to keep the room clear for patient care, particularly since the unit has less staff at night. At some point after I had done my initial assessment, the wheelchair bound girlfriend appeared at the bedside, box of chicken in hand, and settled herself in. I decided to leave her be, after speaking to the charge nurse about it. I gingerly let myself in and out of the room all night, taking care not to DISTURB the visitor! Occasionally, the visitor would ask me to be sure to shut off the lights so that she could sleep. When we did the patient's bath, we had to pick up chicken bones from the floor next to the bed. In the morning, I spoke to the visitor about our visiting hours, and told her about how we encourage family members to stay in the waiting room and check on the patient as needed. She told me that previously the staff was "nice" and let her spend the night. I apologized for this and told her that It was not our policy. About this time, the attending walks in and the guest asked to speak to him in private, of course. Not only did he make things worse, he gave the visitor money! He said he felt sorry for her, because she had no money! This guest had stayed in the room two nights before I came on duty, and was getting guest trays sent up during the day, and was also asking staff for help, snacks, etc. So, you might say, you get two patients for the price of one! I am frustrated by this situation. On one hand, I want to be helpful and compassionate to others and at the same time, I want to concentrate on my patient care, and not this kind of BS from visitors. I am open to any suggestions. It doesn't help to be undermined by the doctor, who now has made me seem like "the bad guy" . Why do we bother with policy if it is not going to be adhered to, and why are nurses so hesitant to speak to visitors about visitation policy? It gets harder to enforce the longer the visitor is allowed to stay.

I just want to say thank you to all who took a minute to support me, or just to comment about a similar situation. It crushed me a little to have this happen, because I am very proud of my nursing care, and have always received good responses from families and co-workers as well as from patients. Perhaps I just need to develop a tougher skin, but I was so incredibly insulted by the suspension, that felt I had no choice but to leave. I think it was time for me to leave, the hospital broke out in scandal after I left, and perhaps it would have been even MORE stressful, so God took care of me by allowing this to happen. I now have much more understanding of how a patient complaint will adversely affect the staff, as well as how devastating it can be to have management that does not support the nurse. I still believe that nurses should ALSO have respect and cooperation....no one should feel that they can curse at a nurse, or yell at him or her, or in any way abuse the nurse, and the nurse should not feel her job is in jeopardy if she is the target of a patient complaint. Yes, I could have appealed, but at the time, my hot head took over...and I quit. It's all water under the bridge now. I feel physically better, I am sleeping better, and I am not stressed out on the way to work any more. vivere

LOL....i don't think so...but its crazy to think that just because someone has an advanced degree, they can move into management and do a good job. my manager had no clue. She loved to talk about how she loves ICU nursing, but she hadn't taken care of patients in YEARS! (thank the Lord)

LOL Thank you. I am considering it as a blessing and although I miss my co-workers, I am now relieved about the ending. I am still concerned about the pay cut, but got rid of my boyfriend also, so I will actually end up just fine. Lots of changes going on, and I am glad about it. Thanks for your support. memento vivere:redbeathe

It will take time, just remind yourself that they are missing out on knowing YOU, a really terrific person. Do not doubt yourself. Another positive route is to help out someone else the minute you see a need, no matter what it is. Believe me, they will quickly grow to love you. We are not much higher than the animal kingdom, who sniff each other out. So stand tall, and let the sniffers sniff....they will learn to trust you. vivere

thank you, my co-worker did back me, but she chastised her as well, didn't believe either one of us.

Hello all! Recently a patient complained to his aunt that his night nurse "didn't care about me". This was a confused patient, admitted for flu-like symptoms, fever, etc. I noticed the patient was very angry by the morning, but did not feel as though he had been neglected by any means, he had been fluffed and puffed, brought anything he requested in the way of drinks, etc., and auntie had been taken care of as well, by given free access to the patient outside of regular visiting hours, offered drinks and snacks, pillow and blankets etc. I informed the supervisor that he had complained, and thought no more of it. Long story short, my director called me in and suspended me for "not taking care of the patient." In report, I was told a different story about the patient than what was reflected, but I documented everything I had been told regarding the plan of care for the patient, and documented everything that was done. I felt my suspension displayed a true lack of support for nursing staff, and I resigned. I have always had excellent reviews from my patients, peers and supervisors wherever I have worked. I felt hurt and humilated that this happened, and that any patient can wreak havoc on an unsuspecting nurse. However, I am happy to be "out" from under this particular manager, who, of course has a string of credentials, but no heart for her staff. I am only one of a stream of nurses to resign since she came on board a year ago. If any one has been through this and has advice for me, I would love to hear a word of encouragement. I also would like to stop having feelings of anger toward the director. After all, perhaps she did me a favor. vivere:crying2:

I hope by now you have gotten out of there. I have been in the same situation myself, and let me tell you, it does not improve with time. The Manager always seems to be the winner depending on how many letters are behind her name. That's all management cares about. My suggestion is to find something else, and best of luck to you.

Agree with all of the above. Ignore her and celebrate yourself! You don't need her approval! vivere:twocents: "when you learn how to live it, life is free of strife, that is why I LIKE LIFE!" Scrooge/The Musical

Thank you for responding. I AM the insurance carrier, for five of us. That is part of the dilemma. It is not just me. I very much appreciate everyone's thoughts as I mull this over. vivere:saint:

there are scads of books out there about knowing when to leave your lover, but i don't know of one that would help me know when to leave my job! i have been happily working at a small hospital for five years, and have been fortunate enough to make a great salary which enabled me to pay off debt, buy a house, and pay for college tuition for my kids. the down side is that i have had 14 managers in that span. i put up with each change, and made the best of a bad situation, because i know my job. now, however, the latest manager has me stressed out. it is no longer worth the money, it seems. every time i drive to work i am stressed before i get there. there are always new policies, new rules, and new threats about "if this is not done by .........you will not be allowed to work!" my significant other says to deal with her, and put up with her for the money, because she will be gone the way of the others before long.....however, this time, my heart isn't carrying me. it will be a huge pay cut for me to leave and go somewhere else. has anyone else been through this. it is a long drive to work, and i am tired of that, as well. however i will be working twice as much at another hospital to make the same money. the hospital is in jeopardy. many docs have left already, and nurses have been laid off. is it worth the stress to hang on, wondering about the future, for a hefty paycheck? have you been through this? i never know who will be working with me in the intensive care unit anymore. it could be a nurse with no experience, or someone with lots, who is a traveler. i have had some wonderful experiences with nursing, but now all i think about is following all the rules to the letter, and completing all my paperwork to management satisfaction, knowing that it will be reviewed. help. maybe you see something that i don't.

I have to agree with what has been said already. If a hospital is offering a huge bonus, as mine is, you can be guaranteed there are serious problems within. I work at a small community hospital which is part of a chain of hospitals. I was in the right place at the right time, and have acquired a fantastic salary. It is not without its drawbacks. It is a FOR PROFIT hospital. We often do without the proper supplies, but the patients have fantastic beds and monitors. We do our own housekeeping, ordering labs and tests, and total care of patients. We answer the phones, direct visitors and due to the short staffing, breaks are minimal if at all. We are scrutinized by our manager like bugs under a microscope. It is stressful, but has helped me support my family. However, I have always kept my foot in other hospital doors, not knowing how long the chain will decide to hold onto this particular hospital. I have had about 12-14 managers in 5 years, and have seen many nurses come and go. Anything I have learned, I have learned on my own, or through other resources. It is time for me to move on. I used to try to recruit for the hospital. No more. I could not expect anyone to put up with the conditions that I find myself in now. It is an incredibly stressful atmosphere. I supply the insurance coverage for my family of six. As soon as I am able to be covered elsewhere, I will leave. At one time it was a happy place to work. In Central NC, I think that Wake Med, and Rex hospital have the highest rate of employee satisfaction. The salaries are commensurate with experience, and will be about equal in most places. Per diem rate for day shift is usually about 32.00 without benefits. At night you can expect to make $35/36 or more. Anyone else have any info on this? We have been trained to be so tightmouthed about our salaries, but many people are underpaid in this manner. Love to all this holidayseason. Hold yourself tall and love yourself! Vivere

I appreciate this advice. I have already taken it twice. The first time, I was overconfident and certainly unprepared. I took it again a couple of years ago, stressed about home situations and not prepared. I WILL PASS

Yes, this is a sad truth about nursing. I am not sure it is just nurses , but that is where my experience lies, so I will comment on what I have known to be true. There are nurses of all ages, who will smile at you and not ever tell you that they have "written" you up, or talked to the manager about something you did or didn't do....some infraction, according to them. It is sneaky, and since you don't know about it, you are not given a chance to confirm or deny the supposed infraction. I am very cautious about reporting a nurse. For example, a nurse may have gotten busy transferring a patient out during the day shift, making sure paper work was covered, etc., and so when night shift comes in, they don't see all the work that was done. They may only see a messy room. We all make mistakes, on a daily basis. Nurses need to realize that they will receive the same treatment at some point, that they are giving to another. Be mindful that just as you are reporting on another nurse, you will also have someone, someday, be following your every move as well. I agree that narcotics are not included in this! I am talking about something entirely different. It is a 24 hour shift, and what one nurse does not complete, I think the next nurse should pick up and finish. We are there for the patients, and not to write up each other. If a nurse makes a mistake, we can tell her, easily and kindly....without trying to get her fired. I recently started working with a young nurse and heard her discussing with a surgeon about an incident which she stated "happened on the previous shift and was not reported"... I am very leery of this kind of communication, which is done sneakily, behind other's backs. I won't be working with this nurse for long.:typing:typing vivere

Just remember the reasons why you are there...it was never about making friends. It was about making a good living, about providing for yourself, and it was about taking care of others, assisting them in the process of health. When you remember those things, everything else melts away. It is the same in every health facility you will work at. Close friendships are formed by some, and for others it seems as though they are always on the outside, looking in. Just know that everyone feels that way sometimes. You are never alone, not in any of the emotions or thoughts you experience. There is always someone else out there who knows exactly what you go through! I am off to work right now! and not too terribly crazy about the idea.....but the money I make will help pay for a son's trip home for Christmas. vivere

Yes, we had it happen with a patient. She bit clean through the cuff tubing....She was otherwise pretty debilitated, and the doctor suggested we just tape the tube in place well. Her sats remained about the same for the rest of the shift. We try to keep the patient sedated enough so that biting is not a problem, and for those patients who still somehow can get ahold of the tubing and try to bite down, we will use a bite block. I had a boss tell me not too long ago that it was impossible for a patient to cough a tube out......but patients will try to dislodge a tube in any way possible a lot of the time. If the cuff has a leak, and the patient has a strong enough cough, AND if the tube is not secured well, you can bet the patient can dislodge the tube so that it is not in the proper place. And they can also extubate themselves while restrained, and sedated, by grabbing hold of the bottom section of tubing nearest the hand. There is no substitute for frequent assessment, at the bedside.