Hancock330

It's impossible for me to express any pleasure in anything said by Jane Fonda. With a background where several family members were active duty military during and immediately after Viet Nam her behaviors, not ever adequately apologized for, make her useless to me. That said, I've found that having gray hair (and all that goes with that minor change in appearance) has definite disadvantages. I have been almost patted on the head while a much younger female server at a restaurant praised me for eating all of my salad, for instance. I can't tell you how many younger males in various settings have called me "young lady" as if it should be perceived as a compliment. All I'm asking is to be treated with respect appropriate to the various situations. I've been an adult for a LONG time -- and I'm NOT in my second childhood. I've worked hard to get to this place in life where I can spend a lot more time doing what I want to do with almost all of my time -- and I want to enjoy as much of my life as possible. I find I'm relieved not to need to work any longer -- though I enjoyed many of the jobs I had in the 43 years I worked as a registered nurse.

I think I would explain to the PSW that she is coming very close to practicing nursing without a license which could land her in court with a possible fine and, if she harmed a patient, jail time if she performed any patient care not covered in her job description. I would also consistently refuse to answer her inappropriate questions during the work day. I agree with requiring her to submit her inappropriate questions in writing. I'd submit them to the director, keep copies in my own records with dates and times, and respond to most of them with some sort of standard comment about needing a license to practice nursing to deal with the issue raised. I wonder if she has some sort of personality disorder that leads her to rebel against authority by trying to undermine the supervisor's confidence.

My first job as an RN (after having waited about 6 weeks for my State Board results), I worked in the old part of the hospital where some of the beds were either "male" or "female" -- and it had NOTHING to do with the patient in the bed. The beds were so old that raising or lowering the bed involved finding the correct crank to fit on the part of the bed at the head and the foot of the bed to perform that function -- and some of the cranks fit over a protrusion there and some fit into a small cavity there. So, the first were male beds and the second were female. Same job -- the hospital had recently joined with several others in the city to have all of the hospital's laundry done at a central location. One night, in the entire hospital (I called EVERY adult unit and the ER) having ONE unit admit to having ONE clean patient gown. Having to decide whether to leave an elderly woman with dementia who had been incontinent in her bed in a wet gown or naked. Valium was KNOWN, PROVEN, and ADVERTISED as being non-addictive. Brown prescription bottles containing several hundred 5 mg tablets on a shelf in an unlocked cupboard in the medication room. Having to call an intern to remove an infiltrated Jelco (short, plastic, IV device) because if the tip broke off during removal, the intern would be prepared to prevent the embolus from traveling to the lungs. Being told at about 3 a.m. by an exhausted intern I had called for this reason that most of the nurses found a way to have the things "fall out" at that time of night. LOL Providing care for the first patient in my hospital who was on total parenteral nutrition (TPN) and trying for 2 or 3 night shift-to-day shift reports to convince the day shift nurses to ask the physician to monitor the patient's blood sugars since the clinitests were so rapidly getting to 4+ that there was no telling how high the blood sugars were. No one seemed ready to make the connection between a solution of 25% dextrose going in IV and sugar spilling into the urine. Clean gloves only to be used when patients were on "contact isolation" -- usually for active hepatitis or a draining wound. Giving L-dopa when it was still investigational to a man so contracted by Parkinson's that he was totally helpless. SQ31245 ( I think) given on a research protocol to see if it was safe and efficacious for hypertension -- it became Captopril when first marketed. As a student, giving Keflin (the FIRST cephalosporin) IM, and the patient finding it so painful he informed his physician he'd rather die that get another shot. The physician chose to "risk" giving it IV, and it worked fine. A reason that every student needs to learn the basics of controlling an IV with a roller clamp is that in any major disaster with large numbers of seriously injured patients hospitals will at least temporarily not have enough IV pumps. The least critical patients, those on maintenance fluids, for instance, will need an IV controlled so they get approximately the amount ordered. Positional IVs. IV boards to hold an extremity in exactly the right position so the IV device didn't get dislodged and infiltrate and, when the IV device was a metal needle, the tip of the needle didn't penetrate the wall of the vein leading to infiltration. Hearing that the men who pushed brooms cleaning the streets in San Francisco made more per hour that I, as a new RN, made. Talking with a couple of RNs who were part of the group who organized the first strike by RNs in the San Francisco Bay area -- who said, among other things, that one day, after work, they were sitting somewhere, chatting, and came to the realization that they loved being nurses and wouldn't want to do any other kind of work, BUT they only worked because they needed the money, and therefore, they needed to be paid what they were worth. It was a long ride -- highs, lows, in betweens. I'm glad I'm now retired, though.

In some places, state regulations REQUIRE employers of RNs and LPNs to put their status in letters an inch high on their name tags. This can be VERY helpful to rational patients. Those with dementia probably won't know but everyone else will be able to tell. Even folks who don't have their glasses on will be able to tell if "this person is a nurse" when the person gets close to the patient.

I graduated with my BSN in the late 60s. The women in my class wore light yellow dresses (with A-line skirts). We wore caps with student stripes on them, and after graduation the stripe changed to reflect the school colors. Our cap -- well, one patient said it looked like a flying bedpan and another said it looked like the back of a '57 Chevy. The poor man in our class had to wear a short-sleeved white shirt buttoned up to the neck and a clip on bow tie and white pants. My first job out of nursing school I was required to wear the white dress-style uniform and my cap. The blasted cap caught on the bed curtains and was a constant irritant. However, if I took it off the night supervisor scolded me. And, I won't go into to detail regarding the view from the rear of (in particular overweight) nurses stretched across a patient in a bed (when the bed was in low position) or a stretcher. The claim that dresses were more modest than pants was given the lie then. My second job, in the early 70s, there was a day when 2 of the RNs dared to wear those new "pant suit" style uniforms to work and were sent home to change into "uniforms" and their pay docked because they were late when they got back. Gradually, the rules changed here, there and everywhere. The caps were NO loss to hospital nurses. The white uniforms, well, I always wore white unless I had to wear something different. Regardless of when, where, or why nurses started wearing white, it became the color associated with the profession of nursing. If you ask the members of the public, it probably is still the color associated with the profession of nursing -- and up to maybe a decade ago, research showed that many adults would prefer for nurses to still wear some variation of a white uniform. It can also be important to remember that how a nurse (or any other worker) dresses can ease the process of establishing trust from a patient or make it more difficult. Almost ANY form of dress can be overcome, but I never understood why one would choose to dress so that a very important part of one's job would be made harder. Another comment is this, "What part of "professional nurse" dressed to go to work does "cute" address?" Clearly, in some settings cute is appropriate -- peds comes to mind -- and sometimes on holidays. But, if you never know when you may have to console a grieving family or deliver some kind of sad news to a patient -- in which cases, "cute" may come across as disrespectful. Too many nurses who wear scrubs to work don't do anything to make them look "neat" -- the scrubs are wrinkled and some are too loose or too tight. And the v-necked scrubs sometimes mean that when a nurse leans over to care for a patient, the patient can see significant portions of the nurse's chest anatomy. None of this makes acceptance of the nurse as a competent professional something that some patients find easy. Again, almost anything can be overcome, but why make the process more difficult for yourself or your patients? A final comment about the caps. For several years I did presentations to my sons' elementary school classes where I took a torso anatomical model from the learning lab -- the one with the removable organs --, several stethoscopes from the learning lab (and alcohol swabs for cleaning the ear pieces), examples of needles, taped to a piece of card stock with the tips covered with the needle cover, etc., to let very young children get more comfortable around the trappings of health care settings. Each presentation included a station where the children could use a piece of white copy machine paper and follow an example and make a nurse's cap. No station was required but most of the girls and some of the boys wanted to make the cap. One year one little girl came to me and said "I still have my cap I made last year. Can I make me another one?" The cap is no longer an accurate reflection of what nurses wear to work, thank goodness, but for many members of the public, it is still associated with all that's good about the profession of nursing.

I'm sorry to hear that you B of N was so unprofessional as to charge you with misdeeds without ever examining the evidence to support the complaint. This is truly a case of nurses (I'm assuming that some, probably most, of the board members are nurses) eating their own. That said, while I was never the victim of a complaint to a B of N and was never named in a malpractice suit, I ALWAYS carried my own malpractice insurance. If you think, for one minute, that your employer will not offer you up as the sacrificial victim if you are named in a lawsuit while protecting themselves and their revenue-source-physicians from damage, you're crazy. And if you assume the B of N or any other "justice" system will automatically be fair, again, you're crazy. When there's any kind of threat to you license you need a lawyer who is protecting you so YOUR malpractice insurance company won't have to pay up to 3 million dollars in damages or to keep YOU as a customer with a license to practice nursing. There's no guarantee that you will be well represented or that the outcome will be fair to you, but just as the old saying goes that the person who has him/herself for a physician has a fool for a patient, so, the nurse who has her/himself as a lawyer has a fool for a client. Lawyers are expensive, and without malpractice insurance you could be out tens of thousands of dollars paying someone to defend you -- and that versus the $115 to $150 a year malpractice insurance costs for all nurses but those in high risk specialties, is a good reason to carry the insurance.

I lived in California until I was close to 30. I married a guy from a very rural part of Alabama -- who definitely did NOT want "a girl just like the girl that married dear old dad" (the words from a very old song). His family never really understood what he saw in me -- and I believe I only went from being "that woman from California that he married" to "our daughter/sister-in-law" when our first child had the great good sense to be male. I lived in the south -- Tennessee and Georgia -- for close to 30 years. I worked in inner city hospitals and rural places that were called hospitals but which I regretted ever applying to work at. The racism was endemic among the natives in all of those areas. And the effects of racism are visible. For instance, how does the average person you almost collide carts with at Walmart respond when you say, with your most friendly smile, "Oops!!! So sorry -- I really need to watch where I'm going."? In the south, if the other person is Black -- I usually get, at most, eye contact and maybe a muttered "OK" or similar. Where I most recently lived on the west coast I would at least sometimes get something like an equally friendly smile and a "That makes two of us!" Where racism is a big part of the fabric of life, Black people -- and any people of color -- learn early, and often the hard way, that they can't trust White people if they're strangers -- they're too unpredictable. I've heard horror stories from all over the nation -- upper mid-west, deep south, rural northwest, every part of the country -- about places where people of color and immigrants aren't welcome. Places where travelers of color or with accents can buy snacks at a convenience store but are advised to be out of town before dark if they want to be safe. It's obscene, but it does still happen. For the OP, I agree with the person who posted that you hit the real Trifecta -- Black, a nurse who's male, and married to a White woman. The only worse thing would be if you were married to a White man. Try to ignore the flags. The people who fly them often lie to themselves and believe their lies -- that it isn't the symbol of racism. And that they don't fly it to announce their convictions to themselves and others regarding who the first class citizens of this country are. For the comments at work, I'd suggest you think about playing "clueless wonder". Ask what that term means for things like the "race card". For the aide who says the patient who uses the N word is really quite nice otherwise, ask "In what ways do you think he'd be nice to me?" Whenever you perceive a racist comment from a co-worker, if at all possible ask the person to explain what it means or how it might apply to you. If you're more likely to have things stolen ask what you have done to cause that and the next time, maybe, what you might do to change that. For people who make it possible, be the friend you'd like them to be. To the extent possible, prove to patients that you are the kind of nurse they really want providing their care. It isn't fair. It shouldn't happen. Unfortunately, this world isn't about fair. If you feel unsafe or if you see reasons to be concerned that your manager is looking for a reason to fire you, find a new job, ASAP. If you can endure where you are for long enough, you may get enough seniority to be in a position to work for changes in the culture of the hospital. If you leave, think about asking for an exit interview with the head of HR AND with the DON. Make photocopies of your journal entries to take to each interview and to leave with those people. In a dry, factual, nurse's note entry tone of voice and choice of words, explain to them what they might want to consider changing if they hope to correct any of their staffing issues by hiring nurses of color or nurses with foreign accents. Don't let them try to explain away by saying "I don't understand why you're upset -- that's just the way people here talk -- they don't mean anything by it." If necessary, ask them if they'd find it problematic working in a hospital where the rest of the staff was Black and they heard comments about themselves using their "White race card", for instance. Would they then decide that's just how people in THAT community talked and that THEY didn't mean anything by it. If the leadership at that hospital never gets told what is happening and what the effects of the comments are, it's a bit unrealistic to expect them to ever change. I'm not the kind of idealistic person who would think these things happen without the administration having a very good idea about them -- but putting into words to them that the events do hurt and they are why you're leaving may make it less easy for them to believe the lies they tell themselves. Finally, you can consider a complaint to the NLRB (I think) or definitely to the Joint Commission. There's nothing like an official visit from someone who can essentially shut you down to make a hospital administration decide it might be time for some real change. Just a thought. Best wishes for a long and rewarding career in nursing.

One more comment on this thread. If you are a nurse at an institution where there are medical students, interns, or residents providing patient care, one of YOUR responsibilities is to "bring them up right". Do NOT let them get away with being routinely rude, acting out, or being less that appropriately careful and caring of your patients. Set limits. Offer to help them if they'll let you. Bring to their attention ways they can stay out of trouble. Let them learn the hard way only if they insist on doing so. Ignore them if they're rude to you unless it would endanger a patient. Remind them to say please and thank you. Reward the behaviors you approve of and try to assure any inappropriate behaviors they exhibit don't work. These people are intelligent, even when they lack common sense and behave foolishly. Behaviors that don't work -- that get them ignored -- will change. But if they're allowed to develop bad habits future nurses will have a much harder time getting them to change. So, work together and bring them up right.

A couple of thoughts. Many states are "right to work" states (what an inappropriate label) so a nurse who complains about ANYTHING can be fired. Unless the nurse can prove the firing was due to membership in a protected group, that is, people can't be fired for being too old, for being male or female, for belonging to a racial or ethnic group, for membership in a religious group, and maybe one or two other categories, but they can be fired because the employer wants to fire them, because their eyes are the wrong color, or because it's Tuesday. No reason has to be given. These are states where union membership is always voluntary (except for people who work for the federal government and belong to a union) and many of them are in parts of the country where "union" is a dirty word. If a nurse in the situation described by the OP could prove sexual harassment, he/she couldn't be fired for complaining or bring charges. That may be impossible to do, however. If you are unaware of what happened to nurses in Texas a few years back where, if I remember correctly, they reported a physician for treating wound infections by rubbing them with olive oil and other similar practices, you should read about it. While justice was EVENTUALLY served, they were arrested, and one was tried (and acquitted), but they lost their licenses, and endured a year or more of hell. When you are accustomed to being the member of a collective bargaining unit (union) and live where nurses are valued and respected -- not just "the girls (with the occasional male being tolerated)" who are supposed to follow the doctors' orders and protect the doctors so that their patients never discover the doctors' mistakes -- you really don't know how fragile your work situation can be. And if you have commitments and responsibilities that keep you from moving to a better place to work, you're pretty much stuck. I do have a final suggestions for the OP. While keeping patient privacy in mind, keep your own records of events you witness with this, or any, physician or coworker. Using a code, date and time each record -- then describe events -- what was done, what was said -- in a dryly impersonal tone that would let the licensure board or jury draw their own conclusions in terms of who started a confrontation and who was at fault, behaviorally. Reports to risk management can disappear, so your description should state whether the same report was submitted to the risk management office, if appropriate. Your documentation should include the names of all persons present at the time of the confrontation, too. I am well aware that risk management personnel advise against nurses keeping copies of risk management reports -- because those may be consider "internal documents" and not subject to subpoena. In this situation, however, a subpoena could work in your favor since you would probably like to have the reports presented in court.

I'm guessing that there were many staff meetings regarding this patient. However, you don't say whether there was an agreed upon plan of care. While nothing should be posted in the hallway, you might try a poster board in the resident's room outlining the plan of care. The diet instructions should be clear; the frequency of staff visits should be clear; a specified time when the aide will be available to assist with hygiene should be clear; etc. Unless the resident has been declared incompetent by a judge, searching her room for "contraband" (unless it is illegal to possess) is probably not legal. If the resident would consent, a videoed session with her regarding the effects of her diet choices and her unwillingness to self-cath as prescribed might protect your license and the facility from the almost certain complaints (and probably a law suit) from her family immediately after her untimely death. Having a place in her room, near her bed, where staff members could initial while in her room MIGHT help -- although an electronic record would be much better because it is much more difficult to falsify (that is, most of us would be unable to go into the record and change times or dates -- on a page to be initialed, a person can just initial all the times at the start or end of a shift). I wonder if it would be legal to create a VERY distinctive clock showing date and time in a resident's room so staff could create a photo record (with cell phones, for instance) showing when they were in the resident's room? Not at all sure about that. NOTHING you can do -- nothing any of us can do -- will change this person's way of interacting with the world. We simply CANNOT fix her because only she can fix herself. We CAN set limits and we can enforce rules. I'm sure many attempts were made to make it easier for her to comply with health maintenance activities. I'm assuming staff made many attempts to get her out of her room and socially involved with other residents and mentally active at something other than sowing hate and discontent. I'm glad your facility was able to evict her. I wish I could believe she might have learned something from her experiences at your facility. Unfortunately, I doubt she has done more than increase her store of things to be unhappy and angry about. I hope you never again have to deal with a resident who is this challenging. Best wishes for a long period of only normal challenges in your work place.

OMG my dear, you most definitely need to research a bit about cortisol deficiency and it's effects on serum electrolytes. If the cortisol level gets low enough the serum sodium drops (like way less than 125) while the serum potassium goes through the roof (like over 6). Cardiac arrhythmias are common, as are muscle spasms, GI disturbances, and a plethora of other symptoms. Death can occur if aggressive treatment isn't given quickly enough. The only thing I find amazing is that after 5 years on cortisol replacement medication the person's hypothalamic/anterior pituitary gland/adrenal axis began working again. I've never known of that to happen -- which goes to prove that if you hang around long enough you'll see almost everything.

Wait until you're admitted to a hospital where a small but significant number of the nurses are your former students. Then you can find yourself expected to "know all about" your diagnosis whether it's a one time event or not. And wait until you're expected to understand why, even though you have a wound that has some scant drainage with no response (yet) to any of the 3 IV antibiotics they've tried, the nurses really don't think they need to observe contact isolation precautions like gloves and a gown when touching things in your room. And, when some of the nurses who AREN'T former students discover you're a nursing instructor, you get to watch as they freeze up in your presence as if you were the dragon instructor from THEIR student days (and if there's a nursing program with more that a couple of instructors that doesn't have at least one dragon I've yet to hear about it). Then they try to escape your presence as rapidly as possible, and you really question the wisdom of telling the truth when admissions asks about your job. Then you have the nurse who refuses to even try to learn how to pronounce the generic names of your medications and those who have tried, and too often succeeded, to forget everything they ever learned about pathophysiology and things like medication safety. I once heard an RN state, categorically, they don't make unsafe dosage forms of drugs, for instance -- ignoring that what's safe for one person may be unsafe for another. These experiences can make it difficult to trust your nurses. And there are those (hopefully very rare) former students who squeaked through the program where you taught and whose mere presence in your patient room might make you die of fright. Finally, by the time you've been a nurse for 5 years, much less the almost 45 I've had, you've HEARD and PARTICIPATED in too many of THOSE breakroom/hallway/report room conversations about patients. It becomes far too easy to let your imagination take over and imagine that other nurses are now saying those things about you. You fall into a trap of guilt compounded with anxiety and get anywhere from slightly to extremely paranoid. I think almost all nurses who provide direct patient care (I'm allowing for some outlier saints here) have said some very judgmental, politically incorrect things about at least a few patients along the way. Most of it wasn't meant to be vicious and was mostly in the category of venting to get it out of your system so it was less difficult to go back into the patient's room and be appropriate, but it was nevertheless said. So, I'd say we all need to distance ourselves just a bit from our previous experiences and our current expectations. We need to ask ourselves what we would want if we were in the bed instead of standing beside it. What I want is for my nurse to ask me what information I want; to answer specific questions with precision -- even if that precise answer is "I don't know." I'd like to be assessed for what my current level of knowledge is -- not asked "Do you have any questions about your diagnosis?" but instead asked "Would you please briefly explain how long you've had this problem and what you understand about the problem, how it's diagnosed, and what the usual treatments?" Best wishes to the OP for getting the kinds and amounts of nursing (and other) care she really needs and wants.

I've seen a lot of pain control issues during my career. A caveat -- the pain scale was created for use in a research project and was not designed or intended for use in the usual patient care situation. I've seen patients who retreat into sleep to escape their pain -- who awaken and become active after a dose of pain medication -- medication they took only because the prescriber or nurse insisted they try it. I've seen trauma patients who refused pain meds because "it only hurts if I move" who had to be urged to try a dose -- so I could go in later and say things like "Take a deep breath -- how does that feel?" When the patient said "It didn't hurt!" I could say -- "You need to take deep breaths to keep from getting pneumonia and pain meds make that possible. You need to take them at least several times a day." I've seen the occasional patient who would never understand the pain scale who reported pain of 10 regardless of their actual pain. People who, when given the lowest dose of the prescribed opioid were "out like a light" -- arousing only to painful stimuli -- for hours and hours after the dose -- and who, upon arousing were given another dose of the opioid for the reported pain of 10, passed out for another 10-12 hours -- when given acetaminophen at bedtime, would sleep for 6 to 8 hours, awaken, again report pain of 10, eat breakfast, have a normally active day, etc. etc. Had nurses given even the prescribed opioid the patient could well have died of the hazards of immobility. For that patient, I wished I could have used the "On a scale of 0 to 10 where 0 is no pain and 10 is the being tortured to death with broken bones and with burns all over your body, what is your pain level?" pain scale. I've seen an adult patient in a sickle cell crisis who, by report, had been awake all of day shift; I worked a double that night and I KNEW she'd been awake, watching TV and talking on the phone, even laughing at stuff, all of evening shift and all of night shift. I KNEW her pain medication wasn't adequately controlling her pain but couldn't get more ordered. No one who's had a lot of pain all day and all evening will be wide awake and doing stuff at 3 am if their pain is adequately controlled. I've seen a lot of different situations. I've also been a patient where the nurse was sure she knew how much pain medication I needed better than I did, regardless of my knowledge of how MY body handles opioids. Being told "You can have the smaller amount of the oral pain med ordered now -- if, in an hour, you still have post-op pain, you can have the rest of the dose" was irritating. I wanted to take that youngster and shake her for her "One size fits all" approach to pain management. Occasionally, perhaps rarely, one will also see someone who's "shocky" from uncontrolled pain whose vital signs will improve with an adequate dose of an opioid. I'm mostly saying that pain management in acute care is FAR more complex than I ever imagined when I was a student and new nurse -- back in the dark ages of the late 60s and in the 70s. I can't say I ever got to the point where I was consistently satisfied with my abilities to assess and manage pain for patients -- but I did get better at how I thought about pain management and about teaching student nurses about pain management. I grew to love patient controlled analgesia machines. The confidence that, if the doses available were adequate to control pain, the patient could get every bit of medication needed but couldn't go into an opioid overdose regardless of how often he/she pushed that button, was wonderful. Now that I'm fully retired -- I can say to those still in practice -- Best wishes for successful travels across what is occasionally a minefield of risks as you try to help manage your patients' pain.

I've gotten licensed by endorsement 3 times in the many years of my career. It may feel like an expensive process, but it usually isn't a prolonged process. You can reasonably wait for a job offer to file the paperwork for a license. These days you can download the forms and assure that you know the requirements. You'll have to have a background check done so knowing when you interview how long the process will probably take will make it reasonable for you to agree to a starting date that will allow you to be licensed by that date. Best wishes for your job hunt and your career. :)

Re: #4 Decades ago -- in the very late 60s -- I had the honor of working with a nurse who had been involved in the original strike by RNs in the San Francisco Bay Area. She said that some nurses were sitting around, maybe on a lunch break or similar, and they came to a crystal clear realization that they LOVED being nurses BUT they wouldn't work if they didn't need the money. AND if they needed the money they ought to be paid what they were worth. Back then, when the minimum wage was $1.25/hour, RNs in some parts of the country were making $2.50/hour. There were also minimal benefits offered -- and retirement plans were almost non-existent. Hospitals relied on nurses to be "dedicated" -- and your cap was your "dignity" -- and other myths so they shouldn't expect to be paid a living wage. Nursing, to me, is a profession, not a calling. It doesn't matter, when providing care to someone with ebola for instance, how "dedicated" you are or whether nursing is your "calling" if you don't thoroughly understand the facts of disease transmission and the precise steps for preventing transmission. I don't mean that good nurses are in it ONLY for the money, just that the money matters for almost all of us. By the time I started to work, as a new grad, at a San Francisco hospital (in June of 1969) I made $4.15/hour and had good health insurance. My studio apartment was $130/month. I didn't need nor did I own a car, using mass transit within the city, and taking the Greyhound bus when traveling to see my parents. So, after taxes and the withholding for my share of the health insurance premium, I brought home a bit over $500/month. Can you imagine trying to support a small family on that? So, yes. If I was going to work, I wanted to work as a nurse -- but if I hadn't needed the money I for sure wouldn't have been working full time anywhere. So, when you say that you aren't in any way doing it for the money, think about where and how you'd do your nursing after winning the lottery in a big way. If it isn't exactly what you're currently doing, you're probably in it to some degree for the money.

I THINK the reason they don't give reasons for a non-selection is that anything beyond the applicant's experience level, any reason for non-selection for some applicants could lead to a law suit under equal opportunity employment statutes/regulations, and if a reason is given for one non-selected applicant, reasons might have to be given to all non-selects. It's part of the crazy over reaction to litigation or the risk of litigation in our current environment. If you want feedback you might get a bit of information if you ask the people who interviewed you (after you've gotten the rejection notice from HR) how you might improve your conduct during future interviews. I resent when interviewers imply that a favorable hire decision is coming your way when those interviewers are NOT the decision makers or, worse, when they give every person interviewed that impression. It makes the process MUCH more traumatic for most people.

I taught in 7 different nursing programs in my career -- from California, Oregon, Tennessee, and Georgia -- as we moved around the country. In none of those programs would the behavior described be acceptable. I would suggest that you and any other willing staff members document specific behaviors of this instructor in "nurses note" fashion -- date, time, setting, what was said, what was done, volume level indicators (clearly audible through an open door to a public hallway at a distance of approximately 20 feet type info), and who was present at the time. Do several observations/notes on different days. Consider recording an interaction or two from outside the room so that the information can be shared with the instructor's employer if necessary. I THINK, but am NOT sure, that because this is occurring in a public area of the hospital no privacy concerns exist in a legal sense. I may be totally wrong, however, and depending on the situation you might want to get advice from the hospital's risk management department before recording or before sharing the recording with the school involved. Thank you for caring enough to consider trying to protect these future nurses from this creature that happens to look like a clinical instructor. She is either terribly incompetent (both as a nurse and as an instructor) or she endured that kind of abuse herself in her nursing program and thinks that it is the proper way to teach. In any case, she needs to be gone.

My heart goes out to you. It will take a LONG time for your pain to ease and you will have to use the coping mechanisms you know have worked for you in the past. I strongly support the suggestions regarding the EAP at work -- and, if desirable for you, individual counseling after that. You asked what you can do now. Remember that nursing provides a plethora of career paths. If this leaves you feeling burned out on ER/CC nursing, consider a different option for a while. Depending on your level of education and what's required where you work, could you do staff or patient education for a while? Could you do nursing supervisor either where you now work or at a different facility for a while? What about seeing if a community college needs a temporary clinical instructor -- if you think you'd enjoy working with students for a while. I don't particularly suggest trying to transfer to do patient care on a med/surg unit, only because the learning curve there and the level of physical effort required might be more difficult -- but depending on your mindset and preferences it is always an option. Would you enjoy some time in the cardiac cath lab where your work? Or the endoscopy unit? Would recovery room nursing appeal at all to you? Etc. etc. etc. I know that I cope with tragedy by keeping busy -- but that doesn't work for everyone. Get some counseling. Take care of yourself so you can continue to take care of others. Try, most of all, to be gentle with yourself. If you usually participate in moderate levels of physical exercise, continue to do so. If you've never tried yoga, give it a try. Many yoga classes are conducted to gently stretch and exercise most of the big muscles in your body and to lead you to a state of relaxation. It might be very helpful for you now. Best wishes and I hope that, in the fullness of time, you, your friend, and your husband can come to a place of peace in regard to what has happened. If any of you thinks that this can, will, or has happened quickly, you are definitely in denial and headed for future problems. Try to nurture each other. I'll be thinking about you and yours.

I'm a few years out of date -- in 2007 I retired from 22 years in the Army Reserves -- but if you are REALLY interested in an Army career, talk to a recruiter about opportunities in the Reserves. I'm pretty sure that IF they offer you a commission, continuing participation would be based on getting your BSN within a stated number of years. There would be the possibility of being mobilized (being called to active duty for a period of time specified by the Commander in Chief -- AKA the President of the United States) and being deployed (sent to one of the garden spots in the world -- AKA the desert -- AKA Southwest Asia). During my time in the Reserves I was mobilized for Operation Desert Shield/Desert Storm by the first President Bush and spent a bit over 8 months on active duty, divided between 2 Army hospitals in the Southeast US; I was again mobilized by the second President Bush and spent 18 months on active duty at a different Army hospital in the southeast US. Now, I entered the Reserves after I had earned my MSN -- but back then, nurses with an ADN could be commissioned and promoted without ever earning a BSN. I KNOW those days are past, but I don't know whether all commissions for nurses with an ADN are past. So, if you're interested in that option, check with a NURSE recruiter (not the person at your local recruiting station). And, not all 3 services that commission nurses have the exact same policies, so you might also consult with the Air Force and Navy reserve NURSE recruiters. Finally, your age matters. If you are over a certain age (somewhere between 35 and 38) you may not be able to stay in a military service long enough to retire, regardless of your qualifications, so if that is a goal of seeking a commission, keep that in mind. Good luck and I applaud your desire to serve your country by being an Army nurse. There are other equally proud organizations, but none prouder for service by a nurse.

If you haven't already assessed equipment condition and maintenance -- and I'm talking mostly non-patient care equipment here -- check on that. Do the carts that bring supplies and food to your floor have well lubricated wheels or do they squeak and rattle? Are the tires on those carts pneumatic or solid? If they're solid, is there any chance to get some kind of air filled tires (that are almost always less noisy) onto the carts? Are any doors on that equipment equipped with flexible seals or do they rattle and clang? Then, look at other "non-human" sources of noise. Do you have a pneumatic tube system? Is it located so that patients in nearby rooms must listen to it? If so, do you "shut it down" from bedtime until time to rise? Next, where do people tend to congregate to talk? If it's near patient rooms, can you reorganize a space or two to encourage them to congregate away from patients' rooms? How do you communicate with each other and with other members of the healthcare team? Do phones frequently ring? Do people "call (yell)" to each other down the halls? How do you manage disruptive patients (I'm especially thinking of demented people here)? Can they be placed in rooms where their vocalizations are less disruptive to the rest and comfort of other patients on your unit? Do you have patient rooms near the elevators? If so, do you have signs to remind people coming off the elevators to control their noise for the sake of your patients? These are only places to start -- and are issues that can be corrected with minimal expense (usually) and with a bit of cooperation from other departments. If all of these things have been done and you still have noise issues, then, depending on what kind of unit you have and what shift you're talking about, you may need to look at alarm noises, other equipment noises, and other people noises. Best wishes.

If the only time you ever give health advice is "on the job" and if, on the job, you are ALWAYS in compliance with EVERY single policy and procedure, and there is NEVER a situation where you are so overloaded that you fail to meet every single standard of care, then you don't need your own insurance. If those things aren't true (and they have never been true for me) you need your own malpractice insurance. To the person who said their hospital said that if she had her own insurance the hospital wouldn't cover her or defend her -- guess what? It is INCREDIBLY rare for a hospital-employed nurse to be sued for what happened in the hospital without the hospital - with it's MUCH deeper pockets - also being sued. And, in that situation, too many hospitals will try to get out of paying by throwing the nurse (or nurses) on the train tracks under the train. I always wanted to know that IF I was named in a malpractice suit (but I never was) that there would be a lawyer trying to keep MY insurance company from having to pay out $1,000,000 or so -- and so would be focused on me and my license. I'm sorry -- but I wouldn't trust protecting my career to any hospital. I HOPED they would do the right thing -- but I didn't want my career to depend on them doing the right thing. Without ones own coverage, as far as I know, if one loses in a malpractice suit, one can lose every asset one has -- the house, your and your spouses 401Ks and IRAs, college savings accounts for the kids, everything. If you EVER advise a friend or neighbor about what to do about a child's fever or whether that laceration might need stitches -- ANYTHING -- even if the person fails to follow your advice -- if there's a bad outcome, you might be sued, and even if you win the suit, your legal fees could leave you impoverished. Good Samaritan laws cover you at the scene of an accident or at the scene of a disaster -- but not in your back yard or at the grocery store when you see that friend or acquaintance. For a "med-surg nurse" the insurance is about $114 a year for $1,000,000 per incident/$3,000,000 maximum for all occurrences; for ICU, OR, and OB nurses (and maybe some others) and for NPs the rates are 5 or 6 (or more) times as much -- because the risks of being sued are that much greater in those settings. I get mine through the my state ANA affiliate -- the company has changed several times over the years but the coverage has remained about the same while going up with inflation for the coverages and costs -- and in addition to covering my nursing activities, it covers liability for accidents at my home if a person not in my family gets injured there. Regardless, I recommend that each nurse purchase this protection -- it's cheap compared to the alternatives if one gets sued.

I suggest you consider your interests -- depending on your education and your job needs (ie, do you need benefits, regular paychecks, a consistent schedule, etc.) -- you might look at doing some "peer review" reading for a nursing journal; you might "translate" medical records for a lawyer or 3 (I would think that doing medical record reviews to determine whether standards of care were provided would be stressful because so much rides on the outcome of a malpractice suit); if you enjoy working with adolescents -- you might explore options for teaching health occupations courses at a high school; if you enjoy working with nursing students, you might offer tutoring services for them -- or offer to proof-read papers and provide feedback in terms of strengths and weaknesses, but not rewriting the papers; you might even be able to contract with a "distance learning" college to connect their students with appropriate preceptors in your area; you might also consider becoming certified to teach CPR -- for either the AHA or the Red Cross -- and teach those courses for lay persons or healthcare providers. Or, if you're really tired of nursing and all of the decisionmaking and problem solving -- seek out a "job" in any of a number of occupations. Just remember that any job that involves interacting with the public is going to have the stress of dealing with difficult personalities. I retired after 43 years in nursing and nursing education. I love my volunteer gigs -- one is at my local, very small, public library, where I work at the circulation desk and do whatever else might need to be done (help people learn to use the computers; help them find the resources they want/need; reshelve books; water the potted plants; you get the drift) -- the other is as a receptionist for my local public radio station. These suit my interests. I hope you can find just the right combination of tasks and environment to meet your needs from now until you're ready to retire. Best wishes.

Hi! We just finished clinicals for this quarter! We're giddy with relief, in great need of food, and it's vital that we consume some alcohol. Now! What do you recommend that we might afford?

I've scanned all of the responses and not seen this -- so, please remember that the "pain scale" was developed as a research tool and was NEVER intended as a clinical tool. In general, it's pretty useless except as a way to see if the patient is satisfied with his/her pain relief. Many patients I've seen, regardless of the explanations they've received, do not understand the pain scale concept. I remember one elderly woman whose pain was always a 10 no matter when she was asked and no matter what pain medication she received. She slept well all night after acetaminophen for her pain and would be snowed for hours after 5 mg of hydrocodone during the day. We gave her acetaminophen and watched for behavioral clues for indications that she might need more than that. I remember a patient in a sickle cell crisis -- I wanted to do more for her but couldn't get more medication ordered -- I didn't care that she was watching TV, talking on the phone, fooling with her hairdo, etc. -- I was working a double, I knew from the report from the day shift nurse that she had not slept during the day; I knew she hadn't slept during the evening shift, because I was there; it was 3 a.m. and she still hadn't slept. I KNEW the amount of dilaudid she was getting wasn't enough -- but couldn't get more for her. I have once in my career given a pain medication to a person who denied needing it -- I was very young and it was in the early 1970s -- the man had been injured in a car wreck and was lying absolutely still in his bed -- too still -- I offered pain medication and he refused. I waited a while, then prepared the demerol and phenergan (remember, the 1970s) and took it to him saying "The doctor wants you to have this shot." I gave the injection, came back in an hour and said "How do you feel?" -- he said "Much better" -- I said "Easier to breathe?" -- he said "Yes" -- and I said "That's why you need to take your pain medications -- so you can breathe and move a little so you can recover" -- he agreed to ask for his pain meds in the future. Pain IS subjective -- I prefer having it ordered as X for mild pain, Y for moderate pain, and Z for pain not relieved by Y -- for the initial order -- then nursing judgment based on prior responses. The exception is probably a person who is hospitalized who has excellent reasons to know what works or doesn't -- I remember being in the hospital over night after a surgery and the nurse refusing to give me a second Percocet because the naproxen she'd given would relieve the pain and I wouldn't need the second Percocet. I'd been living in this particular body for over 50 years at that time -- and had enough experience to know that my metabolism wasn't going to get settled for post-op pain by the one Percocet -- regardless of the anti-inflammatory effects of the naproxen. It's very frustrating to be on the receiving end of someone who thinks they know me better than I know me. I'd advise discussing pain meds with patients as needed and as appropriate. If someone seems "over medicated" discuss the hazards of that, if possible (based on the patient and the situation) and see if the patient will modify the requests for pain medication as needed. Try never to assume you know what's going on with a patient -- be willing to learn from the patient -- and convey your caring. Remember the Golden Rule -- Do unto others as you would have them do unto you" and remember that what YOU almost certainly want is a good assessment and then care based on the results of that assessment. Try only to give care based on what you think the person might want/need when the person really can't or won't tell you what that is.

Not necessarily a scam in the strictest sense of the word -- but, before you start at a private for profit nursing program call your local public college and ask whether the core courses -- English, math, psychology, sociology, etc. -- and the science courses transfer from the private for profit to the public college. If they don't, and if you are planning a career in nursing, I suggest you find a way to attend a different program. I've known too many students who have had to retake all of those courses when they wanted to bridge from an LPN/LVN status to an Associate Degree RN or from either of those to a BSN. I've heard tales but can't be sure they're true, of schools telling students lies about whether the school's courses would transfer so I'd ask that school then check with a public college -- a discrepancy there is VERY telling. If the program under consideration does not have separate science courses, you can be assured that any time you want to continue your education in nursing after that program, you will have to take the college level courses. It is also a good idea to check with either the National League for Nursing's accreditation arm or with the American Association of Colleges of Nursing to see if the program of interest is accredited. This is NOT a requirement for licensure like State Board Approval is, but it is one indicator of quality. Accredited programs have had their curricula examined by visitors from other nursing programs and have filed documentation on student attrition rates, kinds of experiences their students get, amounts of instruction in classrooms and labs as well as clinicals, and pass rates on the licensure exams -- accreditation is no guarantee of quality, but it is an indicator to be considered along with many other factors.