MadelaineT

Parents: When I call you to tell you your child has a 103-degree fever and needs to be picked up, please don't say, "She was fine this morning!" I always triple-check a temperature before calling you, and "fine this morning" does not guarantee "fine all day".

I am currently working as a school nurse in Brooklyn, but through a staffing agency. I love the school where I am placed, and so was asking some of the DOE OSH staff that I have occasion to speak with, how to go about applying for the position that is obviously not permanently filled. I got some very vague answers, most of which led me to believe you don't get to choose as a new hire. One person said, "They do try to place you in or near where you live..." The school I'm at is not near where I live but I'd rather travel to a position I'm happy in than be miserable a few blocks away. At any rate, good luck!

I've worked in hospitals and had plenty of experience with the population you describe. I usually try to treat all patients with the same degree of respect (or at worst, appearance of that). I've only allowed a few "frequent flyers" to really annoy me--the key point being I "allowed" myself to get PO'd. A lot of the comments here communicate the understanding that the only thing we can change is our attitude and how we deal with situations. It can take a large stretch of imagination, but try to think of all patients as vulnerable, frightened people whose world is out of control. Look at what appears to be annoying, selfish behavior as you would shortness of breath, elevated BP, a fever--they are all symptoms. A lot of frequent flyers are accustomed to not being taken seriously or to being ignored. Surprise them. Invest a little time initially into actively listening, saying something empathetic, and fulfilling a reasonable request. Employ humor whenever possible. You might even offer something a little extra to really throw things off balance. In most instances, your respectful behavior will be reciprocated; the fact that you simply listened and took them seriously for just a few minutes will likely beget the same treatment on their part toward you. From that position, you will be much better able to politely but firmly communicate what you can and cannot do, and thereby manage expectations and your own time. And if it doesn't work, or if the patient is too wigged out to behave well under any circumstances, take the next day off for your own mental health! You deserve it.

I agree with imintrouble. Nurses need to stand up and say no to being bullied and bulldozed into taking on responsibilities outside their skills set and training. There is power in numbers. Why don't you all get together and refuse the assignment because you're not properly, adequately oriented to med-surg and cannot possibly deliver safe, quality patient care? Go to the ANA website to read about floating and quote from it. Remember, if something happens to one of the patients in your care, it's all on you. And if your hospital is anything like mine, when you float to med-surg units, you'll be given the heaviest load.

Glad to hear things are looking up. However, because of the poor management support you describe—both your nurse manager and the supervisor were totally useless—I would spend a little time looking around for other opportunities. The next time an issue comes up, will this nurse manager and/or supervisor be helpful? I doubt it. And though the natural next step is to go above the unhelpful manager or supervisor, doing so will likely make enemies of the manager, the supervisor and all the other managers and supervisors they confide in. The shifty mean nurse is a bully, and unfortunately, bullies who are as bold as she is frequently have a ladder of bullies in the administration backing them.

Sunshine520, my interpretation of your entries is that the med error occurred prior to and was separate from the charting issue. Is that correct? At any rate, med errors or near-med errors are inevitable given the load nurses carry and the stresses we face. Making one med error or one charting error should be grounds for a warning or disciplinary action, not grounds for termination. It sounds like the place you were working was harsh, and someday, I hope you can feel relieved you got out of there when you did. In an ideal world—and our health care system is so far from ideal it's appalling—errors such as yours would be used as learning tools for everyone. I had a nurse manager who pined for the old days when nurses could safely admit to an error, which would then result in all of the nurses talking about why it happened and how it could be prevented in the future. As for the charting issue, at my hospital we are able to delete electronic entries, and it isn't an illegal action. Computers, computer software, nurses, and doctors are not infallible; duplicate charting, clicking on the wrong med, and erroneous MD orders abound. In deleting or amending an entry in the electronic record, be it an assessment item or med administration, nothing is "hidden". You go through a few steps, one of which is a typed explanation for the deletion or amendment, and it stays on the record for all to see. I'm sorry for what you're going through. I'm also sorry some of the commenters here have shown such an un-nurselike lack of empathy, but that's the reality of nursing, as you well now from your earlier experience. Take some time off to heal, and then get back to it!

Very true and well said. I would take it further and add: 5. Nurses should stop enabling Big Corporate Medicine to exploit, abuse and scapegoat them. Why do nurses allow employers to bully them into taking ultimate responsibility for more and more tasks that exist outside the domain of nursing? Why do nurses tacitly submit to being steadily robbed of time for bedside care and patient interaction—the most rewarding aspect of their job? If nurses can't advocate for themselves, they can't successfully advocate for their patients. 6. Nurses should stop watching passively, with closed lips as their unit's, or organization's ONE outspoken, ethical, principled, and most gifted nurse—whom they happen to love working with more than anyone—stands up for what's right, citing the Nursing Code of Ethics, and either gets transferred, fired, or courageously quits. It's cowardly. 7. Nurses should familiarize themselves with the Nursing Code of Ethics. Nurses—learn the true meaning of "patient abandonment" so that ignorant supervisors and greed-driven senior management can't use it to threaten you into submitting to a double-shift or other inappropriate or unrealistic assignments. 8. About the abundance of CNAs, PCAs, HHAs who are in nursing school: Ask the laziest, least empathic aides — the ones who always have a ready excuse as to why they should not do what you just asked them to do — why they want to be a nurse. Usually the answer will involve money, benefits or the desirable schedule. Impress upon them that there are much, much easier ways to make money.