jstanrs

One thing I'll add is that whatever orientation program you end up in, do NOT let them cut you loose if you don't feel ready. I've heard too many stories of people being promised a particular orientation process and one day being told, "We're short staffed. You're on you own. Sorry."

I know that in the Dallas area, most nurses working for law firms do so as Nurse Paralegals and do not make anywhere near the money Ms. Milazzo talks about. Expert witnesses are well-paid, but I don't know that LNC certification plays a role; it's more about clinical expertise.

Know that you are very likely going to feel overwhelmed at times and feel like you know nothing. Most of us have been there and it's a good thing. Practitioners who don't know what they don't know can be dangerous. Identify a mentor. Ask questions. If you get put down for not knowing, say, "Thank you", while thinking to yourself, "Yeah, like you started off knowing everything", then move on, finding someone who is willing to share their experience. Know that somewhere along the line, you are going to make a mistake. Own up to it, knowing that it does not make you a bad nurse. (My first was giving an oddly timed antibiotic when it wasn't due - it was q18h, so it wasn't given daily. According to the nurse who caught it, you'd have thought I'd shot the pt in the head. Fortunately, I had a preceptor who was a little more realistic. We wrote it up, notified the doc, I forgave myself and we moved on). Establish yourself as being competent (for your level of experience) and conscientious. Then let people know you want to learn and would love any chance to do so. Then hopefully, they'll come find you when a once-in-a-lifetime case rolls through the door. Maintain a life outside of your job.

P.S. Also report to any regulatory agencies, including JCAHO.

This scenario is so scary, prevalent, and maddening. The powers that be are primarily focused on things looking kosher, despite what might exit their pie hole. And I can tell you from experience that if/when the excrement hits the electronic air-circulating device, it's every man/woman for themself. And bottom line? Even if you could prove that you were only doing what you were told, the board doesn't care. The obligation incurred by your licensure is not superceded by any policy, physician's order, what your boss told you to do, etc... I would report the DON to your nursing and pharmacy boards. Personally, I would bypass any inhouse reporting entirely. Been there, done that, got mountains of paperwork from peer review, the board, unemployment commission to prove it. Fortunately, the board and the unemployment commission sided with me, but it was an experience I would not wish on anyone. And because people tend to move around within an area's hospital systems, I still get blackballed.

I know several nurse-attorneys who limit their law practice to defending nurses before the board because they feel we are treated so poorly in that situation. I commend them.

Are you kidding? The thought of having my colleagues seeing me nekid and drugged-up is one of my greatest nightmares. :w00t:

1) Something with animals - vet, trainer, shelter / rescue operations 2) Attorney specializing in the defense of nurses before the board

Nobody was 'walk(ing) out on patients'; however, that's exactly what administration wants people to think, when, in fact, they had more than adequate notice to make alternative arrangements. I agree with dlatimer that by standing up to administration, nurses are doing the right thing for patients.

It would seem that you are correct. According to the government's FLSA site: Registered Nurses who are registered by the appropriate State examining board generally meet the duties requirement for the learned professional exemption. Many registered nurses, however, are paid by the hour, not on a salary basis, and thus are entitled to overtime pay. Licensed practical nurses generally do not qualify as exempt learned professionals. However, I know that the last time I looked into this, I came away with the understanding that hospitals could get away with not paying overtime even when they were paying their staff nurses on an hourly basis; I know of at least one hospital that was doing so. Interestingly (and frustratingly), through Googling, I just learned that this same hospital recently won a case of a nurse suing for wages lost when she was docked for meal breaks she was unable to take. I hate to sound so cynical, but honestly? I think that this is all a matter of judges ruling in favor of big business.

Some random thoughts: This is a loaded topic because legally, nurses are not entitled to OT pay. (References to OT pay means time-and-a-half. An employer has the option of paying exempt employees for extra hours - including at straight pay - but they do not have to). According to the Fair Labor Standards Act, we are considered exempt from minimum wage and overtime provisions, due to the fact that we are considered 'professionals', based on several tests they use to determine same. http://www.hr.ucdavis.edu/salary/comp/Fair_Labor_Standards_Act (While I do believe that we are 'professionals', I do not agree with the classification based on this test; specifically "The work product is predominantly intellectual and varied in character and cannot be standardized in relation to a given period of time"). Back in the mid 90s, the hospital I worked at arbitrarily quit paying OT and much to my surprise, people just accepted it. Of course, they were less inclined to work extras, which was to the detriment of patient care. (Interestingly, when asked, the CNO stated they we were one of many hospitals in the area with this pay practice. I called every hospital in the area. She was lying. We were the only one doing so). I have read of cases where exempt status was contested and the decision was based on the fact that the plaintiff's pay stub indicated hourly wage. Changes were made to the FLSA during one of the Bush administrations and there were protests from various professions, including nursing, because it was felt that the new law would have a negative impact. In response, a certain HR VP from a large healthcare system wrote that (staff) nurses had always been considered exempt but they were paid OT because it was the right thing to do. Another issue that I wonder about is the 'completion' factor. As someone stated above, bedside nursing care never ends. So, does that mean the employer could make you stay indefinitely but only pay you for your 'scheduled' shift? (Obviously not, but I think you see my point). Bottom line: re-read dthfytr's 09:17 post and be very concerned. By law, this could become the norm.

is it ever okay, regardless of how common it might be? i find it particularly egregious in this situation due to its ultimate effect - the perpetuation of a system in dire need of overhaul - one that literally costs lives. if you doubt that, please read the following: http://www.jointcommission.org/nr/rdonlyres/5c138711-ed76-4d6f-909f-b06e0309f36d/0/health_care_at_the_crossroads.pdf [color=#231f20]excerpted from the above: [color=#231f20]higher acuity patients plus fewer nurses to care for them is a prescription for danger. according to joint commission data, staffing levels have been a factor in 24 percent of the 1609 sentinel events - unanticipated events that result in death, injury or permanent loss of function - that have been reported to the joint commission as of march 2002. [color=#231f20](that's' 386 lives ended or forever changed for the worse). other identified contributing factors, such as patient assessment, caregiver orientation and training, communication, and staff competency, implicate nursing problems as well. conversely, several studies have shown the positive impacts on quality, costs and health outcomes when nurse staffing levels are optimized - fewer complications, fewer adverse events, shorter lengths of stay, lower mortality. [color=#231f20]this report is more than an analysis, and even more than the recommendations that it contains. it is about accountabilities. the joint commission has recently developed and introduced cutting-edge staffing standards that create a new framework for measuring and improving nursing care. the joint commission is also taking major steps to reduce the documentation burden that so often falls on the shoulders of overworked nurses. [color=#231f20](has this changed in your facility?) this latter effort will undoubtedly require continuing attention and adjustment. but there are others with accountabilities as well - hospital ceos, public policy makers, nurse executives, schools of nursing, physicians, private industry, insurors, and still others. we as a country must understand not simply what needs to be done, but who specifically, alone or with others, is responsible for getting each task done. [color=#231f20](sadly, this report was issued 8 years ago and to my knowledge, not a lot has changed).

oh, where to begin...? the cold, hard truth is that healthcare is a business - a heavily regulated business. as a result, the focus of most admins is the bottom line and compliance with regulations so their facilities don't lose medicare / medicaid funding, get fined, bad pr, etc ... regrettably, nurses are a drain on the bottom line - we are an expense. as for regulatory compliance, that is largely about paperwork. therefore, as you would imagine, nurses, or more specifically, the care they give to patients, is not truly a priority, although most admins are skilled spinmasters and will claim otherwise. sadly, at least in my experience, there is no accountability. even when confronted with irrefutable evidence contrary to their claims, i have known admins to band together and lie through their teeth in order to cover themselves. and if you speak up about it, you have a bad attitude, or time management problems, or problems with setting priorities, or are not a good match with their facility... as for your question re: their experience and licensure: yeah, most have some form of both and it boggles my mind that they can do what they do. i have decided that many of them are either alarmingly out-of-touch or appallingly dishonest.

re: "the infamous 'group 1' in texas." beware! according to their website http://www.gp1.com, "we do not just serve the dallas-fort worth or north texas healthcare area. with our state of the art background check, background search and background screening system, groupone now serves the world." i have heard that they now have clients in 17 states. for those not familiar with groupone, they function under the guise of a credit-reporting agency but they have little if anything to do with credit reporting. instead, they serve as a clearinghouse for information on healthcare employees and by invoking the privilege of the fair credit reporting act, they claim immunity from any legal recourse. whereas employers typically will only confirm limited information about past employees - e.g., dates of employment and salary - groupone allows them to say what they please without fear of legal ramification. its abuse is so blatant that "groupone" has become a verb, as in a disgruntled manager saying to a terminating employee, "i'm going to groupone you and you'll be lucky to find another job in this area." to those who have to deal with this nonsense, consider the possibility that a union could put an end to it.

i would like to ask those of you who are anti-union if you have ever blatantly challenged the administration of your facility. i have and the price i paid was horrendous; i have heard similar stories from all too many colleagues. for all the pros and cons of unionizing, i think the ability to demand collective bargaining makes it worthwhile. please download and read the following report and ask yourself if the issues it exposes are being addressed by your facility. http://www.jointcommission.org/nr/rdonlyres/5c138711-ed76-4d6f-909f-b06e0309f36d/0/health_care_at_the_crossroads.pdf p.s. the jcaho report mentions obtaining magnet status - i don't know about elsewhere, but locally, this has lost any significance. hospitals pay big bucks then hurriedly put in place those things they know the investigators will be looking for - staff are even instructed how to reply if questioned. it no longer means what it once did.