UpdogRN

Hello out there. I was wondering if I could get your input on a recertification issue I'm having. I am clear on when a patient clearly requires continued care you naturally will recert the pt. However, has anyone else sometimes found that although you are the nurse assessing the pt and know what their status is, you are still gently pressured to keep the patient? I would never discharge a patient that still required home care services, but I have one or two that I feel have met the goals of their treatment plan and could be discharged. I love educating my patients, but in these cases I really feel that it would be redundant and unnecessary.

Ongoing issue when individual hospitals can dictate their idea of "safe" staffing ratios. I work in Behavioral Health and while the patients may not customarily have acute medical issues as on a cardiac or med surg floor, many are detoxing off drugs and/or in psychological crisis. I have worked with 35 or more patients and 2 nurses....not cute at all.

I am seriously considering a job change, and I wanted to ask about the types of positions that are available. I am an RN since 2003, and I'm already ready to leave the hospital as well as my home health care position (I work per diem at both). While I enjoy many aspects of the job, I am finding it more and more difficult to work within the constraints of the actual healthcare system, as related to staffing, burnout, unrealistic expectations, the usual things that nurses face. I would like to do a job that I can see a positive benefit from the people I'm caring for, instead of feeling like a rancher with a cattle prod moving patients in and out of the hospital like a factory, or teaching and teaching and assessing and assessing and finding that my efforts many times seem futile and don't even matter. I have my BSN and would like to remain in patient care as much as I can, but I am thinking a change in environment from the traditional systems may be beneficial. Any thoughts or suggestions would be greatly appreciated :)