norlns24

Best of luck to you! Also, having that "secret stash"...wow! That sounds really sketchy. Hate to get lawyer-ly about the whole thing, but a clever attorney might use this fact to your advantage when fighting to keep your license intact and background clean. I am not trying to excuse your behavior, but the secret stash of a controlled substance (schedule II) could very well be argued to be a significant contributing factor in this case. The fact that your manager and the owner of your clinic are acting in an empathetic manner toward you is both hopeful and interesting. I'm a bit curious if they aren't concerned about the way the clinic had been being run -- both in the global sense and more specifically and importantly for you, how their exposing your action to authorities might in turn shed light on some shady clinic practices (of which they bear ultimate responsibility).

Almost the exact same rule change occurred at my school, with various HESIs each semester...some counting towards a grade and two "high-stakes" HESIs (one for med-surg and one our final semester, the dreaded exit HESI). However, my program phased in these changes over several semesters. An 850 on any HESI (except perhaps pathophysiology...that's one specialty HESI most of the students in my program did not do well on but it was administered our first semester and did not count for anything...just a practice) is quite doable in my opinion. HESI questions can on their face seem difficult, but a lot of their questions offer some valuable clues that, if you pick on them, can lead you to the correct answer without actually knowing much about the topic. To me, HESI is as much about being able to really carefully read a question and the answers critically and pick out the correct one as much as it is about knowledge. Also, if you study the prep materials HESI puts out, your score should improve a lot because the study preps they publish contain much of the info you need to do well on their exams. My first HESI (for fundamentals, also did not count for anything except practice) was pretty low, somewhere around 730, but once I realized HESI's were going to count towards my grade and even keep me in the program and I actually studied for them, and my scores shot way up above 1000. For my exit HESI, I studied a LOT but did really well. After improving so consistently, I now feel 850 is completely reasonable. Some programs require a 950 in 3 attempts for the exit HESI, so having to attain an 850 is not the end of the world. If you study for HESI using their materials, do a lot of practice questions, and take your time on the exam and read VERY slowly and VERY carefully looking for clues and key words, you really should not have a problem achieving an 850. I believe getting an 850 on HESI is considerably easier than passing NCLEX, something we all have to achieve eventually if we want to practice as RNs. Good luck to you!!

My program never allowed a nurse to administer ANY meds (esp. high-alert insulin) without the **direct** supervision of either an RN (during our final semester "leadership" clinical) OR the clinical instructor (all other semesters)....always someone with active licensure. We had to perform the six rights of med administration with instructor or nurse and we were told to never admin. meds w/out a nurse or instructor directly at our side. Administering meds to a patient with the nurse or instructor in the hallway was expressly not allowed and this fact was made abundantly clear to us and reinforced in clinical orientation each semester. Now I see why! I believe your instructor and the program share some of the blame for this error. I believe my program got it right. I have very little doubt had your instructor been by you side as you completed your six rights and guided you through the actual med admin. (even just to observe as you were indeed in your final semester), this mistake would not have occurred. Yes, I agree, this experience is a learning moment for you. Also, I know others might argue that in the final semester of nursing school, some level of autonomy is necessary as student nurses are transitioning to professional nurses. However, we all can agree that most nursing skill and practice occurs on the job. School and clinicals offer quite limited opportunities to gain practical experience, which is why most facilities offer residency programs/ orientation periods/ preceptors to new grad nurses in order to further this transition. I am disappointed the entire focus of this med error appears to have been placed on you. I believe the best institutions and agencies take a global approach to problems and adverse events. By your description of the event, this process did not occur as no one appeared to consider or question the lack of safeguards I have described. Best of luck to you moving forward.

The OP's post is sobering. In two separate health systems, I am asked about medications (for pain) I was prescribed ONE TIME and never ended up even taking (rx'd for pain related to surgery complications that thankfully subsided and is no longer an issue). In both health systems, these medications are listed as active and I am asked about them religiously at each visit. I have repeatedly told the nurses reviewing my history who have asked about these medications to change my health record to indicate I am not actively taking these medications and NO LUCK! I was seen just a few weeks ago for a regular ENT appt. and was asked yet again about past medications I have never even taken and that were prescribed only one time! This situation imo is potentially counter-productive. I get the rationale for electronic medical records. I get the rationale for continuity of care. However, patients deserve some control over their own medical record and records need to better reflect current health states. In my med surg clinical, we read a very powerful editorial from a journalist with a bipolar disorder dx who has been treated differently and unjustly refused medication by her PCP for pain based on this stigmatizing MH dx. This situation is more than a bit out of control. Yes, OP, you have a right to be hurt and even angry about your discharge instructions. No one should be judged for or permanently labeled by their darkest day.

RE: The "Going to be fired" thread aside, LTC staffing levels, generally speaking, are inadequate. Even all of my nursing instructors admitted this fact numerous times. They stated unequivocally that most LTC facilities in my state (IL) are not adequately or safely staffed. No surprise many are for-profit enterprises. I get that nurses need to be organized, efficient, have good time management skills, be critical thinkers, etc. but at some point the fault (in some instances) lies not 100 percent with an individual nurse's skills in these areas. Some blame for med errors, bed sore development, falls, etc. lies with inadequate staffing. Truth.

Probably depends on how much paper work is involved and who will look good or not look good if this situation gets exposed to a wider audience w/in the agency and how much pressure the department is under to keep costs in check. Firing a new nurse to turn around and hire and train someone else is very costly. If the daughter was hired by the same manager who caught her, she might actually be safe. At my current company, when the labor market was tight and we needed employees for staffing, it was a well known fact that people who normally would have been fired during probation were kept on to cover staffing. I realize in most places, the nursing labor market is ANYTHING BUT tight, but in some areas of the country it is. Also, when one of your hiring choices messes up, the individual or committee who approved the hire looks bad, too. I am not arguing the charges are not serious (as has been outlined in this thread in detail). Just stating a lot depends on external factors in this case as to whether the daughter will get fired.

Generally speaking, for therapeutic communication questions you will find on your MH exams...some basic rules are: 1. The RN generally should avoid giving any type of advice. A better answer is "What do you think would help you accomplish xyz".... versus telling the pt what you would do in their shoes. 2. Reframing/ rephrasing a patient's question or statement for clarification, to encourage the pt to talk and share more, and/ or to show you are listening is good/ generally the correct answer. 3. Use of therapeutic silence is good and usually the correct answer. 4. Incorrect answers often focus on the RN relating his or her own experience to the patient's -- everyone's experience is unique. 5. Anything that promotes a client's sharing of feelings is GOOD, anything (including cliches) that closes off discussion is BAD. 6. Look for open ended questions as a therapeutic response -- if there are 4 options and only one of them is open-ended, choose it b/c open-ended questions/ responses foster communication. 7. Avoid any questions that ask or imply "why" because "why" could be perceived as judgmental or could make the patient defensive. 8. General statements (re: death, grieving) that express empathy such as "I am so sorry for your loss" are generally good choices on exams. I hope these tips help...these are what I remembered from MH!!!

Every program is different, but mine bundled med surg I and mental health in the same semester as well. I would say focus more on med surg b/c that tends to be the tougher class. For mental health, doing practice questions on therapeutic communication and keeping track of the psych meds (by drug class might be easiest) and their adverse reactions/ side effects would be very helpful. Most MH exams have a fair number of therapeutic communication questions, and once you are able to answer these types of questions you will be in good shape come exam time. Psych meds are important to keep straight as well b/c a lot of MH NCLEX questions focus on them. Expect questions, for example, on MAOIs and diet considerations; extra-pyramidal signs/ symptoms related to first-generation anti-psychotic meds; and lithium toxicity signs/ therapeutic ranges. As for med surg...I spent A LOT of time on this class. Do every practice question you can get your hands on through any resource your school/ instructor gives you. We had Adaptive Quizzing by Elsevier which really helped me focus on content for upcoming exams. If your instructor does not use AQ, you can find other similar resources. And most importantly, READ THE RATIONALES. That is where the real info lies...read them even if you know the answer. Never sacrifice studying for doing questions. In other words, at some point before each exam you have to do some questions related to the exam topics to get into the NCLEX zone and reinforce important info that will likely come up on the exam, even if that means sacrificing going over your class notes one more time or foregoing reading a chapter you never got around to reading. I hope my advice helps!

The agency you work for does not sound very consistent or organized. As competitive as nursing is, I am quite surprised your HR dep't is not more conscientious and thorough in formulating and articulating a standardized hiring policy for current and future employees. Many (if not a majority) of newly graduated nurses at present find employment as an RN by taking on employment as a patient care tech or in another unlicensed capacity in a hospital or other health care facility prior to graduation. Not having a written standard and/ or not applying it judiciously just begs for a lawsuit in my opinion. I am not offering an opinion as to whether you have been discriminated against. I am simply expressing my surprise that an HR dep't would allow an employee to hire so many nurses with one standard and then (as you describe it) arbitrarily change said standard so fundamentally without a written policy change. A major focus of most HR departments is to maintain hiring practices that are compliant with state and federal law. I am not stating any law has been broken. However, I believe any HR dep't worth its salt would be ALL OVER the glaring inconsistency you describe, even if this simply meant communicating/ clarifying current policy to your manager.

OP made an economic decision to leave based on the work the position required, the work environment, and the rate of pay & benefits offered. We all make these types of decisions. I do not see anything wrong with leaving. Yes, the job could have afforded some good experience prior to pursuing a career as an RN and may have benefited the OP in terms of networking. However, it is not unusual for students to be hired as RNs out of nursing school with no CNA/ UAP experience. Moreover, clinical instructors, teachers, family friends, etc. may provide the all-important networking opportunities for those students who do not pursue a healthcare job prior to graduation. Also, no matter how large the agency in question is, I believe leaving during orientation will not get the OP blacklisted and shut out of the profession on a large-scale. Orientation is a chance for the employer and the employee to find out if the fit is right. Yes, it's still mostly an employer's market in terms of the employment picture in nursing, but an employee absolutely has the right to walk away from a job -- preferably tactfully and with sufficient advance notice -- if the job is not working out. The OP had another opportunity to earn money this summer and chose it. That is an economic decision the OP felt was the right one to make. Employers make these types of decision all the time; should not employees have this right as well? Again, I see nothing wrong with this decision. Also, I see no reason why the OP eventually cannot find an area of nursing that meets his or her needs in terms of balancing a good work environment, a decent schedule, the right mix of duties with adequate pay and benefits to motivate him/ her want to stay and make a successful career out of it. This area of nursing may happen to be one that is light(er) on duties typically performed by a CNA/ UAP. There is nothing wrong with this pursuit by any of one us, imo -- at all. If the OP can find an area of nursing right for him/ her at an acceptable rate of pay....great! Who are any of us to fault the OP for wanting to pursue the best work environment for him or herself? I happen to agree that CNA/ UAP work is extremely important, but we should all agree it is not for everyone. Yes, many RN positions require the same tasks as a UAP be performed on a daily basis and said RN needs to able to do them well and without complaint. However, the marketplace (by examining differences in pay and turnover rates that exist) demonstrates perfectly just how much more desirable an RN position is compared to a UAP position. To me, it does not follow that because someone does want to spend his or her summer working as a UAP at a specific rate of pay in a specific agency (of which we know few details), said individual cannot or will not be able to excel in one or more areas of nursing at some point in time after graduation.

HR departments typically have a set protocol to follow when investigating employee reports such as described by the OP. If they feel one is warranted based on the presenting details of the report, an investigation can and may have already been launched. As long as no witnesses can support the accuser's assertion that your behavior was clearly racist, there really is not much HR can do to you. Whenever a situation is "he said, she said," their hands generally are tied. Remember, HR is just as concerned about protecting your rights as an employee and action(s) you may take in response to their handling of the situation as they are with accommodating the accusing party. If your account on here has been accurate and comprehensive, I do not see how you can be charged with anything. The most I would expect is a brief discussion and perhaps a sit down with the two of you together with a member of HR (and possibly your respective managers) to discuss the matter so that it can be brought to a resolution.

Parakeet, I only got through about one half of the comments. Based on what you have stated, it is my opinion that you should NOT be providing care to transgendered patients (or perhaps any LGBT patients, for that matter). Your strong (what might be described as very "black and white") belief system clearly is going to get in the way of your ability to provide compassionate care to transgendered patients or likely any patient you perceive as LGBT. I believe the best thing for you to do in a clinical setting is to switch out patients assigned to you who are transgendered or who you perceive are anywhere on the LGBT spectrum with another nurse, if at all possible. Based on your posts I read, the very act of theorizing how you would respond to transgendered patients appears to be causing you a questionable amount of anxiety. In a clinical setting, there most often will be not time for you to weigh internal moral struggles over how to approach a patient/ situation. This fact might easily compromise the level of care your patients deserve and your future agency will demand of you, or it might actually work in your favor and allow you to put your beliefs aside and care for these patients as you would any other. The point is, if there is ANY chance a patient picks up on your disapproval (and LGBT individuals are generally fresh on the scent of disapproval, most of them having endured their share of it), patient care unquestionably will have been compromised. One of the cornerstones of competent nursing care is the trusting relationships we build with our patients. Trust is shattered the second a patient feels invalidated, disrespected, or marginalized. Every nurse will come across a situation/ patient in his or her career that challenges his or her moral compass. In this sense, your struggle is not foreign. One classic example that came up in a critical thinking class my first semester was how we would approach dealing with the parent of a pediatric patient admitted with injuries stemming from child abuse. However, the fact that your disapproval is aimed at a class of people and is so general in nature -- these individuals in your eyes are somehow "wrong" or "immoral" by their very existence -- this is what is most disturbing to me about your comments/ views and why I believe you should remove yourself from these patients' care if at all possible. The other alternatives for you besides swapping patients with co-workers would be to abandon your plan to pursue a career in the nursing professional altogether, take a harder, more critical look at your own beliefs, or seek employment abroad (Saudi Arabia, perhaps) in an extremely conservative society where transgendered and other self-identifying LGBT patients would be rare or non-existent.

Wow OP that is too bad you have had the experience you describe. My school's cohort is amazing. We have a class Facebook page (yes, I realize we must be careful about that...I've read the warnings on this forum about the pitfalls of having a class Fb page) and we support each other so much. There are a few strong personalities as there will be in any group of 60 plus individuals. To me, these personalities are more endearing than anything. For example, one student likes to randomly interrupt class with her special brand of funny outburst and laugh (usually to express an opinion) and we all just give a few side-long glances and let her do her thing. Another overshares her past medical history to the max -- like, I could literally compile a medical file/ chart on her based on the things she's stated...no HIPAA for her. Recently, she shared some private info that helped us understand a complicated disease process & its medication regimen. Anyway, please do not believe every class/ school is like the one you describe. I honestly do not dislike one single individual in my nursing class of over 60 students. Usually, I slightly dislike at least 1 person in a group that large (as I assume most people would) but I like everyone and we've been together for three semesters now. I'm confident an overwhelming number of the students in my class are going to make outstanding nurses and all of them will be great to work with. I hope you find a better work environment than the group you've been with throughout your schooling.

I'm sorry if I sound jaded, but for profit nursing homes will cut every corner they can get away with. I have a friend who is an LPN a nursing home. She regular has a patient load of 45+. How is that safe? She has very little time to provide individualized care. One med pass blends with the next one. CNAs typically earn minimum wage for a mostly thankless job. Until recently, they did not even qualify for overtime. Many more people are concerned about the value of life at conception/ birth than they are about the value/ quality of life at its end. Perhaps its cultural, but that's how it is. That any state would allow 1 LPN to oversee more than 40 patients (most of them with multiple health problems) is beyond me. For-profit facilities are squeezing out every dime they can, and the end result, I fear, too often is the sort of treatment/ conditions described by the OP. Not that he necessarily works for a for-profit institution, or that this kind of treatment is exclusive to them...just arguing it's more likely to occur when profit, and not care, is the underlying mission statement.

Please help! Greetings!! I am currently enrolled in MedSurg II. Our professor has entirely revamped the course. A new and significant component of the course is the use of Evolve Adaptive Learning and Quizzing. My first impressions are: I really like the quiz modules because in quiz mode you get instant feedback and the questions seem relevant. I have 2 questions. Does anyone know how long it generally takes to make 50% goal on the Adaptive Learning (for a single chapter or a grouping of 2 chapters)? I was on it for about 45 minutes today, and logged off at only 1%. I need to make 50% by the end of the week. Our professor claims after 2 or 3 log-ons per week, logged on for "short bursts" (which is how the learning is intended to be experienced), we should be at goal. Is this accurate? I am a bit skeptical I can go from 1% to 50% so easily. Also, we must reach level 2 proficiency on quizzing. I took an exam over past material I knew pretty well and only missed 2 questions (was lucky) and reached level 2. However, we have the option of earning extra points if we reach level 3. How difficult is this? I'm assuming a learner would have to either score perfectly on one or several exams to achieve this level...or, perhaps users are eventually rewarded for consistently scoring well (missing 1 or 2) but not necessarily perfectly, which eventually bumps them up to level 3. Does anyone have any ideas how getting to level 3 works and the time or difficulty involved? Also, (okay, I'm cheating...third question) at what point do you start to see the same questions pop up? I did several quizzes in the same chapter and never saw the same question twice. Thanks in advance for ANY info, advice, or tips you can provide about the Evolve Adaptive Learning and/ or Quizzing. I really want to know what kind of time commitment this is going to be so I can plan my study time.