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joe007's Latest Activity

  1. I think the NCLEX and nursing program I was trained in was BS to begin with. Essentially, most NCLEX questions can be answered by either studying Kaplan or some other test prep materials. My nursing school dean admitted to me that only 70% of our material was presented in the material (about 500 pages of reading per test of which we had four tests every two weeks) and that the other 30% of questions from their test bank were "experimental questions." AKA, no incentive to read the book and understand nursing in a comprehensive manner because doing so was non-feasible given time restraints, but there was much more of an incentive to do random questions on ATI, Kaplan, end of chapter reviews, etc. I passes NCLEX in 2013 with 75 questions and a 3.8 GPA because I understood how the game was played. However, I am a second degree student and believe that if nursing was taught as a comprehensive subject where one draws associations in their answers between clinical presentation and clinical action in a comprehensive scenario to ensure nurses actually understand the depth and width of nursing practice, the nursing workforce would be much better prepared than the "pick the best answer" type model the NCLEX is. Essentially, the NCLEX and nursing school is an IQ test in my opinion. My instructors told me that we need not worry that much about being that great at nursing because "you'll learn when you get hired." My professors also bragged about our program having the highest NCLEX pass rate in the state.
  2. joe007

    Low RN pay

    Make $52,000 a year with 6 years of experience as an RN. I have a BSN. A decent house 2000 sq ft + house costs about $300,000 in my area and a new one with the same sq ft about $400,000+ in my area. I make $1 an hour extra for being in charge of a 31 patient psych unit and usually manage about 8 to 10 staff at a time as a charge nurse/supervisor. I am looking at my friends who are as smart or not as smart as me who are "managers" or "supervisors" at insurance companies, services companies, financial service, or engineering companies, etc. who also have a BA or BS degree and an equal number of years experience and they make about double my base salary and have bonus on top of that. Nursing in no way is providing a standard "middle class" income for me and my family, we are in the lower middle class. Honestly, we are on the edge; one catastrophe away from being in major debt. Relatively little retirement savings. I guess leaving the "field" is the best way forward. I already have an Associates in logistics, BS in nursing, and BA in political science. Honestly, they have to pay better to retain talent and give adequate raises. Sadly, nursing admins only care if you have a pulse and show up to work. They really could care less about your assessment skills, experience, and giving a damn to make things work. I guess some things never change...
  3. joe007

    feeling reprimanded unfairly

    If you are a party in the conversation in 36 states you have the right to record the conversation without other people's permission. Boom!
  4. joe007

    feeling reprimanded unfairly

    We already covered that above. In 36 states it is legal and it's also legal under Federal law. I don't have any problem with being on tape. What do I have to hide? Transparency is important and something that is sorely lacking in healthcare leading to corruption. I recently have been thinking they should have body cams like the police do, but nurses should wear them in hospitals. The coverups and glossing over of CMS violations, etc. is astounding.
  5. joe007

    Reporting coworkers

    Sounds like it's time to walk. Just don't get involved. It's the regulatory agency's issue to find and solve. If you'd like, you can send info anonymously to the regulators. Additionally, if you do get involved, you should put it all in writing and e-mail so it is very clear what you are communicating and when. Additionally, record conversations on your phone when you have them with coworkers/management as evidence. They will try to push you out and destroy you if you report and are identified...
  6. joe007

    Integrity vs job security

    So what happened? Also, why not just print the citation and put it in their mailbox in the middle of the night? Anonymity.
  7. joe007

    Transitioning to Psych / tips wanted!

    Make sure you understand the following Federal Regulations: State Operations Manual Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf A-0154 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e) Standard: Restraint or seclusion. All patients have the right to be free from physical or mental abuse, and corporal punishment. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time. A-0159 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e) (1) Definitions. (i) A restraint is— (A) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely; or A-0160 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(1)(i)(B) [A restraint is - ] A drug or medication when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition. A-0161 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(1)(i)(C) - A restraint does not include devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests, or to protect the patient from falling out of bed, or to permit the patient to participate in activities without the risk of physical harm (this does not include a physical escort). A-0162 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(1)(ii) - Seclusion is the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving. Seclusion may only be used for the management of violent or self-destructive behavior. A-0164 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(2) - Restraint or seclusion may only be used when less restrictive interventions have been determined to be ineffective to protect the patient, a staff member, or others from harm. A-0165 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(3) - The type or technique of restraint or seclusion used must be the least restrictive intervention that will be effective to protect the patient, a staff member, or others from harm. A-0166 §482.13(e)(4) - The use of restraint or seclusion must be -- (i) in accordance with a written modification to the patient's plan of care. A-0167 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) [The use of restraint or seclusion must be --] §482.13(e)(4)(ii) - implemented in accordance with safe and appropriate restraint and seclusion techniques as determined by hospital policy in accordance with State law. A-0168 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(5) - The use of restraint or seclusion must be in accordance with the order of a physician or other licensed independent practitioner who is responsible for the care of the patient as specified under §481.12(c) and authorized to order restraint or seclusion by hospital policy in accordance with State law. A-0170 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(7) - The attending physician must be consulted as soon as possible if the attending physician did not order the restraint or seclusion. Interpretive Guidelines §482.13(e)(7) A-0171 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(8) - Unless superseded by State law that is more restrictive -- (i) Each order for restraint or seclusion used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others may only be renewed in accordance with the following limits for up to a total of 24 hours: (A) 4 hours for adults 18 years of age or older; (B) 2 hours for children and adolescents 9 to 17 years of age; or (C) 1 hour for children under 9 years of age; and A-0174 (Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08) §482.13(e)(9) - Restraint or seclusion must be discontinued at the earliest possible time, regardless of the length of time identified in the order.
  8. joe007

    Leaving nursing

    I actually think you should follow your gut. Maybe try another place or two and then leave the field if it doesn't click. Honestly, it's a thankless job and most nurses seem to be disgruntled and angry once you get through the shallow veneer of niceties which many nurses have perfected because they have to show "customer service skills" in the midst of being powerless and engaged in a futile career defying nature (which is very stressful in acute care life/death situations) where they make just enough to pay the basic bills unless you're willing to put in 60 hrs a week (which will leave you emotionally and physically exhausted) or become a traveler. I have worked at 3 hospitals in 6 years, and all of them have horrible retention. I was working at a level 1 university trauma center in the ED which was union. After working there for 1 year, I was half way up the seniority list. And by 18 months I was 3/4ths the way to the top. Only 10 nurses in the entire department had worked there for more than 5 years. No one had worked there more than 7 years. This department had over 120 full time RNs plus a myriad of travelers. This is at a top five hospital in the state at a major public university with over 50,000 students recognizable to the general public, and they have a great football team. You would think they wouldn't have an issue retaining great staff, but they couldn't retain many because they didn't pay very well ($28 an hour), management was horrible, and doctors would try to throw RNs under the bus when the doctor messed up. It ended up that they fired our manager in the end, but they went through a total of four managers in two years. I worked in another ER and they went through three managers in 2 years. Where I work now, we have gone through two managers two years and will probably be getting a new one soon. "People leave managers, not hospitals," which is somewhat true. Maybe some of the other units at the hospital were managed well? There's very poor management in nursing and everything is about profit. Don't set your sights/ideals too high because you'll realize at some point that patient care suffers so the boss can show a larger profit to their boss. Once you get enough experience that you're not thinking about your skills on a daily basis and understand the deeper understanding of the politics of the unit and hospital and how mismanaged things are, you'll probably become angrier and disgruntled. Additionally, they (doctors and administration) will always scapegoat the lowest man on the totem pole if possible and people lie, lie, lie! There's no integrity or honor in medicine/nursing. If you can find a job in a government agency, work there. You'll have better hours, pay, and a pension in addition to 401K if you work for the feds or a good state government. I work for the military in the National Guard and have been there for over 10 years and multiple deployments. They actually have written policies and directives for everything, which most hospitals do not. Integrity, excellence, and service are vital to the mission and everyone is on board to help each other to achieve the objective. Because there is such investment on training, indoctrination, and technical order formation, the organization works pretty well. Also, leadership actually takes on issues and has authority to resolve issues or implement solutions. Much of the nursing management model seems to revolve around not making a decision and allowing nebulous decisions to be made. One e-mail will say one thing, another e-mail will say something else. When you ask for clarification, the manager may tell one employee something and tell another employee something else. Only one hospital I have worked at had written policies for everything, it was the university hospital in the prior paragraph. Anyhow, because expectations are clear, there's very little stress unless deployed to a combat zone where you have to think about survival. I would suggest that if you dislike what you're doing, educate yourself out of the problem by getting a masters of PhD, or do the American thing like start your own business where you're the boss and make money.
  9. joe007

    Fired for taking vacation

    Interesting take on events. It's interesting that someone speaking in a direct way is threatening to a boss when it is obviously very important to the employee that she retain her vacation for many reasons (family, financial, work-life balance, etc.). Why should she beat around the bush and cave to the will of the boss? What is the boss going to do for her? How many times should she allow herself to be jerked around? Where does it stop?
  10. joe007

    Why do some nurses "hate their jobs"?

    I would argue that you can love being a nurse but be totally fed up and burnt out because of the environment in which they (govt., regulatory, insurance, management, etc.) have created nursing. Essentially, if you actually care about your patient's health and outcome, you really have to start questioning the insane world healthcare exists with the ridiculous ratios and regulations. If you care to advocate, you'll burn out because you have no power to change the system. Caring is what is so demoralizing when the system only cares about money, and you care about people getting the best care. It leads to burnout and apathy. I think people who can care in the current system and not get burnt out are great at cognitive dissonance. Additionally, nursing isn't like other fields. If you miss something in food service, like hold the onions and ketchup, no one dies. If you miss something being a lawyer, no one dies or is maimed. Even in the military and police forces, the number of times you are making life/death decisions is very low, not even a daily occurrence in most cases, vs working in the acute care setting it is literally every minute of every day. That leads to burnout. I have seen people die because things were missed by providers/staff, delays existed in the system, people didn't get the care they deserved. Again, the best nurses are those who practice cognitive dissonance and reason that a certain number of people are going to die because of preventable things like; things will be missed, people will be delayed, you'll be ignored or threatened or lashed out at when you advocate, or don't think too deeply about what happens at work; certainly don't take things to heart. I am not wired that way and cannot separate what happens at work from the rest of my life. AKA, I take my work home and think about it. Unfortunately, thinking about work in nursing is draining and stressful leading to a higher rate of anxiety and stress than other fields. I would like to leave nursing and healthcare, but finding an exit strategy is hard.
  11. joe007

    Psych Nursing - Boring?

    I don't think it's boring at all. Creating a therapeutic milieu is what is different from a medical floor -- which I like because I like calm and creating calm environments. If you like crazy non-stop action go to the ER (been there, done that). What's interesting in psych is when you talk to people and get their story. Additionally, I would argue people are a mystery -- you're the detective trying to figure them out. Unlike physical health, mental health a lot of the time remains nebulous at best. Understanding the diversity of people, their experiences, and how they work will make you a better psych nurse and you will start to see patterns in other patients with slight variations of certain diagnosis. If you find human behavior interesting, mental health is a great field.
  12. joe007

    How safe to you feel working in mental health sector?

    We had three assaults in one day recently on our unit. It is always a reminder that you need to be alert and aware at all times on the unit.
  13. I get what the school is having an issue with. Not showing up and canceling is a no go in nursing. However, I think school is more of a learning moment and should be less punitive. Has the school given you any time to change you behavior? It sounds like they failed to give you a chance to change... Anxiety is real. Are you being treated medically for it? If not you should seek treatment and try to learn some coping skills. Nursing is a very anxiety producing field. Perhaps you should look into another line of work where your anxiety would not be triggered if it incapacitates you. Although, some anxiety in nursing is good because it keeps you on edge. Some nurses are too lax and it ends up they miss critical information/signs/symptoms etc. I am sorry you are having these issues. Nursing is an OK field (I have been working as an RN for 5 years), but lacks good retirement. By far, there are much better places to work. I am in the National Guard and get paid better and the work is much easier than nursing. If you feel called to nursing, fight to stay in. If you are just doing it because "why not" then try something else that might be a better fit. Good luck!
  14. joe007

    Inappropriate Conversations in the Workplace

    Fly under the radar.
  15. It sounds like you like public health/policy more than "nursing." Good for you getting out of the trenches of the US pharma/medical hospital system.