JillR

Wow. This is weird stuff. While reading this stuff I kept thinking that some people act this way because they can. They act innappropriate and when called on their actions the either admit themselves to a psych unit or do something to get admitted. Then people either feel sorry for them or are afraid to call them on their behaviors and the cycle go on and on. I have had 18-20 yr olds that frequent our facility that have never worked a day in their lives and don't have to because they are disability for depression. Well, must be nice. I wonder how the nursing shortage would be if all of the nurses that are clinically depressed quit working and went on disablity. I am sure the tax payers would not stand for that for long. I may just have a bad attitiude today, but I feel that if some people were told that their behaviors would not be accepted because they are just plain unacceptable, there would be lot less of this stuff happening. I do realize that there are people out there that truely suffer from mental illnesses, but the crap others are expected to put up with from co-workers is just too much. There has to come a time that people in administration have to say, hey you can't perform your job either take a leave of absence and get help or you will not be allowed to work here. If these people either don't understand or don't care what behavior is unacceptable, then do they really have the judment required to determine other (patient) health and adequately do care planning and intervene in unhealthy and maybe even dangerous situations for the patient? There really needs to be a serious question of competency in these cases and maybe the best place to go about this would be the Board of Nursing. Only because we all know that in many facilities, a body with a heartbeat is the requirement for employment.

Delirium, I used to feel like this after every sememster. I questioned my motives, and frequently questioned if going to nursing school was the right thing for me. One time I was on break with some of the RN's that I worked with (I was a CNA and EMT) and they were talking trash about the EMT's that I worked with. Later that day the ER/EMS director called me at home and I was very upset and told her why. She said to me "Now you know the kind of nurse you do not want to be, you have the choice not to become like that. Quitting nursing school is one option, but another option is making the decision to behave in the way that you would like others to. I hope you make the right choice." She never once told me what she thought I should do, just that I had choices regarding my behavior. Now, when I work with people with bad attitudes, I just stay away from them. If they want to kiss up to the docs and wait on them, that is their choice. I choose not to act like a maid because I am not a maid and I believe that when nurses act like that, it creates an expectation. I believe that you will get as much respect and you expect to get and earn. You cannot wait on doctors and expect them to respect you for that. Same goes for your kids, would you let your children treat you this way? ( I am not talking about small children, I am talking about older children) If no, then why in the world would you let a mere aquantence treat you like that. I refuse to even respond to treatment that is not acceptable to me. I believe that all the nurses that you are observing as a student are role models. It's up to the individual student to discriminate what roles are acceptable and what are not. Use the positive and discard the negative. Just remember that not everything you will see in clinicals will be kosher. Not every nurse will do things the way that you have been taught to believe is the right way. This is where the good instructors come in to play. If you have decent instructors, you may be able to bring up these concerns and they may be able to help you to sort through your feelings and thoughts. I was lucky, we had great instructors that did not forget what it was like to be a student. Good luck in your decision. I hope you make the best decision for you. Jill

I remember walking rounds with the nurse and the doctor at a LTC facility I did clinicals at for school. I had worked there previously for a years as a CNA. The doctor wanted a psych consult on a lady who was acting the same way she did 5 years previous when I worked there. She had many psych consults in her time. Neither the nurse or the doctor knew this was how she had been for years. I was lucky that the nurse was nice to me and I told her that there had been no change in her behavior in 5 years. They cancelled the psych consult. But it makes you wonder. The DON used to come around and hand out their daily extra useless paparwork every day for the nurses to do on their down time. Made me sad that these nurses never got a chance to really get to know thier patients, but the DON was obsessed about this extra stuff they were supposed to do. They ran constantly and barely got the meds passed and treatments done. God forbid someone should fall or get sick. Not making any excuses for anyone here because I have had these really frustrating patients come in from the same LTC facility without report and such, but thought it was interesting to see the other side of issue while in school.

Good luck though on your project. If I come across any information about this I will pass it on.

I am sorry if I offend you here SueBe40, but I just can't help thinking that is a very risky way of staffing an ER. Hope that the hospitals that impliment staffing based on an acuity system for ER has very good insurance. Hope the nurses and doctors do too. WOW! One more question I am going to have to remember for future job interviews. I say the people that think up these "trends" have way too much time to think up all these inovative ideas and really need a dose of reality if they are going to staff safely.

How can you possibly use an acuity system for staffing in the ER? You never know what is going to poll through the doors. The only thing you could possibly do is project what might happened by using what usually has happened in the past, and that is many time inadequate. Is that kind of what you mean?

Was nursing school hard? For me it was not as hard as I expected it to be. I had heard many horror stories, so I was convinced it would be the hardest thing I would accomplish in my life and it was not even close. The hardest thing about nursing school for me was not the difficulty of the work, but the amount of the work. The amount of time required to complete the work, cut into my time with my children and that bothered me. No it was not difficult to pass. I never thought I would fail. I sometimes thought I would not do as good as I wanted and/or expected to do and somtimes I thought I would not have time to complete eveything. It all got done and I did very good in the end. It was not difficult to grasp the medical terminology, but I had been exposed to it already. I think I would have had a harder time if I had not taken a medical terminology class earlier, but I know I would have made it with or without. I suggest a good medical dictionary. I think you have to consider your motivations when it comes to nursing school. I was very motivated and I don't think I would have stuck it out when I was 18 years old, or even my early 20's.

CEN, You are probably right about the delegation thing, but I was thinking not just in legal terms, but in the terms of this techs reputation at work. Not that the work was not done due to laziness, but the tech was actually told not to hook the patient up to the monitor because the nurse did not believe the patients complaints. This whole situation is just down right scarey, and I think she should cover her action with this one. Either way, I would still suggest being really careful around anyone you are not sure you can trust to be honest. I guess I am not a very trusting person, but I have seen people lie in order to hurt others reputation just because they don't like them or were too lazy to do their own work. I could see her and possibly management trying to use you as a scapegoat. I also agree with writing the event down, it helps not only to recall the situation later if needed but also to allow you to vent some frustrations about the situation.

When I have a person come in complaining of chest pain, they are hooked up to a monitor, VS taken frequently, pulse oxemetry done continuously, oxygen on, IV inserted,ect until MI or any other life threatening cause is ruled out. I don't really care how many times they have been in for drugs or any other reason. Tests that will be ordered are called for usually before the doc even sees the patient. At the very least the doc would order an ECG and cardiac enzymes. The only thing I can think of that you may have been responsible for is if the RN would have stated that she told you to put the person on the monitor and other stuff and then it would have been her word against yours. Luckily, the patient had a significant other in the room with him, this might have helped your case. The techs that worked with me in the ER did not have to ask permission to put someone on the monitor, they just went ahead and did it and it was expected from them. I guess what I am saying is to be real careful and cover your butt. If this nurse did not have a problem lying about putting the patient on a monitor, I doubt she would have a problem saying she delegated a task to you and that you did not follow through. Another thing we do is take a strip as soon as the person is hooked up to the monitor, so you can see what time that happened. I would tend to agree with CEN, that the RN may be negligent, but that you are in the clear.

Not sure about any other state, but here EMT's and Paramedics are liscenced for pre-hospital and transport care NOT for working in hospitals, and even in pre-hosp and transport, they are working under the MD's liscence. When they are hired in ER's they are legally UAP's and are working under the supervision of the RN, they are delegated to by the RN. Now some ER's give them more resposibilities than others, but they are still not liscenced for ER, so they are not liscenced prefessional in this setting. Be very careful what you delegate and to who. Like someone else previously said, it is very important to know the EMT or Paramedic. Don't let anyone tell you that they are not working under your liscense, be very careful. We used them in the ER I worked at and they were great, but they are not educated to work independantly of the RN. They are great assistants in the ER.

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Nursing is the only profession that I know of that is accountable for providing, not only nursing care, but is expected to do the jobs of all other areas in the hospital. We are expected to perform dietary, housekeeping, physical therepy, occupational therepy, respiratory therepy, pharmancy, social work, spiritual care, emotional support, security, safety, maintenence, and depeding on the protocols of the facility medical care for the patients at the hospital. We are accountable for all of the this for each and every patient and then treated and if we are maids because we provide these services. We are expected to be experts in our fields, but not given credit for being experts in our field. We are expected to also be able to competantly work in other fields of nursing that we do not have experience, but other professions are not. I would like to see a physical therapist make sandwiches for a hungry patient, it would never happen. We are expected to get hit, sworn at, treated like maids, and say nothing and just take it. We are expected to give up weekends, holidays, birthdays, and our days off, all without adequate compensation. If we say no, then we are not "team workers". Personally I am sick of being a team member, when we don't even get a measly thanks for it. I work the baylor program at our hospital and then volunteer one or two days during the week to help fill staffing voids, so what does my employer do, they let the weekday people have that day off because I am there as a volunteer. This has happened to me the last 4 weeks I have worked, so I am not doing it anymore. The weekday people don't ever offer to work even 1/2 a shift on the weekend and I know there would be hell to pay if a weekend person was allowed to take a day off on the weekend because there is a volunteer on. It has come to the point that I am not going to volunteer for anymore weekdays because of this. From now on they can call me the day they need me and pay me the two hour call in pay for it too.

If the employers were to compensate employees farely, with consideration to longevity and such, across the board, there would not have to be fear of "hard feelings among employees." The hard feelings come from unfair labor practices, and hiring new employees and new grads at a high rate and not compensating employees for longevity.

If there is a disaster and the facility calls us to come in, we cannot refuse, that would be grounds for dismissal. If they cannot reach us by telephone, and we don't show up, they cannot fire us. I have worked at this facility for six years and they have never declared an emergency, I know they did this once about a year before I started working there, for a tornado touch down. I tell the single parents, that if they are home alone with their children, do not answer the phone, but I don't think that will be a problem, because no one ever answers their phones during non-emergent times anyway.

B&O suppositories are appropriate, and work well for bladder spasms. If the patient does have a hx of drug seeking, does that mean that we hold appropriate intervention because it happens to have a narcotic in it? That would be cruel.