Ruthfarmer

VERY well said.

Yes, a CEO in a private hospital answers to a board of directors--- who are generally only interested in profit margins and dividends to be paid to stock holders. Private enterprises are in the business to make a profit. Which perfectly explains why governmental regulation is necessary to insure that businesses are conducted in such as way as to provide the services they are paid to provide and that they do it in ways that are fair and safe. My local DMV is pretty efficient. There's nothing I can see corrupt there. Some DMV locations may be less efficient than others, but that's more than likely due to layoffs that have created staffing problems. A short-staffed office with fewer people working fewer hours are not going to provide the same level of service as a fully staffed office can. As long as corporations are not paying their fair share of taxes, there will be no way to fund agencies to the level that they can all provide adquate staffing to meet our expectations As to the Post Office, it is completely self-funded. In 2006, Congress passed a law that requires the Post Office to pre-fund 80% of its projected retirement benefits well in advance. A portion of these benefits are for employees who haven't been hired yet. This is a burden that no other federal agency or even a Wall Street corporation is required to bear. This was strategically planned in order to create a budgetary crisis to cripple and then dismantle the post office. These would leave citizens at the mercy of private delivery services, with fewer choices for services that are already more expensive than the post office. As to the "over budget military," the congress determines the federal budget. As long as greed and warmongering set the tone for policy, way too much money will be spent on military spending. As I answer the points of your post, it occurs to me that you are buying into the FUD hype. Fear, uncertainty, and doubt. Certain mass media outlets serve no other purpose than to repeat key talking points solely intended to generate fear, uncertainty, and doubt. They seek to influence people to vote against their own best interests. In order to do so, they seek to make people resent government. Personally, I like having clean water to drink, and safe foods to eat. I like having decent roads, highways, bridges, water systems and other forms of infrastructure. Just like public education and fire/police service, I think health care should be available to everyone. These are the sorts of things government should provide. [h=3][/h]

Healthy respect is appropriate. Fear is not.

BULL CORN.

Bull Corn. Having a wealthy class that controls a government is the definition of plutocracy. Generally speaking, those in power look out for only their own. THAT is class warfare. Questioning the legitimacy of plutocratic decisions is absolutely NOT class warfare. It is a mechanism for survival. Whether the "plutocracy" is running a government or a corporation, unreasonable or outrageous decisions must be questioned. Many plutocratic decisions are, in and of themselves, actions of class warfare.

Very well said!

There are many components to the big picture. Working dangerously short staffed creates life and limb threatening situations. When worse case scenarios occur, they can be disasterous for patients and their families. Let's just set the issue of needless human suffering aside. The financial cost to defend, litigate, and attempt to make these situations right is tremendous. These costs have to be met regardless of whether or not patients are paying their bills. In fact, if there are damages and a breach in the standard of care is evident, then the hospital is going to eat the cost of care any way. My point is that no unit should be short staffed "due to the budget," if the budget provides for excessive and unreasonable compensation for the executives.

Bull Corn. Executives are not doing the work in each of these areas. They have a full complement of staff handling the day to day details. There's nothing magical or mystical about the work executives do. I can promise you that there is NOT one single thing they do that I will "never be able to understand." If there is one thing they attend to that is greater than I would ever be able to understand, then I am not fit for or capable to be a registered nurse. That is simply ridiculous. Taking simple situations and making them complex is not a skill to be admired. It is inefficiency and self-aggrandizing. For example, very bad things happen when units are sorely short staffed. Conducting a study, creating a safety campaign, holding pointless committee meetings, and haranguing staff will not help. Having enough staff to do the work will solve the problem. Cutting excessive CEO pay and bonuses and using that money to fund safe and adequate staff numbers is a simple solution.

You may not live to work the 25 years. Leave the night shift pronto!

In the midst of an unpleasant procedure, I heard myself say, "This will feel so good when it quits hurting." The patient half chuckled, then roared, "I sure as hell hope so!"

Whether it's rural or not is not an issue. Everybody knowing everybody is not really an issue. Make your choices and be gracious. Whether you leave corrections or decline a med surg offer, thank the supervisor for the opportunity, and tell them that at this time you have have considered all the options available to you and that at this time you have to leave or decline the offer. If you want to mention that the path you're taking seems a better fit for you or will further develop your skill set or will help you meet your career goals, you can. Do your best work, be gracious, then stand back and let other people own their own responses or feelings. Don't embrace fear and worry and trepidation about how other folks will respond. If they are reasonable people they will be glad to see you do what's best for you. If they are unreasonable, then nothing will please them. Some people would complain if you hung them with a new rope. You can't cater to other people's ideas about YOUR life and career. You have to do what's right for you.

Offices are frequently overbooked, and sometimes patients have extended waits time and time again. Patients can feel that their time is important, too and they can become frustrated. I don't know if that's the case with your clinic. I do think that if the clinic goes with a policy to reschedule when the patient is 15 minutes late and to charge a $25 fee, then the clinic needs to extend some sort of courtesy or concession to the patients. If for whatever reason, the doctor is running 20 minutes or more behind, then the receptionist should notify the patients in the waiting room of the lengthy delay and afford them the option to reschedule. Years ago, when my former spouse was undergoing chemo at his doctor's office, he had to be fasting before the blood work which was done prior to the office visit. We had a long commute to town for the blood work and visit, and some other logistical considerations that did not allow us to get a bite to eat between the blood work and the office visit. A terrible routine developed where the doctor was running behind an hour and half or more at each visit. I was concerned not only for my spouse, but also for some other patients who appeared more frail and weak. I wrote a letter to the doctor outlining my concerns about the discomfort caused by the overbooking delays. The doctor called me and told me that from now on they would honor our appointment time and would not overbook. The doctor also opted to notify patients upon arrival that there would be a lengthy delay due to some emergent situation. Patients were afforded the opportunity to leave and get a bite to eat and return in an hour or so, or to reschedule. Hurling a zinger or scathing comment will not engender good will or a pleasant interaction. It could bring down some mojo you'd rather not experience.

Sometimes there are no mistakes to be made and there are NO right or wrong choices. Sometimes we have multiple equally reasonable good options. Follow your passion and your interests. Congratulations and good luck with whichever you choose.

And what's wrong with that? (said while wiping boiled crawfjsh fat from my chin.). Cajuns here play fiddle and accordion more than banjo.

Please understand that it was not my intention to call you anything. I'm quite idealistic and optimistic myself. It's easy to find yourself disappointed and to find yourself with the short and dirty end of the stick when others aren't playing by the same "rules."

Naive and idealistic. There are an awful lot of unethical, illegal, an unconscionable things that occur in education, health care, and other areas of endeavor. This is why some areas of endeavor should NOT be operated on a for profit basis. When abuses and wrongdoing occur in some fields, some people can be egregiously hurt.

You are being mistreated and abused. What is being required of you is unreasonable and unacceptable. They should be scheduling their training and orientation at more appropriate times. It is not appropriate to expect anyone to be able to focus and attend properly any sort of training or class after a 12 hour shift. Print yourself a copy of the state nurse practice act and a copy of the labor law referenced above. Next time they try to ambush you and make you stay over, you pull out the copy of the law, and hand it to them. You say, "I would just love to stick around for your meeting, but as it's in violation of the law, I just can't do it." As a new nurse grad, I had a situation on a cardio pulomonary floor where we were essentially playing musical beds with 4 patients and the ICU. I knew good and darn well, that any two of those very fragile patients would be more than a very seasoned nurse could handle. These weren't straight up cardio pulmonary cases, they were compounded with head injuries and GI injuries, and serious infections. When they tried to assign me all four of those patients and two more, I told them I was not accepting the assignment. You could have heard a pin drop. All chatter in the nurses station died down and everybody looked at me all at once. The bluster and indignation went into overdrive. I shrugged my shoulders and I pulled out my handy dandy copy of the state nurse practice act that clearly states that it's a nurse's duty to refuse an unsafe assignment. They ranted about being short staffed, they ranted about refusing to be a team player, etc. ad naseum. I simply said, "You'll just have to call the NM, the CNO, the DON, the CEO, the CFO, the COO, whomever you need to call to get some more help here, but by law, it is my duty and responsibility to refuse an unsafe assignment. With whom and how you choose to staff this unit is your choice." I made some suggestions as to how many and which patients I could reasonably be expected to be assigned. I came to nursing later in life and having worked as a state medical malpractice investigator for a number of years before becoming a nurse, I knew that the situation was untenable, dangerous, and ridiculous. I drew the line in the sand, and figured the worst they could do would be fire me. Being fired for refusing an unsafe assignment would not have shamed me a bit. They didn't fire me. In fact, they called in some of the experienced nurses who were holding office type jobs and had them hit the floor that day to help handle the untenable situation. Like you, I was one of about 6-8 new grad hires all to the same floor. Had I known that I was one of so many hired for the same floor, I would not have accepted the position. Anytime, they have to replace that many nurses on a floor at one time, you can be most certain the place is a snake pit. And it's a dangerous one. Leave that snake pit that you are in and don't look back. If you fall asleep at the wheel and drive into a ditch or an on-coming car after spending your shift plus extra hours at your hospital, you can be sure they won't miss a beat. It will be just as if you never existed or worked there. You must take care of yourself.

Smooth Operators

Tell the classmate that it would be academic dishonesty, and that is something that you don't do.

Could you approach your current employer about tweaking your duties? Is there another nurse on staff who might prefer more of the paper pushing duties? Perhaps you could assume some of her/his patient care duties in a trade. If not, you'll just have to weigh how comfortable you are with the frequency of on-call of the new job against the mind numbing or soul killing aspects of the current job.

Some skin prep applied to wound edges will protect the skin and might help the mepilex stay in place. As mentioned by others, offloading and nutrition are crucial to healing, as is tight glycemic control.

I attended the Emory WOCN Program on site in Atlanta last fall. It turned out to be one of those rare things in life that is everything I hoped it would be and then some! It is an absolutely outstanding program. If Wound, Ostomy, or Continence Nursing is a passion for you, then I would advise you to attend the Emory on-site program. If at all possible, do it ASAP, as the program director, and crown jewel of the program, Dorothy Doughty will be retiring next year. Although, I attended the on-site program, I would imagine that the on-line program is every bit as first class as the on-site program. It is my understanding that the same instructors for on-site work with the on-line students. I can tell you that the instructors are very invested in making the students successful. They all have the true hearts of nurses and true hearts of teachers. They are willing to meet with students before and after class to clarify concepts and assist students in learning what they need to know. It is a tremendously detailed and intensive course of study. If you are truly interested in the subject matter and the WOC patient population, you will enjoy it. If you are a disciplined student and have been successful in previous on-line classes, you will likely do well. As far as preceptors, Emory will work with you to help locate a preceptor. Another option would be to complete the didactic portion of the program on-line and then go to Atlanta to perform the clinical component of your program. There are some excellent preceptors in Atlanta.

That's not a position that I would accept. The position sounds like a no-win situation. They want you to do more and more for less. Chances are they won't provide the resources necessary for you go be successful. Are you a certified WOCN?

Well said!

Exactly! Listen to that inner voice. The trip could cost more than a weeks pay, more than jusr $.