lifetimern

I hate to sound hyperbolic, but your job and, perhaps, your career are in jeopardy! I have seen witch hunts in nursing. The victim of the persecution is often an innocent scape-goat or simply a pawn in some political war they no nothing about. If, as you idicated, you have done nothing wrong, you need to take this very seriously. The time for collecting opinions in a nursing forum is over. You need to consult an attorney and follow their advice. Best of luck and I sincerely hope things turn out okay!

There is never an excuse to degrade or even criticize another nurse in front of a patient or their family. If the nurse really cannot be reasoned with, you should speak with your manager or Human Resources department. This is more than an annoyance; it is a potential liability for you and the hospital.

Because I am not a female, I will refain from excessive cross-gender fashion advice except to say that, when I have interviewed applicants, the more professional the better. Of course, try to avoid heavy perfumes, long fake nails, and tons of jewelry because they are pet peeves for many nurses. By the way, for men reading this, a buttoned shirt, tie, and pants (with clean shoes) are the minimum requirement. Most facilities only require your previous employer info. In fact, most places are paperless or in the process of eliminating traditional resumes/application formats altogether. But, you might be surprised to discover how long some employers will retain information on work history. If you have worked for a large institution in the past, they will likely still, at least, be able to confirm your employment. Finally, don't worry. Seriously. Here is why: if you have been called in for an interview, there is no downside! The worst that can happen is that you won't be offered the position in which case you are no worse off than before the interview. On the other hand, you may get the job, and, even if you don't, you've made a potential contact in your job search who might remember you when the next position becomes available. Good Luck!

The point that the OP is not a nurse is well taken, but I hear the same sentiments from nurses all the time.

I am always so disheartened to hear nurses say, basically, shut-up and take what your employers dish out because you're lucky to have a job. I agree, those of us who are currently employed are lucky to have jobs in this economy (we are also highly skilled, experienced, and marketable), but does that mean we have to throw out fifty-plus years of professional advancement in nursing? Must we grovel at the feet of our empoyers as they use the economy as a guise to strip away benefits, reduce staffing levels, and endanger patients? The other posters may be correct, however, now is not the time risk losing your job. But, it is not the time to lie down cowering in fear of the system either. Get mad. Just keep your cool, and remember how you were treated when your employer had the upper hand. The economy is cyclical. In a few years, you will have the advantage. Then, remind them of how you were treated by making your proposals from a position of strength. Finally, this post is really directed toward my nurse colleagues. While I understand the OP's position, CMAs are not nurses.

I am sorry your experience is so lousy! I will assume, since your preceptor is being asked to take her own patients while orienting you, that your facility's leadership does not put a high priority on nurse retention/orientation and you are, basically, on your own to swim or sink. Here is my advice: Report - Create a report worksheet that breaks down patient information, assessment, and tasks that must be accomplished for each patient. Highlight the tasks that simply must be done in a timely manner so you don't forget (accuchecks, EKGs, ptt draws for heparin changes, test, procedures, etc.) Quick check - Briefly, check with your patients - this is just to make sure they are alive and have no urgent needs - everything else can wait a few minutes. Prep. Work - Check strips and analyze if not already assessed. I pull all my meds and place them in marked containers in each patient's drawer (some nurses do not feel comfortable with this, so decide what is right for you), pre-op/pre-procedure checklists, new lab results, new orders --in short, anything you can quickly take care of now that will save time later. Assessment - Every patient deserves a complete head-to-toe nursing assessment. This is the longest part of my day, but it is necessary. Remember to prioritize patients -- see the sickest ones first. Complete tasks as you go. If Mr. Smith needs an IV, start one. If Ms. Doe needs her linens changed, change them. Get as much done as you can before you leave the room. Chart - Don't put this off too long or you will live to regret it. Get it done as early as you can. Hourly Round - I did this before it was a "thing;" it works. Assure each patient that you will check on them every hour -- then do it. It may seem like this will take more time out of your day, but I have found that patient call light use for insignificant things decreases giving you more time to complete tasks. Be proactive and anticipate problems - try to stop problems before thay occur. If you see that you only have 50cc of NS in the IV bag, replace it now instead of waiting for the pump to alarm. It is correct to prioritize your actions, but never put off for later what can be done now. Take advantage of any time-savers you have. If your facility has a system for recording report, use it. Delegate. Delegate. Delegate. Finally, look for a new job on your days off because not every unit or hospital is like the one you work for. Good Luck!

I am curious what this patients baseline oxygen saturation is. Unless the patient has some underlying respiratory disease or is a heavy smoker, it is unusual for a wakeful person to have sats in the low 90s. If the patient is a non-smoker with no history of lung disease, I would be wary of a Sat. in the low 90s while he is awake. If his baseline O2 sat. is, as one would suspect, in the high 90s, I would be downright concerned. Remember, the oxyhemoglobin dissociation curve illustrates that a sat of 88-90% may represent significant hypoxemia. In my opinion this person needs oxygen and a full work-up to determine what is causing his desaturation.

I, too, agree that you should determine the boundaries of your student's practice. However, is this experience just another clinical for the student or is this his clinical preceptorship? During regular clinicals, students often function under tightlly regimented constraints like the ones the OP described. But, during a capstone preceptorship, nursing students who are about to graduate work with a single nurse/mentor for a longer time period. The goal of these preceptorships is to aid the nursing student in their transition to the R.N. role. By the end of the preceptorship, the goal is for the student to be functioning as closely as possible to the actual role of the R.N. Ideally, the preceptorship begins with the task oriented and externally directed student progressing to a critically thinking, internally driven, and functional "nurse" under your leadership. This form of clinical is fairly new; it is often unfamiliar to many experienced nurses even though it resembles the model used in medical schools and residencies for generations. If you feel the student lacks the knowledge or skill to function in your environment, perhaps, this lack of progress is what should be addressed with his clinical instructor. If, on the other hand, the student has demonstrated a novice level of understanding and ability, you should try to increase his level of responsibility. Now, I'm not saying you go sit down while he takes care of the multi-sytem trauma patient on a roto-prone who is circling the drain, but you have to allow him to push his boundaries to find where his limits are.

I concur with CABG patch kid. I think your actions were correct and appropriate as long as the patient truly understood the ramifications of his decision. BTW, I would have had another nurse (charge nurse, probably) encourage the patient to allow the I&0 cath. The second nurse should offer to perform the cath. herself. If the patient started exhibiting symptoms of distress, I would have become adament that he allow someone else to perform the cath. -- this is when you make refusal more uncomfortable than allowing the procedure -- call the nursing supervisor to talk to the patient, call the doctor to the bedside, insist that the patient try different positions to urinate, etc. He can always continue to refuse, but sometimes people will give in just to shut you up. That is not very textbook, but sometimes I have had to do what I had to do for the patient's benefit.

Often, these on-line discussions are populated by people who simply, for whatever reason, need to vent. Therefore, it seems that opinions here tend to shift toward the negative. I will tell you that I make approximately $39.00/hr. not including shift or weekend differentials. I take home about $2,000-2,500 bi-weekly (depending on overtime, call-offs, etc.). I have worked as a staff R.N. in several different states (TX, GA, MN, CA, to name a few) and as a traveler. I can tell you that, while I haven't always made as much as I would like, I have never failed to make a more than comfortable wage -- even as a new graduate. I have a lot of sympathy for those who make a poor wage as a nurse. I believe their stories because, when I was traveling, I met them. Usually, nurses who make very low salaries ( Whether by choice or circumstance, the nurses who tolerate these conditions cannot re-locate. They are, or at least, they feel stuck. But, let me shine a little light on this situation for you. If you are mobile/willing to re-locate or live near a large metropolitan area, you will be payed a comfortable wage with excellent benefits.

I hope your experience improves beause your first year as a nurse, in many ways, defines the kind of nurse you will be throughout your career. Honestly, seven patients at night isn't that bad. I have to wonder, however, if your colleagues are taking advantage of you. If you notice when you come on shift that you have three contact isolation patients when your co-workers only have one, you need to say something and strongly request that they change the assignment. Are admissions being fairly divided among the staff? If they are not, you must tell the charge nurse that it is Nurse Suzie Q's turn to pick up a patient instead of updating her Facebook status. Don't get me wrong, I am not advocating you adopt a bad attitude or stop being a team player, but if you don't demand fair treatment, there are some nurses out there that will roll right over you! To add insult to injury, they will be the same nurses who will complain that you aren't pulling your weight. Also, I wonder if you are delegating tasks as efficiently as possible. Perhaps, the nurses you mention that are goofing off are more effective delegators. I have found that ineffective or infrequent delegation is a common reason novice nurses fall behind. Additionally, I always encourage new nurses I precept to group activties - try to do everything you need to before you leave the room and go the next patient - and be proactive - if an IV is at 50cc, hang a new one instead of waiting for the pump to alarm. I hope some of these suggestions help. Good luck!

I'm sorry your weekend is ruined! If you have a good relationship with your manager, I would consider calling her and telling her exactly what you've told us. Listen closely to her response and see if you can extract a few more details. Really, I find your manager's behavior a little odd. While I'm sure the whole ordeal will turn out to be minor, you are right to be concerned. So, from this point forward, protect yourself. If you have any further contact with anyone from your workplace, you should take notes, as it is happening, in a composition journal (the old-fashioned black and white kind with bound pages that cannot be easily ripped out). Take this same journal with you to your meeting on Monday --don't forget to date and time each entry and list everyone present during your conversations. Have someone else present in the room if you call anyone from work. If you are unionized, your union rep. should attend your meeting on Monday. Also, if you have individual malpractice insurance, you might consider contacting them. Your malpractice policy may provide you a lawyer. Finally, if this turns out to be a malpractice case or anything that could jeopordize more than your current position, i.e. your license, don't agree to anything or even answer questions without counsel present. Good luck, and, again, I'm sure this will all turn out to be much ado about nothing!

Patients do not relinquish their civil liberties because they are given a narcotic. If I were the patient and a nurse tried to "detain" me, I would call 911 -- or does your facility want you to confiscate their cell phone and deny them access to other forms of communication? While we're on that subject, how are you expected to hold them? I assume you will have to employ restraints. Are you willing to sign your name to that form (even if you can find an MD who will order it)? This is a legal and ethical can of worms! In my experience, nurses have no part in detaining patients unless they are incompetent to make decisions, and there are legal and medical criteria firmly established that define those circumstances. If you feel that the patient is a danger to themselves or the public (which is the only reason "detaining" them would be considered), you should call security or the police and let them handle it.

As you know first hand, Nursing is becoming increasingly specialized. L&D, Postpartum, and NICU are prime examples of areas that require specialized training and experience. It is unsafe for nurses not specifically trained to care for new moms and newborns to do so. I encourage you to advocate for a closed unit. In the short term, this may be a trial for your hospital and your unit, but it is a necessary step to ensure patient safety.

If I held a med. and wanted to notify the physician., I used to flag the chart/progress note section (this was the days of paper charts and post-it notes) notifying the MD. I also passed it on in report. Today, using electronic charting, maybe you could send them a note to their "in-box." I've also always worked in large teaching facilities where the doctors often review the MAR for the last 24 hours before rounds. And, honestly, there are many instances where I haven't told the doc. a med. was held. EX.: Patient was made NPO and Regular insulin held before surgery, patient had an episode of N/V and MV, Fe, and Vit. C were held, etc. Often, I do not notify when the meds are held for discreet, self-limiting reasons. Instead, I look for and report trends in the patient's condition -- are the patient's BP meds being held every shift because the patient is hypotensive, has the patient's Colace been held for two days because they've had diarrhea? This information is often more useful than reporting a single instance of a med. being held.

I agree with your rationale. The BP meds should have been given. Try to find the actual policy at your institution for clarification. It is possible that that P&P doesn't exist or is inadequate, in which case, you could bring it to your supervisor's attention and offer to participate in your facility's P&P committee. You are also correct that the provider should be notified if a med. is held, but use your nursing judgement here! Are you really going to call the doc. every time you hold a med (you'll be calling a lot)? Are you going to notify the house officer when a Colace is held for loose stools at ten o'clock at night? Technically, you should alert the ordering doc. or cross-cover when any med. is held, but doing so will not make you any friends on the medicine side of things. I usually group my notifications and tell the doctors when they round or when I see them.

I applaud your commitment to our profession and giving nature, but give yourself a break -- you've got a long career ahead of you! There is a difference between professional caring and patient centered care and putting the patient before self (and others including staff and other patients). Inherent in the idea of putting the patient before you is that you are somehow less important than your patient. You are a human being first and foremost. You have the same right to dignity and respect as your patients. You did not give up your rights as a human being and citizen when you became a nurse. Patients make choices and are accountable for those decisions. If a patient spits at you, hits, punches, threatens, or otherwise molests you, they should expect an encounter with Securtiy in their near future. If they are confused or mentally altered, it is a patient centered, caring, and appropriate intervention to restrain the patient, under a physician's order, to protect them, the staff, and other patients and visitors.

I'm sorry your first year as a nurse was so lousy. Fortunately, June is right around the corner! With a year experience under your belt, you will have more employment options. Unless you want to "change" your floor's culture, which is difficult even under the best of circumstances, you are better off finding a new job. But, when you are evaluating new units, I urge you to look beyond the superficial (TVs, thanky-you boards, fruit baskets etc.). Look for good teamwork and an environment where nurses are viewed (and view themselves) as professionals. You should never be told "no" when asked for help with a patient. Other nurses may not be able to help right away, but they should have a good reason not to. When evaluating new units, I always ask about the admission process (sometimes I've even asked to see it). In a functional unit with good teamwork, every free person will come to help when a new patient is being admitted. If you notice patients waiting to see a nurse for several minutes after arriving to the floor or nurses asking for transfer help to no avail, move on to the next opportunity. But, even in good work enviroments, hospitals are gossipy, snipy places. Try not to get involved in that behavior, and, remember, as long as you are doing your job and watching your "P&Qs," the mean nurses are really just annoyances -- they can't hurt you. Please believe me, not all places are like the unit you described! There are places where teamwork is mandated and great nursing is supported. You just have to hang in there a little longer and be lucky enough to find a good floor. Good luck!

Just wanted to mention a couple of things. First, I have never been ashamed or demeaned by doing "aide" work. It is all a part of nursing. An RN who refuses to wipe butt is not a well rounded nurse; its part of our job. However, let me just point out that an RN or LPN cannot legally work as a CNA while they hold a valid nursing license. Licensed clinicians (RNs and LPNs) are held to the responsibilities of their highest licensure. No hospital or facility can relieve them of this responsibility. This is a legal truth. If some untoward event were to occur, a nurse acting as a CNA must respond as any other prudent nurse would respond. Similarly, imagine an MD (I know this is far fetched) agreed to work as an RN for a day. That doctor is responsible to their highest level of licensure, and they can be held libel if they do not act as any other prudent physician, not nurse, would. Be very careful of this tricky legal situation!

I think this a great opportunity for you and you colleagues! If policy and procedures are lacking, you should offer to create a committee to develop them. You should offer to chair the committee yourself. This is your chance to make a real impact on how your hospital is run -- now and in the future. You may think that larger hospitals have too many policies, but they are there to protect the patients and the staff. They insure uniformity and increase quality of care. They also "cover your butt," as you put it. Really, I'm surprised that JCAHO hasn't had some objections to your hospital's lack of substantive policy, but, if they haven't yet, let me assure you JCAHO will in the future. I urge you to be proactive in this matter. Who better to write policy and define nursing's role at you hospital than you and your co-workers!

This whole idea that the patient has to have their IV in place until they are, literally, being rolled out the door is more common than you might think. I've never heard of a place so cheap that they won't spring for a saline lock though! I agree, I wouldn't cut the tubing. I would simply remove the IV right before the patient got dressed to leave as others have suggested. If the people you are working with are freaking out because you are removing the line too early, you could always just thread the tubing through the patient's clothes as they dress, leave the line in place, and thread the tubing back out the patient's sleave (with the end clamped and wrapped in an exam glove) when the patient leaves and you d/c the line. Or, you could tell your co-workers that laws governing malpractice and liability, while sometimes impractical, weren't written by chimpanzees. Tell your collegues that removing the line shortly before the patient gets dressed in anticipation of discharge shows prudent judgement with little chance of legal exposure.

Based upon the information you presented, I concur with your decision not to conduct a car to car search for the patient. Not to second guess, but didn't the guy have a cell phone? Couldn't he have left his number so that you could call him? Also, if the patient was in so much pain that he could not tolerate sitting in a waiting room, perhaps the E.D. was where he belonged. By the way, I have a real problem with non-nurses reviewing or evaluating a nurses performance. These people lack the expertise to make nursing judgements or determine the appropriateness of a nurses actions. While the "office manager" may be competent to evaluate certain facets of your job (attendance, dress code, etc.), the evaluation of your clinical decisions should come from another nurse. I would never work in a place where I was expected to accept a clinical evaluation from someone without R.N. after their name; it tells me that the office doesn't respect nursing as a profession.

I am an atheist, yet, I still have faith. Faith comes in many forms, not just that of a higher power. I have been asked to pray with patients. I have never been asked to speak aloud. Rather, I usually sit quietly and hold the patient's hand while they commune with their God. It is often a peaceful and comforting moment to patients and their families. As a nurse, you must find a way to support your patient's spirituality because, for many people, it is essential to their psychological well-being. If asked, I urge you to be present while your patient prays and support them. I suspect you may find it less uncomfortable than you think.

I know there are pockets throughout the country (especially the rural south) where RN pay is abissmal. I actually grew up in one of the worst paying states, Oklahoma, even though I haven't lived there in over ten years. Nevertheless, I have never failed to make a good salary as nurse. In fact, I have usually been payed more than most of my peer group. Also, my salary has increased with my experience. When I first graduated, I made around $20.00 per hour living in Downtown Dallas. Looking back, it wasn't very much money, but, after having lived on bologna sandwiches for the previous four years, I thought I was rolling in it! Ten years later, I make closer to $40.00 per hour, and I still live comfortably in a large metropolitan area. I also know that the benefits in nursing are better than most. I still get more vacation time than most people my age, my 401K is matched at 100%, I have good medical and dental coverage, etc. Some people feel that they have to work all the time and be on "24/7", but I haven't experienced this. I work 36 hours per week (as do most of my friends). Most other professionals who make what I make work a lot more than that. If they call me for an extra shift that I don't want, I just say no. Everybody's situation is different, and I would never say being a nurse is easy, in fact, somedays it is physical, intellectual, and emotional grind. Nevertheless, nursing has always provided me a good living with more options in life than most.

Wow, your the second post I've read today on this subject. The answer is that as an LPN you can work as a CNA. Most states will let you challenge the exam; so, check with your board of nursing. However, and this uber-important, if you hold a license to practice nursing, you are held to the responsiblities of your highest licensure. If something untoward were to occur and a patient was harmed, you are libel at the level of an LPN, not a CNA (even if your are employed as a CNA -- no facility can relieve you of this responsibility). The only way that you can practice solely within the scope of a CNA is to surrender your nursing license, which I would avoid at all costs.