Elaken

I don’t buy this either. If your system was this corrupt you would have seen it a long time before on other issues. I work at multiple hospitals - on Covid units - and the only patients not needing oxygen are there for other issues that would have hospitalized them. Also, once you start something like Remdesivir you finish the course even if no longer needing oxygen. All that being said, if you are here to “inform the public,” have I missed the part where you named the hospital? Because if this is happening it is not widespread and thus it does nothing if we don’t know where it is happening.

Sadly I have never worked in a union. But usually it just guarantees a lot more worker rights because the union has so much more power as compared to a solitary employee. It might be worth talking to the union and getting an idea of what they do and don’t allow from the companies. And what they think of an offer like that for the future. Not to say unions are perfect but honestly I think they are better than what most states have now.

Never ever do this. First of all it is most likely illegal because it probably counts as working off the clock. Secondly you are accessing patient’s information off the clock and that would be a HIPAA violation. What if something changes last minute and they don’t go to you. It is one thing to have been looking while on the clock and they are provisionally assigned to you. Quite different to be in a chart 20 minutes before you work for a patient you never get. And thirdly do not give the company free time. Then they turn a blind eye and say our staffing is appropriate because everyone got out on time.

I am just going to say this - what they wrote down is legally the reality of working in right to work states. Any job you don’t have a contract for (which contracts aren’t common) can completely change your job, your pay, and your benefits. What they can’t do is do it retroactively. And then you decide if worth working there under the new conditions. It sucks but this is what happens when unions aren’t a thing.

At my work we tend to call the pull-ups briefs and the ones that have the sticky tabs diapers. Otherwise you have to use a lot more words to ask what you need. I am not often talking to the patient about them since if they are in the “diapers” it is because they aren’t able to get out of bed easily. So I just say “I am going to check if you are clean.” And sometimes you have to say diaper because a patient just doesn’t understand “brief.”

Maybe look for a magnet hospital? Those require a certain level of nurse satisfaction so I would be surprised if ratios were ever that high. I work for a non-profit hospital network in AZ. I have been there 6 years on day shift. I have had 6 pts for all of 30 mins because a nurse was a no show. I have 5 patients maybe 10-20% of the time. The rest is 4 patients. Between doctors, tests, change in patient status, some days I don’t finish morning meds until after 10. If I had 7 patients I probably wouldn’t get done until time noon! With 7 patients I would be calling consults hours late. Forget the time spent calling lab to figure out why my patient hasn’t been drawn or my results aren’t in. Or spending 40 minutes trying to get a correct home med list. Find a good hospital system even if it means moving. There are many that are still decent. The system failed you. You didn’t fail. The problem is nurses in those situations get so use to it they think it is normal.

As people have pointed out is too varied to know. It is suspect anyone who is always busy (some nurses honestly would be hectic if they had even just one patient) or always having an easy day (probably a lot more they could be doing to improve patient care) but in general nurses probably lean one way or another. I don’t chitchat until I am all caught up. I process information really fast so I can usually chart and keep on top of things quicker than the average person. I am not really into learning a patient’s life story. So although I am polite I don’t go out of my way to have non relevant conversations with them. I rarely drown at work - it might be a mad dash all day but I exclusively only get out late if it is due to waiting to give report. I have a decent amount of chill days. But on average my day is steady with me being fortunate enough to have the time to ferret out information or make a lot of calls or fix errors. Things that nurses who are “always so busy” wouldn’t have time to do.

I am float pool for my hospital network. Our new employees get 2 days and many of them are floating to 5 different hospitals that are all a little different. It is quick but, honestly, it is really doable. I have preceptored a lot of staff and very few did I have any concerns about. If you are a strong nurse and good with technology most can hit the ground running. Just have to be willing to ask questions. Since she had 6 days I don’t think it is egregious for her to not take all the patients on day two though. Clearly she should already know patient care so really the preceptor and her should split the load so they have time to explain charting and hospital specific things. I totally can see the manager deciding to get rid of her because pregnant especially if a state that has some maternity leave. I just don’t know why the preceptor would have any ulterior motives.

I agree KalipsoRed. I am so tired of this “you need to make a connection” attitude. Why? Why is this my job? I am there to medicate a patient. Clean them up. Assess them and catch if things are going bad. Advocate for them. Encourage them to do what they need to get better. Why am I *also* required to do all this emotional labor on top of it? It is already hard enough to keep upbeat when you answer the patient’s 12th call light for a ridiculous request. I am always polite and listen to patients but I shouldn’t have to try and connect with them. I know being in a hospital is rough and I give people tons of leeway on their behavior for that but I think it is crazy to expect us to also carry their emotional burdens. We don’t ask that of anyone else in the hospital. The examples were of people being upset that nurses didn’t cater to their emotional requirements. Maybe the first nurse didn’t even know you had kids. Or that you worked. Or anything else. Attitude does have a lot to with how you handle pain. Maybe saying “good will come of this” wasn’t the best thought but nothing wrong with encouraging a patient to do their best to stay positive and try to reframe the issue. You said you need words of comfort and she thought that was what she was doing. Maybe nurses wouldn’t misstep if patients weren’t trying to keep using us as their support blanket. There is a difference between needing some reassurance from a nurse that things are okay and taking advantage of someone who can’t easily extricate themselves from the conversation. I don’t get complaints from patients and many give their sincere thanks. But I do my best to limit the non-care related conversations. And that is how it should be, IMO.

I am mostly echoing what others have said here but I definitely think needing to explain your reasoning can be pretty exhausting to the other nurses. If I tell you a charting was done incorrectly, for example, odds are I already know what made you do it the way you did. Or that I don’t even need to know. Finding out where you erred isn’t going to make a difference. Now if we are talking about an error in critical thinking that might be different. You need to be selective on when you explain your thought process. Or, if the RN is the explaining to you why you did it wrong that should give you enough to figure it out on your own and not put the burden on them. I love being able to orient new employees but if I constantly hear how they already know something or constant justifications I stop trying to teach. Also, sometimes you just need to go along with things. When I was a new grad 4 years ago my second preceptor was very particular about charting. She wanted it done a specific way. It was not wrong per se but it wasn’t something I would normally do. So I just did it while with her knowing my practice would be different on my own. That is not brown nosing that is just deciding to not make something a struggle that didn’t need to be. Finally, my mom is a nurse with a big abrasive personality. People LOVE her. A crazy amount. But some people really don’t. And some people who love her didn’t like her for months. She gets some amazing effusive compliments from patients. She also gets fired from patients on occasion. I tamp down my personality. I get compliments but not like hers. I have also never been fired from a patient. And although my personality doesn’t endear me to people the same way I know most people think I am nice and helpful and my behavior won’t ever get in the way of performance reviews.

If a patient is at the toilet and I am just making sure they are clean I use toilet paper. If they are excessively dirty, on bedpan, or incontinent we use wash clothes with foam soap 99% of the time. Due to too many clogged toilets we have to specially request baby wipes and honestly I think washcloths work better. Unless their skin is exceptionally delicate. Anyone incontinent always had some cream put on after either barrier cream or criticaid. Everyone else if they seem to need it.

The problem I have with this is it is really hard to say something should be known or is inconsequential. We have a doctor who will think you are the dumbest nurse alive if you have high BP and don’t stop IV fluids. This doc also takes over an hour to respond to being paged. Yet we get told that we can’t stop IV fluids without a doctor’s orders because it is out of our scope of practice. So yes she thinks we are idiots if asking to stop fluid but technically we have to. Or the cardiologist who gets annoyed when calling to inform about some burst of rhythm that I *know* isn’t a big deal but I am not allowed to make that call. The patient didn’t have it before so I can’t just say doctors aware. Yes we all know it is about CYA but that is the game we play. Or this doctor is dramatic about everything so I have to know that he needs to know about X but that doctor doesn’t care. And if I forget the second doctor thinks I am bothering him with inane issues. Or normally I mention the slightly elevated but not at all critical creatinine to a doctor when I see them because they do not want to be called about something that simple but oops this doctor doesn’t round until 6 pm because he tries and avoids families so now he is upset I didn’t call him with that label value. Or the fact that nurses learn *so* much on the job and it is unfair to expect a 2 year nurse to know X and Z are pointless updates but by year 5 she will know it. I don’t think doctors realize how much we have to just pick up as we go and thus every nurse is at a different level of knowledge and ultimately when we don’t know it is the provider who has to be notified. Or how much doctor’s have their idiosyncrasies and we are suppose to memorize them and adjust accordingly. The fact that I am even suppose to know this doctor likes a text, this likes a message through this system, this one likes a page. Or this one you need to give X time to call back before trying again. But this one you need to probably page 3 times so don’t wait too long between each or you won’t get a response for over an hour. Yes. Doctors get lots of calls. And sometimes they seem unnecessary. But ultimately RNs are doing the best and most try and mitigate the calls but doctors don’t really help with that.

My facilities really struggle with this. Patient’s can order whenever they want. Which means someone might be eating breakfast at 0700 and another at 0930. And they might have 20 carbs on that tray or 65. Same with lunch/dinner so it gets way too hard to try and coordinate that because patient’s *always* forget to let us know when they order. Usually dietary will ask if they have been checked before delivering the tray but not always. And then you don’t always have time to run and check them. Usually everyone is checked with vitals in the morning. And then we roughly try and do lunch and dinner when they order. But it depends on the PCT. So, yes, we are correcting off of BG that can be 1-2 hrs later if bundled with meal dose. But honestly I don’t know anyone who has had a hypoglycemic event from that even if not best practice. A lot of our doctors have just started doing basal + correction and not doing a meal dose. That is so much easier. If they keep running high than they put in a meal dose. We did stop correcting at 0300 though and just do testing. Pharmacy found it was interfering with the decisions on how to change lantus and also sometimes too close to morning dose.

As someone above said when interviewing get specific on what a unit takes and ratios. At my hospital every unit takes insulin drips (I know at some this is considered ICU because of the hourly checks but not us nor does it cause a decrease in your patient load). Essentially our med/surg and tele only really differ by drips and procedures. Nitro/amio/diltz drips all have to be tele. But have to call doctor to get an order for rate adjustments. Obvs CABG, Tavrs, caths, pacemakers etc all go on tele. Any unit can get continuous bipap, cpap, trachs, etc. but vents are only in ICU. Every unit can remote monitor a patient and there are monitor techs watching every monitored patient including the tele patients. A few units have monitors so you can look at the rhythms in real time. In general we do 1:4 in days. Occasionally 1:5. I have never gone 1:6. Tele is less likely to go up to 5 than the other units. I literally do not know how some of you do your jobs with the patient numbers and acuities that you all get. All our hospitals are Magnet so I think that is one reason we don’t get overloaded with patients.

My state recently made it a law that you get one hour sick time for every 30 you work (up to 40 a year - company can do more if they want) and you can’t be penalized for taking it. So now even PRN staff get sick time. Which means as a full time staff I can take roughly 3 days off. But if I call out a couple shifts in a row that wipes it out. So I would rather use PTO and get a “point” against me since it is only one point if the days are consecutive. But at two points we get a verbal warning. I think that is too limiting. I rarely get sick and I don’t need more time but I still think it is draconian. Ultimately we are all going to be working when sick and contagious because even a cold is infectious for weeks, potentially. But we should be able to call out for the worst of it.