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The information you provide indicates a hospital in a transition from paper to computer documentation working in a situation almost from 1990. The inspection teams should fail the hospital. That is really not a direct reflection on the bedside nurse. The administration adding more layers of paper to make up for the poor interface of computers today just gives the inspectors big flashing lights to find... Seems to me there were Federal funding available to update computer systems as well as increased Medicare payment percentages for the care given . This computer transition bonus funding was a motivator at the hospital I worked. When the Electronic Media of Epic interfaced across the systems charting stress did decrease after the learning curve of computer use settled . The transition in the 600 bed hospital did not happen overnight it was worked in over a period of 3 to 5 years. The instant fix will take money and time. Plenty of consultants are available out in the field to help with the transition.* ** You mention a coworker threatening you over the use of a computer. That makes me believe there are inadequate numbers of computer work stations. Much of the problems you are experiencing are directly related to equipment funding.* The Pyxis system appears obsolete. The narcotic storage in a separate look box is from way back in time in my practice 1978 . The older Pyxis systems I worked with had drawers that open for commonly used medications. Morphine 4 mg in one drawer compartment for instance Pyxis would generate a screen to get it. The software used an integrated log, dose, time, date, patient name, who took out the narcotic and to have a waste amount witness if only 2 mg* was used for instance . We did a manual count of the amount of cartridges remaining in each drawer entering this in Pyxis. The pharmacy could possibly rearrange the drug storage even using the current system.* Does this hospital use any kind of shared governance? Getting the staff involved in design of charting be it paper or computer will go a long way. There is plenty to be done at your hospital not just the ICU by getting staff buy-in and support from nursing administration improvements could happen fast.* You mentioned being under contract. Makes me ask what really is the penalty if you leave? The hospital system I worked they had a contract time for attendance to critical care class or if they paid toward continued college credit. Those under contract were to pay back if they left before satisfying contracts. Dependent on the amount of stress this hospital system has caused you paying them might be the best solution for you.** One other point I will make you mention you are in the career 22 months. Over my time I noticed the novice nurses between one to two years seem to develop difficulty with the reality dealing with actual stress in an ICU.* We did have support groups as part of our mentor-ship programs finding the sharing* in groups of 6 or 8 from other nursing departments also helped to reduce stress you mentioned. The other hospital units are also experiencing stress Med /Surg, Peds, L& D, ICU when we had them share. Many times I saw this stress you mention is not unique to the ICU. * You did mention the ICU has a high staff transition. Are these long term nurses or from the group of novice nurses as well?* Nursing leadership has some work to do . Best wishes*

Dear Graduate looking for Niche, Reading your concern many novice nurses expressed to me before...... "The only thing I am positive about when it comes to my future is that I DO NOT want to work in a hospital. If I had to it would ONLY be on a L&D/Mother Baby unit. I have no desire for a position in an ICU or ED. I can handle an emergent situation here and there but do not want to be constantly "on high alert" or running all the time from one emergency to another." The general recommendation I gave to my students and new graduates was begin to work on a general Medical/Surgical unit for a year or two to actually gain clinical experience. You do not have enough clinical experience right out of school to decide... Your decision to believe starting in L&D is the best and not liking the ICU or ED is based on too minimal clinical experience. In most schools very little clinical experience is actually given in pediatrics, L&D, ED, OR, or the ICU . My belief is your decision may be different with a few years of actual hospital work accomplished. The real world clinical experience provides organizational skills and the building blocks to work in the many diverse areas of nursing such as a stand alone facility like corrections . Best wishes !

Dear Setup Maybe prior to the exam the instructor should have given clear expectations and an opportunity to ask questions if something was not understood. I am unclear what term you are in? There is reference you did other clinical exams. You mention a " thin binder " was there but do not look in it. Was this information similar to what we would find in a patient chart ? I see a few serious deficiencies quoting from your story. "I also did not know what the enema was " ..... "I assumed the enema bag is what I should use because it the only thing that looked similar to the primary bag." ..... "Also, I didn't know how much to give since I was not given the MAR so I just gave 3cc." Reading your story makes me ask what kind of preliminary Clinical Lab skills training were given to you? There is something wrong or missing from your story about prior instruction. As you describe you were never told what was expected in this exam? You said this is the second time taking the exam?? If this is the second time you were poorly prepared to retake. Did you practice these skills ? You did not know the difference between an enema bag and a primary IV bag? You gave medications without even knowledge of what it was or a dose. I would have stopped you to immediately fail you. I am a pretty liberal clinical instructor. I am sorry to say while I see some possible missing information from the professor. You were totally unprepared and should be failed

Interesting you have worked as an nursing assistant two years while still hating it... Must be something making you want to continue as a Nurse too.... The part of the job you "HATE" you need to discover before you waste more time and money in school. You mention you do not like clinical... this is mostly hands on care..... this makes me believe you do not like direct patient contact. Not wanting to burst your bubble.... The RN does the exact same duties as an nursing assistant and then some... If you were my student my encouragement would be to change majors now. Nursing is a hands on career that involves a lot of hard work with direct patient contact.

Dear Burnt-out in L&D, I am having a difficult time reading you are burned out after 18 months due to working weekends and holidays. In my career I have noticed many novice nurses experience symptoms of burnout at about one to two years on the job. Really what those novice nurses were doing is questioning the choice of career. Even after 37 years in PACU / SICU... with an MSN... weekends and holidays are on the menu for me. Sorry for the lacking sympathy . Good luck to your quest

The hourly rate difference between RNs and NP makes me wonder if Nurse Practitioners have saturated the available positions? My observation is many students are going into the Nursing field graduating.... maybe working a year or two then move on obtaining the DNP. If you have too many NPs in the job market the high volume may drive down the wage. Supply over demand lowers the price. Are bedside nurses a shortage in this California region?

This statement is what concerns me. You should face the consequences of covering up the error. At the same time there needs to be a root cause analysis since the "senior nurse" advised not to complete the occurrence report. The findings when looking at all nurses in your unit may indicate training of not only you is needed. The Occurrence report should not be looked at as a negative finding pointing directly at the nurse involved to punish an unintended error. You did not go to work that day with the intent to give the wrong medication. The error needs to be used as a learning opportunity to see what steps of medication administration methods need review or revision to prevent the same occurrence again.

An IV infiltrate can happen fast even with the IV controllers pressure sensors they still happen. If there is one thing I tell students is always look at that IV anytime they are with the patient. When infusions are rapid rate these especially need watching. While the site may look terrible as long as vesicants were not in use it will get better in time. Any nurse who tells you infiltrates never happened to them it is because they ignored the problem. Learn and move on providing excellent care.

The choice of where to work is ultimately up to you. When I have students ask me similar questions. I encourage time in the medical surgical area first to gain organization and assessment skills strength. Face it the amount of clinical experience you had in school is minimal. When you go to a specialized area as a novice RN my feeling is your experience base gets too narrow. The broader the experience base is then this makes you better prepared for other nursing specialty areas. The two year commitment is a good idea for the hospital as the cost to orient a new grad is high. Dependent on what source you use the cost is 40,000 to 90,000 dollars to train a new graduate. Cost containment is a big focus in healthcare. Best wishes for a strong career

The process of the license completion seems possible. My thinking was along the lines of what BladesMom mentioned about not getting an interview. The health care facilities generally have a question on the application about criminal charges. As the hiring manager I would consider the explanation given by the applicant ... then look at the charges about substance abuse, theft, and battery over a period of 6 years, 2004 to 2010, then considering will these problems resurface. If there were 10 other applications for the same position this prior problem may influence my choice to interview. Interestingly I was influential in the training and hiring of a policeman 25 years ago with a felony conviction, who now is Chief of Police. You would get a fair chance from me based on the letters of recommendation . Good Luck

Life experiences carry into the Registered Nurse career. Numerically you are starting at an age greater than many RNs. The critical thinking ability you bring along will make you a strong Nurse. One thing to think about is.... if you do not take the next 2 or 3 years to become an RN. You will still be 35. Go for the RN!

Obtaining the BSN is a long time recommendation by the NLN. When I started out in 1978 the NLN 1985 proposal was in place..... If you did not have a BSN in 1985 the thought was you no longer would be considered a Professional Nurse. We all know how that went the proposed changes were delayed again and again. Now the current NLN trend is by the year 2020, 80 % will have a BSN or MSN. The ADN and Diploma programs will essentially be eliminated. The Affordable Care Act of 2010 will influence greater education needs for the RN. Making the BSN even more necessary as responsibilities are increasing for the RN. Some states, New York and New Jersey, are working on legislation that will require a BSN in 10. The ten years is from the date of licensure will require a BSN. It is interesting to see the the major comment concerns of going back to school at 50 is more about cost, than the value added education brings to the Profession of Nursing. The hospital in our area currently will not offer a position without a BSN or some indication of enrollment in a BSN program. Most hospitals offer tuition assistance to return to school. My actual amount of cash out for my BSN was not that great and on completion allowed Career Ladder step pay increases of 5 to 10% . I started back to school at age 50 finished my BSN at 53 continued school finishing my MSN at age 56. I graduated with my MSN 30 years after starting as a Diploma RN. The added education did require effort to finish.... The accomplishment of the MSN gave me a great deal of satisfaction, also makes the available positions for a Registered Nurse much greater. My recommendation is to go back to school finish the BSN on to MSN. You will find the DNP or PhD will soon be the next goal on your mind. Never too late to go back to school.

You mention you are working three days per week full time. There are 7 days in a week. When doing my BSN and MSN both required clinical time, two terms. I juggled my schedule at work to accommodate this clinical. I hate to sound unsympathetic to your issue of "Stuck" why can't you switch your schedule around for the term? My program required 60 hours that was easy to get with my assigned preceptors. Things were just a little inconvenient for about 8 weeks each term. Good luck it is just a temporary problem.

There is no relationship to owning guns and being a Nurse. Former Army Nurse we were issued weapons. Did not make us any less a Nurse.

A great amount of responsibility to a novice nurse quitting in the first year falls back to the schools. The student expectations today are not realistic, many new graduates expect to begin as the Director of Nursing at Walter Reed never doing bedside care. Graduate nurses have very little clinical training application. Some states do not even have a required amount clinical instruction hours for generic RN programs. Interestingly most states with LPN programs have a specified number of clinical hours also advanced nursing programs like an NP, nurse midwife or nurse anesthetist have required amounts of clinical hours specified. The middle starting point RN nursing student programs generally have no specified amount of clinical required by the State Board. Perhaps State Boards should require generic RN programs to have greater hours of clinical experience. Lacking clinical experience is then a cost issue for schools. Schools are even having difficulty trying to find hospitals who will allow students. Some states allow the amount of clinical time total flexibility to the school. All clinical can be done on one weekend. This is great for the total on line programs, You too can be an RN . I believe New York and Virginia have programs like this. (Someone can help me here I forget the states) Grade inflation, along with instructors Failing to Fail students to maintain numbers for school/ university enrollment statistics is common. My thinking was NCLEX would pick out these problems. Turns out the current millennial entitled students go to a few day program to Cram for the Exam. Students pay a fee to be given predictive tests and areas to cram study. These novice students then do indeed pass NCLEX. Taking the cram programs does keep the school statistics rate up. Still does not help prepare the student ability to critically think or provide a Novice Graduate Nurse a realistic expectation for success . I retired recently due to students who put no effort into learning yet are still passed by the school. The responsibility for the early transition of many nurses falls to the schools and the State Boards. The cost to the schools adds to the issue If the ability to cut cost is as simple as clinical time cutting. This places the training responsibility back on the hospitals increasing the likelihood the hospitals will need to eliminate poor performing lacking interest nurses. Looking at the common factor to nurse turnover boils down to the dollar.