chashmonit

nobody can tell you what to do. you have to weigh the pros and cons. as a single mom whose kids are growing up way too fast, i can tell you, i wish i had been able to just stay home with my kids, take care of them, and watch them grow. but as a nurse, i love what i do, and my kids, teen, preteen, and elementary school, already have things that take their interest and they don't want to just hang with mommy, though we are very very close. nursing gives me great satisfaction, fulfillment, confidence, money -- ok, not great money, but good money-- a good career that will not go away--check into different fields of nursing, there is a lot out there. i started at a prison, and actually loved it while i was there, which was surprising because i was shy, easily intimidated, and not confident. now i work in an operating room and LOOOOOVE it (read that in a singsong voice) you are probably going to have some trouble getting back in somewhere because of being out since you graduated, but try a prison, or nursing home--you may have to take a crappy night shift to get your foot in the door. if you don't maintain your hours, you lose your license, so make a decision quick. it was hard to get into the hospital, and i think you kind of have to know someone or, like i said, take a crappy off shift. but after you have been there for a while you can ask to transfer. did i mention i love the operating room? you never have 15 patients (or 3 in icu) you have a whole team of people to take care of your just-one-patient-at-a-time, and you are NEVER trying to lift a 500lb patient with only 1 or 2 people like on the floors. and did i tell you i LOVE the operating room pray about it.

yeah, as long as you don't get penalized for getting sent home--which is the policy at our facility. if we leave (even sent home) before half of our shift is complete, we are penalized with a point system...after a few points (fewer than 10) you are automatically terminated. also for calling out sick, missing a clock punch, any unauthorized absence (which includes a surgical procedure or illness for which you have not been approved leave) are only the hands on health care workers required to have integrity so they take every hit and the facility takes the credit but has no integrity? i'm totally disgusted.

is this new for your facility? our facility just adopted a point system, which they claim is the industry standard. many of us object strenuously (and for the most part, we are very conscientious, patient oriented staff) because of the increase in punitive rather than problem solving responses. we objected to being penalized with points for calling out sick because people will come to work sick rather than be penalized, putting patients and coworkers at risk. the response from administration was that they knew we had too much integrity to come to work sick. so if someone has an active mrsa infection and works in the operating room during a total joint replacement... we also asked if there was a reverse point system, in which points were removed or credited to us when we weren't relieved on time or forced to stay late because of staffing shortages, and they essentially laughed at us. our department, even our whole hospital, is furious over these changes, myself included. if this is new to your facility, what has been the general response of your staff?

hey yeah! there are some really good posts here...my clinical (and I am not a foreigner) was weak too, I thought. Your clinicals don't make you proficient, they just introduce you to the skills. That is why hospitals want experienced staff, and that just takes time and practice. Please don't worry--well, worry some, because that will keep you learning, but we don't come out of nursing school perfect nurses. I'll keep you in my prayers, and I know you will be a great nurse.

You have my sympathy, respect, and prayers. My first job as an LPN while I completed my RN and for several years after was in a prison. I loved it--I really did. But where I worked primarily was in the maximum and super high maximum security. Most days and every night there were only 2 nurses, sometimes only one or neither of us were RN's (until I finished school of course) and there were 900 inmates between the 2 of us--600 in max, 300 in super max. The patients were of course chronic care--we sent our sicker patients to the infirmary, where we sometimes all worked, and did more hands on med surg work, or to the hospital when they were very sick. But every one of the 900 inmates was a potential patient, and we were always overwhelmed and overworked. We would go out onto the tiers (12 flights of stairs every med pass, and that's if you didn't forget anything ) to pass meds--no MAR once we had poured the meds and labeled the cup--so if we got to a patient with a cup of 17 different medications and the patient wasn't familiar to us and was saying they only got 1 or the meds were wrong--well, just imagine. While we were trying to focus on making sure the patients took their meds, other inmates on the tiers were calling through the doors, hey nurse, i don't feel good. or i put in a sick call slip and haven't been seen. or so many others, sometimes really serious stuff. many times we encountered unconscious insulin dependent diabetics which we had to run for glucagon for--stopping for long enough to get a doctor's order (not an easy thing inside the walls of a prison, believe me). anyway, you do the absolute best you can do, and you pray, and you listen and you stay aware. you stay highly attuned to your patients norms and you trust your gut. and you LISTEN LISTEN LISTEN because many will complain and you will learn how to triage them with out even seeming to think about it, but to live with yourself if you make a mistake and it causes pain, suffering or death--well, I believe most of us are nurses to alleviate suffering, and the pain we cause ourselves when we aren't able to is worse than what anyone else can do to us. I did finally leave the prison--I missed it for a while, but now I am at home in the operating room and love it. when I walk away from a patient, my part is finished--I am not worrying about or making notes about things I forgot to do that I need to try to follow up on the next day etc. I'm praying for you. You will do fine. Just hang on.

i wonder if she didn't mean it the way she said it...ie...maybe she meant, as we are all taught in nursing school, for example, someone living with an illness is likely to know more about that particular illness than even a nurse. perhaps her mom breastfed 6 kids and knew something that worked better than what the lactation consultant had taught. i know when my youngest was born...and i have 2 older children who blissfullly breastfed...he was jaundiced and due to pre-eclampsia and 6 week early delivery was a weak nurser etc... my lactation consultant advised only breastfeeding, and his bili levels increased so that he was almost readmitted. my mom and i are both nurses, but not neonatal, and between the two of us, decided since bili had to be excreted and he was not eating much (even with that tiny drippy preemie bottle) to give not only pumped milk, but similac... he started peeing, pooping, and de jaundicing . yeah, we had nursing background, but the person teaching us didn't necessarily give the best or all of the information. i believe she was an rn. anyway, benefit of the doubt.

i hope it does help...just remember...a bully will bully in any situation. so, plan carefully what they will do and what you will do in the program, and set clear boundaries from the beginning. Otherwise, I can just see them saying, that isn't really bullying, we aren't going to do that, and belittling you or taking over the program. you will know those people best, but depending on how assertive you are, and I am not so much, choose carefully ahead of time and try to think (also ahead of time) how they might act and how you will react. I don't want you to start to feel empowered and have it fail, and again, check your resources. There is a ton of stuff on the internet about this. and hey, I just noticed your flag and I just have to say this--I think it is so incredibly awesome that a nurse in the UK and a nurse in the US, not ambassador sorts, but everyday nurses, can work together to improve patient care and work environment.

Honestly, I don't have any experience with the unions in the hospital setting...when I worked at the prison, I did not find the union to be any help to the workers either--I think you would be best off approaching it as an educational/pt safety issue and probably the lower you can start the better...however... if you are feeling that your job is in jeopardy, a friend and mentor of mine suggested this to me: write down with date, time, and signature, events that have occurred and each time as they occur, take it to human resources and ask them to file it in YOUR file. It will do 2 things, document what is happening to offer you protection (just remember that unless you tell someone you are being harassed, they are not responsible for making it stop), and call attention to what is going on in your department. They may tell you they want to talk to the person/people who are doing it. The one who told me to do this did not allow them to do that, and only repeated, I just want this placed in my file. Also, if there are others in your department who are being bullied, encourage them to place documentation in their personnel file also. In fact, come to think of it, when you are creating your antibully program, I wonder what would happen if you included not only the victims, but the bullies in the presentation. Although, nurses are so good at intimidation, they might defeat the purpose of the program. Use your best judgement. Good luck. I'll talk to you soon.

Pussycat--you are so very very welcome. let me know if I can help. Just steel yourself with that thought--it is creating a patient safety issue, and we as a department and a facility would be lax if we don't fix it. I can't tell you how much better ours is. Good luck!!!!! and good for you for not giving up!:yeah:i'll be thinking about you.:heartbeat

Good luck Pussycat--we have been struggling with that in our department, but we have had a few strong good people who have really made a difference. Our unit 6 months ago was miserable. It is so much better now. There is a LOT of info out there about nurses bullying. Can you ask your nurse educator for you department if you can do a seminar on nurse bullying, including realistic examples, and then during the seminar, have the people act out both inappropriate and appropriate ways to communicate. There was even an article in AORN not too long ago, approx when the changes started happening in our department. I wish you would try this. The bullying HAS to stop. Aside from making the victims lives miserable, intimidation keeps nurses from being able to effectively provide safe care for the patients. It keeps them from speaking up when something is wrong, stresses them out so they may miss something important. It is causing a safety issue, so get your risk management department involved, and your human resources department involved. If you approach it like, hey we desperately need some education about this, can I do a seminar, they should only see that as positive. If you are interested, I have been really wanting to do a program like this, even though ours is so much better now, because a friend of mine is in a different unit with the same problem--I would love to work on it with you. Just let me know

To RHITtoRN: (Sorry this is long) I wanted to write you privately, but perhaps others will benefit from this. I also experienced something similar. In my case, a teacher who had informed me early in my RN portion that I had no business working full time and going to nursing school, was determined that I was incompetent and wouldn't make a good nurse. Throughout the first rotation I kept asking her to give me patients with whom I could practice nursing skills, ie, foley, NG tube, trach care etc, as I had only had injections and dressing changes, both of which I did regularly working as an LPN. The final patient of the course that she assigned me had just about every problem, and she assigned me to her alone. This patient was non verbal and in terrible pain (so moaning and groaning), she was diabetic and had a gastric tube (those are the ones sewn into the belly, not through the nose), she had a triple lumen femoral line (that means an IV going into a large vessel in her groin that had 3 ports, so 3 different things could be run at once) and had a cardiac drip running (drips drip because you need a tiny bit constantly, no bolus, no stop). This poor lady also had an advanced sacral decubitus (bad bed sore on her butt) and also on both heels. To top it off, because of her non-mobility and skin risk, she was on a clinitron bed that pumps up in different places with air to alleviate pressure in any one place, thus causing a skin break down. These beds are very hard to move patients on. She was due to be turned every 2 hours. I was so overwhelmed, I didn't know where to start. I was late giving meds, nervous (and making mistakes because of that) giving her crushed medicine through the gastric tube, unable to help with her pain or communicate with her effectively. What was more, it was almost the 2 hour mark, and I couldn't get anyone to help me turn her. I asked all of my classmates (we all got along well, but everyone looks out for themselves in nursing school), then all of the CNA's on the floor, then the nurses, then my instructor, who told me to ask my classmates. I went through again (now we are over the 2 hours) and she told me to ask a certain classmate who had a walking, talking, overall easy patient on whom he was doing a care plan. He agreed to help me when he was done, which wouldn't be for awhile. So, now, over the 2 hour time (dinged for that of course) I tried to turn the patient myself. I turned her, moved to wedge a pillow to hold her, and when she started to roll back to the original position I tried to catch her and hurt my back. I couldn't stand up straight, much less finish clinicals that day. My instructor failed me. I was so hurt, bitter, and angry I wanted nothing to do with even my classmates, though they sympathized with me and agreed it was not fair. Then I went to a sister school, found a completely different environment (my first clinical we were to choose our own patient, I, in terror, picked one that paralleled the previous case--the wonderful lady who was my instructor, gently praised me for being willing to jump right in, but suggested that I start with something a little less challenging,) and thus continued my experience there. Now I am a diligent, hard working, detail oriented, caring nurse, and I will never, ever treat a new person or student nurse the way that worthless instructor did. In retrospect, that teacher used to call the clinical site "killer general" obviously saying the hospital that was kind enough to let us practice on their patients was not good. She also stopped that cardiac drip (remember the one that drips because you need a tiny bit all of the time?) to run an antibiotic, even though the TRIPLE LUMEN femoral line gave us 2 additional ports to choose from, and I am sure, had I not been so terror stricken and traumatized, that I would have found she made many many mistakes that could cost patients dearly, because, my friend, remember this, when you make a mistake, hundreds and thousands of people before you have made the same mistake. When your response is to jump on people when they make a mistake, then your response to a mistake you make is to hide it, not fix it. The good nurses are the ones who work to eliminate human error by fixing the system, not by punishing the human. Good luck to you. I hope you end up having a good experience through this.

I'm only 33, and I finished my RN in 05 ( i did the ADN program at a community college, and worked as an LPN while I got my RN) I had 2 young kids and was pregnant with my 3rd when I finally graduated, was divorced, remarried, and immediately divorced again, and living with my mom and her fairly new husband with whom I didn't get along at the time. My wonderful mother pushed me and encouraged me and picked up the pieces when I was an emotional wreck. I spent many nights typing careplans one handed while breastfeeding a baby, wanting to give up almost every step of the way. Please don't give up. Nursing is so rewarding and fulfilling. People trust you with the most intimate details of their lives, and you have the opportunity to protect them and give them the best experience in a frightening and vulnerable time. In nursing school, instructors were mostly eat their young kind of nurses, testing instead of teaching. A few told me I had no business working full time while going to nursing school (imagine, in a continuing education program), and one in particular really tried to fail me, and outright told me I wouldn't be a competent nurse. Since then, I worked (very hard) at a prison for a few years to try to provide good care to a population that is neglected (whatever one's view is about what prisoners deserve, it doesn't change your obligations as a nurse), then moved to the operating room, where I am at least average, and still work hard to provide the best care for my patients, and remember where I was when I was first starting out. Please don't give up! We need all of you. You have my prayers and hopes for the best.

There is a lot of info out there about the detriment of punitive responses in the medical field. Experts write about it in AORN and I am certain other nursing journals, saying that the whole negative response needs to be done away with, for the pure fact that our goal should be, how can we fix the system so that the likelihood of this happening is reduced, instead of oh no, I am going to get in trouble so I'm not going to admit that I ever do anything wrong. A wise, darling scrub tech I work with, told me something when I first came to the operating room that I pass on to every orientee and all of my coworkers on a regular basis. She said, don't think you are so unique that you are the first person to make any mistake out there. Any mistake you can possibly make has already been made by thousands of people before you. Every effort that we make should be on standardizing the system to eliminate human error, not punishing personnel for being human. I don't know if it is most prevalent in the medical field, but I have heard people say, if you make mistakes like that you shouldn't be working in the medical field. Well, then there wouldn't be anyone working there. Kudos to you for returning the pager the "right" way. If we all would lift our chins in the air and stick by each other when this crap happens, I think it would stop happening.

Our facility has a policy that if a state of emergency is declared and we get there within 4 hours of the start of our shift and complete the shift, we get paid for the whole shift. My struggle is that within our department, and most likely others as well, we were told that if there was a chance we couldn't get there we needed to stay inhouse--even if it mean a couple of days before our shift. Then, those who were inhouse were paid straight pay during their shift, and call pay the rest of the time. I guess that is a compromise, but I kind of feel like, the hospital gets the credit when we are there and take care of the patients, shouldn't they take the financial hit for it as well and pay us while we are there? I love my job and make it a personal goal every day to provide the best care for my patients that I can, and we know going into nursing that we are essential personnel, but does that have to mean we are agreeing to just get dumped on? They provided beds for most, but were completely full. Every bed, stretcher and reclining chair were assigned. I live, in normal conditions, 15 minutes from the hospital, but even security refused to attempt to come get me during the second bout (I went in early and stayed inhouse the weekend of the first bout,) even though I offered to walk to meet them as far as they could come. (I also feel this way about being called in to work at 2am and then being sent home early during the rest of the week so that I don't accrue overtime--I don't mind the call, painful though it is, but why do I take the hit and not the facility that gets the credit for it?) Am I alone in feeling this way? Please give me some feedback. Thanks!