rn&run

Still sounds like a culture problem, not a problem of individuals. My company has a ‘points’ system— lose too many to tardies or call outs, you’re out. As long as you stay under the limit your sick time is yours to use. It’s childish, but it works. You literally can’t keep your job if you habitually call out more than once every 4 months. This makes it a generally pleasant place. Everyone gets their full lunch break, so you’re less likely to fall ill due to exhaustion, anyway. Of course, if you fire people for absenteeism, you have to be able to hire more... and that means offering competitive wages and good working conditions. It’s a complex problem, which I do realize COVID hasn’t helped. I’m sorry you’re stuck picking up the slack.

You did great! You assessed, treated, reassessed, and called for assistance appropriately. I’m sorry you’re feeling down on yourself, but you needn’t.

Congratulations on your new job! Common office procedures might include labs (phlebotomy, urinalysis, finger stick blood glucose and a1c), spirometry, vision screening, ekg, ear lavage, giving IM and PO meds. You might set up for and assist with minor procedures (skin biopsy, colposcopy, joint injections... really varies based on what your providers see). You’ll also probably do a lot of telephone triage— headache/dizzy/pain/sob etc. You’ll communicate with home health agencies, pharmacy, insurance— there’s quite a bit of back-and-forth of orders and paperwork. Again, good luck! Be kind, allow yourself to be new again.

Yes you can! I'm an introvert and doing just fine in a busy urgent care. Social skills can be learned by anyone, not just extroverts. I'm not friends outside of work with my co-workers, and I don't share a lot of info about my personal life at work. That's a GOOD thing! As long as you can be pleasant, polite, and assertive when appropriate, introversion is not a problem. Good luck!

Sending you peace and reassurance. All new grads ever make mistakes -- some that cause harm, most that do not. You are very high risk for errors right now, off orientation but still new. It gets better. As a new grad I accidentally hung D50 instead of NS for a diabetic patient's maintenance fluid. They were fine, but needed insulin correction. I can't remember if I was off orientation at that point, or at the tail end of it. I felt stupid and horrible, regardless. There is no way to become an experienced nurse without going through this. It's part of learning. Be gentle to yourself.

The clinics in my area pay comparable to the hospital I was at. Well, the hospital started me out at a higher rate of pay, but my current clinic is much better at giving appropriate raises and periodic cost-of-living adjustments. I now make more at the clinic than I did at the hospital. If you're interested in OR, look for a hospital that offers the periop-101 course or similar -- something that they provide 'for free' after hiring you. It can be a competitive application process but they exist. The one I did required a 2 year contract, but it came with a job upon completing the program, and was well worth it. I grew a lot as a nurse in the OR.

Ugh, I've been there! I prefer to work in areas that don't have high-volume med-passes for this reason. For me, OR and urgent care are two settings in which I feel I'm a better nurse, vs SNF and med/surg. In the OR, it's important to be meticulous, but you can focus on one case at a time (to some extent), and anesthesia administers most intra-op meds. In urgent care, you administer meds relevant to the situation, without having to pass maintenance meds too. I'm in urgent care these days, and I find that being familiar with our in-clinic meds, doses, and indications has made med-errors a non-issue for me now. It's good that you're self-aware! If you like your unit, keep reflecting and refine your practice. If it feels like a bad fit in more ways than one, it's OK to keep looking for new experiences. Good luck!

Slow down. Take a deep breath. This is a small and accidental HIPAA violation. It's not a terminal offense, or something you'd lose licensure over. Really. It's the sort of thing you do as a new grad, which freaks you out and makes you pay better attention in the future. We've all been there. It's bothering you, so I recommend you let your supervisor know, or your company's HIPAA compliance officer (whomever you have a better relationship with). Tell them you're aware you made a mistake, and is there anything else they need from you to make it right? I imagine the worst they will do is assign you HIPAA remediation training. You'll be fine.

I think four 10s is only better if you get your day off in the middle, e.g. on Mon/Tues, off Wed, on Thur/Fri, off Sat/Sun.

'Scared' is a strong word for a work-related emotion. There are conditions it's appropriate to be... more vigilant towards, or to seek more support in managing. In my experience, feeling scared at work about something it's in my job-description to manage, isn't acceptable quality of life. Perhaps you might consider a job change, or consult a therapist.

Hello friend, I like clinic nursing— I work for a family practice/urgent care instead of the hospital now. It doesn’t have the same need for constant vigilance and aggressive patient advocacy, but I still learn new things all the time. I have major depression and generalized anxiety, and I’m a much happier more functional person no longer working inpatient. It was a really terrible fit for me. There’s a trade off of complex nursing function for a more reasonable workload and being treated better by my patients and colleagues. I think it’s worth it.

I've only worked in one OR, but what you're describing @jamiebell is concerning to me. From the Association of Surgical Technologists: "Wound closure is performed under the broad delegatory authority of the physician, as defined by the American College of Surgeons, the provisions for which vary from state to state and according to state law and health care facility policy. Therefore, it is the position of AST that only the individual who has attained the credential of CSFA has the knowledge, training and experience to perform advanced task functions in the closure of body planes. Moreover, the Association stands against a single person holding the dual role of scrub tech and surgical assist. They claim that "when the CST is utilized in a dual role, effective case management, organization of thoughts and activities critical to safe and efficient patient care, awareness of aseptic technique by all surgical team members, and quality of surgical patient outcomes may be compromised. Long story short: if the scrub tech is busy suturing/incising/etc, he/she is effectively unavailable to function in their capacity as scrub tech. Full AST position statements available here: https://www.ast.org/AboutUs/Position_Statements_Guidelines/ Disclaimer #1: In my brief review, the Association of Surgical Technologists appears reputable and evidenced-based, but I am not a member, nor am I a surgical tech. Disclaimer #2: Workplaces do not necessarily adhere to what is right, or evidence-based. Advocating for EBP against unit culture may get you ostracized, retaliated against, or fired.

OP, so glad your pre-existing gender norms helped you overcome culture shock.

I find that good pay, adequate staffing, sick leave, paid vacation, and good health benefits correlate directly with good morale.

You certainly aren't alone -- and you're not a bad nurse. You are ethical. As a new grad, I was really upset about my first med error. The house supervisor (SNF/LTC facility) told me: "If a nurse tells you they've never made a med error, they're either lying or they never realized when it happened." He was a bit jaded, but it was exactly what I needed to hear. You sound ethical. You report the mistakes. You monitor the patient for adverse outcomes. After thinking about all the things that led up to the mistake (distraction, lack of knowledge, understaffing, etc.) and what you can do to avoid them in the future... you also deserve to let them go. It's OK.

These things are true... and I'm so glad I didn't have a clue when I chose nursing. I put up with so much, put myself through so much, as a student and a new grad. It took some really uncomfortable situations to learn about my own boundaries. If I had known all the things going in, I would have chosen a different path. Maybe a more emotionally comfortable path. Probably a more financially tenuous path. Yet I'm proud of the person I have become. I'm a quiet, ethics-driven, compassionate woman, and I learned how rare and valuable that is. I learned what it means to advocate, to be assertive. I'm nobody's doormat anymore. But no, I do not think I could have done it, knowing then what I know now.

I started my nursing career in Denver, and really relate to this statement! So many hospitals and I felt like I would only ever see them from the outside. After about 200 applications to acute care, decided to go for a SNF. Was hired within the week. 13 months later I got hired into the hospital, no problem. I was a good student, but I moved after graduating to live in the area I wanted, so didn’t have any clinical connections. I got to the final round of interviews for a hospital’s new grad program, but the position went to nurse who had been a student on the floor. I was a 3 season athlete all through nursing school, so never worked as a CNA. The SNF was a good place to practice assessment, wound care, and time management. I also got to start on days. In the hospital, I had to start on nights. I hate nights...

I’m 29 and I want to get it. I’ll take vaccination over the risk of harming my parents (and others, but my parents are the vulnerable ones I love most). I don’t think it’ll be mandatory though, just highly recommend.

I think you did all the right things: you assessed the patient and called for a rapid when something seemed significantly wrong that you didn't know how to navigate on your own. You can't know everything... you just can't. Better to get an MD in the room when you think something is going south, rather than have a patient come to harm because you didn't take something serious enough. The more experience you get in your current role, the easier it will become to communicate your assessment, concerns, and supporting information clearly. Your brain is working really hard right now to master the learning curve - cut it some slack and trust that the panic response is temporary. This is a good opportunity to brush up on seizures vs dystonia and their corresponding assessments/interventions. If this random event happens in the future, plan out what you'd like to do differently.

This for everyone who is ready to throw in the towel. Every "I hate nursing" post is one I can relate to. I was there. I hope this brings you hope, and offers a new type of nursing for your consideration. I lived a miserable existence through 1 year in sub-acute rehab (SNF), a year on night shift med-surg, and 2 years in the OR. I decided to give it one last shot or walk away for good, and applied to my childhood family practice. After 9 months of rooming patients/telephone triage/refills/prior auths (which was tedious but I didn't hate), an internal position opened up for quality improvement nurse. It's like nothing I've ever done before! It's a desk job with patient interaction. I do hospital follow-up phone calls to reconcile meds and make sure our patients are stable/safe back at home (and troubleshoot if they're not). Whether it was just a simple lap chole, or a new dx CHF on top of a host of other chronic conditions, I get to call. I have the complete hospital record available for review, and this is what keeps me learning as I try to make sure I'm asking all the right questions. I teach diabetes classes -- group and individual -- with the support of our in-house pharmacist for med management. I meet with patients one-on-one with for motivational interviewing related to diet and lifestyle change. I get to take a full 45-60 minutes for these conversations. This is not an opportunity I would have found by searching job boards. It's an internal position, and one that works well for my lifestyle and personality. I love pathophys and primary prevention. I have reasonably well managed anxiety and depression (which were not at all managed when I was working acute care). I haven't called out sick in 2 years, whereas in all my other positions I was calling out at least once every 3 months. Many primary care practices have these types of positions, and prefer to hire internally for applicants who are already fluent in their charting systems and workflows. I hope this gives you hope.

How about Avagard? It's a chlorhexidine-based lotion approved by the FDA as an alternative to the traditional surgical scrub. Latex-glove compatible, and has a persistent (up to 6hr)antimicrobial effect. Wash your hands at start of shift, before/after lunch, and when visibly soiled. All other times use the Avagard. Saved my skin (literally) in the OR!

You sound like a very reasonable employee and advocate - both for your patients, and the surgeons whom you [are trying to] support. I'm totally biased -- this kind of behavior from surgeons is exactly why I left the OR. I understand they are under extreme stress, but I prefer colleagues with more highly evolved 'people' skills. I've found that urgent-care/family practice is a much better fit for me. There are still plenty of opportunities for triage, patient-education, procedures, and professional development. And a lot less power-playing *********

The visitors did not seem to care about contact precautions.

But what scared Stanley most of all was seeing his nurse doff PPE without washing her hands.

I was having a health-coaching session with a diabetic patient over the phone and asked how he felt about walking as a form of exercise. Patient was a bilateral above-knee amputee. We all say dumb stuff. Welcome to the club!