Jump to content


  • Joined:
  • Last Visited:
  • 123


  • 12


  • 32,819


  • 0


  • 0


guest358111's Latest Activity

  1. guest358111

    Management Progression Assistance

    My sense has been that hospital administration does not view academic management experience the same as hospital management. At least as far as nursing is concerned. In some ways, even though it doesn’t always seem like it, they are two different worlds. Healthcare is a business, and nursing education is in a small corner of that business. Managing a facility day in and day out and being responsible for it 24/7 is hospital management. Academic management of clinical groups is not dissimilar, but is looked at as a micro sphere of hospital management and definitely not the same. It seems to be an unspoken “rule” that working only in academia is viewed by some administrators as a good retirement gig after earning your stripes in the career ( at least as viewed by the hospital). I’m not saying I agree with these perspectives per se, but it is the reality of the current landscape that I can see. That is why there are in some hospital contexts overqualified nurses from an academic perspective doing certain roles that they might feel they are under qualified for… The academic possibilities and the workforce realities do not always meet for nurses. All that to say, if you really want a hospital upper management job, I think you would have to follow the recruiters suggestions and go back to square one. If you don’t want to do that, you should stay in academia where the bulk of your experience seems to be. All the best!
  2. Sounds like you need clarification as to company’s expectation of the role of manager. It is appropriate to want to make sure the patient gets the best care and is safe. However, if as a manager, emergent situations cannot be handled without your involvement on a routine basis, something is wrong. Maybe you need more qualified staff. Maybe the staff you have need more training. You will run yourself exhausted if you have a system where every emergent situation has to run by you. And the staff will allow you to handle as much as you want. But you also have your own administrative work to do that they can’t help you with. You need to be able to have staff below you on your team that you can trust, so that you can spend your time directing the choir, so to speak. I hope that you can find the middle ground. I wish you all the best, these situations aren’t easy!
  3. guest358111

    How do you know when to let a new employee go?

    Never an easy situation. Is 5 months time a normal probationary period for your clinic? That seems extensive. If you haven’t already you should be speaking with HR about how to best proceed. Ideally you should have met with the new employee and discussed expectations and why perhaps these errors are occurring. If there is a fixable underlying cause, then that needs to be addressed and worked on. You may need to give a written warning asking that improvement starts to happen or termination will take place. I would not suggest having these conversations alone. The situation might take care of itself after a few well thought out conversations. Discussing how these documentation errors impact patient safety is generally an appropriate route. There are three options generally: 1. They will improve 2. They will not improve and realize they need to resign. Or 3. They will not improve and you will need to ask them to resign/ terminate their employment. Best wishes for the conversations!
  4. Yes, in my opinion I would hire you. No need to make it overly complicated. You became sick with COVID and due to extended recovery needs you had to leave your position. Put in the appropriate notice and work with HR and don’t burn your bridges if you truly feel you need to leave. You need to give yourself oxygen first. Then, when you are all recovered and able to get back into the swing of things, reapply. And just tell the truth if you are ever asked about it. You can’t help that you got sick, and you need to take care of yourself. And the truth is, this pandemic could last a long time. There will be a lot of job changes in many industries in the upcoming months. Best wishes.
  5. guest358111

    New Career in Management???? Advice?

    If you are someone who loves to have friends at work among your co-workers...and you have good solid friendships and a team with the people that you currently work with...then I would say seriously consider not taking the management job. I only say this because-in order to be an effective manager I feel that it involves a different skill set...one in which you need to enjoy the people that you work with certainly...and develop your team of people and allow them to grow and develop...but the bottom line is-when you are their manager, you cannot be their friend. I mean this in the nicest way possible. What I am basically trying to say is: when you are the manager, you cannot be the friend. You can be friendly, and caring and supportive...but if you are the 'friend' in the same way you are currently with your co-workers-you will lose the ability to be an effective manager. And if having many work friendships are important to you-you are best remaining where you are. That being said- if it works better for you pay wise and distance wise-and you are up for a new challenge....go for it! Either way, all the best on whatever you decide. 🙂
  6. guest358111

    Input on clinical instructor responsibilities

    A few tips that I have...have been doing clinicals for a couple of years now. (of RN students but I feel that some of this will translate). 1. If you are not also employed at the facility I would not do a 'nursing task' that would not fall under the student heading. Therefore, no, don't do a PICC line dressing. Allow the students to watch the nurses-but don't do this yourself. You have to remember that you are employed by the school and not the facility. 2. I have a strict "No meds are passed except with me" policy. Procedures...are ok for the student to watch the nurse do. However, anything invasive like a foley, I would rather be there. The last thing you as an instructor wants is something to be given/done to a patient incorrectly and you had no idea it was happening. I just decide at the beginning of the day what meds we are passing and then let the nurse know. 3. If the school you are working for has guidelines for what the students can be doing along the timeline of where they are in their studies, look for that. 4. Check your state board of nurses for the scope of LPNs. Keep in mind that students of course are not LPNs...at the very least they should have been checked off in the lab on a skill before doing it in a facility. 5. Stop into the facility on an off day and meet with the DON or whoever and ask for their policy book and review it. Hopefully something here can help you...all the best!
  7. guest358111

    The Future Nurse Bully- Is it You?

    Sure to be a much discussed post. Quite the story about the preceptor who said "congratulations on your first initiation." I just thought I would add, for what it's worth, there are difficult and rude people wherever you go. While it wasn't perhaps smart or even nice of the nurse to do that to a new hire- it was also rude and unprofessional of the physician. Perhaps time needs to be spent on discussions for new nurses or even those long in the profession about how it is ok to stand up for yourself -professionally and with dignity. In other words-it's not just the "bully's fault." Everyone has choices and not allowing yourself to be the victim can also be a choice. There are tools as well that can help with that such as conversation classes etc. where conflict management and difficult conversations are role played.
  8. guest358111

    What to do about burn out?

    Caregiving is exhausting hard work. Everyone who is a nurse has the potential to burn out. Everyone has given good advice. I think if you have another non-nursing job option you should do it. And just keep per-diem status for the sake of the resume. :) Why limit yourself with phlebotomy? That might not be far enough away from healthcare to help you get some motivation back. Maybe there is a coffee shop that could use a new employee!? Or anything really...there are many options out there in life. Just have to be brave enough to try something new!! :)
  9. guest358111

    Struggling with report

    When you look up your patients, look at the same thing the same way every time. For example, here is how I do it: 1. Why are they admitted and who is the admitting doc? 2.When were they admitted? 3.What are their recent orders? 4. What is their dietary status (NPO etc.) 5.What is their ambulatory status? 6.What recent labs were done? Write down ones that deviate from normal. Even if you don't know what they all mean...write down ones that are flagged as abnormal. 7.Check the meds and see what is due and write them down. Check allergies 8. See if they are on any IV medication and or need glucometer checks. 9. Look up any imaging that was done. 10. Read the last dictated provider note. At the very least if you look in the chart the same way every time, before long it will become second nature. You can give report in that way as well. "80 y/o patient admitted with pneumonia under Dr. so and so, recent orders include...diet status is...recent labs are...etc. If you know what you are starting with, you know what will have changed before you leave. And even if someone "already knows the patient" I think they should listen to you give a full report anyway. The most dangerous thing anyone can do is think that just because the patient was one way on their last shift they will remain the same on the new shift. :)
  10. guest358111

    Did I cause this rapid response?

    My two cents: You didn't cause this. If someone is admitted with sepsis-all bets are off. Essentially you are playing a game against time and an infection going through someone's system and sometimes sepsis takes a turn for the worse. I would be more interested in his other vital signs (HR/BP/respirations) around the time when you place him on oxygen. That said...what you could have possibly done is questioned the am 20 units of Lantus. Lantus is far better served being given at night in my mind. Officially they say Lantus doesn't peak. Or I should say doesn't have much of a peak effect. But I've seen it happen many times. And if he got the Lantus at lets say 8 or 9 am...around 4pm is just about right for it to catch up to him. Other question would be if he also is on any oral antidiabetic meds along with the insulin. In any case, a good learning scenario and at least it was caught and he is in the ICU. You will be a better nurse because of this. :) I would be more worried if you weren't wondering what happened!
  11. guest358111

    The Enemy... The Nurse Manager

    Nurse management is such a tough job. I have always thought that the management alone is hard, but then to have to do scheduling and coverage on top of that? Crazy. Thanks for such a forthright and accurate post. I'm sorry you feel like you are the enemy-you're not. I'm really enjoying reading everyone's posts-a lot of great perspectives. A few tips from a stint that I had in the management world: 1. Develop alligator skin. 2. You can't change personalities-but you can limit the time they spend behind your door. There will always be a select few people that always have a problem with EVERYTHING and will have to tell you about it every single day/week. I'm not saying their concerns aren't valid...but usually you have to listen to them respectfully for a bit and then figure out how to end it so you can get on your way and your day and make them happy and not get yourself get sucked into the quicksand... 3. Maybe this is naive of me, but don't waste time worrying about gossip on the unit etc. in other words unless something is said right to your face, don't deal with it or waste the energy. 4. And if possible, always granting PTO (as much as possible, you are right about no-one gets 100% of what they want )that might help set a culture where everyone realizes that they all have to help build the sandcastle... Really, at the end of the day though, developing alligator skin was what worked/works best for me. Haters gonna hate and all that. I can't let snarky personalities impact mine or I'd drown in the negativity. Just because you posted this obviously means to me that you are a caring person who wants to do a good job. So don't let it bring you down!!
  12. guest358111

    Young ADON

    I was 20 and in charge of an entire LTC facility and staff for over a year. It was hard. I did some things right, and I did some things wrong (as far as relating to staff). But I learned tons from the experience and everyone I worked with...even the difficult staff. My 'two cents' is this- They already understand that you are the ADON. You don't need to worry about making anyone think that you are 'capable', you just need to do your job to the best of your ability and be fair and understanding to all of your staff. Humility and a willingness to learn from those who are 'under you' in position but 'older than you' in experience will get you far. Watch your back, don't get pulled into, entertain or create drama, if you have any serious meetings with staff have another person there to witness with you. And don't make any quick or drastic changes that your staff will hate. And help them when they need it. :) Hopefully something was of help! All the best!
  13. guest358111

    But Why? Fingersticks and Common Sense

    Great discussion-this has interested me before. I am interested in what others have experienced in this area. It was always my understanding that fingerstick is not as accurate as serum. I have certainly seen differences between the two numbers. Although not usually drastic, it is nice to have the most accurate number possible when planning the overall care of the patient, I would think. Especially in instances such as DKA or HHS. Thanks blondy2061h, MSN, RN for the article on the meters. Here is a link to a study that was done in a ICU between bedside fingersticks versus plasma from the Journal of Intensive Care Medicine: Accuracy of bedside capillary blood glucose measurements in critically ill patients | SpringerLink
  14. guest358111

    Christian Nurses

    What a great topic... I have always been extremely thankful as I navigate the nursing profession...with the anxieties that I can have about staffing and patient care and doing the right thing and the complexities and the complicated patient situations and the often unanswered and depressing situations...thankful that I know Someone who cares more about those I care for then I do. That I know Someone I can pray to for help and roll off my worries onto every step I take from the time I leave my car to the time I get report and start my shift. And Someone I can talk to during my shift. Leave it all with Him to work out, that has worked for me!
  15. guest358111

    Love Nursing? Or Not? That is up to you.

    How much longer do you have until you can take the NCLEX? My advice is to stick it out-after a while I think even the starting pay rate might be worth it for you and then you can maybe find an area of nursing that you like...there are so many choices out there and they aren't all at the hospital. :)
  16. guest358111

    7 Things You Weren't Taught in Nursing School

    This is a very good article-but I have to admit, I am very curious about that insulin story. What about the dose of insulin and how it was calculated/related to the patient made the new grad nurse unsure about it when it didn't concern the Doctor, the Pharmacist and the Preceptor?? I mean it sounds like the new nurse was right on, but wow!