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JKL33

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  1. JKL33

    Nursing Is No Longer Worth It

    Even if it is, that's okay. Personally I hope it has empowered the OP to take self-preserving measures in whatever healthy form may be appropriate. Whatever you believe you're re-channeling, it needs to come in the form of solidarity. You as a caring person may wish that you could magically provide whatever nurses ask for. Your superiors, on the other hand, make plans that, at best, do not take nurses' concerns into account, and at worst are very purposeful in not providing what nurses and patients will need and in not caring whether nurses and patients will suffer. Your mistake is in believing this whole thread is about covid. It isn't. Covid is just breaking the camel's back. If your reference to supplies refers to our PPE dilemma, organizations took purposeful steps that helped bring us to the situation in which we now find ourselves. Some are multi-billion dollar corporations that abruptly stopped caring about N95s/fit testing, etc., 5+ years ago for their own business reasons--and then proceeded to put a couple of PAPRs here and there throughout their facilities. Now any thinking person would recognize that such a plan would not leave them prepared for anything other than an extremely small-scale need for respirators. It leaves them unprepared to protect nurses, but if that is too selfish a thought for your sensibilities, keep in mind that it also left them unprepared to care for patients and to protect patients. Yet they unapologetically decided to hedge their bets and be ready to loudly proclaim their innocence and helpless PRN. Staffing plans that keep RNs in a position unable to do justice to the role of caring for patients even on a "good" (pre-covid) day is another matter of abuse of nurses and patients that has now become abject unpreparedness for the current crisis, including the systematic poor treatment of bedside expert RNs such that their presence has been reduced. What's done is done, you may say; we must accept the circumstances and positively move forward sacrificing ourselves and being real leaders and real nurses who are in it for the right reasons. Is there no value in choosing not to tolerate unethical foolishness and especially abuse? Our Code of Ethics (Provision 5) addresses this. I appreciate your dedication but the case could also be made that those leaders who are willing to give everything and sacrifice everything to the call of nursing would not continually find new ways to accept mistreatment of patients and nurses. It is not unusual to hear from nursing leaders about what bedside nurses should sacrifice and how bedside will need to compromise. (Some) nursing leaders have an endless supply of inappropriate optimism about how things will turn out if only others will just sacrifice and stop complaining. Yes, I do know that leadership positions can be legitimately agonizing and that there are incredible stressors and many sleepless nights endured, but even that is not the same as going into covid rooms wearing contaminated pieces of paper because of greedy business decisions. It also cannot continue to be about the types of sacrifice that cannot in good conscience be thought of as necessary. This isn't about the heroics required in unforeseen circumstances; this is about others making plans for nurses to sacrifice solely because of our own history of doing so even when it is unethical and not strictly and objectively necessary. I again assert that our Code of Ethics does not call for the kind of repeated sacrifices we have been asked to make. Keep in mind that in some of these "sacrifices" we have compromised on a lot of things that have greatly affected patient care (not to mention our profession). You are entitled to your opinion and beliefs on the matter and owe it to yourself to act in accordance with your conscience. If you are okay with the number of good nurses who have been casually disparaged and treated as if they are the problem, that is your prerogative. Personally I believe the topic should bother you on a level other than to call someone's ethics or suitability for the profession into question.
  2. But you're reading the OP as if its only possible purpose is to criticize. The OP asked "why" and has received some plausible and reasonable rationales for why such things might happen. The OP is not criticizing your personal practice. I can't understand the defensiveness. It doesn't sound like the OP went off and reported these practices, s/he came here and asked "why." It wouldn't be unusual for someone to come here to try to get an idea if what they were seeing was appropriate or not before deciding to raise the topic in the workplace; especially newer nurses (which granted I don't know if the OP is a newer nurse or not). Or another question might be why would someone just randomly decide to say that? They just make things up so they can be judgy? Do you read any of the posts on here that talk about the workload/time limitations involved in working the med cart in LTC? Or any of the posts that give hints about their providers' availability and (often lack of) intimate involvement in what's going on with the LTC residents? There are probably lots of posts here that randomly hit on the idea that LTC nurses are not expected to be calling for every little resident need or irregularlity like you might do in acute care. I thought there was even a post where they were continually told by the employer not to call because the facility had some wacko contract with the medical provider where calls were charged individually and they didn't want to pay for said calls. I mean, I guess if you think the most likely thing is that the OP made up a story about what s/he thinks is going on here so that s/he could have something to post on a nurse's discussion forum, that's up to you. It doesn't seem like the most likely thing to me. Lastly, if a med is going to be held, subsequent nurses should be able to ascertain why so that they can follow through on the concern that caused the med to be held and be alert for continued/future concerns. If the OP just made this all up without trying to check the places in the chart that might have given more information, then okay, I'll concede s/he should have checked those areas before coming here to ask "why."
  3. Random thought: The face shield protects your eyes but doesn't it also mostly perform the function of the regular surgical mask you are wearing on top of your KN95? What are your facility's PPE recommendations/policies, and what patient population are you working with? I don't think removing your PPE (when you otherwise wouldn't) multiple times to clean your face is the safest thing and it might not be helping your skin condition. If your skin is getting really bad then it's probably worth a derm consult.
  4. JKL33

    How do I refuse to care for a patient

    This is not to insult your professional skill/knowledge, but have you tried to really work on a rapport with her? If she has problems then causing trouble may serve any number of her psychological needs or maladaptations. Without knowing how you have handled this problem so far, I would suggest at least trying to completely change your interactions with her. Just try it...greet her, say you're glad to see her, make some small talk, etc. Don't treat her like a baby or be patronizing or any of that, but just see if it's possible to start afresh. You should also consult your supervisor to try to glean how they might feel about this/what they might do about it/what it means for you as far as they're concerned. If they acknowledge that this woman is troubled and advise you to just care for her the best you can, that is probably adequate (unless she is doing something like accusing you of abuse or another crime or threatening to report you to anyone other than your employer). If you can't establish a better rapport with her and your employer doesn't solidly and proactively support you (starts counseling you or writing you up based on the patient's complaints and comments)...or if the patient is making threats or allegations that other entities (police, board of nursing, etc.) would be obliged to investigate, I would put my foot down about not being assigned to her care even if it meant looking for a new job. Hope you can get it straightened out. PS - I have seen some nurses get really upset about patients who are just making what is essentially harmless noise. They (nurses) get personally offended and/or don't perceive the harmlessness of the situation. Make sure that isn't what you're doing...it just isn't worth it to get worked up over harmless noise. I guess to sum it up: Ascertain whether or not it's harmless noise. If it isn't, you shouldn't tolerate it. But if it is, then let it go and just do your best.
  5. JKL33

    RN's required to be sitters???

    I don't think anything was said that would suggest you might need to feel bad for someone. Or we could just chalk it up to personal preference!
  6. So....you are doing what the OP is saying that some coworkers are not doing. Where was the judging part?
  7. JKL33

    mask refusal

    I don't even know why it should be referred to as refusing to care for someone...it can just as easily be viewed as the patient refusing the to receive care under the circumstances. With regard to my previous post, though, it would be pretty much open and shut especially if the site had an actual protocol for handling refusals instead of just putting staff and others at risk. Such as, why not ask these refusers to make a separate appointment at hours where they are separated from other clients and the staff is prepared and in full PPE gear? Or some such alternative plan? Give them their option (put on a mask now or make a different appointment) and allow them to make the decision about whether they want care.
  8. JKL33

    New grad......did I make a mistake?

    Couple of different things: 1) I agree with pp that this is not adequate training for a new nurse. I don't know what kind of mistakes you are making, but if they are potentially serious ones then you must focus on slowing down and being conscientious about what you're doing; do it according to how you were taught in school. If some of your lesser duties (as instructed or preferred by your employer) don't get done due to the absolute need to deprioritize them, that's just the way it is. If you can figure out how to be safe and your workplace is not tarnishing your professional record when their lesser objectives are not met, then it's possible to steadily move forward. If you cannot slow down enough to operate safely or your workplace is causing trouble because they are dissatisfied with your conscientiously-paced performance, then you will need to leave. 2) In addition to actual job stressors, this ^ is likely greatly influencing how you feel right now. While that is understandable, you kind of have a decision to make in this realm, too. You either decide to commit to trying to make the best of your circumstances, or you decide that they are unacceptable and you would rather be back to looking for a job. But don't try to do job B while constantly agonizing over how much you wanted job A. Don't doom yourself to failure that way. Take each day one at a time, purpose yourself to be conscientious and to resist feeling pressured to compromise yourself on important matters. Assessing your patients, intervening as necessary, and delivering correct meds and treatments are top priorities. Almost every other thing is going to be lower priority than those items. Good luck to you ~
  9. JKL33

    mask refusal

    You know, our Code of Ethics (though not perfect in my opinion) is a little more nuanced than this. Provision 2 clearly describes "patient" as being an individual, family, group, community or population. The argument could thus be made that a DOH's work involves a primary responsibility for/to entire communities and populations. You're making this out to be a personal ethical-professional issue, when in fact the argument could also be made that upholding a duty to the community (who is the "patient" of the DOH) involves protecting the interests of the whole. In my reading of the CoE, it would seem ethically reasonable to: 1) Seek understanding of the individuals' reasons for not wearing a mask 2) Collaborate to offer an alternative that upholds the duty to both the individual and the rest of the community and 3) Acknowledge these individuals' autonomy/right to refuse care if reasonable alternatives are not acceptable to them So...not doing the above would be the dereliction of duty. If the OP's employer plans to serve healthcare clients who cannot or will not wear a mask, they have a duty to come up with a reasonable alternative plan.
  10. JKL33

    Gender discrimination in pay

    And those rules would be a violation of the National Labor Relations Act.
  11. JKL33

    VIP Patient Demanding His Drugs

    That was my first thought. ** I would follow @FacultyRN's general procedure. I'm sure the physician who has been going along with this would be irate upon hearing that I don't plan to administer the med; at that point I would remind them that they are free to give the medication themselves. I have been in that general situation before where there's a mini stand-off like this. I haven't been so much as reported to management; I assume because the person in question has no leg to stand on as far as pointing to what wrong I might have done and they don't really want to have to answer for the shenanigans they were doing. They hope to bully or bamboozle nurses and when challenged it ends pretty quickly. You have to be a combination of pleasant + I'm-dead-serious-here. Also, don't entertain arguments about the details. The point is "I cannot [legally/ethically] and so I will not." As far as the leaving and driving (assuming the doc or someone else gave the med, and assuming I hadn't been replaced on the case). I'd probably defer his d/c until his ride was present. I assume at some point there would be another stand-off wherein he would simply walk off while being instructed about the things we're talking about. After that there's nothing left to do but immediately notify supervisor and write the note about what he did (including "the patient was reminded of the post-procedure ride policy and rationale, during which he stated "[xyz]" and abruptly ambulated from the department)." Include the name of the admin immediately notified. I do know I would not go along with this; the details of each step depend on what kind of pushback I get, but I've held my ground plenty of times when something is thoroughly wrong and ridiculous and putting people in danger or at real conceivable risk. Never fired or even so much as written up.
  12. I agree with this 100%. Based on my observations I would clarify that this should not by any means be mistaken to mean that nurses themselves are incapable of critical thinking or lack knowledge, ethics, compassion or using the nursing process appropriately. But my experience and observation is that those who want to incorporate more than tasking and obedience to directives will have an uphill battle...they are on borrowed time before they experience "burnout" (a term used in a manner with which I disagree and think it should be called what it is: moral/ethical dilemma, moral injury, inability or refusal to reconcile employer fantasies with actual professional nursing care). So I agree with @Susie2310: What is preferred is dumbed down nursing. I have been in staff "education" sessions where this cat was nonchalantly let right out of the bag with no compunction whatsoever, because they see this as a good thing. "We know how busy you are and we are working very hard to lessen the critical thinking you have to do in order to take care of patients." We are giving everything away when we leave so much of the completion of our education to hospitals. I see their objectives as being completely against this profession.
  13. Yes, there is no excuse for abject rudeness, and I do sometimes wish they wouldn't be so...uh...enthusiastic when they are wrong. Then I tell myself that if they knew they were wrong they wouldn't be doing X wrong thing in the first place. What I usually perceive behavior-wise (maybe this is gracious) is just sort of unrefined customer service combined with an enthusiasm to do what they believe they are supposed to be doing. They don't get a whole lot of info because employers believe it's just too complicated for them to understand and don't want them to use discernment anyway; they're just supposed to follow directions. So...if the main thing pounded into their skull is patient's rights and HIPAA and violations of these...that's what they go with. I can imagine that they mostly believe it is a "violation of [some xyz thing]" to allow someone back with the patient unless the patient insists they come back. It's all just sad. Agree with supervisor though. Practice manager, physician, someone who should know better.
  14. That's a pretty good idea to just take mom home. Pretty unlikely to be a helpful visit if no one is going to communicate with the caregiver anyway; might as well leave. I was with you up to the part about the incompetent front-liners. I guess I come from a relatively low enough station in life that I hardly ever see them as the primary problem in whatever positions they hold. In an office setting you're likely talking about people who probably have a high-school education and maybe a certificate or a little further vocational training (or maybe not). These are people who are solidly in the position to say "how high" when their supervisor says "jump." Short of rudeness and dangerous levels of ignorance about things they are supposed to know, I will almost always put their shortcomings on the ones supervising them and giving them their directives and workplace education.
  15. JKL33

    New Job Stay or Go?

    Don't make important decisions based on these kinds of warnings. I know it's tempting and I know they influence our thoughts and feelings especially if they appear to support our opinion. But they're mostly people talking trash about things they don't know much about. Stick with facts when making your decision. Yes. If they were having a specific acute problem (like upheaval that is primarily due to covid) I would expect them to be forthright about what they need from you, and none of it involves throwing a new grad out to fend for themselves. All acute care patients are sick or they wouldn't be there; the fact that the patients you are being assigned to currently have one or both feet out of the ICU is irrelevant. One of the other bad facts is that they aren't just assigning you to step-down patients (with a rationale and plan for doing so), they are also pretending at some half-assed ICU orientation where you have followed someone around a couple of times. 10 new grads in one ICU is a lot, I don't care how big it is. I say get out of there. Best of luck ~
  16. I know they do, but it isn't. If they have a more reasoned rationale like that given by @FolksBtrippin that's another matter. For yourself it would just be important to make sure you are making thorough assessments, communicating status changes to the responsible provider, documenting and following through appropriately. If, in your nursing judgment, you believe you should temporarily hold something, just follow those steps. 👍🏽🙂
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