Smauf

Over the years I've learned that I have to add up my own hours and compare them with each and every paycheck, because numerous supervisors constantly dock me 30 mins for lunch even when I tell them I don't get a lunch due to no one to relieve me. I have to take pictures of the time clock with my phone, so when the manager says "Oh I fixed it for you." I can say "Nope I'm still short look here right here." It's very sad that I have to do this every day, but I've accepted that I can't rely on managers to fix things when they say they will...especially when it comes to my paycheck and my livelihood. It may sound petty to do this, but 30 mins a day X3 days a week X52 weeks a year = 4,680 mins which divided by 60 = 78 hours a year. That's an entire 2 weeks paycheck of not being paid when you are actually working. As for your original question, our policy is the same as federal law: the employer is not required to give you any break whatsoever including a lunch break, but if you do take a break and it is 30 minutes or over the employer does not have to pay you because you are not considered to be working. If your break is less than 30 minutes, or if you do not take a break, the employer cannot take out 30 mins from your paycheck without violating the law. But yeah I've worked 14 hour shifts before with no lunch or a single break. It sucks, and unfortunately it seems to be the norm for nursing. Just browse these forums and it constantly comes up under lists of complaints/dislikes about nursing. I don't know of any other profession where this is considered normal.

I realize this post is from July 3, so I imagine you've already made your decision, but you should never have to wait 1-2 years for a "real" PACU position. Most PACU's I've worked in only require 2 years of ICU experience, so you are more than qualified. Some will hire new grads and train them if they are desperate, though it's fairly rare. With your experience you should be able to apply to a full-time dayshift PACU job in the hospital without having to "put in your dues". It does sound fishy what you're describing. If they cannot produce a written policy on what you'll be doing, who will be wasting your narcs, who will be relieving you for lunch etc. then I would avoid it. I've met too many managers that will say whatever they think you want to hear, but once you come on board their attitude changes and all of a sudden you are doing all sorts of things you didn't sign up for.

I've recovered all sorts of plastics patients in the outpatient setting, and from the types you've listed the ones that give me the most trouble are the ENT/sinus patients simply because of airway management. Most of them have obstructive airways to begin with, (which usually is why they are having surgery) add a bunch of swelling, bleeding, anesthesia & narcotics and it makes for difficulty keeping their 02 sats up. NC's don't work very well with them, but some places have face tents which I think work great. But obviously they can't go home until you wean them off the oxygen, which the more pain medicine you give the longer it usually takes. I usually apply ice right away to help reduce swelling and bleeding (and it helps a little with pain). I try to shy away from narcotics if I can. Some anesthesiologists will let you give Ofirmev 1,000 mg (IV tylenol), or tramadol but in an outpatient setting you might be limited to how many drugs are on formulary in the pharmacy. I would avoid giving toradol though since it will increase the risk for bleeding. Anways based off your experience I think you'll be fine. I worked ICU for several years, then worked PACU at the hospital before I went to an outpatient surgery center. One thing to keep in mind though in the outpatient setting is that the patients are either going to go home or you will have to transfer them to the hospital. There's nobody coming in to relieve you for your shift, and there's no other department to ship the patient to. I have had shifts where I came in at 6:30am and didn't leave until 9pm until the last patient left. Those are extremely rare but they do happen. Normally I'm out by 5 or 6pm, and on slow days before 3pm. Occasionally anesthesia will give the okay on a patient that they think is an ASA III, but is actually an ASA IV, and it is a nightmare getting them recovered because they have breathing issues, morbid obesity, htn, chronic pain, heart problems, kidney problems etc. Those are the types of patients that are supposed to be done in the hospital, and it can be very difficult to recover them in outpatient because they have to be ready to go home and take care of themselves before you can discharge them. Hope this information helps. Good luck whatever you decide!

Since this thread is almost 4 years old, I'm curious how did you make out? I am also thinking of doing an MSN in Informatics and/or FNP.

Okay after reading your second comment: It is YOUR responsibility to read the policies and procedures. During orientation you are given many papers to sign. Usually one of those papers is in the form of a sheet or check-off sheet that you sign your name stating I have read and understand such and such policies and procedures (usually specific to your unit). Like I said earlier, failure to follow the hospital's policies and procedures can lead to write-ups, termination, or in worst case scenarios make you liable in a lawsuit. If P&P states that all heparin doses must be verified by another nurse prior to administration and you draw up the wrong dose and administer it without another nurse verifying, and it leads to a patient's death, you are responsible whether you knew about the policy or not. If the patient's family sues, their lawyer is going to try to name anybody and everybody involved in the incident. Usually the hospital will just fire you and settle with the family out of court, but in the case where the family pursues litigation, the hospital's lawyers will argue that there is a policy in place for proper administration of heparin, and that you knowingly went outside hospital policy and overrode it. If you try to argue that you didn't know about it, and no one told you, the hospital is going to produce the paper that you signed in orientation stating you read and understood the heparin administration policy, therefore making you liable. Bottom line: READ your policies and procedures. If they refuse to let your read them, or allow time for it, then find another job immediately. I once worked at a place and during orientation I kept asking to see the policies and procedures, but my preceptor and the nursing supervisor said they didn't know where they were at. I refused to sign off on them, and refused to start working off of orientation until I had read them. Magically they found them the next day, and I spent my last two days of orientation reading them...and yes sometimes there are a thousand of them. But again it's YOUR responsibility when you sign YOUR name. The hospital is not going to take the fall for you if you fail to comply with P&P. Protect yourself, protect your name, and protect your license!

It's hard to see exactly where you're coming from. Like the others said it depends on if it's an update to policies and procedures, or if it's actually brand new training that you've never had before. Policies and procedures can be updated as often as several times a year, or as little as once a decade (possibly even longer at some places) depending on the specific policy and procedure. Whenever a hospital updates the policies and procedures, in most cases it's the hospital's job to notify staff of the update (usually through educators, or supervisors). The unit educator or nurse supervisor may print out the new policy, or tell you to manually look it up on the intranet, read it, and sign that you have read the new policy and agree to follow it. An example would be: "Our policy of labeling blood draws for laboratory that includes date, time, and initials, will now include date, time, initials, and the site blood was drawn from. Please review updated policy xx.xxxx.xx and sign off that you have read and understand it." If you don't understand it, then it's your responsibility to notify your supervisor or the educator and have them explain it to you or even show you how to do it. By refusing to acknowledge and sign off on updates to policies and procedures you can and will be written up, and eventually terminated for refusing to follow hospital policies and procedures. Brand new training on the other hand is a different story. If you have never taken ACLS before, and the managers are telling you to sign off stating that you have been trained in ACLS, it is your responsibility to tell them you have not had this type of training and refuse to sign off on it. If they continue to pressure you into signing off on it, alert HR immediately! If HR fails to remedy the problem, alert your nursing law's governing body (in the US it would be your state board of nursing) Many state boards of nursing have adopted whisteblowing protection laws for just this sort of thing. If you do sign off on it you are making yourself liable (instead of the hospital) that during a code you have the knowledge and training to perform ACLS on your patient and failure to do so can be construed as negligence. Usually though in good hospitals (or places that want to retain their nurses) if there is a unit-wide change, such as making the unit responsible for ACLS, the educator or supervisor will sign the employees up for training and notify them about it. Once you've completed your training, again it is your responsibility then to acknowledge and sign off on it, or you can and will be written up/terminated. So bottom line: Read your policies and procedures, ask questions if you have them, and sign off on them once you have read and understand them. Never sign off on training that you have never completed before, until after you have completed it.

Oh and we actually do have computers, it's just that we only use them to print off paper sheets for the chart. We print the paper MAR, paper nursing flow sheets, paper schedule etc. There is no software for computer charting, physician order entry, or medical record keeping on the computers...everything is handwritten on the sheets that are printed off from the computer. But you're right it may be time to start keeping my open for something new, but I would at least like to complete the computer projects that they will let me do here first, so I can have something to put on my resume for my next job

You could do like a lot of us did and get your associate's degree in nursing from a community college. I didn't have the most stellar GPA either when I was a teen just messing around in college, but I applied to CC nursing program and was accepted. After I got the degree, I passed the NCLEX, went to work in ICU for a few years, then went the RN to BSN route. Worked out just fine in the end.

Thank you for the replies. So a little extra background info on me: I have used MS Office quite a bit, including Excel. I learned to use Excel in undergraduate biology because our instructor specifically wanted us to use it for data entry...but I also use it for personal use (recording personal data on miles ran, swam, biked, pounds lifted at the gym, my financial budget month to month-I know I'm a nerd) As far as EMR goes, ironically enough the first two hospitals I worked at use it, but the freestanding surgery center I transferred to in November (which is a satellite of the main hospital I worked for) does not. We do not use ANY computer charting whatsoever. Not even physician order entry, central supply, pharmacy, or labs. Docs still handwrite orders, nurses chart freehand, medications are kept in a safe instead of an automated med dispensing and hand-counted and handwritten on the narc record, and any labs or special tests are written on carbon copy paper and sent downstairs. I literally felt like I went back in time 15 years when I came over here. I asked my director why there isn't any EMR here, and she said that the 4 years she has been the director she's been pushing hard for it, but is meeting resistance from the physicians and nurses who refuse to use it. The majority of nurses here have been working at this same facility for 15 years, and some have even been here 35 years. I imagine it's similar with the docs. She at least said that we will be putting the policies and procedures up on the intranet sometime this year, and would like me to do it and I agreed. She said they would send me to some sort of training course later to learn how to do it. I also revamped the chart audit tool using Excel for them last night at work when it was slow. So I guess it's a start. As far as networking with IT goes, I have never met anyone from IT at the surgery center. We don't even have an office for them, our only offices are for administration, pre-op, and billing. Our human resources, education, etc. is all in a different building on a separate campus, and that building overlooks several surgery centers. I'm sure someone from IT in the main hospital has some overwatch on the SC, but I doubt we ever contact them unless a monitor burns out or something. But I will ask my director next week what our IT situation actually is, and if it's possible for me to become a "superuser" Thanks for the information guys, and if think of anything else be sure and let me know! :-)

Do you think that clock's right?

I am planning on applying to a program to start on an MSN in Nursing Informatics in 2015. I have done some research on what a nurse informaticist does, however I'm wondering what I can do NOW to help prepare myself for it. I understand that school will teach me what I need to know, but I just want to be well prepared. Before I went to nursing school, I had a rough idea of what an RN did, but I wasn't fully prepared for what an RN really did until I had already been a nurse for a year! Should I be buying books and learning to do computer programming while I wait for the applications to open up? Would it be beneficial to brush up on my math skills? Should I try to request special computer assignments from the nursing supervisor? Should I apply for a part-time or PRN computer related non-nursing job? Should I volunteer at computer companies? Should I try and find a nurse informaticist to job shadow? For those of you that are already nurse informaticists what did you do to help you get into the field, and what would you have done better if you could do it all over again? Sorry to bombard the forum with so many questions, but I don't actually know any nurse informaticists in real life, so I am turning to the allnurses community. Any opinions from experienced RN's would greatly be appreciated. P.S. My background information is: Associate's and BSN in nursing. 2 years ICU experience, and 1 1/2 years in PACU/post-op surgery. No specialty certifications as of yet.