gswifty

Re: Goldenhare I do know nurses have a notorious reputation for 'eating their young'. I like to think of it as trial by fire. I'm sorry for your frustration with the discourse on this site, but i honestly didn't read any personal attacks being made against this consultant that were so egregious to be considered demeaning. This is a very emotional topic that has effected a great many of us over the past 10 years as we try to do the best job we can in what often can be a hostile and contentious environment or certainly 'challenging', if you prefer that. Maybe if we were exchanging recipes the topic would be more to your liking? Please consider the content and context.

To Goldenhare:On the contrary, considering the nature of the subject and the strong disagreement many have expressed here, I think he's been treated with civility. You obviously don't frequent other forums, because if you did your sensibilities would be asunder at the discourse that can occur. This is a very nice place. :)

Very interesting thread. My advice to stew would be two-fold. First, the us versus them mentality you have gotten a first hand dose of here is because nurses are the team and glue that hold hospitals together. Management, consultants and even auxiliary and other support staff including therapists are not the team. They might think they are, especially if their services are billable, but they are not. Many of us 'on the front lines' have seen our benefits being chipped away at for over a decade, so you can be as civil and polite as you please since your position is heavily dependent upon the perception of fiscal efficiency and political correctness, but you will always be on the outside looking in when it comes to commiserating with actual care-givers. Secondly, and this is a very simple point, so you should be able to grasp this...Regarding a systems approach to nursing care, when someone tells you to be in two places at the same time then that system has become untenable. Efficiency reaches a maximum velocity and once this is exceeded than you have a system that is failing. You want to quantify everything in your systems approach and it simply can't be done. Exemplars can not be quantified only observed and admired, and that's why non-nursing personal like yourself will never understand a nurses job. But that's a discussion for another thread.

You compelled me to sign in to like your comment. Great thread, very relevant in today's disconnected world. Thank you RNdynamic for shining some light on this common practice.

Start looking for another job. LTC, as it's currently practiced, is an untenable delivery system that's sure to burn-out and embitter. You can only go so fast before you hit max efficiency. Next will be the push for you to cut back on your OT but still get all the work done. As soon as you're expected to be in 2 places at once the expectations are unrealistic.

This is my current dilemma. I said yes to a for-profit two months ago and have seen first hand all the corner-cutting being referred too. The delivery model of this LTC facility is untenable and i consistently work over my shift to complete paper work. The flip side is it's a nice place with some decent people and it's close to home. I just got a call back from a non-profit i applied to two months ago and it appears the job is mine if i want it. I don't want to limit my options but a feel a certain loyalty to my current employer. It seems the for-profit has a revolving door trying to keep people while about %60 of the staff are long-timers. Weighing the pros and cons of this decision is not easy. Any feed back would be appreciated. This comment has a 'shelf-life', as i will be making a decision soon.

Great thread and read. Wow. So i'm not experiencing anything new. I have to maintain my objectivity before i get completely sucked into this dysfunctional mess that is LTC. The disconnect between those who 'direct' care and those who provide it is mind-boggling. And the expectations are so out-of-line as to be laughable, if the situation wasn't so serious/perilous. I've never been a fear-based nurse, though i've encountered more than a few. But the expectations placed on LTC nurses and staff is epically unrealistic. Do our legislators and leaders have any clue about the actual delivery of health care? *rhetorical* I'm not ready to leave, but i know just how unrealistic my job description is. 1,000 tasks, 1,000 details, 1,000 clicks on the computer,..this delivery system is mind-boggling. People have no clue! So what to do? Stay patient focused and know that i can't be in two places at once. Maybe it's almost time to emigrate.

i'm reading through your comment and nodding in agreement with all your fine points, until the end. the fact that you would disqualify someone because they have 'nasty' shoes because it show's a lack of attention to detail, hmmm... it's absolutism like that that has me torn between the uber-professionals and those who would make an einstein analogy and allowance about messy hair or some-such foible regarding the interview process. the fact that we're not mind readers and subject to the subjective criteria of each interviewers standards makes navigating these waters even more treacherous in these 'buyer-market' times. i understand that we're supposed to put our best foot forward during an interview but why, in this economy and during these times, does it always seem that we're all just supposed to be 'happy' that we have a j.o.b.??? i still believe it's just as important for the employer to be a good match/right mix for the prospective employee. interviewing should still be a two way street, imo.

Intend to delete double post.

To me, the rational for the F.R. holds great sway as to how far i would go toward leniency. On my TBI unit, where we often treat pt's that are NOT competant or ambulatory, it is easier to restrict fluids than a "walky-talky",who's potentially beligerent, confused and will drink from the faucet. That's extenuating,...and my realty. But to my point. MOST often we have the fr in place because of hyponatremia. Often borderline low. We only recently added nacl tabs to the sole intervention of fr to increase, obtain and maintain na wnl. Naturally, when i float to a tele unit and the restriction is in place because of a cardiac condition, i don't want to throw someone into chf because of education and/or compliance issues. With the hyponatremia, the body is not going to steer like a race-car(fast), more like an ocean-liner(slow). So, i take it on a case-by-case basis and use my best judgement. Holding fluids on a competant pt who understands the risks is unethical and probably illegal. Doctors can be overly cautious and often do not respond rapidly enough to lift or ease a F.R., imo.