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pebblebeach

pebblebeach BSN, RN

Orthopedics
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pebblebeach has 3 years experience as a BSN, RN and specializes in Orthopedics.

pebblebeach's Latest Activity

  1. pebblebeach

    The avalanche of prior authorizations

    Hi clinic RNs, I was previously a bedside nurse who transitioned to clinic life. We deal with a lot of patients on biologics (humira, etc.). The biggest learning curve for me coming from bedside is the barrage of insurance denials, prior authorization appeals, and of course the multiple phone transfers, being on hold, faxes lost and re-sent, and follow-up involved. The RNs who have worked there for years have said that 2019 has been the worst year yet in terms of pushback from insurance, and has taken up more of their time now more than ever. It takes so long to initiate and complete these requests that other clinical tasks are getting ignored. If you deal with a lot of this at your clinic, how is it delegated? I've heard of clinics hiring LPNs or RNs specifically to work on specialty med insurance/PAs, but that's not in the budget. Curious to know what your practice has tried - even if it failed. Thanks.
  2. pebblebeach

    Social Media and Doxxing - Your Thoughts???

    I have posted a couple photos from work (on a private social media account) with zero mention of patients - just positive reflections ... i.e. on my one year anniversary as a nurse, a selfie of my good friend and I in the break room. I go by the rule also that I wouldn't post anything my boss or coworkers would be surprised by, and I don't vent on social media, certainly not about work anyway. So if our nametags are visible... and someone zooms in on them, that's a punishable offense? (Perhaps if someone doesn't like me enough to report it... yikes)
  3. pebblebeach

    Nurses Eating Their Young - A Twist

    Great advice - saying "I'm surprised you would not come help me when I asked" feels absolutely reasonable. Update 4 months later: that small group of RNs have been since reprimanded after complaints of being v. unhelpful, among other grievances. They've improved big time & I feel comfortable (& less emotional) redirecting that nonsense back to pt care. Good lord, the first year of nursing is tough to navigate with all of these personalities- pts, families, docs, colleagues... it's truly a job that makes you face your lifelong discomforts with others head-on. I'm getting stronger everyday even if it doesn't always feel like it
  4. pebblebeach

    My Preceptee concerns me

    "This student nurse recently forgot how to prime and hang IV bags and even scan them in." Just defending the slower learners over here in the cheap seats... This is a pretty advanced skill for a new student nurse. What is muscle memory to us is brand new to students. Clamping, back-priming, making sure all air bubbles are out, aligning it with the pump and programming the pump? and troubleshooting beeps?! and that slight manual gravity adjustment that can't really be taught to get a secondary in just the right spot -- to do that super quickly and correctly took me a while as a new RN. Doing all of that without repetition of the steps explained to me (yes, multiple times), as a student? No way. Also, experienced nurses have all forgotten to scan a 500cc saline prime bag before, no? +1 to patience
  5. pebblebeach

    Wastefulness in healthcare

    I completely agree with all of this, but if there are no spare films available to you except for in the kits, what else do you do? I wish more of the individual supplies in our kits (right now blood culture bags and port access trays come to mind) left some of the critical items in it (biopatch, angelwings) out separately, so that if you need another you don't have to open another kit. I always wonder who makes the decision of what is packaged together and separately, why is there suddenly a new brand of tape, etc. etc. Medical waste is such an overwhelming problem, as a new nurse I feel swamped enough by simply staying on top of my tasks right now, but at some pt in my career I would like to focus on it. I worked as a tech on an ortho unit years ago, and somehow this hospital could afford a pack of Pampers wipes (like- Costco size ones) for each patient in the admission bucket. The pt would usually ask for more during their stay. Well, come discharge, there's 3 unopened Pampers packs left in the room that have to be thrown out bc the pt has a history of MRSA or something -- meanwhile they could be used by parents who can't afford wipes. That one really got to me. Maybe opened kits/leftover supplies in non-iso rooms can be donated to a nursing school?
  6. pebblebeach

    Nurses with bipolar or anxiety/depression

    I feel you. It took me years in therapy to stop comparing myself to others' issues, i.e. "well my childhood was fine, my parents are great, I've never been abused," etc. etc. It's my belief now after a lot of self-work that every single one of us has experienced trauma in some way. Go to one appointment - what's the worst that could happen? Sending you good vibes, you'll get through this!
  7. pebblebeach

    Nurses with bipolar or anxiety/depression

    Yes. I wouldn't worry so much about the label (bipolar vs. "just anxious") right now. All feelings -- annoyance, hopelessness, flat -- can be "normal," the deviation is how loud the volume is on those emotions. For me, without help, the volume is on full blast. You said you have a prescription for Lamictal. Assuming this was from a psychiatrist? Do you have a therapist in addition to a psychiatrist? (I recommend both, if you can afford it.) If so - bring up the concerns specifically about nursing. Notice when you get annoyed at work, how often, etc. so you can get to the root of it. Yes, maybe the person is just annoying. But does it feel like you're crawling out of your skin, or like you can't focus because you're so annoyed? Therapists can help with those things. Psychiatrists help when you need an Ambien prescription because you can't sleep between shifts. Are you open with your close friends or family about this? That can help immensely. I journal, old-school pen to paper. It helps with identifying how soft or loud I am on that volume scale. Journaling when adjusting to a new med is useful too, literally a sentence or a couple words everyday -- "felt nauseous, more depressed than yesterday, etc etc." It helps to have a timeline and then be able to go back to your MD with that. I'm able to be a good (good enough, sometimes) nurse because of the above -- my small little support system - therapist, psychiatrist, family, friends -- and my meds. I can't tell from your post if you're a new nurse or experienced nurse, but from a newer nurse struggling on night shift, I struggle too, it's a battle like any other illness. You're not alone. Don't worry about the label for now. Feel free to message me on here if you want.
  8. pebblebeach

    Adjusting to NIGHT SHIFTS advice??

    Agreed. I have the positive attitude part down and I continue to work on good habits. I've definitely heard of instances where RNs bring in a doctor's note to get out of night shift after a v. short time on nights. In contrast ... my coworker with sickle cell? She could NOT adjust to nights. She was a fighter until the bitter end, though.
  9. pebblebeach

    Adjusting to NIGHT SHIFTS advice??

    It wasn't my intention to scare -- I'm sorry! I just wanted to be honest about my experience, as nights is not for everyone. I have had to find solutions to the nausea, mental health, etc. and as long as I am consistent, I know I will survive night shift until a spot opens up on days. I did forget to point out (as many have already) that the teamwork on nights really is great.
  10. pebblebeach

    Adjusting to NIGHT SHIFTS advice??

    Congrats on the gig! I started out in a new grad orientation program too, and we started out on nights. I have always been very sensitive to sleep, and my psychologist strongly advised me to not go on night shift, but it really wasn't a choice. So I went into it with a positive attitude and pretended I could be a night person. I've had a hard time. I do all the tricks -- blackout curtains, the original Dohm white noise machine (go big or go Dohm), essential oil diffuser, eyemask, etc. Sleeping between shifts isn't a huge issue now. In the beginning I would have so much adrenaline from shifts getting home that I couldn't turn my brain off -- give that a few weeks and I was tired enough to let that go, lol I've never been the sleepy type on the job, I'm the opposite -- engaged and high-alert (sometimes to a fault -- fine line between alert and anxious). The big problem for me is my days off. I've read all Googlable advice on this: Set an alarm if you nap - GET UP no matter what - and switch yourself back to a daytime schedule. (Or stay nocturnal all week - which I tried once and was so dreary I never did it again, but it may work for some) So, I finish the three shifts consecutive (I prefer that, btw - continuity with pt care and with report is wonderful) and the fourth day is the day to switch back. I will nap for a couple hours, wake up to the alarm and feel like the crankiest human on the planet & like I haven't rested at all, or I'll "listen to my body" (fine line there, again) and next thing I know it's dark (AM or PM? who knows!) I have several missed calls from concerned friends & fam, and I haven't hydrated in 16-18 hours. My mood may be lighter, but my body feels like it's been hit my a truck. I think only graveyard shifters who have experienced this crash can relate to that feeling. I've also never dealt with nausea before and have discovered I cannot eat on nights. (Coming from a big snacker who loves food, this sucks) So I will try to have a healthy meal when I get home or before work, and then bring a smoothie or something my stomach can handle during the shift. I've lost 14 lbs since starting night shift and not in a good way. I've added iron, Vitamin D supplements, and Miralax to my daily routine (don't even get me started on the change in BM habits... my GI tract doesn't know what the hell is going on) My mental health has taken a hit for sure. I have managed my depression pretty well for almost a decade now with a combination of therapy and SSRIs, but having that baseline history of depression added to chronic sleep debt (and sometimes forgetting to take my med because I was so strung out at first w/ what day/time it was) I have had... rough weeks. Two days particularly come to mind when I felt truly bottomed out. Waking up crying, feeling worthless, the whole lot. Thankfully I have been in that spot before, and even knew as it was happening -- "this is chemical, you're exhausted, this is temporary" Still lousy, though. All that said, I know this is not forever. Nights are not for me long-term. The pay is nice, but I'd rather get paid less and feel like a functioning human on my days off. One hack that has helped, I carpool with a coworker on our days that we are scheduled together, and we play goofy songs (Spice Girls, etc) on the drive and sing like fools, it helps my mood so much on those days coming into the shift. Or if I drive solo, I'll sing my heart out to Aretha Franklin or something equally over the top. Whatever works! Keep us posted how you're doing. Wanted to share from the perspective of someone who is on nights but not thriving, but I know I'll get through it.
  11. pebblebeach

    new nurse /gaslighting

    GREAT movie
  12. pebblebeach

    Nurses Eating Their Young - A Twist

    Of course it bugs me, I wouldn't have written all this out otherwise I just feel communication is so important & helps the patient in the end. I really appreciate nurses who communicate well & effectively & it always blows my mind (in any profession, not just nursing) when someone chooses cattiness or immaturity over simple communication. You're right though, I will continue to work on letting it go. Thanks!
  13. pebblebeach

    Nurses Eating Their Young - A Twist

    I wanted to thank all experienced nurses out there (the ones who remember paper charting ) who truly support new grad RNs. What has truly surprised me is the bad behavior I've experienced from nurses younger than me. I'm in my 30s (second career nurse), and the examples I give below have all happened to me from 20-something nurses with a few years on the unit, who ended up as charge RN by default, lack of staffing on weekends, etc. This is how I've felt buoyed by the veteran nurses on my unit, and the opposite from a handful of younger "mean girl" nurses: Calmly bringing me to the side (note: not in front of the staff or patient, and not shouting or in a condescending tone) and pointing out a mistake I made with a pt. This is succinct and not a cat and mouse "do you know what you just did wrong in there?" ( <- This is literally how some parents speak to toddlers, fyi, not how colleagues should speak to each other!) It's also not a place of judgment, regardless of whether or not they are judging my mistake - i.e. "I'm not sure how you don't know this already," or "I thought this was pretty clear to you, but" It is something like: "Hey, Mary, Let's talk over here for a sec. In Mr Smith's room earlier, You didn't do the final MRN check against the patients chemo bag. I checked it, and it was fine, but we always do it three times - at delivery, outside the room, and inside the room before we initiate the med. It's super important because X." Note that there is no hand-holding, no congratulating me on "You did great on this, but ___" I'm not asking for a hug. I'm only asking for respect. Obviously an exception to this is if I'm about to do something immediately compromising to the patient's care, we're in a code, etc. Learning, for me, does not come from a place of fear or shame or guilt-tripping. When a teaching opportunity comes along, and it begins with shaming (doing it in front of others), eye-rolling, or fear ("if you did that and I wasn't in there, the patient could be in the ICU right now") - I will likely not remember the clinical lesson later. All I will remember is the way you made me feel, and I'll start to dread working with you, avoid asking you questions -- which therefore becomes a potential barrier to patient care if you're the only one around. If you're so concerned about the mistake I made and you want to protect the patient, wouldn't you want the new nurse to learn from the mistake without feeling like she's just been verbally attacked? I've had these girls yell at me in front of the patient, refuse to come into a room when I call to ask them for bedside help because "you won't learn anything if I hold your hand", gossip about me / other new grads within earshot, eyeroll when I ask a question and one would "quiz" me on what I just did wrong. If I didn't guess correctly, she said she would wait until I realized it so we could talk about it. How do I know what I don't know yet?! Initially these moments felt like a tidal wave and I took it personally, now, I only approach the nurses who speak to me with respect - and so far, that has been the older nurses. So, I just wanted to say thank you to those of you that know who you are. Does anyone else have "mean girls" on their unit, perhaps maybe born in the '90s....?! (not to generalize or anything) It took me so off-guard, feels very high school and they tend to stick together at work (much like high school) I finally told one of them I didn't appreciate her attitude (outside of the patient's room! calmly! what a concept!) and she told me "if I'm going to make it as a nurse I need to stop being so sensitive." LOL To quote Ellen, be kind to one another folks. (And yes, my use of "women" and "girls" here was an intentional wording choice)
  14. pebblebeach

    New Grad RN: Neuro ICU vs BMT residency

    Thanks, Kareegansee! I will definitely keep my options open, and plan to keep in touch with the Neuro ICU director (we're only a couple floors apart at the facility). I see you're in the SICU, is that where you started out as a nurse?
  15. pebblebeach

    New Grad in Onco/Heme/BMT Unit.

    I'm about to start a BMT residency and this post was super, super helpful, especially the patient education resources. Thank you! edit: oops, that was supposed to be a reply to buckeye nurse RN
  16. pebblebeach

    New Grad RN: Neuro ICU vs BMT residency

    Yes :) It was super helpful for me to type it all out on here, and I did end up going with the BMT offer. Thank you!
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