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All4NursingRN

All4NursingRN

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  1. All4NursingRN

    Bizarre NP Preceptor Experience!

    This is an acute care program in NYC, fairly well known. I’ll fill in more when the semester is over.
  2. All4NursingRN

    Bizarre NP Preceptor Experience!

    Hey all! It seems my preceptor doesn’t want me... long but good! So I’m going into my last 2 semesters of an acute care program. This summer I have my first clinical rotation and I landed my dream rotation right off bat... cardio thoracic ICU at a world renowned institution. My school matches students with preceptors and since I work nights I was matched with an NP in CTICU nights. I contact her via email and we arrange our first night, she seems nice over email. I was extremely nervous and super excited for this rotation... I was literally beaming as I walked through the doors as I love cardiology and critical care. So I show up, knock on the door of the office, she opens the door and I explain that I’m all4nursingrn from x school. I’m on time but it seems she had started sign out with the day NP already. That’s fine. So I walk in the room, she continues talking with her colleague and I stand there looking for a place to put my stuff down ... when she finally swings around says oh yeah you can put your stuff anywhere it’s just us and another NP tonite. She turns back and keeps talking to her colleague. I put my bag down, grab a chair and just sit there unsure of what to do trying to follow along with sign out. She then turns to me and says check the printer for the H&P sheets she just printed. She prints out the H&Ps of our 6 patients for the night and then asked me how I wanna do this. In her words “like do you want to shadow me for a day and then see patients on your own for the rest.. or ??” I mention again (as I did in the initial email) that this was my first rotation and that I have no CTICU only SICU/MICU experience and that I was willing to do things however she liked. I find her question and disposition a bit odd but I sit there waiting for us to start our night while she is venting with another NP over how much they dislike some of the other NPs and providers. Awkward. She then motions for us to leave the room and start rounds and were walking towards the nurses station. As I try to hold back my sheer excitement over getting my dream rotation...I casually ask her some general questions about the unit and patient population as she doesn’t really say, explain, or introduce me to much about anything. I just wanted a general introduction to the unit as I wasn’t given any information other than her name, email address and the service she was on by my instructor. She vaguely answers my questions. She then sits at the desk in the nurses station... talks and laughs with the nurses and the attending then and starts looking stuff up on the computer, doesn’t say much to me, doesn’t introduce me to anyone except the attending as he’s walking away... go figure..smh and also doesn’t tell me her plan for the night. I also log in to epic (which I’ve never used) and just try to mimic what she’s doing because honestly she’s not saying much to me. She gets up without warning and walks off, I jump up and just trail her everywhere she goes... she rounds with the nurses, laughs and greets coworkers in the hallway but doesn’t give me much attention. I casually questions and honestly I’m so overwhelmed by the complexity of the surgeries and just how different they do things at that hospital it’s hard for me to follow along without her explaining things to me. Patient after patient she rounds.. me trailing behind her, she asks me nothing, explains nothing ,doesn’t even really talk to me much but I’m still trying to squeeze in a question or two because it’s becoming so awkward. The nurses and patients are staring at me like who is this??... before I could introduce myself to the patient she starts talking to them. I just feel awkward. She looks up a chest X-ray of a patient that just got out the OR post a mitral valve repair, she sees one of the attending in the hallway and runs a portable computer over to him to check the X-ray out. They’re both blocking the computer so I struggle to see what she’s showing him. They confirm that it’s a pneumothorax, she then goes in the room and adjusts the patients vent settings, talks to the nurse then walks out, me of course running behind her because she’s just running from room to room, again barely interacting with me. She explains nothing. I tell her that I’d like to learn how to read X-rays and ask her how she determined the pneumothorax, she quickly pulls it up the X-ray again but doesn’t give a very clear or thorough explanation of why she thought it was a pneumothorax or what she would do to manage it. This scenario repeats itself for the next 3 hours as she rounds, she goes in the rooms, talks or examines the patient. I trail her closely but she isn’t interacting with me at all. She discusses the patient with the nurses, plays with the lines, vents and then just walks out while I’m attempting to assess the patient (I’m just trying to mimic what she’s doing) so I drop everything and go running behind her again. After we’re done rounding we go back to the call room and she like ok so are you ready to go? Confused... I’m like well it’s only 11pm and I have a few questions and some stuff I’d like to go over. She then says “oh most students just want to leave early, I’ll sign you off for the entire night”. I politely tell her that I also work nights so I don’t mind staying as much of the shift as possible. She seems like she doesn’t want me to stay for long, so I ask her a few questions about the patients and their surgeries, she suggests a book I should use and I pick up my bags, thank her and tell her I’d see her Wednesday. I come back Wednesday, still excited. But same scenario, she’s very detached, vague when answering questions. At this point I’m pretty much doing all the talking because she’s either talking to her colleagues or on the computer checking patient stuff. She interacts a little but not very much. She asks me if I had questions, I told her I had a ton but she doesn’t seem interested in reviewing a whole lot with me. I was honestly fighting back tears during rounds and in the call room. She randomly asks one of the PAs if he wants to share a student which I take is her way of saying she doesn’t want me. Again she suggests we wrap up the night early. I go home after 4 hours. Honestly I fought back the urge to grab my stuff and leave earlier on. I have another 8+ shifts with her as we were instructed that we may keep the same preceptor through the fall before we are assigned a new service. I don’t want to complain as A. My first preceptor I was matched with fell through (she couldn’t be contacted) so my instructor had to find me a new site and preceptor at the last minute. B) this is my dream rotation. C). She has to give me grade of pass/fail for clinical. As an unrelated note it’s even more awkward because this woman is from the same country as my parents (I picked up on her accent lol) so I thought we would’ve bonded, and thought she could be a great resource-possible mentor as there are very few of us in the specialty and our situations are so similar. We’ve both been RNs for over 10 years and transitioning into advance practice (which I’m so nervous about). I told her I remembered when she came to orientation at our school (she’s a graduate of the same program) to speak with us and she pretended to not remember. I remember her distinctly because of her familiar accent. Ive asked her how comfortable she feels now working as an NP and she says she not really comfortable (read as not confident), I also asked her about how she got the job there to which she was vague... sigh. Im honestly feeling dejected right now. I’m dreading going there and feel as if I’ve failed somehow. I bought a few cardiac surgery books and I’m studying ferociously just so I can appear to be abreast of what’s going on. Not sure if she’s just not wanting to teach, not comfortable enough to teach or doesn’t want me as I student. I plan on going in next time and politely asking her to slow down and explain things to me and ask if we could spend some time reviewing the patient plan she assigned me for tricuspid repair (well that was one thing she gave me to do.. homework) I doubt she’ll remember to review it with me though. any advice? It’s awkward and bizarre. She doesn’t have to take a student, it’s purely optional.
  3. All4NursingRN

    Staff Nurses Who Refuse To Precept Or Teach?

    Of course I understand that not everyone wants to be a teacher or professor but a few of my coworkers lately have down right refused to precept or even be a resource to newer or less experienced nurses. The education department had placed a sign up sheet for preceptor training courses and one of my colleagues very adamantly professed her disdain for teaching or precepting and that it "just wasn't in her to teach". ok fine, but IMO it sounded a bit condescending and selfish of one to refuse to share nursing knowledge. She does everything to get out of precepting or cross training nurses. Seems unprofessional to me. I was giving bedside report to a MICU RN who recently transferred to the SICU and the patient was a postop neurosurgery case with an EVD and ICP monitoring. I gave her an overview of what the drain was, how to manage it and transduce for IC pressures. I then told her to refer to Ms. Senior RN who is real good with neuro for any questions after I left. I then spoke to Ms. Senior RN and told her that I endorsed an EVD/ICP monitoring to Ms. New SICU RN and perhaps she could guide her throughout the shift on the neuro patient, she then promptly rolled her eyes and asked why I had to refer the new SICU RN to her?? (Mind you she is one of the most knowledgeable nurses in our ICU but I've never seen her precepting and she doesn't offer up knowledge freely either) Like really? After almost 12 years of nursing this issue still grinds my gears. We should all be willing to help/guide one another. Sure sometimes I'm not in the mood to teach, or my orientee is not a fast learner or another RN asks for my help when I'm super busy, but either way I roll up my sleeves and get it done because if the shoe was on the other foot (like it has been many times) I would want someones help to guide-teach-assist me. I don't mean to make this medicine vs nursing but physicians are expected to teach and mentor from the time they graduate medical school they are thrust into mentoring those behind them. IMO nursing lags behind with this. Is it because we lack pride in our profession?, or feel like victims that we cannot and often do not embody a leadership mentality? Perhaps its it's just part of the nurses eating their young/lateral violence that is far too prevalent in our profession. On my unit its the same RNs who precept everyone while others flat out refuse and go years without precepting. I love to teach and came to this job with experience and for that reason I've literally been precepting since I came off orientation/probation myself (yes crazy I know) because many nurses just refuse to teach on my unit. Heck when I was new to this facility myself a few years back my assigned preceptor (who didn't realize I was sitting nearby) flat out refused to orient anyone (she later apologized saying it was nothing personal when she realized I was in an earshot of her comment) All nurses should have pride in their work/profession enough to want to share their wealth of knowledge at some level. You may not pursue a masters in nursing education or a PhD but you can still be a resource for you unit and colleagues, that's at least the minimum that should be required of you. *sigh* just venting.
  4. All4NursingRN

    Staff Nurses Who Refuse To Precept Or Teach?

    Oh my what a Pandora's box I have opened. Then I wonder what if no one on a unit wants to precept and this I ask speaking from experience. Two years ago every nurse the manager approached refused to precept so she had to mandate someone... oh boy what do you think of that then? Well I'm thankful for those who precepted me way back when, whether they felt like it or not at least they were professional enough not to let it show and exercise patience and I'm sure with me under their wing it wasn't that bad at all (as that I was released from orientation early as a new grad working trauma, yes I am bragging) It's just precepting it isn't the end of your nursing career, I'm sure most of you aren't approached to precept a new nurse every 6 weeks like my current job (our turnover is horrendous) and goodness $1/hr extra for precepting, what a joke!
  5. All4NursingRN

    Staff Nurses Who Refuse To Precept Or Teach?

    The colleague I referred her to is not the same one who refused to precept. That was a different nurse.
  6. All4NursingRN

    Seasoned ICU Nurse Lacks Critical Thinking

    Last night shift I worked with 2 of my colleagues one who is one of the units senior staff nurses (SSN). We each have at least 10 yrs experience, she our SSN has about 30 years ICU experience. we agreed that I would go on break first and our SSN would go last. I return from break and my colleague goes on break next and gives report on his patients, rooms 7 & 8 to her. She is notorious for sleeping on the job constantly falls asleep at the desk so when she asks me if she could go to the lounge and take a 15 min break because she is so so tired I shrug and let her go. The surgical resident then comes by and asks me if I'm covering bed 8, I say no our charge is, but how can I help? He says the patient is more tachycardic and is in pain, could I please medicate him for pain. As as I go to assess Rm 8 and get some morphine I notice my charge nurse back on the unit, talking with the surgical resident about a medical patient in Rm 7. Curious I go into Rm 7 who looks a bit unstable and the resident asks me to page RT. I go back to desk to page RT (who took forever to come) and then answered a call bell in Rm 3. I come out of Rm 3 and see my charge nurse sitting down at the desk charting by the tele monitor and apparently the surgical resident went back to the call room. Still curious about bed 7 (who I am technically not covering and know nothing about but hey we're here for every patient ) I ask her what's going on with the patient and she just shrugs and say she doesn't know what wrong with him and let's wait for RT. I begin to worry and look at Rm 7 on telemetry and his pulse oximeter says 80 and he's still tachycardic to 120s-140s. I go to room and talk to patient asking him if he feels worse, he nods yes, he is diaphoretic, and is using accessory muscles to breath and is also grunting and sounds wet. I immediately increase his fio2 on his high flow to 100 and tell my charge that his saturation is now 75% and that I'm going to page the medical resident who is assigned to him immediately. I speak to the resident and tell him that the patient seems to be deteriorating and will need intubation. Internal medicine intern comes to unit (with RT running behind him) and debates putting patient on biPap and wants an abg first and I tell him that patient needs imminent intubation, biPap will not help. Back and forth debating with intern while my charge nurse just stands there. Intern decides he wants his seniors opinion. Senior comes to floor and patient ends up intubated within 5 min. I was so irritated at my charge nurse.. how are you here with 30 years ICU experience and leave a deteriorating patient, not call the covering MD and just shrug it off? Couldn't she see the patient was in distress??? This is not the first time she has shown lack of skill or expertise. I had a code recently and she had no clue how to fill out the code sheet and was asking me what to write??? She once had a patient with a subdural hematoma, consistent systolic BP in 200s on nicardipine running at only 2.5 mg!(starting dose) because she didn't know that cardene was a titratable drug. I had to titrate it myself. She had another extremely critical patient who coded and she was not ready...no defib pads on patient, I ran the code on her patient while she stood by watching. She freezes in code situations. I feel so unsure now with her covering my patients . I've worked with a lot of awesome nurses with differing amounts of experience but c'mon after 25/30 years how does one still struggle like this? She's a lovely woman but this is so unsafe.
  7. I recently took care of a very critical patient who was not expected to survive (septic shock, DIC) who was to receive multiple units of blood products. The patient expired before the transfusion was complete so on the form I checked off the 3/4 box as that the transfusion was about 75% complete and indicated that patient expired before transfusion could be completed. my manager does chart review and approached me and says that it was inappropriate to chart this and that I should have wrote all vital signs as "0" on the form and wants me to retrieve the chart from medical records and change it. i recently took a course in critical care nursing and nursing documentation and approached the speaker who is a legal nurse consultant and has sat on numerous legal cases and asked her opinion. she said that there is nothing wrong with what I wrote, it is accurate and I cannot document v/s as "0" if I coded the patient because not v/s were taken! It was a code! She was adamant I do not alter my documentation. how do I now approach my manager?
  8. All4NursingRN

    Does your administrator have a college degree

    No clue but I'm very interested in how she got the job with no degree. Is she extremely experienced in her role? But still it's very odd. Does she know people?
  9. All4NursingRN

    Manager wants me to alter documentation on expired patient

    By the way I know some had said earlier in this thread that I should never leave the form blank, that is of course true. I looked the form over when I pulled the chart to ensure I didn't leave anything blank and I thankfully hadn't left anything blank. In the last column where final vital signs are written, I wrote verbatim "patient expired before transfusion completed please see RN documentation" the form was otherwise complete.
  10. All4NursingRN

    Manager wants me to alter documentation on expired patient

    Update: I could not get onto my manager last week to tell him I was not comfortable making the changes (as he was out that week) I went to medical records and amended the form to say "please see EMR charting" so I guess the lab still was not satisfied with the amended changes and flagged it again. Last shift the manager called at 7am and told the clerk to ask me not to leave as yet (my shift ends at 7:30 am) he doesn't show up to work until 8:15a so I hung around for 45 min! As that I did not want to seem insubordinate by leaving. He asked me what happened and I explained that I was not comfortable with the changes citing reasons mentioned in this thread. He then tries multiple times to convince me to see it from the laboratories point of view and alluded to the point that things are not always accurate but they should be done in order to follow standard procedure. He even says that I could have put any number in the temperature column to which I tell him that it is not standard of practice to take temps or any vitals on the deceased. He jokingly says it's not big deal and says that I am a bit stubborn but he thinks it's a good thing that I think things through (excuse me??? How rude) It seems as though the entire thing is no big deal to him. I then begin to explain the legalities of changing documentation ( as that I was consulted not to make any changes by someone with a legal background) and how poor it looks to do so and he again just shrugs it off and continues to stress that the blood bank needs to see numbers on the form and suggests we both go to the blood bank so I could speak to the blood bank manager and in his words "tell her what happened", he also asks me who consulted me on this and asks if I could give him the info for the class where I met the legal nurse consultant as he would like to brush up on the legalities of nursing documentation as well (Smh) We go down to the lab but the manager is not there, so now he seems flustered and ponders if he should go to MR to alter the form. I politely ask him if he will initial the form if he makes any changes to the document he laughs and say "no". He then attempts to back track and says he will not make the changes and will speak to her again and let me know what happens. I have lost all respect for this manager, no one really respects him, even the director (his boss) is quite open about his distaste for him (what an institution!) I don't know what to do or say but in a week or two I will again request the chart from MR to see if he altered the form, and if he did make copies and bring it to HR to show what a deceptive person he is.
  11. All4NursingRN

    Seasoned ICU Nurse Lacks Critical Thinking

    Update: Turns out she is leaving the ICU before the end of the year for a clinic position (very sudden departure) she doesn't seem happy though and is a bit withdrawn lately. She has been getting called in to the managers office quite a bit as of late so I don't know if her departure is any result of that. I'm surprised she is taking a position where she will lose her seniority and title so I believe she maybe was forced out or at least felt that way and sought greener pastures. Sad. It must be hard to leave the people you have worked with for 20+ years, we are planning a little party for her, I wish her the best.
  12. All4NursingRN

    F Grade Hospital

    I don't know if my current hospital has ever been evaluated by leapfrog (is this a regional thing?) but we are a small safety net facility that has been on the brink of closing in past years and rumors are this place may not be here in 5-10 years. Our administrative staff turnover is crazy. I've been here for 3 years in 2 different units and have had 2 different CEOS, 2 CNOs, gone through 2-3 sets of nurse educators, and about 3-4 nurse managers either fired or left (most just leave) not to mention managers of other units and assistant directors who have left, RN turnover on certain units is crazy as well. Numerous attendings have left including about 5 of of 10 long time general surgeons that just left in the past 2 months. *sigh* I maybe getting away from your question a bit here but It is rough working for a failing hospital. A lot of the long time staff believe this place will never close down but IMO the writing is on the wall. my last two facilities were very good institutions with good management, people weren't as warm as my current job and management ran a tight ship. Here at my current job staff here gets along better, but management is very lax (any correlation?? lol) Honestly in retrospect I would have stayed at my last two jobs (I fell for the grass maybe greener line of thought and guessed bad, but I'm thankful for a job), Of course no place is perfect but I like a well oiled machine even if staff isn't super close. I like structure and order and it's virtual non-existent at my current job.
  13. All4NursingRN

    Seasoned ICU Nurse Lacks Critical Thinking

    Thank you your suggestions are very good. Yes our hospital culture is very lax with very high administrative and unit manager turnover. I plan on leaving in another 2-3 years because I'm in school and have other obligations. I may change units within another year or so, probably PACU or cath lab. Im ready to step away from bedside honestly but that's another issue lol. They send out employee surveys every year but I don't ever remember getting the results.
  14. All4NursingRN

    Seasoned ICU Nurse Lacks Critical Thinking

    Wow you're really lucky indeed! I wish my facility showed some care for our break times.
  15. All4NursingRN

    Seasoned ICU Nurse Lacks Critical Thinking

    Lol yes I guess you are right time isn't a remedy for incompetence. Still sad.
  16. All4NursingRN

    Seasoned ICU Nurse Lacks Critical Thinking

    I have worked in this icu for 2 years and she has always been like this. The culture of my facility is very lax and people just cover things up until something happens. At first I thought maybe she was working multiple jobs or had little kids but she doesn't have multiple jobs and her son is a pre-teen?? I thought perhaps she is diverting as well but i don't know but I believe she's either on some medication that makes her sleepy or she perhaps she has a disorder like some have stated. I have spoken to my manager about the work ethic of a nurse without naming names out of months of concern, he kind of shrugged it off eluding to the that some just have better experience than others??? But that he understands my concern. For now I'm just keeping a paper trail of everything.
  17. All4NursingRN

    Seasoned ICU Nurse Lacks Critical Thinking

    Thanks Davey! She has admitted that the manager has spoken to her numerous times about her performance issues. She often leaves hours after her shift and the manager has told her she is too soft for the charge nurse position. She said she has cried in his office before and told him if he doesn't think she is fit for the role (after about 10 yrs as SSN) he could demote her but I don't know what came of that discussion. Honestly I feel like my hands are tied, the manager knows she has performance issues so what else is there for me to do? I feel like a rat, snitching about her work ethic because she does have wonderful bedside manner, but her clinical acumen is very lacking. *sigh* Thanks for hearing me vent!
  18. All4NursingRN

    Manager wants me to alter documentation on expired patient

    Interesting question
  19. All4NursingRN

    Manager wants me to alter documentation on expired patient

    Oh wow this is very similar to my situation except I don't know how my manager will react to me not taking his suggestion if "0" as the patients vitals.
  20. All4NursingRN

    Manager wants me to alter documentation on expired patient

    Thanks!, at the time I did chart that the transfusion was not completed and the reason why in my documentation but I have a feeling my manager did not fully review the documentation, it does seem as though the lab flagged the form due to the missing vitals, referred it to him, so he just wants me to fill in the blanks.
  21. All4NursingRN

    Manager wants me to alter documentation on expired patient

    Thanks texasholdem, the patient was extemely critical and it was explained to the family that he more than likely would not survive, he was on several vasopressors and had received about 13 liters of fluid blouses. His vital 15 minute into transfusion were within his typical limits at the time, no fever spike and all other vitals consistent to his pre-transfusion state. Another reason why I do not want to write in his vitals as "0" is because I too believe that makes it seem as though there was some transfusion reaction that occurred instead of the possibility that the patient succumbed to septic shock. He was in pretty bad shape, found down at home and received cpr in the field, we resuscitated him for about 10 min and when we reached the family via telephone they said to stop cpr immediately, so I believe they understood that his condition was grave.
  22. All4NursingRN

    Manager wants me to alter documentation on expired patient

    Thanks for the responses. It is the transfusion form of itself that the manager wants me to pull from medical records and alter. Also on our transfusion forms we have 4 check off boxes on the bottom indicating how much was ultimately administered 0, 25%, 50%, 75%, or 100%. Like someone else alluded to, our lab reviews all transfusion forms and does not want to see any blank spaces but to write "0" as a temp, HR, or BP seems inaccurate and false to me.
  23. All4NursingRN

    Manager wants me to alter documentation on expired patient

    He wanted me to chart that the patients vitals were "0", as in that the patient had no temperature, HR, or BP.
  24. My co-workers and I are noticing a surge of young relatively healthy patient who are willfully incontinent. They have no structural bowel or bladder problems and are a & o x 3. We are a surgical unit with mostly stable post-op patients. Last shift I had a 40 something year old woman who was a few days post-op. I went into her room and she told me she had to urinate, so I told her I could grab a bedpan really quick but she insisted that she would just go directly into her diaper I then told her to press the call bell when she was done, instructed the PCA that the patient in room 2 will go to the bathroom and may ring the bell. I gave report to my colleague and went on break. When I came back from break I went to ask the patient if she wanted to be washed up and she said yes and as I cleaned her she said she needed to urinate again and commenced urinating on herself again while I was cleaning her.. she then chuckled and said she was urinating on herself all night and when I asked why she didn't ring her bell to be changed she just smirked and did not respond. I have had multiple patients like this. I had another patient again a/o x 3 who would defecate on herself and then ring the call bell. One of my co-workers puzzled said... " I dont' get it, if they have the presence of mind to know when they are soiled why can't they also ring the bell for a bedpan" Again none of these patients have had a bowel/bladder issue with incontinence?? None of them have expressed a feeling of incontinence, they just seem to not really be bothered. Somewhat unrelated but .. another patient I had who was a 25 year old new mom post c/s who was ambulating to and from the bathroom independently a few days post baby had a terrible odor that was filling up the hallway in front of her room. I went in, introduced myself and asked to look at her c/s incision (as that I thought it was infected and that was where the odor was coming from. It wasn't the incision, it was her vagina! I asked her if she would like to wash up (because everyone at the nurses station was aghast with the stench:barf02:) and would like a basin with soap and water to wash up at the sink. She refused insisting that the PCA come wash her up in bed, the PCA was on break so I washed her up myself as she refused to sit up out of bed, all the while her complaining that no-one understood how she felt giving birth and eating snacks. Her mother and boyfriend just sat in the room amongst the stench with straight faces Again, I understand being hospitalized and having surgery is rough, but days after the surgery some patients seem to regress or be depressed and refuse to be cared for properly?? Has anyone experienced this?
  25. All4NursingRN

    Alert & Oriented Patients Who Pee and Poop on Themselves

    i believe the patient requested the diaper and the day shift RN put it on as she requested. The patient had a new ileostomy which was leaking from the bag down into the patients perineal area (as the ileostomy was located below the umbilicus) so it was messy. I think the patient just didn't want to be bothered going on and off the bedpan which I understand is very uncomfortable but still...
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