Rhonda V

I am working in a hostile work environment at this time. My supervisor is constantly in a bad mood at work, and often speaks to the staff in unprofessional manner. She has been reported to Human Resources more than once in the past. She was most recently investigated in December 2009 due to one of our CNA's filing a complaint against her to Human Resources. I was called into the office in front of the Administrator, and I told him how abusive she can be with staff. She even talks to our Administrator (her boss) in an unprofessional manner...and he doesn't do anything about it. After the investigation, it was determined that she was just "doing her job." She continues to belittle me almost on a daily basis, and it really hurts because I'm a sensitive person. It's not in my character to "fire back", and I'm very intimidated by her. Other coworkers of mine know what she's like, but at least we have each other to vent to. We have a new male ARNP who started at our company a few months ago, and he definitely has fired back at her. She picks on him a lot. I've even told our Administrator that I think it's wrong how she talks to him. His replay was, "I just have a thick skin." Everything else about my workplace is nice except for my supervisor. I'm not at ease working there because of her, and I've been there for over 1 year. She can't be reasoned with, and I'm not comfortable talking to her. Some of our staff are aware that she has her own problems including an eating disorder. She weighs herself sometimes more than once a day at work, and a coworker swears she heard her vomiting in the bathroom during the lunch hour last week. She's as skinny as a stick and has the body of a 12 year old boy (she's in her 50's). She obviously has mental problems which makes her treat others this way. She's worked for the company for about 8 years, but they'll probably never get rid of her. What upsets me most is why or how a corporation like ours can continue to allow a supervisor to remain in the position she's in when she's already been written up and had complaints against her. Other people have quit because of her, even a lab lady! There are bad nursing supervisors in lot's of places, but I just had to let you know that you are not alone and THEY ARE OUT THERE!

Thank You for all replies. I totally agree....I hate giving more than 4 shots to these little kids. I don't even think I'd allow my own child to get 6 shots, but my supervisor wants us to do them all if we possibly can. It makes our clinic look good on reports. We use a lot of Pentacel or Pediarix. I asked my supervisor and another nurse this same question, and I was told to use the front thigh muscle (rectus femoris) for some IM injections if needed. We often give a combination of Pentacel, Hep A, Hep B, PCV. Add on the H1N1 and seasonal flu which the providers will order, and you have a total of 6! It sucks, and many times it makes me feel like a cruel, heartless, person to turn little kids into human pin cushions all day. It's the one part of my job I don't always enjoy...and it takes forever to prepare them....writing down the date, lot number, site, amount, dates for the vaccine information forms, and not to mention NDC numbers on every vaccine. We use Child Profile, so copies are made of the vaccine record and enounter form and attached to the Child Profile summary of vaccinations due. Then we have to grab the vaccine information forms and update the shot card. It can literally take up to 20 minutes to prepare one set of shots (that's just the way our clinic does things).

I work in a very busy family practice clinic, and a big part of my job is doing pediatric immunizations. Many of our pediatric patients are now getting the H1N1 and seasonal flu vaccine in addition to the required immunizations due for their age. Unfortunately, this results in some of our pediatric patients getting up to 6 injections in one visit! I am experienced in doing pediatric injections, but sometimes I'm not sure where I can safely give some of the IM injections. I understand that the vastus lateralis is the preferred site, and I will normally give no more than 2 IM injections in one leg. Sometimes I get into a situation where I have 6 IM injections to give, and I'm not sure if the deltoid is OK to use, especially in children 6-12 months. I don't normally use the deltoid in children that young, since the muscle may not be as developed. What is the maximum number of IM injections (0.5 ml each) you can safely give in the vastus lateralis? Can the deltoid be used in a child 6-12 months? Thanks for all replies.

Correction: Actually, I've only been turned down once so far. The first LPN job I applied for was in a family practice clinic. The job posting got cancelled. Anyhow, I was really hoping to get the walk-in clinic job, but I guess it wasn't meant to be. Still, I'm really surprised why they wouldn't consider me.

I have been an RN for 10 years, and I recently decided to re-activate my LPN license. The reason I did so is because some of the places I'd like to work (like walk-in clinics) are only wanting to hire LPN's. I know I'd be making less money, but that's OK. These are the types of jobs that I'm most interested in. So far I've been turned down by two places before even getting an interview. I thought that having an LPN license in addition to an RN license would make me a more desireable choice. I know that it might look questionable why an RN would want to work as an LPN, but I'm not asking to be paid as much as an RN. Can you think of any reasons why they'd turn me down? Am I too overqualified? Thank You!

I'm not implying that LPN's are less than RN's. It's just that I put a lot into getting my RN....lot's of studying, test taking, stress, and anxiety. I think I would have been very comfortable working as an LPN and making good money, but at the time everyone said to go for the RN. I don't think there is really that much difference between an LPN and RN...just more education and what you legally can and cannot do in the clinical setting. I think LPN's sometimes get the better jobs, but aren't paid as much.

I've been an RN for almost 10 years, but now I'm thinking about working as an LPN. I often find some good LPN jobs that I'd like to apply for, but I'm afraid they would not consider me if I'm an RN. I like clinic/office nursing, but most of the time they are looking for LPN's. I didn't keep my LPN license after becoming an RN because I heard it over-rides the LPN license. I know most clinics want LPN's so they don't have to pay them as much as RN's. Is it possible to have both licenses? I'm not concerned with the reduced pay, but I know it would be taking a step back.

Hello! I will be starting my new job in a few weeks at a local VA Outpatient Clinic. I've heard that VA nursing is quite different from "civilian" nursing, and I was wondering what those differences may be. Thank You! Rhonda, RN

Hi! I have been an RN since 1998 and before that time, I worked as an LPN. Once I became an RN, I stopped renewing my LPN license. Lately, I've had the desire to return to office nursing. I've noticed that many Dr offices aren't looking to hire RN's, and they want LPN's instead. I've had an interest in applying at a few places, but don't know how they'd feel about hiring me as an RN. When I first became an RN, I was told that I no longer needed to keep my LPN license current, but now I wish that I had. I know it probably doesn't look that good for an RN wanting to work as an LPN, and it brings up questions, but I don't mind the pay-cut in exchange for an office job with regular hours. Is it possible to keep both licenses and work as either an RN or LPN? I'm planning to contact my state board of nursing to see how I'd go about reactivating my LPN license which I received in 1996. I would like to know your opinions on this matter, and if you think it's OK to do this. Thank You! Rhonda, RN

Hi Everyone...I have a question on what is the best way to count a patient's respiratory rate. I've always been taught that you continue to hold the patient's wrist after taking their pulse while you observe them breathing. When I used to do it this way, the patient would usually interrupt me and say, "What's the matter, don't I have one?" (thinking I'm still taking the pulse). I also feel kind of silly watching their stomach or chest rise. They look down wondering what I'm staring at. Then I tried another trick which seems to work...I take my stethoscope and tell the patient that I'm going to listen to his heart when I'm actually listening to him breathe. This works because I not only hear the respirations, but I can feel the chest rise with my stethoscope. The disadvantage to this, however, is that I've found that some patients will tend to breathe very lightly or will try to hold their breath thinking it will help me hear their heart better. Another question I have is concerning respiratory rates. I understand that the normal respiratory rate for an adult is between 12 and 20/minute. I usually count respirations for 30 seconds. Is it just me, or have any of you run across some patients who breathe less than 12 times/minute? I literally counted one patient who was around 9 or 10/minute (and he was otherwise alert and stable). I'll count for a full minute if the respiratory rate seems slow, though I don't feel right about charting a respiratory rate below 12 if the patient is otherwise coherant and stable...I work in an urgent care clinic, not a hospital where narcotic pain meds or sedative might be to blame. Is it possible that some people can REALLY breathe that slow and have it be OK? Thank You for all responses on this!

We have a provider at our clinic who routinely orders postual vital signs on patients who have been vomiting. A few of the nurses I work with (including myself) are not real sure what is the correct way to do them. Some say you should wait at least 1-2 minutes between laying, sitting, and standing while others say you should take the vitals as soon as you get the patient into position so that they don't have time to compensate. Also, do you repeat the pulse and BP each time on the same arm or does it matter? I thought that if you take the BP right away on the same arm that you'd get a false high reading since it was just taken. Any help with doing postural vitals would be appreciated. Thank You :) Rhonda

I tend to have re-occuring dreams that I'm back in nursing school working on the Med-Surg floor. I tend to feel the same anxieties in my dream as I did in real life. I dream that I'm always running way behind with patient care on the Med-Surg floor...late with vitals and assessments, late with giving out meds...it's pretty funny, but I'm always glad that it's only a dream.

Hi! Med-Surg can really be stressful, but you gain a lot of good experience. Do they have an RN preceptor program at your hospital? That would be the best thing for you especially if you are a new RN. They assign you to work with another nurse on the floor who can train you and oversee your progress. Try to do one thing at a time. I know just about every nursing job requires you to multi-task, but you should keep your mind on what you are doing at the minute...this is especially important when giving meds or hanging IV's. Try not to get distracted...maybe see if you can be assiged to 3-4 patients rather than 6-7 while you are learning. Then gradually start taking on more patients as you feel more experienced and confident. Hope this helps! :)

Hi! I was diagnosed a few years back with OCD. I take Zoloft for it and feel it's in better control, but I still find myself repeating certain tasks at work. I also feel a need to be very precise and accurate when taking vital signs. I find myself repeating blood pressures on each arm and recounting pulses and respirations just to be sure what I got the first time was correct. It's crazy. I'm very detail-oriented (which can be a good thing) but I tend to be a little slower than others. I was wondering if there are any other nurses out there who go through this too or have OCD? Thank You!

Hi! I'm another one who has trouble saying "no". Many times I've been "put on the spot" by coworkers wanting me to switch days with them. I've now learned to wait 24 hrs before saying yes or no. Tell them you must check your schedule first and that you'll get back to them. This will give you some time to think about it...in the past I've said "yes" too quickly and then regretted it. Hope this helps! :)