Rensoul

Currently I live 2 hours from the my job. I don't commute daily though and have an apartment within 5 minutes of the hospital (Long story). If I could have an hour commute it would be pushing it IMHO. There are days I do well to stay awake an hour after I get home much less drive. What are the chances of you moving closer to the job? Do you know anyone else that works there that you might be able to crash with if you had a bad day? What are their scheduling policies, & what are your scheduling expectations? Ren

While I know where you are coming from on this Argo (never ask your staff to do what you are unwilling to do), at our facility I don't even know where the mop buckets would be. Our environmental staff each have their own cart that they bring stocked to the floor daily. I wouldn't know where to start getting supplies! I don't feel that I am better than anyone else, however (as this has been pounded into my brain) while I can do environmental services job, they cannot do mine. Just my .02 RenSoul

I work on a busy ortho/neuro unit. Nurse to patient ratio is usually 6:1 and sometimes 8:1. We rarely have 2 hours between a DC and an admit. I'm usually DC'ing a patient and w/in half an hour admitting another one. Our ANM's do all they can to space out the admits, but the logistics of it can get hairy. With direct admits, ED admits, and Recoveries you stay crazy busy all the time. Granted, electronic charting in our facility has expedited the process somewhat. That being said, a direct or ED admission takes roughly 90 minutes to do and a recovery patient takes about 45 minutes when you factor in interruptions/medications. We are required to take all tubing from the IV pumps & take them to the soiled linen room, if they are in precautions the nurse is also required to disinfect it w/ Cavi wipes or Dispatch. Same goes for PCA pumps and wound vacs. I regularly empty trash & generally attempt to keep a room relatively neat while I am in the room with the patient, regardless of what that entails. I am baffled as to why the PTB (powers that be) think that nurses doing housekeeping on a consistent basis is effective? With Vandy being Magnet and therefore EBP based, I am curious to know what research said that this was a good idea?

Ginger, My facility went to EPIC this last year. At first it was a bit intimidating, but it does get better. Once you've practiced a bit it makes more sense. The biggest thing I've run into is knowing where to find where things are in the Order Entry tab because they aren't always labeled the way you would think they would be. I will say that it makes discharges SOOOO much easier. It took about a month for me personally after training to become really competent with it. We'll be optimizing the system soon, so will have some revised features to work with. I'm in Med/surg ortho-neuro so I usually have anywhere from 4-7 patients. Charting as you go is a life saver and personally I feel it's more intuitive in EPIC than it is in Cerner or Care-link. Keep practicing, the playground is a great resource. RenSoul

I've had patients like that, though usually it's the family members that get me going. I've also had a Dr. come to my "rescue" with a family member who thought that his wife getting discharged right this second was a higher priority than a code that had been occurring earlier and had delayed their d/c. Pt husband was getting all nasty and snarky with me & I was desperately trying to get things done so I could get the man out of my hospital. Dr. overhead him giving me a hard time and just flat went off on the man and told him to sit down & be quiet and that he better be nice to the nursing staff. Made my day to see the look on the mans face.

This article nails it. Having just come out of a 3 month orientation period with some awesome preceptors, this is really close to home. Some observations: 1) I didn't see the OP as being harsh. The goal is to assess what the preceptee knows and to work from there, regardless of the teaching method. Case in point, if you make me watch everything and then do it, I will bomb every time. However, if you show me once, walk me through it once, and then let me do it on my own, I'll get it every time. We are all familiar with the teach back method, it works. 2) I would much rather have someone be upfront and honest about their intentions/personality in the beginning rather than feel like that person is being fake and get blindsided by it later. At least OP is being honest about how they are and what they expect. Expectations are part of every relationship, and both sides are responsible for stating what theirs are. 3) A smart student/orientee should be watching their preceptor to see what the resources are. You never know when you will need said resources. IMHO this is not the expectation of reading minds. It is the expectation that we learn from experiences. If I see my preceptor consistently go to specific people for things, it tells me that my preceptor values their opinion for a reason. 4) Different strokes for different folks. If you know that OP's precepting style wouldn't work for you, Kudo's. It means you have the self-knowledge to realize what works for you & that is part of being an active learner. To the new grads/orientees: Yes, orientation is overwhelming as a new grad. There will be days when you feel you can't do a *&^% thing right. It will pass, you will gain confidence & skills. It will click. Hopefully sooner than later. Life begins outside of your comfort zone. Seek out new knowledge/skills as you master the older stuff. Don't take thing's personally. Criticism (constructive or not) can be hard to digest and it takes some time to learn the art of stepping out of the situation to look at things objectively. You will never run out of new things to learn. EVER. If you do, you'll be 6 ft under. Thank you OP for a great article. I was lucky enough to have not one, but 2 preceptors like you that kept me from making some serious missteps as a student & new hire. RenSoul

I too landed on a med-surg floor. While I'm not up to full speed yet, I'm getting there. I wanted med-surg before I spring-boarded to another area just so I could have a really strong generalist foundation. I think I may just certify as a med-surg nurse because I can't think of a specialty that I would want to specialize in for fear of leaving something important out.

Congrats!!!! I'm finishing up 5th semester right now. Ordered my cap & gown today in fact! Keep going it's worth it =) RenSoul

Depends on which class & which semester. The acceptance rate right now is 64 per semester. Usually you have some that fail their one class that come back, in addition to others that have had to take leave & then come back. Currently our 4th semester class is the biggest they've had (they had to offer Critical care in the summer to accommodate all the students for clinicals). We had had 80 students in class last semester during med-surg & Women's Health (L&D & Maternity). Are you thinking off attending? If so shoot me a pm & I will be happy to answer any questions I have. RenSoul

As a Non-trad & a bit of a misfit, I too worry about this. So far in clinicals I do great with the patients, but my fellow students less so. I think a lot of it is me having a chip on my shoulder about being judged to be not good enough. I dropped out the middle of my sophomore year, obtained my GED in what would have been my Jr. year. Was married with 2 children by my 21st birthday. Many of my fellow students came into the nursing program fresh out of high school and I just can't relate to them most of the time. Many of them are great people, but I've just never had the starry eyed innocence that some of them have. So I just do my best, hope that it's good enough and go on with what I need to do. You'll get there too RenSoul

As a mom of 3 kids of my own & various 'adopted' kids, I can say unequivocally that I have no interest what so ever working L&D, PP, or NICU. General Peds might not be too bad, we'll see how that goes after my Peds rotation this fall. I'm waiting w/ bated breath till all of mine get out of the house! Do I love my kids? Absolutely. Do I think it's my life's calling to forever deal with kids? Not in a heartbeat. Kudo's to the OP for doing what's right for you & not what everyone else thinks you should! RenSoul

I don't remember how many hours our program requires, but I do know that for fundamentals we spent 6 days in LTC learning how to pass meds and do ADL's (depending on the acuity of the patient) for med surg we got 2 days a week (8 hr days...ish) for 6 weeks rotating through Ortho, cardiac telemetry, and Oncology, with 2 days in periop, and a day in an Oncology clinic as well as a day of skills lab. In OB we had 1 day of skills lab and then rotated thru L&D, Post-partum, and Nursery, one day for each. Personally for me this is more of an overview of skills, and while I can go and practice in lab (and do), working with a mannequin is not the same as working with a person. I wish we had a larger hands on component of classes/ clinical. Just because I'm going to school to be an RN doesn't mean that I won't be expected to know how to do basic tasks, or have knowledge of basic procedures.... I would love to have a clinical course doing nothing but hands on skills.... even if it's in the form of a CEU after I graduate. I know that on the job learning is a big component...however, not knowing basic skills is a hindrance not only to the SN, but to the nurses that share pt care w/ that SN. Just my RenSoul

:yeah:You hit the nail on the head. As a SN I dread clinical rotations. Not because I don't enjoy patient care (Pt interaction is a bonus for me), but because I feel like we don't have enough time to get our skills 'set'. This past semester (3rd, med-surg) it was discovered that there were students who had never given a bed bath. I have dealt w/ 2 PEG tubes (still not comfortable with that particular skill set), I have done 1 Foley, and lots of med passes w/ the accompanying drill of information from my instructors. I'm attempting to work in the local clinic as a SN just to get some of my skills. RenSoul

Currently I am 3rd semester at MTSU. I was the last class to have the GPA and ACT used as a basis for entry. Yes it is extremely competitive, but it is doable. When I was admitted I had a 3.2 GPA and a composite score of 25 for the ACT. Now they do an interview format combined with the results from the HESI. I'm not sure what kind of questions they ask. All of the instructors there are great (even the ones I didn't care for, I learned something from them), and they are all passionate about what they are doing. As another person said on another thread, MTSU is a highly regarded program in this area, as is Belmont. Your instructors are bound and determined to mold you into a competent, caring, and well rounded nurse by the time you graduate. Hope this helps RenSoul

I sooooo understand where you are coming from. It took me failing Pathophysiology, for DH to understand that there was no way I could continue to pass while trying to study in the kitchen when all 3 kids had access to me, the TV was blaring etc. He finally broke down and remodeled our bathroom (that never got used) into a small study. I have everything I need to hermitize myself as needed to study. When Med-surg clinicals started, I stayed with another nursing student (I live 1 1/2 hours from campus), in order to maximize time to work. We belong to a car club & I haven't gone to an event in over a year, and he won't go with out me. He wants to have friends over or go to their house on the weekend and I have to study. It's not that he doesn't want me to succeed, but he doesn't always get that my one track mind only works w/ minimal distraction! For those of you who are adult learners, you might want to check out the Association for Non-Traditional Higher education (ANTSHE) website. It gives tips on how to maximize study time. Also see if you have a non-trad program on campus that could give you tips on explaining to the family how it's going to be. Keep on trucking guys, it will be doubly precious in the end when you finish in spite of all the distractions! RenSoul

At a certain point you have to stop explaining. I haven't spoken to my mother in 4 months, my kids are at turns deliriously happy to see me, and absolute twerps when I get home, most conversations w/ my DH have been via cell because I had to leave @ 5 am to get to the clinical site by 6:30, and I miss all of them terribly. Three semesters into this roller coaster, I have finally gotten people to start leaning on each other instead of me. Saying no was also a big plus. There are only so many ways that you can slice & dice any 24 hour period. What are your priorities? What kind of family do you have? These all play into coping skills and the like. FAILURE IS NOT AN OPTION! for me. I want this so bad it keeps me awake at night plotting out ways to maximize study and clinical time. Apply the nursing process :), it's great practice at problem solving. Finally, in the end it's a temporary situation. Don't waste your time trying to convince people of how hard it is. Your time is precious & shouldn't be wasted on those who don't want to listen! RenSoul

Good Job! The stare works great for recalcitrant children, fellow students, even goofy husbands at times. The last thing you want to do with a person like this is get into a verbal confrontation. The poster who says you will learn from even the meanest person is correct. I had an English GTA like that while doing my prereqs. I couldn't stand her, but I did learn something from her. It's hard when we are doing our best to do a good job and when someone continues to bust our chops for it. You have to be able to separate the wheat from the chaff with some reflection. Questions like: Am I missing something important because I don't like this person's delivery of criticism? Another point to ponder is this: She isn't there to be nice to you (though a little courtesy goes a long way), she is there to take care of patients (and yes we hope she is nicer to them than you). When you depersonalize the criticism, you take the emotional sting out of it and it's easier to do something about it. Rensoul

Honestly I don't know if the NM can clue him in or not, I was not there. I do however agree with you that a little kindness can go a long way at paving the way for how things should be.

any time we communicate with someone else we are adapting to each other as we learn the give and take point of each person. the goal here is not bludgeon the m.d. with our superiority because we are in our own country, the goal is to provide superior care for the patient. yes it seems counter intuitive for us not to make eye contact when asking questions or making suggestions, but if you won't give any ground at all then more than likely he won't give any either leaving your patient out in the cold. aside from being childish, it defeats the purpose of m.d./ nurse collaboration. the person to be chided here is the nm for allowing this behavior to continue w/o cluing him in that he will have to adjust too.

This is true, however it could also be argued that the Dr. is creating a hostile working environment along with putting patients at risk because he is uncomfortable with female nurses doing their job by making suggestions. Another part of this is that you can pull the military trick on not making eye contact for very long. You make momentary eye contact and then look at a fixed point above the shoulder. By doing this you are technically respecting his wish for less eye contact AND doing it in a manner that does not indicate submissiveness.

Thank you BC, Though I am going for my BSN for now, in the end I want to be an NP and possibly get my DNP. My NP is the whole reason I wanted to become a nurse and she "tests" me every time I come in with one of my crew. Everything from patient position in the room (especially when there are family members in the room), to letting me see my son's ears on the otoscope when he has an ear infection. Great lady :) That is why I was so disappointed in the level of care my mil was getting at the other place, I KNEW what it was supposed to be. Also to one of the previous posters who made a comment about age. You are correct, I just turned 34. I didn't figure out what I wanted to be until around 30 But situations like this one only strengthen my resolve to be a nurse and advocate. Smiles cost nothing, compassion is free, and there is no excuse for treating another human being in the manner my mil was. I will state my case as suggested via letter to the director of the facility. My goal isn't to get anyone fired or in trouble...it is simply to make sure it doesn't happen again to any one. Rensoul

An update: Today my mil saw the FNP that I use for primary care and was pleasantly surprised when she went through all of her meds one by one, set her up with a nephrologist and is working on finding some sort of water based exercise as even walking is painful r/t an old hip fracture and a pelvic fracture last July in addition to back and shoulder surgery in 99. I think all in all the FNP spent almost an hour with us explaining what she was looking for by drawing more labs , putting a note in her chart for additional tests when we get the labs back depending on what the labs say, and most of all, simply listening! I was almost jumping up and down for joy because I wanted my mil to know that this is what it should be like. Thanks again for the great advice guys, I'm glad to know I wasn't about to go off the deep end unnecessarily! Rensoul

Thank you both for your replies, I too thought that it was unethical. I am trying not to approach this out of anger as that get's nothing accomplished, however I am trying to see both sides and like you sharkdiver I think "firing" her would have been the better option in this case. We are in the process of firing her PCP. The PCP had made the comment "oh your not dead yet?" to my mil after one of her hospitalizations. I realize she is an emotionally needy person, but that was uncalled for. If my mil is such a burden to you then we will go somewhere else. I have made her an appt. @ the local Magnet Hospital, where I have had great care in the past. They have a comprehensive diabetes center that I hope will offer my mil the support she needs. Renal failure is scary no matter what state of mind you have, and should be treated compassionately. Her biggest issue is portion control. She does really well at choosing her foods, she just does really crappy when it comes to the size, and she is an emotional eater to boot. I am still considering what action to take in regards to the Dr.'s office. I would hate for any patient to be treated this way. Another thing I wonder about is a possible HIPPA violation. When I spoke to the FNP, it was over the phone and she had no way of verifying that I was who I said I was, yet she went right ahead and discussed my mil's case. Though my mil will eagerly tell you that I advocate for her, there is no paperwork that I am aware of that states this in any of her charts. Thank you again for your input and encouragement, Rensoul

Hello all, I have an issue that I would like to have some insight on from practicing nurses since I have two years to go before I get to claim that honor. My mil received a copy of lab work via mail from her endocrinologist that stated (hand written) she was in third stage renal failure last week. There has been no contact from the FNP or physician at the endocrinologist's office other than this lab work. No phone call to request a visit to discuss the lab work or even explain the labs, nothing. When I contacted the office this morning to ask about the lack of follow up, the FNP told me that since my mil was "non compliant", she was trying to 'scare' her into getting things in control. When I asked about her needing to get into to see the nephrologist, I was told that they didn't normally do that until stage 4 and dialysis was imminent. According to the labwork and the FNP, my mil's eGFR has gone from > 60 to 46 since her initial hospitalization r/t the spider bite in late February. Despite repeated attempts to see the Dr. she keeps getting the FNP and while I normally hold FNP's in high regard, this one has me wondering where her head is. While I am not arguing the fact that my mil is non compliant, I question the way in which this was handled. My mil has lost her father, been in and out of the hospital due to a spider bite (she was dangerously close to being septic), and has had ongoing cardiac issues, all in the last six months. I am not making excuses for her, however it does affect how she handles things. She is fragile (there is depression there already) enough that many more situations like this and she is liable to say "the heck w/ it, it doesn't pay to try anymore". She does try to stay in compliance, she's just not incredibly consistent. My questions are as follows: 1. Am I right in thinking that news of this nature should have been presented in person? 2. Why on earth would you give someone news like this in the hopes of scaring them straight and not offer education, support and follow up? 3. What would be the best way to handle this? My intention is not to go in there guns a blazing, however my job not only as her dil, but her advocate as well is to ensure that she gets the care that she needs. I don't want to come off as the idealistic nursing student or the pain in the rear family member, but this seems wrong on so many levels. Rensoul P.s. I realize that I have a unique view of my 'patient' by being her dil and that I can't expect everyone else to know what I know. If I have left info out that you feel would help you help me then by all means ask me, I could have easily left something out with out realizing it.