Ginger35

Wow! I really appreciate the responses. I think EPIC is better than other electronic charting software (to remain nameless) - just even getting started has proved challenging at least for me anyway. I know that this playground has been meantioned before in class. I think we have to actually go to the hospital to use it. Don't think I can access that from home. I will follow-up on what has been suggested on here. Anything to make this and patient care go a bit easier.

Hi, Well to make a long story short. I have been a nurse for about 18 years-ish or so. Got my start in acute care on a cardiac telemetry unit as a first job. Then started working ER and Trauma a few years. Then, eventually went into management positions of various sorts - which even though encouraged to pursue management - it just didn't work out. So - after being away from the bedside for 5 years-ish or so. And completely took a break from healthcare and work alltogether for about a year. I have decided to go back to the bedside on an Open Heart Step Down Unit. Just had open house orientation this week and will be taking tele course soon. Then ACLS and on the floor for the hands on orientation. I know that the hands on clinical will come with a little bit of time. However - the computer system called EPIC.....well - that is a different story! And I am someone that is well acquainted with computers..........Just not this software program. We went through some of the EPIC orientation this week, but still feel lost. Even, just getting started assigning patients to yourself seems to be a bit of a task. If I can get past this, well - then I think the rest will come a bit easier. This appears to be a better program than the facility I came from had - but geez! Does anyone have any recommendations for someone like me coming back to the bedside and experiencing EPIC for the first time? I really would like to self study at home. (of course work with IS/IT/Nurse informatist too) Any web sites out there for tutorials? I know that the software can be somewhat hospital specific - but I would like to think the basics are fairly similar. A bit overwhelmed..... Ginger

If you have no restrictions by your physician - then - no restrictions means no restrictions. Of course, even with a healthy spine - you want to prevent injury. I too have had previous spine surgery and employed in different positions with different employers. They can not refuse to hire you just because of a history of spine surgery - unless - you fail the physical or have restrictions from your MD. Good luck! Ginger

Wow - I can see that people are commenting on seemingly both ends of the spectrum. Yes - the k was critically low and yes you were doing what you can to intervene with what you know. And yes, the physician did have merit to her rant. However, I would like to *think* that since this physician has "been there done that" with replacing potassium - that there should be critical thinking on both sides. What I mean to say is that the MD is culpable too and should have addressed any potential noncompliance issues such as burning at the IV site on the front end with you. This is a very common complaint with many patients having this done. Some patients tolerate it more that others. Some patients need their IV diluted or have the warm packs. Then there are others that need a little lido added for IV administration. Then there are some MDs that will order on the front end to give IV then if patient can not tolerate to do......... I have seen that too. So the MD should have had a little foresight on this too. Yes - communication is key. With that being said there is plenty of blame to go around. Tomorrow is another day. You have learned from this and will most likely not do it again. Trust me there will be a day where you will be preventing this doc or others from preventing harm to a patient. When we practice nursing or when docs practice medicine - there are risks associated. It comes with the territory. Now, go home get some rest and kick some butt on the floor tomorrow. Take care, Ginger

Hi Bleverett, I am going through a similar situation where I was "let go" based on inaccurate information at a skilled nursing facility. I have just shy of 20 years nursing experience. I can not say everything on here because the BON is involved. However, I strongly agree with the above of obtaining an "Administrative Attorney" that goes in front of the board frequently in your state defending nurses. I do not have the money either really to retain an attorney- but I did manage to scratch up enough funds to get the ball rolling with one for a retainer. I am willing to even cash in part of my 401k if needed. I have had insurance in the past - but did not use it and eventually felt that "I didn't need it". Boy was I wrong! It is amazing how others can make up stuff about you and elevate it this far. Just amazing. As someone going through something similar - this is hard to do, however, please do not talk with your former co-workers or employer about what happened. It is amazing how the truth gets spinned into something that it isnt. Obtain an Admin Attorney to appear on your behalf. Do not talk to the BON any further until an attorney is obtained. This person will speak for you to them. The good news is that the patient was not harmed. Does not appear that there were missing narcotics or anything like that. So - I would like to believe that the BON would perhaps have you do something like CEUs on medication safety and pay a fine. Something along those lines. If you have any proof that your DON is falsifying documents - this is a BIG No No!!!! What ever documents you have from her related to work performance, discipline (if there was any), any policies that deal with that. - Put everything together and give to you attorney. I am sooo sorry you are going through this. Good Luck Ginger

Thanks Shannon, That is great news. I am not sure where West Chester is, but I will check it out. Thanks so much, Ginger

Hi, It has been awhile since I have posted on here. Anyways, I am a RN with approx 19 years experience with a BSN and a masters in business. The last 5 years have been in two different management roles working 60 - 70 hours a week in the last role to the point of burn out practically. Then, my parents (both - but not at the same time) became ill and being the closest living relative, I felt that it would be best to make sure they were cared for. So, I took a year off from working to help them. Parents are now doing "ok" and we are now renovating their home to make more ADA compatible. This extensive remodel should be complete in the next two months or so. (I hope). Anyways, we are looking at relocating to the Cincinnati, Ohio area and I just want to be a nurse. Most of my clinical background as a RN is in Emergency and Trauma. I would love to go back to this type of bedside nursing again, just need to know what the hiring reality is in this locale. The last time I worked in this capacity was 5 years ago. Would any of you out there be able to provide any information in regards to this area of Ohio hiring? Would really appreciate your insights. Thanks again, Ginger

Hi Camixander, I have not been able to find anything concrete as of this date. Since posting this question - I left being a Med Surg manager and moved on to a different managerial position. ~However~ I do know that either CMS or the National Patient safety goals will be coming out with guidelines soon with some sort of calculated HPPD (hours per patient day) for safer staffing ratios in hopes to improve the quality of care. I have not seen any numbers come out yet. What I did was looked at the California staffing standards with ratios of 1:5 max and attempted to come up with a staffing matrix as close as I could to it. You will want to know what your average daily census is on your floor and what your budgeted HPPD is. This can be a bit challenging to figure out - but it can be done. The CFO at your facility or your DON should have your budget HPPD information. Good Luck, Ginger

I would say that if you are able to handle those kind of patient loads - I agree with what others have said. You have gained a lot of experience and sharpened your skills. Get out while you have a license. Now, if you fear that your nurse manager will be vendictive about you transferring to another department by writing you up and stuff like that to keep you on the unit. I would have a meeting with HR first before putting in the paperwork to transfer and tell them your fears if you plan on working for the same hospital. Perhaps, HR may have an "employee representative" to help you. It isn't right for the nurse manager to do that unless it is legitimate. Keep the conversation factual - things you can prove. You have to be careful what you say to anyone in HR - my experience with them is that they are there to protect the organization from a labor law violation - not you.

This may vary state to state - but if you are still doing work and not getting paid for it - then the employer runs the risk of a labor law violation. At least that is what I have been told by HR from 2 different employers in 2 different states. Sounds like a toxic environment. I have worked under similar conditions and it stinks. Recently, I managed a med surg floor and the nurses were upset with me because I came up with a staffing matrix to keep the ratio at 5:1 (max)(small hospital). They thought that this staffing was "horrible." It is interesting to note that they are making nurses at other placed take like 8 patients a piece on a regular basis. Regardless, I hope that you are able to find something that has better staffing than where you are at. I think it is time to have a look at what all of your options are. Sincerely Ginger

Dear Cleo, I am so happy that you were able to post this. I have just gone through something similar. I'm fairly new to management, DON that is non-supportative, with insubordinate staff on the day shift (about 3-4 of them) who found out that they can manipulate the DON so they can get "their way". Plus, I was not familiar with the facility, culture, nor the community.....It is a long story. ~Also~ what Mydesygn has posted..... I just wish I have read it sooner because this mirrors everything that happened to me. Thank-you both for posting your experiences because I was beginning to feel that I was "nuts" or something. The word "sabatage" couldn't be a better word to explain what has happened to us. For months now, I was thinking that it was me being "new to management." However, that may be the case only to a point. We will all have our "oversights" as new managers. However, in order to be successful - there needs to be some sort of mentoring which didn't happen. Wow, I can't tell you how greatful I am coming across this post. I hope bumping it to the top will help other managers out there in similar situations. I hope that you trusted your gut and got out of there into a better position. Thanks again for posting (both of you) Sincerely, Ginger

I had 14 years expereince plus a MBA - the story is the same.....

llg, You hit it right on the head!!!

claudette, Please have a look at my thread on "resigned from nrs mgr position" in this forum. I don't think I mentioned pay on there ~but~ I know how much my staff RNs made compared to what I made.... Hourly, they made a h#!! of a lot more than I did (hourly) and they were not responsible for the floor 24 -7!!! At least not at this organization I worked for. However, I do think it depends on the unit you are on. If you are thinking about being a Med Surg manager - I say forget it!!! That job stinks!!! Go for the "specialty" areas. Just my Ginger

OMG!!! That is what I see too!!!

Snappy, I'm just wondering what your plans are with the law degree plus a MSN / MPH - I have a MBA currently looking at a law degree (may be). We'll see. This is a neat conversation to see those who want to enter nursing and those of us who are either wanting to leave nursing in search of their second career or branch out from nursing. Ginger

Lonnghorn, Thank-you! I would love to talk too. I attempted to send you a private message / e-mail - but it looks like there is no contact info listed for you. I have mine on here. If you are uncomfortable listing contact stuff - please feel free to use it. I would love to compare notes. Sincerly, Ginger

RN 1989, Thank-you for the response. I really do appreciate it. I work at a small rural hospital. Once I received my 1st quarter report (fiscal year begins & ends Oct 1), I was informed I was over budget. After finding out that piece of information, I came up with a staffing matrix until I can comb numbers apart. I am trying to maintain a ratio of 1:5 on days, 1:5 on evenings and 1:7 on nights effective immediately until I can put the data together. Unfortunately, those that I trusted to downstaff when census decreased (charge nurses & house supervisors on evenings & nights - mostly on the weekends)- just didn't do it for whatever excuse. So, now that I have numbers to prove overstaffing issues - they will just have to deal with the current staffing, which I still think is more than generous - even when taking acuity into consideration. So, with my new staffing ratio currently - my staff are crying the blues. They are using the banter they can to prove that these ratios are unsafe. I just can't believe it. I guess they were use to having it easier than that. This is just a general Med Surg floor that typically gets GB, Appy, colon resections, CHF-ers, COPD-ers - etc. It's not like they have to take on any major drips other than maybe a heparin drip, invasive lines or any majorly complicated cases. This kind of complaining just makes me sick Especially, knowing what I know and comparing notes with others to confirm what I was thinking. Believe it or not, my CFO has issued a HPPD for my floor at 13.3 - I can't believe that either. Something just isn't right with that. I was thinking that an average HPPD was around 8 or 9. Talk about frustration!!!

Hi, I am fairly new to management. I manage a 27 bed Med Surg floor and I feel like I can never achieve a "balance" between being overstaffed vs understaffed. I have a good idea and have come up with my own staffing matrix - but wonder if there is any literature or group or organization that gives their perspective on staffing ratios on the Med Surg floor. I belong to the Med Surg Nurses organization (AMSN) - however, when I go to look up staffing standards, all I get is a "position statement". ~ This is very frustrating. I know that acuity will come into play, however - I would just want some sort of direction to go that is fair and safe for my patients, nurses, and fair to my department as a whole. I really hope someone here can guide me in the right direction. Thanks, Ginger

1) No, I would not knowing what I know now - The risks do not outweigh the benefits. 2) I say finish the degree since you have gone this far with it - then follow your heart.

Thank-you Thunderwolf, That is my plan - I try very hard not to favor anyone and take pride in being fair. What I get for one - I will get for all - unless it is something that the female staff would appreciate more than the male staff - then I will have to look at the cost and make it equal. Okay - now for more ideas:confused:

Hi, I am a nurse manager over a 28 bed Med-Surg floor with about 30 people that work for me. Anyways, I would like to get them all something they can all use. I want to show them that I do appreciate them and they are all valuable to me and the floor. I know that many say that goodies are great - which I do plan on putting in their gift bags. However, I want to give them something that would last longer than that. For those of you that will say an increase in pay - I'm all over it - but this will take time with admin. Actual gift ideas is what I am looking for - I would like to give them gift bags with a few small things in it. I am a very practical person - so here are some things that I have thought of: Pen lights lotion Pens chocolate (of course) small flash drives (maybe) As you can see -I am having a creativity mind block. I would appreciate the Med Surg nurses input on this if possible. Thanks, Ginger

Hi, I am new to nursing management and come from an ER background (mostly). Anyways, I am looking for a professional guideline for safely staffing a med surg unit. Are these guidelines found by any of the professional organizations? Perhaps in the medical surgical nursing organizations? I just want to staff a "safe" unit for my nurses and not staff only according to $$$ in the budget. Any direction in finding out where I can find some resources would be greatly appreciated. Sincerely, Ginger

I am a new nurse manager too. This topic was previously discussed in this link: https://allnurses.com/forums/f67/about-productive-hours-per-patient-day-10309.html I hope this helps you and that admin above you make you feel empowered to make the fte changes necessary for your needs. Good luck Ginger

Wow! I'm very impressed just reading the last couple pages of this thread! An interim CNO position is very impressive and it sounds like you may well be on your way to becoming the permanent CNO. I can see that my situation relates to this thread well.....where to begin..... My background is ER mostly. I have accepted a Med-surg management position in a rural hospital (28 bed unit). At this point, I have been there for about 2 months. Of course, I have not been there long enough to form an opinion in regards to liking the position or disliking it. Even after recently completing a master's degree(MBA), this is an overwhelming experience. My biggest challenge is staffing and then scheduling. Constantly, it is in a state of change to drive anyone to pulling their hair out and I only have 27 FTE's. I'm not even sure that I have completed most of the things I have in my own orientation packet - let alone going over all of the staff's. That is what this week-end is for - figuring out what there is still left for me to do to become familiar with. I think my biggest challenge in the near future is to make sure that my floor is up to snuff - especially when state board makes their rounds this fall. I will be reading over all of the regs here starting this weekend along with completing CEU's required in Ohio, and coming up with a core schedule for staff (they use to do it from scratch every 6 weeks) - self scheduling - that didn't seem to work out well... Okay, well - enough of my "rant" sort of speak. I'm not really complaining, just trying to figure things out. If there is anyone willing to mentor a new manager online - I would definitely be interested.