Delicate Flower

Yes, money matters, but it's a complex issue. Do you think more money should be spent on enhancing the food and creating more warmth in the care environment (better furnishings, decor, etc)? Do you think that money should be spent on these areas at the expense of other needs, such as equipment, supplies, and staffing? The problem is that resources are limited, so there is going to be a give and take on where the money goes. Health care is so darn expensive as it is, for a number of reasons. How does this fit into cost containment?That being said, I have worked in facilities that are pouring money into the hotel-esque features: room service, improved accomodations for family members, bigger rooms, plush waiting rooms, breathtaking lobbies, etc. There is an environment in healthcare where patients can choose where they go for their care, to some extent. And many patients are choosing based on the accomodations as much as they are the actual healthcare they receiver (as many are better judges as to the quality of a grilled cheese sandwich vs. the quality of surgical care they receive). Sometimes I look at my patients, whether they are poor, rich, educated, uneducated, whatever, and I look at the technologically advanced, interdisciplinary medical, surgical, and nursing care they are getting, how each and every person who comes in contact with them in the facility is there to help them in some way, and I think: wow, do they even know how lucky they are? Some are very grateful, but some seem to take it for granted. Yes, I understand you want to go home, but you know we saved your life, right?

Go get yourself cleaned up immediately! That color is NOT part of the approved dress code.

Help! Call a Code Green!

The doctor wanted agressive pulmonary toilet. Too aggressive you think?

Which wipes do we use for facial decontamination again? The purple top or the brown?

Yeah, weighing diapers is pretty much a NICU/peds thing. I've never seen it done in adults.

What is babbling?

I feel for you. I have been in a similar situation where I got called by the manager (at home, on my day off), to discuss some horrid behavior of mine that allegedly happened the week prior. I had NO idea what she was talking about, and spent half a week crying about it. Turns out, I was wrongly accused- the person who was at fault for said horrid behavior was a person sharing my (not very common) first name. The manager was set straight, but I never received an apology (big surprise). The worst part of your situation, even though it is different from mine, is that the accusation is SO FAR from the actual truth. From the sounds of it (and I believe you- it's not hard to tell your character from your thoughtful and well written post) you are doing a very fine job for such a new nurse. My though is, why do your co-workers, and especially your manager, even expect you to be helping your coworkers. As a brand new grad with less than a year on the job, you are SUPPOSED to be still figuring out things for yourself. You are meant to be asking questions. Your coworkers should be helping you! If you are helping your fellow nurses by giving meds for them and answering their call lights, that is awesome. It shows you have your time management figured out pretty darn good already - something that isn't easy so early in your career. Bravo! So yes, it sounds terribly unfair. Unfortunately, the world of nursing (like the rest of the world) is full of unfair BS. Unfortunately there is not much you can do about the unfairness aspect. What you can do, is keep doing what you are doing, but be alot more obvious about it! Don't be so quiet about everything you do; advertise it a little bit. You are smart enough to know how to do that without being obnoxious. No matter where you work, there will be people who don't like you. It has nothing to do with you, and everything to do with them. Nothing you can do about it. Just do your job, take care of the patients, be a team player. Don't let the BS get you down:)

I agree with all of the PP. Most hospitals I have worked in have had a process in place for patients who want to give a compliment or special recognition to an employee who provides great care and/or service. There are feedback cards and surverys which the patient may fill out. Many patients also choose to write a letter to the unit manager and hospital big wigs in which they can thank and recognize individual employees. If he would put it in writing, you could potentially get a copy of this feedback and put it in your "portfolio" along with references, positive evaluations, and so forth. Just black out the patient's name to protect his privacy :)

I don't know whether your symptoms could be called PTSD, but they are defininitely under the anxiety/panic attack umbrella and are severe enough to get in the way of your work and life. I would make an appointment with your MD ASAP. There is no need for you to deal with these debilitating symptoms. Medications can help. I had a clinical instructor who brought me to tears on many occasions. I wasn't like many of my classmates who had worked as aides or techs before going back for RN. I had never even set foot on the inpatient hospital world and I had no idea what to expect. In those beginning clinicals I struggled to answer the question: what does a nurse do, exactly? What is the big picture? I had a vague idea, but I didn't really know. I made the mistake of asking this instructor to help me clarify the issue. After a brief pre-conference, he gave us our assignment and released us to the floor, telling us to be back in 8 hours. Before leaving the room, I asked him something to the effect of: can I just review something with you? What are the things I need to focus on accomplishing during these 8 hours with my patients? What are my goals and objectives? Instead of answering me, he gave me a stern look and told me to follow him, then led me to an empty patient room. He shut the door, and then let me have it. He said "There are 12 other students in this rotation. Every single one of them, besides you, knew exactly what they were supposed to do and went out to the floor to do it. Why is it that you have no idea what you are supposed to be doing?" I cried like a baby. When it came right down to it, I was over-complicating things (I have that tendency). I knew essentially what I was supposed to do. I just made the mistake of thinking my instructor was there to guide me and help me build confidence. I explained to him that I was just a little foggy on what exactly a nurse's day looks like. How does she organize her tasks? How does she manager her time? In those days, we were forbidden from "bothering" the patient's assigned nurse. We were not to ask them any questions or otherwise take up their time. It wasn't like the students I see now who basically get to shadow the assigned nurse. My "punishment" was that I had to come back on my own time and "shadow" a nurse during her shift at the hospital where we were having clinicals. I had to take a day off work to do this. The nurse used me as a free "aide" and was sending me off to do CNA type tasks and I really didn't even get a better understanding of what the RN shift was like. But overall, it helped me get over myself a little bit and come to realize that I was making things a lot harder than I needed to.

I think it's interesting that peope seem to know when someone is calling in for "BS reasons." How do you know? Do they tell you? Yes, there are some who do advertise their bad intentions to call of for a stupid reason, so then it is obvious. But in most cases, I think you have to give people the benefit of the doubt. I don't think anyone should be penalized for staying off sick, when they are actually sick. I do not want you and your germs around me at work. Likewise, I do not want to be coughing all over my immunocompromised patients and slogging through 12 hour shifts feeling like the worst kind of crap when I am sick and should be home in my bed. For me, it actually wouldn't matter whether I had paid sick leave or not. What matters is the policy: If I am going to be punished for calling off, then I will come to work sick. Yes I wear a mask and wash my hands, but I will drag my butt to work and get through it somehow if the alternative is going to affect my status at my job. I think that is a sad state of affairs for us to be in, in the healthcare industry. I think you should be able to call off when you are sick, period. Paid time until you don't have any left, then unpaid, but not getting in trouble or penalized for getting yourself healthy and keeping your germs out of the hospital. If there is a fear of people abusing the system or faking it, require a doctor's note. If there is a fear of people using their doctor/NP friends for bogus notes, then make people go to employee health.

I do think pay affects my attitude. I am willing to deal with more BS if I know I am being well compensated. That being said, $3-$5 an hour is not enough to tip the scales for me, unless it were part of an ongoing path to higher compensation (climbing the ladder).

Ethics, I agree with you completely. I do not take issue with any other professionals and would not begrudge them their fair compensation. Like you pointed out, the issue is with the systems and how they have evolved. Everything is relative.

Have been perusing the job openings at my facility, and have taken note that 3 positions have STARTING salaries that are $5,000+ more than what I currently make: -Occupational Therapist -Chaplain -Radiation Tech The way these postings work, is the starting salary would be entry level, little to no experience. It just goes up from there. So I can conclude that these individuals would be either relatively inexperienced and making more than me, or experienced and making LOTS more than me. Now, not to knock either of these fields, but I have been a nurse for 8 years, have extensive education, and am certified in my specialty. As an ICU nurse, recognizing subtle changes in condition, knowing how to intervene, and responding in an emergency is a daily occurrence and can make or break the patient's outcome. I think it says something about the VALUE placed on nurses at the bedside that this is how we stack up against other departments in the hospital. Just sayin'

Wow, Ruby. I enjoyed reading that. Just like a Harlequin! I don't blame you for losing respect. Do you know for a fact they are sleeping together? I mean, sharing a chair makes it pretty obvious that something is going on... The facts that he is married and his wife is pregnant definitely make the relationship more scandalous, but even a straightforward relationship, when conducted at work, is downright inappropriate. It makes everyone around you uncomfortable, and you can be sure you aren't focused 100% on the job when your object of lust is sitting next to (or under) you. Just don't, people. I almost feel bad for Heidi. At 21, I didn't know what the heck I was doing. I'm sure she knows it is wrong to be messing with this dude, but she's got stars in her eyes and by golly, he's a doctor! Someone needs to confront her and tell her: Nothing good can come of this. A whole heaping load of bad, but nothing good.

You will not be able to bypass the BSN and go straight to the MSN, even though you have a related BS degree. The nursing world is very particular about the "N" part of their BSN. Unfortunately, BS + ADN does not equal BSN. However, as PP mentioned there are lots of bridge programs that will allow you to earn you BSN on the way to getting your MSN. You will still have to take BSN coursework, but you won't have to separately apply for admission to the MSN if you do a bridge program. Many programs will accept your previous BS credits for gen-ed stuff like statistics, research methods, etc. But you will still have to do the bachelor's level nursing coursework.

I tend to think the best of people, until given evidence to show otherwise. When someone calls in sick, I assume they are sick. Unfortunately for me, I am very susceptible to minor illness like colds and other viruses, and I can count on getting sick at least 3 times a year. Lately it has been more since I have young children spending time with other young children. I have gone to work sick and miserable due to policies like others have mentioned. But given the availability of sick time and a policy that allows its use, I would much rather stay home and be sick than go to work and be sick. Yes I wear a mask at work and wash my hands like crazy, but spending 12 hours taking care of sick people when you are barely making it yourself is not ideal. I also wanted to note that there are some things you may do while you are sick, like shopping (can't help it if you need tissues, medicine, or food) which does not automatically mean you weren't too sick to work. Going to walmart is a lot different than going in for a busy 12 hour shift caring for immunocompromised patients. Partying on the other hand is a different story.

INTP, Float pool I am extremely introverted, to the point where I have no friends (just acquaintances and people with whom I am friendly). Growing up, having friends felt like a requirement, and I went along with it, but I always struggled and found maintaining friendships to be more of a chore and a burden. Going out, hanging out, even talking on the phone with a friend is a struggle for me. Now that I am of an age to make decisions for myself, I choose not to have friends. I have my husband, my kids, and my dogs. I don't have the desire to be with anyone in my free time besides them. I would rather go to work than go to a party, any day of the week. At work, I am friendly to coworkers and patients alike. I don't think anyone would ever guess I am so introverted and friendless! But I don't view work as a social environment. Even though I have to interact with people there, our interactions are set and guided by what we are there to do. We are not there to entertain one another.

PMFB-RN, I was thinking of your avatar the whole time reading this thread, and I was wondering if you would chime in!

Does she have stable BP or does she have problems with hypertension or hypotension? Is she on BP meds? If her BP is normal and she is on no meds, maybe you can tell the doctor and get an order to only check BP weekly or PRN. If she has dementia, does she have a POA? Maybe the POA could refuse BPs on the patient's behalf so you would be covered in not checking them.

I hate the waste and suffering that occurs with futile care at the end of life. However, I think much of that could be avoided if the public were more educated on end of life decision making and palliative care. Yes, euthenasia is illegal, but for a competent person to decline treatment is absolutely legal. Have a living will, have a health care POA who knows your wishes in case you can't speak for yourself.

"She's loud and outspoken. Markedly unattractive and overweight, in her mid 40s, she describes herself as having been in the ICU "forever." She's large and in charge, and everyone knows better than to argue with her because she's always right, and there's only way to do everything. An adult learner, she was a former waitress or CNA before "gettin' her RN" now attending an online-for profit school for her BSN or, more likely, refusing to further her education at all. She has been uplifted from a low income upbringing to "professional status" and for years has been drunk on an artificial sense of authority as an RN. Her particularly favorite hobbies include talking endlessly about her experience, describing the problems she has with "today's young nurses," and behaving rudely toward float nurses and travel nurses and medical interns just getting out of school because "they should know how to do all this without asking." She also makes frequent trips to the manager's office to pester and annoy. I transitioned from my hospital's float pool to the medical ICU about 6 months ago, and we have one of these in my unit." The way this is written is not to describe the one individual the OP has to suffer in his ICU. The title of the post and the first paragraph is set up to describe a type: "the bully queen of the ICU." OP is asking us if we have worked with one, or if (forbid!) we may be one ourselves. But how will we recognize her (for it certainly must be a female)? Well, the first paragraph provides the characteristics we should look for to identify the bully queen: -she must be fat -she must be ugly -she must be "low class" -she must be rude and outspoken -she must hate new nurses and young nurses -she must be arrogant The next paragraph transitions to describe the individual with whom the OP works. I just wanted to clarify for those who believe that OP was just creating a nice descriptive narrative to describe this one individual bully. If that truly was OP's intent, it surely was not written that way.

I don't think OP is asking for harder assignments necessarily. It's about being automatically dismissed as being competent to take care of sick patients, just because you are a floater. Less sick does not mean easier, and vice versa. There are sick patients, and then there are sick of 'em patients. When the regular staff gets sick of taking care of them, they give them to the float. I have floated for four years in many different facilities in three states for four major health systems. What I can say, is it all depends on the facility and unit culture. There was one place that always seemed to stick me with the crap assisgnments. If there was a difficult family, "needy" patient, or volcanic poop explosion on the floor, that assignment had my name all over it. I'm not asking for balloon pumps of fresh open hearts. But clearly if you feel "comfortable" with my competence in giving me a STEMI admission, you should feel comfortable giving me an actual acutely ill ICU patient. It's better where I work per diem now. I asked management to get us the "CCRN" badge buddy because that gives validation to your skills when you are otherwise an unknown on a new unit. If you have certification, that can give you some credibility. I can understand why one PP's hospital's float pool nurses quit within 6 months. It sounds like a horrible environment for floating. I wouldn't last long either if I was being blamed as a scapegoat for everything that went wrong and met with an attitude of "the float nurse did it." When you get good at floating, you get good at knowing the various nuances of different types of units, and you know when to ask questions. If those units have such obscure policies or ways of doing things that the float nurses can't adapt, something is wrong.

Wow, Commuter. Thank you for sharing that. You are always so introspective and self aware. Off topic, but I remember another post when you described yourself as viewing people as objects, and having a blunted affect. That stuck with me because I can see those qualities in myself. My parents depress me as well. I live 8 hours away and enjoy much better mental health when I avoid any contact with them whatsoever. They do not have myriad health problems like yours, but they are just depressing in other ways.

I just started a new position and I fear it is one of the toxic environments of which you speak. It has nothing to do with the patients, and everything to do with the staff. The manager is an arrogant control freak. He has obvious favorites among his staff who have earned that distinction by tattling to him about every perceived shortcoming of their fellow RNs. He shows no interest in actually talking to the majority of the staff members or getting their input. I've never seen him say one word to an actual patient. The guiding principle on how the unit is run is "I've done it this way for years and it's always worked." Falling out of favor with the manager results in punishment in the form of undesirable schedule and assignments. New staff are not welcomed, but hazed. It took me 2 weeks to get the chance to enjoy my first knife in the back courtesy of one of the manager's favorites. Egos run amok. Nurses power tripping to step on top of each other to gain the manager's favor and become one of the chosen elite. Secret societies work on quality improvement "projects" so their members can get promoted for higher pay, and patient care is almost an afterthought. Who cares about what patient care you gave, as long as the documentation is spot on? Documentation is tailored to the needs of auditors, not patients or caregivers.