Annewr

I was going to post a new thread but you all answered my question fairly well, I think. Have an ADN and was wondering if I should go BSN or right to MSN focus probably on administration. I am looking at LTC, not hospital based. I have had enough of that. If you have any clarifications, or other insights, please let me know. I've doing this for 17 years and finding it harder and harder to get new jobs, and being held back at my current (at least that is my perception).

This reply is totally on the money, starting with "influential few, and ending with, "have to deal with it as well."! I am really becoming concerned that nursing managers aren't getting enough of the right-type of training that will help them to suppress some of the less positive behaviors that are instinctual to females. I have only had one male nursing manager in 17 years.... Posted in response to SamAdams8-this is what happens when you type in the dark, sorry

Wow, I have never been through this particular type of "grind" before. However, I am experiencing the nepotism thing at my current job. It seems as though all the managerial staff are people our management, ( I am deliberately being cagey here in case they recog. me:) ), worked with in her last couple of jobs. Never mind that their experience is less current or no where near as comprehensive as mine is. And I like these ladies. However, I have been advised that since I am not of the "twin-set and pearls" category of people, I will likely not advance. (This was expressed to me by peers, not the above-mentioned "Talbot's-crew"). This must be a joke, that I am sporty and not girly and my kids are 4 legged and don't go to school with hers. Give me a break. But, jeez, you are right. Non-conformists need not apply...

I've posted essentially this same request under a different thread. Hoping to receive as many responses as possible. Essentially I have been a nurse for 17 years. First 5 as an LPN in LTC, the rest in various acute care settings incl. med-surg, ICU and ED. Came back to LTC for reasons not nec. to enumerate here. To get to the point. I can't rely on the advice from my orig mentor due to a very pronounced passive-aggressive nature in our relationship when I became comfortable enough to start challenging her long held beliefs. Don't want to denigrate the lady as she IS very knowledgeable but she doesn't accept the possibility that my 17 years of nursing compare to the incredible number of years she has worked at our facility. I don't want her job. I don't want to have constant confrontations when she states as fact, what is really her opinion, and what has been acceptable for decades as this institution. We give really great care. I want to stay, but I need a foundation of LTC regs, compliance issues, etc., so that I can become a bit more, er, proactive in advocating for patients without starting yet another mini-war of her against me. If I have some basic knowledge of LTC regs combined with my own experience and passion for the job, it will give me a leg-up, so to speak, and maybe I can help to end some of the outdated practices that would never be acceptable in the hospitals I have worked at. When I recently called into a question a practice that the old-timers considered a nursing judgment, I was shocked at the push-back. I found numerous nursing articles, and now the policy has changed. I don't want the constant confrontation. I want to be educated, share whatever knowledge I had before returning to LTC and be respected, as I have shown respect, over, and over, and over again at this job. Certification will help me to get there. So, please suggest where to go for this education. Real knowledge I can share and help to mentor the youngsters I love to work with. Not simply repeating the pablum I have been dished because, "thats always the way we have done it here." Please help me to help my patients and the newer nurses I work with so we can make a change for the better, so we can be even better than we already are. I know, if it ain't broke, don't fix it. But where it's "broke" the state doesn't see. They don't know some of the things that have been done because of a focus on paperwork compliance. They don't see the ethical issues brushed under the carpet, that make me crazy. We are a great facility. I want to help us be even better, but I can only do that if I can prove I have made a genuine effort to learn the regs, etc. Any, all advice, welcome, always. Thank you for your time. Regards, Annewr

I just want to add my 2 cents. I've been a nurse for 17 yrs, 5 as Lpn and the remainder, RN. I have worked virtually everywhere. I finally decided to return to LTC for numerous reasons, not the least of which is the unprofessional way acute care nurses care for their patients and each other when under stress. Unreal people. The ED was the worst. I quit after a year when I saw what a meat market it was. Also did ICU, med-surg. I believe I made a real difference everywhere I worked. Very passionate about giving evidenced based care, listening, and if necessary, hectoring MD's to get results. I am confident, not pushy, and decided LTC would be nice. So, I support all the LTC nurses I ran away from so quickly 12 years ago. Now, I am hoping to get some certification so I can move up the chain in my facility as we are woefully outdated in our policies and procedures. But, we give awesome care. I love the interactions with most of my patients. They can be so sweet, even when they are trying to be nasty, its kind of fun, but mostly they want some control. Many have lived long productive lives and find their situations difficult to transition to. I totally get that and am very supportive. I know I sound like Florence Nightingale or something, but I'm not and I know it. I have my faults too. I don't like to make people accountable, it makes me uncomfortable. I recently stepped down from an Acting management position because of long-timers still practicing 1970's era medicine. So, really, I am looking for advice on advanced creditation. I avoided these programs for Med-surg, I.V. therapy, and others for reasons too numerous to mention here. Does anyone have any suggestions on really good programs for certification. I want to learn what IS correct, what IS necessary as far as compliance is concerned because I can't trust the info the old-timers are giving me. They have their own strengths, but in my facility, they consider me a thorn because I don't believe certain practices are nursing judgements, I don't believe the redundant paperwork is necessary. I want us to move into this century and don't have a mentor. Any advice on certification programs would be greatly appreciated. I esp. need to know about state regs, compliance issues, F-tags. etc. Just cause it seemed to work for 30 years doesn't mean its correct for this day and age. Any input would be appreciated. I don't want to change jobs again because of conflicts with more senior colleagues who refuse to retire. I would rather work with, than against them. Help! Thanks for your time in reading this.

Maybe I posted this originally, in the wrong section. In 12 hours I have gotten no responses which is unheard of on this forum:) Okay, the short version. Have worked in almost every nursing envir. am new to current facility, but have done LTC in the not too distant past. Question, need job descriptions you might offer for the unit mgr on rehab, medicare, short-stay units. Who does MDS's, care-plans. Do you do I & O's? How long do you allow call lights to go unanswered for? Do you answer call lights? (At this place, apparently, the nurses don't....????!!!) I am near having a stroke at this great little facility I took a part-time position at. It seems there are vital activities that no one particular person is responsible for, so no one accountable. I am not really sure what I should be responsible for-please note, I DO answer call lights, am willing to do almost every task including cleaning the floor if nec...:) Very old culture. Don't want to step on toes. But want to provide great care, promote team work, decrease incredible overtime usage, and i mean incredible!!! (11-7 nurse left at 9:45 a.m., no deaths on her shift, can't figure out WHY she was still there? Admission time consuming, but should SHE have stayed to complete, or should day shift mgr finished it?) How many patients do the staff nurses have on their team? Who does treatments, orders/re-orders meds, does kardexes for new month, calls the docs, notes off orders?? If you could include your state, size of facility, your role, length of time in that role, suggestions, etc. I really feel the need to have broad knowledge before my discussion with DON about changes that might be implemented, or maybe I just need to shut up and be grateful for a great paying job, with little apparent stress??? I like to EARN my pay. I want to be efficient. In this environment however, I don't seem to have clear guide-lines. Any and all info will be helpful. Please respond if you have direct experience with this type of unit. Many thanks for your anticipated responses to this post!!!

Unless I missed the point, I think part of the frustration expressed is that nursing is TOO driven by protocols. If that is the source of your frustration, the ICU will drive you nuts. Everything is protocol driven. Yes, you can do an assessment, draw labs on your own, "per the protocols", however, every action is PROTOCOL DRIVEN. So, you are not really working autonomously. The only place I have ever seen true autonomy in nursing function/actions is the ED. The ED docs and NP's will almost always support the increase of fluids, the anticipation of, but not administering without order, for lasix. You are in the age of protocol driven nursing. No doubt because so many of your/our predecessors failed to act, or acted inappropriately, and, someone died. These protocols are literature driven and maximize patient safety. But, don't let this make you feel autonomous. True autonomy is acting with diligence to a recognized need, wherein someone, or some protocol hasn't told you how to react and then, following through-in essence, the nursing process-remember that?:) One of the reasons I left ICU environment is the task-driven activity inherent in protocol nursing. Just my opinion. I have seen brand new nurses oriented to ICU/ED and without adequate experience elsewhere, they really believed in their skills. Then you watch them with either more than 2 patients, or with patients they will have for more than a few hours, and, they sink (either due to having to multi-task, the frustration of not getting immed response to problems, knowing how to talk to alert patients, family teaching, patient safety, mobilizing patients, etc.) Every new nurse should get his/her feet wet in med-surg. It is vital to understanding the nursing process, the difficulties facing the floor nurses when you try to shift your patients to them. You will also see how the floors "hold" their discharges until the end of their shift, how much time they do or don't have to sit around and BS in the station etc. Med-surg nursing gives you vital information about nursing and especially, about your facility "culture". Very important knowledge to becoming a great, well-rounded nurse. I know there are many who will disagree with this. I firmly believe in this opinion however, as I have personally seen it. Having a difficult charge nurse is an opportunity to problem solve. Follow the chain of command. Find a really great mentor whose advice you trust. Learn to work within the constraints, get your "real education" and then you will be more valuable to your patients and coworkers wherever you go!!! Lousy, lazy charge nurses are everywhere, but, not every charge nurse is lousy or lazy. Also, rely on your staff educator. Maybe you can stimulate the need for an inservice. Either way, its a learning opportunity!!!! Rock On!

Throughout the course of my career I have been in ALMOST every conceivable setting. LTC, med-surg, ED, ICU, home care...Okay, here is the question and I need input from everyone with experience and an opinion. I will share your views with my new D.O.N at my part-time job. Here it is...what job description would you give, at your facility, for the nursing mgr at the rehab (medicare, short-stay) unit at your facility. Please tell me your State, Size of your facility, your general capacity at the facility, your length of experience there, who does MDS's, who does care plans...anything you want to say... I have taken a part-time job at a sweet little facility in my state. It is not currently my primary job, but eventually, it could be...I don't know if the reactions I am having to what I am seeing are relevant, or if I just need to take a deep breath...we appear to function so loosely that no one is accountable. I don't think any one person is at fault. I am not sure anyone is at fault. But, to leave call lights ringing for minutes at a time while nurses are at the station almost gave me a stroke. I answered many of them myself. When I was first in LTC a ringing call light was almost an emergency...(I know its not, but just saying...) Okay, ladies and gentleman, I need your input...Thank you so very much. The patients who are voiceless, often, Thank you so very much!!!

Wow, has been many days since I got on this group. Cannot believe this thread is still running. If you don't get enough satisfaction from the previous posts, and know that there are so many out there suffering with such co-workers...do you need to quit? Please leave before becoming embittered. Really. Way too many burnt out nurses caused by co-workers, not the job and it's demands. Very sad. So many really great nurses,....lost. Love to all, heartfelt and sincere...Safe shift everyone:)

To TF: So funny, so true...orange leopard print thong....I'm dying:yeah:

To AndrewRN, I just thought you showed amazing understanding of interpersonal relations. Regardless of your age. You will be an asset to conflict management, both micro and macro. Good for you:yeah:

Okay, everyone, take a deep breath. I have been on this site for about a week. The snark, not helpful. There were, IMO, really good responses to "What would you have done?". Snark is funny/acceptable only when the recipient knows you and understands your sarcasm. Otherwise, just hurtful/nasty. As we are all anonymous here, well, you get the point. In addition, I have begun to wonder if this site isn't the respository of the opinions of all the people I left some nursing jobs to avoid...I "get" the "venting". Or, should I assume that we are training each other through "tough love"...and to think, I just recommended this site to someone just entering nursing. I can take it, I just think its an immature coping mechanism, and believe me, most of your peers do also...

Wow, Hearticulture, I couldn't have said it better. I came to nursing as a second career and it changed me as a person in all of the best possible ways. I can't agree more with everything that this poster stated. It woke me up, made me able to handle extremely stressful situations and emergencies with more calm than most of my coworkers. I found my personal strengths through nursing. Very well put. Thanks for stating what makes me "stoked" every day I go to work.

Just one more thought.... If you are thinking of going into nursing for the money, please don't. Just don't. There are already more than enough people "nursing for dollars".

A couple things come to mind, What is the census like at your facility? Does he have private insurance? Is he keeping others from taking a bed on a specialty unit? If you have empty beds and a high medicaid population... (we have all seen this, as unlikely as it seems in this era of managed care...) If he truly seems to be a "psych" case, then you could contact your facility/unit patient advocate as he is not receiving the appropriate care. If you feel strongly enough, you could also contact your facility/unit Ethics committee. You mention that there is nothing in the H&P, that is most unusual. Esp as he requires total care and has had no diagnostics.. What was his admitting diagnosis? If he was admitted for infection, your psych unit likely wouldn't take a pt requiring IV antibiotics...Does he come from a SNF? Does he have any use of his extremities? I have personally cared for a number of patients with very poor, er, communication skills. Our facility once "housed", for over a year, a dialysis pt who was banned from all area treatment centers due to his removing his access needles and threatening the staffs with his HIV infection. Finally, the hospital bought him an apartment and he came to our hospital for inpatient dialysis even though he was now, outpatient. He acquired his infection as a result of IVDA... Finally, while he is screaming, as long as he has a call light, you can ask your manager if it is approp to close his door. Most importantly, while it is extremely stressful to care for such a patient, do your very best to turn a "blind eye" to this verbal barrage, it may be a defense mechanism that requires empathy, rather than anger...I know, its easy to say, much harder to do. More info would be helpful:) Best of luck in this very difficult and disruptive situation...