Elinor

A huge chunk of posters basically write that social media is an inappropriate” venue for voicing complaints... so therefore she deserves to be charged with professional misconduct and lose her career?? That's the implications of these posts. It was in poor taste to post on Facebook... so she should suffer the consequences!” Nurses, just like everyone else, have a right to personal lives. In those personal lives, they have the right to vent on social media. People post phony news stories on social media, use hate speech on social media, stalk people on social media, and are massive stupid jerks on social media every day -- why should nurses be any different? We get to be stupid, mean, dishonest, and jerky just like everyone else. The key being: in our personal lives. In this case, this was firmly 100% in this nurse's personal life. This was not her employer, not her patient, and not about something she did professionally. She should not face professional sanction for voicing her opinions, right or wrong, in poor taste or otherwise. This is complete overreach by the SRNA. If this decision stands, I hope she sues them and wins – not just for her, but for all Canadian nurses. Because this is tyranny. Here were the charges” made by the SRNA: 1. Failure to follow proper channels: In their decision, the SRNA literally wrote that before she could publicly criticize, she had to notify, in order, the individual care providers, their manager, the director of the facility, the health board of the facility, the health board of the region, and the minister. It is only if all of those efforts have not led to a positive change would you be able… to take the matter to the public.” Let me start by saying that, prior to writing this post, I read the Canadian Nurses Association Code of Ethics. Nowhere in it does it say that, if you are a nurse, you are not allowed to complain about anything in healthcare publicly without notifying all the above persons first. Also, note that she didn't write about seeing anything illegal; if she had, she would have a duty to report. That's not the case here. 2. Impact on reputation of facility and staff: First of all, she did not give the names of any staff members. Secondly, the SRNA failed to provide, or even attempt to provide, any evidence that her comments had any impact – positive or negative – on the reputation of the facility or staff. In a court, you would have to provide some evidence of a negative impact. They didn't even try. They literally just quoted a couple of her negative comments. 3. Failure to first obtain all the facts: The SRNA writes that You have made public your conclusions without first having obtained all of the relevant facts [directly from the facility and the care providers].” Really? Also not in the Code of Ethics. So, before a private citizen who happens to be a nurse in her professional life can post opinions on Facebook, like people do every day, she has to conduct interviews of all the persons involved? How would she even do that? And why would this be her personal responsibility? She's not the police, and she's not responsible for investigating, after the fact, what happened at her grandfather's facility in his last days. Sure, we'd all like to think that we think carefully before we post, and try to have a balanced perspective, and try to be in possession of all the facts… but a brief, five-minute perusal of social media will quickly show you that this never happens. And we don't go around finding ways to punish people because they didn't get all the facts before they posted. If we did, a certain president elect would not be. 4. Using status of registered nurse for personal purposes: I'd love to tell you the meat of this argument, but I can't, because the paragraph following it doesn't substantiate it. So I will attack it at face value. First of all, nowhere in the Code of Ethics does it say that a nurse should not identify herself as such; you could actually argue the opposite, that in healthcare-related discussions, people have an ethical duty to disclose their profession. Secondly, she in no way profited from this post. In order to say that she used” her status as RN for personal purposes,” you would have to make an argument that she in some way personally gained from her social media posts, or at least attempted to. Not only did they fail to make this argument, I don't see any way that they could have. In her posts, she refers to herself as a health care advocate” and calls on the staff to please do better next time!” Her motives seem pure: she is grieving, frustrated at what she perceives to be inadequate care, and hoping that by speaking up she can effect change. She could be 100% wrong; that wouldn't change the fact that she was not using her licensure status inappropriately for personal gain. Having finished reading the DECISION of the DISCIPLINE COMMITTEE of the SASKATCHEWAN REGISTERED NURSES' ASSOCIATION” in the case of Carolyn M. Strom, I can tell you that it's a sanctimonious, unsubstantiated, finger-wagging piece of crap. Another Canadian nurse said something very similar in this thread. I wonder if the real topic isn't the way that the Canadian BONs are overreaching. If they have Canadian nurses frightened to speak up about anything they see in healthcare under threat of losing their license, that is a real problem. A system where the largest profession in healthcare is effectively being silenced, not allowed to speak up about problems within healthcare, is very dangerous and frightening. For nurses and for the public. Exactly. You don't have to agree with this particular nurse or think what she did was wise – I personally do not make posts like this with my real name – but you should be able to recognize the potential ramifications of her silencing.

I personally know many nurses who are in grad school, applying, or want to apply in the near future. Out of dozens, I only know two who don't want to work directly with patients. Why is it not "caring for people" when you're an NP? Believe it or not, you are still physically touching your patients, looking into their eyes, hearing their stories, becoming part of their lives -- maybe for decades and across generations in primary care. It's not a zero-sum game. We have way too many nurses entering the workforce now, thanks to shortsighted decisions made years ago, and that will continue for a while. And we need more primary care providers in the US, which is what most NPs become. We will need more nurse midwives and CRNAs as well. The nursing profession can afford to send nurses to grad school. When I hear this complaint -- which is often -- I wonder if the complainer is really upset because she feels that the value of her own career and raison d'être is being called into question. Like that, if other nurses want a different job, that must mean she's a fool for sticking around -- or somehow the work is less meaningful because other people don't want to do it. I have two answers to that. 1. Your work will always be meaningful. We need you. The world needs you. Every kind of nurse matters, from school nurses to floor nurses to flight nurses to APRNs. Patients can't survive without you, and you've personally saved lives doing what you do. You know this. 2. The other side of the coin is that nowadays floor nursing is really difficult and unpleasant for a lot of people, in a lot of places -- not because of the nature of the work, but for all the reasons that it's difficult and unpleasant for you too sometimes. Poor nurse staffing, EHR demands, administrators, etc. I don't need to elaborate. If some people want to leave, it's not necessarily because they don't like nursing, or caring for people; most of the time, it's because they hate all the BS. So don't make other nurses the bad guy. We need to work together to make every part of nursing better for nurses, which means recognizing the value in each others' work.

This question needs to be picked apart a little more. Do you want to be a clinician? Or do you want to work in public health? They are not the same thing. NPs are clinicians, first and foremost. The NP pathway is a clinical one, where you specialize in working one-to-one with individuals of a clinical population in a clinical setting. If that's what you want to do, the path that would make the most sense for you would be to get an accelerated BSN in nursing, then go to grad school for an MSN or DNP as a nurse practitioner. Note that there is no PhD to be a nurse practitioner, because NPs are clinicians -- the PhD is a research doctoral degree, and the DNP is the clinical doctoral degree. NPs can get PhDs later, for instance if they want to focus instead on research or teaching, but they are sort of superfluous to being an NP. If you actually want to work in public health (e.g., developing and implementing public health interventions and policy or doing research), a degree as an NP -- whether MSN or DNP -- does not prepare you for that. You would need to separately obtain a nursing PhD -- which, again, is NOT an NP degree, it's a totally separate degree that does not make you an NP, and there is no need to become an NP before you get a PhD -- or simply go to graduate school for public health rather than nursing (either a masters or doctoral degree). If you want to work in clinical practice as an NP, but you are also vaguely interested in public health, you can also go to grad school to be an NP somewhere that offers a (nursing) minor in public health. But if you have serious ambitions to have a big impact in public health policy or research, I'm not sure how far this would get you. You might end up having to go back to school again anyway for a PhD. If you get to the point of considering this, you will want to discuss it with senior persons in the nursing department who are involved themselves in academia and can advise you. Why do you want to be an NP? What do you think NPs do, and why does that appeal to you? What exposure to medicine have you had? If you really are considering being a clinician, you need to follow an NP or MD around for a few weeks. Otherwise, this could be an expensive and lengthy mistake. TLDR: figure out if you want to do public health or be an NP, because, while they are not mutually exclusive, they are not the same thing and you will be setting yourself up for two rounds of graduate school (in addition to the undergrad schooling to become a nurse)

Yeeaahh... This may come as a shock, but you're just another kind of bad patient. The kind that doesn't want you to look at their veins, they just want to tell you to go in this one spot and that's that. And they don't care if you tell them that, in your professional judgement, they probably shouldn't be getting out of bed on their own right now -- they know best and they are going to do whatever the hell they want. The kind that is a total a-hole when you are just trying to do your job and get vitals and do assessments and give meds that you have to give because they "want to be left alone." You say "firm" -- I say "PITA."

I have to agree with enc123 -- this isn't really true. NPs other than psych are generalists, but divided into acute care vs. primary/chronic/non-acute care, and divided into age groups. You have your FNPs, who are the full spectrum of infants to death and do family medicine, but not acute care (so they are currently phasing the older generation of FNPs out of ICUs, for instance, but you can still work in an ED as long as you are providing care for the non-emergent patient conditions; my ED fast track is staffed by NPs). Then you have adult-gero acute care and adult-gero primary care, and peds acute care and peds primary care. Note that these are very broad categories. NPs within these categories can work in any specialty -- cardiology, orthopedics, endocrinology, rheumatology, etc. Just not psych, that's it's own specialty: the psychiatric mental health NP. With both NPs and PAs, you receive training in all body systems and you can work in any specialty that is within your scope of practice. But with both, if you work in one for a while, that's going to end up being your specialty. I don't know of any NPs or PAs that get handed around from specialty to specialty. Lastly, "physician oversight" is not the right term. About half of states still require collaborative agreements -- NOT oversight. This number is dropping every year. So true... Can we just call a spade a spade? If you're diagnosing and treating, your practicing medicine, I don't care if you're a PA, an NP, an MD, a DO, etc.

What you should choose depends on what you want to do with your career. You say you want to go back to school -- for what? For almost all paths in nursing, med surg is a plus. Office RN is only good for future outpatient or administrative work. Definitely get the situation with your license being falsely listed as LPN corrected ASAP. You can present it as a problem with you being misrepresented in the medical records with a license that you do not possess. I would, frankly, be concerned about this office manager from now on. Yes, office managers often do not "get" the finer points of nurse licensure, but the fact that she doesn't think even this enormous problem matters -- falsely documenting the nurse's licensure in all the office's medical records -- is a major red flag. Would she list a DO's license as "MD"? When you get a chance, you should also look for an opportunity to address the problem of the MA's falsely representing themselves (presumably also to patients) as nurses. Perhaps the office manager is not the best person to have this conversation with... do you have a clinical (RN) manager? How much do the physicians seek RN input? Again, frame the issue not as a personal complaint, but as one of liability and also patient trust. Nurse has a legal definition. Erm, no. This is insulting. One of my jobs is at a peds PCP office. The RNs do NOT do what the MAs do. We do assessment, triage, phone advice, phone treatment, we take call, and we do a whole lot more. MAs do the routine tasks -- they put patients in rooms, give immunizations, and draw blood. They do not assess, they do not give advice, they do not discuss medications, they do not discuss labs, they do not triage, and they know their scope of practice. And they are excellent at what they do. Secondly, do you use "all of your skills" that you learned in nursing school? From psych, L&D, peds, LTC, and every rotation and every class unit that you had? No, because RNs specialize. Primary care is a specialty. Respect. [sorry for the salt! I just get sick of hearing it.]

I like it. She went out in style, and gave her coworkers cake to eat. Although Walmart cake? Really? I would have gone to a bakery. But hopefully her future employers won't be social-media savvy... As fun as it probably was in the moment, it was not a smart career move.

Sorry if someone already said this, I have to leave and don't have time to read the whole thread. One of my jobs is in peds primary care. The issue is that epipen brand is not on your granddaughter's insurance formulary. Your daughter drew the short straw at the pharmacy and got someone incompetent or in a rush who didn't bother to tell her this or trouble-shoot it for her. There are two other options for epinephrine pens (in my region, anyway), and she should call the pharmacy and make them figure out which is on the formulary. She should: 1. Call the pharmacy and ask them to run, first, adrenaclick (junior if the granddaughter is under 30 kg, regular if she's over) -- they can run it before it's prescribed to see if the insurance covers it. 2. If adrenaclick is not in the formulary, have them run generic "epinephrine pen." If you get a crummy pharmacist that doesn't know what you're talking about, give them the NDC numbers to look it up. NDC# for regular epinephrine pen: 54505-0102-02, NDC# for junior epinephrine pen: 54505-0101-02. 3. After your daughter finds out which brand is in the formulary, call the prescriber and tell them to send that instead. 4. Find a better pharmacist in the future who will do this for you automatically when they discover the problem. They can contact the prescriber on their own to fix it when an out-of-formulary med is sent. The issue with these is that the manufacturers didn't do the extra process to make them legally generics for each other (even though they literally have exactly the same thing in them), so the pharmacist can't just substitute the generic. They have to contact the prescriber and get the rx switched, or at the very least tell the parents what to do.

I don't think the BON can use it against you, because they would have to prove that you are unfit or it would just be plain old discrimination. Previous psych hospitalizations does NOT make you a criminal, and psychiatric diagnoses including MDD confer legal protection as a federally protected disability (though I wouldn't use this unless you have to, as someone else pointed out). But everyone else is right -- keep this to yourself. Stop contacting the BON. Frankly, they never would have known about this if you hadn't told them. So let them forget about it. In general, be very careful about who you disclose this information to. In the last semester of nursing school, one of my classmates disclosed to our small group during our psych rotation that she had had psych issues and had been hospitalized before. She brought it up because she was scared about being back in that environment -- but instead it ended up being really great because she realized how much stronger she had grown and now she wanted to be in the position to help other people, etc. We were a good group that all got along and often talked about personal issues, like family or boyfriends. I thought it was pretty great that she felt comfortable talking about this, and I was really supportive. So I was kind of shocked later when I heard the two other girls talking about it and saying, basically, that she was crazy and maybe they should "report her" to the instructor. I don't think anything came of it, but it was a pretty disturbing incident. When it comes to mental health issues, people will surprise you -- for better or for worse. Some people are enlightened and wonderful and supportive; others will disappoint you. I'm just going to say it: nurses are judgy. As a group, we can be close-minded and judgmental, especially of the competency of other nurses. So be careful who you trust. And that means not your coworkers, not your boss, not your teachers, and definitely not the BON. If you ever need a leave of absence from school or at work, go through medical employee/student services -- don't disclose your diagnosis to your teacher/classmates/coworkers/supervisor, simply tell them you are having some health issues. Anything more is none of their business. Also, you are currently in school full time, working part time, and in recovery from a serious illness. So congrats to you. Keep getting the support you need to succeed, including therapy, and don't feel guilty that your parents are helping you too -- most US undergrads get some support from their parents. And that's perfectly fine.

Hi Dogen, thanks for your advice. It's reassuring to hear that the strongest answers aren't necessarily the best. I think "answer honestly" might not work out well for everyone, but I guess that's kind of the point of the tests.

These tests are so nerve-wracking. Two major health systems in my area (and possibly more) are using the same personality test to screen applicants, so being able to pass is pretty high stakes. I don't know whether I'm passing or not. The answers are always: Strongly Disagree Disagree Neutral Agree Strongly Agree So for instance, the question will say something like: "I prefer to stay busy." Or, "I work best with people from the same background as me." I've been answering "agree/disagree" to almost everything, and only occasionally using "strongly agree/disagree." Mainly just because that "felt" right to me... less extreme, more conservative and temperate. So my answers to the above would be agree and disagree. Am I doing it wrong?? Are my answers too wishy-washy? I had previous read that they don't like extreme answers, but I wonder. For people who do well on these, how did you answer? Strongly agree or just agree?

She's not rationalizing or skirting responsibility -- I think she pretty clearly feels badly about it and has been ruminating. She did point out some upstream systems issues that probably contributed to the error. Yes, you can always identify a person or persons at the end who made the mistake, and you can blame them. And yes, they made the mistake. But that is an unproductive approach, because guess what? Everyone makes mistakes. Lots of them, every day. The approach that's actually effective for reducing errors is to analyze contributory systems causes, like interruptions, no pharmacy notification, no bedside scanning, a system where a charge nurse has to pull meds for another nurse, etc.

Thank you for your reply, Boomer. You might be right. I suppose whether it's seen as a plus or minus will depend on the person I'm talking to. But I probably would be really uncomfortable feeling like I was hiding something in an interview anyway... and interviews are scary enough without having something extra hanging over my head. I have thought about per diem for the flexibility, but I need guaranteed hours and benefits. I'd appreciate anyone else's thoughts -- what are the chances this information would stop someone from hiring me? And have you ever been in this situation, where you knew in advance that your time at a job would have an expiration date, and how did you handle it?

I just started looking for a new staff RN job. I also am in grad school, and will be done in May 2018. After that, I will look for new work as an clinical nurse specialist -- possibly with the same employer, possibly not. Ethically, I think it would be nice to tell interviewers that -- but if I tell them, I don't think I will be hired, and I need a job. And while I think telling them would be the nicest, most ethical thing to do, I don't think I HAVE to tell them. I think I have a right to keep it to myself, just as I would have a right to keep it to myself if I intended to become pregnant, or had cancer, or was in the military reserves. Sure it might affect them, but it's my business. So I guess my question is... when I go to an interview, and from then on, what's the best way to keep this to myself in a practical way? I need particular days off each week, and they vary by semester. Should I just say "I would need off these two days every week for personal reasons" and leave it at that? And then deal with each new semester as it arises? How flexible are most hospitals to demands like that? And what should I say if they ask me for details? On the plus side, I'm available all weekend every weekend. Maybe I can "trade" that for more flexibility...?

And you can bet that they will keep having unlicensed personnel do more and more, and all of it on our license with our supposed supervision, while they stretch us over more and more patients -- although how we can be in 50 places at once supervising all the tasks we've supposedly delegated, I'll never know.