rhellner57

1) with his experience and the fact he is in a RN program, he should have the understanding that this is not the way to chart and to alter a chart is a red flag to discipline. Any alterations in documentation should follow guidelines of line through and rewrite. To remove another's signature stands on shaky ground. 2) I agree that reeducation is necessary but that he needs to have some reprimand so this does not occur on a frequent basis. Get away with it once and the scenario may continue until harm may occur. 3) I question why he went behind the other nurses' back to rescind the order; open communication would seem more reasonable and justified.

To answer your questions 1) was a nurse for 47 yrs. I started in rural nursing, moved to pediatrics and then float nursing eventually focusing in OB/GYN NICU until the last 4 yrs when I returned to my love of geriatrics. During Covid, I was infection control in SNF and Rehab facility, and floor staff and then moved to Nebraska and was DON in a SNF for 2 +yrs. (2, 3) currently retired and working as a sub in a school district with handicapped SPED. 4) Shortage in geriatric nursing focuses on inexperience offered during nursing school in my thinking. Also the work is not easy and usually you are the only professional nurse overseeing the entire facility and the multiple diagnosis. (5,6,) In the SNF, you see a variety of elderly. Add rehab to the scenario and you have a different approach. The is dementia, obesity related dx, some familial issues, physicians do not always feel the same way r/t the age and dx of an individual over-medication can be an issue, end of life support, wound care and wound vac, and resident safety. With the changes r/t sepsis ( was cardiogenic shock when I went to school) and the sudden onset of changes, the focus on reducing bedsores and encouraging the CNA's to follow through with preventative measures, this adds to ones daily routine. I feel that the lack of criteria to individualize care (acuity)and most facilities needing to fill existing beds over addressing individual needs has moved the nurse or care staff to having significant work loads and less time to adequately assess resident needs. This leads to either short term employment and increased dissatisfaction w/I the role of geriatric nursing. To encourage nurses to try geriatrics, the facility needs to show support and make the position manageable and satisfying. When we were able to focus on acuity, there was a greater personal satisfaction but w/ CMS guides to make numbers the issue and 1 nurse for 40 residents - we are not going to find many nurses willing to exert themselves to this abuse. (8) As far as ageism goes, I do see more older nurses assuming the care of the elderly. Often the older adult does relate better to an older nurse or CNA over a younger person. Experience in medical nursing, good orientation/extended support systems, and the evidence based practice focus aids in preparing a nurse for this roles, however, most support is very short-term and you find yourself from the frying pan into the fire. As the DON, I was often involved in many treatments to relieve the staff nurse of some overload. This is rare that a DON even comes to the floor, let alone hands on care. I was told this often. Time management also is essential. All staff need to be onboard and focused. Sorry this became so long but I loved and still love my residents, support those families that frequently visit, answer question to the best of my knowledge and even though I am retired, I still enjoy researching issues that relate to older adults and publish a news worthy article for our church and assist in education.

In response to Zaphina; I initially was interested in pediatrics and threw myself into learning all I could from my coworkers that would allow me to function the best I could. When I graduated, I went to a small community hospital and the experience of jumping from the frying pan into the fire was immense. I have to credit nurses that had been functioning in this way for many years, especially (MODERATOR EDIT OF NAMES - PLEASE DO NOT POST IDENTIFYING INFO ABOUT OTHERS) as well as my LPN's and aides. I learned to start IVs successfully by following a CRNA. After I moved to Colorado, I was PRN at St Anthony's where I tried all facets of nursing from cardiac to ortho to ER but my previous experience in Peds was the opening in the door. When I went to OB, I started in nursery and when an opening in L/D, I applied. At first they did question my ability and I plainly stated that it was a great interest to me and that I would love to show them that I had the stamina and eagerness for this. We settled on a trial run of 6 months and then to reevaluate. I never looked back but did add NICU to my skills. You asked about traveling, With Med Solutions they allowed my to focus on OB but I also filled out skills lists for Peds and step down Med surg. Your recruiter can be your best ally or worst enemy in locating skills that you desire. The oomph that you put into your desires and if this radiates through interviews will be your calling card of success. Good luck

I am a diploma grad and later in my career got my BSN. I feel like the basics received during my initial education was the backbone of my knowledge and the way I practiced. As for the questions in ageism- years of experience do add to the salary offered. As for being resistant to change and harder to train, I disagree as I was a traveling nurse in OB for 12 years. During which I learned new processes and computers in each new facility. My last 4 yrs were in SNF/Rehab where I learned new ideas regarding sepsis and Alzheimer's care which are newer entities since 1978. Going back to when I started, many changes have occurred and one must keep up to function as a team. As for the next 5 questions, older nurses are less moody, more energetic, less likely to be on the cellphone, and often negotiate picking up shifts for the betterment of the team and our patients. We may come across as questioning management and have a hardened exterior but the years of being the servant to the hospital and doctor are of the past and we found a voice. As for longevity that we offer, retirement does come with benefits and as an older nurse, we must call it quits for our own well-being. Sorry this was lengthy but From my beginnings to now, I have had to adjust to EBP, new equipment and learned through hands on experiences. Newer nurses have much less bedside experience when the graduate than the older nurse had and they need to understand that we are willing to assist them in the basics.

Program needs to be accredited if you want to proceed with advanced degrees.

I feel that some of these nurses need to get an understanding of what it may be like to be overweight and not be shaming. If you haven't walked in their shoes then be respectful of them. I am considered overweight and yet , I often see myself working circles around some younger nurses who are "tired" " got no sleep because baby" " this is my 6th shift in a row, I am tired" and I can go on. All of us have different metabolisms, habits, and challenges and unless you are a direct clone, you would not know which it is. It has been studied that night nurses tend to have more difficulty losing weight related to day sleep, mindless eating to stay awake and activity that goes with their shifts may be more low key ( of course depending on staffing and type of unit). Please any co-workers who want to shame another, think back to why you are a nurse.

I would hope that this is not real but I have been a nurse for many years and have not heard blatent comments or witnessed discrimination related to weight. I am overweight and many times have attempted to lose weight and presently have lost a number of pounds only because at my top weight, I felt winded if having to run for an emergency and want to be able to physically meet the demands needed to the best interest of my patients. I have seen some nurses eat themselves into early retirement or disability and have heard and seen jokes that depicted a very large, sargent like nurse and a patient that is quaking in his bed etc. This day and time, with discrimination and bullying on the forefront of lawsuits etc, I would think that most would not relate weight issues to the ability of doing their job

this one was to another question I saw about nurses eating their young and maybe it was within some of the comments here too

I am not sure of where you are at, your family situation or if you could pick up and move but many states especially midwest with many rural and critical access facilities, rural or facilities located in areas of great disparity (maybe even your state) or even starting in a local nursing home/extended care or even veterans or Indian reservation hospitals, have programs that offer reimbursement for your education to begin your practice, get some experience and then see how many doors open for you. Also I advise getting into a medical surgical unit and keep the ICU, ER, OB until after you have spread your wings a bit.r

at least you didn't say "old" nurses eat young. I have had some real great discussions while obtaining my BSN on this subject and most of my colleques know exactly how I stand. I try to help the newer nurse but they must be willing to understand the reasons behind how I do things too. We all have to do the critical thinking that it takes to be a good team. I learned it as team leading in the diploma program as well as the many hours in direct patient care and the writing and rewriting care plans while newer nurses have a new avenue to learn there roles as nurses. The older nurse has endeavored to advance as times have changed while many of the newer nurses have grown up with computers and are definitely more versatile with them - we are in this together and need to share expertise. By the way, recently, i have seen more newer nurses chewing on other newer nurses and belittling each other than the other way around. As a traveler, I often see the challenges felt since I am often the new kid on the block and temporary at that.

Tell him that many people have reservations about open sites but with AllNurses, I have felt that I can express or respond to situations that make a difference in my career. As long as we stay respectful to each other, I don't see a problem. There are many other avenues that are not nearly as respectful, many of which I just pass over their comments, don't respond to but let them vent in their way.

I am not stammering out a response was adequate. In defense of the doctor, she needed her facts in a row, direct communication is what is desired and needed especially when you wake a doctor in the night hours. I agree that she needed to report these changes in patient status, did she address pain issues, anxiety or other factors that can affect status. Could she have employed a rapid response to assist her before calling, have a good SBAR for communication reporting what, why (situation, background and assessment) and directly asking what she wants the physician to do (response) that she feels would best take care of the patient before additional problems accelerate.

Having just finished a college credit course in Sociology, I find that these co-workers are culturally inadequate and insensitive. I agree with the respondent that states your needing to go to management with your concerns and then I would be open that the comments being made are not acceptable making these co-workers realize that you are not a pushover or doormat. I wish you the best and try to maintain your composure before I would jump ship and run.

I have worked in facilities that use them faithfully as well as facilities that do not like them. Personally, I find my mothers more willing to move in bed and get up sooner with them on. In some places they are put on the bed as the pt is transferred from OR table to bed across the entire abdomen. I have never seen any problems with irritation or heard complaints. Some cultures insist on using a girdle, even with lady partsl deliveries, for additional abdominal support following delivery. The abdominal binder is easier to remove for abdominal assessment but either are there for support.

there are not a lot of facilities that I know of that want or invite professional nurses to be a part of union. I worked for 1 facility but there were still issues. I work contract and like many I often get to work. I try to not allow a cancellation clause to be put into the contract since the challenge I faced one other time, however, this present contract has it in again and I missed it. Last week they put me on call 2 of my three shifts. I was disappointed with them even though up to now I felt we were working together nicely. I was able to make up the shifts since it is a holiday weekend and we were busy and low staffed. I have a travel company behind me and hopefully this was 1 charge nurse's way of power struggle with the upper management and it won't continue to be an issue. I feel for the fulltime staff and feel that we all can rotate on call or LC'd or work in other areas. I am not cross-trained but willing to work as a sitter or aide where I can be helpful