lylenrn

Congratulations on your acceptance to the program. I agree with the previous poster. I would suggest that you request to be PT or PRN. Fortunately, since you mentioned to your manager that your goal was to become an RN working in L&D, she/he is not unaware of the possibility that you might have to adjust your schedule. The good news is that when you finish with the program you will also have L&D experience (that looks good on a resume). Also since the census in L&D is not constant you might still end up with time off when the census is low. The first to be cancelled is agency staff, then PRN....then PT. Wishing u the best of luck in whatever u decide>

As an older nurse i want to have a simple answer for why it takes so long to chart,but its not always short and simple so perhaps i can take you through an example: A few years back i was involved in a lawsuit against the hospital by a patients family. This patient had a poor outcome, and the family was very angry (understandably). I will say that i consider the click/point three minute charting to be reserved for pts that are stable walky/talky progressing as expected in other words probable discharges. When i have patients that have change in condition usually a lot of narrative charting is included (aside from the drop/point/click). I will chart when the patients condition changed who i called, what they said, whether orders were given, what the outcome was of those interventions. Whether i needed to go up the chain of command (nursing supervisor/medical director) based on the md response. All of this is timed. As you can imagine its also time consuming. In this particular example my charting was extensive. I cannot tell you how uncomfortable it is to sit at a conference table full of attorneys (only one of them being yours) and answer for the care you gave a patient years before. It was the thorough narrative charting on this particular patient, my interventions, reassessments,etc that got me dismissed from the lawsuit early (after the deposition). I think it was the time consuming charting that made it evident that the problem was recognized, steps were taken as ordered and still there was a poor outcome. Unfortunately, some of the people that subscribed to "speed charting" saw that lawsuit out to the end (a couple are no longer practicing nurses). Based on this experience in my career my motto is "either spend the extra time as care is given, or spend it with a familys attorneys later".

working 7p-7a... hurray for OT

It's an awful feeling when the count is wrong. I have had it happen a couple of times, sometimes because the sheets have been adjusted or because a dose is more than one pill and requires two pills/signatures. The keys should never be turned over until after the count is done/other nurse is endorsed responsibility. If this nurse insists on "starting early" how about counting out early? I love our pyxis.....but every now and again i work at a snf and it is a pain to count all those pills. God forbid the count is incorrect,....they start to eye you suspciously. I know the feeling. Best of luck in your new position. Make the count a priority so that you are not the one under suspicion.

Glad to hear you re-thought the California idea. There are more unemployed new grads here than you can shake a stick at. Its very hard to find a job here without experience, and sometimes challenging for the experienced to get to the areas they prefer. I cant say that Texas is any better, but i have heard of a couple of new grads from here finding jobs there. One even got a relocation allowance in these times. Glad to hear you plan to have the job before relocating. Good luck

Unfortunately, the bottom line is always about money. I have noticed mostly in nursing homes here they have posted the patient staff ratio. Usually will say something like 40 pt....4 cnas...2 lvn....4 rns. The problem with this is that probably 3 of those rns are not directly involved in patient care. 2 lvns have 20 pts a piece or 1 does tx and the other does meds....and the lone rn...is charge for all. During the admissions process they are very proud to show these staffing sheets to prospective families and the families expect all these people available for the family member (if they only knew). Usually later after admission they find there really arent as many people available to attend to every need immediately. I have found that the general public often thinks nurses have 1:1 care and are there to attend to their family member only.

Look at the bright side. Now that you have someone on "the inside" perhaps they can keep you posted about upcoming open positions. It never hurts to have a friend put in a good word or two to a manager. Especially if they are doing well on the unit. This could still work out to be a positive for you. Its true, "sometimes its not what you know but who you know". Keep positive.

This reminds me of a school nurse we had in high school (ms K). The only thing that students got sent home for was if they had a high fever. Any other ailment got the same treatment. The student was sent down to cafeteria for oatmeal, given tylenol and instructed to lie down. Maybe this had something to do with the fact Ms k was an old army nurse and figured tx for anything else was "walk it off". In most cases, since students knew they werent going to go home early and didnt want to spend the day laying-in with Ms K, we either carried our own med supplies or stayed home from school.

It is unfortunate that this behavior continues to be tolerated,but i dont think much will ever be done in these situations because docs generate income and nurses are an expense for the hospital. I worked at a community hospital over a decade ago with a very emotionally labile surgeon. He would do surgeries late into the night (mn/2am) and get very angry if a nurse called about a change of condition. He would make a point of coming in the early am to complain to the manager about these nurses/calls and got more than a few fired. Once he had a sixteen year old die less than twelve hours after surgery, nurses had called at least three times during the shift without orders, nothing happened. You know the reason that a complaint was filed against him with the medical board finally?? He made the error of trying to bully another surgeon (like the nurses) over a surgical suite. He went so far as to intentionally contaminate the sterile field to keep this surgeon from using the suite that he thought he was entitled to. Ever wonder if being mentally unstable is a prerequisite to being a surgeon?? Or is it their brilliance that drives them mad?

I too would vote for staying on the crazy med surg floor. The only reason i make this vote is because i know it is possible. Your description of your unit sounds exactly like my unit (although not med surg). It is not the ideal working condition but it pays the bills and provides the opportunity to improve nursing skills. Good luck to you.

Here's an incident that happened at a snf near me recently.....CNA caught having sex with demented pt. Pt was so confused she couldnt have possibly reported it and even after proper authorities alerted pt was no help in giving information about incident. My point? while this population may have issues with confusion and report incidents that never occured. What about the rare occassion when sexual assault actually does occur. These reports all have to be taken seriously. There are some sick people in the world, unfortunately, some of them are in healthcare too.

wow 120.....amazing. My state also requires an RN in building for 100 pts. But i recently had a friend who is new grad RN accepted a job at SNF with 80 pts. A large portion of those had am meds, drsg changes and blood sugars. She found she couldnt handle it and quit. Guess what they hired two LVNs to replace her. That is an unreasonable workload, but employers know its a buyers market at this time. People are desperate and they are banking on our need to pay bills and keep a roof over our heads. Good luck to you in your search.

As a previous poster stated i dont think you have much to worry about from the board of nursing if its not in their practice act. However, many employers are doing internet searches and you would be surprised at the things they find. I recently saw a new poster at work. ( I work for a company with 13 hospitals and growing) This poster states that one should be careful about what is posted on the internet facebook,etc., because you dont know who can view these items and can be grounds for termination. They didnt specifically say r/t hipaa. Right now in nursing its a buyers market. They can get rid of you for almost anything as there are plenty of unemployed nurses (some cheaper) waiting to fill those vacancies and employers are taking full advantage.

Amen!

You are correct Esme. The MD got involved. I think 1 person got fired over this. But even if i had gone back 48 hrs it wouldnt have helped. The order was further back than that.

Hey all I am angry enough this morning to spit fire. My manager wrote me up today because we had a patient on IVF@100 cc/hr who went into resp distress on my shift and i transferred him to icu. Here is the part she wrote me up for: The patient arrived on our unit a couple of days before i started working that week. IVF were already running when i received the pt. When I did the 24 hr chart check the fluids were not listed on those orders but on his admission orders ,which was before the 24 hrs. Why would she think that i would go past the 24 hr point looking for someone elses mistakes. The order that said the fluids were only supposed to run 500 ml was part of the admission order. I think she is trying to create a paper trail. Lately this woman has been very emotionally labile, so much so that at least a third of the dept has left for other jobs or other depts? When u do a 24 hr check do you go days back to look for errors??

I have experienced both CNAs and MAs calling themselves nurses. It is very confusing for patients. I have even had the experience of a CNA giving a patient medical advice. When i corrected the information the patient was being given (as RN) the patient chose to believe what the CNA was telling her. Sometimes this "claiming" of titles one has not earned can have ill effect on pt outcomes as they are not sure who to believe. Whenever someone is parading as a physician without having a license, their pictures will be plastered all over the news and internet as practicing without a license. Nursing doesnt prosecute many for claiming this title.

I knew i had come to the right place. I thank you all for your replies as well as for sharing your stories. When i have asked other people this question (even other nurses), they look at me as though i am crazy. Some still have the idea of docs as Gods. But to me this has always seemed a recipe for misuse down the road. My injury was bad and requires treatment but i have always questioned this combination of meds. Michig...i dont think it would be very useful to discuss this matter with my PCP. He referred me to the pain managment doc and thinks hes the best thing since sliced bread. I will try going for a second opinion though again thanks all

While i agree nursing is an art/science. I am not so much into the acting. I cant baby talk my patients, they would know in a instant that it is insincere. Have i scared more than a few with worst case scenario....yes and it works very well in gaining their compliance. I have also held more than a few confused lols hands to calm them in their confusion. I witnessed recently a new grad begging a patient (Pretty pls with candy on top) to do labs. Of course, the patient wouldnt do it. I felt more than a little embarassed to see such a display. When she asked for my assistance, i explained to pt that labs are done on a daily basis on this unit to keep track of electrolyte imbalances that may not be compatible with life. Did the pt understand...yes....did the labs get drawn??...yep. I find some people are insulted when you try to talk to them as though this is kindergarden and rightly so.

MIchigoose I really appreciate your input. I understand your recommendation about talking to doc but heres the prob. I am a registered nurse, although i have legitimate pain I am uncomfortable with the way this guy hands out meds as if they were tic tacs. Do i have pain??...Yes. Although i dont consider taking the meds as he prescribes because i think is a recipe for disaster. I havent had a prob with meds....but think its real easy to get one. I think i am predisposed to this type of thing as i have family members who are/were addicts. See my prob?? I feel the need to be ever vigilante or there but for the grace of God go i

I have read here a lot of the posts on addiction and have found them to be helpful. Now I have some questions about the development of addiction. Last year I was involved in a auto accident (rear ended on the highway). I was off from work for a few months,but have returned. I am still doing PT, seeing a couple of specialists including a doc for pain management. At this time i feel that the current meds prescribed are very effective. The problem is that i am worried about becoming addicted to these meds. Currently i am prescribed Duragesic,Darvocet and Opana. Duragesic is the only one that is used as prescribed, the others i attempt to use an OTC anti-inflammatory first and if ineffective then use the others. I am very worried about becoming addicted to these meds. From what i understand about addiction it often begins as a pain relief measure and develops into a physical need. The physical need for them is something i would like to avoid. My questions...... What were some of the first s/s when you knew your medication use was no longer therapeutic?? I have always thought the impaired nurse was one who obviously (slurred speech, confusion,sleeping) has taken a substance and it affects judgement. What about prescribed meds without these symptoms?? Thanks in advance for any info you can provide

I think you are correct in thinking management is setting employees up for a fall. I have worked in psych facilities where we had patients on 15 minute checks. It all works fine to go back and forge charting....until an incident occurs. EX: there was a suicidal client who hung himself in the bathroom. On the 15 minute charting it listed the client as being in the cafeteria for lunch. Guess who's going to have to account for that error in charting during the investigation?? Seems management is only concerned about being in compliance "on paper".

I cant give your the research on outcomes with proper body mechanics. But my chiropractor has more nurses on his patient list than any other profession.

I worked agency for seven years trying to avoid the politics of being on staff. It worked pretty well. I have worked both contract and per diem. The worst part of working contract is that with guaranteed hours facilities will often try and have you work on units that you may not be comfortable with. EX: on one contract I was to work rehab/med-surg. When the census was low they would often try and have me work oncology. This was fine unless they expected me to infuse chemo. In that case i refused and went home. Working per-diem allowed more flexibility in that i could choose the days i wanted to work. The problem with that is that when the census decreases, you would be the first to be cancelled. Usually an hour or two before the shift. The other problem i found with per-diem is that in a 12 hour shift, i would sometimes be transferred to three different units spending four hours on each. Even worse, being sent home in the middle of the shift (7p-7a) didnt like coming home at 2am. Even with the above complaints, the only reason i stopped working agency as a full time job was because it has become seasonal in my area. Plenty of shifts from about Sept-March. Not a shift to be found during the summer months.

The end of last year my NM hired about 10 new grads on our floor. More than half of them are currently out or will be out shortly on maternity leave. One of them even transferred to ED, lost her position there and was allowed to return to keep health benefits for delivery. I know all managers are not the same as mine but there have to be a few out there. Wishing you good luck and health during this special time