catlover314

I am going to assume that the snarky tone I read was not intended. I know that to many people manager = evil idiot. I just don't think that the tone of this thread is to help managers manage better; it is more about how awful managers are. That's not a terribly helpful approach, but I guess it does help people vent. I am just saying that constructive feedback is one thing, attacks and belittling are something else.

Just wondering...why is this discussion in the nursing management section of AN? The point seems to be to complain about management, which seems like a different issue entirely.

Another idea: check the facility's educational classes section on their web site when considering your options. Do they have preceptor classes for their nurses? And do they have unit based educators? It might signal that they know every nurse doesn't know automatically how to be a preceptor. If they recognize that you would probably find a place that meets your needs better than your first place. Best wishes to you!

When I am on another floor, I like being able to tell who is who...whether that is by a big title attached to my name tag or by scrub color...either one works. Our hospital has big tags that hang a bit below our regular name tag that has a very visible title. And yep, the docs have one that says MD and they wear it. When I am in any hospital/clinic as a patient or as a family member I do care very much about the role of the person I am talking to. But again, I don't care HOW I can tell people apart, I just want to be able to sort it out.

Agree with above that your current unit doesn't sound new grad focused, but a word of caution as you look for a new place...there is also some unspoken sense that you were doing them a favor...'moving from a large town to a small town' to take their job, along with a minimizing of the errors you made along the way. You'll want to avoid that kind of stuff as you move forward as it can come off as lacking accountability. When explaining why you are looking for something else let the new interviewer know that you learned a lot about what kind of structure you need to learn effectively. You don't have to even hint that you need SOME/ANY structure (like it sounds was missing!) but just emphasize what you have learned already and that you want to build on that foundation in a more structured new grad situation. File away those errors you mention in your memory bank...each of them can have just as serious an outcome as a med error (and none should have made it past a good preceptor!). In many places mislabeling meds once gets a written warning and doing it twice gets you shown the door; it can harm the original patient and whoever's name got put on the lab tube. Mistakes in mixing formula can be devastating, depending on the error and who got the wrong stuff and a breast milk error can be a huge mistake. Mistakes in charting can lead to changes in treatment or additional testing. While moving forward, don't minimize those errors, but learn from them and think about what you can do to avoid them in the future. Those are some substantial errors, but again an actively involved preceptor should have intervened. When interviewing, have a list of questions ready for them...are there didactic classes, will you have an assigned preceptor, will you be meeting with the unit educator or manager on a regular basis during orientation...that kind of thing.

"Will attend more staff meetings." versus "I will attend at least 50% of staff meetings (Specific), as evidenced by signed attendance sheet (measureable), prior to my next evaluation (time-measured). Attendance and participation in at 75% will qualify me as a significant contributor, and 100% participation and attendance will qualify me as a role model. Participation will be measured by review of notes and entries in my performance journal. " Implied is that this goal is both appropriate to the job and realistic. The more specific and measureable the goal, the easier it is in the long run...I know exactly what I need to do to meet the goal, and what the outcome will be. Another one..."Will take more student nurses." versus "I will precept nursing students with positive student feedback during the coming year: Six students per year will be solid performer, 9 will be significant contributor and 12 will be role model. Evidenced by journal entries and feedback from students."

Agree with other comments...give notice and don't burn bridges. Reason for leaving? Family reasons. As in, "my family wants me sane and happy." Ok, I wouldn't say that last part out loud, but find yourself a better job and then give notice.

And no state income tax, and much lower cost of living than Cali.

Reservation hospitals are run by the Indian Health Service, try googling that for more information. I think you are probably looking for Pine Ridge reservation, not Pinehill. Best wishes.

Going into management isn't typically in the minds of new nurses, so maybe that's some of the "why do people look at me like I'm crazy?" you refer to in the title of this thread. Not saying there's anything wrong with that, it is just an observation. For me the good parts of management are: feeling like I can help others grow in their careers, helping the unit improve in quality and size, and feeling like I can be an advocate for the staff. The bad parts? Sometimes I cannot help others, or they don't WANT the help, sometimes I cannot get what the staff wants and they see that as a lack of advocacy, and sometimes there are hospital wide things I don't necessarily agree with but I have to support as a manager. In addition, see the post above. It is definately a mixed bag, and it is a job that never really shuts off. Thick skin is required.

Our HR dept has a housewide policy on mandatories, like BLS and NRP as well as licensure, and it clearly outlines the process for expired mandatories. Check your nursing or HR policies.

Have all inborn errors of metabolism been ruled out? Some states' metabolic testing doesn't catch the less common things that can create symptoms like you describe...though cardiac seems a more likely cause. I am also wondering about the benefit of trying to feed a kid to eat who is obviously signaling that eating is NOT ok, for whatever reason. All that time and energy may lead of a true oral aversion. I'm one of those older nurses who used to be proud that I could 'feed a rock', but I've learned that I may have been creating more problems by being so agressive. Food for thought, so to speak.

OP: Off topic a bit, but my teenagers loved the Musical Instrument Museum in Scottsdale. And northern Arizona has a lot of facinating things to do and see. When it gets nice, you should take them to Oak Creek Canyon/Slide Rock State park. Those are the kinds of things that can make the hard times as a traveler worth it. Good luck!

No experience with UMC, but did work at another Vegas hospital as a traveler. It was a long time ago, and since it was a different place and time, my experience is probably not helpful. But, of course, the upside is you are in Vegas. We did a lot of casino hopping, tried to find the best hot dog in Vegas and who had the best penny slots (see, it WAS a long time ago!). And then we would go to the desert, to Scotty's Castle, etc. Lots to do and see that helped balance out any negatives. We even went to a 'house' and visited with some of the girls, which was facinating as a nurse...but that's another story.

Many thanks for all the responses. I am looking at all options, including what regulations need to be met, but I appreciate more feedback and ideas. What you like, what you don't...that kind of thing.

For units using central breast milk storage for the unit: What kind of refrigerator do you use for breast milk? How is it organized, and how many beds does it serve? What do you like or dislike? Same question re freezers...what brand, how is it organized, how many beds in the unit? And of course, the most important question...does it meet the needs of the unit/staff?

Try googling "cms hcahps". Should lead you to detailed information.

Unless your leadership experience includes management (hiring, budgeting, responsibility for productivity, etc) you may find that it doesn't count as much as you would think. In which case you would be brought in at whatever the low end of the manager scale is in your area. I know many managers who make much less than staff nurses make.

Agree with kayern's comments. As a manager, I first ask myself "Is there a policy violation in this complaint/issue?" Then I ask myself if this is a people problem or a process problem or a combination of the two? I try to ask a bunch of questions til I'm sure I get all the issues involved...and it sounds like this is truly a multi-layered problem. Lastly, after I've listened and asked my questions to clarify the situation, I ask the person with the complaint what they want me to do. Sometimes people come to me to blow off steam, sometimes they want help deciding how best to handle something, and sometimes they want someone else's head on a platter! But usually, people want a functional work environment that is safe and pleasant. I've done the two way meeting a couple of times, when that's what people wanted. They saw it as a way to work on their own conflict management styles, and it was successful because of the people involved...not because of me. I was just there to keep things constructive and on task. Conflict resolution can happen with a boss just laying down the law in some situations, but it isn't a one size fits all kind of thing. And the bottom line is, two people cannot achieve resolution to a conflict unless they talk to each other at some point in time but there is a lot of work beforehand that has to happen before that can be successful.

We have housekeeping clean the bedside at discharge, however our PCTs do a large share of the actual cleaning. They wipe down any plastic wrapped item with Caviwipes and any paperbacked product goes on a cart to be Bioquelled. The bedspaces are all wiped down on a rotating basis so even bedsides with long term patients get a good cleaning at least once every two weeks. On a daily basis, the patient care areas (counters and drawers) are wiped down by nursing or PCTs and isolettes are changed weekly with cleaning by PCTs.

Anyone know your rate of redraws?

@ christyrn05: If you mean they are both new grads with background experience in non-nursing areas, I would have to evaluate both their background references and the amount of clinical time in each program before making a decision. Purely on line would come in second, but I think all programs have an element of practicum I think. If not I would be very hesitant as nursing in books is a far cry from taking care of real people with real problems. If the question means you have two nurses with a similar nursing background/experience, the schooling itself isn't as important to me as the interview and their references.

Thanks, Nicuguy!

Looking for information on lab draws: Does lab draw your specimens (excluding line draws, I assume!)? What is your redraw rate? Do you use IStat or Gem point of care testing, and if yes what are the positives and negatives? What is your elevation (wondering if redraws correlate to increased elevation)? Appreciate any responses!

We have only a few transport nurses; they work 2/3 of time in the unit, 1/3 of time at the transport base station. They were expert bedside nurses before becoming transport trained. The transport portion of training was extensive and handled totally by the hospital's transport division. It included a lot of flight training as well as time in the OR learning advanced skills. The program is only 3 years old, so we are still learning and growing. The nurses had to apply for the position and be approved by the unit's medical director, the transport director and the transport division's medical director.