Devnation

As other commenters have said, it is likely entirely legal. That does not necessarily mean your only options are getting the cert or being fired. Definitely get in touch in touch with HR and find out if this is an official written policy. If it isn't, you have at least some standing to resist getting this certification. Also, you seemed to tacitly imply that you and your colleagues will likely be difficult to replace. That is leverage. It is very expensive for the hospital to have to hire and train new nurses. There is plenty of research concerning the cost of nurse turnover that you could present to bolster your position. If you think upper management might be more supportive, you can send an anonymous letter via snail mail to the director of nursing, or the chief nursing officer politely stating your case and asking for clarity on behalf of your unit. I would also question why this is suddenly a priority. If it is about Magnet status, is there another certification more relevant to your work? (Sorry, I know nothing about oncology.) If so, you can try to negotiate with management and ask them to accept an alternate certification and suggest a more reasonable timeframe. If you decide to take action, it is important to have the support of a plurality of your fellow colleagues. You must stick together, and that can be the hardest part. All too often, nurses do not use what power they have and just submit. Some commenters are saying that you should just quit. However, if you have personal reasons for wanting to work there, despite crappy management tactics (e.g seniority status, ideal location, vested pension, etc.), do not let them drive you out without respectful pushback and offering other options that work for both management and staff. Good luck!

I know that it's too late for this situation but it's something to remember for the future. Never sign anything without time to calmly review and reflect on it, doubly so if you think it is inaccurate. I would speak with the manager who asked you to sign the form and request a meeting with him/her and an HR representative. If your hospital is unionized, even better, involve them, too. It is all very well to be self-actualized and be above pettiness, but don't let them get away with bullying behavior. If it goes unanswered once, they'll do it again.

This. I wish I could like it a thousand times. I'm not a school nurse but I totally agree!

It's not hysteria, it is fact. Yes, there will be an oversupply of primary care nurse practitioners in the very near future, at least. Don't take my word for it, check the statistics on the Department of Health and Human Services website, to quote: "National Trends in Primary Care Nurse Practitioner (NP) Supply and Demand: Approximately 57,330 primary care NPs were active in the U.S. workforce in 2013. Trending forward to 2025 and using current supply determinants (e.g., entry and attrition rates), approximately 72,960 FTE primary care NPs will enter the workforce and 19,540 FTE NPs will leave the workforce. A net growth of 53,210 FTE NPs (93 percent) will result in a projected national workforce of 110,540 FTE primary care NPs by 2025 (Exhibit 3). Assuming the current national NP demand equals the current NP supply of 57,330, the demand for NPs is projected to reach 68,040 FTEs by 2025, an increase of 10,710 FTEs (19 percent). This growth in demand is driven primarily by an aging population with commensurate increased health service needs (90 percent). Expanded health insurance coverage exerts a relatively small (10 percent) impact on 2025 primary care NP demand." TL;Dr HRSA is predicting a surplus of 42,500 primary care NPs by 2025. https://bhw.HRSA.gov/sites/default/files/bureau-health-workforce/data-research/primary-care-national-projections-2013-2025.pdf

...And as of today, all clinicals are cancelled for every degree program on campus.

I'm an ACNP student in Maryland and clinicals are still in session for both undergrad and grad students, so far. Classes have moved to online.

I think it was you who said earlier that the expectations of nurses are sometimes too high. In many respects, I agree. It seems sometimes that nurses are expected to thrive and excel, despite innumerable obstacles. Yet we are the first to be blamed when things go wrong. We are often the first and last line of defense for our patients. I think the recognition of this fact is why nurses have been rated the most trusted profession for over 15 years. However, we have struggled in the respect department. We tout nursing as a profession, distinct from other healthcare roles. If we truly believe this, we must be responsible for our actions and judgments. It is not legally defensible, nor do I think it's fair, to point out what others did or did not do. We cannot blame inaction on "just following orders." It does not matter that the doctors or other healthcare professionals didn't sound the alarm. The nurse, as the primary safeguard for the patient's well-being in the facility, had a responsibility to protect lives and he/she/they abdicated that to the judgment others. Any prudent and reasonable nurse knows that elderly patients cannot withstand elevated temperatures. They did not need any emergency/disaster training or EMS to know that. If there was no formal evacuation plan, they should have asked EMS/Florida government officials for help. Threaten to call the media if you have to. They may not have gotten evacuated earlier but they never even asked or discussed asking. Most of the patients who died were NOT in hospice while at the nursing facility. Some were discharged to hospice after being evacuated and hospitalized. The case report also determined that a few of the patients, including at least one that was in hospice at the facility, could not conclusively be attributed to heat exposure, so they won't be charged with those deaths. It is not my intent to be confrontational, but I have to admit I find it a bit callous to even bring their hospice status up. Even if every single one was in hospice, they deserved to die comfortably, peacefully, and free of anxiety, not burning up in their beds. What bothers me, even more, was the false charting, and the attempt to falsify records after the fact. Mr. Colon charted that he was routinely rounding and assessing patients. Video evidence contradicts this. After the facility was evacuated, several late entries were added to charts, some documenting care given after the patient was transferred or already dead. This is a black mark on the integrity of our profession. It doesn't matter how much your supervisor threatens you, this is just plain wrong. I agree that manslaughter feels harsh. I'm not a lawyer, so I don't know what other lesser charges could be applied instead. The false documentation alone makes me comfortable with criminal charges. I'm not even sure that any jail time is in order. I would be satisfied with community service and/or probation. I do absolutely believe they should lose their licenses. I worked in a nursing home as a CNA while in college, and my sister has lived in one for almost 10 years. I understand the pressures they face. I also worked agency for a bit, lured by the high salary. I was assigned once to a very sub-standard emergency dept, where a patient with an active MI was taken, without my knowledge or approval, for a CXR while I was medicating another patient. I will only say that things went downhill from there, and I vowed to myself and my agency that I would never set foot in that place again, and I didn't. Nurses need to understand that protecting patients come first, always. And after that, always, always, protect your license. You worked too hard to get it to sacrifice it for an organization that almost inevitably will hang you out to dry at the earliest opportunity to save itself.

I thought long and hard about the various comments. I decided I needed more facts so I read the STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS Case Report which I have excerpted below (in italics). While I don't feel jail time is in order, I do believe that some criminal charge is appropriate, and that they should all lose their licenses. Also, as I said before, there should be others in management at the defendant's table as well. TLDR: The nursing home staff NEVER asked for evacuation, despite communicating among themselves that the patients were in danger. They only called EMS after patients were already in distress. Evacuation was initiated by the hospital next door and EMS after three patients were sent to the hospital (and subsequently died). Video and chart evidence suggests patients were neglected. There is ample evidence that charts were falsified afterwards to hide neglect."15. Although multiple experts testified at the final hearing that 'shelter in place until it is no longer safe to do so' is the standard of care in the nursing home industry during a hurricane, no testimony was presented to show that Hollywood Hills undertook an evaluation at any time after the loss of A/C whether it was more dangerous to relocate or evacuate patients versus continuing to stay in place indefinitely while waiting on restoration of power to the A/C." "29. Hollywood Hills staff members communicated with each other before, during, and after the storm on a group messaging service, 'WhatsApp,' which included key members of the Hollywood Hills management and staff, including Mr. Carballo, DON Castro, Mr. Williams, and others. These messages reveal there were increasing concerns about the impact of the conditions in the facility by at least the morning of Tuesday, September 12, 2017. At 9:40 a.m. on Tuesday morning, Mr. Carballo ordered no more resident admissions until the A/C was restored and asked the staff to secure more fans. 30. Shortly thereafter at 9:58 a.m., Jocelyn Rosario, director of housekeeping and building services, informed the messaging group that the 'patients don't look good' and 'we need fans.' Despite this alarming message, Hollywood Hills' management and supervisors did not follow up with staff present at the facility to determine which patients showed signs of distress from the heat. "32. Later that morning, Ms. Tellechea, nursing supervisor for the day shift, notified the group that the residents 'had a difficult night.' She advised that the facility continued to be without A/C and ice, and suggested that staff try to buy ice for the residents.4/ Ms. Tellechea also stated that it was too hot in the facility to conduct normal therapy operations. Again, no Hollywood Hills management or supervisors responded to this warning or directed specific actions be taken to protect the patients." Minutes after this message was sent, the first patient coded. "40. By Tuesday, September 12, 2017, Hollywood Hills was aware of the rising temperature and the potential dangers posed to the residents--some of whom had already been identified as impacted by the conditions in the facility. Despite clear evidence that the heat was affecting the residents, Hollywood Hills failed to document any efforts to provide extra care or monitoring to the residents, nor was the staff instructed on how to monitor and care for the residents more effectively, or to prepare for possible evacuation of the facility." "September 13, 2017, Events Prior to the Evacuation 41. HFR Crew 31 returned to Hollywood Hills in the early morning of September 13, 2017, responding at 3:07 a.m. to a report of a resident with cardiac arrest who was not breathing and did not have a pulse. Additional HFR backup also responded to assist. The HFR crews vividly testified about the hot conditions in the facility. One first responder described the temperature inside the facility as 'ungodly hot'...HFR measured Resident 1 to have a tympanic temperature of 107.5 degrees. Lt. Parrinello and Firefighter Wohlitka testified that they had never seen a patient with a temperature that high...Less than thirty minutes after transporting Resident 1 and leaving MRH, HFR Crew 31 was dispatched back to Hollywood Hills...When HFR found Resident 2, she was nonverbal, had labored breathing, was hot to the touch, had vomit in her mouth, and had a tympanic temperature of 107.5 degrees. The credible testimony and documentation from HFR contrast sharply with Hollywood Hills staff notes that Resident 2 was 'awake and alert' without any vomiting or other signs of distress." If you read nothing else, please read this part: "The experienced MRH staff had never seen multiple patients with temperatures in excess of 105 degrees, like those at Hollywood Hills. In light of the escalating situation, the nurses became extremely concerned for the safety of the residents and walked over to the Hollywood Hills facility to assess the situation firsthand. 56. Ms. Meltzer credibly described the conditions in Hollywood Hills facility when she exited the elevator to the second floor as, 'there was like a blast of heat like when you open your car door at the end of the day after it's been sitting out.' 57. MRH staff and HFR vividly described the scene at Hollywood Hills on September 13, 2017, to include Hollywood Hills staff visibly sweating from the heat and overwhelmed by the number of critical patients. Staff was heard shouting, 'they are dropping like flies.' Patients were disoriented and visibly uncomfortable inside the facility. One resident was found in a fetal position on a mattress with no sheet, in a diaper 'saturated with urine and feces,' hot and visibly sweating. 58. HFR and MRH first responders quickly recognized that the residents were in extreme distress and it was not safe for them to remain inside the facility. After Resident 4 was found deceased, HFR and MRH staff concluded that other patients were potentially in danger. 59. Earlier that morning, Hollywood Hills staff members had discouraged HFR from checking on other residents. Staff members told HFR that they conducted rounds and every resident was within normal limits. However, given the unfolding events, Lt. Parrinello rejected the contention by Mr. Colin, night shift supervisor, that the staff had already checked on the other patients and that everyone was okay, telling him, 'you told me that before and now we have multiple deceased patients so with all due respect I don't trust your judgment and we're going to check on everyone ourselves.'" "60. HFR and MRH staff all agreed that evacuation of the Hollywood Hills facility was necessary to protect the residents. HFR Battalion Chief Robert Ladwig assumed command and was in charge of operations at the commencement of the evacuation."

Undocumented immigrants are not eligible for Medicaid (except for extremely limited emergency services), and just because a person appears "able-bodied" does not mean they do not have a disability, physical or mental.

It has not been stated in any of the articles I have read that the facility ever requested evacuation from the state. It is possible that if they had, they would not be facing charges. If any executive or administrator told them not to request evacuation or transfer of the more vulnerable patients, they should be charged. I was not suggesting that 911 should have been called to evacuate patients. I am saying the nurses did not monitor the patients well enough to recognize the developing crisis in some patients, and call 911 for them. I believe I read that three patients coded within 2 hours. We know there are clinical signs that happen before these occur. I also have not read anywhere that the majority of the deaths were among hospice patients. Besides, it wouldn't matter if they were. Hospice aims to provide a calm, pain-free death. Dying because your temperature elevates to 109 F is pretty much the opposite. I sympathize with these nurses and feel that they were placed in a very difficult situation. The director of nursing and administrator should have been onsite. Nurses this new to the facility should not have been left to manage this alone. I would not be surprised to learn that these nurses had been pressured to refrain from asking for evacuation. Ultimately though, your license and more importantly, your patients are your responsibility. I'm not comfortable with the thought of them going to jail, yet I am also uncomfortable with nurses abdicating their responsibility to their patients' safety. I am glad I will not be on the jury.

You are correct. We would not have taken all the patients at once. They should have been divided among the local hospitals. The point remains that emergency services were not contacted sooner and people died as a result.

Here we go again... Another tragedy waiting to happen. Clearly, the aftermath of Irma has taught nothing. This time, if any patients die as a result of power failure, they need to prosecute the owners and executives of these companies, not just the nurses. Also there should be an investigation into the numerous deadline extensions. Why are they being so careless with human lives?

Although three nurses and the administrator where charged, there seems to be plenty of blame to go around here. It is unclear just how much staff was present. The nursing home states they were fully staffed before and after the hurricane. I took this to mean that although there may have been just three nurses present, they still had CNAs and other staff onsite. The administrator and the director of nursing should have been onsite as well. They both came in once patients started dying. Why not earlier? During disasters staff roles may have to expand. Did they have dietary or other staff round on patients and offer residents more water? Did they identify higher risk patients and have them checked on more frequently? These things help with early recognition of patient decline so that help can be summoned before they are in crisis or code. The corporate office/owners are also at fault for not providing necessary equipment and good contingency planning. Hurricanes in Florida are hardly unheard of. This nursing facility needed a generator powerful enough to keep their A/C running. It is well established that the elderly are more susceptible to heat-related illness. In regards to the person who mentioned paperwork necessary to get a patient to the ER: that kind of thinking causes delays that get people killed. I worked in the ER for many years, and we never refused or turned away a nursing home patient over paperwork. Ultimately, nurses are responsible for the care of their patients. In a situation like this it is best to err on the side of caution and simply call 911 if there is suspicion of patient deterioration. Whatever difficulties the hospital experiences is not your problem, and more importantly, not your patient's problem either.

I do not know of specific examples, but my state BON states they will seek an injunction against a person misrepresenting themselves as a nurse, and there is a fine of up to $20,000. Since this is a judicial order, it has the force of law.

If there is a university near you with a graduate nursing program, I would look at taking a few classes as a course-work only student. These programs will usually allow you to take a couple of graduate level courses without being accepted into a degree program. Take ones that you will need for any program, like statistics. This can help bring up your GPA if you do well, and it shows your commitment to pursuing education.

Ok, I guess I'm the lone dissenter so far. I don't think you should quit, at least not yet. I understand because I was in that boat too. I was great in the classroom and mediocre at clinical. I was frustrated by this and began to dread clinical. In passing I heard the head of my program say to another student, that it was not clinical that caused people to flunk out, it was usually the classroom portion. I decided to take this very small and cold comfort to heart. Nursing is a profession that requires a huge adjustment period. I felt prefectly awful at it (and probably was) for the first year. Then it got better. You have already invested a significant amount of time, money, and energy in nursing, and you loved the academic part. There are so many different avenues in nursing that you may find that direct patient care is not your thing, but psych nursing is the bee's knees. Or maybe hospice, community health. If you like research, these days you can go directly from your BSN to a PhD program, no clinical required. But all that starts with your BSN. So I would look into some non-clinical nursing jobs and talk to a trusted faculty member about your concerns. If after that and soul-searching you feel you need to quit, go for it and don't waste time on regret.

I would ask for a copy of the unit policies. If you do not have a unit policy that states PALS is required, they should not have taken action against you. Is it a good idea to have it if you treat children? Absolutely! Should it be a requirement? Probably, yes. However, it isn't fair to penalize a person for something that isn't unit policy. If there are no written unit policies, that is a problem in and of itself.

They are blatantly taking advantage of you. When you accept a management position you have to understand that extra pay comes with extra responsibilities, including coming in to cover when your facility is short-staffed. If I were in the position to do so, I would call the ADON and tell her to figure out how to cover the shift, or figure out how to replace me. Resignation tendered, effectively immediately. But that would only be if I were able and willing to do so.

In my state, nurse is a protected title and the BON reserves the right to file an injunction for fraudulent uasge. The penalty fine is up to $20,000. Most states do not have a law regarding who can give verbal orders. However, multiple professional organizations recommend that verbal orders should only be accepted from a physician, APRN, or PA. This could be considered a care standard, something a reasonable and prudent practitioner would do. Meaning if you do accept a verbal order from unlicensed licensed personnel you could be opening yourself up to malpractice charges. If I were in your shoes, I would report this to the BON under the guise of asking their guidance. I would explain the situation and ask how to proceed. I would then inform my supervisor of their advice and act accordingly. I think this needs to be done regardless of your personal connection to this woman. This is a matter of safety and liability.

Yes! Thankfully, it does get better. I spent my first year feeling like an utter moron, and my preceptor was a woman who was responsible for 4 people quitting. She was very experienced, and had a wealth of knowledge, but she liked to snack on your soul a little as a 3 am pick me up. I learned everything I could from that woman and rode it out. It was tough, but learning and perseverance won out. For example, I started in the ED, and back then my IV skills were atrocious. Now, I can get blood out of a turnip, and people call me for difficult sticks. And that preceptor? Eight years later I was an agency RN working at another hospital in PACU, when my former preceptor walked in. She had never worked PACU and had a hard time catching on. I watched her struggle and had plenty of opportunities to make her life worse. But I didn't. Instead, I killed her with kindness and helped out whenever I could. Watching her reaction to that was far more satisfying than any torment I could dream up. Hang in there, it gets better!

If you post on allnurses.com about any mistake you've made expect a healthy dose of judgment from those who I have to assume must be perfect themselves, or else they'd know better than to kick a person while they're down. Since the people commenting here are neither lawyers, nor do they likely work for the board of nursing in your state, I would contact those sources first. I don't think you'll gain much more continuing here.

I was in a similar position when I started my AG-ACNP program. I was working two jobs, going full-time, pregnant, with a two-year-old and husband. I felt I was doing everything poorly. A year and a half later, it's still a struggle. Here's what I learned: if you have a support system, USE IT! If you don't, try to develop one. It really does take a village, so cash in every favor from every friend and relative you can. Thank them profusely, and make it up to them down the road. Don't turn down any offer of help; you'll need especially when the baby comes. Define your priorities and let everything else go. I'm looking around my living room right (as I get ready for clinicals tomorrow, and work on a take home test) and it's a disaster. Toddler toys everywhere, but that's ok. My kids are clean and fed, and I spent the time I could've been cleaning tucking them in. Organization is key. I use a Google Calendar and have it color-coded to reflect work, school, and personal events. I set reminders frequently. I can't say this will make everything OK, but it has helped me a bit. Good luck!

I can't speak to Arizona or California, but I have not seen a hospital anywhere in my area (East Coast Mid-Atlantic) that prefers ADN to BSN on any unit. ADNs can get jobs here, but BSNs are preferred. Many of the hospitals in my area offer tuition benefits for RN-to-BSN and graduate degrees.

In reply to Jules A: They are all DNPs, and most have been NPs for 10 years or more. They are all adult and/or acute care, as that is my track. Some do procedures, like bronchs, chest tubes etc.

I was taught that if it's wet, and not yours, wear gloves!