Decade1

We had a flag tab and a special place in the chart rack for charts with active orders. We had a Unit clerk, somebody trained in medical transcription or the like, who would transcribe the orders onto the paper MAR. The nurses were responsible for double checking the transcription and signing the order off. We also did a daily check to see if any orders got missed on Night Shift. The paper MAR was for three days and night shift. Nurses would also double check these for proper transcription after the unit clerk transcribed them before they went active for the day. For ancillary departments, there was usually some sort of clipboard system, and also general communication between actual human beings. There was no click click and everything gets done magically. You had to talk to humans. It was significantly better. I hate technology.

As a bedside nurse with 15 years of experience I am at the top of the pay scale. There is no more room for career growth for me financially. I got an accounting degree and am starting at the bottom in a career where I have the potential to make more income in the future. I continue working in nursing part time to supplement a beginner's salary, but as my accounting income grows I will leave the field altogether. This financial motivation is separate from my other concerns regarding lack of support, unsafe and poorly staffed shifts, and general dissatisfaction that prompted me to look into other fields. I do not think I am alone in taking this path.

I was a fulltime nurse for 14 years and in healthcare for 6 before that. I got an accounting degree and am learning a new job. It's challenging and interesting. I am really glad I left. Sionara!

Not legally binding. You could also argue the nurse was forced to sign the contract under duress in order to keep their job. Plus all they are stating is that they will "do everything they can". This does not mean they will prevent every fall. Bunch of ********.

The real problem is your employer shouldn't be asking people to keep their pay a secret. It's discriminatory and a violation of rights. 'Pay Secrecy' Policies At Work: Often Illegal, And Misunderstood : NPR

I just use isolation stethoscopes for everyone, if the hospital wanted a higher quality assessment they'd provide me with a higher quality stethoscope. I can get enough information with the crappy stethoscope. I'm not spending my own money for my now corporate employer anymore.

Also, it's pretty lame to take a union job if you're so anti-union. Move. Find another job. Isn't that what personal responsibility is about? Quit whining and change your own situation. You get zero sympathy on this one newbie. Gotta pay your dues. You don't seem to care about anyones else's situation, or how many years they've given to have that seniority. Why would you then ask for people's sympathy about you situation? You get none.

Quite frankly, inflammatory language, like "wipe the union filth" off is totally nonproductive. I WISH we had a union. Trust me, we get trampled on without it. Welcome to healthcare. If you think having/not having a union has much of a basis in you getting what you want it merely demonstrates your lack of experience, ignorance of history, and sense of entitlement. Good luck with that. I'm sure you enjoy working less than 40 hours a week and not being mandated to stay. Here's a phrase you might take heed of "Thank you, unions", because without them you'd have neither of those rights. And remember this: "Virtually ALL the benefits you have at work, whether you work in the public or private sector, all of the benefits and rights you enjoy everyday are there because unions fought hard and long for them against big business who did everything they could to prevent giving you your rights. Many union leaders and members even lost their lives for things we take for granted today. The right-wing attack on unions is nothing more than ignorance, lack of education, and propaganda."

SO TRUE!!! I'm sick of the healthcare system cutting costs on my back, literally. The job expectations are outrageous. Welcome to nursing. It's no better in acute care.

Get business like about it- ask for the time off, if they don't approve it deal with the repercussion and move on. I wouldn't think this is a fireable issue, but even so worst case scenario you get fired and get another job. Life goes on. Your employer does not own you. You are free to plan your life as you wish. The less emotional you get about it the better. Things will probably work out anyways. They often do, but not until we get all stressed about it.

This type of pricing, along with exorbitant mark-ups in hospitals, and many other medical billing practices are part of what contribute to bloated medical costs in this country. Other countries successfully research drugs and provide healthcare to all their citizens for less money than we do in the US. An overhaul of healthcare has to start with fixing the payment and billing structure that is outdated, not evidence based, gives providers, insurers and consumers no concept of the real value of a treatment and could bankrupt us if left unchecked. I've seen it in practice. Dr. So-and-so always wants a pre-auth for XYZ fancy new medication instead of the cheaper more commonly used version. Tell me he doesn't have some other "in-vested" interest in promoting this drug rep or that medical device's product. I'm not talking about being paid a fair amount for your work and training, but over bloated costs for every little thing create distortions in choosing good values.

I would LOVE to hear you, personally, tell some with AIDS or cancer who happened to contract toxoplasmosis this exact thing right to their face. You either a) don't fully understand the repercussions of your position or b) don't care about the repercussions of your position and, boy, is that heartless coming from a medical professional.

At this point in my career I'd rather not even get report. I can figure it out from the chart. If I can't you didn't chart well enough. We can A) go into the room and do an introduction or B) go over information in detail outside of the room. I don't need to look at things while you are there unless something is going on that you better show me. That's why I do an assessment. We cannot go over every detail in the room, with the patient, while they try to tell the history of every single thing we mention or require an in depth explanation of medical jargon that will never be relevant to their understanding of their condition and/or plan of care. And realistically I cannot do bedside report in 25 minutes for 4-5 patients with 3 or more nurses. It is logistically impossible. In a perfect world, bedside report is great. In the real world, there is not time for that. Nor is it warranted on 90% of situations. Some of our patients are on our unit for months. They do not want to hear all that at 7:15am every single day. It should be tailored to the situation, at the discretion of the nurse, who is professional, with a license and therefore should be capable of deciding how to provide care and inform their patients. Management in the halls to "check up" on us giving bedside report is insulting and demoralizing. Why aren't you working on filling the empty positions so we can adequately staff the hospital? Priorities are topsy turvy these days.

8 patients blows. Completely unrealistic that you could safely care for that many people. The only point it serves is to line the pocket of someone further up the food chain than you are. Find another job, quit, and tell them how crappy their job is and that they don't have any right to treat people ( you or their patients) like that.

Think of it this way- the more you put into your retirement at a younger age the more you'll have in your nest egg when you retire. Not to mention the tax savings you'll receive from lowering your income bracket. Also, you can withdraw without penalty in limited circumstances, particularly homeownership, or borrow from yourself if you end up having financial needs in the future. The maximum amount you can put into a 401k/403b is around 17,000 or about $1500 a month. You could do that and still have over a grand a month to have fun on. Wish someone had explained this to me right out of school.

Here's an idea.... when you really have no idea what you're talking about, don't say anything. OP keep your nose clean, work hard, and prove you're worthy. You'll get your license. Depending on where you live you have to potentially have to jump through hoops, and no matter where, you'll have to explain yourself, but a criminal record IS NOT and SHOULD NOT be a life sentence. Don't beat yourself up too much, but STAY OUT OF TROUBLE.

"I appreciate your offer, however, my current financial situation does not permit me to spend time unpaid at my place of employment. I wish you luck in finding a candidate who can meet your requirements." AND DO NOT TAKE THIS JOB NO MATTER WHAT! They will chew you up.

Wow, this one has lot's of comments. I didn't read them all so it's likely I'm repeating someone, but here's what I've noticed. The instructor has a group of students, drops 2 or 3 off per floor. Leaves, maybe checks in, maybe doesn't. Then you all go have your post conference. I enjoy having students so I don't mind, but really it is another task to complete. When I was in nursing school (I went to the University of Pittsburgh which is top rated) the instructor stayed with a group of 6 or 8 of us the entire time, had access to pyxis to give meds and was always present during med passes and helped us with out assessments, reading charts, etc. You are paying thousands of dollars to a school who is responsible for your education. I am willing to share knowledge, have a student follow me, perform some basic tasks, etc. But your experience is not my responsibility. And there are truly some days (lack of sleep, stressed out, busy assignment) when I don't have the will to teach you anything. I do it, but I do feel it's a way to shift costs and that always seems to fall hardest on the low man on totem poll. Which will be you if you intend to be a bedside nurse.

What pertinent private information could you have possibly ascertained from looking at a chart for about 1 minute? You could have easily mistakenly opened this chart when looking for another persons. Not fun being a scapegoat. I too would be livid, get an attorney, and sue them for wrongful termination.

Something else I've learned along the way is they're peeved if you call and even more peeved if you don't call. I just call. I don't really care if the on call doc gives me attitude. Chances are I wore my big girl pants that day, and if not I just go have a nice little cry in the bathroom and a large glass of wine when I get home. Honestly, when I'm in doubt-I call. They're being paid (handsomely) to be there to take your calls. Also, as a little revenge, if you tend to be a douche about me calling you it's amazing what I can make seem urgent at 0300. I tend to call those people just a little more.

I remember a place and time when situations like this were treated as a learning experience and did not need to involve a disciplinary action. Sometimes the exact right thing to do so far as protocol etc. isn't clear or there's differing opinions. [Contrary to the idea that everything in medicine is reducible to an algorithm.] If someone, especially in a position of authority, has a differing idea of to interpret or implement care the issue could be discussed and taken as information about how to proceed correctly next time. I have never been "written up" (God forbid I make a grammar error) in over a decade of nursing. I wonder how long I'll continue to avoid this as people, rather than supporting one another, seem to revel in flogging each other and making an example of their errors. It's in part a trend of society (think mean girls); let's expose someone's flaws and make them weak so we look better. Also, it's just the easy, lazy thing for management. It requires less of their time than actual education and staff engagement. Now that I've stepped off the soapbox: you should have let the doctor know. It sounds like you weren't negligent. You made sure to involve the resources needed to care for the patient, but keeping the team informed is part of your responsibility. Did it require a write-up for you to understand that? Unlikely; it could have been presented in another fashion. Should you fight it? It depends. What are the consequences? Does it matter if your opinion is different from your bosses? If the write-up could interfere with your career plans I would consider a conversation, in a professional way, explaining why you think this is excessive. Otherwise, I'd let it go. IMO a place that needs to resort to frequent write-ups to address issues in patient care has much deeper issues. If you are firing/disciplining your staff with regularity you need to look at your hiring processes, training methods, and management style more closely.

I believe the moderator edited or deleted some posts so we aren't getting the full picture of the assault on the consultant >

I did not find the question of the OP offensive, nor do I find it offensive that he would like comments from nurses to add to his perspective. I do, however, understand why nurses have a distaste for consultants in general. Let me tell you about some of my experience with healthcare consultants, it may bring some understanding of the gut reaction of contempt the OP endured. My hospital employs Studer Group. I hate their whole "scripting care" approach. It sounds fake and people see right though it. I believe my patients appreciate my genuine care and concern over any recitation of pre-scripted flowery language. Also, the care I provide is complex, I am not working at a call center. I can figure out how to talk to people on my own (thank you very much), so for all the $ the hospital has paid, forget it, in one ear and out the other. Find a robot if you want a script recited. Studer's focus, as far as it impacts my bedside care, is on touting things like patient rounding and bedside report. Both of these are great things and I can see how they contribute to better patient care. However, I am asked to perform bedside report on 5 patients during the 30 minutes our shifts overlap and following the shift huddle which automatically reduces that 30 minutes to 20 or 25. (We get a lot of pressure to get out on time and reduce incidental overtime). Giving a thorough nurse report (which includes medical jargon and explanation of working differential diagnosis that may not be appropriate to report to the patient yet) has been replaced by a 5 minute smiley, social, introduction time. Not that this doesn't have value, it's just that it's probably more important to take the time to I tell the next nurse the details of why the patients here, their condition and what's been done, etc. Patient's need to be informed of their plan of care but ensuring that this happens at shift change is an inconvenient time for this. It goes more smoothly if you've had time to fill the patient in on the POC and educate them on their condition before shift change, but there isn't always time for this during the shift. The hospital, which is experiencing financial struggles just short of a crisis, also thought spending money on tablets for use during rounding was an appropriate allocation of funds. (Mind boggling, I know). I think a better solution to making sure patient's are aware of the POC would be to make sure their nurse is available during the shift for explanation and education which would require adequate staffing. (More time and money should be allocated to patient education in general, but as this is poorly reimbursed it often gets left to the wayside, a topic for another thread.) Also, the whole "hourly rounding" and "safety rounds" thing is just common sense and something we called "checking on your patients" before a consultant group gave it a fancy name. It's part of good nursing care. This of course is something that adequate staffing permits nurses to have the time to do. And while we're on the topic of nurse time I have another example in mind. I have been a nurse for over 10 years, have done travel nursing and seen many different hospital systems. When I started at my current hospital their transport team did not bring a wheelchair or assist patients (even completely mobile ones) into it. I was shocked. You expect a nurse or tech to spend time tracking down wheelchairs to get patients to tests? Yup. I did a few patient safety reports for delay of care due to my frustration with this process (you could never find one, in part due to hoarding since you had to track them down). Not sure if anyone listened/cared, but fast forward 2 years later our shiny new "patient experience consultant" implemented a process where the transporters bring a wheelchair and are being trained to assist patients into it. It's unfortunate that they have to pay a consultant to solve a process issue that was identified and could have been addressed by listening to a nurse working in a direct care position. Which brings my commentary full circle here; I think many nurses frustration with consultants/management/leadership is that they are paid, sometimes better than the direct care staff, to make decisions and implement processes that impact their workflow and practice while simultaneously disregarding suggestions and input from them. Many issues consultants identify could be solved by common sense and adequate staffing, thorough training, and employee engagement. When institutions invest in consultants while failing to invest in their employees the institution, the staff, and ultimately the patients lose. Not that consultants are worthless, organizations just need keep their focus on direct care staff as well. I'm sure what the OP is experiencing is a reflection of the nurse perception that the nurse doesn't have the ability to recognize what they need to efficiently do their job and therefore a shiny new consultant must be retained to figure this problem out. It's part of a larger problem where nurses feel disrespected and undervalued by hospitals while providing services critical to the continued function of said hospital. The cuts the OP is wondering about are often part of the problem- we are tired of being the constant source of a place to make cuts in general. We work hard and wish we were valued and our opinion and input respected (and I mean, like, for real, not just lip service). Bedside nurses have knowledge of patient needs that no administrator, consultant, or even physician can fully appreciate, yet our input is often ignored, or perfunctorily requested and then promptly disregarded. The emotions on this thread are part of a larger issue in nursing that is not new. Nurses need a voice, to be part of the process. But we have been let down and left out of many of the changes hospitals choose to make. We need safe and adequate staffing levels, time for our breaks (not just a threat of take lunch or be written up), and to be empowered to advocate for our patients' needs. We also need fair pay and nurse retention. The business model of healthcare does not value nurses, it just views them as a cost to be "cut".