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How does that work? If someone stops breathing but has a pulse, unless you do something about it, eventually they will have no pulse. Are you supposed to just stand around and wait for the pulse to stop, then do compressions because they are not a "DNR" as well? I realize I'm being nit-picky, but this image just made me think of Peter Sellers in Murder By Death: "Not breathing. No pulse. If condition does not change, he'll be dead!"

quote from akulahawk: I don't know that this is universal yet. I know a lot of hospitals are moving to this model for definition of DNR, but I don't think all have caught up yet. Some people interpret DNR as no compressions, no intubation only, but meds and shocks/TCP are OK depending where the person falls in the ACLS protocol. Would be interesting to see the differences between states/facilities. quote from music in my heart: THIS*** is exactly what's wrong with end of life care in this country. It is the one area where we are, as you put it, ethically bound to provide substandard/ineffectual care. In all other areas of what we do we are ethically bound to provide the most effective, evidence based practice, but not here. This absolutely has to change, and as I said before, should come from the organizations/experts who drive practice through protocols and standards of care. It will only change if we change our protocols. Working in oncology I've worked with a few attendings who say, "when they go, call the code but page me too. I'll come over and pronounce them." That way we don't go on and on in a futile effort, and the family knows we tried. It's not a slow code per se, but maybe a "short code"? We still go all out, but at least someone has the good sense to put a stop to it at a reasonable point. I think that's the main problem with codes - they can go on indefinitely if you let them. Meanwhile the person's chances of meaningful recovery decrease with every passing minute. There really should be a time limit on those things.

Quote from Samadams8: I'm a little disturbed by this line of thinking. It sounds, I don't know, paranoid maybe? I don't mean to pick on you in particular, but I've noticed this type of general theme a lot on Allnurses, and I feel the need to say something, because it is potentially damaging. I know a lot of people come on here to vent, and we want to to give them our support and lift them up. I get that. However, acting like the people who are venting are 110% A-OK/perfect/blameless while big, fat, evil, maniacal administrators/managers/higher-ups/bigwigs/"the powers that be" are setting them up to fail, is frankly, not realistic. It perpetuates the attitude of "us vs. them" instead of holding people accountable for their actions and truly helping them. That is, helping them emotionally (through understanding, support, and encouragement) and professionally (by helping them to acknowledge their own short comings and make a genuine effort to improve). Blaming others, especially when we only hear one side of the story, does nothing to help an individual improve or reach their full potential. All it does is perpetuate the concept of victimization and create a form of classism within nursing that is not helpful. I am not naive enough to think that management are all angels, nor am I cynical enough to think they are devils either. We all need to start looking at situations from the other person's perspective (yes, even managers/administrators) or we will simply keep perpetuating all these negative stereotypes about one another. That's all for now. This post has been a long time coming, so I appreciate any who read it. Thanks for the vent.

I'm so sorry this happened to you. You sound like someone whose heart is in the right place, judging by your level of humble introspection - very mature, and not often the case when someone is fired (people always want to blame the manager or someone else instead of taking responsibility for their own actions). These are all qualities that will serve you well in your next job. I also have to wonder if it was more than just these few incidents. You admit to a lack of critical thinking in these circumstances, are there any other occurrences that demonstrated a persistent lack of critical thinking throughout orientation? If so, this would be another area on which to reflect before you start a new job. Some of the new grads we had to let go where I work were really sweet people who were fastidious and so afraid of doing the wrong thing. We were all heartbroken about it because we so wanted it to work and were really rooting for them. Gave them extra time, etc. Managers do want their employees to succeed, believe it or not. Unfortunately, repeated patterns of behavior despite remedial training still did not yield the results we needed for these new nurses to practice competently or independently. Sad for everyone involved, but not all settings of nursing are appropriate for everyone. I firmly believe that anyone can find their niche in nursing, it may not be the one you initially want or expect, and that's OK. Chin up, reflect on your strengths and weaknesses, and keep searching for your nursing "home". I do hope you find it soon.

So glad I'm not the only one who didn't have clinical prep work. As I was reading this post I was thinking "what the?!?!? Did I miss something when I was in nursing school?" The idea of coming in the day before seems preposterous to me, for the reasons already mentioned. Also, I have to wonder how that affects learning. I am an experiential learner, and we would do a report every day after clinical. It was much easier to apply what we had learned in class to the patient's situation after having some experience with the patient, really helped to put all the pieces together. You don't show up to work knowing what patients you have ahead of time, so why should you in school? It doesn't reflect the real world...

I don't do obligatory gift giving. Not for Christmas, birthdays, anything. It feels fake to me. If I see something I think someone will enjoy, I'll get it for them, just because, doesn't matter if it's 12/25 or 6/17. Makes it more genuine that way. Occasionally if I find something and it's close to a holiday/special occasion I'll hold on to it for the event but usually just give it right away. Maybe this makes me a Scrooge but mostly it's because shopping gives me a ton of anxiety. I am always terrified the person won't like their gift and it will all have been a wasted effort. I also don't enjoy receiving presents - I am a simple person and most gifts that people get me never get used, so I would frankly rather not receive anything at all. The most appreciated present is just that - presence. I would much rather spend quality time with friends and loved ones than have them waste their time and money on shopping. Also, kind, heartfelt words mean more to me than anything else. Tell me how you feel, what you enjoy, what you appreciate about our relationship. That is life-affirming, and something special shared between loved ones that no one can ever take away.

Had a co-worker who was a total germaphobe. The thing was not only did she have all those rituals, she would talk about it incessantly, how everything grossed her out. Seriously, it would occupy a large percentage of conversation with this woman and it really made me want to ask "How/why are you a nurse? Clearly working in the hospital is exacerbating your neuroses..." I feel bad for these folks, OCD is terrible and can really cause major anxiety and impair a person's ability to function. My poor cousin's hands are always bloody from excessive handwashing with very hot water.

Jean Marie, What a sweet story. I think all children should have exposure to those who are less fortunate, whether they are poor, sick, elderly, disabled, etc. It builds empathy and compassion at a young age, and kids don't get enough exposure to that sort of thing anymore. I used to visit the elderly homebound with my mom when I was little, and it definitely shaped the way I view the world. Your story also reminded me of when I was a little girl, my dad was out of the country and my mom was in the hospital. My sister, 14 years my senior, took me with her to some college classes. Most professors I am sure cocked an eyebrow at the five year old sitting in the back of a chemistry class, but we didn't have any other options. I remember her classmates giving me magazines to look at, and putting on a white coat (which was huge on me) for lab. I got the sense that the students enjoyed me being there - they thought it was cute, my sister was proud of me, and I felt like a big girl to be with them - definitely a confidence and self-esteem builder. I'm sure your children felt the same, and it is clear you are very proud of your children and they way they behaved that Christmas, as you should be. I guess there's a lot to be said for "bring your kids to work day", especially on Christmas :)

elkpark: Yes! Coding people is, in a way, fraudulent. It's providing care that has been shown, time and again, to be largely ineffective. How is that practicing evidence based nursing/medicine? It is sooooo expensive, and we are essentially taking our patient's money under false pretenses. I've heard of wrongful death and wrongful birth suits before. What about wrongful...life? vegetation? assault and battery? What should we call it when we "bring someone back" only for them to die a slow death later? I don't know...maybe down the road, as more evidence is accumulated, the ACLS/BLS protocols can change so as to cut down on this stuff? Such as, unwitnessed inhospital arrest with PEA, no pulse after 2 rounds of epi/CPR, end the code....we'll see. The way things are I think that's our only chance to cut down on all this suffering and waste.

I think the biggest endorsement for any facility comes from the customers. I will never forget when my sister joined the Little Sisters of the Poor. They run nursing homes for impoverished elderly, and they do it with precious few resources (yes, they still go out and "beg"). When we were visiting my sister at one of the facilities a little old lady walked up to me and said "I'm 106. There are several centenarians living here and do you know why? It's because they love us..." Still brings a tear to my eye to this day.

"For instance, I read up a few days ago on a program called "Does Jesus care for Klingons..." it cost just over a million $." It was one session of a larger workshop run by the DOD that totaled $100,000, and it was entitled "Did Jesus die for Klingons, Too?", discussing the implications of Christianity if life is discovered on other planets. Somewhere out there Tommy Lee Jones and Will Smith are snapping to attention... In all seriousness though, this question of healthcare as a right really does come back to where we as a nation want to place our values. I am always torn over this, as the compassionate side of me bristles at the thought of anyone suffering for want of money/insurance coverage. Then the practical side of me kicks in, and I realize that all the best intentions in the world don't mean much when you don't have the means to pay for it. With no money, there's no mission. Here's my reference: http://www.cnbc.com/id/49844670/Did_Jesus_Die_for_Klingons_Too_The_Pentagon_Wants_to_Know

This can be a truly challenging thing to discern, even for those who are trained! All it takes is one encounter with an over-sedated patient who was discounted as actively dying to make someone gun shy with narcotics. For example, a patient with seven fentanyl patches on who was of course confused but still complaining of pain. Family and clinic docs thought he was reaching the end based on his presentation, when he changed into his gown for the exam the nurse saw the patches and maybe that's what's wrong... After switching out his meds and giving the fentanyl time to wear off, he returned to his old self and lived for several more months. Did he still have a terminal disease that warranted hospice? Yes, but in his case that day it really was the meds, not the disease process causing his symptoms. I imagine this is something that is particularly challenging with the elderly population as the reaction to narcotics may be more pronounced, and it can be difficult to discern, is it the disease or the meds? An experienced individual should be able to put the pieces together and determine what's going on, but you're right, sounds like these people need more education...

Reply to cienurse: "Do you fear the unknown?" Interesting question. I fear that you would not give me a job, for my answer would be yes. However, I would follow it up with my definition of bravery: Bravery is not the absence of fear. It is being afraid but acting anyway. Only fools do not feel fear when the situation calls for it, because they fail to understand the gravity of the situation. Seeing a carotid bleedout for the first time? Terrifying. Being brave enough to act anyway? Priceless

This is a toughie. I understand the wish to not saddle your child with enormous debt after school, especially since he'll have to go for 8 years! While I agree with the above posters, I am also sensitive that your son could accumulate double the debt they experienced from school. Have you talked about it with your son? I am the youngest of five children in a one income household. All of my siblings had school paid for by a combination of scholarships and my parents, none of them had any debt when they graduated. When my sister was looking at schools I was 13. My dad sat me down and was honest with me "With the cost of school these days, there may not be enough for you..." I understood and appreciated his candor. He paid room and board freshman and sophomore year and gave me $400 grocery money junior year. I covered the rest through scholarships, grants, loans, and work. It can be done, but he needs to know in advance so he can plan accordingly, especially if he's expecting you to pay. It is true, some people are not mature enough to have mom and dad pay for college, they drink it all away. Others are mature, appreciate what their parents did for them, and are productive with their time. Only you can decide which type of person your son will be, but it starts with a conversation. I say keep the job you love, and talk with your son.

My alma mater had us include clinical experiences under a heading "clinical experience", not "employment". The point was so that potential employers could see where and what type of experiences we had under our belt. Also the "objective" line would say something like "graduate nurse seeking position as an RN on a medical surgical unit..." This way there would be no confusion about our background. Once we had experience working as a nurse, we were instructed to remove the "clinical experience" section from our resumes - they were only to be used when we were new grads. On a side note, I once got a position as a nurse extern because of my handwriting. No lie, I went to a job fair and filled out a postcard. The HR lady said she picked mine because out of 400+ cards, mine was the easiest to read. God bless my second grade penmanship teacher...