luvbug9956

It is lonely at the top! I have to say though, although this seems like a weak answer, sometimes it is time to move on. My first career in management was very difficult - I managed a group of unusually dysfunctional nurses and other staff. My director was very difficult to work for, and the organizational structure was also a barrier every time I turned around. I stuck it out for four years because I believed that this was just "being a manager". I was very successful in developing the unit, the program, and implemented some very great things - however, the inter and intrapersonal nonsense was, like you said, keeping me up at night and making me very unhappy. I recently (4 months ago) obtained a management position in another hospital, and I am SO happy. You don't have to put up with disrespectful and dysfunctional staff, weak directors, and unsupportive organizations - there's lots out there and sometimes the grass IS greener. I know it seems like a cop-out, but it's the BEST decision I ever made. Just be sure to really weigh all your options - I was offered 3 other positions prior to taking this one, and none seemed like the right fit. I am now where I am meant to be, with respectful and hard-working staff, a FABULOUS director, and a supportive organization. Trust me, it ain't all sunshine and rainbows, but it is SO different from what I was assuming management should be.

I get up at 5:15 on work days and I tend to wake up around that time on my off days...but try to get back to sleep until at least 7:00. I am one of those who feel like crap if I sleep past 8:00 or so.

I draw back to check for blood return anytime I access a port. When I do that, I just go ahead and waste 3-5 cc's. I want to know that I am flushing into a patent line!

Telemetry units are notoriously difficult. I floated to tele one day from my med/surg unit and was flabbergasted. I had a new-found respect for all you tele nurses I work in oncology, but really wasn't happy on the inpatient side. I moved to outpatient oncology after two years. I am now extremely happy in the profession, but actually MISS inpatient nursing! Ha...ya just can't win! It WILL get better once you gain the experience and the confidence. Trust me. But tele may not be right for you.

I am a recent (5 years ago) grad, and I struggled with the same issue. Do I go and work for awhile, or go straight to grad school? I decided to work, and I am really glad I did! I have already moved into a leadership position with my BSN and am now in a really great spot to start my Master's program. I truly don't think it's about paying your dues. I think that, with a Master's degree, you are showing that you have an advanced level of knowledge and skill. Whether you want to do leadership, clinical specialist, nurse practitioner, or education, you truly need basic experience to do any of those positions. It may be hard for someone who hasn't worked yet in the nursing field to realize what those advanced positions entail. You will never find a staff nurse who will respect you as a manager, leader, clin spec, or NP if you have no basic nursing experience. Unfortunately, that's just the honest truth. Honestly, a BSN does NOT prepare you for the realities of nursing...especially the politics that exist. And a resume that includes a 4-year BSN degree followed by a Master's degree, but NO work experience will NOT get you very far. I am on a recruiting committee that helps to choose leaders and clin specs for our organization. There are MANY applications for each position; someone with no work experience will not obtain a position in our organization. That's not to say you can't go straight for your Master's, but get some even part-time work experience. There are skills you never practiced in nursing school, whether it be a BSN or AA degree. And, if grad schools in your area are like they are here, there are probably 20 spots for every 500 applicants - you will not be selected without proof of progressive work experience. Like the above posters have stated, it's not about paying your dues....it's a reality.

I worked there for about 2 years as a student, and then 2 years as an RN. There are positives and negatives and I think it depends on which unit you work. I worked newborn nursery/postpartum as a student and it was great. GBMC is known for their OB program, and it really shows. However, I moved to the med/surg/oncology unit and had a (mostly) negative experience. Positives: great team on that unit (I miss them all!), mostly relaxed atmosphere, self-scheduling, no rotating shifts, fair holiday requirement, free/convenient parking, good benefits Negativies: poor leadership (my old manager has since left, so that may have changed), very little input asked from the staff when changes are made, fairly low pay rate, mandatory overtime (uh-huh, and we though that didn't exist), bully-type coordinators, and difficulty getting staff on night shift (meaning that day nurses often work over). I don't think I would go back to GBMC at this point, but never say never!

I have to say, my facility received Magnet status about a year ago. And honestly?? The staff nurses hate it. They don't feel that they are receiving any benefits from it. And they are required to do a LOT more work. They must be members of committees, audit performance improvement initiatives, be involved in unit education, etc. My honest opinion (I might get shot for saying this....)....it's another thing that takes the RN away from the bedside.

I will be starting my grad program in August, and I am currently enrolled in the NP/CS/Oncology program at UMB. I am going to start with one online core course this fall to ease myself in. I work 40+ hours per week (5 8-hour shifts) as a clinical leader. When I attended the orientation, they said that it is nearly "impossible" to work full-time through the program. So, has anyone been through this program (or a similar one) and been able to maintain full-time hours?? I REALLY want to go through the program, but am the major breadwinner in my family (hubby is a contractor and winter work is always slow). I cannot go back to being a staff nurse at this point b/c I rely on the leadership income. I am also quite shocked that all of the grad courses are middle of the day on like a Friday! No way will my employer allow me off EVERY Friday to attend a class from 11am-1pm! And even if they did, it really wouldn't be fair to my coworkers that I have every Friday off. I really expected some evening options, and there really are none. I am thrilled to have been accepted, as I know UMB has a great NP program. I just don't want to set myself up to fail. At this point, I am considering moving into the Leadership and Management program (completely online) and taking oncology courses as my electives, but my ideal position is to be a clinical specialist in oncology. Can anyone give me their experience in this (or a similar) program??? Were you able to work full-time? Were there ANY evening courses offered?

Nurses in pediatric oncology tend to be quite loyal...less turnaround time. It would probably be very difficult for a new grad to obtain a position in that field. I would suggest starting in adult. This way, you could start on an inpatient oncology floor that also sees medical/surgical overflow and get a good variety of experience. This will help you to manage your oncology patients ' comorbities if you choose to specialize further into oncology. Just a thought!

I agree with the above posters. We did not institute CBI unless our patients showed initial signs of hemorrhagic cystitis (first sign of blood in the urine). I would think that infection rates would increase drastically with prophylactic CBI...

Taxanes are always given before carboplatin, or severe pancytopenia can occur. We actually give the Avastin FIRST in our clinic. We do this for convenience, as we do not wait for the patient's lab results and can start the drug immediately, then giving the rest of the chemo after the labs come back.

There is a big difference between chemotherapy and biotherapy in regard to both toxicities and method of action. I am 26 and have worked oncology for 3 years. There is no definitive data on whether nurses working with chemotherapy have a higher risk of fertility issues. However, in my facility, once you become pregnant, you have the option to not hang chemo. Many of the nurses that I have worked with over the years have had normal, healthy pregnancies; some have gone through IVF to get pregnant. Whether or not this has anything to do with hanging chemo is unknown. To protect myself, I always wear my PPE...gown and double gloves. There are also different levels of risk...at my facility, we do not mix the agents, we just hang so there is much less risk of exposure.

We usually give chemo with ANC of 1.5 or above. Often times we will treat with a lower ANC with filgrastim or pegfilgrastim support. It also depends on the patient's regimen. If you are a member of ONS, there is a great online lecture through their web site that discusses ANC, GSF support, and discusses high-risk vs. lower risk patients.

I work in an outpatient oncology clinic infusing chemotherapy. In the years that I have worked in oncology, Phenergen is rarely given. With the new alternatives out there that have FAR fewer side effects and increased efficacy, it's just kinda fallen off the map in cancer care. If it is given, it must be through a patent IV with a positive blood return and must be given over at least 15 minutes as a piggyback diluted in 50cc...never pushed as it is VERY caustic to the veins and can cause increased side effects (dystonic reactions) at higher infusion rates. The only times that I have given Phenergen are when other alternatives have been ineffective and this one doc prescribed it all the time (but he was still prescribing IM Demerol/Vistaril for pain, so...). Our facility has changed the policy to reflect this new data...if yours has not, that would be a great performance improvement opportunity to stir up! http://http://www.ismp.org/Survey/Survey200608R0.asp?ps1=Hospital&ps=Q4_2='Hospital'

In one of the hospitals that I had been previously employeed, an LPN program was piloted, as they had previously not employed any LPN's at all. The program was piloted on one of the medical-surgical units and I think that it has since dissolved. The LPN's of course could administer meds, but no IV push meds, and could not do assessments. This actually was found to burden the RN's, as the RN staff had been cut, with the assumption that with the LPN's, less RN's would be needed. The remaining RN's thus had to still assess patients, with a much increased patient load (up to 10 pts compared to their previous 5) and still were required to give the IVP medications, including pain meds. Then whenever a patient would "go bad" the RN was still responsible for the emergency treatment and plan, all with a much increased nurse-patient ratio. There are absolutely places where LPNs are used and highly appreciated! Most LPNs I know have a fantastic work ethic and desire to learn! I think that this is why LPNs are used so often in long-term care; the patient conditions tend to remain a bit more stable and IVP meds are more rare. This provides great opportunity for LPNs...it just doesn't seem to work well in the hospital setting.

I totally agree that most of us are VERY hard-working and I am sorry if it came off that way that I was putting down the rest of us hard workers, but don't you find that the few that are not seem to have a very poor influence over the rest of the team, causing lower morale and frustration?

I had an interesting discussion with my husband this evening about the differences between nursing and other professions. My husband is a contractor and has had a lot of experience with "bad employees". I was talking about how HARD it is for someone to get fired in the nursing profession. I love that nursing has a sort-of unwritten policy regarding education vs. discipline. For example, if a med error is made, most of the time it is the job of management to re-educate and determine what happened rather than discipline the nurse; I mean, we are all human and make mistakes...our mistakes just tend to have an impact on peoples' lives and health! What I have a huge problem with is the tendency for this to extend to issues with work ethic! I have worked with many nurses who have: 1. horrible attitudes and tend to display these attitudes in public spaces (i.e. the nurse's station) 2. attendance issues (calling in repeatedly or just not showing at all!) 3. refusal to comply with policy or changes in policy When speaking with my husband, who manages people, these are all fireable offenses in his line of work, or at least disciplinable (is that a word??). Yet, in nursing this just seems to be par for the course! I am all for the educational approach with nurses who make honest mistakes...I completely disagree, however, with how much some get away with in other areas! I can't believe that in an office setting, an employee would get away with yelling at another one in front of customers without at least getting a stern talking-to! I mean, are we really that desperate for nurses! Being someone with a good work ethic, I find that those with bad work ethic negatively affect my job. When I first started nursing, I thought that this was a problem with my nurse manager on that unit, but I have seen it time and time again with other managers in other departments. Just wanted to vent!

I did my senior year practicum on the MultiTrauma unit. I learned a lot, but I do have to agree...a bit much for a new grad. They offered me a position when I left, and I politely declined! Plus, the rotating shifts were draining...sometimes the nurses are a week on days and then a week on nights! I also didn't like the patients' conditions and had a hard time not being able to have a conversation with them...now I am in oncology and LOVE it! A lot of nurses at Towson University do their practicums and clinicals there, and I have yet to find a nurse who has taken a position! It's just a bit too much for a new grad!

I live in northern Baltimore county (cockeysville, near Timonium and Hunt Valley) and work at Sinai, in the city. To answer your question, Angel75, my husband and I make a very good living (he is a contractor) and are still renting an apartment. The houses in the county are NOT worth what they are asking for them; barely any are affordable for the first-time home buyer (which is us) except in the areas of Parkville, Dundalk, and Essex. To get a townhouse in an acceptable neighborhood, it runs about $250,000-$400,000 (depending on where you go). Townhouses in Harford County used to be a little cheaper, but are steadily climbing as well. Single family homes (that don't need a lot of work) run from $350,000 on up to the multi-millions! Of course, you can always buy for a lot cheaper in the city, but the school systems are horrible...I know there are probably good ones out there, but as a whole, I would not compromise my future children's educations for affordable housing. My cousin, his wife, and child live in Fell's Point, which is an "up-and-coming area", and still complain of safety issues. Just take a peek at Baltimore's crime stats! I would absolutely stay in the county or look in Carroll or Harford Counties, which are still within reasonable distance. It is becoming unaffordable to live in the nicer areas of the city due to recent renovations of the row homes, skyrocketing their prices to above $400,000! My hubby has worked on some of these rehabs, and they're just not worth that kinda money! I live in an apartment in Cockeysville, rent a 2-bed, 2-full bath for $875, which is a great deal; I'm just gonna stay there until I find something acceptable. It's a tough road livin' here (higher price of everything) but the pay for nurses is exceptional (depending on where you work) and the choices for nurses are the best available...Hopkins, UMD, Lifebridge, GBMC, St. Joe's, I mean, the options are great! So we're still here! Good luck, and start looking in the county! Lots of blue ribbons schools in the county! Plus, you can take I-83 right into the city and it's an easy route to Hopkins, especially if you are working 7a-7p...you will miss the traffic! No dealing with the one-way streets or I-95...I went to Hopkins from Cockeysville for clinicals in school and had NO problems!

I have become quite concerned recently about the work ethic of our nursing tech. More concerning, however, is the way that the problem is being dealt with. I work at an ambulatory infusion clinic. Most of the patient care is done by RN's, and we have about 9 RN's per shift. We have one nursing tech who works 9-5 M-F; her responsibilities include taking each patient's vital signs and weighing them upon coming into the clinic, drawing blood (which we rarely delegate, so she doesn't do it much), delivering comfort items (blankets, drinks, etc.), and filling our supply carts at the end of her shift. When compared to the responsibilities of inpatient nursing techs, I don't think that she realizes how good she has it! She is a single mother of 3 and has to take public transportation to work. Here are the incidents that have occurred in just a few months time: 1. Several personal sick calls 2. Several sick calls re: her children's illnesses 3. Two deaths in the family 4. Two no-show, no-calls 5. Multiple days requested off for things like jury duty, children's doctor appointments, and evictions (which all sounds a bit suspicious...) I understand that she does not have support and has a difficult life to deal with. However, we need the help! Each nurse sees about 8 or 9 patients per day, and 4 or 5 are in-depth infusions; her help is vital to us. The nurse manager has done everything possible: counseling, work ethic lectures, an in-depth job descriptions...we even gave her her own space with her Dinamap, scale, and computer-on-wheels to help make her feel more valuable. The issue is, she is union, and there are steps that need to be made. It is so frustrating for the nurses, because she will be thisclose to being fired, then has a bout of good attendance, after which action must be started all over again due to union rules. She is playing the system, is quite manipulative, and I am personally tired of all the crocodile tears. I am very compassionate to the single, working mother, but this has gotten ridiculous...anyone have any advice for how to deal with staff that have poor work ethic? How can we make her see how good she really has it!!!! Is she taking advantage of us??

Sorry....this is long! I am a nurse 3 years out of a BSN program. For two years I worked inpatient oncology and for the past year I have been working in an outpatient infusion clinic. I had a difficult time at first "proving myself" to these nurses that I had earned my way to work this highly-sought-after job. I guess they felt that I hadn't "paid my dues" in the inpatient setting for long enough. Anyway, I have an exemplary educational record (1st in my BSN nursing class), just passed my oncology certification exam, and have very high goals for myself. I love being a staff nurse, but am looking more toward a leadership position. I will be starting my MSN program in August and am looking toward an MSN/MBA track. Anyway, there is an open Clinical Leader position in the Outpatient Infusion Clinic where I am currently employed. This position entails both clinical and "business" components, including chart audits, scheduling, and payroll responsibilities. According to the requirements, the applicant must have a BSN (I do), have 3 years or greater experience in nursing (I do), and have plans to work toward an MSN (I do). I have been considering applying for the position, but here are my reservations: 1. I am young (26 years old) and still pretty fresh out of school (3 years). 2. I am afraid that the other nurses will not respect me or potentially make my job difficult. 3. I am afraid of rejection or failure (either won't get the job or will fail miserably...) Nobody that is currently working in the clinic is interested in the position. We currently have 2 serious applicants. One is currently a clinical leader on the night shift on our inpatient oncology unit and, from what I understand, is not truly interested; just wants to move to day shift. He has never worked in an outpatient setting and only oncology experience is the past few months that he has worked on our inpatient unit. The other applicant is a critical care nurse with no oncology experience whatsoever. Our clinic is extremely busy...we have one of the top onc docs in the area and he attracts tons of patients! We see about 50-70 patients per day! I have a very difficult time with potentially hiring someone with NO oncology experience! As current nurse managers and leaders, what is your opinion? Should I apply for the job? How do I then handle the current staff (if anyone has worked inpatient oncology, you know that it is a dog-eat-dog world for some reason...) Last summer, I was offered a Clinical Leader position in a much smaller Cancer Center at another hospital, and at that point had only 2 years experience! How does the staff typically react to young leaders?

I currently work in a pretty intense outpatient infusion center (we see about 80 patients per day); recently we have had some disagreements re: protocols for administering certain drugs; i.e. how often to take vitals with certain drugs like Taxol and Erbitux. Me and a few other nurses want to help develop some policies but we are kind of at a loss to find evidence-based information or manufacturer instructions. Anyone know where I can find good info re: things like vital sign recommendations? It's gotten frustrating because some nurses vital for Doxil or Avastin, some don't....and of course the patients notice! Can anyone help?

One of our unit's staff nurses is a very poor nurse and we have no support from the management about this subject. This nurse has NO bedside manner at all (and we work on an oncology/inpt chemo floor) and is verbally rude to patients and families (that is, if they are lucky enough that she acknowledges them at all!). I believe almost every staff nurse, as well as some registry nurses, have gone to the management with complaints. And yet, nothing is done!!! Here are just a few of the issues: 1. Ignores call bells, beeping IV pumps, and requests for help 2. Our policy is double-signing insulin, yet no doses are cosigned (is the pt getting them at all?) 3. Pt's state they dont remember getting their normal daily meds that day 4. Pt's state that they never were physically assessed, yet complete assessments are charted 5. IVs, PAC needles, central line dressings, and IV tubing are not changed per hospital policy 6. Blood transfusions are almost always left for the next shift, even if the order is from 9am This RN has absolutely NO sense of teamwork. And actually, many of us end up pulling her share. For example, her pt came back from a test, needed to be pulled back into bed from stretcher...she sat, pulling up labs on the computer while 4 of us lifted her pt back into bed. We are all tired of the pts suffering. Day shift hates to work with her, and try to sign up on the schedule so that they dont work with her. Night shift hates to follow her because they spend their whole shift catching up on what should have been done and listening to pt complaints. What boggles my mind is that she still works on our unit! The manager wants to have "written complaints" from us about her. To us, that is not our job...it should be the job of management to follow up on our complaints. Many of us do not want to be pulled into the middle by making formal, written complaints. This puts us in an akward and unfair position. Plus, there have been several written complaints from patients and families, and still nothing was done, which, to me, is a travesty. And the nurse is breaking hospital policies daily. We are all about at our limit; but we dont want to leave this unit because the rest of the staff is so supportive and we love our oncology patients and what we do! We have an excellent reputation and this one nurse could ruin patient satisfaction! Has anyone had this problem? How do we get management to listen and do their jobs!!!!!!!!!

I have IBS and have suffered without meds because it is so sporadic...an attack once a month or so. But the pain is unbearable. Antispasmodics are available for certain IBS patients for pain. Zelnorm is now available, but I think it is only for the constipation kind. My sister went on it a few weeks ago, and I am considering going to my doc to ask for it. I get constipated for a week or two, then eat something to trigger me, get severe (10+ level pain) pain on the left side which is relieved by defecating, but usually cannot have BM for two hours or so after pain starts. I've started doing enemas as soon as the pain starts, but sometimes gives me diarrhea for a day or two! No win situation! Immodium tends to be ineffective for IBS patients. I just try to avoid trigger foods (high fat, fried, or dairy for me). If the pain hits, and I am unable to relieve it, a moist hot towel on the abdomen sometimes relaxes the abdominal muscles enough to allow a BM to occur.

Where I work, a list has circulated of unacceptable abbreviations. Among them...U (must write units), MgSO4 and MSO4 (must write out morphine or mag sulfate), and must use mcg for microgram. I believe this to be excellent policy. However, the hospital has also deemed QD unacceptable...doc must write out "every day". Also a good policy. However, there is a huge deal with the docs not complying, especially with the QD policy. Each time this is written in the record, the order cannot be carried out until clarified verbally, and the doc must come rewrite. It makes a lot of extra work for the nurses, who must call frequently during the day! Has anyone also had this problem in their facility, and how was it handled? This will be a problem for us only for a few more months, as we are going computerized! But it is still a time-consuming issue!