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JKL33

Posts by JKL33

  1. 7 hours ago, HeartbrokenBabyNurse said:

    I can’t iterate enough how many people have reached out to me and told me what a bullet I dodged working on this unit with this particular manager. Could they have been just being nice to me? Sure. But it came from people that work within that hospital so they have more experience with this person than I do.

    It's possible that you indeed dodged a bullet.

    I think it was ridiculous of them to even mention the tardiness related to the badge. The one they gave you was not programmed correctly. At (most of) the places I have been someone would have apologized to you (not have expected an apology from you). For that.

    But more things went wrong. And it isn't that something (else) went wrong; it's what what happened next. Every one of us can expect to have something go wrong at some point. So you woke up late for class. Not great, but usually not a deal-breaker. This is no time to be texting a friend about it, though; it's time to call whomever is your upline, your manager or even the house supervisor...some live person, and inform them that you are supposed to be somewhere and you're on your way.

    This is standard expectation in the nursing world. For many of us in acute care/inpatient nursing, not following the proper late/call-out procedure is considered "no call, no show" and subject to disciplinary action. There must be very extenuating circumstances involved if not following the notification procedure. But I don't think that's why you were terminated either.

    If you really did tell your manager/clinical coordinator that you were told it would be no trouble to reschedule the class you missed, and if you didn't indicate that it was another orientee who told you this, then *that* was likely your fatal mistake. That is essentially what is called a "lie by omission;" you implied that you discussed all of this with the proper people, and allowed someone to think something that wasn't true based on what you didn't say.

    So....it doesn't matter whether the manager is an ogre or not. It doesn't matter whether it was your aunt or the pope who told you that this woman is difficult. It just doesn't matter. We often don't control the consequences of our mess-ups, but if integrity is compromised we have even less control and fewer options for rectifying things.

    These comments are offered w/ helpful intent and are solely in response to sentiments in the quote above. I fully believe you can and will move forward successfully if you understand all of the concepts involved.

  2. On 3/1/2020 at 3:23 PM, Buckie said:

    1 nurse of the 2 that I shared cart with was asking if I was checking the narc count sheet paper and the actual sheet when I was counting with previous nurse. This is LTC bytheway. I said no, normally I go with the number that is called out during counting. She kept on telling me I should always double check. Which is true but in reality not many nurse does that. 

    Well, that is at their own peril. No way should you do what they do!

    I would not work in an area where access was shared and it was my word against someone else's with regard to narcotic counts.

    On 3/1/2020 at 3:23 PM, Buckie said:

    In the end supervisor signed off for it that she gave which she clearly did not to make count sheet even.

    Just get out of there. That's ridiculous. To whom did she say she gave it? There would be some serious hot water involved in doing absolutely dumb things like that if people find out--it constitutes falsification of a medical record, fraud, etc.

  3. Not in a similar situation but you are certainly not the first who has been in situations where things weren't being done as they should be and most people were participating in the wrong. It's too bad.

    I never have and don't plan to use my personal devices for work-related communication. Is this official communication coming from the employer (which would still be a wrong way to go about it) or just people gossiping (also very wrong)? I would remove myself from that regardless.

    Don't give medications without a specific order or in accordance with a properly vetted protocol.

    Make sure you aren't participating in these or any other seriously wrong things while you decide whether you need to find a new position.

    Good luck~

  4. On 3/3/2020 at 3:44 PM, Hurricane said:

    But what are some “fatal flaws” that once promising new grads have, that caused them to fall on their face in their first year of work, and have to give up the career?

    Fatal flaws:

    - Very poor self-esteem. This is the enemy of success in numerous ways from the ability to communicate effectively to the ability to make good decisions for oneself

    - Lackadaisical attitude

    - Lack of critical thinking; poor judgment

    - Poor understanding of and/or communication with others

  5. 3 minutes ago, HeartbrokenBabyNurse said:

    I’m not sure how to respond to criticism such as this because I never had occurrences in previous employs where I had to be terminated. This is my welcome to the real world moment. I worked very hard for my degree so I have every bit of faith that I can indeed get it together. 

    S/he is just pondering the unfortunate aspect of this being a professional job, not a dime a dozen job. It is an empathetic statement, not a criticism, I'm quite sure.

  6. Heartbroken,

    It's good that you have recognized where you went wrong. Hospitals are pretty serious about their business. Although I certainly don't agree with everything they do, they have hired a professional and are within their rights to expect professional behavior. It's too bad whenever we humans sometimes have to learn stupid lessons the hard way, so I do have compassion for your situation.

     

    1 hour ago, HeartbrokenBabyNurse said:

    I was told when I accepted this position that the manager was a nightmare to work for and that I should’ve accepted one of the other positions.

     

    In your own best interest you will do well to forget that you ever heard that. (I wrote a paragraph I'm erasing because things don't need to be rehashed. But just know that, while it may console you to hear that a manager was supposedly known as a wicked witch, that information is not actually helping you. Just forget about it).

    It seems kind of unlikely that you would be re-hired by the organization right away, although if you are granted an interview you may be able to convince a hiring manager that you learned a quick and very difficult lesson and are prepared to prevent any similar missteps. It's good that they have noted your file as being eligible for rehire.

    Put out lots of applications and just humbly go forward.

    Best of luck ~

    🍀

    PS: I am not sure what my peers here will think of this idea (so it isn't official advice 🙂) but if it were me, I would consider writing a card to this manager in which I would thank him/her for the opportunity to be hired as a new grad and state something about my regret over how things turned out. "Dear _______, I wanted to thank you for hiring me as a new grad and giving me an opportunity to work in/on _______[unit]. It is a wonderful unit and I enjoyed being paired with [preceptor], who welcomed me and started off my training with a knowledgeable and patient manner that I really appreciated.  I regret and am so sorry for the misunderstandings and missteps on my part that reasonably called my reliability into question. This has been a sad but invaluable lesson for me. Should our paths cross again in the future, I will be prepared with the professional demeanor that my patients, coworkers, and employer deserve.  Kind Regards, [your name].

  7. 3 hours ago, RN-to- BSN said:

    It's common that the nursing STUDENT does not have access to EMR.

    It's a common thing, yes, but overall a student not being allowed to have full access to relevant parts of the record and/or not being expected/allowed to document in that record is a newer development. The possibility of a student messing up a record is something that has been an accepted part of the learning process for lots of generations of nurses, and isn't any kind of irredeemable catastrophe. 

    EMRs have changed things, it's more difficult to give everyone the access they need (and should have)- and keep track of all of that - just due to the logistics. But we manage to keep track of other stuff, like whether or not everyone has had their immunizations and completed their HIPAA training and all of that. So to some extent this is a matter of people unilaterally deciding that allowing students to get functional with EMR use is just more trouble than it's worth.

     

    1 hour ago, turtlesRcool said:

    If it's being charted under my name, I'm making damn sure I see it given.

    That's part of the problem, though - it shouldn't need to be charted under any staff member's name. Students' actions should be documented by them with the approval and cosignature of their instructor. From the sounds of it we're in a pretty bad place with schools and clinical sites not working together on much of this. Hospitals act as if it doesn't benefit them to have students rotating in their facilities and they're just doing the world a huge inconvenient favor by "allowing" it. Making it the staff nurse's problem, hobbling the learning process by limiting access and privileges and the overall contentious attitude needs to stop. The experiences need to be allowed and they need to be properly proctored by someone for whom that is the primary responsibility.

  8. @svicente0520,

    I am very sorry this has happened.

    I know it is extremely difficult as a novice to know when it's okay for things to be different than what you were taught in school, and when it isn't okay; when it's right to follow the lead of more experienced people around you and when to know that you need to do something different. Altogether these are factors that affected this situation. Making sure to have the right patient (and all of the "rights") is one of those things that is always non-negotiable.

    I don't think it's right to place a student in a situation where the usual process of properly administering medication that is used in the facility is not made available to the student nurse and then to react harshly when it doesn't go as it should.

    But...the way to move forward here is to just learn the lesson, and also have your eyes opened to the overall situation: There will be plenty of opportunities to cut corners or to do be expected to do things in a way that is not overall safe or best, so the bottom line is that when pressures and expectations, sometimes even rules, are such that the patient is placed at risk -- be able to recognize how to operate so that safety is not compromised. If you can learn that from this experience you will be ahead of a lot of people.

    Best of luck ~ 🍀

  9. 15 hours ago, Etak said:

    I feel ridiculous even saying this, but yes and I haven't even cracked it open.

    Crack it! 👍🏽

    When there's so much to keep track of it's natural that something ends up on the back burner for a while. But now you know you need it. 🙂

    Good luck ~

  10. Edited by JKL33

    1 hour ago, adventure_rn said:

    When people steal those masks, they gain zero protection, but make it so that healthcare workers can't do our jobs. It makes my blood boil.

    The public should be given (only) appropriate rationales about masks and the mask situation, immediately.

    Tweets from officials that begin with "Seriously, people..." don't even sound like well-prepared, well-informed statements that anyone should listen to. It sounds sarcastic and insulting and will encourage people to question the motives of the request--simply by the way it is delivered. Then they are more likely to buy, take, or steal whatever masks they can get their hands on and we can despair all the more.

  11. It would be interesting to ask (your instructor's) permission to interview more than one leader if necessary in order to complete the assignment. It would mean that you'd have to find even more people, yes, but OTOH they might be willing to answer one or two questions (some of which are fairly involved if you include the idea of explaining them to the student) even if they don't believe they have the time to be interviewed for 30 minutes or more.

    I expect some nurses will feel that it's unacceptable for leaders to "not have time" to help students learn. But reality is that this is a problem. Many of our workspaces run very lean and as great as that is for business there is a truly and actually a limit to what people can do with the time in a day--that part is something that few want to acknowledge.

    This isn't about you or your request, melrose21, just more of a musing about the state of things. I do hope you're able to get this assignment completed without too much difficulty.

  12. Edited by JKL33

    42 minutes ago, bigldiesel said:

    As stated every de-escalation attempt was made, for this (AO4, highly aggressive, non-compliant) pt, so the question is chemical restraint vs Shears for clothing removal.  I agree with the posts above and will choose chemical restraint as a last resort. (Context: 5 other patients, consisting of 1 ICU, 2 IMC, 2 medical, needed care and no providers were available for chemical restraint orders.)

    This is where, as an RN, you need to call for some accountability from other quarters rather than feeling forced to actions that, well, are probably towards the top of the list as far as being offensive, traumatic and least likely to facilitate any sort of therapeutic relationship with the patient.

    It's okay to do that; to start calling the responsible people and saying, "nope, this is beyond the pale, get some more help."

    Good luck ~

  13. 57 minutes ago, FolksBtrippin said:

    Just make it a never event. Get adequate 1 to 1 staff. It should never happen.

    I am not opposed to the idea that if something is inherently/absolutely wrong then it should never be an option and yes, no matter what some other way  must be found. I guess one of my concerns is that it isn't just the clothing. None of the interventions utilized in the worst scenarios are great. Physical restraint, chemical restraint, etc.--all of these are traumatic. They each individually have major potential for injuring someone's sense of dignity. Yet every option for handling a situation can't be taken away. These interventions are not absent from the spaces where specially-trained psych nurses are in charge, either.

    I am not sure to whom you're suggesting "get adequate 1:1 staff." The staff nurses here discussing how to handle situations IRL/IRT are not in charge of that. That's what I mean, it would be like me telling psych to "get an appropriate bed for this patient, then, if you don't have one, because this patient needs it." I would not go into your spaces and give you a directive like that because it is not helpful.

    1 hour ago, FolksBtrippin said:

    Your questions about implementation and logistics are not appropriate for this forum. How many psych nurses? That would depend on the size of your ED of course. Whether it should be a separate psych ED, also would be about resources and population density and all sorts of things that are site specific. 

    The questions are appropriate if someone purports to be participating here with helpful intent. How should I know if you or someone else reading this may have been involved in implementing the suggestion you made about staffing the general ED with psych nurses? Maybe someone else has some experience with this even if you don't. But you're the one who made the suggestion as if it were as simple as pie so it isn't unreasonable for me to have thought you might know something more about the matter.

    1 hour ago, FolksBtrippin said:

    Your statements about using words like milieu are extremely rude and also very ignorant.

    We are asking for definitive, specialized help **for the patient** from the ED, one of the worst places possible to try to maintain a therapeutic environment for patients who need psychiatric care. You are here criticizing us when we are not set up to provide the kind of care that can be provided elsewhere and you want to retain the right to say, "sorry, can't help you." No I will not apologize. I can't even begin to fathom how you think you are the offended party.

     

  14. Edited by JKL33

    3 hours ago, FolksBtrippin said:

    You check for dangerous items and you use a 1 to 1 for whatever you can't control. You never force a patient to disrobe ever. 

    Why are you acting this way? You quoted me agreeing with something and then posted that ^ in response.

     

    3 hours ago, FolksBtrippin said:

    Interesting that you found my suggestion below the belt, it was not intended to be offensive. Psych nurses are experienced with the population.

     

    I would apologize if I thought I misunderstood, but I don't think I did and your subsequent responses also don't suggest that you intended your comments to be helpful for improving the situation we're talking about.

    What is your idea for practical implementation of the above idea? You either actually have one (or at the very least a vision of the way you wish things could be) or you aren't trying to help anyone.

     

    3 hours ago, FolksBtrippin said:

    Maybe that is why you chose to make the comments you made about about the milieu, which are certainly offensive and uncalled for.  You don't know what you don't know about psych nursing.

     

    I wrote what I do know and it was not incorrect. My comments about the milieu were not unfair, you came here to tell others what they are doing wrong and to suggest that psych RNs staff a general ED while at the same time what we are faced with is difficulty obtaining definitive (I.e. specialty) care for the patient. My problem isn't actually with the inpatient psych end of things; they have plenty of their own difficulties and lack of resources. My problem is with you coming here to criticize everyone given the situation in which we all find ourselves; you have come here with a decidedly different tone than just about everyone else who has participated so far. If this is indeed that important to you then give us some real suggestions.

  15. On 2/27/2020 at 5:08 PM, Adri0418 said:

    He is extremely smart and knowledgable of the nursing process

    He really doesn't sound like either of those two things. He sounds like someone focusing on minutiae which he can criticize as a means of distracting everyone from his own deficiencies (real or perceived).

     

    On 2/27/2020 at 5:08 PM, Adri0418 said:

    even made an effort to try to get to know our team of nurses and PCTs prior to starting

    This sounds nice but it's somewhat likely that it was just manipulative. He tried to preempt everyone's scrutiny by disarming them, then when the rubber hit the road and he actually had to perform he freaked out and went into "distraction as a tactical maneuver" mode.

    He's either fairly inept or just thinks he is. Truly capable people rarely behave this way...they're too busy actually doing what they're capable of.

    Unfortunate situation.

  16. Turn over every possible stone, including consideration of possibly finding a different employer who is willing to actually help with facilitating placements instead of playing playground bully games with the schools. I know someone who did exactly that when his/her employer acted like a control freak and made it difficult for employees to secure advanced clinical placements within their system which controlled a large region. Simply got a job with an employer (major competitor, actually) who was more than happy to help. 🤷🏽‍♀️

  17. 2 hours ago, FolksBtrippin said:

    Patients should be able to wear their own clothes.

    I have no issue with that to the extent that nothing about the clothing can be used to harm self/others or to conceal dangerous items.

     

    Quote

    Emergency departments should be staffed with trained psych nurses. 

     

    How would this work logistically?

    I don't think it's correct to to compare the care delivered in a space that takes all comers of every age and diagnosis to that of a highly controlled space where concepts like "accepting (or not accepting) the patient for admission" and the words "not appropriate for our milieu" exist. The ED "milieu" is neither better equipped nor more appropriate. Complaints about the attempts of extremely-strained safety nets to handle these patients as best they can and calls for trained psych nurses are a little bit below the belt given the facts of the actual situation.

    Perhaps psychiatric hospitals and facilities should be required to operate psychiatric emergency departments? That seems a little more logical than deciding that the general ED should be staffed with psych RNs (how many?)

  18. 59 minutes ago, Tenebrae said:

    Just because its policy people doesnt make it right or best practice.

    Ideally we could keep everyone safe while maintaining very flexible policies. It doesn't usually play out that way given the numbers, the range of potential situations, the resources, etc.

     

    1 hour ago, Tenebrae said:

    I think it also particularly could be trauma inducing and create more distress for the patient. 

    I'm 99.9% sure I wouldn't have cut them off, myself. But, devils advocate: Being held down and given injections while terrified or paranoid seems about as awful as some of the other actions we're debating. Plenty of patients would say that is a traumatic experience and if that were the situation up for debate I'm sure we would hear similar sentiments to what we are hearing with this situation.

  19. 16 minutes ago, LibraNurse27 said:

    And I hope that if I showed up to the ED in psychosis I would receive medication for my condition like any other patient rather than be forced to comply with rules that I can't currently comprehend.

    What happens when the therapeutic intervention (in your example, the benefit of taking medication) is also something that the patient disagrees with or can't comprehend? Unfortunately we're back to the original problem at that point.

    I am not trying to be contentious but these are situations where we're already beyond the easiest answers. When offering solutions to very difficult situations they need to be realistic to the situaton. So far we have heard that the patient should 1) be given a chance (I agree, although even multiple chances may not work) and 2) should be given medication if they can't otherwise comprehend what is being asked of them (which means it's also quite possible that they will not comprehend the therapeutic potential of the medication or wish to take it) which puts us back to forcing something vs. not forcing.

  20. Developmental stages and milestones are something that just kind of needs to be memorized.

    Here's a pretty good video and you can look for more like it

     

    Do you have any exposures to children? Not really fair but having some exposures helps a lot. Take any opportunities you might have to observe children and make a guess about their age (helpful if someone can confirm age after you've had a chance to observe). Or, if you are around a child whose age you already know, observe to see what types of things are being done at that age.

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