Apples&Oranges

I'm not a new RN, but new every 13 weeks, and dealing with EXTREMELY condescending and rude docs and a PA on this contract. I just CANNOT believe what these nurses put up with! Multiple times in only 7 shifts, I have been the recipient of eye rolls, horrid condescension, outright dismissal when presenting legit concerns (NO, this patient cannot go home, he can't walk, or even crawl, he's still in active withdrawal!) And (I've asked 4 times now for a DNR order for this pt who has a clear advanced directive...Nope.) Admin is aware of the problem, and apparently this team has been "spoken to" by HR multiple times about their (collective and individual) behavior. It's unreal how quickly, with the doc I've worked with most, (again, only 7 shifts) the attitude has shifted. I've looked him straight in the eye on multiple occasions, and said something to the effect of, "I'm not sure what you meant by that comment, but I'm telling you from my experience that X is what's going to happen if we do Y without Q. I don't really care, since neither one of us will be here when he (pulls out the NG, has a seizure, has to be exposed to more radiation d/t another CT...) but in the interest of his (health/comfort, whatever) can you just hear me and do what I'm asking?" He has started to actually come to me and (not ask for advice, that would be too much...) hint subtly that suggestions would be considered. He actually commented the other day that I was to be commended for "using my own judgement" and not feeling the need to "bother him" by "getting confirmation" on a patient concern. Um, thanks, jackass, but I don't need your approval to educate my patient. That said, it really was validating, and the charge and two other nurses heard him, and were like, "How the hell did you do that??!! Actually get him to talk to you like a person, instead of a peon??" Honestly, I know my ***. And I'm not afraid to tell you what I know, and what I DON'T know. Now, if I could only get the PA to stop thinking she is God's gift to Neurosurgery... ETA: Maybe mine's not the most helpful post for a new nurse...more of a rant, but I will say, confirm your feelings/suspicions with a more experienced nurse, Unit Director, even House Supervisor. If warranted, stand your ground! Docs, NPs and PAs will dismiss your concerns if you are emotional or seem unsure of yourself. Once you have confirmed that your concerns and recommendations are legit, be calm, firm and direct. Don't let anyone dismiss you.

The 2 years of experience thing is to PROTECT YOU, not to make getting a job easier. Nurses who say to get more experience are trying to HELP you. We've seen so many 1 year first time travelers leave in tears day 2. Or get cancelled 1500 miles from home - with no savings or backup plan. ANYONE can get a travel job with a shady agency after 1 year. But hey, you do you.

Wait, don't LTC nurses have like, 30 patients at a time? And only 8 hrs to deal with all of them? IDK, I don't work in a LTC facility, but I can't imagine they have much time to breathe, let alone call in refills...is there a reason that they can't let you, as charge, know when they are running low, and have YOU do it? Seems more appropriate for someone not in patient care to be making frequent phone calls to pharmacy and MD offices than to have headless chickens who are already swamped with meds, wound care, dealing with family members, charting.... It's like us hospital nurses with our sacred whiteboards...if management had soooo much time to chat with the patient, inspect the room, notice that my whiteboard was from last night...freaking change it yourself! You obviously "have the time!"

If the pt wanted the port accessed because she has horrible veins, and didn't want to be stuck 50 times for blood draws, yeah, that makes sense. But because the PCA works better in the port?? Oh, hell no. Your ability to get high from the narcs we are giving you for PAIN is not a higher priority than infection prevention. If you were that hard of a stick, they wouldn't have been able to throw in that peripheral. Sorry, you're getting your meds through the line that was placed. It is, obviously, already there.

I almost fainted and vomited when I saw a circumcision. I had no idea how barbaric it would be. Not to judge anyone else's "sensibilities" or experience, but I think anyone who doesn't react negatively to that, at least a little, at least the first couple times might be a bit "off." That said, I don't have a problem with most other surgical procedures, except for bone marrow or punch skin biopsies. OMG, I absolutely refuse to be in the room, they make me lightheaded. Everyone has their things they can't stand. Like mucus, or invasive eye surgery. Or broken teeth. Ugh, I have to stop. See what I mean? But watching a dressing change with muscle, bone, tendon exposed is no big deal for me, same with caring for a patient who has no skull, and exposed brain after a crani, or going to cadaver lab and practicing bone drills or excision on dead bodies. No big deal. Again, everyone has their things they simply cannot do.

You wrote that you only have one year of experience. That may be part of the problem. Regardless of what agencies tell you, it's not enough. Get another year, at LEAST. You will be glad you did when you don't end up in court.

Easy and travel are not usually terms that go together...but I think I get what you are asking. Assuming that you know that you need AT LEAST 2 years of experience (preferably more) before you take a travel contract... Smaller hospitals are usually easier. People tend to be nicer, you have less of a chance of getting floated to some crazy specialty unit where you have no idea what they are talking about or expect - example, I was floated to a 40 bed seizure unit my first day off orientation (1 day of orientation on trauma, mind you,) in a 1600 bed hospital. EVERY SINGLE patient was actively seizing, and I was expected (because I was a traveler) to know how to deal with that. Know the protocol, order sets, procedures, etc, with ZERO orientation to the unit. Welcome to travel nursing! That's one of a hundred examples I could give. In a small (400 or less) bed hospital) you would be more likely to float to less specialized units (like tele, med surg, PCU, ED hold, OBS, cardiac...) but you still have to know what to do in each of those units. I was pulled in a small (360 bed) hospital my first day off orientation (my first travel assignment) to be charge on a cardiac critical care unit (huh? I had no real cardiac experience - I'm a neuro nurse!) and within 2 hrs of shift change, a fresh heart arrested and we were doing CPR on the floor. The ACTUAL floor. Like the thing you walk on. I had to run the code b/c I was the most experienced nurse on the unit...I had no freaking clue what I was doing! The docs were asking me what the next drug in ACLS protocol was! This is what can happen when you are a traveler. You are expected to know EVERYTHING, be able to handle ANYTHING, at ANY time. Please don't take a travel contract until you really feel confident. When you do, get another year. I kind of wish I'd taken my own advice. So, to summarize, anywhere you go as a traveler, you are expected to be an expert in everything.

If you were my little sister or my best friend, I would tell you to start applying for hospital jobs. It may not be what you want to do long term, but at least you will get an orientation, experience and something to put on a resume. Hand out in the hospital for a year. If you stick with corrections as a new grad, particularly with no real training, you will pigeonhole yourself, and it will be difficult to find work in an acute care (or many other) settings if you choose to do so in the future. Better to open doors than to close them...just my 2 cents.

Every time you go to the grocery store and pick up an apple, orange or pear, someone before you with MRSA, VRSA, VRE and C-diff touched that same fruit without washing their hands. Same thing every time you drive a rental car, touch a doorknob, walk on carpet, check into a hotel or enter a car dealership. Every single place you go, everything you touch has these bacteria on ANYTHING another person has touched. Is that gross to think about? Yep. Can you get away from it? Nope. Where do you think all of the "infected" people go when they are discharged? To the same gas station, Costco and Wendy's you do, every single day. Wash your hands before you touch your face. You'll be fine.

OP, you are playing with fire. You overstepped by looking into this patient's history and meds and you'll be lucky if it it isn't flagged and caught by IT as a privacy violation. If not, you dodged a major bullet. I was a PCT/sitter and student for a loonnng time while in school. The is so much more to this situation that you are not privy to, nor should you be. You are NOT the nurse. You just don't know what you don't know about assessment, addiction, withdrawal. Keep your head down, your ears open, you may learn something. And stay out of patient charts, lest you get DNRd from another facility. Huge mistake. Hope you've learned from this.

Wow. A few years ago, working in neuro critical care, I got a call about a true family emergency - not going into details, but it was horrendous, to the point that I was sobbing on the phone, begging my family member to "just hold on, I'll be there as soon as I can, please, it will be ok, I'm coming RIGHT NOW!" The charge heard me in the break room, said, "just go. NOW, your [family member] is more important than this. Go." I threw my papers at her, yelled, "everyone is a full code, thank you, I'm so, so sorry!" and ran out the door. I didn't give report. She had full access to the computer, notes, what meds my patients had and hadn't received, diagnoses, etc. Should I have been reported to the BON for abandoning my patients?? I hadn't called off in over 6 years, never left early, never came in late. Ever. Sometimes family comes first. I hope that when, inevitably, you have a true emergency, your co-workers extend the same professionalism, understanding, compassion and competence that mine did to me. Good luck finding that support if you choose to "report" a fellow nurse in crisis.

Certification and certificate are two very different things, and most nurses don't understand the difference. Certificates (like ACLS, TNCC, ASLS, PALS) can be taken by anyone, and SHOULD be, if you work in areas that benefit from that knowledge. Certification is a different animal. These are things like SCRN, CCRN, PCCN. They indicate that you are an EXPERT in your field, and require study, experience and an exam similar to NCLEX, but specific to that area of expertise. Your friend may be as confused about the difference as most other nurses are.

I hate when they do this to me. It sucks. That said, it's part of traveling, most places, to float first, often (though not everywhere) for 4 hour increments. As far as central staffing is concerned, we are often not real people, only "Traveler Apples," and "Traveler Oranges," to be plugged in to any open space q4. Though my current facility has a written policy to NOT automatically float travel first...guess what? I have done 4 hours in CCU, 4 hrs in IMCU, four hours in med surg...and NO ONE else on the unit floats. They just refuse. The charge calls them and says, "Hey, they're going to float someone...do you want to call off, and we'll float a traveler?" Yep. That said, I'm making 50$/hr to staff's 27, so...I take deep breaths and suck it up. I am LITERALLY on the schedule listed in a separate section under per diems as "Travel Oranges"...good luck!

I was told today that RNs can't put in IVs or draw blood at this facility. My response? "Yea!" Two fewer tasks for me to do!!

Hey, MurseSmith, Just telling you now, cause if you try and post on any other forum, you are going to get slaughtered for your name - it is not only illegal (per state and federal law) but against TOS on this site to refer to yourself as a nurse before you've passed your NCLEX. I went to CCAC, (years ago) which is why I still check these forums, and I don't want you to get the bashing I've seen others go through. My advice? Change your username now, before it becomes an issue. You're not a "murse" you're a "murse hopeful" or something - BTW, many men (and women) take great offense at the "murse" moniker..."male nurse" is not PC, we are all nurses...again, just trying to save you some grief. To any of you CCAC hopefuls, please take heed, and remove "nurse," "RN" or anything else nurse related from your username. You'll get banned. And you'll totally get WHY once you pass NCLEX.

Cross Country is garbage. They sold my information (as a VMS, I would NEVER work with them directly.) If we would all stop working with them and their parent company (AMN) conditions would improve tremendously. Just my 2 cents.

You're upset that you can't work for HCA hospitals anymore? Take it a a blessing!! You are one lucky girl!

I say it at least once a week - I used to be an extremely nice person. compassionate, helpful, sweet, always had a bright smile for everyone. Then I became a nurse.

When I was a tech, I placed IVs, as well as Foleys, straight cathed and drew blood. It was part of a push to take time consuming "tasks" away from the RN, and let them concentrate on NURSING duties. I wish our techs could put in IVs, it would save me an hour or more every shift that could be spent on actually being a nurse, rather than running around like a headless chicken doing tasks that almost anyone else could do.

While I have my own feelings about beside report, when done correctly, and incorrectly (I have replied to these threads before) are strong, I have to say, AGAIN, that according to the regulations, bedside report is NOT a HIPAA violation!!! It's NOT. Even if you think it is. Even if you want to believe it is. There is an entire section in the Joint Commission's Report clearly stating that incidental exposure (and it SPECIFICALLY mentions bedside reporting in semiprivate rooms) is NOT a violation. This has been debated to death. I get it. You don't like it. I don't do it at my current assignment, nor did I at my last one, simply because that was not the culture. I did 3 assignments ago, and at my last permanent job, because the culture there was that it was expected. Whatever. When in Rome, dude. But I get so frustrated when people throw up this HIPAA BS every time someone mentions a name, diagnosis, symptom, etc., or posts a photo of their kid's thumb lac on FB. 98% of nurses have not read the regulations, have no idea what the JC, DPW, DHS, or any other regulating body's standards are on ANYTHING, yet they throw out opinions as if they are facts and expect everyone else to share their outrage. **Wow, that was a major vent. Not sure where that came from, maybe being told that we are now being written up for not having our whiteboards updated at 8am, since DHS is inspecting...pretty sure that's not their thing, insecure assistant nurse manager Mary...but carry on with your OH, SO IMPORTANT JOB...** OP - while it's true that it is NOT a violation, please take the rest of my growling with a shrug and a grin. I just had a bad day ;-)

Sounds better than mine. We started with 130 and graduated with 37 of the original class. 100% NCLEX pass rate. Most people who start nursing school don't finish. I think it's mostly because they have no idea what they are getting themselves into, and schools are not selective/rigorous enough in their admissions processes.

I was in a very similar situation to yours. 3rd degree, older student, experience with the "real world", mental health and psych. I worked as a tech on a trauma unit, and one day saw a question posted on the white board in the break room - don't remember what it was, but the comment was something like, "Gunshot patients are the whiniest bunch of pu**ies ever!" I was APPALLED! Was this the attitude of the nurses I would be working with? I thought nurses were supposed to be so compassionate, caring, healers, trying to alleviate pain...that's what I wanted to do, right? It made me sick. Fast forward 5 years. I can tell you that gunshot patients are some of the most obnoxious, whiney, needy, people you will ever encounter - and it has NOTHING to do with the actual pain they are in. I won't go into the psych or family dynamics of this, but I can promise you one thing - once you have a couple of years of experience under your belt, you will see this encounter much, much differently. And feel a little silly for being so offended by it. As I am for my reaction at the time. With experience, comes a much different, and well rounded perspective.

I dealt with a new nurse the other night (she volunteered that she's only been a nurse since December) and I could tell that she'd been on the receiving end of some aggressive behavior from other nurses on the unit (not my unit, I'm agency.) She gave an excessively detailed report, reminded me repeatedly of how she had checked drains, pulses, neuro statuses, pain medicated all of the patients RIGHT before shift change (so you don't have to do it) and "fluffed and buffed" (her words) everyone within the past hour. She reminded me twice that everyone's labs were done and sent, and nervously asked me 3-4 times if I had any other questions about each patient. When I assured her that she was fine, go home, get some sleep, if there's anything she missed, I would take care of it, her eyes filled with tears, and she told me that so many of the nurses on the unit had "yelled" at her, reported her to management, told her that she was a slacker, because of things that were missed during her shift. She said, "I am a worker! I run my ass off all night! They always find something I did wrong and report me!" I stopped her with a hand. Look, here's the thing - if you show me a PATTERN of slacking - like, lying to me and telling me you tried to draw blood, and patients REPEATEDLY tell me nope, no one came in all night, or I catch you on your phone when I come in (30-45 min early every morning) but then you give me a list of things you just "didn't have the time to get to," then, damn straight I'm going to call you out on it. But if you try your best, and a few things get missed (you're new! You don't know everything when you're new!) there are a couple labs or meds you didn't get to...no problem! This is a 24 hour job! And it would take something UNBELIEVABLY awful for me to go to management - you can bet you will have a heads up, cause anything I say to them, I will have said to you first. That's called professional courtesy and being a grown up... I have no problem saying, sorry, I missed that K+ replacement order, for the pt with a K of 3.3. Sorry, thanks for taking care of that for me! Or, sorry, I couldn't get that UA, she didn't feel like she had to pee, but the stuff's in there. Thanks! Or, my personal fav: Nope, I have absolutely no idea when the last BM was. BMs are literally the last thing on my priority list. But he's right there, you can ask him if it's important to you! With confidence comes the ability to say, nope, I don't know, didn't get to that, didn't care about that...but I took care of the important stuff - your Cardizem is titrated properly, I got US to come up b/c i suspected a DVT next to the PICC, and I stopped your pt in 4 from leaving cause Case Management had transport on the way when I found out she has 10 steps to get to the bathroom and two casted legs. And lives alone. And no friends or family. And no home health set up. But sorry, I absolutely forgot to give the 6pm Colace. Thanks for taking care of that for me! See you in the morning!

Some great tips, but I do have to disagree with #6. I would HATE to be woken up at 3am (or even 10pm!) if I were on call, so "Hey, I'm so sorry to have to call you this late" is not inappropriate. Yeah, it's his or her job, and responsibility to take call, but it still sucks. Having the common courtesy to acknowledge that working 12-24 hours, THEN having to be on call for another 12 is rough does not demean us. That said, I get where the OP was coming from.

Since I've stared traveling, I've learned that this is totally facility/culture specific. I've worked in places where it was not only encouraged for nurses to give their recommendation, but expected...the resident was waiting for it, and if I didn't give it, he or she would ask, "well, what do you think it most appropriate?" (I LOVE these hospitals, but they are few and far between.) A few assignments ago, I called the docs and said, "Blah pt is having this, I did this, here was the response, I'm going to give this, if it doesn't work I'll give this, K?" That was my experience. I was freaking BLASTED. Like, how dare I suggest a course of action, as the lowly nurse?? Where I am now, about half my patients are teaching, half aren't. The residents are fabulous, and we collaborate and work well as teammates. The PAs on the specialty teams are full on egotistical jackassess. Weird, cause usually PAs are super receptive to suggestions and good relationships with nurses. My point is, feel out the egos wherever you are. Some places will appreciate your input, some won't.