KalipsoRed21

And that I 100% agree with. But as a nurse, I am disturbed that even other LVN an RNs in an ambulatory office setting seem disempowered to do basic problem solving. My manager even supports such. I really do feel a nurse should be capable of thinking of going "well Losartan is not typically an abused medication like narcotics, muscle relaxers, and some antihistamines. The pharmacy just doesn't have 50mg tablets on hand at this time and are requesting to know if it is okay to fill this script with 100mg tablets and write instructions to take 0.5 tablets instead. Let me call the patient and see if they have an issue with that (they could have a swallowing issue or something that may make taking tablets hard instead of capsules or something.) Once patient is aware and okay of the change then just sign the effing order my name and the MD name and send it in. There is no effing reason to involve the doctor for a basic refill and change like this. Cover your *** by sending the Md a note of what you did and if they have an issue to let you know. But approving insignificant changes to medications that do not involve a dose adjustment are well within the scope of practice for an RN. But at my institution they pretty much rely on the doctor to review and approve EVERYTHING before taking action. Thus making the processes take FOREVER when they could be much more efficient and relieve the doctor of minor issues so he/she could actually use their highly educated brains for the more complex care issues. Just effing dumb.

I hate how inefficient healthcare has become. My husband and I have Express Scripts. They say they sent us an order of Losartan and my husband shouldn't be out. He would have been 30 days short. So I called his MD and asked if we could have an emergency 30 day script I could fill until Express scripts would be willing to send me more. I paid out of pocket for it. It is time for us to be able to get our script from express scripts, but they won't send it because they need clarification from the doctor. They only have 100mg tabs on formulary and need MD to approve 0.5mg tabs daily. The staff at the MD office printed it out and put it in the doctor's in basket to deal with sometime next week. I find this absolutely the most disgusting thing about Texas. So MAs and RMs can refill scripts but do not have the wherewithal or the will to be accountable and thus they don't…”because the doctor has to do it.” .? As I work at the same hellhole my husband and I get care. There at written protocols that go "Tamsulosin -if last office visit within a year go, submit the refill. If it is a few months after the LOV, refill once and tell patient they have to come in. But even this protocol and looking at the LOV note MAs and LVNs are not willing to do what I would find perfectly reasonable and within scope. Call the patient let them know about the proposed change, if there is no reason by the patient that he can't take half a blood pressure pill then a RN would just send the script...well I would. But now they use MAs who don't see that kind of problem solving as within their scope....actually apparently neither do most of my BSN colleagues. So now my husband and I are waiting 2-4 more days to get the script sent back to our pharmacy once the doctor looks at it and says its okay for the pharmacy to use 0.5 a 100mg tablet. So how does this help the doctor and clinic handle patients efficiently? It doesn't. Look pain meds, muscle relaxers....okay I see the issue. A script you can see the patient has been on for at least 3 years for blood pressure a RN can't make that call. WOW!?

Excellent advice. Also I would ensure that all this testing they demanded would be billed to the hospital if it wasn't...you may not win, but all you needed to do was prove you weren't intoxicated in anyway. I would also ask the lawyer if you can sue them for mental anguish. Then I would quit this job, quit nursing, because my dear the bullying doesn't get better the longer you are in it. You just get meaner.

Floyd, have admit here, you sound a little nuts. You went to the ER you work at, was able to not get yourself fully triaged (cause it sounds like IF you were the average Joe coming in off the street you would have been a far higher level of care than you were able to make yourself) and are happy with a 2K bill?! Your argument is that healthcare in the U.S. is better and sustainable because YOU manipulated a system you have more familiarity with than most to get a lower bill? Sorry sir, that is hardly an argument. On average at a decent hospital with standards a middle aged man (just guessing, maybe young man?) comes in to the ED with nausea, vomiting, diarrhea, HR in the 150s and orthostatic is going to get a line, fluids, a monitor, an EKG, CBC and BMP or CMP.....possibly a troponin x 2 which means at least a 3-6 hour stay since most places I worked at required 3 hours between trops. Also the statement "made the mistake of sticking a pulse OX on my finger....is there an urgent care or ER that doesn't record a full set of vitals? Is your argument that the average lay person shouldn't allow themselves to be fully assessed? What am I missing because I don't believe that made much sense? Thank you for clarifying.

Nope. And that is all she really needed to say. "I'm sorry, there is no one to send to assist you, is there any other way I can help.” And I would have been like "no, thanks for checking.” Because having no staff I'm use to. Getting things done as "best we can" I'm use to. Telling me to be effing happy about it and that you, a manager that doesn't even work in my department or know my staff, "should be able to get this done with the staff you have.” Nope, not okay with that ***. I know how much I and my staff who recently lost a husband and the other their father, can get done. They are trying but they are in mourning and not super efficient at this time. But anyway you go about it, I'm tired of being told to have a good attitude about not having staff and not being able to get patient care needs met. And I'm also tired of sacrificing my meal time and my personal time to get patient needs met . I did end up apologizing to the manager for getting as angry as I did, but I really did feel talked down to. All she needed to let me know was that there was no spare staff. Not tell me to "step up". But yes, I am over healthcare. I have tried several positions in nursing, it sucks. Most of what we do is not patient care, healthcare as a field is not well and no one at the top is wanting to do anything to fix it because we are now about "profit". Though no one will our right say that. I wish I knew what else to do, but I don't, not that I haven't been looking. "Dare to be fired". Yep, I'd like to see that happen, because when management is pulling *** like letting a 2 week old new grad have a full team to herself with a heparin drip patient....they have to have people like me on the floor. And I promise you there aren't enough nurses on the floor with experience to save you from those who don't know.

? I do hope you read that the term you in my response was a generalized you and not intended to be personalized? You as in any person, not you a poster. I am not angry. I will not tolerate lies and disrespect regardless of the title or alphabet after someone's name. I may not be eloquent, but there is no doubt what I mean when I communicate.

Also, respect goes both ways. She didn't throw a cuss word at me, but condescending statements don't require cuss words to be just as disrespectful as a cuss word. Just because I called out her *** behavior using an actual cuss word does not make her more "professional". It just makes her a more deceitful person if you ask me. Management can tell me no one is available and you need to do the best you can. But they sure as *** are not going to talk down to me and tell me that the impossible is possible if I just believe it hard enough. Respect goes both ways. I didn't lie to you when I asked for help, you don't lie to me and tell me if I just cross my fingers and wish upon a star you bet I have enough people to get caught up today. *you being a generalized term and not indicating any single person posting.

I have been able to walk out off a job twice with no notice, and get another one within a week without any issue and telling them that I walked off. Everyone is so desperate for nurses that you barely need a reference.

Today I asked for help for my clinic. My normal supervisor and manager weren't in. So I sent my request up the chain because we are like a week behind. Management came back with a "I need to delegate better, you have plenty of staff today" response. I responded that we do have adequate staffing today, but we haven't for 4 days, and I would like to get caught up. Then management came back with...in writing “…we need everyone to work together and not start with the mentality that it is impossible.” And then I went off, because THAT statement is condescending. So I told her, in writing, that statement was a poor ASSumption on her part. Just like that. Then she went off about how I'm not going to be disrespectful to her and I was like ditto sweetheart. Then she told me I wasn't going to get anywhere with that attitude. ? I said great! I'm not trying to get anywhere. I have absolutely NO desire to go up the chain. I just wanted to get caught up. Don't be condescending and not expect me not to go off. Just say you don't have any god damn staff to spare today, do the best you can. ***ing managerial ***es.

I'm okay with wrath. The next job is always a few days away if necessary. Thanks for this.

I think Time Management is such a funny term. Mostly because it assumes that there is time available for me to manage something. My current rock and hard place is this clinic I work at. It is my first clinic position and I overall enjoy it more than I have most of my other nursing positions. Like for the first time I have stayed here a while instead of job hopping. But a good portion of that decision is the little country town I live in. The job is 15 min from my house. The next nearest viable area to find work is 45 - 50 min away. Anyway, I attempt to manage 9 surgeons in 8 specialties. It is a surgery clinic. So we do in office procedures along with preoperative education and management. 2 of my physicians are oncologist so I'm also trying to manage referrals to medical oncology and radiation. Actually all I can say that my managers told me I'd have a small portion of things to do and it keeps getting bigger and more. My manager tried to tell me that my problem is the physicians that I work with won't do their portion of the work and this is why I'm having problems. However, she also tells me she has asked the director of the doctors to "do their share" and his reply was "I'll ask, but I wouldn't bet on it.”. Which, to me, means that the work she is thinking the doctors should be doing is an overwhelm on their plate and why it is getting pushed to me. So now my management feels that my clinic "could work" if I wasn't doing all this extra work....all this extra work that my doctors feel like I should be doing. Of course my manager has asked that they do the job her way and they tell her no. And then her answer is for me to "just push it back to the MDs". And I'm thinking if you can't get them to agree to do it why do you think I can? It's me and an LVN and 20-40 patients a day with procedures and surgical education and cardiac clearance follow ups and so, so much more. There are all these basic "housekeeping" things I'm suppose to do like check fridge temps, and keep up with staff education....for me, the LVN, and all the MAs that get floated to our clinic. And I'm just not now. For 18 months I've stayed late, worked through lunch, tried to come up with systems and pathways. And when I was willing to do all this extra, we weren't to far behind. But I'm done now. I took this job because it was suppose to be 8 hour days. It is regularly 9-10. So I just quit doing stuff. I get as far as I can and then just leave. Things are getting missed. JACO is coming soon and we are soooooooooo not ready. And my manger just keeps saying "get it done". So I guess I may get fired but I'm only getting done what I can in 8 hours.

Yes, I do that too. I' m just tired of the Poole who are suppose to be able to provide problem solving skills and guidance being less experienced than me. But I sure as *** don't want to be a manager. They are abused more than staff, and for what? A modest pay increase? Please.

That's what I think, but manager said greater liability in documenting it in the MAR under administration even with the comment. I guess I can just put it in a note....surely some other *** will have a problem with that. ?

So let's say a doctor put in an order for a med. Tells you he gave the med and please document. I document that the provider states he administered this medication. I have tried not documenting it and then billing comes back and says they can bill for the med unless it is documented....they send the notification to the MD and he sends it to me. My supervisor has told me before how our clinic has not been billing for meds appropriately and since we loose so much money due to this, we can't have more staff. Now I know this is *** but it is what is said. I guess what I'm asking is, am I in more trouble for documenting a medication I was told was given (making note in the comment section that the physician states it was given but this RN did not witness) OR not documenting the med at all? Opinions welcome.

So my surgery clinic position is 8-5pm. We hypothetically get a lunch. I say "we", but it is just me and an LVN 20-30 patients a day total spread across 8 different surgical specialties. I also have a 3 year old and am the breadwinner for my family. I just can't help but feel I'm missing out on her growing up. I want to participate in her day school, but it is 8:30-2:30. I want to take her to gymnastics or dance class, but the latest classes are at 6pm. I barely make it in time and if clinic runs late I don't get to go and my husband won't take her so she misses it entirely. If I'm lucky enough to get home at 5:45pm, I get to see her for 2 hours before bed. I just can't figure out which is better, not seeing her at all for 3 days a week and missing half the holidays. Or seeing her very little everyday, and getting holidays? And I'm amazed that I now work "8 hour" days and feel as exhausted when I get home as I did when working the floor. I want a 6 hour 5 day a week job? Not bedside, preferably no surgeons. ??

Nursing is not a flexible job. It is a great misfortune that businesses try to call themselves "family", I believe this leads to a great misunderstanding between employees and employers. But this is mostly for the benefit of employers, would you be likely to let family down? When you need help, they certainly don't have your back like family, do they? While I do think this was a hard notice by your employer that they can longer be supportive of your difficulties, I don't think it was a bullying attempt....although it feels that way, because family should always have your back, right? YOUR EMPLOYER IS NOT FAMILY. So don't give them that sort of dedication. Also, with all you have going on, I would take as much FMLA as you can and start looking for part time work if you can afford to. It may help your stress level. Maybe start asking yourself what you want to do next. I've been a nurse 15 years too. I hate it and pretty much have since I started. It is a good paying profession but honestly the best people fitted for this job is not people who care or are compassionate, but people who can do tasks and shirk responsibility successfully. The people who can look at it as a job and not as a calling. Because it is all about profit and how fast you can provide the job....they aren't even concerned about like you doing a good job, much less a great job. Any care or compassion you show their patients does benefit them...you know, the one patient that will give them a good review, but they don't really care about you doing anything more than your tasks. You are nothing to your employer so quit believing it should be different. Good luck and I hope your year improves.

I'm sorry if you felt my response was anger at you. I'm not angry with you or the dedication you had for your job. I'm just angry in general at the poor work conditions apparently managers and staff have in healthcare. No job is worth one's family time. And there are enough people and profits in the U.S. that it doesn't need to be this way. But your story did confirm for me that furthering my education in healthcare is not a good choice. More of the same stupid *** for no pay and no family time. No thank you.

This is useless information that further points out how bad healthcare is. If I Google search how much an MRI of the knee costs on average, Google says it costs $500-$2000. In 2017 my husband's knee suddenly became very swollen. I got him a same day appointment with his PCP who sent us next door to the hospital for a STAT MRI. My insurance company said they would not cover the cost of this emergent MRI because we went to a hospital that was apparently "blacked out" of our insurance plan. Like I figured the hospital was not in-network, I had no idea insurance companies could just plain not agree to pay for care at certain facilities. His PCP told us that is where we needed to go so he could get the results right away. He was teying to do right by his patient and keep him out of the emergency room. The hospital sent us a bill for $6,000. One cannot simply Google an estimated price of service and be anything close to accurate. One has an easier time estimating the value of a used car online than they do medical care. Furthermore, you cannot take the initiative at most hospitals and call ahead for an estimate. Hospitals make quotes like these incredibly time consuming to get and the estimates are often not even close to what they actually charge for services. An average patient does not know enough about services being provided to them to catch errors in a bill themselves and often are stuck between their insurance company and the hospital when insurances deem the service is not necessary, but the service has already happened. The hospital isn't going to be out the cost so they bill the patient. Also, to get assistance trying to fix a bill or ask questions about ones bill is a lengthy process that most working class people have to do extreme things like take off days of work to deal with.

Congratulations! So happy for you!! I have a plan too! 5 - 7 years to secure my kid and then I'm out too. I have to many other interests to put more time in to develop my nursing skill. I'm done.?

Hearing Aid specialist here I come! My husband is getting his retirement soon!?

I'm so sorry you dad had to endure that lack of care. I agree with you about the reporting thing being very disheartening. I reported serious hospital violations to the state of Texas as well and nothing happened. I got the same letter saying my complaint investigated and done. If no one is being held accountable except for a scapegoat nurse here and there as sacrificial lambs, where is the integrity of our field? I wish more people had the resources to sue and that administration had to pay it out of their own pockets.

Gratefulbutnotstupid, Thank you for your response. I am glad you found satisfaction in what you were doing as an administrator to basically have no life of your own for 13+ years. I, however, find that ridiculous. You sound like you were a dedicated leader and I'm very sure your team appreciated you for the most part. I will however call *** on the fact that you should have ever been put in a position at all. I can pretty much bet every time you were "working the floor" you were also working your administration job...because they just bleed together...and I don't care what you try to sell me, you can't do both well at the same time. You did what was necessary to ensure your residents got what they needed. That is what nurses DO. None of us are strangers to this concept, what floor nurse do you know that regularly gets to have breaks, eats, or pees at work? I would say it is rare that a nurse WOULDN'T sacrifice his/herself for the benefit of their patients and co-workers. What I'm saying is that the profit margin of the 'investors' is not conservative by any means. They could have made sure you had more than ample support so you could regularly be at home with your family? Surely there was something you must have found valuable in missing all that time with your family and loved ones? Was the salary that good? Because, I'm sorry, I do not find great value in spending gobs of my time helping others at the expense of precious moments with my own family. Or being with my family but being to exhausted to participate in my own life/family. That work life balance for leadership is STUPID and counter productive...but it probably is much cheaper than any alternative. I honestly feel that that work/life balance is why managers expect that in some small sense of their employees too, and again, the only thing we have proof of is that we get one shot at life. So what does my employer do that is so wonderful that I should be that dedicated? My employer would drop me in a heartbeat if they had to....actually I saw exactly that happen to a bunch of outpatient nurses during the pandemic. Also, my employer can notice me being late and cry me a river. In 15 years of nursing there has probably been less than 20 shifts where I got out early or on time....or got my lunch. So please tell me why I have to be worried about clocking in 1-2 minutes late? Professionalism? A word that has no definition but to the person who is trying to use it. Professionalism means entirely different things to different managers, much less the part of the country you live in or the area you work. Punctuality alone an arbitrary measure. When placed in context of 20-30 days of 2-3 minutes tardy AFTER shifts you can easily see that I gave up my lunch and 30 or more minutes of my evening.? PUH-Leeze. You have a tinsy winsy point that the off going shift doesn't deserve to be late, but I work in a clinic at my current job...there is no shift to relieve. There are just 9 surgeons having clinic as they please, regardless of my lunch or my clock out time. Sigh, I really wish I could see some value in being in management because I don't see my next step in nursing. I almost think my next career goal is to go work at COSTCO or Starbucks. I'd rather stay at home with my 3 year old and my husband any day than go to work. Sure I like people, and I feel good about serving my community, but not more than I value my time at home. And sadly, I don't really find myself having admiration or respect for those who do. I more often see them as over worked, resentful, out of touch, shallow, and money hungry. I did not use to see it that way, but 15 years in the field has made it so.

Now there is a real thought. I think it would be more beneficial to have an RN who has certification in the areas s/he is working in rather than a BSN. I still hold that I feel highly critical areas of nursing should have a BSN as well. To be honest I didn't find school to be overly helpful in learning techniques, skills, or time management. I did not learn to be a nurse at school, most definitely. I learned to be a nurse working the floor. However, the step by step process of thinking through a problem, identifying solid literature from 'Google' fluff articles. Those were valuable lessons from school and still help me in my practice today.

"Some times" formal education IS irrelevant for SOME people. But establishing average pathways of achievement usually occur because 'on average' the required amount of education achieves the desired outcome. The question is 'Are they going to phase out ADN.’ In general the answer is 'No'. On average I think we can all agree that ADNs are under utilized. But I would maintain that 'on average' the best outcomes for the patient and the employer in highly critical areas (ER, ICU, Stepdown, Transplant, etc) would be a BSN RN who has has at least 2 years of floor experience. Best basic would be Tele Med Surg.