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Posts by JKL33

  1. Edited by traumaRUs

    ED nurse here and I agree with the article.

    Where the arguments break down is that, while many of us dabble a little or rely a lot on gallows humor to get through our days/nights, we largely aren't turning that into slogans for "in your face" public displays.

    "I tubed your girlfriend last night!" [insert "Caduceus" symbol] pretend this is a PSA about binge drinking

    "Relieving Pain when they're circling the drain!" [again, Caduceus] pretend this is a PSA about end of life care, having living will/DNR in order, or perhaps even a political statement about assisted suicide

    "I come through when your kid turns blue!" [symbol...] Obviously a PSA about choking hazards....

    I'm not buying it. Are all the slogans mentioned in this thread worth a chuckle? Sure, I'll go along with that. I'd prefer they weren't used for "in your face" public consumption.

    If you are proud of your profession, carry yourself that way.

    If a bit of gallows humor keeps you healthy in your profession, by all means, indulge.

    If you enjoy sharing PSAs, do so.

    If you are somewhat insecure and need to show the general public how awesome you are with a slogan such as the Narcan thing...think about spending some time on things that would help you enjoy a healthier self-esteem.

  2. No one can predict with any certainty how it will be looked at, since hiring individuals may be more or less sympathetic to your exact career choices. Most I've come across would respect and understand a situation where things just weren't a good fit. But someone else may be concerned about "job-hopping".

    One thing I wanted to mention is that, while leaving one position after a short period of time (such as your current position) may not be a big deal and may indeed be the right thing to do, it really behooves you to consider exactly what it is that is disappointing about the job and then ask yourself what are the chances that there are similar disappointments in the next place you might look also. For instance, I'm disgruntled about a couple of nursing trends that I deal with at work, but I know they are happening kind of across the board in acute care these days - so it wouldn't necessarily benefit me to change jobs for solely those reasons. And the thing is, you leave one job, no big deal. When you find the same disappointments at the next job, you may eventually decide to leave that, too...and now you're starting a pattern that will definitely be of concern to future employers.

    Good luck with your decision ~

  3. Well, you might as well give it a shot if you're interested. Now that you've asked yourself the question it's probably not worth it to spend the rest of your life wondering "what if" - and I don't say that just because it's medical school you're talking about, I say that because you've expressed interest in what is essentially a different career.

    Good luck!

  4. Edited by JKL33

    Let's see: Three days is not enough time to orient either a tech to a tech position, or an RN to an RN position. A brand new graduate is no more "ready" to hit the ground running with tech duties than s/he is with RN duties based on my observations. It doesn't make sense that you would learn everything you needed to learn about the patients, the setting, the policies and especially the routine in only 3 shifts. Goodness, just finding your way around and starting to remember where everything is stocked would take that long.

    This says NOTHING about your ability to successfully practice nursing! Just remember that when you begin to orient as an RN, you will have a learning curve ahead of you.

    I do have one caution for you, and based on your post, I think it is important. I would find out *now* what the plan is for the RN orientation. As a new RN you will need a rather lengthy orientation compared to what you have received as tech. I think you need to investigate whether they plan to invest a little more in your success than what they have demonstrated so far. Do not set yourself up for failure by agreeing to an inappropriate new-RN orientation.

    Best wishes ~

    ETA: I need to edit because I thought you were still waiting to take the boards. I can sort of see why they didn't invest in a lengthy tech orientation...you hopefully will be doing this role for a very short period of time. Regardless...nothing about the 3 shifts you've done as a tech says anything about your ability to be a great RN.

  5. I have worked with precisely a 12:1 ratio in acute care, but it was over a decade ago - - it was the regular/expected staffing ratio on my unit from 23-07 at that time, though. Each RN was assigned with a tech, but still. It was an Onc unit, so the RNs were overwhelmed pushing pain and nausea meds, hanging blood products and antibiotics, and of course chemo. I trust things have changed. I certainly have not heard of any ratio like that lately.

    I love patient care, and I love doing in the acute setting. I have zero desire for any hospital nursing job that doesn't deal directly with patient care. That said, I haven't been thrilled with the way things have changed even in the past 5 years or so. There's just an abundance of extraneous "stuff" that is becoming an overwhelming distraction away from excellent patient care. I despise spending 5 minutes assessing my patient as quickly as possible and then 15 minutes clicking box after box, for one example. That said, it is a rewarding experience to care for patients; to be a nurse. I agree with the positives you mentioned in your OP as well. I wouldn't let your instructors' stories scare you away from something for which you may be gifted. It's possible they say those things to help weed out those who aren't too serious...and it's possible their information may be flat-out incorrect.

    Think it though. If you want to care for people and you love the material you're learning - those are good signs! Nursing is certainly an opportunity to never be bored and never be done learning.

    Best wishes ~

  6. OP - Why are you assuming that someone is taking humor in this situation? You know what they say about assuming, right?

    Did you ever think that maybe the person(s) who created this did so to make the statement that *nobody* is immune from an overdose? It can be anyone from any walk of life including a straight A student.

    Ha, ha...not so much. If that's the message meant to be conveyed, it could've just said something along the lines of "Honor Students Get Narcan, Too", or some such thing that had a more PSA feel to it and didn't involve what "I" did to "your" honor student. No, this is a direct "tit-for-tat", or "Oh yeah? Well ______!" response. Fairly childish...so I guess it's cool if that's how one wants to represent one's profession.

  7. On the other hand...

    There's an element here of taking things too personally. People are crazy, just completely ignorant and/or unthinking with their expectations of what can or should be able to be diagnosed or what type of advice is practical and safe to give over the phone. Too often they want to make a phone call and have someone else fix their problem, and become rude when it becomes clear that they might have to inconvenience themselves beyond the phone call.

    Their unreasonable attitude should be "water off a duck's back" to you. Their rudeness or their insults actually say nothing at all about you. You may find your position more tolerable once you train yourself not to become insulted or riled, and develop some of your own scripting and paraverbals for dealing with the situation.

    If you really don't enjoy anything about the work, sure, resign.

    Best wishes ~

  8. It's usually not a bad idea to keep other irons in the fire when you have the opportunity to do so. The per diem job isn't likely a huge commitment, so why not go ahead and start the new job and evaluate whether or not to resign from the per diem position sometime down the road?

  9. Edited by JKL33

    Personally I just think it's stupid in that "Everybody look at me, I'm a Rockstar" kind of way. It's actually more about the braggadocio of the person wearing it than the problem of either overdoses or honor students, which I guess I just don't find attractive or impressive. Same reason I wouldn't be caught dead wearing or carrying anything with any "nursing" slogans on it ("Would you rather speak to the doctor or the ***NURSE*** who knows what's going on?"). What is hilarious is the number of times I've seen people wearing these and, well, they haven't quite actually made it to Rockstar status yet. :rolleyes:

    ETA: I have a family, and it includes honor students. I don't need any shirts, tote bags or bumper stickers representing those facts either. All stupid.

  10. That's awful; I think you will find sympathy here for this scenario. I have no doubt these occurrences have shaken your sense of confidence and well-being. I do think you should contact an attorney to help you with BON interaction. It might also be worth it to find a professional with whom you can discuss what you're going through.

    I didn't want to believe in the phrase " nurses eat their young" because I could never treat another human being any less than I would want to be treated. Well I sure believe it now. Two highly trained nurses that I put my faith in as bosses and mentors turned on me.

    Please try not to think of nursing this way based on these occurrences. I think it's possible in both of these scenarios you were treated harshly as part of their program to preemptively reject any responsibility for the working conditions and/or to cover up institutional deficiencies.

    Realistically, neither one of these errors warrant you having difficulty with your license or with being employed as a nurse. I don't have advice, but I do send positive thoughts your way, that you will encounter the right legal help so that what has transpired can be put into proper perspective with the BON.

    (Oh, I did a little searching online out of personal curiosities related to your general situation, specifically about reporting medication errors to the BON. It may be worth it for you or your lawyer to be familiar with the ISMP's "Just Culture"/Patient Safety article(s). Obviously I don't have all the details of your situation but the ISMP's recommendation of having a "Just Culture" with regard to medication errors does consist of quite a few concepts that are in your favor.)

  11. "how did anyone let this girl graduate nursing school? How did she even pass the boards?"

    This kind of thing is most often spoken by one of a couple of types of people:

    -Someone who hasn't been a student/new grad for a long time and doesn't realize the gap between formal nursing education and everything else the new nurse needs to know in order to function independently and confidently

    -Your run-of-the-mill person who doesn't quite feel good enough about himself/herself and tries to feel better by criticizing and undermining others

    Whether due to genuine ignorance or something more mental health-related, there's no excuse for that type of commentary on a nursing unit and I'm sorry you had to overhear it.

    Two things that may help improve your perspective about everything you wrote above:

    -Start practicing the discipline of not allowing inappropriate communications to insult you personally. These may come from patients, families, or co-workers (unfortunately) but regardless of who says them, you need to practice not absorbing them; not wasting emotional energy on them

    -Take some time (even just a few minutes) to take credit for everything you've learned so far! You feel unsure of yourself right now (as we all did) but certainly if you think of your first day of orientation and work forward, you will see that you have learned an enormous amount. Just take some time to let yourself be encouraged by that.

    Best wishes ~

  12. It is very possible that I'm taking this too personally. I tend to take things personally, even when trying not to.

    I am in no way implying that the techs are jealous of me, nor do I see myself as "better" than they are, since I was tech myself for 2 years. I appreciate them and respect them a lot. I guess all I'm saying is I want to be taken seriously as a nurse. I'll have to discuss with my preceptor. Thanks for your input!

    I just mentioned it because it's something that crops up...possibly even more when someone changes roles and is now delegating to your peers whose role you used to share. I do think I wrote that a bit harshly - I actually meant it as just something to be aware of (from their point of view as well as yours).

    You'll do fine; just make sure you straighten it out with your preceptor so you're managing everything for the latter part of your orientation. Best wishes!

  13. I think you are taking this too personally and making too much of it. There are very practical factors that are likely influencing this right now - namely the fact that your preceptor is in charge of those patients right now. That's not to say that things shouldn't be reported to you, just that the techs are busy and they know who is ultimately responsible for those patients and that's their go-to person. Secondly, since at this stage your preceptor likely gives you some independence, there are undoubtedly times when s/he is available and you're in a room. It's also not uncommon for techs to see bits of what's going on with the orientation and go to the preceptor as a way to not overwhelm the new nurse who is trying to juggle lots of other things.

    As the PP notes, this is fairly simple. Talk with your preceptor and let him/her know that you'd like to receive these messages so you can learn to incorporate that aspect of managing your patients. Ask if s/he would be willing to refer the techs to you when they have an update/message.

    It almost sounds like you may be thinking that the co-workers you "left behind" in the tech role when you became and RN are going to your preceptor to purposely slight you; implying that they may be jealous. I hope that's not the case because that would be kind of a "big-headed" way of looking at this. My advice is just don't go there with your thoughts. Treat them with respect and earn theirs.

  14. Meaning they need verbal confirmation of yes or no. It's listed on your employment contract. I work in a position requiring a ton of call but even on our non call/scheduled days off we are required to call back or answer the phone to whatever they are calling about. Many times it's with schedule changes. Low census, etc.

    Okay, thanks for the reply. It disappoints me to hear of yet another insanity being incorporated into nurses' working conditions. I will go out of my way for an employer and have done it many, many times - as lots of us have. But they don't provide my phone, and they don't pay my phone bill, and they don't pay to keep me on-call in the fashion described above. What do people get paid for all of this? I'm fairly sure no one would pay me what I would require to be at their beck and call. I happily use my time and resources voluntarily to help others, but won't have them stolen for someone else's profit.

    Maybe I'm behind the times; I find this somewhat appalling. :down:

  15. OP - It's awesome that you were able to do an ED preceptorship. Work hard, learn all you can about the conditions you will come across, and strive to really understand what is happening with your patients; anticipate the direction of their course of care. That's how to do ED nursing, in a nutshell.

    Best of Luck! Come back here and let us know how you're doing!

  16. Your job description should include specific physical requirements such as amount required to be lifted; you should check your specific requirement, but for the sake of discussion let's say it's 50-60 lbs. And yet, how often do we think nothing of having only 2 nurses/techs pull a 250-lb patient up in bed without using any assistive devices? I use that as simply an example to point out that even the most simple and common things that we do, we rarely do properly.

    My back is in good shape but earlier in my career, although I personally used proper personal body mechanics, I didn't follow good principles overall (such as having enough help for the task at hand, or always using the necessary equipment). Quite some time ago the stupidity of that finally sunk in and I decided to just change my practice one day. No more doing something wrong just because it might be quicker than gathering help or using assistive devices. I simply will -not- lift in an unsafe manner any more. So if I'm asked to help with a task that I know should take 3 people, I'll say "Sure - but we need to get one more person to help us." My experience (which I admit is kind of a best case scenario) has been that the attitude has spread, and the expectations from peers to do things unsafely has decreased significantly. An unexpected bonus. If peers get on board and everyone helps each other, EVERYONE is safer.

    Recommendation #1: Do NOT lift in an unsafe manner. Just don't do it. And I do mean literally refuse to do it. Don't lift more than your job requirement (not because you're a "slacker", but because it's already written out as being the amount your *employer* thinks is reasonable!). Don't be pressured by co-workers to do things unsafely. If you are working alone a lot or in a circumstance where it is your employer that fully expects you to lift unsafely (which would likely be against written policy and your job description...) you need to talk to them about solutions to that problem or else find another position. You are not a human lifting machine (nor a human-lifting machine!)

    Rec #2: As soon as physically able (with your doctor's recommendation if necessary) - begin a core strengthening program. Get yourself stronger. This will help keep you in good shape so that you can lift reasonable amounts safely.

  17. The second time I attempted and failed, then asked for her help. I guess I know who not to go to now.

    Au contraire! :)

    [Assuming she is indeed an expert at what she does] - I have pursued these types nearly relentlessly when I've come across them in my career. They come across as being a little bit gruff, but it's a shell worth cracking in my personal experience. I have learned so very much from this type.

    [if she's a grumbly run-of-the-mill non-expert, disregard the above. Observe and decide]

  18. I suppose it's possible that it was an oversight, but I'm still highly suspicious since they made sure that I was on the schedule for Memorial Day, a Monday, and I typically don't work Mondays. [/i]

    I see from your other posts that you work a lot, and I'm "on your side" here, so-to-speak. I get it. Still, it might be worth just considering this:

    Let's say they are using a scheduling program/template that allows "standing" items to be populated forward repeatedly, such as your working of Tuesdays. So say that comes forward every time there is a new round of scheduling to be done. Next, they go through and add in the folks who are supposed to be working whatever holiday crops up during the scheduling period they're working on. Then they continue to build the schedule from there. That is how they would be sure to get you on the schedule for Memorial Day even though you don't typically work Mondays, and the same sort of system would've pretty easily allowed them to overlook the fact that you were pre-populated for that Tuesday, 7/4. It's a really big and difficult job, I can't say that I would remember, "Oh - purplegal shouldn't be on here, I remember she worked Memorial Day" - you know? Plus, depending on what kind of system they use, they may only be able to view portions of it at once, then a different portion, etc. They also wouldn't have noticed there being an "extra person" in the numbers for that 7/4 shift due to the fact that it is an understaffed shift, so there's nothing to cue them number-wise, either.

    Generally-speaking, if you don't need or care about this job, it's best to let it go under other (better) circumstances...

    If you're just venting that's understandable. I'd still try to turn it into a positive if possible. This time around.

  19. If they are demanding that you call them back it is in your best interests to do so.

    Over time it is often in one's best interest to maintain appropriate boundaries with regard to this. It can be very difficult to prioritize family and other obligations when constantly faced with the guilt routine. Having to say, "No, I can't help" repeatedly doesn't feel good (in and of itself). Feeling pressured to explain your personal plans and/or give a rationale for why you need to say no - which someone will undoubtedly make a judgment about...none of this is good. This is a pretty common occurrence in the ED; daily or even more than daily in some places.

    The kind and professional thing is to let them know one is unavailable - which the OP has already done.

  20. Hi OP, I work in a psych unit and walk in your shoes. Have you looked into taking a NCI training course? The verbal/nonverbal communication section of the course is really helpful to teach how to deescalate situations as well as help staff cope in a behavioral psychiatric environment.

    It has topics on how to set limits, how to assess/identify the different behavior levels and how to respond to patients with the following behaviors: (anxiety - level 1 using support, defensive - level 2 using directive, risk behavior- level 3 using physical intervention as last resort, and tension reduction-level 4 using therapeutic rapport. It also teaches how to identify challenging question vs informative questions (not to answer challenging questions and allow silence) and how to use negotiation properly. And using critical judgment when to remove the resident from an environment with an audience because it causes a domino effect to the other patients.

    Also, has topics on staff coping skills such as taking extra breaks, knowing your own triggers, staying calm and saying a mantra like "its not about me" and having empathy for the residents because you do get to go home after your shift while they have to stay there. The best part of the course is learning reflective thinking. "What could I have done better? "What can I do next time?" This course uses a teamwork approach on how to assess, plan, anticipate and use direct communicate with psych patients. The more knowledge you have about your patient population and training the better the outcome. i highly recommend.

    Great recommendation; it would be wonderful for nurses in many different areas, I'd think.


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