sblanchet

I can't believe administration would suspend an entire shift over something so ridiculous! Couldn't the patient have stayed in the ED? When confronted with situations such as these if I truly feel that I am not able to care for yet another patient I do what I have to to get by in the situation and then when I get home I type myself a little "memo" about what happened, to whom I spoke, what I said, what the response I got was, etc. This has come in handy many times as people turn around and lie sometimes. I, too, have never heard of any "form" relating to unsafe staffing. If you really want to get gutsy there is always the local paper, or investigative journalists who many be willing to look into these matters. I have done that. They may try but employers cannot fire you for exercising your freedom of speech.

When I was younger I did twelve hour shifts and loved them. It was well worth the extra days off. I lived in sunny South Florida then and had so much extra beach time! Now as a woman of a "certain age" with three school age children I find eight hour shifts to be about as much as I can do on any given day, but I am fortunate to only need to work part-time. If you are young and energetic I would say go for the twelve hour shifts. They're great!

It sounds to me like you simply went into the wrong profession. It's too bad you were not able to figure this out while still in school. Still, there may be hope that something will work out. I agree with other writers that you should try to find a hospital that will provide you with an ED internship; a true internship including class work as well as an extensive orientation with a preceptor. All areas of the hospitals are short and while some background in med/surg would be helpful I am not sure it is essential so long as you have some practical training as part of your orientation. Are you ACLS and PALS certified? Those certifications would be helpful to you. I would also advise you to calm down a bit. Just because you have learned how to do something doesn't mean it has to become boring. Nursing is not about performing a set of tasks in order to move onto the next set of tasks on a new patient. Try to look at your practice and skills as part of a whole. Patients are people and they all have varying needs and experiences they bring to their interactions with you. I have worked in a variety of areas of med/surg and have found oncology to be the most multidimensional; always new information coming down about treatments etc., psychosocial issues for patients and families, complex, multisystem issues for patients related both to the illness itself and the treatments and their impact on the patient and family's life. It is a great area.

Finally, one last thought about this discussion about so-called nursing "theory". What ever was the point of changing the description of a certain sound in the lungs from "rales" to today's accepted word, "crackles"? It is all nonsense. The sound is the same. The significance of this sound in a patient's lungs has not changed at all. Changing the name of something does not represent any advancement in knowledge for nursing or any other discipline. The concept has been around for ages. If nursing wants true recognition as a profession it should get away from such silly exercises in renaming things that are already known.

When did I ever say that only wounds are called alterations in skin integrity? I used that as an example. I am well aware, as pointed out by another writer, that the term can apply to any number of things and as such has no particular meaning in and of itself. Understanding that certain patients are at risk for "alterations in skin integrity" is no different than understanding that they are at risk for skin breakdown, which is the way such things used to be taught. Changing words or phrases and simply, arbitrarily,assigning certain phrases as "accepted" for use, as I said before, represents no advancement in anything and most certainly does not designate nursing as a profession with its own scientific body of knowledge. It is simply the adoption of a jargon to describe things nurses and others have known for years.

It is absurd to state that anything as verbose as saying "alteration in skin integrity" constitutes some kind of shorthand . By your own account the phrase can mean anything and so therefore actually means nothing. It would be so much simpler to just describe, in succinct language, whatever characteristics of a person's skin one wishes to discuss. I stand by my contention that memorizing jargon is most definitely not the same thing as acquiring knowledge. Anyone can memorize jargon. It does not require any specific knowledge base. I rather doubt that physicians, scientists, mathematicians or other knowledge based disciplines engage in this sort of nonsense.

Nursing theory is a fantasy, plain and simple. Sitting around "theorizing" about where imaginary patients fall on "the health/illness continuum" is more properly called engaging in conjecture. There is no more proof that any answer is correct than there is that if you step on a crack you will break your mother's back. In addiiton while nursing set out to separate itself from medicine and develop its own scientific model in order to be recognized as a separate profession, this has not been accomplished. Learning to call simple things like wounds, "alterations in skin integrity", is not a separate scientific body of knowledge or way of looking at the same thing by different disciplines. It requires no specific set of knowledge and is more properly called memorizing jargon. Jargon is not knowledge.

I graduated in 1981. Nothing annoys me more than listening to "old timers" bragging to today's new grads that when they started they took 60 patients by themselves, cooked all the patients' meals, did all the laundry, walked ten miles to work uphill both ways, etc. I remember having a hall of 26 patients on evenings with myself two Lpn's and one aide. Most of the patients weren't even sick! Those were the days when people could be admitted for a barium enema, an arthrogram, a check-up, or whatever else. Patients were kept in the hospital extra days to accommodate families who didn't feel like picking up Grandma on Tuesday so could she please stay until Friday? Most if not all of the patients on the medical oncology unit where I work would have been in intensive care when I started. I hope new grads do not pay attention to this kind of nonsense. They face very difficult, very sick patients. It also amazes me the way the hospital lobby has been so successful at thwarting efforts to have nurse/patient ratios written into law. Day care centers operate under such mandates, so why not hospitals, too?

Blow bottles are NOT the same as incentive spirometry. Using blow bottles a patient exhales to force the ball or whatever it is into the next bottle. Incentive spirometry is the exact opposite. The patient inhales as much as they can to use it. That is why blow bottles have fallen by the wayside and been replaced by the use of incentive spirometry.

Do nurses out there really need MD orders to do nasotracheal suctioning? Where I work it a patient requires it a nurse can just go ahead. In addition I have not seen blow bottles in use for a number of years as trying to forcefully expire air collapses the alveoli instead of expanding them. Are they still in common use?

Actually it is hard to take seriously anyone who claims to have "book knowledge" and can't even spell properly. Everyone has a role to play. RN's, especially the ones coming out of university settings, have much to learn from LPN's who know what it is like to actually take care of patients. In fact things have gotten so bad in RN training that healthcare has been dumbed down to the point where no initials can be used when writing or transcribing. It is hard to believe that people with so much "book knowledge" apparently don't even know what KCl is; it has to be written out specifically as potassium chloride. I knew what KCl was when I graduated high school.

It is certainly all right to cry at such a sad situation as this. When you get some more experience under your belt you may find yourself more able to detach yourself from events such as this but there is no denying that situations such as this are very sad. Just remember that your presence there, providing comfort and listening to and helping this woman reach her family are all such very important things in this world. I work in oncology and had always shied away from this area, fearing the sadness of it all, not knowing what to say. I do not cry often but there are always those few patients who touch you deeply. I have cried with families after things are over. Just remember that yours is a hard job but so much better to do something to help the suffering than to fear it so much that you cannot do it at all. I am sure you will be a fine nurse.

I have always worn my stethoscope around my neck. It doesn't seem very efficient to have to keep taking it out of your pocket. It I have a psyche patient with a history of violence I just don't use it at all if there is no guard present. I don't know what type you have but Littman makes any number of lightweight models.

In the first place I have worked in seven different hospitals and have probably used every type of pump on the market. I am not impressed with any of the drip counter pumps or others that have tubing that you can take and use to run fluid by gravity. I cannot think of a situation in which this would be necessary. High volume rapid infusion can be accomplished with straight macrodrip tubing. As I said in the first place but knew would happen anyways, I have worked with many foreign nurses, probably more than most nurses on this site. I lived in So Florida and worked with Canadian nurses, Filippino nurses, nurses from Guyana, Jamaica, England, Australia, you name it including from most areas of the United States. As far as healthcare in Canada I am entitled to my opinion and I am not impressed. This same nurse told me she had to wait approx 3 months for an appointment for a physical and then the MD spent approx 5 mins with her. In addition she told me the province had stopped reinbursing physicians for calling patients with lab results, etc, so that after waiting three months for the physical, it was another three months to get the lab results. Patients had to be physically present for the MD to be able to bill the government and so people are coming for idiotic things like getting lab results, taking up office appointment time that could be better used seeing people who are actually sick. I know of no true innovation, technological advances or anything else that has come out of Canada. Read Mark Steyn at Mark Steyn.com for more insight.

Oh, heaven save us from the cliches that are supposed to substitute for knowledge! "Lifetime learner", "Thinking out of the box" and other such nonsense. There was nothing wrong with hospital-based training except that the feminists went berserk and wanted them destroyed. Never mind that other people might have wanted to train in hospitals. I went to New England Baptist Hospital School of Nursing. We did our clinical pediatric rotation at Children's in Boston. The politics of nursing was quite heated then. Talk of indentured servitude, patriarchal healthcare, hand-maiden. University education was supposed to break the shackles of this prior system designed to denigrate women. A few years after I graduated, Children's as well as numerous other hospitals in Boston started refusing to accept nursing students for clinical rotation unless they were in BSN programs, essentially killing off the hospital-based schools. And off nursing went, burning their caps and wearing canvas underwear like all the other feminists. Now I read articles about such "innovative programs" to address the horrible lack of technical skill on the part of the BSN grads. Their schools may actually team up with hospitals to provide hands on training! Talk about reinventing the wheel! People may think what they like about BSN vs ADRN or whatever, but I do not consider sitting around in university classrooms engaging in conjecture about where imaginary patients fall on the "health/illness continuum" a scientific or technical endeavor and in no way prepares nursing students for the high tech, demanding field they enter. Furthermore, as far as whether nursing has developed its own separate "science" distinct from medicine and so can be recognized as a profession, that is nonsense. Calling simple things such as wounds "alterations in skin integrity" or my personal favorite, an illness an "alteration in health maintenance" is not a specific separate body of knowledge. That is called memorizing jargon.

I don't really care so much about this issue except that you might think that nurse managers and so-called nursing "leaders" would have better things to think about than this! It hardly seems like the most pressing issue facing nursing today. Many at my hospital feel it is just one more slap in the face, i.e. you didn't fill out all your paperwork, you left two t's not crossed and four i's not dotted, Mrs Jones in 585 complained that she waited three seconds for you to answer her light, Dr. so and so said you were rude to him, the supervisor said you complain too much when the floor is short, and on and on and on. And now, we don't like the way you look either!! So there! I know quite a few people who are about ready to quit anyways because of all the hassles and this for some reason represents the straw that broke the camel's back. The whole thing is absurd. It is amazing to me that this is happening in so many places. It's always monkey see monkey do in nursing management. Anyone remember patient-focused care and what a fiasco that was? Another whim of nursing management that totally destroyed morale. At the rate things are going they're lucky anyone shows up for work. There are plenty of 9 to 5 jobs, no weekends no holidays at outpatient centers, infusion centers, insurance companies, home care, school nursing. Where are these people coming from? No doubt there will be big ad campaigns, "Garden Variety US Hospital:Our Nurses Wear White!!". Give me a break.

I remember having to insert a foley for the first time. Anxious, heart racing, but I was ready. This was the VERY olden days when each piece of equipment was in separate packages, patient was placed on a bedpan and cleansed with soap and water. I waited and waited for my instructor, my patient all washed already, and the instructor forgot to come! So here is this poor woman, me like an idiot making her stay there with her legs apart for who knows how long! It was horrible. Then when the instructor did finally come in, she moved the table on which I had all my equipment to the bottom of the bed for some unknown reason, leaving me to reach quite a distance all the while trying to remain sterile. What a nightmare!

Lucky you to have a nice manager. Our Director of Med/Surg is fond of telling nurses who express concern about short staffing to "put up and shut up". How sweet!

I recently worked with a nurse from Canada who was a real snot. I have worked with many foreign nurses and I do not want to be accused of generalizing here. But this one was a real pain in the butt. She had been out of school a whopping year and a half doing ortho before she graced us all with her presence on the oncology unit at my hospital. She took the chemo cert course which I had found quite difficult even though I have been a nurse for 24 years. I asked her how it went and she told me that it was "all basic nursing"! I told her I had found it harder than the ACLS course. Everything was always, "in Canada this, in Canada that...". One morning I really lost it with her. She was complaining about the plum pumps we use at our hospital which I happen to think are pretty nice. She said she liked the ones in, you guessed it, CANADA, because you could take them off the pump and run the IV on gravity. I told her I was familiar with those, the old IVAC pumps which were not really pumps at all, just drip counters, but that I hadn't seen one in use in years and assumed that they had all been put in museums where they belonged! On second thought maybe the US sold them to Canadian hospitals for use on the few lucky patients who manage to get admitted before their conditions become fatal. :angryfire

It is terrible that your skills are not valued by rn's and others. No one in healthcare is "just" anything. Everyone's job is important. Everyone brings a special set of skills and expertise to the job. I work with a tech who is also a certified phlebotomist. She and I have fun together trying to find a vein on patients who will be difficult sticks when I have to restart their IV's. She is much better than I am at doing this. Techs have taught me much about how to do physical care on patients; tips for how to change patients quickly and get the brief "just right", something I was not very good at for a very long time. I rely on one tech in particular who works full-time while I work part-time. Her observations about patients, particularly if a particular behavior or whatever represents a change from previous nights, is so helpful to me if it is my first night with that patient. I know what you mean, though. I work with loads of nurses who won't do their own vital signs as that is "tech work" or whatever. It isn't right. Everyone should help each other to keep the unit runnning well and so everyone feels supported and valued.

Let's see if we can guess how your "manager" handled or will handle this problem. After 24 years I am convinced they go to a special school where they all learn the same technique. Since the manager's first priority is not to make any more work for herself, she must turn you into the problem. This comes in the form of such remarks as , "Funny, you seem to be the only person who has this problem with Sarah; I haven't heard any other negative remarks about her". Now, you're the problem. This tactic is designed to get you on the defensive and start questioning whether you have any right to speak up! Second in line might be something along the lines of, "Is there anything in particular going on with you lately? I've heard people are saying that your attitude has become quite negative". Now you are really in for it. It's Oh My God time!! Have I been that bad? Maybe I really AM the problem!! Now, the manager has won, so to speak. She gets out of having to support you or address this problem in any way as well as not having to deal with the possibility of possibly firing this insubordinate tech and replacing her, which would be an enormous hassle, not to mention cost the hospital money training someone new. Is this even remotely how things went? This is actually all the rage if you read nursing management magazines. It is conveniently called having staff "take ownership of problems" which makes you wonder what managers are needed for anyways or what they actually do for a living except perhaps scrutinize all your paperwork for any box that has not been properly initialed, etc.

Last night I took report from a nurse in the ED at another facility about a patient who was on her way to my floor. The nurse said the patient had a "history of multiple suicides". I bit my tongue.

I would never even consider endangering the welfare of my children just for a job as a registered nurse. We just had a blizzard here in Connecticut and I was told by a supervisor that the hospital "wasn't accepting calls to say people weren't coming in". I was already at the hospital; I worked 7P to 7A during the storm. Well, screw them. Let the management including the VP of nursing risk their necks to come in! Funny I didn't see any of them around all weekend! And guess what they gave us for coming in? A $3.00 pass to the cafeteria which is not even open on nights!! Well, thanks so much! You can always get a job as a nurse. If you like your job then, yes, I would try to find alternative arrangements when you have time. I have never seen any institution show the kind of loyalty to employees that they feel entitled to expect in return.