JimmyDurham9

Career is just one aspect of a person, and while it possesses a certain significance in choosing a person with whom to spend one's life, in the grand scheme the nature of your inquiry is centered on shallowness. At the end of the day, attraction is relative to person, circumstance, time, and God only knows what else. I'm not a woman so this may not be an opinion the OP is exactly looking for, but when it comes to relationships it all boils down to a basic concept: are they a good person or not? I'm most irritated by the fact most people buy into the illusion that gender and professional competence in nursing (and other professions) are so tightly linked. Reading comments that support men in nursing because they are super helpful when it comes to the physical aspects of the profession irritates me. That is also the case when people say things like "I can see men in maternity or post partum maybe being an issue" and "the guys I went to nursing school with even did well in maternity clinicals; if anything they were more embarrassed than anything else." Comments like that imply that men are sex crazed beasts incapable of controlling their libidinous impulses even as a human infant is making its way out of a lady parts. True professionals focus on the tasks at hand thus rendering any commentary on gender, sex, and dating as they relate to nursing identity irrelevant

Udemy and Coursera are two sites that have awesome classes that are also free.

I'd like to clarify if it is against the rules to mention resources you consider useful by name. If there's something that has helped you out and you have vetted as a resource that isn't a waste of time or a scam, then that would be amazingly helpful for nurse-writers starting out. I don't see it any different than another blogger here name dropping Wordpress as their choice of blogging software. These types of resources are tools in the tool box of getting started. Just so long as our innovators don't directly profit from referring people to the resources or let some conflict of interest bias the recommendation, it doesn't seem like it would do any harm. I only say this because I have wasted countless hours reading the near infinite number of "tools" and "resources" and researching sites dedicated to freelancers, and come away only knowing that there are near infinite number of people looking to take advantage of anyone they can. These freelancer sites- most of them are scams. They want membership fees, and then you compete with millions of other freelance writers for jobs that demand outrageous production levels for peanuts. Or the employer wants someone with a doctorate in some obscure field to write a book length technical manual a week for $50 a month. It's bananas.

Yes, I work in LTC, and am familiar with survey inspections. And yes, I have been in some of the most God forsaken situations having to juggle critically ill patients, pass meds, and sometimes even get caught up in a tsunami of a code, and still be expected to have meds administered within a 2 hour window. I read what you're sending here. I merely shared what I see as a similar predicament that I encountered in another specialty, since I am fortunate enough to work in a LTC facility that actually places safe care as priority one. It all comes back to documentation though. Department of Health pores through charts and records and staffing schedules, etc. If the "med error" is a matter of a facility's inability or refusal to staff adequately, then they deserve the tag. That tag is a sign to the administration that that things gotta change or they need to reevaluate their ability to operate as a LTC facility. Too many patients or medications is not an excuse. The facility has a duty to its residents and staff to provide the means to safely carry out care- be that by hiring more help or making available to staff additional training or continuing education on topics of delegation, time management, etc. The sad fact is that too many LTC facility administrations are blind to what these surveys actually are, and use them as regular occasions to come down on hard working staff instead of carefully examining the way the facility runs.

I can see where you're coming from, but like it was said before, you may be underestimating the value of critical thinking skills. I may be in the minority, but I think a nurse with strong critical thinking skills can easily overcome a perceived lack of clinical skills, so long as they don't let anxiety get the best of them. With those critical thinking skills, you can figure your way out, and in a safer manner than a nurse who is purely rote clinical skill programmed. TheRNJedi is absolutely right, ambulatory care is an incredibly unique specialty. I LOVE ambulatory care settings because they offer me the nice balance of somewhat stable, but also anything could happen at anytime situation. BUT that depends on your setting. If you work in a call center for an insurance company doing nurse advice line work or primarily function to triage phone calls for a clinic or hospital, then yeah, I could see your boredom. Sidenote- telemedicine is making strides - those telephone triage skills you're honing may come in handy in the future. Urgent Care and Minute Clinic settings are good places to find a nice balance that isn't too overwhelming like acute care or even an ER might provoke. You get your primary care type cases, then you get someone who has a gnarly laceration, then someone comes in with chest pains and nausea x 3 days, or someone unexpectedly drops in the waiting room. It's a grab bag of interesting variety. I love working urgent care and primary care. You might also want to consider occupational health nursing. Many corporations/factories have clinics for their employees and sometimes even the employees' family members. Depending on the industry, you could see anything from heart attacks, sinus infections, to amputations. I also loved occupational health. I found my occ health experience to be far more autonomous than any other nursing position I've ever had. I tend to work well independently and know my limits and how to follow protocols, so I had no problem assessing and stabilizing potential heart attacks and controlling bleeding from amputated fingers until the patients could be transferred to higher acuity care.

Does that mean that the meds just didn't get passed? Or if you didn't meet the 2 hour time frame that you were penalized? When I worked critical care, there were periods of consistently being short staffed and I have to tell you, my eMAR flagged me and my co workers constantly for being even 5 mins early or late, but we also had a spot to document the reason and every time I documented "Workload/Staffing issue" and I filed an incident report. Every time.

Those of you who discovered LTC was not a fit for you and left it, bravo. Bluntly speaking, you have no business working the specialty if you had such a powerfully negative response to it. Others still working in LTC and sharing similar adverse responses to your work, it might be time to consider another specialty. I disagree that the standards of care are jokes. They are the ideal to strive to; they are certainly how I'd like to be treated were I the patient. And not following the standards and arbitrarily deciding what meds and BP checks are unnecessary and withholding or delaying them are actions that put otherwise good nurses at liability for negligence and could be argued as practicing outside their scope. My greatest annoyance is with LTC facilities that shape up for survey, then return to their typical dysfunction. Survey should not be a matter for fear and anxiety if the staff and facilities do their jobs right. That means documenting, advocating for their patients, promoting resident dignity and autonomy, speaking up and making it known to any and everyone in the administration if there is an issue you see and offer a solution - go so far as to frame it as a patient safety issue, few administrators can argue with a nurse who opens with "This is a matter of patient safety; let's come up with a solution." Some LTC facilities suffer from poor leadership and toxic staff which contributes to high turn over and over worked aids and nurses. But in my experience a lot of the headaches we nurses complain about stem from poor time management, poor prioritization, not delegating or not understanding delegation thoroughly, miscommunication stemming from communication skills that aren't as strong as they could or should be, lack of assertiveness, and/or a lack of dedication to advocating the patient's best interest in every sense of the meaning. It's easier to complain than put forth effort to speak up and try to affect a change that might include reporting the facility to CMS And I don't mean any of this to be judgemental or offensive to anyone - we're all human and I don't think there's one of us that can't hang their head in shame thinking about at least one situation where we could have done more to improve our situations and our patients' situations more, but took the easy path of least resistance instead.

Thank you for your comment! I LOVE that you would not commit the patient oversights I have seen in my experience! I agree that experience plays a large part in it as I have seen RNs commit similar and sometimes worse errors and not blink twice; only reacting when someone else intervened, and only then to be offended. In hindsight, I realize that my comment may have been a bit adversarial from a RN/LPN perspective, which I didn't intend. LPNs have their place and value in health care; I just believe given the worsening health of average patients in clinic settings, it's becoming imperative for urgent care and primary care clinics to stop excluding RNs. Patients will benefit from it or suffer because of resistance.

That's been my experience too. The documentation. I'm dealing with cajoling from management to administer more vaccines an hour even though I think our nurses are going an appropriate amount of time. They are being encouraged to use the patient's consent for as the documentation instead of using EMR and documenting site, vaccine lot and expiration, etc and not waste time assessing temps, etc.

Hard work and taxing some days. Fulfilling always despite the taxing days if you're lucky and truly want to be a nurse.

Primary care models are in a state of change currently. Unfortunately, the norm tends to be the idea "least number of staff that maintains the bare minimum of quality care." If a clinic sees approximately 50 patients a day on average, it's not unreasonable to expect that there should be one provider, one clinical care person, a receptionist, and possibly a cross trained individual who can help with labs, vitals and receptionist duties. I'm an advocate for at least one RN operating as a clinic manager/nursing supervisor present if not whenever the doors are open, then at least 50-70% of the time in addition to either a medical assistant/lab tech and/or LPN. I'd add MAs and/or LPNs according to patient volume. A RN costs more, but they are well worth it and what they bring in terms of training and education reduces costs, increases clinic efficiency, decreases patient wait time, increases daily volume, and increases patient care quality and safety. The current models where an urgent care employees only LPNs or MAs is clunky and outdated given that urgent/primary care patients are sicker than they used to be since many have several co morbidities and/or don't use urgent care facilities appropriately(i.e. Going to an urgent care for MI or stroke symptoms instead of the ER). The reality is that urgent care clinics are gonna get high acuity patients who's symptoms require fast recognition and appropriate intervention. MAs lack the assessment skills and scope of practice to legally and safely provide this care. LPNs could arguably be more or less adequate if they have protocols in place and those protocols are enforced. I've worked in an urgent care with LPNs and MAs and patients with symptoms that indicated potential life threatening issues went unreported or properly addressed until the provider happened to make it around to them. We're talking O2 sats of 80%, chest pain with SOB and N/V, and people with head injuries and altered LOCs. One patient presented with a laceration actively bleeding and the receptionist had him sit out in the waiting room in clear view of the LPNs and MAs who would step to call patients for their turn. No one stopped and went "Wait a minute that guy has a saturated towel wrapped around his arm.

I'm curious about what an appropriate average amount of time to safely administer a flu vaccine is while still making the patient feel unrushed. Certainly there are exceptions if the patient has questions or the nurse assesses some patient need that requires further exploration, but what about a straight forward vaccine administration?

Thank you for your advice and words of encouragement! I've found I do best with school age kids because I find it easy to be silly and banter with them. I tended to take more of an authoritative role with adolescents, particularly when I would have to literally chase some of them around the exam room to administered a vaccine or get a strep swab. I've also had adults behave like that, but at least then I have the option to say " You know what? We're not doing this. You obviously don't want this treatment, and you have every right to refuse." Kids are different because whether they like it or not, if the parent says go, then we have to do it. I don't have a problem with powering through with a screaming kid because I know what we're doing is in their best interest, but I'd like to mitigate the experience for them.

I had to read this multiple times because I couldn't believe my eyes. There are sentences in this post that are absolutely out of line and disrespectful. You should be ashamed of yourself for this: "Do we want someone taking care of us who is forgetful and can't do physical work as much as younger nurses?" There is absolutely no way this could be construed as anything, but age-based discrimination and ignorant stereotyping. Then I read through the other comments following it that were dividing up; each side trying to prove who works harder or has it worse. That right there is what is wrong with nursing. Nurses fighting and quibbling with each other instead of coming together. Your staffing levels aren't adequate? You see a coworker who lacks the skills to provide competent care to patients? Speak up and do something! Nursing Practice Acts in addition to ANA Scope and Standards for Nursing Practice, Principles for Nursing Practice, and Code of Ethics for Nurses ALL state that it is the duty of the professional nurse to speak up and take action in the presence of a patient safety issue. As nurses we are accountable for the care given. Fair or not, it's the hand we were dealt when we signed on to the career. Let me give some specific examples from my state: Mississippi BON Administrative Code describes unprofessional conduct (grounds for license revocation) as: Assuming duties and responsibilities in the practice of nursing when competency has not been established or maintained Inappropriately delegating tasks to individuals licensed or unlicensed when the person lacks educational preparedness, experience, credentials, competence or physical or emotional ability to complete the task. Failure to adequately supervise, manage or train persons to whom nursing functions are delegated or assigned Failing to immediately report facts known regarding a nurse who fails to render care in accordance with current standards of practice or illegal practice of any licensed nurse Failure to safeguard the patient's rights and dignity Intentionally or negligently causing or allowing others to physically, sexually, emotionally or verbally abuse a patient Abandoning patients Failure to appropriately act in safeguarding the patient from incompetent healthcare practices or practitioners And those are just a few of the examples classified as unprofessional conduct. Additionally, it lists among the responsibilities of the RN: Directing, supervising and evaluating nursing practice; applying nursing knowledge, administrative techniques and teaching principles toward the ultimate goal, excellence in patient care and promotion of good health practices Recognizing the abilities and potentialities of all nursing personnel and providing supervision, management and training to each individual in the attainment of optimum performance Obtaining instruction and supervision as necessary when implementing nursing techniques or practices For anyone who doesn't believe issues like staffing and working conditions are being brought up please look here And here, check out resources on professional standards while you're at it. Since someone brought up the issue of lateral violence, and some of our posts in the thread seem to illustrate that bullying and incivility is a real problem in the profession, please, take a look at this public call for comment. ANA is seeking feedback on the proposed position statement on Workplace Violence, Bullying, and Incivility. It's a chance to speak and do something. Nursing doesn't have to be the nightmare it is to some of us. It can be changed for the better; it just takes nurses coming together in public, the community, and most especially in the healthcare organizations, and saying poor working conditions, inadequate staffing, and poor training and support are patient safety issues that threaten the public the Boards of Nursing and government agencies claim they exist to protect, and it won't be tolerated any longer. Anyone who hasn't already, needs to get familiar with their state's nursing practice acts and administrative code as well as the professional standards developed and published by professional organizations like ANA, AORN, AWHONN, etc. Use the very codes and guidelines against the healthcare organizations that the nursing boards and courts of law would use against anyone of us for actual or perceived professional failings. Knowledge is power. Experienced nurses- love you guys. You bring skill and wisdom to the table that shouldn't be underestimated or dismissed. Anyone who refuses to see your value and accept help you're generous enough to offer is doing a disservice to their patients. Let's be honest here, the nursing education in this country varies in quality. When you take into account the fact that more Americans are living longer and with more health issues that challenge all nurses, then it illustrates why it's so important to do what's necessary to help out and fill in the gaps in the experience of new nurses. New Nurses and upcoming nurses-Love you guys too. You're coming into a profession with fresh eyes and the opportunity to innovate it and benefit from the knowledge and experience of men and women who have much to offer no matter their age. To disqualify their contribution because of age or the idea that "they need to retire" says volumes about the people who hold those beliefs, and it's not pretty. In fact, it's just a poor as grouping new nurses together as all disillusioned and incompetent. You came to nursing for money? Cool! We all gotta eat. You come to nursing because it's your calling? That's great! Too many people don't get to do that. Regardless of those differences our goal is the same: provide the best care possible.

I'm starting a new job on pediatric floor, and the only peds experience I have is in primary care. I'm nervous as all get out, and reading up pediatric nursing, which is only making me more nervous. What I'm most curious about is dealing with pediatric patients during the course of procedures and treatments. My books all simply say "Soothe child" or "Reason with child" "Reassure child" or "Explain procedure to child." Now, I understand you need to communicate with them appropriate to their age and development, but from my primary care experience, there was NO reasoning with scared children, no soothing that seemed to be effective 100% of the time, and explaining the procedure was frowned upon by the management because it took too much time, and sometimes made the fear worse. I have a strict code of not lying to any patient if they ask me if something is going to hurt or medication is gonna taste bad because these people need to trust that I'm being honest with them. When kids asked me if medicine was gonna taste bad, I always said "It won't taste good, but I have some juice you can drink after." and if they asked if something would hurt, I said "Just a little bit, but it won't hurt long. You may not notice, because you're gonna be helping me out and talking to me." I''m flummoxed to report that those approaches were also frowned upon by management and coworkers. Any practical advice on helping to make a kid feel less anxiety and increase cooperation while also remaining productive in terms of time management? I mean, "soothe child" is nice and all, but what does that mean in that context?