MicsterRN

I work at a manufacturing plant with 1400 employees, and we have an occupational health department of five RNs and a nurse manager. I love my job! My "patients" are walking, talking, and working to support their families, but they have problems or knowledge deficits like inpatients. They are the same patients as the hospital nurse… Only they haven't had that MI or CVA just yet, for instance. Or they've returned to work with new medications and new diagnoses. Our clinical skills are just as essential as the acute care nurse, but in Occ nursing, we can direct the team member to appropriate level of care to prevent the emergency, such as getting them to urgent care for a new Rx for untreated hypertension. Or educate the 4-month pregnant team member why prenatal care is absolutely necessary (and assist her to locate a primary doc in company insurance network). I think my favorite aspect of my nursing practice in the workplace is that our " patients " are in a headspace where learning can occur, time spent to ensure understanding, and the person can process and and ask questions. Whereas, in the hospital setting, it's hugely stressful for patient and family during hospital admission - it's a crisis on some level, the time is just not available for intimate 1:1 engagement for wholly effective teaching and learning. So we pick up where the acute setting nurse left off, reinforce the teaching that was already given but the patient may not have understood or received well due to stressors. I also worked inpatient medical rehab, and I really enjoyed that, because the patients typically had a two-week length of stay or more. With Primary Nursing model, the relationship was built, and teaching could be done in small bursts and reinforced many times for successful transition to home. It was physical work and yeah, we worked short staffed at times. Overall, I am grateful to still wear scrubs but not work in a hospital. I am a vital component in the continuum of patient care!

Satisfaction is a function of expectations. To attempt to impact the satisfaction (survey results) without managing expectations is utterly baffling to me, as this is a no brainer. The hospital is NOT a hotel, but hotel marketing Could be a great benchmark for managing expectations! Imagine "Hilton TV" that is the default channel when you flip on the hotel TV. Tell patients exactly what to expect (these aspects will be congruent with survey question verbiage). For example, a common sensical approach (to me), is a Patient & Family Channel on the hospital TV, which is a default channel. Short video clips, sort of like commercials, that play on a loop. Channel can be changed, of course, but watchers will probably stay 4-6 minutes before flipping. Examples: "Being away from home in the hospital is stressful, so here is how we are going to support your healing: -All health care providers will perform hand hygiene before giving you care. It is important that ALL of your visitors wash their hands, too! -You, the patient, are the center of you treatment plan. You can expect your provider to tell you what changes are being made as well as anticipated discharge, including post-discharge plan. -Family support is an important aspect of healing. For the convenience of your visitors, they can get snacks in the cafeteria from 7am to 8pm or get a soft drink in the vending machine in the lobby. (It's a huge pet peeve of mine when VISITORS utilize nursing time requesting a soft drink for themselves, and more time is spent re-directing to where they need to go to get their needs met. Once upon a time, the Patient Orientation booklet/binder may have been effective, but that was preceding Press Ganey and preceding a TV at every bed. When "customers" are allowed to invent their own expectations, there is likely little chance of of achieving the lofty, unrealistic, or mis-aligned expectations. Tell patients, family, visitors what to expect. As those execrations are met, the stated satisfaction will align. I don't see where hospitals are uniformly communicating to patients what expectations they should have - satisfaction scores will always fall short until expectations are first managed.

Occupational medical professional and safety professional are quite parallel. Join AAOHN (at company expense). Join your local chapter, as well. Are you taking on workers compensation? Case management needs to be with you - not HR or EHS manager. My concern for you is the absence of nursing experience. You need exposure to other nurses from whom you can learn. If you have the stamina and motivation, I would urge you to consider a PRN role on med/surg unit - maybe two weekends a month. I almost suggested LTC, but after a quick and insufficient orientation, you wouldn't really have nurse resources to help you learn the nursing practice.

My medical director has his own occupational clinic. My company doesn't pay him an additional rate for serving as medical director. It's pretty much hands off - sometimes I send him a text message with an injury picture, or I will ask for a quick phone consultation, but that is rare. I have medical directives that he is signed off , and I have standing orders for our AED program and the OTC Meds in my clinic. Basically, when I need to escalate a case for medical treatment , the injured worker is going to his clinic.

To 1Buckeye: For learning purposes, may I ask the procedure performed and in what clinical setting? I am so sorry for your loss and the disturbing memories.

Occupational Health. No evenings, nights, weekends, holidays for me!

Use your EAP! Free, confidential counseling. No one trying to "fix" you - just listen. I wish more folks would utilize this very valuable benefit, and there's no copay, deductible or co insurance - b/c it's not health insurance. Of course the psych clinician will also recommend you to f/u with your OB, but use the free therapy that's sitting there for you to use!

Occupational Health! Case management! Disability coordinator! utilization review! You can continue to use your brilliant nurse mind and without taking a pay cut! Must be open to learning! Your greatest muscle is your mind - not your back! Warning These jobs usually involve regular business hours, no weekends, no holidays

You are a nursing professional. In upholding your highest level of professional standards, a concise written letter of resignation is the best action. For you in your career.

For the thank you card naysayers, I might implore you to consider the thank you card as such: Reinforce how your skills and experience will align with the requirements of the position and the value you will add. Use what you learned in the interview - prove you listened actively. The purpose of the "Thank You" isn't actually to give thanks... it's the last sales pitch. It's accomplished under the guise "I appreciate your time and the opportunity to learn about ...." I think an initial phone screen or HR interview warrants a Thank You email, but once you get the peer interview pod or nursing manager interview, get out the nice pen and stationery. The practice of sending hand-written Thank You cards is a lost art, which is precisely why it will be noticed. It takes extra time, thoughtfulness, and it takes an actual stamp. If you are willing to go the extra mile for a competive position, these are just the nuances that could sway the decision. I have been successful for each job I really wanted.

The topic is appreciated. Protecting our patients' rights to autonomy is our duty. "Being Mortal" (2014) Gawande, Atul, is an excellent, thought-provoking read. If you're more in to movies than books, watch "You're Not You" with Hilary Swank. The RN's role in initiating the delicate discussion of code status, or rather changing the code status, is really tough. I've never actually performed CPR, but I have accomplished these conversations a few times (thus preventing a code). It was hard. I was scared. Family members were shocked, then cried - the patient is still alive. One fond memory (a proud professional moment of mine) was having an intimate conversation with a woman on my inpatient medical rehab unit. She was admitted to med rehab with dx "debility" following initial hospitalization for PNE. She was in rehab to get stronger! After 1.5 wks of intense therapy, she continued the decline. Still witty, laughing, A&Ox4. She said, "When it's time, it's time. But the kids won't let go". The "kids" visited in the evening. And I started in: Your mother's code status is Full Code, but let's talk about your mom's wishes and what code status actually means. Through sobbing tears, the children supported their mom and code was changed to DNR. She was transferred to Palliative Care. I checked on her before each shift, and then four days later, she was gone.

Do the incident report. Reporting is the only way to ensure practice aligns with policy. Maybe the CN made the wrong call; maybe the supervisor enroute with security should not have turned away. YOU can allow the process to work, only by way of first submitting the incident report. It will be investigated. The incident report is the only way to quantify if staff are regularly subjected to an unsafe workplace. Document the events in an incident report. Maybe you have not completed an incident report before. It's not nearly as intimidating as your patient, I promise! Just the facts. What you said "in quotes" and what the patient said "in quotes". Date. Time. Names. What you did and what the patient did. Leave out your thoughts and feelings. Leave out what you thought patient was thinking or about to do. Document what was said and what was done. The most effective method to accomplish results is to write it down. Always keep a copy for you! Best regards.

It is quite responsible and self aware of you to examine your feelings. The blessings of nursing are the countless options. With you working in schools, you've matriculated to a position that likely suits your strengths and also allows you to avoid daily dealings with direct, medical touch. Cheers!

Nursing Student who has not yet developed warped coping skills: Did you mean "cheese with that whine?" Forgot the H. Read the posts with an empathetic, open mind. It's a window to your future.

You must know someone who knows someone that is experienced in Human Resources. Have your resume and cover letter reviewed by a seasoned veteran. You have less than 20 seconds to grab attention - it's all about the cover letter. You have to say how awesome you are and why it would be a superb choice to hire you in two paragraphs or less! Secondly, cold call human resources and request an appointment with the recruiter or nurse hiring manager. I did that six months ago. I spent about 45 minutes talking to the HR rep about her home remodeling, horses and non-nurse stuff. Then I applied for a job months later. I got an interview with the hiring manager, and when I name dropped that HR professional's name to the manager, he said, "She gave you a raving recommendation!" And THAT was from an informal non-interview 45-minute in-person conversation. Best wishes to you!