joe007

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.

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...

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!

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.

Why report? Why not just leave quietly? If she reports, wouldn't that open her up to some sort of investigation since she is interim DON?

Well, I can say I feel the same way, but have only been a nurse for a little over 5 years. Thanks for sharing.

If an employer has job openings posted and is understaffed they can tell the state DOH that they would hire people, but no one is qualified to fill their positions, look at all the job openings we have open. Therefore, the legislature will put more money into nursing programs and create a nursing surplus to further drive down nursing wages. It's a win win for the hospitals and a lose lose for nurses. Admins aren't stupid and they don't have your best interest in mind.

Don't worry, the admins that started down this path to a hellish environment years ago probably got massive bonuses and moved up in the company ladder so they can do the same thing at a systemic level. The new managers probably were told to run it like it had been run by the higher ups that created the system. Don't worry, no one will go to jail, the higher ups get to keep their bonuses, and the middle managers will be replaced...

As for using an "illegal" recording in court, there have been many instances where such recordings have been approved by the court when criminal conduct is captured. It's not black and white. Anyhow, I record conversations. Once you're illegally threatened, you'll do what it takes to protect yourself. Think about Michael Cohen, Trump's lawyer. Did he get any additional time for having many tapes of convos between himself and his clients which he handed over to Federal Prosecutors? No. He didn't. But I guess he also didn't break the law because under Federal law and NY state law, he has the right to record those convos.

It's smart to do things via e-mail. They are all discoverable in the future if legal action is needed. Additionally, I know a PI who tells me you can get copies of your credit report which should include what other employers/background check uncovers and what others have said about you. As for recording: https://www.mwl-law.com/wp-content/uploads/2018/02/RECORDING-CONVERSATIONS-CHART.pdf

Medicine and nursing is very corrupt. That's why CYA is always cited. Additionally, never go into a manager's office without your smart phone recording the convo. They like to have a manager and someone else in there as their witness when they do throw you under the bus... your only proof is audio of the convo. Anyhow, sorry that happened to you.

Sorry you were fired. Knowing what I know about administration it doesn't surprise me even if you did nothing wrong that they would drive you out for something unrelated to the real reason they wanted to fire you. It's interesting how many RNs seem to live in fear of administrators when the "emperor is not wearing clothes." The climate of fear is all admins have to assert control and a great way to do that is target and terminate people who speak out. This is why nurses need strong unions.

How old are you? If you're under 35 get out now; honestly, the stress will only compound as time goes on.

I think people should document in first person and use other coworker's names and positions. The idea of this third person lingo being a standard and not using names being superior is a bunch of bunk and putting you as the note writer at risk. Ultimately, if you refer to "charge nurse" instead of "Billy the charge nurse" lawyers will ask you who the charge nurse was that day and you'll have no idea. Schedules may have been lost, manipulated, etc. and you will have to rely on your unit/hospital to provide that information, which may or may not be accurate. What if they ask you how many nurses were working that day and out of those nurses how many are qualified charge nurses? If so, how do you know which charge nurse you told which information, AKA they could posit you told the wrong charge nurse? Anyhow, if you refer to "MD" which "MD" are you referring to? How many physicians work in your hospital on day shift? How many hospitalists cover your unit/hospital? How do you know it wasn't a specialist you talked with? etc.? It seems that the style works in favor of the hospital and coworkers at your expense. Shocking, I know, to think that the nursing industry is set up to be the patsy for billion dollar corporations and multimillionaire physicians.

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...

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

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.

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.

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?

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.

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.

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.

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!

Fly under the radar.

Everyone has their own pace. Just realize that sometimes it isn't you, it's the facility, culture, or general environment/energy of a place that doesn't allow you to self actualize. You have not failed, you just realized where not to work. In the future, you may do very well working in those places. Good luck.