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babs_rn

babs_rn

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  1. babs_rn

    Nurses tossing scrubs for all-white uniforms

    Why can't the other non-clinical departments change what they wear? Why does it have to be the nurse? I have a problem with nursing uniforms for two reasons: One, they're not conducive to the physical nature of the job; and Two, well...you paint a room white to make it look bigger...it surely does my a** no favors. If you want to look professional go for solid scrubs and leave the bunnies at home unless you work Peds. But ultimately professionalism is an attitude that will come through regardless...
  2. babs_rn

    What is it like working for Divata Dialysis?

    I have to agree with you on that point. It is, more often than not, a matter of the individual center/clinic and the regional administration. I recently walked into a center that has had..mistakes made by staff due to lack of education, mistakes made in water treatment (also due to lack of sufficient understanding of the importance of the system), not to mention actual building/facility issues. In my 10 weeks here I have utilized the resources available, with the support of a fantastic RD, and have a heavy-duty training program going on, re-educating everyone from the basics on up. Those who are well familiar with the material can consider it a refresher, but everyone learns something (and once this is done no one can claim "I didnt' know")...building issues are being addressed though I pray for a new building when the acquisition is complete. I won't get into the differences between DaVita's and Gambro's computer systems. I will say I prefer DaVita's and look forward to working with it again. Just more user-friendly, but then it's newer, faster, and we're all entitled to our individual preferences. Staffing-wise, I work around a lot of Gambro CDs who are working the floor full time as charge nurses...and I know my day is coming there too. DaVita FAs have to do it too when there's a crunch, and in our state an RN has to have 6 months of dialysis experience in order to be able to charge. Six of one and half a dozen of the other on that end of things, we have 26 stations and often only one RN in house and with staff call-ins, she often winds up having to take a bay too. So that's not just a DaVita thing, that's an "available staffing" thing. For-profit companies are always going to be about the bottom line, period. The fact that they exist in healthcare is a topic for another forum.
  3. babs_rn

    Noncompliance a factor in transplant evaluation?

    Our various transplant centers will automatically disqualify a chronically noncompliant patient. No sense wasting a perfectly good kidney on someone who won't take care of it.
  4. babs_rn

    Intimidation Tactics as Teaching Tools?

    Yelling? no. Degradation? no. Making you feel stupid? Well, remember no one can make you feel stupid unless you let them. Your emotions are under no one's control but your own. But it makes you work harder, doesn't it? Or makes you quit. Separates the "men from the boys" so to speak. i think that's the purpose. May not be necessary for everyone, but it is necessary for some. It's still sink-or-swim out there. And yeah the students do work under the instructors' licenses so there's a lot at stake there. And if too many students flunk boards, the school loses its accreditation. So they only want to graduate students who will pass the boards and they will push the students to see what they're made of. Either they rise to the challenge or they quit. But it is as one instructor said once..."when I send you on your way, it means that I believe that you are safe enough to take care of my mother." And from what I hear, the schools here are about to lose their accreditation because of the kinds of nurses they're turning out. So see...its NOT just me.
  5. babs_rn

    Got any funny acronyms at your ER???

    Oh yeah. Had a doc who ordered Serum Porcelain Levels when a pt was a "crock" or FOS
  6. babs_rn

    Phasing out LPN's.

    I guess I could see a CMA in a physician practice but in a hospital environment? No. Never. So JCAHO won't let licensed nurses assess but they'll let unlicensed people give meds? Surely others see something wrong with that whole picture? Another way to try to get cheaper alternatives to nurses. Operating under the assumption that nurses are just skilled at performing tasks and have nothing else to offer. How sad. Do I really have to go on another spiel about how nurses are there to make judgment calls, tend the whole person (not just the physical), and as many med errors and potential med errors as I've seen new grad nurses make, I would be horrified to ever let an unlicensed person give meds to my patients. No. When a nurse has gone through what a nurse has to go through to be a nurse, what message is this sending to him/her? That what you went through is really nothing? Something to be devalued because we can train somebody faster and work them cheaper to do what you do? No, you can't do that. There is no way a few months' education can train someone (who doesn't have a license to lose) in the intricacies of what WHAT they're giving the patient can and will do to that patient in a certain situation, when to hold the medication (sorry but "hold med if a or b happens" won't cut it. There are just times when a nurse "knows" something isn't quite right and will hold it pending a further assessment) and what to look out for when giving it. I don't like it. People aren't machines and I swear it seems the powers-that-be seem to want to treat the patients and the nurses as exactly that. I'll be glad when all this cycles on out. I'm just not sure what will happen that will spur that. Oh and for the record - I've worked with LPNs who have better assessment skills and better judgment and just all around better NURSES than a lot of RNs I know. I don't see phasing them out. I do think we need to sit down and re-define the roles though. We can better utilize the nurses we HAVE instead of worsening the shortage by putting so many out of work. I don't think JCAHO is doing anyone any favors here by defining nursing roles. We have nurse practice acts for that.
  7. babs_rn

    PHS has taken over our prison

    Yeah it has been awhile. Only way I do corrections now is with the agency though - here in GA the company that has it now has some ridiculous policies and low pay rates so actually many of the prisons are staffed with almost nothing but agency nurses. We know where our bread is buttered. I do it prn on the side.
  8. babs_rn

    drinks at the nurses station

    I agree totally. One does get parched from all that running around and besides, some of us get a little hypoglycemic too. We still must take good care of ourselves if we are to take the best possible care of others. Now if only we could get those foleys and leg bags so our bladders don't blow up to the size of exxon tankers....
  9. babs_rn

    Intimidation Tactics as Teaching Tools?

    Exactly what I'm afraid of. That's kind of my point here. Where's my supervisor? lol....I AM the supervisor. Have been for years. Orientation? Except in the outpatient dialysis environment (10 weeks and the new grad I'm about to mention was nowhere near ready in that time) orientation consists of ...here's where the supplies are, here's our paperwork, here's your customer service class day, good luck...(unless you're in a big hospital - and the nearest big hospital is 80 miles away). We bent over backwards to help these new grads. Eased patient loads, I took more on myself to do that. Not a day went by that I didn't get tired of hearing myself say, "Focus. Pay Attention." I bit my tongue so many times. Added more grays to my head. The nurse who killed the postop patient is no longer a nurse. Fortunately that wasn't my area. The heparin drip off the pump was another nurse on another shift thank GOD. The rest of it was on my dialysis floor. Taking care of a patient load of my own plus charging plus clinical coordinator plus precepting someone who suddenly thought I wasn't supposed to be able to tell her or show her anything once she got her license - and there was still a world of things to teach her from a licensed perspective. But the day after she got her license she stopped listening. It took me awhile to realize that was the problem but I was too busy trying to teach her concepts that she should have had drilled into her in school, much less teach her to be a dialysis nurse. I went to the administrator and we did all we could to try to help her but it just got worse. Finally she quit without notice. I don't think she's nursing anymore either. The chest pain situation got to her, I think, but sheesh. Even a lay person knows that chest pain has to be checked out. And she flat out lied when she claimed not to know the patient was a cardiac patient because we had talked at length several times about this patient's recent hx of CABG x 3 because it directly affected some care issues we were having with that patient - I took time with her to explain everything every step of the way - We were nice but I know it was showing on me. Other peers of mine share MANY similar experiences and similar concerns. Standards of care are just not being taken seriously by the newer crop of nurses from the local schools. It's frightening. And their instructors are VERY nice and supportive. So apparently nice and supportive doesn't work when it comes to building character in a nurse - makes 'em nice, sure, but they're not thinking and everyone is suffering for it. So we either need a more stringent screening program for prospective students or the unpleasant challenges are going to have to continue so that we graduate people who are capable of the kinds of critical thinking and judgment that nursing requires.
  10. babs_rn

    Intimidation Tactics as Teaching Tools?

    I'm sorry you miss my points here. For the third or fourth time I never said humiliation or temper tantrums are okay. Every crop of every profession (including nursing instructors) has its bad seeds. It sounds like he's questioning the student to make them think twice to make sure that they know that is what they are supposed to do. It sounds like he's trying to make them check and double-check and triple-check themselves. As they should be doing. Always. Because we are always learning and if we ever stop, we become dangerous. I have worked with dangerous. It isn't pretty. Confidence is important but too much confidence in a student (and a new grad) is dangerous. One must never be afraid to admit that he or she doesn't know - but will find out. One must always know to look things up. I don't pretend to be a "god" but I'm an experienced nurse who knows her limitations and has a high (and safe) standard of care. Even as a new grad I knew to ask questions and I knew to check the meds I was giving and if I was unsure about something (as I often was) to go find out FIRST. I'm afraid that has been lost here. Nursing students never quite understand the rationale behind the behavior of their instructors until they get out there on their own and screw up a few times. Then they see. You're SUPPOSED to doubt yourself. And think about it and check again. That's the SAFE thing to do. And when that doesn't happen, we get the kinds of nurses I mentioned above - literally putting patients at risk - and worse. A woman DIED post-op because her nurse gave her a paralytic instead of a pain med and left her to go on break, and she wasn't monitored. A nurse almost gave a patient an air embolism and would have if I hadn't stopped her. A patient's MI would have gone untreated had I not just happened to check in on her and her new nurse. Do you see what I'm getting at here? When the student isn't pushed to think and think and question and think more (however unpleasant the approach may have to be to get the student to prepare better and to realize that he/she doesn't necessarily know - to get him/ her to really think hard) we get nurses who simply don't think. And then patients die and lives are ruined. Not only the grieving family but also the nurse who gets named in the malpractice suit and loses everything they have ever worked for and will ever work for. Confidence comes with time and experience, which the student is just getting a start on. Unless there is some kind of personal insult going on here, and he's just double-checking you on your planned interventions (regardless of tone of voice - wait till you deal with some docs if you take tones of voice personally - it's important to develop a thicker skin) then what he's doing is NOT treating you like the scum of the earth. He's forcing you to THINK. and then think some more. And hopefully to inspire you to study harder next go-round so you CAN answer him more confidently next time. Maybe even quote chapter and verse. Maybe even quote HIM. Sounds to me like what he's doing is TRYING to inspire you to be a stronger and more confident nurse - again something that cannot be faked.
  11. babs_rn

    Intimidation Tactics as Teaching Tools?

    I don't want a "nice" nurse. I want a strong, compassionate, intelligent nurse who knows what the hell she's doing and who knows what her limitations are. As an ED NM (over me) put it, "Sweet and dumb is dangerous." Okay...look. I'm not harsh at all (and no I'm not a nursing instructor) ...but my fellow nurses and I are sick to death of nurses coming into the field who should never have graduated. Nurses who don't expel the air in a syringe before going to a patient's bloodline (I personally snatched one out of a new nurse's hand as she put it into a dialysis patient's bloodline with 1cc of benadryl and 2ccs of AIR in it) - nurses who don't know the difference between SL and SQ. Nurses who take heparin drips off pumps to hang by gravity for transport to a hospital 80 miles away. Nurses who give Sufentyl instead of Fentanyl because it "sounds like the same thing" and then go on break and wonder why their patient is CODING when they return. Nurses who draw up Fluvirin for PPD. Nurses who don't think to look up medicines they don't know before giving them. (17 yrs and I STILL never give a med I'm not familiar with until I look it up) Nurses who can't seem to understand the IMPORTANCE of paying attention to what they are doing. Nurses who don't recognize chest pain ("like bricks on my chest") in a CARDIAC PATIENT as something to be concerned about. No exaggeration. These are things they should have learned in school. And I'm sure these things were taught but somehow the IMPORTANCE of it got missed, as if it were all just lip-service. All this I have seen happen within the past year and it just amazes me that these nurses were even allowed to graduate without mastering certain basic concepts such as the five rights of medication administration. They apparently memorized things but they haven't learned (the definition of learning being a change in behavior as the result of new information and knowledge) them. Believe it or not I am very easy-going and I don't expect someone to learn something overnight but I DO expect them to have some basic SENSE and to REALLY try, and I'm not seeing that. Again I am referring to my geographical area here, which is a rural poverty-stricken area and many see nursing as nothing more than a quick way to a better paycheck - I just don't think those people should graduate unless they make some basic changes along the way. Nursing is still a "calling". I take each one on a case-by-case basis but unfortunately I only see maybe one or two out of a class who really take it seriously and really do try. Meanwhile I see many trying to play politics and butter up the nursing supervisors. It amazes me. I see nursing students on hospital clinicals who might change a bed and might give a med or two but that's all they do here. There is no sense of responsibility for the care of the patient instilled in these people. They go socialize and take frequent breaks and try to leave a couple of hours early if they can get away with it. THAT is what I am seeing HERE and it's NOT working. And they still graduate and somehow manage to pass boards and then it's like everything they "learned" is gone. As if, as I mentioned before, they just thought it was some information they were supposed to have to pass a test so they can get a job and nothing more, like none of it's really important. And no, nursing isn't the military but it does still require a certain amount of character and integrity and sacrifice and accountability and for those who may not have that going in, one of two things has to happen - either it develops (which does take a wake-up call to do, like it or not the fact remains that adversity is what builds character) or it doesn't and if it doesn't then that person does NOT NEED TO BE A NURSE. I do not want that person responsible for MY care. I absolutely DO believe in weeding out the ones who can't hang, who don't take it seriously, in making them pay attention to what they're doing. Unless I missed something somewhere, you can't afford too many mistakes in nursing. The average lay person may be used to getting along with an error here and there in other jobs with no really heavy consequences but that's not always the case in nursing...people get hurt, people die, people sue, there's just NOT a lot of room for error in patient care and if you think there is, then I don't want you taking care of me either. I am a very vocal patient advocate and an old-school nurse and I make no apologies for it. I support my nurses and I support new grads but I will also say that if you pose a risk to my patients, I don't care who you are, I will be on you like white on rice. My patients trust me and my coworkers actually enjoy working with me because they trust me too. I'm laid back about a lot of things but quality of care is NOT one of them. I'm not bitter but I am frustrated with this kind of attitude coming into our workplace because it is for the rest of us to pick up after them and clean up their messes and WE are responsible for that. Yes I'd much rather work short than supervise a nurse whose care I can't trust. I would much rather answer what someone may consider to be a "stupid" question than to have that person go and make a terrible mistake. It frightens me when I work with a nurse who doesn't realize that the question should be asked (as happened with the chest pain situation - she went on as if the patient hadn't complained, I just happened to walk up and find out about it, she then told me that she just didn't realize it was important). THAT is what is wearing me out. I don't have a problem with nursing students - I have a problem with nursing SCHOOLS not getting things through to them. They've taken that soft, "nice" approach around here and this is where it has gotten us. Plus the nurses graduating from them are totally unprepared for the rigors of the actual world of nursing. At least we were prepared. Only difference when I graduated was that we had no more homework, no more tests, no more huge care plans, and we got paid instead of paying. So the transition was much easier for us than it obviously is for the new grads these days (who seem to do nothing but complain). Yes, we had that much reading to do. Granted, many chapters were repeated in future lessons as concepts became cumulatively more complicated. But there's absolutely no exaggeration. It was very thorough. Each one covered chapters from two med/surg books, the nutrition book, the pharmacotherapeutics book, plus others that I honestly can't remember now but we bought many books at the very beginning that went with us all the way through as all total concepts of care were covered - not nutrition here, drugs there, but the entire disease process, the body's responses, compensation by other systems, diagnosis, treatment, complications, therapies of all kinds, prevention, what to expect, assessment, patient education, documentation, nursing diagnoses to go along with, nursing interventions and nursing care involving every possible drug and treatment and what they would do, (and nursing dx to go along with those too) etc etc etc - for EACH section and each major illness and then how that would tie in together with and be complicated by other co-existing disease processes. It was a damned good education. Our instructors/professors took a personal vested interest in the quality of nurses they turned out. My eyes stayed crossed. Books went with me everywhere, never did I have a waking moment (except in clinical) that I didn't have an open book in front of me. Probably read each chapter and each segment of each chapter 6-7 times between studying for tests and searching for the documentation for the planned interventions on the care plans. I read so much I frequently got to where I couldn't absorb another word. And I've have to re-read what I had just read because it I had totally missed the whole thing. If it hadn't been 17-19 yrs ago I'd have been happy to share the syllabus...but I had a big bonfire and burned it all after the pinning ceremony Even so I'm not trying to complain about how nursing school was (though one thing I learned there was - FORGET medical school!) - The starch and the whites and all that was just part of the times (though I still shudder to see nursing students with bright fake nails and tons of jewelry fixed up like they're going out the club but for their scrubs). We had an absolutely beautiful traditional capping ceremony and it was a rite of passage for us. Same for the pinning ceremony. And there was a great deal of satisfaction for me when the very instructor who gave me the hardest time, who pushed me so hard and in so doing, taught me that I could either lay down and die or stand up and be strong and finish on time despite the difficulties and the hardship - and in that, that I really did have the strength in me to fight back and win by shaping up and not giving up and by graduating without having to come back and repeat the same classes same time next year, was the one who put that pin on my starched white uniform and smiled at me with pride. She pushed, and I didn't fall down and die. I despised her, until one day after it was over when I realized what she was doing. She was pushing me so I would be not only a strong nurse, but a stronger person ( I was the baby of the class, greener than grass and had never encountered that kind of hard work and those kinds of expectations before, and I passed the NCLEX-RN at the tender age of 20 - and was charge nurse of a 35-bed tele floor within 6 months - there was a shortage then, too). It takes that kind of gumption to do what we do for the long hours that we do it and to give up what we give up and to still find fulfillment and rewards in it. Nursing school is more than about learning how to perform tasks and give meds and do procedures and do paperwork. It is about learning how to BE a nurse. BIG difference. On so many other threads in this board we mourn the passing of the patient advocacy, of the mission of nursing, of providing care to the whole person (mind, body, and spirit), of the community-centered care model and we express so much frustration at the large corporate "bottom-line"-centered model of healthcare that predominates these days, and all the consequences that we suffer because of it. We still want to stand up and be counted as Nurses, and for the world to recognize that we are still something special and cannot be and should not be dispensable. If we want to continue to be able to do that, then we have to send out competent, skilled, sensible, reasonable, intelligent, caring, thinking people into the profession - and the schools around here aren't doing that. And the patients are suffering, and so are the rest of us. And if nursing students can learn to "fake their way through" as one previous poster suggested, then we're ALL in trouble. The only thing that offended me was that concept right there. If it's even POSSIBLE to fake one's way through nursing school, then the schools have to back up and look at things and are just going to have to make it tougher, not easier. If nursing school is soft and easy, there's no respect earned by obtaining that position - nor is it deserved. Back in my day the community looked at you and respected you because you "made" a nurse. You made it. It was a big deal. It was hard, hard work and required a great deal of sacrifice and we were respected and trusted for having done it. And if we have nurses working alongside us and caring for us who have faked their way through, then God help us all. There goes the whole profession and everything we have worked so hard for, and there goes the care and safety of our patients, who already get lost in a system that considers them merely sources of revenue.
  12. babs_rn

    Got any funny acronyms at your ER???

    I developed two as a result of a couple of patients we had seen...one inspired the DQA right off the bat (Drama Queen Alert) - the other came about after seeing several twenty-something men accompanied by their mothers who answered all questions and tried to sign all consents and basically didn't seem to be able to function away from Mommy.....ASA (Apron String Alert).
  13. babs_rn

    Intimidation Tactics as Teaching Tools?

    We don't have the whole story on that matter - I never said that temper tantrums are okay, and i never said humiliation is okay. But what people may find to be "intimidating" is something that is entirely subjective. I've seen students and new grads complain about things that are entirely appropriate, quick interventions before they do kill a patient - interventions that may not be all "nice and sweet and soft" and are instead rapid and stern and direct - but that's what's needed. Society is removing the concepts of personal responsibility and putting everything squarely on the shoulders of the caregiver - the teacher is responsible for the student's learning and the nurse is responsible for the patient's compliance, etc... it's just WRONG and that DOES coddle the individual, who then is lost when faced with the reality of a tough world - A nursing education IS intimidating to someone who doesn't know what to expect in it. It IS difficult. It SHOULD be. We cannot afford to turn out everyone who thinks they want to be a nurse into the world to take care of us and our families when they are not cut out for it, not dedicated to it, do not take it seriously, are only in it for the paycheck, etc etc etc. I have seen way too many of them who literally apparently only view what they are being taught as just something they have to do to get a decent-paying job. We cannot afford to have that working alongside us and we SURE can't afford to have that taking care of us. All I can say is that the nursing schools in this area have gotten VERY lax and it is showing up in the quality of new grads who are turning up - and these nurses are still passing boards and they are making very grave errors. Nursing education is not there to change the system - it is there to prepare the student for the system that is and then once they have enough experience perhaps they can have a hand in finding solutions to the bigger problems. But I know that I would want MY nurse to be dedicated enough to have had to have worked for it and not used to skating through. Nursing students today (again, in MY geographical area) are being supported to the point that they are horribly under-prepared for the reality of the working world. Sure it's nice to have all those warm fuzzies but they're literally killing patients. They're missing important points. We can't afford that. You have to have a thick skin to be a nurse. You have to be able to take the abuse from your patients. You just have to. It's part of it. Yes standards should be VERY high. Our lives and our care depends on it. I'm not the only one. Even just last night at work all my coworkers were complaining about the quality of the new grads, how they just seem to be in it for the paycheck. We can't have that. I can keep saying that till I'm blue in the face. Lots of nursing traditions have gone by the wayside, and some of them needed to go. But the tradition of care of the whole being and of the high STANDARD of care and the dedication and the personal character --- cannot. And sometimes it takes a little wake-up call to shake up a person enough to make them see the seriousness of the matter. That's not just in nursing, that's in anything you do - well, anything that matters, anyhow. As a society we have this trend toward trying to make everything in the world soft and pleasant and so we wind up with a bunch of spoiled brats who can't handle the real world when they're suddenly faced with it. We are in this for a larger purpose and I, for one, am not going to let that larger purpose go by the wayside.
  14. Just a suggestion.....(since our admit assessment is 5 pages long)....why not call your nearest dialysis center and introduce yourself and ask if you could use one of theirs? There is an extensive admit assessment, then each tx requires a pre- and post- assessment which is just basic v/s, lung sounds, heart sounds, level and location of edema, condition of access/site, orientation level, whether they have visited an ER, been hospitalized or had an OP procedure since seen last (if they have the center bills more for the tx) and if you're in CA you have to add a pain scale. You also want to look at the particular extremity the access is in - is the arm (or leg) swollen above or below the access? (If swollen above could indicate some venous stenosis and the access may have to be cleared) Is the area distal to that warm or cool (if cool could indicate "steal syndrome")? Is there pain in the affected extremity? Post tx we also indicate bleed time (how long it took each site to stop bleeding) - if over an hour, we know that either there are access problems beginning to develop or we need to cut back the heparin - or both. Hope this helps.... Barbara
  15. babs_rn

    Intimidation Tactics as Teaching Tools?

    Nope but i did walk to clinical cause i was 18 yrs old on scholarship at a small junior college, lived in the dorm and had no car. You were starched and pressed and pristinely white, no nail polish (a fellow student got sent home for having clear polish on) and no jewelry but a watch and maybe a plain gold wedding band and you carried your cap in its little plastic carry case and you carried your shoes lest they get a smudge on them on the way. And yes you bet that was easily tons of reading, easily that many chapters per week (and no, there was no time for partying or dating or a job. You ate, drank, walked, talked, slept, dreamed, and breathed nursing. It took DEDICATION - it took DRIVE - it took PROVING something to yourself to graduate. It took HARD WORK - and most years the state board pass rate was 100% too) ....we had a number of textbooks to pull from for every single disease process...pharmacotherapeutics, nutrition and diet therapy, Brunner's Med/Surg, Lippincott's Med/Surg, and so on and so forth.....yes ma'am. It was brutal. After graduation it took me two years to be able to stand to even open a magazine to read for pleasure. But the program graduated nurses who knew what they were doing too, and who knew their limitations. If you didn't make it, you weren't supposed to make it. They weeded you OUT. Which still needs to happen. Nursing schools around here are under pressure from their administrations to pass everyone for the tuition and to ease the nursing shortage - and we're getting inundated with nurses who are dangerous and who don't take it seriously enough. I'm all about supporting the student nurse in clinical in my area (but in dialysis they dont get to touch ANYTHING - just watch and listen and learn) though in hospitals their clinical instructors can't be found and they don't do anything there either - our clinical instructors STAYED on our backs, I got an unsatisfactory in clinical one day after an MVA with 11 stitches in my knee and a brace on it because I was too slow and I left a siderail down. One siderail. Only "U" I ever got. Course I was also pending a closed reduction of the nasal fx I sustained in the same MVA - my nose was flattened and to the right but I postponed the surgery because I couldn't miss clinical as I had already missed one day since I was on my way to clinical in another town (last quarter of school and I had JUST bought a car on the "college graduate program", had had it all of 1 month to the DAY) when I wrecked. We were assigned 2-3 patients and we did total bedside care for those patients, their nurses didn't have to do anything at all for them because we did it all and our instructors were RIGHT there checking up on every little thing. First clinical day right after morning report we had to turn in the paperwork on our assigned patients (we received the assignments the day before - this is before the advent of managed care - we had to write down EVERY lab value on each patient's chart, each dx, each med, each test performed, then go back and write down the significance of each lab value in relationship to the patient's dx and why it was appropriate for that test to be ordered for that patient, make handwritten drug cards on each med, and write out long and detailed care plans for each patient (minimum 3 nursing dx per patient, no care plan books allowed, and document the rationale for each planned intervention (minimum 3 per nursing dx) citing book, page, and paragraph number for each one. (most of us got started on it around 4pm (at the hospital on our own) and finished up around 1-2am, and had to be in report at 0630). And our care plans always came back bleeding red ink to be corrected and try, try again. And God help you if one of your patients got sent home, then you had it all to do again on another patient, all to be completed and turned in at the end of the second clinical day. It was HELL. You had to really want it to finish. That was the point. I'm not talking about temper fits and humiliation but nursing requires so much dedication and sacrifice that the student (and the medical/nursing community, not to mention the patients) is done no favors by being coddled and spoon-fed - the student has to show drive, initiative, and resourcefulness - and a certain strength of character that will not be shown nor come through if the student isn't challenged to become that - if they fail, then another field is perhaps better suited for them. And by the way, as tough as we had it in our ADN program, the rules were even more stringent in the area tech schools for the LPN students. I know a couple of girls who got sent home because they got stuck in the elevator and thus were late for clinical (a BIG no-no). Reason? Nurses weren't supposed to take the elevators. Those were for the patients. Nurses took the STAIRS. They broke that cardinal rule and they flunked the day because of it. And nope, sorry - the student is NOT the instructor's "client". They are not there to serve you. You are there to learn and you have the responsibility to learn. They present you with the information but the onus is on you to take it in and internalize it and utilize it appropriately - NOT fake your way through, and NOT to just memorize it long enough to pass a test. Because in the long run, we are ALL here to serve the patient and the community, and to do it safely and to do it well. Remember - as the nurse, you are even responsible for knowing when the DOCTOR is wrong - if you carry out an order that is inappropriate and you don't know it's inappropriate, if you don't question it (and even tell the doc if they really want that done they'll have to do it themselves and then enjoy the heat from taking THAT stand)... ignorance is not a defense in a malpractice suit.
  16. what is a DH?