nursep2b

Yes, I was a little insulted at the assumption I can't see the bigger picture. As a matter of fact, I have worked as a part of administration in a small LTC facility but left because I felt guilty taking a paycheck. Double and triple checking yourself is great but there are only so many hours in the day. I had someone in the floor today and that set me back a good hour. The bottom line is that in a LTC setting continuity of care through having the same nurses on the same floor is imperative to reducing and eliminating errors as much as possible. To the newbie who could never imagine not giving a med...I think you may be in for a rude awakening. No one is immune to med errors, I don't care who you are. I also think you will be hard pressed to find a NP or even a doctor who does not make mistakes, I don't get the shock and head shaking over a nurse practitioner student making mistakes. Being a np doesn't mean you are flawless by any means. We find md and np mistakes more than once in awhile.

It's especially frustrating when you're trying to pass morning meds and therapy whisks your patient away, sometimes for the whole morning. We nurses do not have time to chase patients down when they are not on the hall. It's also hard for everyone not to show their frustration as the hallways are constantly packed with not just employees but patients and wheelchairs, you literally cannot walk through the mess, we're all on top of one another. The carts are a mess, too. So much time is wasted looking for things. The meds are in drawers, and scattered around the cart. This is a place with two kinds of staff; those who stay a short time and those who have been able to stick it out awhile. I really think this is the kind of job where there should basically be the same nurse assigned to one or two halls. A lot of the patients are high acuity (dialysis, brittle diabetics, etc) and there is just so much to know about these people and their needs. There are also a lot of errors due to miscommunication. Doctor's appointments are frequently missed because someone failed to arrange transportation or sometimes the ambulance will show up and there will be nothing on the appointment book about any appointment (I suggested a case manager to the boss people after I noticed this. Guess it isn't in the budget). Sometime's, I have wondered if Mcdonald's owns the facility because they are running the place like a fast food joint. I've gotten attached to the patients and feel like I could like it there, but it's hard to swallow the finger-pointing and criticism after you've spent most of the 12 hour shift running your legs off, sweating and really trying to see your patients have been taken care of. The bosses will acknowledge floor work is exhausting and can be very difficult but in the same breath berate you and make you feel like...you're skating on thin ice.

Please elaborate. Also, share how you've not made any medication errors and how you are certain you have not made any.

The bottom line is that I wonder if I should be looking for another job. I always try to be consciencious about signing the records, but they also apparently are going behind us counting meds.. I also know from experience it is a lot easier to point out others' mistakes. I could go through there now and find tons. Another thing they are harping on is getting done and getting out of there on time.

I'll try to get to the point but this is a little complicated for me. I'm a BSN and am actually halfway through a nurse practitioner program. It became necessary to find a job a few months ago and I began working at a very large nursing home. I've worked in a nursing home before, but it was small and a lot less busy compared to this one. The place is so crowded with laundry pushing carts up and down the hall, janitors buffing the floor, housekeeping pushing their carts and you pushing yours. It's literally like trying to maneuver through an obstacle course. Anyway, being a newbie I don't have the luxury of choosing where I want to work, so I'm usually floated wherever a nurse is needed. This is where medication errors are coming in. I don't have a problem on this particular hall where I usually work, but I got a phone call from the boss and was scolded because they had found holes in the MAR I had not signed and when the carts were audited they had found some medications I had not given. She also told me she knew I had been moved around a lot but I was going to HAVE to be very careful. She also told me there are a lot of others guilty of the same thing (which you can look through the MARS at any time and see holes everywhere) so I was not just being singled out. Still, I can't shake the feeling I'm skating on thin ice, and it really stinks because I'm trying hard. It's bad coming home, sore and exhausted after running 12 hours and in the end you still get flogged for not being good enough. I'm on the schedule tomorrow and feel like I need to go talk to the supervisor, but I don't know what to say. I want to let her know I'm willing to do what I need to so I can be what they want me to be. I did tell her I was sorry I turned out to be a disappointment and she told me I wasn't a disappointment but it sure sounds like I am. Jobs aren't easy to come by around here so I'll be up a creek if I lose this one. Any advice?

I have heard there are a lot of opportunities in the midwest. I would imagine that areas where np schools are nearby would be pretty saturated.

No one seems to think that going with anything other than FNP is a good idea. I'm in an online adult np program because I was told that was the only program I qualified for because of my lack of pediatric experience. If the "specialty" programs are not any good, why are the schools selling them? I hate to think I would not find a job after all the time and money spent on this venture.

I agree with baburton. Our family MD leads anything but a glamorous life. He has a small rural clinic, gets up early to make hospital rounds, sees the same old thing in his office every day, listens to the same old complaints, and gets up the next day to do it all again. Not really a lot of glory in that. He has a wife and a house full of kids to support, drives old vehicles, he can't even afford to hire a full time office nurse. Yes, he is a medical doctor, and he should be admired for the sacrifice and hard work it took to get through it all, but he is just a regular Joe at the end of the day. I personally think the role of NP would offer more benefit than MD.

I'm going into the third semester of an Adult/Geron NP program. I believe I would have been better off in the FNP track but this particular school was very picky about having certain types of experience for different tracks and I was told I only qualified for Adult/Geron (primary care). So...I'm going to make the best of it. I'm assuming my best chances at employment will be in places like urologist, cardiologist, endocrinologist office...places that only see adults. Running a small clinic and doing housecalls would be a dream come true, but we'll see how things go.

I'm in nurse practitioner school and will start clinicals this fall. The specialty I am studying for is Adult/Geron NP (primary care). It's not a requirement but the school is suggesting we buy our own otoscope/ophthalmoscope. They sent a list and the ones listed are all expensive. Can anyone suggest a good one that will give me the most for my money? I figure the otoscope would be what I would use most in a clinic setting, I just don't know what would be a good one. Thanks.