JKL33

What are you thinking is the more appropriate response? Unless there is a lot more to the story, reeducation isn't wildly inappropriate, is it? We don't always need to be harsh to the Nth degree when someone has made a mistake....

People often ask about their resume and what they have to put on it as if that is an official document for notifying a prospective employer of your work history. It isn't. Your resume is your own personal marketing tool. Your application is another matter, at least in the eyes of the prospective employer. Leave whatever you want to off of your resume. However there definitely are employers who will terminate the application/hiring process if they discover work history that you omitted from your application, especially if they specifically asked you to provide a particular length of work history on the application. And you often have to check a box stating that the information you have given is true and complete to the best of your knowledge.

Common understanding would be that clinical has something to do with patient care/performance of nursing duties. As opposed to something like attendance issues or conduct concerns for example. But there is a lot that could in some way loosely fall under the clinical umbrella so it's hard to say.

What clinical decision tool did you apply in this scenario? And what policies do you have (if any) about applying C-collars in your ED that apply to this scenario?

Nah they need to cite their claims, not have me Google. Preferably APA style.

I can see how it would be helpful for learning but I can't go back and find out whether this would've helped me better learn the things I now already know. I don't think it is completely different than care planning. My old style care plans were very appropriately critiqued in our program for specifics and goals and the effort required to come up with a logical and cohesive plan of care which required a degree of understanding the health concept and how things are interrelated. The information about grading these concept maps also makes clear that patient specific data and measurable goals etc are important. I really don't care if someone wants to get to an end goal a different way. Go for it. I have never felt ill-prepared the RN role during my career. I do think that with the superiority claims in the article they should at least reference the studies that clearly prove it. Pretty sure they taught us that in nursing school also. ?

Are any patients ever on full monitoring at this facility? We all know that it's obviously possible to monitor SpO2 at a central station. But that doesn't determine whether or not your facility has the equipment. Does your place ever have patients on full monitoring where nurses are able to see a central monitor? It seems like your manager is saying the facility does not have the equipment. I don't mean to be discouraging and your concern for your patients' well being is not wrong. But if they do not have the equipment that they already DO KNOW that they should have, you're probably going to have to make some personal choices about how to respond. They don't need to hear about court cases or anything else; they are well aware of the risks of what they are recommending and they don't care enough to have prioritized this. If they really do not have the necessary equipment, your reasonable options include things like: communicating with the providers about which patients do or do not need continuous monitoring, notifying provider when their order cannot be accomplished at that facility, seeing if there are *any* reasonable compromises such as grouping these patients near each other and/or making sure they are near a central or more frequently accessed area like the nurses station or med room where it may be easier to hear bedside alarms, helping to devise a policy for discontinuing monitoring that is no longer needed if certain parameters are met, requesting an additional staff member on shift to help monitor these (unlikely but could be requested anyway), and whatever else you can think of that might possibly help alleviate this situation. Aside from that, your options are the same as a multitude of other nurses who have ever been in the position to care for patients in a range of less than ideal circumstances: File incident reports when appropriate, document notifying providers and supervisors and their responses if/when it is literally impossible to perform an order or any time patient safety is compromised, resign/leave if you think you absolutely cannot provide reasonably safe care, report them to regulatory bodies. Etc. If it were me I would inform them at the meeting that they either need to get the equipment or inform all providers that continuous monitoring cannot be performed at the facility and that the patient needs a higher level of care. I would let them know that the current situation is unacceptable and that you intend to inform every provider every time and will document having done so. I have stood up in similar ways on quite a few occasions. I would carefully deprioritize anything and everything that isn't directly related to the safe care of the patients on the unit, and carefully prioritize what IS directly relevant to that goal. Obviously there is a personal risk involved but if it's something you are being objective about and see no other solutions then you should do what you feel you must. No disagreement that these are very frustrating and sometimes scary situations.

Please clarify—is the DON meaning that you should disable the alarms due to the noise complaints and instead visually check the machine (as it will be facing the door) and the patient every ½ hour? If so, I definitely would not do that. If these portable V/S machines are all you have to monitor pulse ox then...it is what it is; you can't just silence them. There are a lot of issues at your place for which your facility/employer would reasonably be more culpable than the individual nurse, but disabling an alarm is something that an RN would be solely responsible for. And "they told me to" is not a defense. Either the patient is sick enough to need continuous monitoring or they aren't. If they are that sick, they'll have to put up with the alarms. If they aren't, talk with the provider and see if interval monitoring of vital signs is acceptable. You should do the same if there aren't enough machines for continuous monitoring...talk with the provider and see if any of the patients are appropriate for interval checks rather than continuous monitoring.

No first hand knowledge but this seems very unlikely to affect job prospects. For one thing, there are so many people who do choose to seek help (therapy, medication etc) for mental health conditions, I kind of doubt employers can afford to be that choosy, not to mention the number of these that are excellent employees. Your mental health is very important. There is no shame in seeking to restore/maintain good mental health just like you would for any other type of condition. It also bears considering that UNtreated mental health issues are not risk-free with regard to this topic, either. If I were weighing out the pros/cons I think I would come down on the side of being in a good head space and letting the chips fall where they may. Having or trying to get a particular job when you're not in a good position do well (both personally and professionally) is not risk-free; neither personally nor professionally. Lastly, cliche but probably also true: You don't want to work anywhere that they would reject you solely because you chose to go to counseling. They already suck by definition and that would just be the tip of the iceberg as far as how much they don't care about you. Take care ~

It doesn't have to be a blanket company policy per se, but there absolutely needs to be a care plan on paper for this patient. Just as you are requesting, someone (or group including the patient if possible) needs to come up with a reasonable response that is appropriate for this patient's situation and stick with it. What kind of specific plans/approaches have already been tried?

My first code; 1) I *walked to the nurses station* and reported that my patient didn't seem to be breathing 2) The lovely seasoned LPN paired with me told me to get the crash cart while she started doing compressions 3) pretty sure I wrecked some railings and dinged some walls and luckily didn't hurt anyone trying to steer the crash cart all the way across the unit 4) the code team arrived and this big old jerk yelled loudly WHAT HAPPENED HERE? (that was his way of asking for the basic background info) and my response was “…?she had cancer?…” Yep. That's what happened.

They can be accurate and as detailed as necessary. I understand what you mean, though—looking at a chart now kind of reads like, "someone dutifully went though and clicked the boxes" rather than attended to *this* specific patient. On the other hand, a lot of narrative charting had also become duplication, low-importance items, repetitive, and rather generic, in the same bland way that clicking a box feels to you right now. (Imagine years ago....people would dutifully go around and hand write or later type something like "resting with eyes closed, resps even/unlabored, NAD" on *every* chart. It very much eventually had the same feel you're talking about now, which is "did anyone actually look at *this* patient? ) Unfortunately I see the benefit of making chart reading as bland as possible given....uh, things. Everything. People.

Just curious how we know this is copy and paste and not dot phrase designed for use in this way. Regardless, if the documented statement is accurate, well then it just is. Hate to break it to you but there are also such things as basic care plans/templates/assessments that are pulled into charts and tweaked as appropriate. And is, in fact, part of what allows care to be provided at all. Otherwise we could see a fraction of the patients and spend our time manually re-documenting the same phrases over and over and over, in addition to the other housekeeping and administrative tasks that delay care and prevent care from being provided to more people in a timely manner. To tsk tsk about this is to perpetuate misery...this issue falls into that "death by 1000 cuts" category that is responsible for unnecessary misery.

Agree with comment above. Beyond that I would not go overboard in professing how much (you think) you messed up. You don't need compliance people going scorched earth over something in which the spirit of HIPAA has not been breached. I would take the tack of letting them know why you were in the charts and nothing more.

Try not to make more of this than what it was. For some of us it isn't difficult to go straight into humiliation mode and start internally berating ourselves, overanalyzing, worrying what it means and in general feeling awful inside when something doesn't go as we wish it would have. To sum up your scenario most succinctly, you missed a difficult IV start. That's it. That has happened to every nurse who starts peripheral IVs. Frankly we all have also missed what should have been an easy poke at some point, too! Using this paragraph ^ as an example of where we go wrong. You are now kind of "catastrophizing" what happened. This was not because of your age and is WAY more likely to have been related to (if anything) lack of frequent practice/repetition at a skill. Also your colleagues (older or younger is irrelevant) made a comment — so what. We don't know their intentions but IF they indeed were trying to mock/criticize, well that's cute. ?, who cares. It's very easy and also very emotionally immature to mock others, especially when you aren't the one who will need to perform. Best thing to do is move on. Along the lines of the poster above me, be a good learner, don't criticize and catastrophize every mistake. You're a human being. ?

Any more discussion on this at your workplace? I think the answer to your question kind of depends on what duties call typically entails and at what kind of volume. There's a huge continuum; from answering a rare call after hours all the way to acute add-ons to your schedule + multiple after hours calls + fielding urgent issues during the office day + managing the boxes of out of office providers.

We each must do what makes the most sense for our personal needs and priorities. With that out of the way... Personally I would not underestimate the value of ^ this. Your workload sounds more than manageable. Managers are often not *less* critical than what you are currently experiencing even in places where the workload is 3x or more than yours. Because there is even more for them to criticize and complain about when nurses are overworked. In your situation, the possibility of changing to a position with 3-4x the workload and still having to deal with petty nonsense criticisms is real. If it were me I would base any decision to leave primarily on how much this weekend issue is bothering you and whether or not you can speak with them and come to any satisfactory compromise about it. Unless your management is downright evil I wouldn't make their pettiness my main issue. You WILL find ridiculous criticisms everywhere and it becomes 100% intolerable when you are being criticized while also being run completely ragged due to workload.

Is the act of signing just meant to be an exercise that encourages participation/buy-in? I know this is not the same but sometimes actions like these are used for that purpose rather than a true legal purpose. Example is older elementary children being asked to sign a paper listing classroom rules of conduct. I would be very surprised if what your patients are being asked to sign is meant to convey legal consent. It seems wording would matter and it would also matter whether they understand the intent of the document (what it is and what it isn't). Interesting question! I'd be interested in your thoughts on the above and also what the lawyer says. Hope you get answers.

This is a process problem at your hospital. Getting a bed assignment shouldn't be dependent upon an individual ability or willingness to strong-arm or sweet-talk others in just the right way. It should be an expectation that the empty beds are going to be filled. The floor is being called with the details. I'm a little surprised that any place big enough to have formal bed management staff is still allowing any of this to happen on the receiving end. Consider discussing/confirming current expectations with your supervisor. It is very unlikely they will say that throwing a fit is an acceptable response to an admission or that any tactics that significantly delay the admission are acceptable. Now if -your- department is frequently making assignment errors that truly involve assigning an inappropriate bed based on acuity, that is a different issue that requires different solutions. But if that is not a common issue, then the back and forth is completely unnecessary. The patient is coming up, period, here's their details. Bottom line is that your job is to know where the open beds are, assign the bed when you learn of an admission, and inform the floor. You should be pleasantly professional with verbiage to that end. "Hello! This is so-and-so from bed management; just calling to get you the details on a patient coming your way." Or some such. Good luck!

The person who wrote that (6 years ago) is not incorrect all around. There is some nuance to the answer to questions like the one written in the OP, that's true—for example if someone indicates they are choking right in front of you and you are prepared to perform correct maneuvers or can call for help by all means do those things. There are other scenarios that are not nearly as straightforward. Sometimes the best answer actually is to stay out of it. If someone doesn't know which is which they probably aren't the best one to be worrying about it. The OP even indicated that these scenarios were not their strong suit, and that's just the beginning of why not every person who has graduated from some type of nursing program needs to feel obligated to intervene. Not every nurse knows more about this *and* can realistically DO more than anyone else who might be there. We are usually talking about BLS procedures here, not emergency surgery. The bottom line is that the answer here includes a lot of "IFs"

^Yep. Sorry I haven't been back after asking the question about your orientation but this is why I asked in the first place. Someone who has been successful in a place like IMCU doesn't just go elsewhere and "fail" on the type of things for which these people were criticizing you. Not often anyway. Learn what you can from this experience and move on. ??

What kind of organized orientation and mentoring have you had during this transition to (what I consider to be) a significantly different population and specialty? Correction: specialTIES

It really isn't a very thoughtful or observant claim. Nursing has every type of person; whatever way a person could possibly be described or categorized, some of those are nurses. I've come across very few actual bullies in nursing. What I have seen far more is just that at the end of the day this is very stressful work. Right from day one we are imbued with the fact that people could get hurt or even die based on what we do or don't do. We are taught medical and nursing means of healing and all in all it culminates to the idea that nearly everything we do with a patient could have some kind of consequence. After learning all that, we get into the workforce where we find out that employers of nurses generally don't care about (consider/value) our work in the way we were taught of its importance. We are workers to them; a sort of necessary evil. They want what they want from us and tend to use negative means to try to get it. Many of us have experienced or witnessed the way nursing staffs are threatened in various ways (write ups, termination, reporting to regulatory agencies etc) in the course of employers trying to control the workforce. My conclusion has been that all of ^ this together creates sort of a pressure cooker situation. Is it possible to remain kind and helpful and uplifting and supportive under these conditions instead of feeling stressed out, threatened and, frankly, afraid and run ragged? Sure. But it takes a LOT of courage and a lot of strength that we often just don't have. We work in a situation where someone WILL come to complain or remind or chastise if any little box is left unchecked. It just isn't for the faint of heart, IMO. I find the original statement to be triggering as well. It's quite a self focused statement.

It is usually referring to a point of first contact where people receive routine outpatient medical care (especially preventive care, management of common chronic conditions that don't require specialist management and acute conditions that don't require hospital level care). Usually including general peds, family medicine and general internists etc. Yes it is typically a clinic setting. For what kind of position are you applying? If "primary care" as defined above doesn't make sense for the role/application, is there any chance they are asking about primary nursing care, which is a nursing care delivery model often utilized with inpatient care?

Oh boy... I'm me and you're you. But I would take the opportunity to let them actually do some planning on finding my replacement. I have low tolerance for being straight up treated like I am stupid or must be so desperate that I don't deserve fair dealings with the employer.