pppp87

No the only prns we have our emergency seizure meds. The MDs are to prescribe orders very cautiously and specific to each resident since most are geriatric and all our developmentally disabled. The doctors have not complained at all and encourage me to call with any issues. I spoke with my supervisor and the clinic nurse from last week. They both assured me that nothing I did was wrong, and that it was the doctors decision to make it an emergency call. My supervisor told me to do whatever I need to do to maintain my license, and not worry about what anyone else thinks. The culture here is to bash and gossip, and unfortunately a lot of that behavior is seen in our DON. She is a good nurse in a very stressful job, and takes that out on staff openly in our meetings. She berates people who ask "stupid" questions and literally just creates an atmosphere where everyone hates admitting mistakes and nev hesitates to point out those that do. I believe I know who may have told tgis gossip to ny staff and plan to ask her about it tomorrow. We also have our monthly meeting with the DON and the newest staff members so I may bring it up then as well. The job is not very demanding, but the gossip and attitudes are just ridiculous.

I've been a nurse for over 3 years. My current position is in a group home setting that is funded by the state. We have several different group homes with adults who have DD. My position before working here was on a step down floor, so total different ball game. It's been a somewhat difficult transition for me, because I'm used to "acting now", having the MD on standby for whatever I may need. I try not to abuse that principle and the MD actually encourages me to call about anything, even if it's just me not having a good feeling about the resident. I've worked in a nursing home before also, where we were able to act somewhat independently of the MD. If Johnny gets a scratch on his leg, and he's not allergic to ointment, it's 5 am in the morning, just apply some and follow up in the morning. My current job is state-funded and our DON is all about calling MD first for orders. I work on day shift so it's not a big issue. So, my issue with this job is mainly the gossip. It is SO prevalent. To the point where people won't tell you to their face what they think or question your actions, but will raise all kind of hell behind your back and notify supervisors. Apparently, the new gossip about me is that I call the MD about everything and don't use nursing judgement to carry things out. This was told to a staff on my home and asked to be anonymously told to me. Smh. I've called the doctor 3 times last week, one was for hydrocortisone for a rash, one time for barrier cream for a stage 1 coccyx (we need MD order for any ointment). Last time was a call after a resident had seizure like activity, and threw up. He sat down, I checked his vitals and systolic was 82 in one arm and 84 in the other. I called the MD, who told me I needed to call an emergency call to our clinic nurse right away (meaning the clinic nurse will have to come out and assess and bring him back to the clinic for monitoring). I called the clinic nurse, who got upset because she had several other things going on. She said the staff needed to bring him. I told her staff is shorthanded right now and can't, but regardless MD requesting emergency call since he's hypotensive. All she focused in on was the fact that I said staff was shorthanded and can't, and got furious that they were being called out. This MD is known to always ask for residents to be seen in the clinic when you call about anything. But anyway, I guess word is getting around that I called an emergency call simply because the staff was shorthanded, which was not the case. I usually don't care when people gossip but to attack my nursing judgement because I "call too much"? And then to not have the guts or ethical conscience to discuss it with me or at least my supervisor? I care immensely about my residents and try to act as if they were kids or grandparents. If my child gets a scratch on his leg, I want him on some Polysporin. Unfortunately as a nurse, I can't just apply it and run on about my day. I have to get a MD order to protect my license. And the MD I primarily work with has no problem with me calling. What if my resident has an allergic reaction and I've been applying ointment BID for a few days? I was off for 3 days and there were 3 new orders for my 10 residents when I came back (an antibiotic drop for redness to eye, ointment for hand peeling, oral antibiotics for superficial leg abrasion) so other nurses have been calling and advocating for "minor" things as well, which I see no issue with. I'm going to talk to my supervisor later. But I just really hate that this place is full to the brim with gossip. It wouldn't matter if people actually directly called me out on whatever they thought was wrong, but behind the back insaneness is really annoying and frustrating. Any tips on how to deal with this?

Hi! Yes I did! It is very similar to geriatric/LTC so you should enjoy it. You moreso than in LTC have to be and advocate for your residents, because they can't speak for themselves/tell you when they're in pain. I don't have too many guys with dementia, but all with DD and it's very rewarding to correctly assess a situation and give your resident the care they need. I do hope you look into a position!

I've been a nurse for over 3 years. My current position is in a group home setting that is funded by the state. We have several different group homes with adults who have DD. My position before working here was on a step down floor, so total different ball game. It's been a somewhat difficult transition for me, because I'm used to "acting now", having the MD on standby for whatever I may need. I try not to abuse that principle and the MD actually encourages me to call about anything, even if it's just me not having a good feeling about the resident. I've worked in a nursing home before also, where we were able to act somewhat independently of the MD. If Johnny gets a scratch on his leg, and he's not allergic to ointment, it's 5 am in the morning, just apply some and follow up in the morning. My current job is state-funded and our DON is all about calling MD first for orders. I work on day shift so it's not a big issue. So, my issue with this job is mainly the gossip. It is SO prevalent. To the point where people won't tell you to their face what they think or question your actions, but will raise all kind of hell behind your back and notify supervisors. Apparently, the new gossip about me is that I call the MD about everything and don't use nursing judgement to carry things out. This was told to a staff on my home and asked to be anonymously told to me. Smh. I've called the doctor 3 times last week, one was for hydrocortisone for a rash, one time for barrier cream for a stage 1 coccyx (we need MD order for any ointment). Last time was a call after a resident had seizure like activity, and threw up. He sat down, I checked his vitals and systolic was 82 in one arm and 84 in the other. I called the MD, who told me I needed to call an emergency call to our clinic nurse right away (meaning the clinic nurse will have to come out and assess and bring him back to the clinic for monitoring). I called the clinic nurse, who got upset because she had several other things going on. She said the staff needed to bring him. I told her staff is shorthanded right now and can't, but regardless MD requesting emergency call since he's hypotensive. All she focused in on was the fact that I said staff was shorthanded and can't, and got furious that they were being called out. This MD is known to always ask for residents to be seen in the clinic when you call about anything. But anyway, I guess word is getting around that I called an emergency call simply because the staff was shorthanded, which was not the case. I usually don't care when people gossip but to attack my nursing judgement because I "call too much"? And then to not have the guts or ethical conscience to discuss it with me or at least my supervisor? I care immensely about my residents and try to act as if they were kids or grandparents. If my child gets a scratch on his leg, I want him on some Polysporin. Unfortunately as a nurse, I can't just apply it and run on about my day. I have to get a MD order to protect my license. What if my resident has an allergic reaction and I've been applying ointment BID for a few days? I'm going to talk to my supervisor later. But I just really hate that this place is full to the brim with gossip. It wouldn't matter if people actually directly called me out on whatever they thought was wrong, but behind the back insaneness is really annoying and frustrating. Any tips on how to deal with this?

I have an interview tomorrow at a DD residential center that's funded by the state. I have experience in LTC and acute care. I'm really hoping that I get the position, because it pays surprisingly well, I have a LOT of patience for geriatric and DD populations, and I love the pace of work at LTCs. I'm not really sure what to expect though?? Is it similar to working at an LTC, getting report, passing meds, helping with care, documentation? Are shifts 8 or 12 hours (I'm hoping it's 12 hours!). Any insight would be welcome!

It's been 4 long weeks since I lost my job. I was terminated after 15 months working on a step down unit. I had 3 writeups total during my employment all related to not completing education on time. One was a module, one was a skills check off, the last was my BLS card was not renewed on time. I take full responsibility and have made no excuses in interviews. I talk about how I learned from my mistake and am was actually up to date with all of my education on the day of my termination. I made a binder in November after my last write up and was keeping up with the quizzes and modules. I have never had my marks against me for patient care, have my BLS, ACS, working on step down certification, and just had my annual evaluation in February with nothing but positive remarks about my patient care but unfortunately marks against me keeping up with education. I graduated with honors, have always been responsible, but for whatever reason just didn't deem the mandated education that important. I studied on my days off, I would always eventually completely the education, but not always on time. I understand where I messed up and willing to change that. I didn't think this mistake would haunt me as much. But the only other major hospital system in my city is BIG on education. I have interviewed with 3 managers at 3 of their different hospitals and they all have stressed their focus on education. The interview always seems to go downhill after I talk about my termination. I try to present myself as a clinically sound nurse who just was not negligent with the mandatory education on our unit. I am sooo depressed and frustrated!! I miss patient care. I miss working. 3 back to back interviews that all seemed to end on a negative note has deterred my confidence so much! I get so nervous during the interviews, even if I'm well prepared. I feel like I am having to relive the shame of being fired every time I'm interviewed. No manager has seemed to have mercy or understanding. They all look at me like I have a 3rd eye when I bring up my termination. I have at least one more manager to meet with but I want to try to have this one end positively at least. Any advice on how I can bounce back from this termination? ::desperate::

Yep.. I haven't given anything to date without an order here but it is what is expected in an emergency here, especially at night when the doctor is almost always not readily available. During the day, IV's have been started, D5, fluids, neb's etc have been given w/o an order. We should really have a Dr oncall here..

The evening charge called the hospital this evening and found out the pt was admitted to the ICU. My DON is still brushing it off and saying that everyone here probably has urosepsis and that's something that could be treated here... I was offered a job at a PCU in a teaching facility so hopefully I can move on and get a better nursing foundation there...

@missnurse01 thank you for your comment! my don was acting as if i was sending her out for resp distress. I never stated to the NP, DON or EMS that she was in distress. But a sat of 82% clearly just isn't right. thank you for your kind words and comment... @psu_213 thank you for your comment. my don actually encourages us to give meds without an md order. she criticized a new nurse, asking her what she would do in an emergency if she wasn't able to get an md. her expectations are that we act first and get an md order later. being a newer nurse, i don't have the experience to do so. nor, would i, since to me its unethical. we have an md for a reason... thank you for your advice about calling in report to the er. I've never seen it done here actually but I would love to give the ER report because I'm sometimes worried that EMS won't relay everything to them..

I've been at an LTC facility for 3 months now. One thing is clear at my facility: take caution before sending residents out to the hospital. I was always taught as far as LTC goes, especially as a newer nurse, "when in doubt, send them out." At my facility, the DON seems to be overly concerned with the # of Medicare patients and how it affects the total reimbursement from Medicare, i.e. $$$, folks. Anywho, I had a 65 yo resident with hx of cva, afib, dvt, esrd and hypertension. Due to the cva, she has dysphasia and can't communicate well. It's apparent to everyone that she's "with it" and understand's what's going on around her but her speech is distorted. She's usually always "talking" though. This morning at 0500, in the middle of my medpass, the CNA's grab me and tell me she's lethargic and not responding as usual. I go in and sure enough she's very lethargic and not responding verbally at all. She's able to follow my commands and squeeze my hands, but very weakly. She couldn't lift her arms at all. Her eyes occasionally rolled in the back of her head and she couldn't keep them open for long. She had a fixed stare at times, so I thought maybe she was having a cva. Her skin was cold. Her bp was 139/77, when her SBP is usually 80-100. Her o2 sat was 82%. I put her on 2L. Her bs was 114, no hx of DM. After I put her on 2l, I wasn't able to get a pulse ox reading. I grabbed the other nurse who was working and has years of experience and she agreed that she didn't look well. I sent her out and 20 mins later the ER Nurse calls me with an attitude saying she's treated this patient 3x before and this is her baseline. I calmly told her she's been a patient of mine for 3 months and this is definitely not her baseline. The woman argued with me that because of her hx of cva she is completely nonverbal and doesn't speak. I explained to her she does speak, although incomprehensibly... The patient was admitted for urosepsis. My DON said I did a good job assessing, but why didn't I think of giving her a nebulizer treatment? To my knowledge, the resident has never had respiratory issues. She basically told me I should've done more to try and keep the resident there because it looks bad when the hospital is audited by Medicare for readmissions. I just leave work sometimes feeling horrible. I try to put my patients first and care for them as I would my family. I don't have all the insight and years of critical care experience that my DON has. If that was my grandmother lying in the bed, I would definitely call 911 after doing all I knew to do and still feeling something wasn't right. We're not even able to call the doctor at night, we text him. And it usually takes him eons to respond back. The DON almost expects perfection. If something would have happened to the resident, I would've been blamed. Can't win for trying at this place! I managed to get all of my paperwork done, call the family, finish my med pass, medicate a seizing patient and deal with some low blood sugars and all she could point out were the things I missed this morning!! Ugh :/ Just venting...

Hey all. I'm ending my 3rd week in oriention on a med surg floor. Things are going okay, definitely not perfect but I'm learning. My coworkers have made some comments to me that concern me. The first was from another nurse that precepted me on my first day on the floor. I was scared as hell. I've been out of school for a year, did some home health for a few months and this my first acute care experience. I'm a shy person and get anxious sometimes (looking into counseling next week). Anywho, as much as I try to fake it, I don't come across very confident and I know it. Anyway, the nurse ended the day telling me that I did a good job and he told me to keep coming back. So a week later, and I'm working with my assigned preceptor. I'm standing by our computer doing chartiing and the guy says (very loudly) "Do you know what you're doing? Do you REALLY know what you're doing? Do you even care?" The 4 or so staff members turn and look at me. At first I thought he was joking (he's pretty sarcastic), and I was getting a joke ready for his 1st question, until he hit me with the 2nd two. I was speechless, caught off guard, didn't know what to say. I couldn't even make eye contact with the guy I was so embarrased. The second comment came today from one of the nurse tech's. We had a patient who's been on the floor for about 3 weeks. Everyone knows she is notoriously needy and is on the call light every 30 min complaining about something. This tech even complained about the patient earlier. The tech comes up to me and says "Room 42 is asking for her nurse; she says if she doesn't get her dressing changed in 5 min she's calling the nurse manager." Me and my preceptor laugh it off. I go get the stinger so I can pass some of these woman's meds while I'm there. I'm visibly upset because we've done 110% for this woman and it still hasn't been enough. The tech walks by, looks at me and says "PPP87, you sure you still want to be a nurse?" I thought she was joking, so I said "Riiiiiight?". But apparently she was dead serious and walked away. I was able to calmly explain to my patient that we wouldn't be able to get to her dressing on day shift and handle the problem (ie I didn't let her see me upset). It seems like my coworker saw my smug look and assumed I would go in with the same nasty look on my face. But a lot of the patients complain that are tech's are nasty to them (I've seen some of it). The techs', nurses and even my preceptors don't always LIKE the patients when they're talking about them at the nurse station... so why is it a big deal that I'm not visibly happy about going into my patients room for the 700th time that hour? I have a lot of insecurities as a new nurse, but I'm wondering what kind of vibe I must be giving off to my coworkers that makes them question if I even want to be here? I want to be a great med surg nurse... but every day on the job I"M scared as HELL!!! Being a shy person doesn't help. I don't understand how I come off as not caring or uninterested in being there.