I am sorry but you have a job and expectations of that job. Bosses don't care about your personal issues they are managing staff. If everyone was late for various reasons no one would show up. If you have personal issues take time off to work it out. These behaviors won't be tolerated anywhere so you have to get it together!!
This is a daily occurrence in the facility I am in. I have them increase fluids and I may order some labs. I don't treat anyone for UTI unless they meet criteria. I do the same thing for URI unless they have underlying pulmonary disease. I am anti-antibiotic!!!
I do find the attendings don't care so order abx to shut them up.
I currently work as a NP in LTC. Since I have been there I noticed a very reactive environment versus proactive. I watch staff and administration put out fires everyday. Despite any recommendations to help them improve they just keep the craziness. This mentality affects me tremendously as they expect me to work in the same way. I find myself overwhelmed and working late hours. The DON has stopped speaking to me and now reports any and all issues to my collaborating physician. How can I do my work and not let unsafe staff practices bother me. Staff turn over is about 70%.
I love my boss and the residents but I do not like the cover ups I see. Suggestions so I can work in peace.
Don't fret! Your first job will make you feel like a student....as you can't learn everything in nursing school. You will feel like this for the first year you work. That is expected and normal. Look for opportunities to learn and ask questions, read and research. Every nurse has been down this road. Be patient and give yourself time!
Are you a RN or LPN? I always thought its a good place to start.
1. Find out as much as you can about the facility. What is their reputation?
2. What will be your role? Long term or subacute. Nurse patient ratio, how many techs? Each shift.
3. Is the facility paper or computerized?
4. How long is orientation?
Best advice when taking the test. Is to answer the question they are asking! Don't read into it. I have done the Adult and the Adult Gerontology both AANP and passed both with little studying. You can do it!
I have a question for NPs in the nursing homes. Have you been asked to write orders for giving a resident a certain amount of fluids every shift? Let me start of by saying that this is because the staff do not regularly offer fluids to residents. I refused to write such a order as I feel this is a internal issue they need to address.
They also want CXRs on every resident that coughs. I am all about assessment and ordering appropriately. When they don't like what I do they go to my collaborating MD to get a order.
I don't like it. A lot of safety concerns and look to us to deflect their problems. It's very sad for the residents.
You need to consider the medical, social, etc, diagnoses/problems to develop the nursing diagnoses. Students yes are learning so for them to be so fancy with their "own/diagnosis Its not that cut and dry.
Preoperative spinal patient with major comorbidities. Lots of nursing diagnoses from just that information alone. Make it simple!
Did you consider her other diagnoses? If the patient is having surgery that will be important. It always isn't the most obvious. Have to look at the whole patient. As your gain more experience you will develop it. Just think about what are the most important things I need to consider.