TheOracle

I recently separated from a clinic job of 2+ years that I loved and an employer who had promised certain positions and responsibilities to take effect when I finished my BSN, which I have now done. The only thing that we couldn't finalize was a salary. The clinic owner offered me a a salary that was equivalent to LPN pay. Given my love for the job and the opportunities and challenges that the position was going to offer me, I attempted to negotiate. I countered with a number that was $10,000 below what a beginning RN makes in a hospital in our area. It was a figure I could manage with and could work with to remain at a job I loved. Plus I found it to be extremely reasonable when taken in context with the position being managerial. When I counter offered, my boss said "So when will be your last day." I asked "I beg your pardon?" and she stated my request was ridiculous to ask for in a clinic and that everybody wants clinic jobs and would kill to take a paycut for the opportunity. While I respectfully disagreed that that was an entirely accurate situation, I pointed out that I was making more currently and that she was asking me to take on more work and responsible as well as take a paycut. And she said "I don't see it that way. I see me handing you an excellent opportunity and you spitting on it." I told her I was sorry she felt that way and gave her a date. Now, I'm not quite sure how to address this in an interview if I'm asked about why I left my last job. I'm trying to craft an answer that doesn't make me or my boss look unreasonable, but at the same time shows that she was going to trust me with more responsibilities. And I think the less that's said about it, the better for all involved.Any advice?

As I said in my original post, I lack perspective when it comes to this and I can understand where you're all coming from. I appreciate the feedback. I'll take all measures on my end (including auto deposit) to ensure something like this doesn't happen. I can acknowledge and accept my part in this and grow from it. It has been my experience from working in HR and Payroll in the past that the employer has a responsibility to pay their employees correctly and when they say they will. Sure, mistakes happen, but it was never something that was accepted or tolerated from the employees I dealt with. I can't tell you the number of people who came in threatening to sue or cussing me out because they called in sick on payday, but still wanted to come by and pick up their check, but company policy was that they couldn't get it until Monday or because the auto deposit didn't post at midnight. Anytime I've encountered things like this in the past, it's been a big deal and always unacceptable. So you gotta understand where I'm coming from in my surprise that payroll stuff shouldn't be an issue. I mean, that's what being said right? Am I misunderstanding?

I see your point and I agree; however, I'd be less apt to be irritated if in the past when I haven't been available on payday my check was just left with one of the other nurses or on my desk - most frequently on my desk. Also, I work every Saturday and have done so for two years and my check has always been brought in and either given to me or left for me to pick up. In such instances, the thought that security would be an issue to consider or prior arrangements being made never occurred to me. It's entirely possible that if this was done by a faceless corporate entity, it'd be something I'd be more willing to overlook - once. But I work one on one with these people everyday and I work hard. It's very difficult to not be stung by the sheer amazement on my boss's face that I asked for my paycheck. I feel like I'm pretty understanding: last pay period I was shorted $50, another pay period my check wasn't signed and I couldn't get it signed until after the weekend, another pay period, my hourly rate was almost 5 dollars less than it should have been. Each time I was made to feel like I was being outrageously unreasonable for requesting a correction and each time I'd have to wait until the next pay period to collect my difference. I'm having a hard time gauging at where does the line get drawn? When is it that I'm no longer the unreasonable one for expecting that my employer have the responsibility and competence that is expected from me? I've never encountered this before

I need some perspective please! I work as nurse for a privately owned clinic and paydays are every two weeks on Friday as set forth in the handbook I was required to sign when I started. Well, this past Friday I had a class run long (my class was an hour away) and I wasn't able to make it in time to pick up my paycheck before the clinic closed. I work Saturdays and figured I'd run to the bank at lunch. The check wasn't there and my boss said she'd call her husband to see where it was (he's "office manager".) Three times I asked again during the day and was put off. By the end of the work day, she's walking out like nothing's out of the norm and I said "Excuse me, but I need to be paid." She says: "Oh, well the check is at the accountants office where it would have been brought from yesterday if you'd been here and there's nothing you can do with a check until monday anyway, the banks are closed so you can wait until Monday. Just give us a call when you need it. Have a good weekend" To say the least, I was flabbergast because I have never had anything like that happen to me before. My first instinct was to get very irate and refuse to leave until someone got me my compensation. When I went after her out the door and told her that that wasn't work for me, she said that if I participated in auto deposit I wouldn't be caught in this situation and wanted to know where I would get a check cashed anyway before monday. When I explained that my bank was open until 12 on Sundays, she said I'd still have to wait because the check was locked in the accountant's office and that maybe I should sign up for auto deposit on monday. I don't like that she was making me feel irresponsible and unreasonable for expecting to be paid for my hard work when everyone else (including a nurse who also doesn't participate in auto deposit) got their pay. Auto deposit isn't required and I was told I could do either I preferred. I prefer paper check because sometimes pay stubs aren't given to the participants or there money might not show up on time or correctly and it just seems less of a hassle to me to just go by the bank. Am I blowing the situation out of proportion? I manage my money well enough that it doesn't just totally mess up my personal cash flow, however I did have to delay some bills for a couple of days. My feeling is that I performed the work expected of me (and very well I might add) when it was expected to be done and in exchange I am to be compensated at the time that was agreed upon when I began my employment. I am not required to explain why I need my money or why I utilize check form still and the fact that I was being placed into such a position is disrespectful and offensive. Further, it shows me that the people I work for just don't care if their employees are paid. I have been considering resigning on Monday citing this incident as the reason. But my wife tells me that is silly if I'm getting paid on monday anyway. Even if it is silly to leave my job, I feel like at the very least I need to make it clear that this is unacceptable to me and won't be tolerated again. There are several positives to the job that could benefit my career in the long run and I enjoy the work and clinic setting, but interfering with someone's livelihood and cash flows for however small amount of time is a grievous action to me. Plus, I grew up with a father who quit a job every time he felt "disrespected" or grew disgusted. I mean, requesting that he work late (depending on his mood) could be considered a reason to leave a job, so I don't really have a good role model to base my actions off of. How do I handle this situation in a manner that is appropriate? Is something that needs to be tolerated at all? I worry that if I just let it go that it will open up a can of worms. I'm already disturbed by the fact that there's something about me or something I've done or do that makes my boss feel as if it is okay to be this way towards me and that I would understand.

That sounds very similar to a midwife; not a bad idea, but I would think that even if it falls into the scope of practice in your state, you would need to be able to prove your expertise to potential clients with certifications, experience and the like. Is this an area in which you work now? Also start with assessing customer base/need. Other than that I'd recommend having a business manager - someone to manage the money, bills, etc. It's next to impossible to run a business AND provide quality care. I've worked for providers who have and have not employed business managers with their practice and the difference is startling. I don't feel like a provider who also directly runs and monitors the day to day business aspects of a practice can be totally committed to providing care a lot of patients need d/t a preoccupation with the financial bottom line. There's gonna be a battle of values. Of course this is just my opinion

Hi everyone! At the clinic I work in I am the primary educator for our diabetics. I work with the newly diagnosed and "veteran" diabetics alike as well as organize and teach in a monthly diabetes education/awareness program we host at our clinic. I'm curious about what teaching styles, tools, and techniques you guys have the most success with and response to? I would describe my style as something that borders on partnership, empowerment, and coaching. I don't like preaching to or "parenting" our patients (even the noncompliants who can be frustrating), but I place a heavy emphasis on facts. I'm pretty aggressive on scheduling follow up visits and all but harassing the patients to come back in. I think my biggest challenge is keeping everyone motivated in an instant gratification society. One new thing I've started doing is utilizing Health Vault from the ADA. I sign them up in the office and show them how to use it, but instead of leaving it to them to keep it maintained, I take the log of their blood sugars I ask them to keep and I enter it into Health Vault for them. The best feature is the graph it compiles of the results. I pull that up during their visit and show them that they are making progress rather than them just having various numbers and my word to go on. I can point out the upward and downward trends and help them identify patterns. It's a little more work for me, but I'm finding that it has an awesomely positive effect on compliance and highly recommend it. A lot of the patients are eager to keep and bring in the log to see how far they're coming along. What are some things you guys do to help promote compliance? What do you view as the biggest hindrance?

Hey guys, I've done a search and can't seem to find a satisfactory answer to a question posed to me. One of the medical assistants in the general clinic I manage approached me with a concern about an LPN's pediatric IM technique. The MA said she observed on 3 separate occasions the LPN administering Rocephin in the dorsogluteal to children whose ages ranged from 4-6 and the MA asked for clarification on IM admin in pediatrics. I was taught that proper technique is to not use the dorsogluteal on anyone regardless of age d/t chance of damaging the sciatic nerve or nicking the sciatic artery, but that children were especially vulnerable to this possibility. Like most of us, I was taught vastus lateralis for children. Then the question became what constitutes a child? What is the cut off on using the vastus lateralis? More specifically, when does using the VL stop being first choice IM site? I don't recall that ever being addressed directly in school and in my own experience if I've ever had a doubt I went VL. I consulted with both NPs I work with and one told me that you could never go wrong with VL on anyone regardless of age and she did not want the dorsogluteal "proper" used on anyone, instead preferring to go more lateral than the traditional DG site. With children she was adamant that VL be used and her definition of "children" capped off around 9 or 10 for the same reason I was taught in school. The second NP said VL on children 2 and under, then dorsogluteal "proper" on everyone else. My own personal research indicates they both are right in a manner of speaking. What I've gathered is VL in ages up to 36 months. Then once the DG is "well developed" the site can be utilized; however, now the most appropriate place in terms of avoiding nerves and arteries, etc is the ventrogluteal plus larger amts of meds can be administered. I may be blind or not as search engine/journal savvy as I thought because I'm having a hard time locating credible documentation that addresses the specificity of age range r/t to selecting IM sites. Or once the child reaches preschool/school age is it the size of the child that dictates site selection? What is standard policy at your facilities?

Thanks guys! I appreciate the input. I don't hover over this MA any more than the others. My observation that she is abrasive with the patients is merely my own and hasn't been shared with her. I find it odd that she gets no shows into the clinic, but is very non-therapeutic once they're in. I finally had a serious sit down with my boss and she told me (as it has been advised here) to stop going out of my way to make this employee happier in her work. She told me that I do the evaluations and it is my call if "the girls" (her terminology) get raises or if they even keep their jobs. It is part of their job descriptions to meet the standards I set forth and I don't owe anybody an explanation for expecting the standards are met. I feel soooo much better and more prepared to handle this situation now. It helps knowing I'll be backed up. I've had bosses before who wouldn't back me up. Thanks again for all the awesome advice! :)

In my experience, I've found that some people don't pay any attention to gender, while others focus only on that one aspect. You'll run into men and women both who will see you as whatever stereotype they've been programmed to see you as. I've worked in places where I was seen as merely the "heavy lifter" or an over qualified "orderly." I've also worked in places with women M.D.s where I was mistaken by the patients as the doctor simply because I was a man. I've also worked with male M.D.s who treated me with a little more respect than my female colleagues. It is all really dependent upon whom you encounter and what their own views are. At the end of the day just focus on earning respect from people rather than males or females

Ladies and gentlemen, people, humans -whatever is not an offensive term: what I said would be no different from my "woman" boss saying I'm her "boy" or "guy" or calling me "her" medical assistant or "her" RN except that in this case I happen to be a guy who sought some advice among peers. I feel like I wouldn't have been called out on this had I been a woman. My choice of words in an internet forum were just words to try and communicate a situation. My apologies for allowing my political correctness to lapse momentarily. I in no way meant to imply that women were girls or vice versa or that I view any woman as my personal property. Now back on point - I agree that I should choose my words carefully when I deal with subordinates, which is where the medical assistants and LPNs have been placed in the hierarchy in this practice in relation to me -politically correct or not and all gender aside. At the end of the day I am the boss and if doing the job according to standards set by federal regulations, nursing practice, and our own clinical practice board is too much then they will each need to find another place of employment. I'd really like to enjoy a meeting of the minds with the team and try my best to facilitate that, but the long and short of it is that if they insist on an organizational pyramid, they'll find me at the top.

I appreciate the advice everyone! I feel the need to weigh in on the question of my "professionalism" in referring to the female gender as "girl." As the only boy in the clinic I am automatically set apart from the others. They group themselves together and refer to themselves as "the girls." In my dealings with them, I never make a reference to their gender yet my gender is always up for discussion. If the worst thing I do is, occasionally view girls/females as similar in regard to gender then I think I'm still ahead by a lot. I could take the mindset of my boss who has made it very clear that she hates working with females as she finds them very irrational and nit picky and she has on more than one occasion pressured me to find more men for our clinics. So, given that viewpoint and the viewpoint of others I think I'm doing okay. I am sorry if you are offended by the word "girl" though. In my context it is merely to identify basic biological differences in our species and felt "females" would be a worse word choice.

You should address to yourself why you hate your job. Cause you might end up with another you hate. Also - if you don't apply for jobs because you're afraid they'll pass you by then it's not pregnancy that's affecting your ability to get another job, it's your own fear and assumptions.

Just scanning through the forums I can see that all of us have at one time or another had to deal with a difficult personality at work. I wanted to put my situation out there and see if I could get some feedback on how I'm currently managing a situation that is really starting to put me at the end of my rope. I am the only male working in a clinic/urgent care; I am studying to be a FNP and am the only RN (aside from NPs) in a clinic with LPNs and medical assistants. I work in a managerial capacity ensuring that patient care is delivered effectively and safely in a streamlined manner in addition to occasional odds and ends in actual practice. I started as a medical assistant at this clinic while in nursing school and worked my way up to where I am today and am continuing to work towards becoming a provider. I'm noticing a split with the girls at work - one half is very open and willing to work with me to build our success and the other half wants to bicker and complain and fight me on policies that are set outside of my control. One of the girls in particular is giving me the most grief right now and she frequently stirs the others up. She's roughly the same age as me (mid-late 20s) and says she started working as a medical assistant when she was around 16, eventually going no further in education than becoming a certified medical assistant. She moved from another state where she had more liberties (such as administering medications) and a more hands-on role in lab work. In our state medical assistants can't administer injections and that's just the way it is. For the most part, her job falls into reception type duties and phlebotomy. She initially expressed dissatisfaction with this, so I took measures to involve her more in the lab as well as clarifying that she could draw up meds provided there was documentation she had been trained to do so, it was not a controlled substance, and that another nurse checked behind her. After that she still persisted in complaining about how she was not challenged in her job and how stupid it was that she couldn't do what she knew she could do; further she complained the LPNs were keeping her out of the loop on doing lab type stuff. I had a talk with my LPNs to reiterate that if they needed a hand to let the medical assistant know. I was only half surprised to find that they tried to involve her, but she always made them feel like they were imposing on her and that she would make a fuss about how she couldn't leave reception and that it was on them if she got in trouble. So they just stopped going to her. As I looked further into it some of the others were lodging complaints that this girl had confronted them on numerous occasions accusing them of talking about her because they were either ending conversations when she walked past or were attempting to keep from grand standing with patient details that didn't directly concern her. This girl comes in to work and is distantly cordial and she is sharp at what she can do lab wise, but there's something missing in her attitude. Ask her to help with something, she sighs heavily, will roll her eyes (and think I can't see her out of the corner of my eye) and just gives off the overall energy of a bad apple. She complains about everything. This past week I listened to her complain about having to work the day before and the day after Thanksgiving and when I offered to see if someone would switch with her she refused and continued to complain. She complained to me, her other co-workers and one of the providers about how sorry it is that our boss insists on being up, but isn't working herself. She complains because her pay is low and that if the boss didn't go buy a new dress or eat out maybe the pay would be better. etc etc etc She complains that no one helps her, but she never indicates she requires assistance. I finally had her convinced if she was unhappy with how her professional life was going she would have to do something to change it and so she enrolled in college (part time) again with the hope of becoming a RN because as she said "if they let you in, they would be crazy to not take me." Now she complains about how hard it is to work and go to school and it's stupid that she has to do it because she knows what she's doing, etc. etc. Never mind that I did her job while going to school full time and am still going to school full time as well as working full time. What started out as passive aggressive behavior and backhanded compliments when dealing with me is now progressing to more and more hostile behavior and speech. She ignores me if I ask her something or she'll just turn around and walk off if I'm in the middle of talking to her. She goes around me completely on tasks and problems that I specifically handle in the clinic, so I'm always out of the loop. I've tried focusing on her positives and made it a priority to catch her doing things right and letting her know what a good job she's doing and she smarts back about how I'm just trying to brown nose. So I can't win with this girl and it's about to make me physically ill. The rock and the hard place I'm stuck between is that the boss likes her and thinks she's smart and sharp; from a professional clinical stand point I agree that she has valuable skills, but I'm worried that her personality is gonna be a problem not just for me, but the patients as well. She wants to be taking vital signs and brief HPIs and I'm not okay with that because she's too abrasive and non-therapeutic in the dealings she already has with our patients. With this girl on the clock, our no shows are at an all time low because she gets in there and gets the patients in by calling and following up with appointments. If the decision were completely in my hands, I'd have fired her weeks ago. But at this point my hands are tied and I have to find a way to manage the situation better - any advice? I'm south of fed up with walking on egg shells around her by a few thousand miles.

Hey Guys, Just started working with a new FNP who is flabbergasted by our lack of visits from drug reps, etc. in our urgent care/primary care clinic. I have to agree. We've been open over a year and have 1 regular who doesn't really do that great of a job. The NP and I share the concern that being a rural clinic our pts won't have money to get started on meds until we can set them up on some type of assistance. Or even better- be aware of an assistance program for reduced meds offered through the Pharmaceutical company. If reps came by and talked to us about such situations and left starter pack medications or anything, I think we'd be heading in a right direction. Any ideas on where to find reps and let them know they have willing and interested audiences??

Agree with above. Just be yourself. It's really strange because being a man I'm usually very popular where I work. It blows my mind the number of women I've worked with that will openly say how much they hate working with women. I currently work with all women and the boss says she'd hire all men if she could because women are too catty, too personal, and too "clique-y". Personally, I think that's a little sexist, but as a gender outsider I do see some of that. I say keep it friendly and not overly personal and just don't sweat it.

Awesome field. Like the others said there will be areas you have no interest in. Mine was OB. But you can do anything with nursing. If you get bored with one area, it really isn't all that difficult to transition into another area. You may need to get some extra training, but that's no big thing depending on what you want to do.

For where I live (about 45 minutes south of Memphis) a nurse fresh out of nursing school could expect to make about $17.50 /hr and that is the low end of average. A less insulting offer would have been around $30,000/ yr and even that is slightly low to me, but it's workable. Like someone else pointed out, managing two clinics would be 50+ hours a week and I'm very iffy about salary positions since I've been burned in the past. She made no further mention of any other benefits like commission or PTO or anything. What ticks me off is I could go work at a hospital and make $15,000-$20,000 more than what she offered just working 3 days a week. Plus great benefits, overtime, etc. And I think that's exactly what I'll do. I just can't live off $20,000 a year. If she thought more of me and offered something a little higher I'd do my best to make it work because I love the job, but I can't do a pay cut AND not be appreciated

That was my line of thinking. I'm pretty flabbergasted that I even considered it. I'm a RN. I was just thinking, did I really put myself through the hell of nursing school for $20,000/yr?

Hey all, Just wanted some extra opinions on a situation - I'm still what some would consider a "new" nurse with less than 5 years experience. I've been employed at a primary and urgent care clinic for over a year and my boss has begun opening a second clinic in a town about 30 mins away. She told me that she was promoting me to "clinical director" over both locations and that I would be salaried at --$20,000 a year. My initial reaction was one of perplexity. She said "promotion", but I heard "more responsibility" and "less pay." I did the math and on an hourly figure, I would be making around $9.25 /hour which is much less than the medical assistants. I brought this up and she countered that with this position came a job in a clinic, with benefits, and I wouldn't have to work nights in a hospital, and that the salary was one she'd be comfortable paying her own mother, and that we live in Mississippi and $20,000 was reasonable. I don't agree. I feel like I'm getting shafted and I'm a little offended she thinks she can pull one over on me. I'm good at my job and she has on many occasions told others how I do the work of 3 nurses rather than one. My next goal is FNP and in MS we have to have a preceptor, which is hard to come by as I understand it (and she has agreed to do this for me) for a certain amt of hours before we can practice independently (with a collaborating physician of course) and so I'm trying to decide if this is something I should overlook or if I need to stand my ground and find another job if need be. I like clinic work and I'm not above working in a hospital, but it just seems like a clinic is the best place for me given my career goals. I've gotten a lot of advice - some saying dump the job and others saying I'm stupid for being picky about something like a clinic position - most people would kill for that. Any thoughts?

Thanks! I'm glad you were able to settle things to a degree with your co-worker!

At the end of the day the only thing that matters is the care of the patient. In the nursing hierarchy the RN supervises the CNAs end of story. CNA's assist patients part of that job assisting is supporting the RNs. I too was a CNA and it wasn't always the most pleasant job, but it was what it was. I had responsibilities and keeping a running tally of who had done what and how many breaks everyone had had was not among them. To be completely honest, I didn't go to work to take breaks and lunches. I went there to care for patients and earn my pay. JSlovex2, doing any and everything that you are capable of doing is within the job description of a CNA. Sure an RN can do what a CNA can do, but a CNA can't legally do what an RN does, so it doesn't exactly follow to expect RNs and CNAs to switch duties as dictated. It'd be the same as getting ticked off at a doctor for not administering a med he rx'd because the RN had been working since 6 and he only showed up at 11. Rules of polite society dictate that it is nice and polite to help one another even if it isn't one's responsibility technically. As long as there's a CNA on the clock and they are not tied up the RN shouldn't have to worry with things like bed changes because he/she has other responsibilities. In all technicality it IS the CNA's job to help out the nurse if even in an indirect way. As for the lazy comment - the OP never said you called her lazy. She said one of her CNAs did in her original post. I'm sorry you got stuck with poor nurses, but all you can do now is not be like them and try and have empathy for someone who's job is being made harder by unprofessional people. OP - I agree with the advice already given about keeping a record of the CNA's unprofessional behavior then having a sit down with them separately and attempt to work it out between the two of you. I'd also keep management abreast of the situation. Should the behavior persist take further action ie. writing them up/reporting them to appropriate management. And ditto - how is it going?

OP - The fact of the matter is they try to tear you down because they know you are not like them and they hate that. You are a person who has the courage to call for change and from their response it appears you are also the person with the power to bring about that change. You threaten them and their comfortable complacency in their work. I am in a similar position at the clinic where I currently work. I arrived 2 months after the clinic first opened doors and patient intake and treatment in addition to the lab and x-ray imaging were in shambles. Assessment data was sketchy at best, lab test logs were not kept, etc and these nurses were never corrected because the provider felt it was easier to just go in and correct the information herself. At first I just did what others have suggested: what was expected of me and kept my mouth closed. Only I didn't do the job to the other nurses' standards; I did it to my own and my profession's standards. I got shoved into the bad guy role when the provider started calling me out as an example of how the work should be done. She clumsily attempted to foster a healthy competition of a sorts and I became the hated staff member. At that point I decided to go all in - hell, they already disliked me. I pointed out deficiencies in their workload stream. I posted suggestions/reminders of procedure directed at no one, but as memory joggers for us all. For every shortcoming I saw, I offered a solution. So I wasn't just complaining and criticizing willy-nilly. I wasn't so tactful when it came to areas of deficiency that could endanger patient care or shut the clinic down. I brought these issues to the provider's attention directly with information from official agencies like CLIA along with my solutions. I created the records and logs that should have been kept all along in the lab according to CLIA and these systems held each person accountable for doing or not doing what was required. When we had our CLIA inspection, we exceeded what was expected of us. The things I did were in the best interest of our clinic and our patients. Lab results and inventory no longer get lost in the shuffle costing the clinic money - money that could go toward benefits, raises, etc. But these nurses on this staff resented it all and me included. Eventually, semi-open hostility turned to behind my back sniping and passive aggressive hostility. The provider promoted me first to lab and x-ray imaging manager then to clinic manager. My pay increased, but so did my stress. And I can agree with those who say I made things harder on myself, but in the end, right is right. I have to say, please don't ever limit saying something to when it's your license that is affected. If something is being done or not being done and it is or can adversely affect a patient, then it's your responsibility, not only as a nurse, but as a human being to speak up. Our mission is to help people regain and maintain optimum health and in that context anyone who isn't actively advancing or supporting that mission should be dealt with. No one person is above that mission. Now that I have jumped onto that soap box, I do actually have some tips that I've learned the hard way that might help make being the voice for change and improvement a little easier: 1. Never call anyone out directly in front of others. Always consult them in private and even then use those ever popular "I" statements. 2. With some personalities you may have to suppress the eye roll you will inevitably feel coming on, but if they do something that endangers the patient, when you consult with them privately come at it from the angle that you don't want them to lose their license should something happen to the patient. Appeal to their own ego. 3. Try to gather support individually among your co-workers prior to bringing up the change or suggestion to the manager and group at large. People want to feel like they're in control of their own destiny whether they actually are or not. 4. When something succeeds share the glory and credit the team. If it flounders take sole responsibility. It's harder to dislike or be disloyal to the person who would take a bullet for you. 5. As hard as it is sometimes - focus on the good the team members do and recognize that. With some people you may have to be as enthused and encouraging as you would with a 2 year old, but it works if you can pull it off as genuine. Address the negative as needed, but don't let that be what they get most of their attention for. 6. Present new ways to streamline work or correction of mistakes as hypotheticals. For example: "I see we keep the hard copies of lab results next to the shred pile. Do you think if we put them over there in the lab or here by the computer we could save our future butts? I don't know about you, but when it's busy here I can just see me shredding those results by mistake." 7. A spin on number 6 is bringing up an unattractive work habit/problem that is present in a staff member as a problem of your own or the problem of a hypothetical person like member of your family or your husband or wife's boss. It doesn't directly call them out for their mistake, but let's them discuss it. Plus people love being consulted for their advice. (NEVER use another coworker of yours as an example). For example: "Hey Unpleasant Co-Worker, do you have a minute? I need some advice. My husband was telling me how his assistant/coworker always seems to disappear when the going gets tough. He's at a loss on how to handle it and I can tell it is really wearing him out. He asked me what he should do and I have no idea what to tell him. What are your thoughts?" (Note - Some people are just too oblivious for this to sink in, so it won't always work). Anyway, sorry for the long post. My tips aren't 100%, but I have had an easier time in managing people and change at work since trying them out. Good luck and don't stop striving to be better!

I work with a group of cynical nurses one of whom makes it her life's mission to make me as bitter and cynical as she is. We've agreed to disagree, but I see the glee in her eye when she thinks I've had an experience that should shatter my faith in humanity. The NP I work with is a mystery to me when it comes to treating patients. Her Rx'ing policies aren't consistent. A pt who came in with a sprained ankle might get Ultram and Rx ibuprofen whereas another pt with the same injury gets Lortab 10 qty 30. Again, a diabetic with neuropathic pains in his lower limbs got Ultram, which she calls just like Lortab. But then a lady c/c sore throat gets Lortab 10 30 qty with refills. I'm like everyone else in that I'll carry out the orders no matter my thoughts on them, but it's starting to bother me. We had an entire evening seminar after work one day dedicated to recognizing "drug seekers." We are now "highly trained" to spot drug seekers. My problem is many: - I am a nurse; I don't have time to police patients in regard to their medication use outside my scope. Doing so takes precious time away from nursing patients thoroughly. We have to look up patients who meet certain criteria like no insurance or pain or insomnia as the primary symptom on our state's pharmacy board for rx's filled BEFORE SHE WILL SEE THEM. I could be see other patients or focusing my assessment on the pt's pain in the time it takes to look them up. - Who are any of us to doubt a person's pain? My co-workers and NP roll their eyes when the pts are in for pain, they huff and sigh when I give report or prejudge that certain conditions are being exaggerated. One time I had a pt with a migraine and one of the LPNs sighed annoyed and said "this idiots here for dumb head. Tell him to take some tylenol and quit wasting our time." The NP overheard this and had her revisit info on migraines, but she herself commented to me that if they thought they were gonna get their high here, they have another thing coming - it probably wasn't hurting that bad. I don't understand what everyone is so afraid of? I wonder if it is less about patient safety and more about the ego not wanting someone to try and get one over it. If a pt presents c/c of pain and the exam is done and any necessary labs or procedures are done to r/o any differentials and pain is not resolved and still remains at a 10, then it seems to me that the physical exams and actions have supported the order of pain medication that is generally used first line to tx severe pain as the patient has rated it. Repeated visits and f/u are then for following other options and referrals. My worry is that providers are taking liberties deciding who is and is not deserving of adequate treatment. Most unsettling is that these attitudes are setting the stage for poor or under-delivered care.

Congrat guys on your new jobs! Here's a bit of unsolicited advice that was giving to me by my first boss: when you make a mistake. Own up to it. Then. Not later. Own up and correct it or get help correcting it. Then modify your behavior appropriately so it doesn't happen again. Don't try to hide it. My boss was one who preferred you come directly to her if you made a mistake and let her know a) a mistake had been made and b) what was being done to correct it. 98% of the time she jumped in and helped and taught. Her biggest pet peeve was when someone made a mistake and then either tried to cover it up or fix it by themselves. She said 9 times out of 10 they had made it into a bigger headache than would have been avoided if they just came forward.

I see the point you are trying to make by bringing recommendation letters from patients, but as Marc said, the BON may not view them in the same light. The nurse/patient relationship is one of unequal power. Who's to say those patients didn't feel obligated to write those letters favorably? Who's to say you didn't hold good care for ransom in order to secure a favorable recommendation. See what things could be thought? A patient wouldn't be considered a reliable source because of the nature of his or her relationship to the nurse. Furthermore, I'm not unconvinced that they will view it as a violation of the nursing/patient relationship as it disturbs the fundamentals of the relationship. A patient should not be made aware or brought in to a nurse's personal or professional problems. Our worries are NOT their worries, ever. The relationship is an unequal distribution of sharing from the patient to the nurse only. That said, you want to show what good care you provide and what a good and professional nurse you are. Statements from patients will do the opposite of that. Accomplish the same with letters from supervisors and co-workers. They are the ones who can attest to what kind of care you provide and they are more qualified to do it. I get the impression that you included the patient's testimonials because you wanted "lots" of letters. Focus on quality over quantity. 3 or 4 well thought out professionally written letters from colleagues who are familiar with your work ethic and skill set will do better than a 1000 handfuls of letters written by patients. Now, you do know that worry over what hasn't come to pass yet is senseless? It's hard not to do, but there is nothing to be gained from worry. Prepare your appropriate paperwork and recite to yourself why you are a good nurse. Focus on that. Not what might happen. Focus on what is. You're good nurse because you care about your job......you're a good nurse because....-you get the idea. Try to keep a cool head and take each step one at a time. Good luck! We're here if you need support and we are rooting for you!