bbyRN

Your claim that capitalism is at fault, as if central planning - socialism, etc - would solve anything is at best a mistake and naive. If you think the national HC systems of the small countries in Europe can scale to US size, that's wrong, that's inaccurate. And no, one cannot aggregate all the European countries together to make the argument. For many real reasons. Not fantasy solutions. Btw, the European HC systems are mostly NOT the socialist systems that we are led to believe. Europe is NOT some utopia - again for many real reasons Do healthcare system execs and dweeb managers suck. Absolutely. Politicians, ditto. And all the nice words coming out of some politicians and 'activists' mouths will just repave the road to hell. Who do you think is going to be in charge of the 'new' anticapitalist HC system and govt? The US offers the most opportunity for all of us 'good' people to make the HC system, govt, etc better. We, each of us and in small organized groups, neighborhood by neighborhood, county by county, state by state, can make this work and make it work for us. A central soln will lobotomize, castrate, and sterilize a real solution.

Fully staffed. That's a joke. Fully staffed = understaffed. There has always been a shortage of nurses. The only reason that there was any controversy about this is because those who hire nurses refuse to hire enough. The need is always there. The business decisions should not be used to measure the need. Had the execs in the healthcare industry not ruined healthcare in the past 30yrs, maybe we wouldn't have some of the problems in the Covid era.

I should have added: Easier said than done. It is so hard to have commitments to multiple parties, circumstances. I've worked in corporations before becoming a nurse. The mantra was always "Do more with less". How convenient! ZDoggMD talked about this. He talked about "moral fatigue" (I think that's what he called it on his Youtube channel.) Not burnout but "moral fatigue". The awful feeling of wanting to provide excellent care, but the staffing does not allow it. And that excellent care includes not only our patients and LTC residents. It includes each other and our families and friends. How many fewer mental health cases, suicides, and poor health could be avoided. Yes, there are always people who take advantage of the system. They might be able to be weeded out if there is enough staff to take their places reasonably. How many nurses and doctors and allied health care workers are actually not trying to pull their weight? Maybe they need to be helped to work in a more appropriate area - not a punishment but to help all of us and our 'systems' work well. These people have training and desire, and not everybody can be a great HCW.

Staffing. More nurses. Especially! in LTC. I've been there. It's sick. And in LTC, the management wants these to be more "home" style. Yeah, crushing meds and taking the time to help dementia and early dementia residents to take their meds - especially crushed: try tylenol, senna for taste, and the K tablets that can't be crushed but can be dissolved in water, tastes great too! - takes a long time. A long time. 20-25 residents is not uncommon. Even for a full shift TMA. Do the math for multiple doses per shift. And, try the Q2hr parkinson's meds. And a nurse not only passing meds but dealing with falls, acute changes, fights, feeding those who can't feed themselves, talking with unhappy family (sometimes fair, sometimes absurd). This 'home' style means no hand sanitizer by the door, either inside or outside. Or, who knows where the last aide or nurse or resident left the bottle of hand sanitizer. How about when there is not enough hand sanitizer stocked on the floor? Something needs to change in TCU, LTC, memory care. Thanks to the Infinite One who gives the floor excellent management. Thanks to some of my managers who understood and cared about both the staff and the residents. The residents might not always get great care, but they never get great care with the staffing and management the way it often is.

Thanks Rose_Queen and RNLovinglife ?. Here's a website that might be helpful for anyone looking for a remote (work at home job). Flexjobs.com. You can look around and see the offerings yourself. I am amazed at the quality of the website and the job searching filters. There is a pay for its services. I think I paid $30 for 3 months access because 1) I was wowed by the services and quality and 2) it looked good enough to get my feet wet in this job search for a remote job. We can set up job notifications for nursing jobs in whatever state, for part-time or full-time, employment or freelance, 100% remote or partly remote. Wishing you all well and a good recovery from the transplant RNLlovinglife. I have come to the conclusion that for me, given the BMT and my complications, it's going to be a roller coaster for the rest of my life. I'm getting more comfortable at accepting that. Thankfully, my BMT careteam has been fantastic - not perfect, but that's not possible and only leads to a waste of life and disappointment.

Yep. Another option. Get a MSN (sorry, more debt maybe) and get a nursing informatics major. There are so many non-clinical nursing jobs out there. It's crazy. Get certified in one or more of the gazillion certificates available and either work for the system or go free lance. If you really want to go into debt, go to law school. Get a job with medical devices and sell and "liaison." Revamp the whole healthcare system by participating in creating an EMR that actually decreases charting time AND makes data/information/notes available to everybody. Become CEO of a large insurance company and standardize coding/compensation (whatever payments/payors/???? are called) and make healthcare great again.

What's there to discuss or feel bad about? The RT didn't document it, the pt said that they didn't recv it, the pt was SOB, then the RT interferes with you caring for another pt, violates HIPAA, destroys the patient's trust in her care, is a jerk, giving a neb is within your scope. Sounds like the unit leadership is screwed up (no surprise), sounds like there's poor leadership in many places, not enough staff, hospital administrators too often suck as leaders and problem solvers. Healthcare 101.

As a 2nd career, I worked as an RN for 3.5 years, 1.5 as a nurse manager on a dementia floor and TCU, and 3 years as a CNA in dementia and TCU. (Got sidelined with a blood cancer and hope to get back to work soon.) I did not experience hostility or obstacles because I was a man. My masculinity did not take a beating and, in fact, I felt like hot @#$@ because I was a nurse/healthcare/dealing with stuff that others don't want to deal with. Some patients were a little taken aback at first, but they were usually pretty happy after a couple days. As a nurse manager, it took the staff - a lot of women of various ages and experience - a little time to warm up to me, and then we became quite a team - I miss them and they have said that they miss me. Often female nurses said that they liked having male colleagues.

Hi. I'm looking to support healthcare in a decent job using my RN but as an RN with a new disability. I am about a year post bone marrow transplant (BMT) and in the process of living a new life with graft-vs-host-disease (GVH, GVHD), after effects of myeloablative induction, etc. I struggle with physical and cognitive fatigue, though it's getting better; work-out but it takes days to recuperate; have to stay away from highly infectious environments; have difficulty with appetite and weight; and so on. But I can walk, talk, chew gum, use a computer and EMR and other software. Continue with continual education. Advocate for healthcare, healthcare professionals, and patients. It would be very cool to work for a good organization - wouldn't we all. If anyone has any ideas and websites to look into, please let me know. It will not only help me, it will help a lot of us.

More or less like many other nurses have commented, but in my own words: Is anybody listening (ie active listening like we are supposed to do) and do they have the commitment and power to make the necessary changes? How do we find these people and impress upon them the emergent needs for nurses? Myself? I write my State reps and senators, sometimes feds, with research showing all the things that the nurses write on allnurses. I also talk with my colleagues in a non-provocative way about writing the politicians.

Two things: 1. Humility includes acknowledging that one is unable to help someone and admit that. The example of what would you do if a new nurse (or an old nurse) asked for help inserting a catheter at the end of the shift. If your 4 year old is waiting for you to pick him up or your mom is depending on you at a certain time, maybe you can't help. Maybe, you need to look selfish. That takes a lot of humility to perform one's duty and look "bad." Of course, an explanation might help, but a lot of people are very judgmental and talk behind people's backs. Being a martyr is not the same as having humility. Of course, when you make a commitment to your co-workers, they would be able to trust that you stick to your word and have the competence to manage your time. So, respect could come out of such an instance. 2. I forgot what the second point was.

Thanks for sharing your story. It make me, and others, better nurses and better people.

I agree with this. What are your (OP) considerations? To be tough and tough it out? See the advice above. To have a decent (maybe great, maybe OK - it doesn't all depend on you - that's an ego-minded philosophy that has nothing to do with reality) nursing career? Then keep working to have a decent career - don't stop. Innovate, move on, find good people. There are more good than bad and sometimes the circumstances turn good people into monsters (everyone in the US is stressed.) You still don't have to put up with it. There is never enough time or perfection in nursing, or anything else for that matter. Anyone who says differently is naive, unaware, or dishonest and has an agenda that has nothing to do with you.

Maybe on break while eating? Ask her just how long she spent scouting the nurses. BTW, there's no time to play cards in LTC. My nurses are some of the the most dedicated people I have met..

How do you know it was only 5ml short last weekend? How are the amounts kept track of? Isn't there a notebook with signatures of the nurses or tma's who worked each shift? If not, then management screwed up with policy. Why is a big bottle of narc hanging around for so long? Management screed up and nurses get screwed.

For $100-$200/yr, I see no reason why a nurse would go without malpractice insurance. The legal system is so convoluted and there are so many business reasons for employees to NOT be protected that spending at most 0.2% of one's yearly income should be considered a cost of doing business as a nurse. Like buying scrubs or shoes or a gym membership. Furthermore, when the legal system makes a mistake, the "little person" pays way more of their income than a hospital or clinic or etc. Ideally, one never has the "trigger" hit on their coverage. Of course, G-d willing, the insurance one buys isn't run by a fraud, as well. Thankfully, there are good people like RiskManager, but one cannot always count on that.

This understanding of the context/scope in which we practice in is really important. MrNurse knew he had a minute or two before escalating care and he knew he could really escalate care effectively - not just make a phone call or something similar. He had the experience and knowledge, was in a particular environment, and probably other contextual things, to attempt care before escalating. All these things had to be present. It is unfair, by management or others, and unsafe, (and incompetent) to demand action in circumstances/context/experience that does not positively support either or both the action and the possible outcomes.

I agree with all the posters who said that you thought through the situation correctly and did the right things. My colleagues and I in TCU/LTC have similar questions on the situations that we are faced with. At least we can call over to another unit to get the experience of another nurse, but it sounds like in a school you don't have that luxury to have another nurse, much less a physician on hand. A second set of experienced eyes. I am constantly learning and looking things up in order to determine what is emergent, what is urgent, what is less urgent, and how to triage. Just because we can call an on-call physician does not mean we do not have to triage because the on-call is dependent on our observations and ability to clearly communicate situations in which our people have serious co-morbidities. [Added edit:] Also, the on-call has little or no history with the pt/resident even if she has the chart open in front of her - the on-call is at a severe disadvantage and the good ones err on the side of carefulness, like you did [end edit.] This maybe is not true at the school-age level, though it may be becoming more complex. Moreover, if things go south from some intervention, you/we do not have resources to address, get labs and assess, the new situation in a timely way when there is already an airway/respiratory situation occurring - like earlier posters said. As for pulse oximeters, I think we all need to learn more about exactly what the readout means. Just because a pulse ox reads >90% does not mean everything is OK. Also, anyone having dyspnea, tachypnea, SOB, etc is going to have anxiety and that anxiety is just going to feed back on the dyspnea. So, which is it? You heard adventitious/abnormal lung sounds - that's what you have to go on. You cannot doubt your assessment. Later, you can learn and practice more. That's another thing, it is great to work with other nurses and physicians in order to have our own experiences/understanding/thinking validated or improved in a way that works for us.

When society, the legal profession, and POA's make it possible for every patient or resident to have a one-on-one caregiver 24/7 or at least really robust, well funded activities teams, then maybe there can be an "ethical" question. "Hypothetical" question as the OP wrote? This is not hypothetical; it happens, though most family/POA's have some understanding of their 90yo's and the limits of caregivers and healthcare systems such that they make a request but do not to make a big deal out of napping and other behavior (not "behaviors" but behavior in the common meaning of the word.) Sarcasm: let's amp up the 90yo so that this pt/resident becomes a fall risk and then have to answer to the POA, the facility, the State, etc for falls. No, it's not one or the other, but too many families and professionals/administrators create these either/or situations with debilitating effects on good aides, nurses, and physicians.

I hope that any nurses who had to work shifts to cover the open shifts that the nurse manager needlessly created did OK, didn't make any errors due to fatigue or unfamiliarity with the unit, didn't hurt themselves due to fatigue or unfamiliarity with the unit, didn't mess up plans with their families, and so on. This nurse manager is probably one of those nurses that screams, "Unsafe, unsafe," when someone makes the same errors that they made and covered up.

The difference between the administrators and the ED patients is the admins get their drugs elsewhere. Don't think the people making policy aren't often addicts themselves. They might have OK physicians who get them onto SSRI s in time to avoid opiates and then make their kids docile with meds so that they can spend more time making money. Plus, well off people have many more acceptable ways to hide or dress up their addictions.

Sleep deprivation, under-staffing, restricted resources, bottom(-line) feeding, staffing harrassment, violent management practices, etc. Lots of unsafe, legal practices. Some even highly valued but denied.

My RN to BSN program emphasizes public health and "leadership," which translates into changing the healthcare system through applied research (whether public health or evidence-based for trench nursing) and politics. There are no acute skills on the individual taught. This is all OK if a student is aiming at a PHN or policy wonk job.

I thought all nursing jobs were like this. a) There is always more work than there is time for and one has to choose between patient care and management care (ie documentation and clerical duties.) Being called on (written up) staying late to actually do a good job is at the capricious discretion of management. b) Being called to fill in shifts for nurses who call off - likely due to stress or just being p!ssed off or because the facility just cannot find enough nurses to fill the shifts. Outside of the hospitals, isn't it standard process to ask nurses in orientation to take independent care? Even recently graduated nurses? c) Being lied to or no transparency? That's also expected management practice, is it not? Aren't we lied to everyday about something? Staffing? Expectations? The care someone else did/didn't do? "You're not safe," when you make errors that everyone else lies about never making? (Except for those of us who are perfect.) Respiratory rates of 18? d) Unless you work in a union, can't employers fire us "at will" - cause or no cause? So, where's the problem? "Work harder, smarter, more efficiently." No, it's not possible. You have 25+ years experience and so on, as an earlier post declared. Still, that's what we are told by the same people who lie or can't take the time to listen to a competent person.

Thanks. This, as well as the whole topic of delirium and its significance, is really helpful.