scribblz

Hello and welcome to our forum @LexxNervous ☺️ Those ratios are fairly consistent across many med surg units in MA. I will say more than four patients on 7:00 to 3:00 and 3:00 to 11:00 is hard. Especially 3:00 to 11:00 where you get hit with admissions and discharges. But as long as they agree to not exceed five until 11:00 p.m. it's doable. Of course if you have an emergency, it doesn't matter how many patients you have you are focusing on the emergent patient. In a well-run unit the rest of the nurses look out for your other people, the supervisor pauses admissions and hopefully you have a good orientation so you're prepared. Depending on your hospital they may even have a code team and/or nurse educators to provide support. I worked LTC and SNF for 10 years before I went from LPN to RN, and it was pretty brutal in terms of patient ratios. I found my hospital experience to be much better in terms of length of orientation and in having more resources and staff. I commend you for being motivated with your own education and to continue to look up things that you experience that you don't understand. There are some amazing nurse educators on Youtube. I highly recommend the YouTuber "ICU advantage" even though he is explaining concepts that are more common to the ICU and critical care he also explains a lot of things that carry over to med surg, and is a delightful human being to learn from. I wish you the best of luck and hope that your hospital experience is a good one. Please feel free to reach out for help if you need it and let us know how you're doing!

LOL this is so true. I have a assistant nurse manager who loves to ask me to work and then complains when I occasionally cost her overtime even though I'm saving her department from running short due to call outs. The other day she sends me this ridiculous email that is both asking me to work more and then complaining about how much I work. I wrote a thoroughly scathing email in response... Read it a few times with a big smile of rage filled satisfaction and then after enjoying my witty writing came to my senses and edited to a super congenial response that couldn't possibly come back to hurt me ? Losing your temper always feels good at the time but bad very shortly after... the inability to control yourself is a bad habit to indulge in.

To answer your question I'm never mad about being fed ? That being said I do think charm plays a great deal into people winning awards... But I also like to see my colleagues be recognized for their acts of kindness/ excellence whether they are heroic saves or just everyday that meant a lot to somebody. As nurses and human beings it can be a gut reaction to feel a little resentful or jealous when someone receives recognition and you feel like you yourself are not seen. But we all just have to rise above that and realize that life is not pie someone else being recognized does not take away from our value and self worth ?

Hi OP, I realize this is a really old post so you may not see this...but on the off chance you do wondering how you like home infusion nursing?

Curious if you ever found a position as an IV nurse? There is a big difference between being good at peripheral IVs and being a PICC nurse. I started out by asking the IV nurse to teach me how to place regular peripheral IVs (PIV) then made it known on my med Surg floor that I'm happy to put everyone's IVs in (if I wasn't too busy). Once I had a hundred or so sticks I applied for a home infusion job and to be per diem on the IV team. This allowed me to be trained in accessing ports, using ultrasound (still a ways to go on this one) and placing PIVs in babies/kids (toddlers are so tough!). I studied for 6 months using the INS membership resources and CRNI study app then went to test for it and while it was hard I felt well prepared/ passed on the first try. I'm hoping to acquire a day shift position on the IV team so that I can be trained to place PICCs and Mids but waiting my turn as it goes by seniority. This IV specialty section of all nurses is super quiet. Would love to hear about other IV nurses experiences!

That's horrific and unacceptable care. I'm so sorry you had to experience that.

You might want to give a brief explanation as to why you want to work on a mother baby floor. Personal experience or just what about it draws you. Think of experiences you've had on your current floor where your empathy and critical thinking made a difference for your patients. Feed those stories into your cover letter. If the unit you're applying to is in the hospital you already work in you might want to reach out to the nurse manager of that unit and let them know that you've applied. If the conversation goes well ask if there's any option to shadow someone for a shift or part of a shift. Good luck!

Hello OP, I feel for you, and how difficult your situation is. If I understood you correctly your RN license has been under investigation with no formal findings for over 2 years? This hasn't placed any restrictions on your ability to work as an RN? If it hasn't then, unless your attorney advises against it; I would proceed with your life as if the investigation is without merit. Collect character letters from colleagues/ supervisors who think highly of you. Apply for your NP license and apply for NP positions. Have a simple, honest explanation ready if future employers ask what the formal complaint was and maybe an example of how you've grown/ improved since. Best of luck to you!

I've worked all the shifts, but for the past 15 years or so it's been 7p-7a 24hrs/ week at my hospital and then home infusions at people's houses the remainder of the week. I love having an acute and a non acute nursing job. It allows me to be a night owl and supplement my income/hours with a side job where I make my own schedule. As long as you allow yourself "you" time to catch up on rest/ tasks, night shift can be amazing for flexibility.

You sound like you may be a good fit for an area that does procedures such as cath lab or Endo or Infusion nursing. All generally 9-5 or similar hours Mon through Friday. You perform similar tasks/ assist with procedures in a structured environment. It's nothing like the chaos of the ED or med Surg. Some people would be bored out of their minds and some will be content with having a routine work flow. There's so many ways to be a good nurse and enjoy your nursing career. Unless someone is very similar to you; it's often unhelpful to look at what worked for them and think that is also your solution. A better place to start is to assess what aspects of nursing you like and what you don't. Then research different nursing positions and apply for what fits your strengths. There's forums here for a lot of specialties, and there's many more of them out there. Good luck to you!

This is why palliative consults are necessary. They cut right to the chase of quality over quantity. In fact I've seen some people get both by having their symptoms managed in a non-aggressive manner. If someone has a poor prognosis it should automatically trigger a palliative consult. It's not a "don't treat" it's a "don't treat mindlessly for the sake of treating" with no care to the suffering of the patient. Over the years we've become less and less holistic in the healthcare profession and more aggressive in diagnosing and fixing problems. Meanwhile we kind of do a lousy job with preventative medicine and don't support our providers who do provide this necessary care. I am generalizing but that has just been my personal observation and experience working as a nurse in the US. it's not particularly surprising as most of our healthcare is for profit and frankly sick people who get better are not profitable.

Agreed. The bigger the place the less likely to be trapped with petty people who succeed off the work of others. Also research culture, non profits are less likely to have these types of people. Positions with a lot of autonomy are also less likely to have these kinds of interactions. I do home infusion nursing per diem and in 1 year I've met 1 co-worker and my DON. It's fantastic, I take good care of my patients punch in on my phone submit my paperwork digitally and punch out of my phone and go home. not that it's 100% drama free I still have to deal with the idiosyncrasies of the pharmacy ? but significantly more peaceful than when I did LTC.

This is fantastic @subee ?

"Presume good will" I like that. Thanks for sharing! To the OP: We all have a default level of expectations for others that we meet. Optimistic people tend to give people the benefit of the doubt more easily and not be as easily offended. Different periods of my life when I was younger, less secure and anxious about how I was perceived I was quick to worry that people thought I was inadequate. As I got older and more comfortable in my own skin I realized that by owning my mistakes and learning from them, I simultaneously was becoming less sensitive about them. Being defensive is a mal adaptive coping mechanism for fear of criticism. The solution is to embrace feedback. Good or bad, assess that feedback. Is it valid ie. Is there evidence to support it? If someone is being rude or bullying you can still take back the power in the dynamic by owning the situation. Ie. Yes, I did xyz incorrectly. I'm unfamiliar with it, and I'm going to learn more about it. If you really want to drive them crazy smile when you say that and walk away. Then you go your own way and learn everything there is to know about whatever it is you struggled with. People will notice this about you, and the right people will respect it.

I think we'll run out of nurses who know how to take care of vented patients first ? and if this ship doesn't turn around soon we probably will be rationing ventilators by Feb-March.

I completely agree the point of the Union/ strike is to put pressure on management to exceed to nursing requests to improve care and quality to patients and make sure that nurses are being given the support they need to succeed in that hospital. The strike is a last resort when all other negotiations have failed. My 2 cents are: No one wants to strike. It's lousy for all involved. I absolutely do not want harm to come to my patients while we're striking. I'm grateful there is a (too expensive to sustain/temporary) workforce that will care for our patients while we strike. In the long run it's a necessary push and pull to improve standards of care in an industry that is increasingly for profit.

Oh my goodness. 2021. Not last April. And we're still working like Covid just hit. Blows the mind.

I think you are 100% on the money! Given this time of crisis all those nursing students who are being denied their clinical could come be SNAs instead and Gain valuable experience and be a huge help to their local healthcare facilities. People always say it's so hard to get in to hospitals as a new grad, but SNA's are almost guaranteed to get in for preceptorships and new grad RN positions. If ever there was a time for a mutually beneficial relationship to be invoked now is the time! Also there are tons of elective department such as GI RNs that are looking at using up all their unemployment time when we so desperately need our ends of any kind they could be buddied up with experienced Med surg RNs so that we can handle the ridiculously large assignments we have been given these days. At this point I don't want more money; I want more staff. I want to feel like I'm not endangering my nursing license, sanity and conscience every single day when I go to work.

Same ?‍♀️?‍♀️?

I believe that the government is intentionally terrible at certain things because the industries and corporations who paid for many politicians' campaigns are getting what they paid for. We are a capitalistic society with minimal safeguards against this happening. I'm fine with individual state run health insurance, in general I think local and state government is more effective than the federal government. I think with private insurance you run the risk of having people with pre existing conditions (cancer, diabetes etc) be excluded. The market has to be regulated to protect consumers. I wish providers had the power over the industry rather than insurance. I think expanding Medicare to cover everyone is the most efficient seeing as how we all pay into it anyway, but I share your concerns regarding how many government institutions are run badly. I think the solution is to run them better though rather than give up on them/ work around them. As to illegal immigrants receiving care... well they live here...they work here... eventually they are going to get sick or injured and need treatment. They are a necessary part of our society. I don't see too many people born in this country picking produce, working as maids and CNAs and any other number of heavy work low wage jobs. The solution is a path to citizenship or work visa rather than keeping them unseen, unprotected workers.

Well let's explore this...we both work in healthcare, and I hope we both agree that all people require some form of preventative/maintenance healthcare and emergency healthcare. So when I say it's a right what I mean is that it's a basic and universal need. I think our current system of multiple insurances tied to people's employment and income is impractical especially with today's unemployment numbers. But uninsured people are also a burden to the healthcare system. The emergency room ends up picking up a lot of mental health crises and poorly managed chronic illness. We can't turn people away, and society pays for the have nots one way or another. Why not make healthcare affordable and universal?

Plenty of successful social democracies out there...look at quality of life for people in Denmark and Sweden. The whole fear mongering that we'll "end up like Cuba and Venezuela" is an overused playbook. I find it hard to believe that people honestly disagree with their fellow citizens being paid a living wage and that healthcare is a human right. The violence and pain caused by poverty should concern us all. The shrinking middle class should concern us all. The wealth consolidation should concern us all. Those with wealth and power are laughing at us all the way to the bank, sorry all the way to their off shore accounts. Because the keep the people divided and pissed off at each other playbook so that those who are making all the money and consolidating all the power can do so unimpeded... oldest most successful playbook out there. So yeah you worry about out our "socialism demise". I'm going to worry about how the courts are stacked with judges who don't value individual rights over corporations. I'm going to worry about gerrymandering and our ability to hold honest elections. I'm going to worry about the notion that facts and science are suddenly now valid or invalid based on people's feelings. I'm going to worry about the FDA and our education system being dismantled and undermined at every turn. I'm going to worry and be pissed off about what is currently happening, not what might happen in the future... because the present is quite enough of a hot mess. Super disappointed about this "made great again America" 1 out of 5 stars, would not recommend.

Thank you @speedynurse I appreciate all the tips!

Proving discrimination is almost impossible. They don't have to explain why they didn't pick some one. In my opinion people pick applicants who they get a good feeling about, often that means they remind them of themselves. Applicants who are different from the person doing the interview may be very qualified, but they may unconsciously be biased against them. Affirmative action says off all the qualified people you have to pick a candidate you ordinarily wouldn't. And I think that should include older hires and second career hires who ordinarily might not be considered because they might have baggage or have less years to give to the company I think of it as mandatory osmosis on our country's journey to homeostasis ☺️.

Full disclosure: new infusion nurse here! I started doing home infusions (IVIG mostly) about 7 months ago. I got a per diem position on the IV team at my hospital a couple months ago. Since then I try to pick up at least one 3-11 or 11-7 a week to get the hang of it. I joined AVA and also read the INS journals too. I watched every Youtube video I could find related to vascular access. Nonetheless I am struggling with the feeling of imposter syndrome, and in particular I am struggling with toddlers and babies. I've tried the wee sight, I have been able to find a few good veins in the hands and feet, but even if I somehow get the flash the IV won't thread. I work in a relatively small community hospital and if I get paged to the nursery it's always for a baby that's in trouble. So not only am I brand new at it, but I have anxious doctors and nurses hovering and respiratory also working them up with the lab waiting for me to get done too. I am really struggling with getting past my anxiety and doubt in my ability to put IVs in babies. I only started doing IVs in adults 7 months ago, and I put in 15-20 IVs a shift for adults but babies I get paged for maybe 2x/ month. I never refuse to try, but after a couple failures I encourage someone else to try. Other than just keep at it and one day it'll click does anyone have any advice or tips?