telealli

Please help a nurse out!

hello everyone! I really hope someone can help answer my questions! I finished my first week of work at my new job as a QA/QI nurse and although the learning experience is a bit overwhelming, I love what I do! I graduated last year and have experience working in the hospital and as a hospice nurse. I just have a question for you that I hope that you can help me out with. I work for a non-profit clinic that is Federally Qualified Health Center (FQHC) and yearly they are audited by the Health Resources and Service Administration to determine if they still qualify for grants. My supervisor (the CEO) of the company has explained to me that my duty is to maintain the clinical policies & procedures (P&Ps) of the organization, which is one of the things that get audited. I am the first QA/QI nurse to have this position in the organization, and the clinical manager (who is not a nurse nor does have any clinical background) has been writing and maintaining the clinical policy and procedures. I have no experience in policy making whatsoever and would like to get guidance on how to go about this. Since this is the first position fulfilled for a QA/QI nurse, my resources have been limited and I can't seem to find the answers that I need or any right person from our organization to help me out. I want to know how to go about writing policies and procedures that comply with certain standards. But I have no idea what standard to go by? Like do I go by HRSA or Clinical Quality Measures (CQM). The clinical manager who was in charge of the policies and procedures told me that she googled most of the information and copy and pasted some from other P&Ps that she retrieved from other websites. I do not want to go about this protocol of googling and copy and pasting. I want to know how I can use my clinical expertise and what nursing resources I can use to initiate and implement P&Ps. So far there are a lot of P&Ps that the clinic is missing. Please help me out! Thank you :)

Hello all! So I have finally landed the nursing position that I think I can excel in. Honestly, floor nursing was not for me, although I did enjoy the direct patient interaction and gained a lot of valuable knowledge and skills, the work was too technical. I am one who likes to research and write a lot. Likewise, my search for a position like this ended today! I was offered a position as a case manager/quality assurance RN for a non-profit organization that serves low income individuals and families, including those who are uninsured. I am really excited about this new opportunity and hope that it is a place where I will love to work at! Just a few questions though for those who are experienced nurse case managers and who are currently on the process of learning in their new job. What is the best way to prepare for this position? I know that I have to be knowledgeable about health insurance, Medicaid, Medicare, etc. what kind of information do you think I need to research on? Also, my manager told me that I would also be responsible in writing policies and procedures for the organization and responsible for reviewing documentation. Honestly, I am kind of nervous. I am confident in my ability to write, but what resources can I use to prepare myself for a task like this? Thank you all!

Hi Sugarlips, I am currently in the process of applying for a PHN position at LA County. PHN is my dream job and at the moment it is difficult to find a career in that path. Can you give me some tips on the process of getting hired at LA County? What is the exam and interview like? Thank you

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Also, as a new graduate the hospital provided 2 months of orientation, no classroom education just clinical, where I felt like I was just thrown in there! I feel that I did not receive proper orientation...I mean how could I when I just find out that we are suppose to cosign for LVNs like that and then find out that this is illegal??? I had days where they just threw a chest tube patient out at me when I never took care of a chest tube patient before, I of course asked my manager to look at the patient with me...but seriously how wrong is that??! The only unfortunate thing is that I signed a 3 year contract with this hospital, and if I break the contract I have to pay $30,000 for the training they provided...which makes me wonder why it cost them so much because I got such a bad training. My plan is to hire a lawyer to see if there is a loop hole out of the contract because I did not get proper training. I have already made several mistakes, which I admit to, but it is because I find myself so stressed out with the workload. Providing total care to patients with no CNAs at times. I feel so trapped, I just feel like there is no way out. I know I am a good nurse and that quality of patient care is really important to me. My patients love me, but I just do not feel safe at all at this hospital.

The reason why I think that my license is at risk is first of all, I am a new graduate and at my hospital LVNs have their own patients, and we are assigned to "cover" for one or two, sometimes three of their patients. I learned during orientation that I had to cover by giving their patients' IV medications, but I recently found out that I had to cosign for their assessments as well..for example, no one taught me that at the end of the shift, I have to state that I concur with the assessments of the LVNs....like am I just crazy or how am I supposed to cosign for them when I did not even assess their patients or was not taught to (there was no protocol that taught me to do this). Recently the state came to my hospital and said that RNs are no longer to cosign for LVNs, and that we have do the LVNs' shift assessments, IV meds, and discharge work. Last week I worked on the floor I had 5 patients myself and was assigned to "cover" 2 of the LVNs' patients, meaning that I was IN CHARGE of 7 patients!!!! Is that illegal? My hospital does not use team nursing at all. I mean this is too unfair...having 5 patients is already a load, but 2 or 3 more?? So I had to assess all 7 patients. I live in Cali and there is a law of patient nurse ratio of 5:1 in med surg and 4:1 in tele. Anyone else thinks this is unlawful? It makes my stomach feel sick.

Hello, I work in a very unsafe facility. The safety of patients are at risk, I am afraid that if I work another day, I will lose my license. I am working this upcoming Monday and I seriously cannot work there another day. I am aware about giving two weeks notice for professionalism, but I do not think I can work there for another two weeks. How do I go about sending my manager my letter of resignation and not having to work at that unsafe place on Monday?

I am currently a new graduate, been working on the tele floor for about 4 months now, and I know I shouldn't say this but I already absolutely dread going to work every single day. I mean I just feel so alone at work, I mean I am constantly worrying about making mistakes, I've already made 2 so far. Even on my days off, my mind is just filled with worries of messing up, making mistakes. I cannot even enjoy my days off. I feel like the hospital I work for did not provide proper orientation, I only had 2 months worth of it, no classroom education provided just clinicals. What makes it worse is that I signed a 3 year contract to work for this hospital. I know that was my responsibility, but I did not know how horrible the circumstances are in this hospital. I really feel like they don't care about us. They do not provide us CNAs at times, and that really affects patient care when you're too busy doing CNA work increasing your risk of making a mistake. I mean I don't mind cleaning patients, but when it interferes with doing something more important then it is a big issue. I also feel like most of the nurses gossip too much. I mean this is just too unprofessional. I am friendly with everyone, but still, I just have a feeling they still talk bad about me and my mistakes at times. What makes it worse is that management is friends with some people, and I feel that if I complain about those people, it would just turn out bad for me. I've never had so much stress in my life, I mean I can't think of doing this for 3 years. I feel like that is why this hospital made new grads such as myself sign this contract so that they can retain us and we have no choice to leave, considering so many nurses have quit before (from what I have heard)...doesn't this seem just not right to you? I feel like I have no support, no one can understand what I am going through right now. I just feel sick to my stomach going to work, I have no support at work. Sure I have my family and my boyfriend, but it is different. I am always scared and nervous at night, before I go to work. I always pray, it helps but I still feel anxious. I hope someone can respond to this. Is this feeling normal? I mean I just feel bad, all of my other classmates have been loving their jobs (from what I see in social media), and I am just here dreading each day at work. I just pray everyday that my patients, myself, and my license are safe. I always try to do the best for my patient, but I cannot help it if mistakes happen I would love to read others' feedback. Thank you.

Thanks for the response...I am not saying that they should have defended and spoke up against the dr for me, my charge nurse was right there when the dr. was putting me on the spot regarding the Ativan thing and I am pretty sure he knew or was given report by the other charge nurse that the patient was combative the nite before since they had called a code grey on him and was hitting staff. And after I read through the nurses' notes from nite shift the pt was severely agitated, trying to pull his lines and trying to fight staff. My charge nurse should have pretty much just reinforced what I was telling the MD the reason why they gave the Ativan (I already explained to the MD, but apparently my words don't mean a thing because he kept blaming me!) I just get frustrated thinking how he put me on the spot like that. NOw everyone at work is gonna think I'm just that stupid meek girl!

Thank you everyone for your comments! It is a pleasure to know that there are nurses out there that are supportive of each other. I really wish I had that support when that MD was embarrassing me in front of everyone. I mean those nurses (even the charge nurse) was just sitting there listening to the MD give me that lecture, I mean don't you think the CN could've backed me up a bit?? I really wish I had more support on the floor like I do here on allnurses. It is such a relief to know that I can always get support, even if I do not get in on the floor! I am a new nurse on my 2 month by myself and I still need to learn to be more assertive.

I just feel so bad about an encounter with an MD today that I wanted to share it and get support and feedback from the nursing community. So I got my report from my patients in the morning, I had to trade a patient with another nurse b/c she had 2 confused patients so she gave me one of hers. So I just receive report and get busy with another patient. The surgery dr. for the confused pt asks for me and asks all these questions to me, I answer his questions but I could not answer all of them b/c I did not receive a good report from the nurse that gave me report. He got mad and sarcastically said "What kind of report are you getting?" in front of everyone in the nurse's station. So the confused pt was given Ativan around 0400 by NOC nurse for being combative and hitting other nurses ... I guess the Ativan made him lethargic in the am. The MD seemed to put the blame on me asking me why is he on Ativan...like how am I supposed to answer that, I mean I was not the one that gave it! I told him the pt was being combative so the NOC nurses gave it...he just looked at me like I was stupid and gave me a whole lecture (like 5 min) of why Ativan is bad for the elderly...I mean I understand this perspective that some elderlies are sensitive to Ativan, but seriously why is he making me feel so responsible to what is going on with this patient!?? I just felt humiliated in front of everyone...I started crying to one of the CNAs who was super sweet enough to help me calm down...I just felt so belittled like I did something wrong... I would really appreciate any comments (please don't be mean) thank you!)

So I made my first major medication error. Lo just feel so terrible right now about it, it just puts my self esteem down that I dread going back to work I feel so stressed out now that I just barely got out of orientation this month (I'm a new grad that recorded 2 mos of training). I wanted to post on this site because I know how much support you can get from other nurses on here. Please feel free to leave comments. So here was the scenario: I received my patient in the morning she had a hx of encephalopathy. Her sodium was elevated to 160 so I called the MD and the MD ordered her to go to ICU ( I work in the telemetry floor btw). I also got an order for D5W along with other orders. So I followed the instruction and hung up the fluid. I take my patient to ICU and give report to the nurse. About 30 min later the charge nurse from ICU calls me and says that I hung the wrong fluid! I hung D5 with 1/2 NS instead of D5W! The patients sodium level went from 160 to 165 and she angrily scolded me "you know this could kill the patient right" I stomach just dropped and I felt so alone and scared. I know that this was just a stupid mistake I guess I just looked at the bag and just saw Dextrose 5% and did not see the latter 0.46% NS. I felt so horrible throughout the shift I was just scared something bad was gonna happen to that patient who was already in the ICU. I just felt like I just made the situation worst! The charge nurse from ICU filed a med error report and got further MD orders. I got called in my managers office and she have me a whole lecture about the difference between the tonicity of fluids! Although she did not write me up I still feel so terrible! I just had a bad feeling in my stomach and could not even finish my lunch! I know that the sodium level was really critical, but I'm just wondering now if something bad could happen to the patient and this could trace back to me. I feel so stressed out and alone right now. I mean this is my first RN job! please comment, please no negativity right now I could just use positive words!

really? No one wants to give me advice

Hello nurses/future nurses! Since I've received so much positive feedback from one of my recents posts regarding NCLEX study tips: I've decided to share with you all my journey in finding an acute care job. My dream job is to work in the telemetry unit...I just simply love everything about the heart and geriatric patients :) I've read various stories here at all nurses.com about so many new grads having trouble like myself in finding their dream position, or any position at all. I simply enjoyed reading others' stories because it makes me feel like I am not alone on this "fight." I've become so inspired and motivated by other writers here I thought that I would share my story with you all so that I can get feedback from you guys! So I graduated in June with a BSN in nursing, I passed my NCLEX and got my license in August. I have been applying to jobs every single day, and probably have applied to the majority of hospitals here in SoCal. So far, only one interview for a new grad position in the PCU unit (which unfortunately got cancelled due to budget cuts) and one interview for a psychiatric position (it's been 2 weeks since the interview and I have not received a call from them). I was hired in the beginning of October as an RN Case Manager for a Home Health Hospice Agency. I was willing to take any position right now because I though it would be better than just sitting at home waiting for a phone call, so I took the job! It's an OK job but I really do not feel like I'm actually doing nursing stuff, I mean what I've been following an RN for admissions and visits to patient's home, but all I've gotten to learn was PAPERWORK! Documentation is an important skill to learn, but I want to expand my learning and skills so that I can become the competent nurse that I want to be! I barely get enough hours, I mean I only work probably the most 5 hours a week, and that does not result in a big paycheck, considering my gas. Also, I do not feel that this company cares about my safety because they just called me randomly in the middle of the night to do trach care for a (VERY COMBATIVE AND ABUSIVE) patient ALONE! I mean seriously, I'm an RN, but I'm also a new grad...I really feel that they are just taking advantage of me! But I decided that I should not quit, because I do need the money since my student loans are on the way (this January ) I have just made it clear to the company that I am not going to do anything that puts the pt at risk, myself at risk, and my license at risk. So I'm just sticking through this Hospice agency until I find a hospital/facility that really cares about my learning! I have been recently hired at a long term care facility as an on-call nurse. I do have a passion for working with geriatric patients (I just love old people!) but it is on-call only...so its just another job where they call me when they need me, which does not make me feel very good as a nurse who is craving to learn and take care of patients! Also, I am just afraid that as a New Grad, the RN responsibility for this facility is that I have supervision of the all facility for the whole shift as the only RN, so that really makes me nervous. But the DON did explained to be that the LVNs and CNAs are always happy to help. I just wanted to get opinions from anyone out there on what they think? I decided to take this opportunity since they are going to train and orient me. I mean it is better than my Hospice job where they just push me out there to patient's home, where I have no idea what I am doing. I have just be praying to God that my time will come to finally be able to use the skills and values that I have to share with my patients. I truly believe in my heart that I will be a competent and compassion nurse. I do admit that I get frustrated many times, and wake up with a feeling of emptiness every morning because I know that my learning has not been consistent and that I am always scared that I have been given a leadership role already, where I just want to learn my skills. But I know that I just have to be patient. I would really appreciate any comments from anyone out there about my current experience. Thank you.