EquestrianRN

My husband is making the boom town trek to Williston, N D in the next few weeks...I'm staying here for about six months until he gets settled in a job and his plan is to camp out while job hunting, then live in a "man camp" for a while, saving all of his earnings...our son and I will come up once we have enough money saved to put down on a rental to start with...yes, homes there are insanely EXPENSIVE (all housing is in the many thousands per month for two to three bedroom basic homes, though insiders say this is VERY SLOWLY improving), & until I've gotten a nursing job. Hospitals there want L/D RN's badly, and that was my specialty for six of my 16 years. I know I need to recert my NRP, my advanced fetal heart monitoring, and mymaternal/child nursing courses (my last 13 week L/D & NICU stint was in Sept of 09, so its been a while, but I stay current in my reading of changes in the field and absolutely know I could literally jump back into it overnight. I'm applying for my ND compact licensensure this month as well as signing up for the afore mentioned courses one at a time in a row, so I should have all I'll need to get hired. The pay seems basically the same as what I'm making here now...maybe a but higher if you go through a travel company and have an option for them to buy out your contract... Definitely want to get into l&d again, and with planning to start applying to NP programs Jan 2014, the whole thing is very exciting to us...we've wanted to move north FOREVER, & with my husband, though 43, being a vet (Army, 82nd Airborne), a welder and big rig driver, he should do well getting an intro position SOMEPLACE...two close male friends will be helping him get placed as well, as both are with the oil wells and know with his work ethic and intelligence/level-headedness, he can EASILY stick out the first six months of grunt work before they allow the roustabouts to really move up and prove their mettle... Honestly, I can't WAIT TO MOVE! We're selling ALL OF OUR BELONGINGS other than vehicles, survival gear, firearms, and essential sentimentals, and TOTALLY STARTING OVER! We were crushed six weeks ago when my husband was laid off, as getting a job here is torture, since the economy here in Tucson, Az is about as bad as it gets...but then ND BECAME OUR SAVING GRACE... We've done hundreds of hours of research, and though Williston is a total ****-hole, the SURROUNDING AREAS ARE PHENOMENALLY BEAUTIFUL! We plan down the road, once we're settled in fully, to build our dream mini-ranch, have a small farm house on about five acres, two horses, and other animals, an AWESOME GARDEN, and just work hard to live as far off the grid as humanly possible for people with "regular jobs" and a teen aged son! We're praying his mom and aunt may want to come live with us where they can utilize their knowledge of gardening, living off the land, self-solvency and all they grew up with, plus allowing us to provide THEM with FREE housing for life!! They are not young, and they are always worried about making their S.S.$$ stretch. We don't want them to have to worry anymore...and this way, they can hang onto their money for whatever they wish to do with it FINALLY, after lifetimes of struggling, and not have to pay us anything. Our son will have a ready-made career in the oil fields as soon as he finishes high school...at 18 to be making close to six figures while living at home and getting set up for whatever he chooses to do in the future and to be able to do it without any debt/loans etc...(if he decides to go to college, or start a business, or both, he'll have the cash to do so!)...we've prayed long and hard and Williston its going to be our family's saving grace! Anyone who wants to PM me to talk ND nursing, jobs for hubbies, housing, or just talk about it ALL PERIOD, PLEASE DO! :0)

My direct supervisor, at 35, is four years younger than I, has two children under age three and went from LPN school, worked as an LPN for seven years and then earned her BSN, got a supervisory position, has a happy marriage, a well-off lifestyle, and works extremely hard. People knock her every way possible saying, "I'm not going to take direction from a one year RN who then went into management & thinks she knows more than I do...not to mention, she's going to leave her kids with family while she goes BACK TO SCHOOL in January to get her NP!" My comment is always this,"Yes. She has far less experience than those of us with nearly twenty years bedside nursing, with Bachelors degrees in nursing, and with the life experience that she hasn't yet encountered. However, she's got SOME PRETTY TOUGH STUFF to get through a BSN @ one of the top non-private universities for nursing while pregnant, to do get first year of bedside RN nursing with an infant at home, to do her first year in management while pregnant with a SECOND baby AND WITH a 13 month old at home, having to learn to balance new motherhood, being a good manager, as well as telling nurses with far more experience than she obviously has how to do a difficult job and be taken seriously!" Can you even imagine that kind of judgment and pressure? At her point in life, I was nowhere NEAR STEELY ENOUGH to write up a seasoned nurse for making an error which I hadn't yet made myself because I'd not been in the field long enough to get the CHANCE TO MAKE AN ERROR, REALLY! On top of it all, she's beautiful, thin, and people are flat out jealous of her! I've gotten friendly with her because aside from my not currently being in management, (I have been in the past), we have a lot in common. I have always been judged as "stupid" because I have a certain look which others describe as "youthful", because I'm small; and unbelievably, (this one blows me AWAY with its pettiness!!) though my husband and I struggle for $$ as much as or more than the next person, so much so that we couldn't AFFORD WEDDING RINGS WHEN WE GOT MARRIED TEN YEARS AGO, thus my grandmother gave us her wedding set so I'd have something TRULY SPECIAL...thus, I wear a 3 karat wedding ring (it is a 130 year old family heirloom, and I wear it proudly, never hesitating to tell those who compliment me the story of it being given to my hubby to give to me, etc...and that we could never afford such a luxury, etc...), & my husband, wearing the band my grandfather left to him, which Pop wore while married to my grandmother for 62&1/2 years is equally proud to have been given such!)...so people THINK WE ARE WEALTHY because of one item of jewelry, that WE THINK WE ARE "better than them"!! Its so sad the petty jealousies people will judge others about... Everyone (new coworkers and new patients) who've ever thought me "dumb" due to my appearance quickly change their tune when I open my mouth and, with compassion and knowledge, am able to explain exactly what is happening within their body, or their loved one's health, and they see that I'm much more than what shows on the outside. I never tell my manager she's doing "too much", because it's working for her!! Plus, the amount she is doing inspired me, at age 40 in six days (!), when I was starting to feel "washed up", that it was time to get my butt in gear and earn MY NP ALONG WITH HER!! As soon as my husband starts his new job, I'm applying to go back to school and get my Doctoral NP...WHY THE HECK NOT?? I love school, always got A's in every class throughout college and cannot wait to see what opportunities are out there to not only improve my life and that of my family, but to allow me to do a lot more to properly help my patients! The next time you see someone being told they are doing "too much", stop and consider the SOURCE...AND, IF YOU AGREE, STOP AND WONDER IF PERHAPS YOU MIGHT BE DOING "too little", & don't want to be outshined!!

I worked night shift, 11p-7a for FIVE YEARS. WITH two small (grade school through middle school) kids, a very ill husband who required help with everything except childcare overnight while the boys were asleep, and as the lone charge/staff/licensed personnel at a stand-alone level I psych unit. Somehow, do not ask me how, it worked! I suppose that on the very chill nights, and because I literally adored my three BHTs, (my only night shift Co workers, like, they were practically my very best friends in the world!) we'd have actually a lot of fun! The tough nights, with multiple really acute pts, multiple admissions, or restraints/other emergency situations were tough, BUT, you can get through ANYTHING for eight hours right? Nonetheless, my husband thankfully recovered, he went back to work, the boys entered high school and life changed. Finally, when I became ready to own a horse, I knew I had to be off a number of days per week without having to sleep all day to make up for the cumulative exhaustion of five years of all those nocs, plus all the extra work I had to do at home while my husband had been ill!. So in taking my current job, I was thrilled to work three 12s...they are three in a row, which would be great, EXCEPT... A usual day is 14°IF I'M LUCKY. AND, MANY DAYS ARE 16°easily! The work, though hospice, is SO ACUTE I DO NOT SIT ONCE ALL DAY. We do everything on tablets, and an admission is three hours of tablet data entry, no way around it. To chart on one pt is about one hour, depending upon their care plan. So you do the math. One nurse with five pts to start = 5°minimum charting (that's with no new orders, no events, no incidents, and no deaths...on a hospice unit? For every "extra" occurrence, add thirty" of charting. One admission? 3°MINIMUM. SO...we're up to eight (+++) hours charting in a twelve hour shift, and I still have yet to bring up pt care! A-h a! Kind of a conundrum if you ask me! And...we have no unit clerk so I answer phones, myself and a single CNA, so as the only RN with one CNA, I naturally assist with all turning, bathing, etc...you see where this is going? Our pt acuity is so high too that we have CBIs, multi dsg changes and q1° meds often... Therefore, THEORETICALLY, TRUE 12°shifts sound like a dream to me! Three 16°shifts, not so much, as it takes me almost three days to recuperate from two nights with four hours sleep and that kind of crazy day every day. Needless to say, until things change at my job, or my job changes, having a horse is a non-possibility, and my life us all about sleep, just as it was working five 8°nocs! :0) I sometimes wonder though if I'm not simply a workaholic, because as tough as it truly is (& it is! Most new hires quit in the first week to month!) I really have fun at work! I'll stand there charting and bonding with patients and their families just because I'm not willing to get "behind" on either aspect, & I get glorious positive write ups from families, for the time and nurturing I give to then and their family member who is ill. And despite the insane amount of work I'm/my Co workers are expected to do, somehow, my supervisors are really nice, caring people, who are, just like me, trying to make the job work in a corporation that sadly seems to care a lot more about the bottom line than patient care. That's why I feel I better do all I can...otherwise...who will?? Thus, I suppose until I collapse one day soon (joking, I hope!), I'll keep sticking it out and do my very best to make it work! I've internally "committed" one year to this company to see if I notice corporate changes occur which will make life easier, staffing improving, or anything else changing to make this job more "user friendly". In three months, I've gotten FASTER AT EVERYTHING than I'd ever thought I'd be...I've learned to multitask better than ever before and I've been an acute care nurse, other than my five years in psych, for my whole 16 year career! So I've gained a lot, too, and I believe that after this job, there won't be a THING I can't do, and do very quickly and accurately...That's certainly part of my reward, as well!

Honestly? Once you get to that "place" with a manager for whatever reason, sometimes it is truly just best to walk away...As Tewdels said, there can be a million reasons that a manager chooses to treat you that way and rarely does it have anything to do with you. I recently left a job I loved and had been at for five years due to a similar manager coming in and destroying everything. She was abusive verbally, not just to me, but to my coworkers whom I respected and valued highly. My thoughts were that if she couldn't get me to leave of my own volition, she would try to find something to come after me with, or come after my license with. About two weeks after I had put in my resignation and left the position, she turned two other nurses in to the board for something that was completely asenine. I just kept thinking "that could have been me, and very likely would have been if I had stuck around long enough! Thankfully, after an investigation, both nurses were rapidly cleared of any wrong-doing, but I had felt that the job was DANGEROUS for some time; basically to all of the nurses working under her, and no job is worth me risking my license due to some psychotic individual with an axe to grind. Get out...there are lots of other jobs for nurses thankfully, and you deserve to feel safe, and to have a manager who works with you, and for you, as hard as you are working with and for them! Very best of luck to you!!

Absolutely agreed with all above. Push the teamwork angle. I say this because it is true, you MUST BE A TEAM! Remind her, in private and respectfully, that in order for you each to provide pts with the best care possible, you simply MUST WORK TOGETHER. AS WELL...model what "professional behavior" is for her at all times. Most likely, she will either realize you see her as an equally important part of your team of two, or, she will maintain similar behavior, only with the truly "high up" BOSSES, AND THEY WILL NOT TOLERATE SUCH FOR A MOMENT. In that case, most likely, she'll hang herself with her own rope/behavior, and they will get rid of her in short order...you just do your best to maintain calm, CONFIDENT, PROFESSIONALISM at ALL times, and you'll do FINE! Best to you, it's a tough situation.

About 95%of our pts are taken on by our medical director at time of admission onto hospice services. I suppose we are very lucky, as she is tremendously knowledgeable not only about palliative TX modalities, but also about the ever most random, unexpected occurrences. She does an enormous amount of research and from what I can ascertain is "married to her work" (Great for us & pts, questionably unhealthy for HER; though she's a "big girl", & assume she can take care of herself!). We offer the patient's MD/NP the option to either remain on as the primary once the pt comes on service or defer to our medical director. Nearly all decline, deferring to our Md. She is excellent because when I've called her saying, "pt "x" is experiencing symptom y, & I've never encountered this." She is very quick to say, "ok, please explain to the pt that the latest research on their disease indicates that 45%of individuals will experience symptom y, and that I'd given drug z, should result in total reversal of symptoms within 48°. If not the outcome we find here, the second line approach is to give drug m, along with foot soaks q 4°, & we should experience a total reversal." She blows me away with her knowledge base, not to mention that she is wonderful with the patients and families, and that level of intelligence + bedside manner is so rare in my experience!

Arizona... Inpatient hospice unit, full-time day shift, (3 12's/week) with 16+ years exp (though returning from psych to hospice with a five year break since last working hospice = they get to start me LOOOOW)= $30/h; full-benefits at a "reasonable rate" and 401K@ 100%employer match, education reimbursement. O/T HIGHLY "frowned" upon...though obviously time and a half for over 40h/wk. Supposed to be eligible for a wage increase with first evaluation...rally hoping I can at least get back up to the $33 I was pulling in psych, since this job is infinitely more challenging! We shall see...honestly? In this economy? I feel damned blessed simply to have a good paying job, WITH BENE's, working for a company which may be as corrupted as the others but really values treating it's employers with a great degree of respect. That is the biggest change since my last position. That company treated us horribly and never let a week go by without reminding everyone where the door was...

Excellent comment above by "Goals in Transition"...I couldn't agree more! One major thing that hospice nursing has taught me: The sort of people whom we truly enjoy taking care of as patients are the ones whom even in death teach us the most about life...for example, I notice that those who have spent their lives loving others, giving their all to make the lives of not only those directly around them, but those in other "circles" better, through volunteerism, teaching, WHATEVER! These are the folks who have a constant flood of people at their deathbed. The people whom they have touched during their lifetime NEVER FORGET, and come back long before death, but also at that very special time in the individual's life, just to ensure that person truly knows what a role they have played in contributing to others wellness of mind/body/spirit. Sometimes the patient will be a person who may not have touched a huge number of lives directly, but it is evident those whom they HAVE TOUCHED, THEY HAVE TOUCHED DEEPLY...through speaking with and watching their family members, sometimes only three or four, sit vigil, hour after hour, day after day, because of the immense love they feel for that mother / father/ grandmother/grandfather...and you simply know that because of the amazing love and warmth they showed those family members, the world HAS TO be a better place through what their offspring have put into it. Then the converse is seen...the person who has not one soul on earth interested in holding their hand, dropping by for five minutes to offer comfort at their life's end..and you can USUALLY see why. That patient is often at the least totally emotionally closed and at the most, outright unpleasant with any and every possible communication they make. I have learned so clearly that what we put out into the world IS DIRECTLY what we get back. THIS has caused me to DESIRE to be a kinder, gentler me. I have always been very loving, very giving, and would give my last dime if I truly thought someone needed it more than I. Nonetheless, I have also been guilty of being closed off at times to those simply wanting to care for and love me, as friends or family, and that has changed immensely. Not because, "I want lots of people at my deathbed"! No. Not at all. Simply because, I've finally seen with my own eyes exactly the way everything we do with the short lives we are given MATTERS! And the last thing I'd ever wish to do with even one minute of my time is to put negativity into the world, as it is brimming over with such as it is!! So, to answer your statement: love your little ones, hold them tight every day and appreciate every single thing they bring to you and others. Teach them to love and to do good things all the time. If they ask you about your day at work, or learn that you work with the dying, use that as an opportunity to teach them that life is short but beautiful. That people do die, and that the better their life was, the more they got to experience, be internally enriched by and in turn, enriched others, when the end comes, it is so much less hard. If you are a Christian, teach them about their relationship with Jesus and the importance of that relationship. If you are another religion, teach them to follow your doctrines and this will show them that even after leaving this earth, they will go on to experience incredible things in their afterlife... Don't allow them to be the fifty-something year old woman, dying alone from COPD, struggling for every breath because her cigarettes meant more to her than her kids who can't be bothered to come from out of state to be with her at the end, or even to call. Interestingly, those patients are the ones I'll spend my few extra minutes with...holding their hands. Whispering that they "HAVE DONE GOOD IN THEIR LIVES", reminding them that they are not alone. Many people DO "earn" their end-of-life-receptions or lack their of; but no one by my estimation, deserves to be "punished" at such a critical and often, if alone, terrifying time. That's the pt whom I remind of their worth daily until they pass and am sure to pray a little extra for...because there isn't anyone else there to do such for them.

We have a ten bed unit staffed with ONE RN and one HHA for up to seven pt's...if we have more pt's (8-10), we are given an additional LPN. USUALLY agency, usually hasn't been there prior, and legally, cannot perform admissions, obviously. Interestingly, if our pt's are general inpatients (higher acuity) those #'s stand. If the seven are a mix of routine homecare inpatients and general inpatients, NO EXTRA LPN. Our computerized charting takes an average of 45"/pt if one is very rapid (both rapid at answering assmt questions and typing; which thankfully, I am!), and a total admission takes no less than three hours to complete under the PERFECT CIRCUMSTANCES. Thus, on an average day, with say five pt's, and an admission, that adds up to around eight hours charting (plus much more if many new orders are received, if there are any incidents whatsoever, and so on...) There is no unit clerk, no one to answer the phones on days, which ring approx every 5-10". Sometimes we have to break our pt care into three minute time segments. It is a tremendous, almost impossible challenge to ensure pt's receive optimal care, families receive optimal comfort, and other, ancillary staff (MD/SW/chaplain/managers, etc...) receive the necessary info to do their jobs. All I can say is you get darn awesome at prioritizing and time management or you don't last long. Of course, no one has but one 3" bathroom break, you eat while moving, and you are lucky to drink water over 12 hours. I come home so exhausted that I'm lucky to take off my clothes before falling into bed after a thirteen hour day (am/pm report included) & family knows better than to talk to me after work. I adore hospice...the way it was ten years ago. I still adore the pt's and the idea of giving the care I'd hope I'm giving...but its easy to wonder whether that is possible anymore. Hope whomever is getting wealthy (corporate biggies) due to keeping our staffing #'s so low is REALLY ENJOYING the money they're getting, because dying people & their families are getting shortchanged no matter how you choose to look at it! Still, I do my very, very best wherever I can and pray it makes a difference. My patients tell me they are thankful for me...I always wish I could tell them "ooh, you'd be so much happier if I was able to give you the care I WANT to give you!"... :0(

As a hospice RN, I actually can appreciate how the overuse of "debility" is viewed. It really IS too general. It is a syndrome, certainly, and not a "disease", as it were. I have faced the same issues (obviously) regarding Medicare and their distaste for the listed, overused hospice-innitiating "diagnoses". The thing is that we, as admitting hospice nurses can simplify the process by utilizing the skill which should be inherent to us as professional nurses...DESCRIBING that which we SEE, using measurable universal guidelines which are not subjective, rather than oversimplifying, by simply TITLING a person with one syndrome or diagnosis name or another. I say this because hospice corporate entities can readily utilize "Dx's" as a way to "slip a person into the system", thereby collecting reimbursement for a completely inappropriate patient to get on service. With utilization of specifics, and defining what we as nurses are seeing, we can avoid any greed in the system from our end, also changing the manner through which hospice admissions coordinators are viewed by the medicare big wigs... E.g. "Mr. Jones, a 69 year old caucasation male widower since approximately ten years ago, was diagnosed seven months ago with end-stage-renal-failure and end-stage liver-disease. Mr. Jones, with the appropriately emotional however complete support of his family, and, after discussing such with his pastor and friends, has elected to discontinue dialysis and other palliative therapies and come onto home hospice service at present, with the understanding that he may eventually require inpatient hospice care, for the following reasons: At initial diagnosis, of renal and liver disease three years ago, the pt. was 5'9", and at a healthy weight of 190#. Pt was classified with a functional level of "high"; AEB still driving daily with no reported unsafe driving incidences per his daughter (who often rode in the car with him). Mr. Jones had been effectively completing all of his own grocery shopping, cooking, and house cleaning. He was, also, until approximately three months ago, maintaining his mental acuity very effectively through working daily crossword puzzles, reading novels, and volunteering once per week with an elder-literacy program. As for maintaining his physiological strength and dexterity, again until about late March, he was actively gardening in his back yard every evening, and claims this was "also helpful for me before going to bed, as a means of relaxation". His gardening also was effectively acting towards promotion of heath, as it provided him with fresh, vegetables to eat as well, from his own garden. Since discontinuing dialysis and since the diagnosis of liver disease was increased to end stage, his weekly labs reveal the following (include dates and all labs), his abdominal girth had gone from pre-hospice: (include measurement) to a current: (include measurement) due to ascites, despite weekly fluid taps beginning back on:( insert date), removing an average of 4 L of fluid with each procedure. Pt is unable to drive or garden anymore due to "extreme weakness", as described by the patient. He has become significantly dyspneic due to the ascites, with ability to speak only four words, then pause, and continue with the sentence; generally pausing every three to five words to catch his breath. He has been started on 2L 02 by NC as of two weeks ago, with minimal decrease in the level of dyspnea; now able to speak seven to nine words before pausing. The dyspnea as well as pressure from the ascites has effected his appetite greatly per pt. He is able only to consume one to two very small meals daily, and rather than heavy amounts of fresh veggies, his choice is to consume high calorie, fast food items which are easier to have delivered to him by his grandchildren. His weight has declined to 150 # since two months ago. His muscle mass had dropped as well according to a pre-hospice measurement of ( ), & current measurement of: ( ). He no longer drives, nor does he shop or clean for himself, as he is "too weak and I can't breathe well-enough to do any if it well enough to bother". He does not garden at all, as with the ascites, he says he cannot comfortably bend over whatsoever. Pt does have a lot of emotional support, however, no one in his circle can devote the time needed to meet his at homecare and ADL needs, thus at this point, assisted living or care home are the only real options for pt. He understand this, and had been looking with his daughter for an appropriate gone, as well as, sadly, working to sell his own home. **so...this should go on into greater measurable details in terms of a functional assessment Rather than writing "ESRF/ESLF" resulting in "DEBILITY" & eventually, "AFTT" as your diagnosis, the above gives medicare the needed MEAT to sink their teeth into! I cannot imagine any denial/questioning of services with that degree of info present; & realistically, I didn't even scratch the SURFACE in terms if what I WOULD WRITE were this gentleman an actual pt! Anyhow, thank you for reading all of that! Just my... FORTY CENTS WORTH! Haha...

Yes, I prefer that sort of delineation myself...gives the nurse some freedom but also lets you know before you've run through your MAX for that patient (in meds that have no outlined "ceiling", such as opiates (& UNLIKE APAP!), while setting exact boundaries regarding the briefest time between MD requires between dosages! :0)

I could not agree more with your comments! Nurses, as a highly driven group of professional "perfectionists" (certainly a generalization, but I believe a true one, after having observed this in myself and my co-workers for my 15 years in the field), absolutely thrive upon praise...when managers enter the unit anew and immediately begin truly LISTENING to their staff, actually TRYING OUT/implementing staff nurse's ideas, and really praising ANY job well-done, regardless of it's overall importance, the staff nurses will be drawn to attempting to further please that manager with every ounce of their being...even the very "burned out" staff will eventually begin doing so. When, on the other hand, managers begin immediately to change everything based upon theory, without really GRASPING the particular dynamics of the unit upon which they now work, this demeans and degrades those staff nurses who, (however "ineffective" the old way of doing things may seem), MAY VERY WELL have been part of the group of RNs involved in putting that practice into use long ago, when that way of doing things may have BEEN "the" best way to go. Not to mention, many managers, IMO, make the TERRIBLE error of firing staff in their initial 60 days as a manager to sort of "Put the FEAR into the staff" that bad or ineffective tactics will NOT BE TOLERATED ON ANY LEVEL and THIS manager is NOT TO BE TOYED WITH! All this does is anger and sometimes terrify existing staff into doing a shotty job because they are so busy nit-picking their every action, out of fear that they, too, might make some isolated error and become the next nurse used as "example-fodder". Finally, as you no doubt know personally (!) we nurses respond a thousand times better to praise than to degradation...if an RN is doing poorly on the unit, (calling in sick a lot, starting arguments with MDs and NPs, etc...) find out why and use a "retraining" & understanding approach, followed by excessive praise each time, as the manager, you get anything RESEMBLING the outcome you are ultimately seeking. This will show you as being the "new kid on the block" who does NOT want to bully the staff, but wants to assist them. You can still maintain your managerial "superiority" & respect, whilst teaching the staff HOW TO BE EXCEPTIONAL. Some RNs may not remember what "exceptional" care provision and professionalism even LOOKS LIKE, depending upon how long they've been in the trenches on a poorly running unit. To me, the opportunity to really get in there and turn things around, making a great unit out of a crap pile is a huge winfall. How very lucky you are to HAVE JUST SUCH a chance...Be sure you do everything possible not to squander it!! **Here's to you**, and wishing you the very best of luck with your position. Obviously, through your question here alone, you deeply WANT to succeed...my guess is that YOU WILL!! :0)

Very good points, QueenJulie and Liveyourlife! We obviously have some excellent "critically thinking" nurses out there... I have often wondered these days, when, of the "new grads" coming through my facility; one-third are PHENOMENAL and they absolutely blow me away with their intelligence, attention to detail, and ability to critically think through any problem put before them... However, the other two-thirds really have given me pause and I felt, cause for concern, in terms of the depth and breadth of things they absolutely do not understand... Clearly, ESPECIALLY regarding those graduated and working nurses on this site (but certainly not ONLY, so please do not misunderstand! I'm absolutely NOT SAYING that students don't have these same abilities...it's just easier to SEE IN the graduated/working population), there are some AMAZINGLY INTELLIGENT AND BROAD-THINKING minds in nursing today...this thoroughly impressed me when I first began "stalking" around 'AN' prior to joining; reading through the topics and what not... These factors are not only evident when nurses are discussing the biggest issues relevant to our carers, but also the smaller points, which people in the field for any length of time obviously grasp exactly in the manner which they should. This gives me great hope for the future of nursing! :0)

The consensus thus far, as I see it, is that for OBVIOUS REASONS, TID is not often, or ever really, anymore, used for PRNs! And as a few have stated, computerized MARs are written by pharmacists to take any potential "guesswork" out of the times to administer when MDs still choose to utilize acronyms rather than exact times for PRNs ... Interestingly, my hospital is a stand-alone facility where the RNs still transcribe ALL THE ORDERS! Up until recently, RNs also filled all the meds from "stock psych meds"which were kept on cards in our own "pharmacy"!... Our entire process is very archaic, I realize...moreso even now as the trend towards computerization of MARs is enormous and has swept nursing especially in the mere five years I've been HERE...We have ONLY RECENTLY stopped stocking our own RXs! Great info..thanks again all! :0)

Simply guessing here, but I'm thinking that when the OP stated she didn't even know she did it, (hung up on the provider), what she may have intended to say was that she perhaps had either answered the phone, MD was on the line, and perhaps the RN couldn't hear her/poor connection/or else maybe, she spoke to this person and when finished, hung up, and the MD wasn't quite done talking...who knows? I've worked with a tech who has poor phone transferring skills...on occasion he has hung up on somebody accidentally. Once, it was a case manager calling for me in the middle of the night; on another occasion, he tried to transfer an MD's call to me and wound up simply hanging up on the MD...in the middle of the night, no less! In those situations, each person (1st time, the CM, 2nd time, the MD) thought they had been purposely hung up on, despite that tech having been polite as could be just prior to the botched "call-transfer-attempt". Regardless, they were each so mad (that a MERE "pee-on-tech" had the HALL TO HANG UP ON THEM, accident or no!) that they each emailed our supervisor, demanding to know why they had been hung up on! Just FINDING our manager's email had to be FAR more complicated and onerous than simply calling back and ASKING the tech in question, "Excuse me, sir, did you intend to hang up on me, or was it a technical problem?" This is what I would do, and what "most" people without complexes would/should (IMO only!) do. At that point, the BHT would no doubt have apologized and explained that our phones can be tricky, and he certainly meant them NO disrespect... Your post smacks of an MD with a G-d complex and a NASTY ONE at that! I often wonder why it is these days that the self-esteem of persons who "should" be on top of the world, emotionally, is often so low that something as simple as a telephone error sets them off nine ways from Tuesday! This "doctor" REALLY NEEDS to get over him/her self and perhaps invest some personal time in a yoga or mediation class-for-the-suspicious-and-insecure! :0) I'm not in the least trying to make fun of your predicament. I'm trying to point out that based upon your response to what you believe to be a doc with an axe to grind (on your head, no doubt!) Is normal, & they are the one with the TRUE "problem"...yours is only temporary...in other words, you only have a problem for as long as it takes for you to (very unfortunately) kiss their "tushy", do it as soon and as fast AND AS "genuinely"-sounding as you can possibly muster...then ensure you make them feel they are up on their pedestal WHENEVER you are interacting with them, so they never have to get their "wittle fewwings huwted", & I would imagine that given a bit of time, you will be fine in the future where they are concerned. They, however, will no-doubt suffer from terrible bouts of paranoia and insecurity until they obtain some self-esteem (not too likely to occur, sadly) and realize that the world is NOT out to get THEM, personally, and that they, too, are susceptible to telephone errors by others. They may also hope to understand one day (again-not likely!) that there will also be persons who speak to them (as I'm guessing you likely did) from time to time in a manner that does not make them feel as if the universe is here to meet their needs, and their needs ONLY! (shame on you...what EVER COULD you have been THINKING, speaking to them as an EQUAL!?) :0) Wishing you the best of luck. Remember, always be polite, courtious, (even, actually, ESPECIALLY, WHEN you are only talking to the janitor!). ALWAYS be honest, show your excellent morality and treatment of everybody, and have the utmost self-respect...if another person such as this "VERY-IMPORTANT-PHYSICIAN" ever questions your behavior, ALL of your co-workers and supervisors will KNOW who you are, how you consistently treat people, and will tell whomever is causing you problems just that, (& that they were CLEARLY MISTAKEN ABOUT HOW THEY "thought" you treated them!) and you'll be FINE! :0) G-d bless you, and again, sorry this cruddy situation found it's way to your plate!