Rob72

"Violence is not part of the job." I strongly disagree. It is an inherent part of the job. The problem is that nurses are not taught how to recognize, verbalize, or document inappropriate verbal or physical behavior. Attempting to create a "violence-free" zone ensures that someone, at some point, will use violence. Why? Because all the "nice" people wag their fingers and tongues and there is no immediate, overwhelming, response. The idea that violent behavior is corralled or modified by verbiage is a failed concept, as demonstrated by the efforts in Corrections Science, from ~1960-1980. Unfortunately, the idealists, with their student loans to pay off, and their ideals to sustain, have moved into Public Education and Healthcare. Press-Gainey is a huge problem, as their overall model is based on sensation and reality-denial. If a patient is presented with the (real) choice of restraining their impulse, or receiving care at County (jail), or being tazed, they generally choose to conform to the stated standard. Truly violent people, with limited impulse-control understand that a minor assault charge is nothing to fear and they are likely to get what they want by threats and modest expressions of force.

Okay, is that all of the story? Raising your voice only gets you in trouble in a frilly-lace undies facility that has no desire to resolve issues, only pay their MBAs to take a trowel and spread a nice warm layer of BS over everything. "We all talk alike. We all like the same things. If you say a Member of the Collective is WRONG, you are a violator. We will not tolerate YOU." If it was a scream-down, that's a bit more of a problem, but as long as it wasn't a disciplinary action with/to the BoN, it should not be a significant issue. I may be a variance of the collective here, but I have little patience for the concepts of "verbal violence", "bullying", etc.. Do they exist? Yes, but they are "Unprofessional conduct" or "Insubordination". Creating a special concept of violence is mental wanking for folks who can't deal with reality. Anyhow, if you're seeking assistance in new coping methods, and assuming your performance otherwise is good/excellent, it should not be a problem. Your main issue will be receiving constructive criticism constructively and changing something of your self-concept after termination.

Please don't misunderstand, I'm not spouting "BSN Hate". I am noting the significant financial and political incentives that have been brought about by "dumbing down" that educational system. If someone who can barely read at a 10th grade level can be accepted into a 4 year college, there is no "superiority" in the "level" of education. I would also note the SES inequality inherent in the model. Lower SES may gain entrance but have significantly higher drop-out rates and higher career change rates for those that do complete a program. Higher SES is an overall indicator of higher capacity for learning, in, "time for development purchased", if in no other way.

If you re-read my post, I did not say that; you have inferred meaning. I have worked on a University affiliated campus for just under 20 years. Having worked with 2 and 4 year students, the BSNs have more theoretical base, but generally less practical base. Individuals vary, etc., etc., and outcomes will vary regionally depending on the number of non-traditional students and ADN/ASNs completing the BSN program. Yes, there is substantial lit on the "better outcomes" associated with BSN staff. Having worked in research for 10 of my years, I would note that I am unable to find substantial literature indicating bias-weight r/study population and pre-BSN levels of practice, years in practice before obtaining BSN and independence of BSN-level ed vs. institutional outcome-measure improvement initiatives in the previous xx number of years prior to the study(i.e., the hospital emphasizes reduction of MRSA transmission and institutes a training policy, vs. MRSA transmission among BSN and non-BSN RNs.)

I think this is a fairly accurate summary. Not many people have a functional understanding of handling weapons as tools and not as "the Magic Wand"(including Mil and LE). Security is present to confine the non-intentioned offender and/or to talk down the offender lacking a clear expressive plan. "Swift and Certain" is a foundational Corrections theory that fell out of favor in the 60s. It does, however, seem to have the most consistently repeatable and generalizable outcomes (vs. "rehabilitaion" or "re-socialization"). Its present iteration: "Swift and Certain" Sanctions in Probation Are Highly Effective: Evaluation of the HOPE Program | National Institute of Justice

"I have insurance." Translation: the tax base has been broadened because if you work, you will pay. So-called "increased access to care" is still a very much unknown quantity, as outstanding deductibles and co-pays have not yet reached critical-mass in debt-under-collection. I work with a Ryan White program, I have a pretty functional understanding of the funds-shift and the practical consequences.

I'm always a bit hesitant to post on this topic, but its been awhile, so what the heck... The BSN requirement is an artificial socio-economic barrier created to "thin the herd" because colleges and Universities have a vested financial interest, and hiring facilities have liability limitation incentives. Back 40-odd years ago, with the liberalization of student loan policies, followed by the diminished entrance requirements enacted in the '80s, Higher Ed realized they had a whole new customer base. All they have to do is keep them flowing through and maintain a reasonable pass-rate. Community Colleges were not a part of this market, until fairly recently; ergo, when they start cranking grads out, the job market is flooded, meaning the University programs are in danger of dying (because of the significantly lower cost of the CCs). Along with the entrance of CCs into Nursing Ed, the Diploma Programs began to die off. Why should an institution invest thousands of dollars into an employee likely to leave w/in 5 years(this is also a fairly new phenomenon, IMO r/lack of real depth in Nursing Ed. Whooooole other discussion), not to mention instructors, insurance, etc..(No "?" because this is a rhetorical statement) So (Higher Ed says), how do we deal with this, and not collapse the network of Community Colleges relying on all this loan funding? We network with them! The CCs "prep" for entrance into the Univer$$ity; they split the funds. My experience has been that neither Community Colleges nor Universities turn out notably "superior" grads(i.e., statistically quantifiable). Dilpoma programs do.

No, we have responsible professional judgement. I would second mystcnurse's comment, regarding other theraputic meds used by nurses. Medical MJ is not some mystic, happy panacea. It is impairing(no less so than take-your-pick-of-narcotics) and it is controlled. The DOT and FAA have thresholds (which are actually fairly liberal) and medical MJ will in most cases cause one to exceed the safety standard. Your facility and State BoN may have different standards, but I would not be optimistic. Never confuse "feel-good" with safe practice.

Given the "weight" that your financial/business experience carries in your work history, yes, it should be included. I would remove industry-specific tasks (i.e., if you worked with a wholesale food distributer and loss assessment related to spoilage, for instance) and tone up the generalized experiences that translate well into your overall decision-making, administrative skill-set.

Hmm. I did an on-line program, with 5 lovely, charming ladies. I was also the oldest (36). 3 of us had spouses and kids, the other 3 were engaged, and all of us worked full time, in addition to school. Definitely friends, but I think all of us would have found 8 hours in a group a questionable investment of time. So. Overall, it's a maturity issue. I don't know how old the two of you are, but I hope you married with a common-commitment in mind (having raised 3 daughters, I will say being "in loooove" as a reason for marriage is iffy, at best). My wife didn't like my being in school, and we did have conflicts, and if I didn't have the character to deal with that as appropriately as I could, that was certainly not an issue with her. It will definitely be a reality check, and while it may be hard, that's not always a bad thing. God bless you both.

The question is: are you planning to be a Research Nurse, or a Specialty Nurse who works in research? There is a difference. Once you have 2-3 years as a Research Nurse/Coordinator, you should be able to run a protocol in essentially any discipline, recognizing that you'll need to do some study on the basics of the specific practice area. After 10 years in research, my frustration was that I could take a protocol from start to finish in any area, but my clinical depth wasn't growing. If you have a passion for a practice area (OB, Transplant, whatever), get your floor-time first. If you have a passion/interest in the new and different, going "straight" research is not a bad way to go.

Having worked at a trauma center in Wichita, KS, in the early 90s, I've been around for 2 such incidents. Regardless of my environment, I will walk away from trouble at every opportunity. Regardless of the trouble, I will walk away. To the OP: I would say the co-worker was very foolish, and I would have an issue with the behavior as well.

Okay, generally, Esme and I are on the same page, but I would like to (perhaps) expand on what I read. Yes, patient ratios are "recommended" by Jack-O, Nerds In Hiding, and Morbidity and Mortality, 'scuse me, "Medicare and Medicade". These ratios, however, are subjective, as noted. The ratios under which many practice are determined by overhead/"clients"/nurses. Why? Because there is no ICD billable unit for nursing care, ergo, the physical facility takes precedence over nursing staff. Nurses are a dime-a-dozen and easily replaced. The "customer service" model of tile floors, coffee bars, etc., are used to make up for questionable care-practices. It works, as long as there aren't too many Sentinel Events. If we want to change these standards, "someone" needs to bring a class-action suit, probably against JCAHO, substantiating patient endangerment by incompetent policy direction(i.e., allowing MBAs undue influence in care-delivery).

What astounds me is the screaming impetus for treating the "diabetic epidemic", but an utter lack of use, and training on, the insulin pump. There is no reason that an inpatient could not have the sub-q cath placed, and use a simple (theft)alarm-equipped pump. Equally, as the sub-q glucose sensors evolve, there is also no valid reason not to have them wi-fi-ed to a central monitor, as we do in cardio, for real-time monitoring. Also, while it might be "hard-core", the DON should be challenging the use of SS and BID FS orders and the use of Novolog/Humalog in relation to standards of care.

Ha! Sent you a PM. If you're in OKC, I may have a lead. No, you don't need a BSN, and its a good field.

Could be any of the above. Nursing school doesn't "waste time" on such "mundane" skills as venipuncture.:icon_roll A tourniquet should lightly compress the skin, and never requires the slingshot-pulling motions frequently seen. Extravasation is also possible (I sincerely hope not!). Me- an old NICU/PICU phleb...

Sliding scales are less than useless. If you are using Regular insulin (which I assume to be the case), the 0600 FS will give you a baseline for correction at mealtime, but is meaningless w/o a meal bolus ration. Translation: 0600 FS is 209, so you have 2 units of Regular ordered. Great. That will correct the 209, but does nothing to process the food being eaten at 0800. The next FSBS (I'm assuming 1000) is a shot in the dark, as the BS is on its way up, and the Reg is running out of steam. Docs don't like getting paged for acute hypoglycemia, and hospitals don't like paying staff to monitor as closely as is required. Hospital policy rules the day, but one of the DNEs here should be able to send you towards one of numerous articles demonstrating that improved glycemic control (non SS) decreases M&M.

A legal document, for administrative filing(i.e., "event" reporting, audit trace, shift discrepancies, etc..), would allow use of otherwise "controlled" information, just as a Police report would. Please note that duty rosters, med receiving/unit dispensation logs, and information relating to the operation of the unit do not fall under HIPAA, if they do not list PHI(and PHI is not employee's names). Email may or may not be HIPAA controlled. If it contains PHI, and is unencrypted, it is a violation. No PHI, no violation. If you are not being allowed to complete a report relating to work at work, then employer may be reportable for violation of reporting practices, depending on exactly what you are documenting. Bear in mind, internal memos/documentation may be covered under the facility's Employee Handbook confidentiality/disclosure section, but that is generally not HIPAA related (though there may occasionally be overlap).

Hurst reviews practicals, Kaplan is, "the thinking". Honestly, what helped me most was looking at each question, and prioritizing the answers according Maslow.

Lots of variables there, tho' on the surface, you are correct. However, if there is a femoral, no, it won't be changed readily, and one hopes there was a good reason for placing it (i.e., peripherals are inadequate to infusion demands). Radial lines are becoming more common, and I believe that's a good thing, overall. The "best" answer is that if you have a marginally AAO patient, and/or an incontinent one, check the diaper frequently, and use a larger dressing, if this is a known problem. If there was poop under a dressing, its time to change the dressing, and hopefully do some positive site care.

If you are able to verbalize what constitutes assault, vs. battery, and how the two progress, and if the patient is lucid, just call the Police. I have no idea what the situation was, obviously, but it would not be unheard of for a supervisor to escalate a non-compliant patient's behavior(in a controlled, intentional manner) to have the patient removed from a facility, but for yuks & giggles, it is unacceptable. My thinking is, if it was serious enough for you to post, its serious enough to follow through. If this was "venting", it was very ill-considered, as you've stated refusal to comply with your duty to report. ...and Esme got there first. Okay, I just ran across the related post. Psych facilities are their own world, and I would pretty much say you're SOL, assuming what you saw qualified as A&B. Knowing that 2 RNs and 2 aides have been assaulted & battered at our local facility, one resulting in a permanent spinal injury, because of the facility's "no intervention" policy with the residents, I have a feeling I might understand where the super was coming form; maybe not, but if the monkeys run the zoo, and know it, playing screwhead with them may be one of the last ways to retain some measure of control. YMMV, I do not know your facility, this response is biased by personal experience, etc., etc..

Yeah. In cases of diminished capacity, the healthcare proxy (in out-patient settings) or the CMO (Chief Medical Officer) bear responsibility for the actions of the individuals. Document explicitly what you observe, experience and do.

Do you have any friends/family in the Oklahoma City area? I know of a job that is opening within the next few days that I believe would suit your needs. A temporary OK endorsement (90 days) is $10. http://www.ok.gov/nursing/endorseused07.pdf The position is in research, with Neurology, at Oklahoma University.

Remember- the first debater to refer to the other as "Nazi" loses. With the understanding that both the National Socialist German Workers' Party and the Proletarian Revolutionaries had the penchant for applying labels, and saying, "youareyouareyouare...", I'm wondering who's standing where...? In any case, if one has no consideration, or concept of, the other party's frame of reference, one is unable to objectively evaluate the relative arguments. The, "possession bias", is too high. "Gross" and "pretentious" have clearly defined, demonstrable, objective meanings, as did the protests against "conspicuous consumption", 40-odd years ago- the considered,determined and wide-spread destruction of a given resource(s), for the purposes of self-gratification.

I believe we are in agreement, barring slight semantic differences- choosing not to be insured, without advanced personal financial planning, is gaming the system, just a slightly different track. Community/Charity hospitals were always fairly "rough" by comparison, but they were also cyclic, as with any other supply and demand system. It wasn't until the early 80s, when a progressive, permanent, wave of closures and for-profit Chpt. 11 acquistions were seen. Sociologically, the drive for the current system is the securing of a constituency. You are absolutely right. Our problem is that we do not have the Constitutional requirement of, "fair and equal protection", being enforced. Its no surprise, and the social devolution is exactly what de Toqueville warned against.