weesyanne

Someone who is argumentative with their coworkers is sometimes masquerading as a nurse, CNA, etc. They sometimes know just enough to be dangerous. I know about a nurse who argued with her coworkers about everything. One day, the police came in and arrested her at the facility. She was not even a nurse and never had been. This happened at a place that I used to work for in Atlanta, back in the mid 80's.

I worked it. It is not considered a holiday in our facility. Straight time, but if you called out, you had to have a doctor's note.

I've seen it. We had a nurse well into her mid 60's that never sat down and was ALWAYS, ALWAYS way ahead of any younger nurses. Please don't generalize.

I was not on the cell phone. It was in my locker. I was online at the desk for about 5 minutes, sending my brother a quick, short email. Our mom is not doing well, so I try to stay in touch. His cell phone is on the fritz, so I sent email. Maybe my timing wasn't the best, although I had just rounded. Anyhow, thanks for the advice.

I forgot to say that my manager is the one who wrote me up, so I have already spoken to her about the issue. I'm concerned with what to do for future issues that I may have with this tech or my colleagues. I have looked at my behavior and I can see where she may have gotten the impression that I wasn't helping my tech or being a team player. If I keep notes on what I help with or what I do for the tech, I don't see how something untrue could possibly be used against me. Thanks again.

Thanks everyone. I just thought a notebook so that I knew dates and times and could prove what I did would maybe help, if only jogging my memory of events. I'm not keeping it for anyone but myself, in the event that I am called into the office again and accused of the same behavior. The person complained that I didn't help her feed patients (not true) or get them out of bed (also not true). Other procedures I assist with as I can find time to help, but I have the responsibility for assessments, IV's, meds, intervening when there is a need to call a physician, etc. I probably have 10 times the documentation duties that she has, but unless I'm up doing half of her work, I guess I'm a terrible nurse, lazy, etc. I've always helped my tech out and I don't understand this attack on me. In the past when I've done things that are normally tech duties, I've given my data to the tech to chart, such as something under I&O, but I'm not going to do that anymore. If I did it, I'm charting it. If I turn someone, I'm charting it. If I get someone out of bed, I'm charting it. In the past, I've been asked by the tech when I've done stuff like this and they've charted it as if they've done it. No more. I'm concerned about the legality of having a notebook in my workplace. If I don't put identifying information about patients in the notebook, I don't think it will be an issue, but I don't know how my supervisor would see it. She might not like that I'm documenting stuff on my own. Before this, I never paid attention to anyone else and what they were doing. I kind of did my own thing with my patients, asked for help if I needed it, or offered help when I wasn't busy. Now I'm super vigilant. The other day, I saw the last coworker start to walk away from the desk. I got up and walked away as well. I was accused of sitting at the desk too much, so I want to avoid that. If I'm never there by myself, I don't see how anyone could say that about me. I know that perception is reality, especially when it comes to the boss. I have told the secretary that I can't sit at the desk to cover while she goes to the bathroom, gets something from another unit, etc. anymore. I would sometimes do that, but no more. This whole situation has made me very self-conscious and keeps me on edge.

I'm in kind of a bind. I recently got written up and some of the things that were said were not true. I asked for dates and times, but I was seen as being defensive. Some of the things said were from a particular person who works with me. She claimed that I didn't help her when she needed it and described an incident where I wouldn't help her perform a procedure or a patient care activity. I honestly don't recall the incident. And it's not because my memory is failing me, it's because I don't think it happened, at least not the way that the person reported it. The problem is, she was very convincing to the person that she reported it to and made me look like I'm lazy. She brags to others about how she can get what she wants from the supervisor and that she "has the touch". It just irritates me to know that she is a master manipulator and the person she reported me to has been duped again. Unfortunately, my supervisor caught me online in my email sending a note to a sibling (she accused me of being on another social network, which I wasn't). That incident made me look like I wasn't giving 100%. I haven't received any complaint from patients that I'm working with that I'm aware of, or at least that wasn't mentioned in the write-up. And in reality, there are days that I don't sit down for many hours to chart, relax, eat, etc. I'm considering keeping a little notebook with dates and times in it detailing my activities during the shift without names. Is this something that would be frowned on by most organizations or by risk management? I'm not naming names, but I would like to keep some details of what I'm doing to verify to my employer that I am indeed not guilty of being unhelpful with my team members. I don't think this would be considered anything related to HIPAA, but I'm trying to figure out how to preserve my reputation at work, which has always been excellent. I would be willing to wear a tracking device at this point. Has anyone else had this type of problem and how did you handle it? I really don't want to start over anywhere else.

I would interview with the hospital that has the open positions. You don't necessarily have to accept the first job offered to you, but it is worth your time and effort to prepare for the interview with the out of state facility. Interviewing for a job will help build your confidence level and help you know what to expect in the event that the facility closer to you agrees to interview you. I wish you the best of luck in your job search!

Sorry that you are having such a rough time with your preceptor. In my opinion, if he is constantly talking about you behind your back and putting you down in front of coworkers, he should not be a preceptor. Your job as a preceptor is to mentor and to teach, not to denigrate someone. I like the suggestions above about writing things down and reviewing them when you have had time to calm down. When you talk with him, use "I" language, as suggested by JoPACURN. Unfortunately, even if you remain professional, he may not respond in kind. Have all your points carefully thought out and practice them before you speak with him. I'm sorry----only someone who loves to teach and mentor should be precepting new nurses.

Someone mentioned the fact that one of the National Patient Safety Goals is to improve the effectiveness of communication between caregivers by implementing a standardized approach to "hand off" communications, including an opportunity to ask and to respond to questions. What happened to you violated this principle. Yes, you probably should have checked the board for any changes. Yes, your charge nurse should have notified you. It sounds like a system problem for your hospital. I would suggest that you approach you manager and discuss your concerns with him or her, making note that this is something that JCAHO addresses and that you are concerned about patient safety in this type of situation.

Diary Girl, I have been called names and told that I was incompetent by a patient and I have been a nurse for almost 23 years. It happens to a lot of us, regardless of the length of time we have been in the profession. I was reading your post and the responses. If you look at this lady's underlying statements to you, you realize that she has suffered a lot of losses recently, including her spouse. This may be her only son. Her perception, while probably not accurate, is just that---it is how she saw the situation. It wasn't accurate, according to your posts. But to the person complaining, their perception is their reality. How do you change that? You probably can't. The best thing to do is not to get defensive with the person who is going off at you. It only increases their anger and frustration and makes them more likely to complain. If you sit down and listen to the person who is complaining, they will 9 times out of 10 calm down. Their perception of you and situation may change as well. They perceive that you care enough to listen. This is how I choose to defuse negative situations. It doesn't work 100% of the time, but most of the time I have seen it calm situations down. It isn't "evidence-based" scientifically speaking. The patient that called me a name didn't change his perception. I asked a colleague to switch my assignment the next day, which he did. I can laugh at the situation now. I'm glad that she came to you and apologized. That was the right thing for her to do. You did a good job handling the situation.:bowingpur

You've got to be kidding! She was offended by the word butt? God help her if she ever is working around me when I'm frustrated. She might hear the f-bomb. Darn, I'd be fired, wouldn't I?

I wanted to comment on whether pregnant nurses/techs should be given isolation patients. I think it all depends on what the isolation is for. I can see not giving a pregnant nurse a patient who you know has CMV or shingles/chicken pox. But as far as patients who are isolation for other diseases, I don't see a reason to restrict who their nurse can be. Granted, if there is an option to give a pregnant nurse an assignment without isolation patients, it should be done in the interest of putting her mind at ease. I happen to work on a unit where a majority of the patients are MRSA positive and some have VRE, acinobacter, pseudomonas, ESBL, Klebsiella, etc. It would be impossible to give a pregnant nurse an assignment without an isolation patient. I have two kids and worked during both pregnancies. With the first pregnancy, I was on a cardiac stepdown unit and most of my patients were not on any type of isolation. During the second pregnancy, I sporadically had to take care of isolation patients on a general surgical unit. I had a guy with full blown AIDS that I got a needle stick from when I tried to place a used syringe into a needle box that someone had left jammed. I found out the next day that he also had active Hepatitis B. When they checked my titers, it was found that I didn't have antibodies, despite getting the shot series several years before. They gave me immunoglobulin and I showed antibodies at that point. I tested HIV negative for all the tests that they gave me after the needlestick. I panicked when that happened in 1993. I took care of TB patients during the pregnancy as well. I guess what I'm saying is that if there is a feasible way to prevent a pregnant nurse from having a patient on isolation that it probably should be done, but on some units, that would not be possible. Also, there are many patients that you do not know have a disease for which they need isolation until several days after being admitted, so you are assuming some risk by working as a nurse. As for the statement from the nursing instructor to the pregnant student nurse, I would not rely on not being given isolation patients if you are pregnant after getting out of school. It depends on the unit, the patient mix, the level of staffing, whether you are required to float, etc. lots of factors.

Where I work, the shift diffs for nights are substantial. I think for evenings, they're something like $4 and for nights $5, plus the weekend shift diff is about $5-$6 per hour on top of it if you're working then. The night shift can be extremely busy. At my job, the research department conducted a call light study to determine when the patients were calling the most. The overwhelming majority of patient calls for assistance were between 7P-11P. And that is with a staff that has 1.5-2 times the number of patients each and without the support that days has--the day nurse has 3-4 patients, while I average 6-7. We are extremely busy, especially during the first 5 hours of our shift. I have had to take my patients to CT at all hours of the night. I've also had to draw blood on them in the middle of the night when they spike a temp or develop chest pain. Our vent patients are very, very anxious, especially at night. The are calling constantly for the nurse or PCT, frequently for reasurance that they are doing OK, for suctioning, etc. My nurse phone never stops ringing some nights. I have learned to try not to feel guilty when I have a "quiet" night. And I don't sleep AT ALL. I have worked nights for most of my 23 years as a nurse. At some point, I may switch to days, but not any time soon. I find that most everything in our hospital (and most places that I have worked), centers around the day shift. Almost all of the parties, luncheons, celebrations, inservices, conferences, etc. occur on days. We sometimes feel left out. But sometimes that can be OK.

Hello and welcome to the site! I'm originally from TN myself. Glad you're here!

I hope this helps you decide if a field is right for you!

Oh my goodness! She must have a death wish.:selfbonk: We had a patient years ago that had numerous central lines that had become contaminated with stuff like e-coli and enterococcus. The doctors finally figured out she was contaminating her lines with stool. I think her diagnosis ended up being Munchhausen's.

When I first got out of school, I was waiting to see if I had passed my state boards. One day when I went to work, I was the only nurse on the unit. :uhoh21:Everyone else was a tech, and I didn't even have my license and was the only one scheduled to be there! So I'm not surprised to hear that has happened to you. I wouldn't feel comfortable taking on the responsibility that soon, so I would speak up asap. Tell her you cannot take the charge responsibilities as a new grad.

You can be a nurse and be on antidepressants. I know a lot of nurses that are on antidepressants. It's very common. :smiletea2:Lord knows that some of the units I have worked on would be in a lot of trouble if the nurses weren't taking antidepressants!

Suesquatch, A lot of us have had bad work situations. I once worked a job for about 8 months that I really hated. My supervisors were mean and the charge nurse wrote things in my evaluation (which she laid on the medication cart in the middle of a very busy nursing station) that were not true, like that I left narcotics at the bedside in a patient's room. I think that they were setting me up to get me fired or worse, so I quit that job and didn't look back. What a horrid place. Since then, I have worked places that were good and not so good, but I have never worked anywhere where I felt my license might have been threatened like at that place. I wrote a rebuttal and placed it in my HR file and I went to the DON to complain about the evaluation. I told her, "I have never received an evaluation like this in my life. If this were someone else's evaluation, I would probably think the person needed to be fired." Suesquatch, life is too short to stay somewhere you are truly unhappy. I hope you find your niche in nursing sometime soon. If there is a problem that you can fix, then work on it, but sometimes it isn't you, it's the culture of the organization. Sometimes the workplace is sick :barf02:and you need to run, not walk away.

NIH defines lates as being gradual in onset and that the nadir occurs more than 30 seconds from the beginning of the deceleration. Variables are quick and the nadir occurs less than 30 seconds from its onset. Even if a decel occurs after the peak of a contraction, it isn't defined as a late unless the nadir occurs more than 30 seconds from its onset. I know that isn't official wording or anything, I don't have time at this moment to actually look up the exact wording, since I have to go to work shortly. Our hospital uses the NIH definition as our criteria in naming what a particular fetal heart rate pattern is. If a baby looks beautiful before and after a decel, I would be hesitant to call it a late for that reason. Most of the time with lates, I see a non-reactive strip that is not reassuring. I don't labor patients on antepartum. I will call if I see anything funky. If a physician doesn't want me to call them, then they shouldn't order continuous fetal monitoring, the way I look at it. :trout:

I call any late because I am an antepartum nurse who is one floor up and down the hall from the nearest OR suite in the L&D. L&D nurses don't generally call because they are normally actively laboring the patient when the late occurs. When you have a 28 weeker with severe PIH who exhibits a late and you are the antepartum nurse with 3 or 4 other patients, you have to do what is safest for the patient. I didn't call a spontaneous decel one night when a lady had it (to clarify, it wasn't a late, she wasn't contracting). She kept having the decels over the course of the next couple of days and the next thing I know, she has a dead baby. There was a knot in the cord. With variable decels, I generally just watch the patient for a while, change her position and base my interventions on NIH guidelines. I always, always run the strip by a couple of coworkers and the charge nurse prior to calling a physician. Our policy states that the antepartum nurse has to call for any late decel. I'm comfortable with that. If I worked L&D, where the OR was within easy sprinting distance, I would probably react differently. I just think you should do what in your judgement is the safe thing to do based on where you are working. If you're in L&D and there are a number of physicians nearby and your patient has a late, then maybe you don't call. If it's 1 AM on antepartum and your PIH patient has a late, it's a different story. That being said, how many pregnant women are probably walking around having all kinds of decels and we don't know it because they aren't on the monitor continuously? We would probably be OK not to call one isolated late on our unit, but our policy (developed with the input of OB physicians and the labor and delivery unit) mandates it.

I would call a late decel on a patient. Lates signify placental insufficiency, not cord compression, as would be the case with a variable where the baby temporarily compressed the cord. I always run it by my colleagues and the charge nurse prior to calling. I make sure it meets the NIH criteria for a late deceleration prior to calling. I know that a lot of Labor and Delivery nurses will disagree with me, and that is their perogative. I worked on an antepartum unit for 8 years and we had to call them. The Labor and Delivery nurses didn't always call them when the patient was in active labor and had a late, but we did not labor patients on our unit if at all possible. It's quite different when you have a patient in the late stages of labor and there is the capacity to do a STAT C-section within minutes if the baby crashes. We had to let the physician know so that he or she could make the decision about whether to transfer the patient to labor and delivery, observe them for a few more hours, or whatever. If we didn't call an isolated decel and the patient had a bad outcome later that day, guess who's action the management and physicians and risk managment question? The nurse who didn't call the physician when he or she saw an ugly late decel. I had a physician rake me over the coals for calling him once. I didn't apologize, I simply explained that I had to do it by the hospital policy for antepartum patients on our unit. Sorry, they're getting paid the big bucks to make those decisions, not me. Managment backed me up on it. The patient had severe PIH and delivered a couple of days later and the baby was in NICU for a long time. A good outcome, thank goodness. I won't risk it.

Most skilled care facilities will accept a g-tube. They are very common in nursing homes. My dad had one and we had no problem with his nursing home placement on that basis.

Where I work, the ratio for days is 1:4 and for nights is 1:6 or 7 sometimes. We normally have that same ratio for techs as well. Sometimes it's OK and sometimes it's really bad with this ratio.