RxOnly

I have several legitimate reasons for not getting a flu shot, but it's not about me. I want to focus on the patient and not about my own reasons. Unfortunately many of my patients are a little nosey sometimes which makes that difficult.

Thanks for this- that was the point of my question: what to say to turn it back to the patient because it's not about me. I might try adding your quote to my usual script.

For those of you that elect not to receive the Flu vaccine, how do you respond to those nosey patients who ask "Did YOU get a Flu shot this year?" ...I don't feel like I should have to lie and say yes, but I don't want to cause a great debate. They would usually ask while I was giving them the injection- I feel like all of our patients at the clinic asked me that last year and I fumbled with answers. This year I'm pregnant and don't want to hear it!

I think I know what hospital you are talking about! One that recently changed ownership?? If it's the one I'm thinking of then you made a great choice!

@CapeCodMermaid, if you mean you're in management, I'd be glad to have you as my boss any day. I find myself "liking" a lot of your posts on this site (we have similar opinions!) Are you in LTC? I think a lot of nurses overlook LTC because of all the stigma that the not-so-good facilities have. Where abouts is your place? I may be able to send a great nurse your way!!

I don't know if it's a regional thing, but south of Boston the kids call them "Johnny's" or "Johnny Rottens" Neurontin is one of the most abused non-controlled substances around here. One night shift, I even heard a guy sharing a recipe for a "Southie Cocktail" which involved peeling open several Neurontin caps and pouring the powder into a can of Redbull. What the heck!? Neurontin will give you a buzz at a high enough dosage, and it will also increase the effects of opiates (by some chemical reaction in the brain that I can't quite recall). I used to call it Vitamin G (for Gabapentin) because the doc's prescribed it for EVERYTHING... I had guys say they were on it for seizures, mood disorders, anxiety, headaches, nerve pain, sleep, the list goes on. And about you ignoring the girl who raised her hand and yelled "Tylenol!" GOOD JOB! I know we're nurses and are supposed to take care of patients, but part of taking care of them is promoting independence and self care. So, if she can walk and talk there is no reason she can't sit up and say "Nurse, do you mind grabbing me some Tylenol?" I used to call our nurses' station the "fish bowl" because it was surrounded by plexi-glass windows. Patients used to knock and point at me, then make sign language about that they wanted (meds, a sandwich, whatever) ...I used to magically turn blind when that happened until they appeared at the nice wide doorway to the station where they had plenty of room to make their requests.

I'll repost it if one of the admins don't switch it over! They're usually good about that stuff :)

Girl, I could have written the same post. When I worked detox on the night shift, I was lucky enough to at least have another nurse to back me up. I never tolerated shouting or demands. My response was always "I have doctor's orders that I have to abide by. I apologize, but I can't stray from them for anyone." or "Excuse me, I haven't cursed at you and I'd appreciate the same courtesy. I am a professional and would like to be treated as such" or "I expect to be treated with the same respect that I give you" And then, I would DOCUMENT MY BUTT OFF. Every swear, every derrogatory word they'd say and what my polite but firm response was. Another thing I'd do is get clarification from the MD about what meds can be given together. I used to have patients scream at me for both Tylenol and Motrin together. The order didn't specify if they could be given together or not, so I had my nurse manager get it clarified since it seemed like every nurse did it differently. Same with benadryl and melatonin for sleep. It seemed like when I got in at 11pm there was a line at the nurse's station for benadryl. I had enough to worry about with new admissions and scheduled meds. Finally nurse manager and Doc decided that they could choose either one or the other with their 10pm PRN meds. After all, they are there to detox- not take alternative mood altering meds. One thing that SOMETIMES helped me was when I told the patients "We don't want you to suffer, but unfortunately detox isn't pain-free. We're trying to help you learn to live without these meds." ...if they persisted, I'd tell them "If you lay down and honestly try to sleep for 45 minutes, I'll give you a dose of (insert name of whatever PRN sleep med is ordered), but I really need you to try it first." PM me anytime... I could vent about working detox for days...

The New Grads I know in MA got jobs in the following areas: Pediatric office (two RNs) Methadone Clinic (one RN) Detox facility (three RNs and two LPNs) "Adult Day Care" (LPN) Home Health (one RN and one LPN) Something they all had in common is that they applied for hospital jobs knowing their chances were slimmer, but graciously accepted whatever offers came their way and made the best of it. Times are tough. It sucks and all we can do is pray for change. I'm in Southeasten MA. I used to work at the Detox facility I mentioned. My manager actively sought new grads because she felt they were eager and easy to train (we also didn't pay much). One of the new RNs put in her time and got a job on the detox unit of the local VA hospital. Now she's making twice as much and has more opportunity to transfer. Notice none of these are hospitals? My hope is that everyone finds that dream hospital job, but any nursing experience is better than no nursing experience!

This. Sometimes you just "know" ...do you remember any of the nurses on those floors? Was there an especially welcoming unit? Go with that one. And congrats on being brand new with so many choices!!

It's definitely proper to send one after the interview, just like you did (might have helped you stand out and get the job! congrats!). It isn't necessary, in terms of etiquette, to send one after the offer, unless you feel like there is someone in particular that really affected the hiring manager's decision (in that case it's just a nice gesture to send one to that particular person) Hope that helps!!

I think your first thank you note was enough. Thank them again in person when you start training :) If you are REALLY itching to send another thank-you, I highly doubt they will rescind your offer due to over-enthusiasm :)

Everyone is different, but it seems like I always hear "Give it a good year to really get comfortable..." I may not be much help, but from reading your post I get the sense that you are a bright, diligent, conscientious person and that you are getting these tough assignments because your unit knows you can handle it :) Keep up the good work!

I'd have put $30 as well. Especially knowing people who have started at the same facility at the same rate, it's perfectly reasonable! Putting $36 might make someone in HR think "she expects top pay and we're looking for someone who will accept less" ...although you don't want to sell yourself short, with such a tight market you don't want to give them ANY reason not to hire you! Plus, that's just a ballpark figure. It just gives HR an idea of what kind of offer you are looking for. The number could still vary at the end.

I literally almost quit my FT nursing job at detox to work at Starbucks. Only reason I didn't is because the other interviewee had food service experience and she got hired over me! Luckily I've moved onto a M-F Internal Med clinic job which is fine for now, but If I could do it all again I'd have stayed away from nursing.

I'm not sure how much help this response will be- but I work in a new internal medicine clinic owned by a major Boston hospital. They are big on the Virginia Mason movement. It's all about efficiency and safety. How can you accomplish your tasks with the least amount of excess time/movement whilst having all the supplies you need right at your fingertips? It's about creating SAFE shortcuts. Eliminating waste- stocking only supplies you actually use, and keeping them in a location that makes sense. It's about streamlined communication so that everyone is on the same page. I think some of the MD offices around the country that a really hard-core about VM have even eliminated waiting rooms. The rational being that when you arrive for your appointment on time, the doctor should be running effectively and efficiently enough to see you right on time. Of course this is a perfect world... I'm guessing that the Virginia Mason hospital will be big on patient safety, efficiency, and both patient AND employee satisfaction. I don't know much about uniforms, but I would guess that nurses would be in one particular color so that they are easily identifiable (going along with efficiency). Sorry my response is geared more toward the clinic- but I can definitely see how it would apply to the hospital setting!

::applause:: THANK YOU!!!! Couldn't have said it better myself!

Are all the docs in clinic on the same page about prescribing? It's irritating at my clinic when one doc follows our narcotic contract to the letter and another hands out scripts here and there when he feels bad. I feel like when all the docs get on the same page it makes things easier. People tend to back down a little more when you can throw the words "It's our clinic policy and we can't make any exceptions" at them. Our manager is great in the sense that she won't let patients verbally abuse us. If a patient is getting belligerent over the phone, we are allowed to say "John, things have escalated too far and I am going to have to end this call now." and then hang up. Of course we have to document our butts off when we do that. Is there a policy in place that would allow you to end a call like that? I know it doesn't help much when they show up in person, but at least it helps get them off the phone, if only until they call back!

Any experience is better than no experience! And you might love it! Go for it..

Clinical Institute Withdrawal Assessment

Prior Auths take sooo much time and were so diffucult to squeeze into the little time I had between patients at a clinic I used to work in. Finally, they hired a part-time MA specifically to do prior auths. She worked M-W-F 8-5 and made all of our lives SO MUCH EASIER! She'd also help mail out result letters and things like that. Not sure if that's an option where you are, but it's worth considering!

Maybe a little holiday bonus since it's that time of year. My manager buys a birthday cake at the end of the month and we celebrate all of the employees who had a birthday that month for a few minutes in the break room. We will be putting a bulletin board up in the break room where we will post nice things that patients have said about staff members, and nice things we have to say to each other. Also- every so often we're asked "How are things going?" and changes are made accordingly (obviously within limits) For example, we were all irritated that there wasn't a computer in the lab area for recording results. We had to go all the way across the clinic to find a free computer to document things, and it would take an extra few minutes (that you really don't have when you are in a busy practice). It was a pain in the butt. We asked nicely and two weeks later had the computer.

It's a sucky thing for the child to have to deal with... but I agree that it needs to be done for any controlled substance... I remember when I worked in Peds- there was a 15yr old boy who swore his mother knocked his Adderall down the sink when she was doing the dishes that morning. Said he had his morning dose before it happened. Sounded fishy, so we did a urine (with his and Mom's consent). Totally negative- no more Rx! Mom called to thank us a few weeks later. She went through his text messages and it turns out he was selling the stuff to his buddies. Geez!!

Not at my current clinic, but at a family practice clinic that I worked at about 2 years ago. It was absolutely ridiculous and made me SO angry. And the patients kept doing it because we continued to accomodate them! Is 911 called for every patient while the nurse is doing an assessment? I feel like even though patients kept coming with those complaints, it made me feel slightly better knowing that they weren't "avoiding" the hospital trip because they chose to walk into the MD's office unannounced (since we called 911 no matter what). I feel like that's the reason a lot of them walk-in in the first place...

Please let us know if you get the maternity job!