spaniel

It’s your beautiful intention that counts. Precision of the exact words not so much.

Old bat former ICU/CCU. Surgical ICU, Neuro ICU, psych nurse here:::: Now much of this depends on how large a city you live in. What about a site that does ophthalmology surgery. Of course you’d only find that in a big city most likely. Yes, you’d be pigeon holing yourself a bit. Again you’d want a hospital that does a real orientation for this speciality. Boston (MAss EYE and Ear) for example. Wills Eye (Philadelphia). Post op floors for the few that still exist only if you have preceptors available.

This is exceptional information. Please send it pronto to leaders in the field,both medical and governmental.

I do not agree with the ADD or Adhd "route" necessarily. If you are a bit older, new learning make take some time. With that said, there is an added bonus of accumulated wisdom with older folks (i.e. am referring to myself as I refer to someone 'older'). There is way too much multi-tasking out there in my opinion anyway,taking the nurse away from what is crucial. Would you consider a field such as hospice,where the demand is for compassion rather than speed, rote performance (that should be done by a secretary anyway).? I work as a consultant and frankly the horizontal violence and low level conceptualization of much management is worse than I've ever seen it. With rare exception, LTC is a losing battle these days.

Yes, a very desperate situation. Let us also put a lot of pressure on the bigger medical corporations to increase donations-stat. The big sports conglomerates also... From my understanding, the need for even basic comfort meds, i.e. pain meds for crush injuries in the street is severe. God bless all involved in whatever capacity.

I am so very very pleased for you. Nontheless, what a heartache you had to endure. Even though LTC places are certainly not all the same, I do not believe it is a place for newer grads to work, for many reasons. Again, as I posted before I hope you try to go for a hospital with a very decent orientation and preceptorship. I really am saddened by stories,especially of new nurses, who have tried so very hard to get through school and are then slammed by a broken system. Again, congrats to you.

Oh yea, the QA board sure sounds effective... now we have nursing staff facing a "parole board". An administrator at one of the local nursing homes was a no show for many days, did not even provide a phone contact for when the DOH came to audit...and this person gets a severance pay. My answer to the DON who wanted a positive way to motivate people. Try self scheduling if possible-it helps a bit.

Yes, try your local MRDD group homes. Or better yet-maybe a day program where there would be a few other nurses. I've worked in this field in the past and if this is truly your interest, you would be a Godsend.

Indeed that is bullying, abuse, whatever you want to call it. Can you imagine, being offered Compazine, then being asked to work-ridiculous. Leave the job.

I hope others join in here. BLEB is on the main drag. It is fairly near Yankee Stadium.While the neighborhood used to be atrocious, I believe it is truly on the upswing. This is a perfectly reasonable question, and i would not hesitate asking the recruiter for tips. Then speak with some folks, if you can, in the area-i.e. lunch room.Now,I would be more concerned with safety if the hospital were on one of the side streets. It is not.

It has been thirty years since I've graduated (RN). I am ever so grateful that I had the opportunity to have a supportive management and orientation for my first job. This was at a mjaor medical center in NYC. With that said, they ran us ragged too, but at least there was support. Yes, a mistake was a mistake, but we dealt with it in a positive way.Had everyone been fired for a mistake (or lack of working equipment), there would have been no one left to care for patients. With that said, try to find the very very best place to work . Don't try to find the "first job" that will "take" you. As a new nurse you want the best in mentorship. Do you still have a good relationship with anyone ( a former professor) at your nursing school? They may be able to help you through this time. I hate, hate seeing this type of thing happening to decent folk. But frankly, I would stay away from LTC. Get yourself into a teaching hospital with decent mentorship and leadership.

Oh my! That surely is a case of psychobabble from the administrator. When the Titanic did not have enough lifeboats, that was not a "external locus of control" problem of those who were frustrated trying to rescue people. I would ask- has the administorator of DON followed up on the issues of inadequate supplies?

I work as a consultant to nursing homes, and have been licensed,oh, for about 30 years. I am seeing a horrific trend in which DONs are physically escorted out of the building. A typical scenario is this-staffing is cut, the DON (understandably) gets a bit heated about serious cuts-and is escorted out of the building! Mind you-this seems to be the latest "strategy" for admins/CEOs. I am astounded that nursing has gotten to this point. Certainly I can understand anyone being "escorted" if they lose physical control, but that is not what I'm referring to... Does anyone have an idea what help the ANA (or any legitimate professional entity) could do to discourage this type of draconian management style? I know of several nursing homes that continue to have "acting" DONs as no one in their right mind would risk their reputation at these"said" homes. Can you imagine the humiliation of it all-While this has never happened to me, it is giving me serious thought about changing my career out of the long term care setting.

Rats.. the forum was updating so I lost my reply. I've read many of the posts on borderline/alternative methods,etc. This really has been thought provoking. I also believe relationships heal. I also believe that DBT is a very strong,workable method. If I recall,it may have been Miranda (and others) reminding us that BPD is indeed a spectrum in terms of expression and severity. One area of "alternative' treatment I believe can lie in the therapeutic work with animals. Please do not think I'm advocating this for those whose impulse control is severe. I do think there is a major issue in attachment and with the bleak inner landscape of many folks with BPD, "feeling" an attachment is not easy. Frankly I believe this is one of the fundamental problems. I'm not naive enough to think that funding would be easy to obtain. But there are a few tx centers that work extensively with animals. .. but not your run of the mill state hospital or inpt/or outpt. center. In fact, there are a few prison projects that hook up the offender with a particular dog. This person is "charge' person in terms of the dogs physical care. Again, I'm giving away my age here... but some "old" psych state hospitals in Pa. had farms. Laregely, these were shut down in around 1972. Oftimes, the critters became the "raison d'etre" for long term pts. I'm not suggesting this in lieu of a more comprehensive tx-but I do believe their is true value in the human-animal bond. I've seen it again and again with BPDs who've yet to establish mutual human relationships.

Are you kidding? This is an excellent idea. You might want to also consider teaching: 1) Strategies for the patient with dementia,etc. 2) Smoking cessation. I wish there were more nursing entrepreneurs in this area. Otherwise other specialists who are not nurses tend to "take on" these roles.

Lordy, you guys crack me up. The l980's- the "middle ages' or something akin. Okay here goes... I think I might start listing some of the positives: In good treatment facilities, there were: 1. Actual treatment plans (not the bogus ones requested by the insurance programs!). For example, pt. was given a choice of therapeutic work, be it in the large garden, the thrift shop, or some other disciplined activity. 2. A few exercise programs. 3. art therapy and dance therapy with licensed providers 4. Group therapy typically twice a week 5. Stays that lasted beyond 4 days so a person could actually be helped 6. RNs with actual training that "contracted' to talk with the patient at least 15 minutes a night. Alrighty folks-pre-1970: 1. State hospitals that actually had farms. 2. Student nurses slept on "campus"-at the state hospital 3. Nurses wore white dresses and gasp- a cap and their pin. THOUGH-on the more "advanced" family unit where family therapy was encouraged, nurses started wearing street clothes! 4. Volunteers from the local colleges came to work with adolescents to help them maintain ties with their schools. (That was what I did). One could also work on the geriatric ward and do music(That was what I did). There was more activity for the seniors than there is in the better of the LTC settings. 5. Doctors and nurses sat in the SAME conferences and lectures... gasp I can tell you what I see in the local "university" based psych unit TODAY. Same anti-psychotic shuffle (albeit sans Thorazine). Virtually no-one talking with the pt. Zero and I mean zero recreation room. Certainly no art/music therapist. The psych unit was converted from a med-surg unit. Discharge planning can mean discharge to just about anywhere. Yep they now do a drug screen. ECT is far less. And as y'all know, many of the psychiatrically ill are now housed in jail.

I'm not sure if I totoally understand your message. I have worked along side of Psych NP's who have "quotas". to fill per "mandates" of their companies. I have seen some rather atrocious care-spending 5 minutes with apt. then rendering a dx/med change. On the other hand, I had also worked with a Psych NP who was in her own private practice who did superb work. Some of the big industry companies farm out rent a docs too. Is this what you are referring to? I am not a NP but am an RN with advanced degree-who also has considered getting the NP for prescription priv's. But I could never do the 10 minute deal-to make some CEO rich.

I worked in the CCU a long time ago (1990)- but figured I'd answer you. I went to the CCU after about 2 and three quarters of a year in med/surg. I had superb orientation in an excellent NYC hospital (Albert Einstein)/ and had worked med/surg at Cornell. Two years was fine-but the great mentorship helped.

Dave- Yes- Excellent. Should you ever need to change "day jobs' you can always be a reporter! (Please take this as a complement).

Hi- "therapist 4Change", we've "met" on a previous discussion. I'm the person who's dually licensed as RN and psychologist. And a bit old- and with a major tendency to vacillate... I go back and forth between going to a local NP psych school, then forgetting about it due to the fortune I'd rack up.. time investment,etc. Now I'm curious, how easily do you think it is to get license reciprococity in La. as a psychologist? ( As an RN- very easy). By the way, the local NP program,which is pretty decent just raised tuition again. And like you, I have other interests-am in 3 music groups. Alas, my dear husband and I still have a house to pay off. But I figure, if I need to work til age 80 I might as well have RxP in some form>>> Being silly here. But seriously, I do so much interfacing on serious med/surg issues anyway,I would do well to have the RxP... maybe.

I went to an Urgent Care Facility for my ear. The M.D. "assigned" the "tech" to do an invasive procedure-well not majorly invasive-but it did involve placing an instrument in my ear. As I noted the tech to be shaking I asked if she had ever "done" this before (flushed an ear/removed wax). She indicated "nope" and I then ascertained she was not an RN or LPN. Grant it- this is not cardiac surgery... but as the syringe with needle came to my ear.... All I can say is that the general public better wake up. (Obviously I did not "let" the tech continue.)

Alrighty - I had the norovirus (used to be called Norwalk). Now-It's basically what some people call a "stomach flu". I work LTC consulting/psych but am an RN as well. Anyway last year the "stomach flu" was going around one of my LTC facilities. I was so ill from it that I threw up ,oh lets say about 20 times...was severely dehydrated. I really could not stand because of weakness. I was really sick for about a week. Even the youngsters at work became very ill...the CNAS/LPNs and RNs under 30! My doc indicated that there may have been some particularly vicious strain this year. Anyhow- Back to the OP's dilemma. I have worked in the health field since the late 1960's. Never have I seen anything like LTC today. I am seeing care deteriorate by the month. Some suggestions: 1) Try to get a position out of LTC. With this, you can simply explain (briefly) that you seek a different type of experience. As you do this, use words that are positive. 2) Seek out a place that offers a decent orientation and build your skills (i.e. dialysis) 3) Consider a non-typical role,working with developmentally disabled people. The reason i say this is that the state systems still generally demand a certain ratio/quality of care. Back in the l970's care for the dev disabled was very bad...in fact similar to what we are seeing in LTC now. Because of protections that have been put in place for this population (dev disabled), staffing provisions are better. You are probably too young to remember how Geraldo Rivera had cameras in the dev disabled settings. This brought many of the abuses to light.

My first inpatient experience was in l969. (Yes, I was really really young and not a graduate yet!) I have worked in outpt.,inpt.,med-surg.,CCU/ICU, developmental disabilites, and so on. I have worked in "back-wards" and in posh places. Frankly I have had very very few mishaps. A bit more in the adolescent units-chiefly things like breaking glass (that was supposedly unbreakable, but obviously not). Once there's decent medication oversight/decent staffing, violence really was not a major issue on INPATIENT. Now with this said,I feel that psych ER is a different matter. I see a trend of cost-saving where the nurse or "tech" does the eval with not enough security at hand. Anything can happen in the ER and indeed one of the docs did receive a permanent head injury. However, I don't,once again, see this as the major issue in decent inpt places.

Hi- I work in consulting in geropsych, by the way. Yea,I have to wonder if this might have been age discrimination. The need for well versed nurses in geropsych is quite high-and as you indicate you have umpteen years in med-surg. But again, -very difficult to prove. Frankly, their loss I'd bet. I would also hedge a bet that they call you. I truly know what the turn around can be like for geropsych. It can be extremely stressful. So if you send a letter back to then "thanking" them for the interview anyway I bet they keep you in mind. I'd send it to the Director of Nursing as well as a "key" person who interviewed you.

Asking their credentials is a very very quick way. But I must say I still have my pink Dobutamine T shirt from the 80's-I think. Actually I did learn from a recent "lecture" on the Alzeimer's meds!