JBMmom

Well, many of the suggestions that would be likely from here would include seeking out other facilities, so the options are limited. She's probably got a good amount of unit seniority as well, so any move is going to have both benefits and drawbacks. But 10 years is a long time to stay somewhere that's miserable just for a pension. I'm sure that giving that up would be tough, but would be a devastating financial move? I can see that you have a concern for her health and wellness, sometimes giving up one thing can have unexpected benefits. If she absolutely has to stay within the organization, perhaps an administrative role is more what she's looking for. Less of the drama of a floor position, but definitely a trade for different stressors. If she still really likes being at the bedside, it may be a challenge to find a better environment. Good luck!

IV access is generally a pain at my facility. Many newer nurses aren't trained well in placement, and I know that as a floor nurse I worked always in hospitals that had IV therapy teams so I never became very proficient myself. Personally, I don't love them. I wouldn't be comfortable giving a pressor through them, and our policy doesn't allow it. We do use them for blood draws, but they don't draw well for very long. Our infection control team loves them because they're not central lines and there's definitely been a push to use them more in the past year or so.

Don't knock the experience you're getting in the SNF while you're there. You're developing time management skills, assessment skills, management skills and you're getting more out of it that you're giving yourself credit for. I started in a SNF and myself and many of my coworkers have found med-surg positions, other acute care positions, some have gone into the administrative roles in LTC and acute care. You say you bombed the interview, but it was only your first one. Where did you have trouble? Work on the things that trip you up so when you get another interview, and you will, you're better prepared. You have to have a more positive outlook of what you've achieved so far, because you've achieved things! You've graduated from your program, you've passed NCLEX, you're a NURSE. You've got drive and persistence, some people wouldn't have invested the time and effort you have, they would have given up. You'll find something, but don't make it seem like you haven't done anything yet, you're a working nurse and you have many skills. Good luck with your future endeavors.

The hardest part for me is when we're doing things to people because we CAN not necessarily because we SHOULD. Putting some patients through "treatment" towards end of life, sometimes with the knowledge that it's not what the patient would choose if they were able to state their wishes (be careful who you appoint as your surrogate decision maker), just makes me feeling crappy as a human being.

Are you saying he made these comments after having anesthesia or just unprovoked comments? I wouldn't put much stock in what anyone says when they've been under the influence of some pretty strong medications, although I guess it could be an indication of personality if that's what comes out. Sorry for what your friend has dealt with, I'm sure that's tough.

My concern is whether you're going to potentially miss a crucial intervention point with the sticky note option. I understand you're going with it and that's your choice, as long as it's acceptable in your work environment, however, there's a big difference between leaving a sticky note with a mild elevated BP vs an O2 sat of 82, heart rate of 160 or BP 80/40. If something needs to be acted on IMMEDIATELY, like low oxygen saturation levels, abnormal heart rates, or critically low blood pressures then yes, I would expect a CNA to drop whatever they're doing and find the nurse, or any nurse if not the assigned nurse, because that's going to be a rapid response/critical situation before any of your other stable patients. As the nurse I'm most definitely responsible for reviewing my vital signs, but it might be an hour later. If I'm in a patient's room for an extended time and I don't see your sticky note for another hour, that patient could be in crisis. You need to be able to critically assess which vitals are appropriate to leave in a sticky note and which need immediate attention. No nurse expects their co-assigned CNA to be chasing after them for every little thing, but as a team, communication is the key to patient safety.

I wouldn't be able to tell you whether you're making a mistake, I can only share my experience. I enjoyed my med-surg experience but in the end I chose to move to ICU because I wanted to know more about everything going on with my patients. My med-surg busy was more physically busy in that I covered a lot of ground with 6-8 patients on nights, spread throughout the 30 bed unit. For the most part, the patients were very stable and I could usually count on at least 1-2 to sleep a good portion of the night. When things got crazy was when there were more labor intensive interventions like CBI, hanging blood, post -surgical pain management. And when I had a patient experiencing an acute change in condition it could throw everything else way off schedule. In ICU, for the most part I'm in my patient's rooms multiple times an hour. The chaotic part is managing 8-12 drips on 1-2 patients (and sometimes 3, but hopefully one is less busy), and when things start going bad you're stuck in there trying to fix stuff. There's a lot more to know about each patient and their condition and current interventions. Vent settings, drip titrations, etc. (I don't work in a high acuity unit with ballon pumps or CVVH) You're much more involved in every aspect of patient care than on a med-surg floor. You won't know until you try it, good luck with whatever you choose.

I think there were some positives that came out as a society. For example, my church now has services through different streaming options and people that were once at home and unable to be involved in any way can now be back in touch with our church community. I have a friend whose family started Sunday night zoom calls and they've continued even after the pandemic so people can stay in closer touch. I think we came to value connections more when we couldn't have the same ones we had. On the healthcare side specifically, I can't think of many positives, but in my unit it definitely increased our sense of teamwork in that first year. We were on the front edge of something that no one really was an expert with, so we were all learning together. The doctors/RTs/RNs all worked in a more collaborative way than I had experienced previously. But the fact that almost everyone died despite our efforts was disheartening. We did end up with some crazy travelers throughout the pandemic, so there are still some funny stories kicking around the unit, which are good for a laugh every now and then.

I think even more than varying from hospital to hospital, this is going to vary from unit to unit. The mix of personalities that ends up working in any given unit can impact things in so many ways. I know that in my hospital there are two med surg wings that would be great for new nurses, but a third is awful because two of the older nurses are flat out mean. And it's not only older nurses responsible for this type of behavior. My own unit has developed a clique of nurses that hand off each other the best assignments and pick who will get the worst ones. It's just sad when people use making other people badly as a way to make themselves feel better. It's not only nursing, though, it's human nature and happens in all areas of life.

I'm unclear on your situation, are you working now? Or were you working in one of these areas in the past and considering returning? I've been in the ICU only six years, and I've got some experience in three different units. The culture in each of the units has been different and I could see some having more of the behavior you describe than others. (except the hitting, punching, etc- that's sort of a universal, sadly) Unfortunately, you don't always know the base culture of a unit until you're working there. And then you're potentially stuck with a difficult situation. I wish I could give you some solid advice, perhaps you would benefit from a remote position as others have mentioned. But if you really enjoy direct patient care, you have more limited options and you're potentially going to experience the same thing. Have you considered exploring travel nursing to check out the places with only a short term commitment? Your experience should definitely get you in with a travel company and I know many people I work with are able to travel all within an hour of home, but that will obviously depend on how close your hospitals are. Good luck with whatever you decide.

That's going to be a very subjective and individual decision. While there are certainly guidelines within each organization, ideally I would say I am in no position to judge what other people deem as a necessity for their health or the health of others. However, in my head, I do sometimes judge when it impacts others and appears to be someone taking advantage.

induced, please excuse my typo. (was too late to edit)

Everyone has made a mistake. Everyone. You are not going to lose your job. You acknowledged the mistake, you'll definitely never make that one again, and you will move on. The patient is fine, just maybe didn't get the full dose that time, give yourself a break.

Oh me neither, and I never would have thought you would either. I guess I just misread the initial post and then that made me also misunderstand the responses.

You're much older now, there's a very good chance that you will have passed through, and out of this stage, although you need to reframe your mindset. You said you currently work in a hospital, are you ever around catheters now? Maybe you could be in a room with someone inserting a catheter? And you'll start seeing catheter insertions early in your nursing clinicals, and I guess if you REALLY can't handle it, you'll find out. But there's very little chance you'll get through nursing school without having to do it. Clinical instructors aren't going to let you just pass on it if your patient needs a foley. I'm pretty sure I had done at least a dozen by graduation. Good luck.