inthedistrict

One last thing: For those scoffing at mentally ill nurses working (and for the mentally ill ones in the trenches!), I recommend you read "A First Rate Madness." The author posits that in times of calm, the best leaders are the sane ones. In times of crisis, though (and what is nursing, if not crisis!)? You want the mentally ill. Lincoln is the perfect example. Awful depressive (another great book: "Lincoln's Melancholy."). Indeed, there has been a lot of speculation that Florence Nightingale herself was bipolar. If nothing else, she had some fantastically productive times, and some fantastically low ones. I'd argue that well-controlled mentally ill nurses make GREAT nurses. Mental illness does not equal instant sainthood, but, if you're lucky, it makes you sensitive, creative, compassionate, and, yes, tough. A very wise friend of mine once said that people can only walk with you to where they have been, meaning that if they've never been truly down, out, and broken, they just can't go with you to the darkest, most broken places.

Here's how I see it: If you had physical pain that made it hard to do your job, you would take a pill. Joints ache after 10 hours, do you quit? All of these people scoffing how they'd never take a pill to do a job....have you toughed out every work-related migraine? If so, why??? Meds aren't an easy fix. The side effects can be terrible. Switching to find a good fit is common ( all those chemical changing your brain all the time are no fun). And no doc I've ever worked with doesn't also recommend, if not require, therapy. And even on meds, you'll have days where you are anxious, days when you are blue, days when you are happy. It doesn't make everything sunshine, roses, and smiles. Plus, if you have good, healthy brain chemistry, they aren't going to do much to help you in the first place (except a benzo or something, I guess). A normal person taking my anti-epileptic wouldn't notice a difference in mood, according to my doc. I do. Q.E.D. I'm saddened that so many health care providers still hold the old "buck up" attitude. Trust me, trust me, trust me, I'd kill to be able to buck up, and NOT need all these interventions...not drag myself out of bed in the mornings, not wake up with dry mouth all night, and to be able to lose the 10 lbs I've gained on my meds. I'd have a lot more cash and a lot more free time without all the doctors appointments. I agree it is sad that people are given meds by their PCP instead of therapy. The coverage system is wacky, and we need to do a better job providing therapy and proactive education about coping skills. I'm shocked hospitals don't require training in stress management. But....telling someone in crisis to shoulder the burden of getting themselves well, and somehow implying it is a moral failing or a lack of will that they aren't coping better is pretty crap-tastic.

I'm with you. There's something wonderful about a nice, clean, lotioned patient resting on neat fresh sheets. People underestimate what a difference it can make.

Love this! Thank you. What a great thread!

Per protocol, they must have cleared a swallow test to get a diet (that's where I worked as a tech, so I know that much is done). She was in high fowler, soft mechanical.. There wasn't suction in the room, which was a problem, especially since this was only the 3rd or 4th hour we'd been on the floor as students. I've operated suction before, but I doubt anyone else in my class has. Sorry, I should have added those details. I understand that if they are coughing, they aren't choking, so no heimlich :)-- but, theoretically, what if they ARE choking? Sometimes, we can take all precautions and something still goes wrong. Or, the situation has changed and we don't learn we need extra precautions until it is too late. In that case-- what should we do???? I would think suction wouldn't be of much help-- can't get it down far enough to clear something deep in the throat, and don't want to push it further in. thanks so much for all of your help. I'm clear on prevention, just not clear on a plan B if prevention doesn't work. I'm big on always knowing my plan b! :)

Nothing wrong with people with their doctorate to practice as "Doctors." They just can't practice as PHYSICIANS.

Yes, before school, and LOVED it. I didn't have an tech experience, and I worked under an EMT license, didn't have a CNA, so there was a steep learning curve, but it was doable and exciting. I was in a 14-bed medical IMC in an inner-city hospital, and the only tech on the shift (w. a 2-to-1 nursing ratio, but trust me, that's only because everyone was incredibly sick and needed that much care). I'm sure it varies from hospital to hospital, but I was responsible for q2 vitals on every patient (made easier by tele), accuchecks (usually 8-10), turning, bathing, ADLs, and then everything else that needed another set of hands. Usually come in at 3, light restocking, answer a call bell or two, do 4 pm vitals & accuchecks on all patients, and dealing with whatever I walked in to (bathroom, water, need to get nurse, request for pain meds), then trays came, feed who needs it, change one or two people, turn some people, 6 pm vitals, change some people, clean some people, turn some people, get sent to check on some people, do an EKG or 3 for the new admissions, then shift change, so filling the nurses in on what I saw during the day as they oriented, run down for blood, then 8 pm vitals, then more accuchecks, 2-3 patient baths, some dinner, transfer a patient, then 10 pm vitals, another couple of last minute requests from nurses, then home. On the IMC I saw EVERYTHING medical. Expect almost everyone to be total care, with lots of tubes, wires, and IVs to deal with. Lots of trach patients, lots of patients with GI issues (some shifts, you'll feel like all you do is clean patients. No sooner are they rolled on to clean sheets then they go again). You'll see all sorts of complex medical issues and co-morbid conditions. Psych, auto-immune, cancer, lots of COPD, hypo-/hyper- everything in the body, lots of renal failure, people going thru the DTs dementia, DKA, end-stage AIDs,....usually these people have been sick a long time, so get ready for some textbook-worthy bed sores. You'll really be trained to be alert for small changes in status. See a lot of codes called. Prepare people for the morgue. Etc, etc, etc. Plus, you'll learn how to read a room, you'll get really good at handling difficult patients and families, and you'll get to practice being an advocate as you advocate to the nurses. It's such a high-stress place for patient's and families, and requires a big emotional IQ. Honestly, you are really lucky! It's such great experience for a student. Warning you now, it's unusual for me to sit down for a TOTAL of 45 minutes a shift. Meals are eaten in about 5 minutes, 15 if we're really slow. During shift change I'd get to sit by the call bell for maybe 20 minutes, between interruptions, and by the end I could usually pull up a chair in a pts room when taking vitals, but that's brief. But, that's ok. It will FLY by. And some nights, esp. the overnight, you can get a little more breathing room. I think the unit staff will make all the difference. I lucked out-- my nurses were AWESOME to me, and taught me a lot. Show an interest, ask questions, and you'll really pick up a lot. If there was time, and a cool procedure, I'd always be called in to watch. If I was with a nurse in a room, he or she would make sure to explain to me step by step what they were doing, or explain the rational. I think they were also excited by my excitement-- of course, it feels good to have someone really admire your job! Best of luck-- I'm jealous. I miss the fun of the floor and can't wait to get back out there as an RN.

At clinical the other day, we had an aspiration-precaution pt. have some dinner go down the wrong pipe. The student working with her was watching her like a hawk, doing everything right, and the pt. was fine-- coughed it back up. I wasn't working with the pt, I was was the pt. in the adjacent bed. However, the other student called to me because I was a tech before school. I hopped over the chairs, sat the pt. up, and since she started a productive cough I didn't need to do much more than that. I'd had this situation happen when I was a tech, and at the time asked the nurses what I should do. I didn't get a good answer. When I asked the instructor after this, I didn't get a good answer either. "Well...you'd do the heimlich, like on anyone else." "But what if the patient is bed bound, in a soft bed? Drag them down?" "Yeah...you just...you know. You do what you can." "What about the morbidly obese?" (We see a LOT of them in our hospital) "You just have to do what you can." Is that really the answer???? Our instructor is great, so this really surprised me. Is there a source where I can learn what to do in this situation? I have to imagine someone has protocol in place for a bed-bound, aspirating patient. Is there a way to help clear the airway while keeping them in bed??? I just don't think in an emergency situation, alone, I'd have the time to get the patient safetly out, bear their weight to hold them up, and then be able to perform thrusts. OF course, call for someone, etc, but....in some situations even additional hands wouldn't be enough, fast enough, to do anything. I wouldn't forgive myself if I lost a patient this way, especially for lack of knowledge! Thanks so much for any help! Articles or websites with the answer would be great, too, so I have some EBP materials to back me up.

I worked as a CNA before nursing school, and not only did I get used to poo, I actually grew to appreciate it. Poo can tell us SO much about a patient's condition, and you'll hopefully be proud of just how much poo tells you. I've found that while the "ick" factor doesn't universally go away, ration, curiosity, and habit do take the forefront. Now, mucus? that's another story. I still felt physically, viscerally ill every time I suctioned a patient. I hoped it would go away, and working in critical care, I had plenty of quality trach time, but....no. My hats off to respiratory therapists everywhere, because I'd last about 2 hours on that job.

Very glad to hear you are going to go talk to the university. PLEASE do so. Even if it means you finish a semester later, or something like that...you need to get your feet under you and get a firmer foundation. Please also let this make you very aware of your limits. If you are feeling stressed, rushed, etc, STOP, and go get a faculty member. IF there is the least bit of doubt, go get a faculty member. If you feel you need more supervision, ask for it. If this is a problem for your school, that is a problem WITH the school. No shame in not being perfect-- think of how much more UNperfect you'd be if you made a med error that had serious adverse effects. It's knowing what needs to be perfect and what doesn't that makes a good nurse. It would be nice to make sure every pt. has ice as soon as they ask, but I'd rather fail in that and make sure no one gets hurt. I'm sorry you were so upset by this board, because being upset makes people defensive and myopic. I hope that knowing you have support and understanding gives you the courage to do what is right here, and get yourself the help you need! That is hard, but not as hard as what could happen if you don't. Quick addendum-- just because we see your point about not having someone pick up that you were unsafe doesn't mean I'd go in to the university guns blazing and blame him. I wouldn't actually mention your instructor at all. At the end of the day, the problem is deeper than your instructor, and that's the level you need to fix. Good luck as you take the steps to fix this problem. It is brave of you to do and important!

I just wanted to chime in and say that I'm sorry for all the harsh criticism you've received. I understand why you've become increasingly defensive and I think people are being very unfair. Not really sure why this is playing out this way. It is unprofessional, not to mention rude, to ignore a student request for a recommendation. I doubt you'd be hurt if she politely declined. It would have been easy to say, "Dear OP, while I'm flattered to be ask, unfortunately I only give out 1 to 2 recommendations a class, and I am not able to give you one. Best of luck!" It is the only fair thing to do, actually. I hate asking for recommendations, but as numerous bosses and professors have assured me, THIS IS PART OF THEIR JOB. Professors should know this comes with the territory and know how to deal with it appropriately. Thank goodness I went to schools where faculty knew this was expected of them and handled it beautifully. I'm hoping the instructor meant "uncomfortable with your clincal skills...." "....being at the level the scholarship expects." If she genuinely did mean that she thought you were unsafe or below average to a point where your career could be in jeopardy, she did you a disservice. No one improves if they don't know they need to. I can understand that you feel blindsided-- someone told you you were doing well, and then they tell you after the fact that you weren't doing well at all. Not ok. Not professional. Not what school is about. That being said....this woman is not a professional, and she is incapable of giving you feedback that will help you. Asking her to clarify, writing her up, etc, won't do you any good, and will probably hurt you. IF she didn't tell you then, she certainly won't now, not in a way that will be constructive. Drop it. You are too angry and hurt, this won't be good for you. Take heart that your current clinical instructor seems to be more realistic, tells you where you need to improve, and thinks your skills can get to where you want them to be. In the long run, a lousy experience, and confidence shaking, but not a major setback. Good luck! This is a stressful time, waiting on a scholarship. Don't let one immature professor get the best of you. In the future, though-- good rule of thumb is that if they didn't love you, don't even raise it. Not ALWAYS possible-- sometimes you need a professor from a certain subject, etc, but for the most part, faculty makes it wordlessly clear when you have them in your corner. IF you find you don't have those sorts of relationships, start to seek them out! Ask questions, go to office hours, ask for advice, etc. I'm not saying it to be calculating, but because school is much richer, easier, and more fun when you have great, deep relationships with the people mentoring you. Bonus is that it really helps you get to the next step, because you have a better sense of what the next step looks like, solid advice on how to get there, and authority figures who are cheering you on.

While I agree with everyone that the fault lies with the OP.... ....what kind of shady nursing program are you attending?!?!?! Any student who realizes only AFTER a medication error that they need to check the 5 rights has not received a nursing education. Any student who is too anxious to admit mistakes has not received a nursing education. Any student who thinks that "a teensy amount" isn't a big deal hasn't received a nursing education. Any student who puts two yellow syringes next to one another and goes on autopilot hasn't received a nursing education. Etc., etc., etc. People in my program bemoan the fact that the point of nursing school seems to be to leave us in a constant state of terror, but now I know why! I'm shocked on your behalf, but especially on behalf of your patient, that no one noticed how much you were struggling, that it had to reach this point. To me, it DOES indicate that something is seriously amiss. Human beings, all of us, have a tragic lack of self-awareness. We need others, TEACHERS, to guide us and gauge how prepared we are, especially if we, like the OP seems to be, are not naturally wired to be able to see the forest through the trees. If a student is dangerous, the mentor should be able to see that. Of course, things slip, and they aren't perfect either, but....I think this person genuinely had no idea she was a problem. That's why we have school-- to weed those people out, or beat a different way of thinking in to them! I'm also actually pretty shocked at the mentor's response. I don't yelling helps, but I also don't believe a casual "well, know better next time," helps, either. It's further evidence that something is rotten in Denmark. OP, I'm sorry for this situation. I know that internal pressure to get it right, quickly, perfectly, and be superwoman. It seems like you are a very anxious person, with a perfectionist streak that is self-defeating. I do see how you feel thrown in the deep end, and that's a scary place to be. Hating yourself, and the pathos of your mea culpas, doesn't fix it, though. I promise you. Have you thought about reaching out and working on these issues? Anxiety doesn't go away. Feeling the need to be perfect doesn't go away. Inability to see priorities doesn't go away. Inability to be proactive doesn't go away. I can bet you if you made this error, there are other errors, ones you can't see, waiting in the wings (that's true for all of us....if we could see the mistakes we were going to make, we wouldn't make them!) . Is there a professor you can talk with honestly?? It's a shame they haven't reached out to you, and have failed in monitoring and guiding you (even if that is guiding you to a different caring profession) but you are learning a good lesson-- no one is going to make you a good nurse but YOU. You need closer watch right now. No shame in that, just shame in not making sure you get it. Best of luck to you.

Hi! I just started at Georgetown's ABSN a few weeks back. I looked at Yale, Hopkins, Columbia etc, but Georgetown was a) right next door and b) offering a hefty scholarship (which is something to look in to!). If they weren't paying 80%, I'm not sure that I would have accepted. Now that I'm in and beginning, however, I am really impressed by the caliber of the instructors, the hands-on attention, and the student body. It is night and day from the state school where I did my pre-reqs. The classes are very hard, but that's because Georgetown expects to train leaders in the field (90% of graduates go on for grad degrees within 5 years). However, they give you tons of support, free tutoring, lovely facilities, and, most importantly, top notch instruction. They seem to have a heavy emphasis on networking with alums, and offer research and study abroad opportunities. I've been happier than I even imagined at the school, and I think it is worth the price tag (even out of pocket) IF: -It's not an enormous financial hardship. If you have to sleep in your car to attended (I know a student in a class before me who did that), do not go! AND -You have certain goals in the field-- doctorate, teaching, etc-- that you want to pursue at a regional or national level or in the best institutions (Mayo, Hopkins, Mass General, etc) AND -You thrive in a competitive enviroment with lots of stress, not from courses but from your classmates! AND -You are ok with the fact that you are going to go through all of this stress, competition, and financial burden and still be seen by many people as "only a nurse". AND -You can stay humble and recognize that your name brand school isn't a golden ticket or a mark of superiority (not saying you would think that, but some do...) (note that I didn't say, "Get in to grad school". From what I have seen in the hospital where I worked, and in my own family, if you have a decent degree, good experience, and make the right career moves, you can get in to a grad program. There are lots) Honestly, I believe there are great teachers and great students EVERYWHERE, and in nursing more than most fields, where you go is not of primary importance (right now). Do my patients care where I went to school when I am cleaning them up? Not even a little bit. Half of them don't even know recognize the names of any of these schools. Some of the best nurses I worked with as a tech were ADNs. That being said, nursing is changing, and I think mostly for the better. As we fight for more professional responsibility and respect, I think that where you go will count for more. In some ways, I celebrate this-- I'm GLAD i'm getting such a rigorous background in patho, for example, even if we are literally told to study 15 hours a week while taking 5 other classes, and I know it will make me a better practitioner. I'm GLAD we are going to be more educated and have more autonomy. (And always disheartened by people who don't understand the point of theory or, say, a gen ed like literature. We want to be well rounded, thoughtful people in all senses!) I'm GLAD to be taken seriously. I worry, though, that as we professionalize we risk becoming elitist. That would suck. It goes against everything nurses stand for, I think. I don't want to be in a field where people care where I came from, I want to be in a field where people care what I'm doing. Sorry, I don't know if that helped. In summary-- From my experience, these fancy-pants programs are awesome. Really, honestly awesome. But not going to one won't stop a truly motivated person. It's icing, I think. Just make sure to seek out the challenge anywhere you go, and you will be a great nurse.

Not safe not safe not safe! I'm so sorry. I hope your nurses were understanding. There's nothing worse than being slammed AND having to waste ten minutes explaining why you can't check sugars. Are you in a position where you can go to the charge nurse/nurse manager/respected nurse on the floor and ask to come up with a plan? there are nights when I've said, "Nurse, here is the floor: 6 people on kayexalate, 2 GI bleeds, 8 finger sticks (2 q2s), 1 person in restraints, 3 admissions, 5 rooms to strip and set up, 1 person pulling out there vent and 2 needy families (or whatever). I've already changed 5 people, I spent 30 minutes getting so and so bathed, and now x needs a dressing change. How do you want me to divide my time? What makes the most sense for all of us?" Sometimes, I think our nurses just get so busy and stressed that the forget that I'm one person answering to at least 6 "bosses" and 14 patients. When I spell out for them what I'm doing, and what is on my plate, they are usually great about respecting it or coming up with solutions (e.x.,-- "help the wound nurse, I'll do sugars"). PLEASE remember that you are one person, and assert that! Patient safety comes first-- but you are NOT responsible for missed meds, pulled ivs, etc IF you told the nurses how busy you were and that you were unable to complete vitals, keep a 1:1 watch, etc (which I'm sure you did!). Legally, my undestanding is this ultimately comes down to nurses, though we are there for support. Were they also upset about this ratio? I hope so! They should be advocating for you, too. If you are consistently not getting the support you need, document document document (including conversations with the nurses), and bring it to your manager AND the nursing manager. Your patients (and you!!!!) deserve decent staffing levels. I hope you have some allies in this fight. It's such a tough job sometimes, and we've all had those nights where we just want to curl into a ball and never come out (but don't have time!). Hope it turns around for you and hang in there. These phases do pass-- and holiday periods are usually the worst!