mdsRN2005

Wow that is horrible. To clarify, you mentioned that the rural offer "locked you in" for 3 years. I assume this means via contract? If so, do you know what the penalty is for breaking the contract? I'm thinking if it's minor (like repay a sign on bonus), you could take that job long enough to get NP level med sure experience, then after about a year break it to go somewhere with higher pay. Obviously if you do this, be planning in advance to repay the sign on bonus (I would just set it aside in a separate account and not touch it). However, if the penalty for breaking contract is that you have to buy out the remaining contract (as in pay the remaining salary!) then I'd avoid it at all costs. But if it's the first option, could this job be a temporary solution while you keep looking?

This is one of those tough calls where it'd be easier to make the decision if you knew the time frame you were committing to (like if a day shift nurse was planning to retire in a couple months). Obviously that's unlikely, and it's such a gamble taking it without knowing. But one point to consider is that it'd not only get your foot in the door in this department, but also would get experience in this specialty which would transfer elsewhere. In the event a day spot doesn't come open soon at your facility but is available at another one, having experience in that specialty will give you a leg up. But only you can decide whether you can tolerate nights for a while.

When I used to train new nurses in the ER, I'd get a short piece of IV tubing to let them practice on. We'd do this after they'd already stuck several IV's and had missed a few. I typically knew what they were doing wrong (too deep an angle, not getting the entire bevel in before trying to thread, etc). However, showing them on a clear "vein" helped them actually see it and was the lightbulb moment for most. Once they realized which mistake they were prone to, they could practice figuring out how to compensate. You can also mimic various patient conditions. For example, to mimic veins you can see but not feel, put a pillowcase over it. To mimic obese patients (especially those with big AC veins in a deep crevice!), roll up two paper towels then try to stick between them. Give this a try, and if you need help assessing your mistakes, ask an experienced nurse to help you troubleshoot. Hope this helps!

The "clinical" hours are not to observe clinical care, but rather the upper level admin role which you don't have experience in. Any reputable MSN program will require this. If no one at your facility has a MSN, you may have to do your clinical elsewhere. Although when I was researching MSN admin roles, one program director said that they will consider letting students shadow the CEO or a VP (even if not a nurse) since their intent is for you to see the business side of healthcare. But if not, you'll definitely have to look at other facilities. Your instructors may be able to make recommendations. And if your university is a teaching hospital, then you should be able to shadow someone there. But transferring to a different school will not eliminate this requirement, and will likely also result in you losing progress.

While the ideas mentioned above are all good ones, I somehow doubt that an employer who is advertising for very specific specialty experience would waive it if you tell them you went to a conference or took CE classes etc. (Although these are great ideas that do otherwise boost your resume!) However, if they're asking for experience in that specialty, I expect it's because they want someone who can hit the ground running. And unfortunately no conference, CE class or committee - while great ideas - can prepare you to dive into a specialty you've not worked before with little or no orientation (which I suspect will be the case). Look at the bright side. There's probably a reason they don't have enough time to train a new nurse - likely high turnover or a sudden exodus, which are signs of a bigger problem. Alternately they may just not be a very good learning environment. Either way, you may be better off. That said, don't give up on your dreams of working in these specialties. Look at smaller rural hospitals (especially community access). They are typically more likely to waive these type requirements, and they can be good places to learn. If you can find one that will hire you, work there for a year or so before going back to a bigger hospital - although you may like it and decide not to! Just avoid giving any impression you don't want to stay long, as that would be an additional reason not to hire you. Good luck!

I agree with others that this would be a hard no for me - *unless* the post-orientation pay rate is significantly higher than market or this was a specific job that I really wanted that wasn't available elsewhere. In either of those cases, the short term loss *might* be worth it for a long term benefit. But shy of either of those reasons, definitely not.

In addition to reviewing what you were told during the interview process, do you have a way to access the job posting you applied to? Assuming you applied online, it should still be available in your application history. But I agree, discuss with the doctor to find a resolution. I have a sneaky suspicion this is just coming from the MA, who may be resistant to a new provider.

Not an OG but came into nursing at the end of the paper chart era. I worked ER at the time so many of the questions you ask didn't pertain to us. But much of our communication over new orders/tasks/etc had to do with the location of the chart. For example, when we triaged a new patient, it was put it a rack by the ER physicians. This alerted them (loudly - it was metal on the bottom!) that there was a new patient to be seen. (Obviously if a patient was critical, we'd verbally tell them). If they were going to see the patient, they'd get the chart and take it with them or put it by their computer to keep another doc from grabbing it too. To that extent, if you knew that one doc had already seen the patient, (maybe he came into the room when the ambulance arrived), you'd give it to that doc versus putting it in the rack. After the docs wrote their initial orders, they'd give it to the unit secretary to make/print lab slips. The secretary would then pass it on to us nurses. If it was just meds no labs, the doc would give it straight to the nurses. There was a shelf above our desks with racks that corresponded to each section of rooms. After we'd drawn blood, given meds, etc, we'd give it back to the docs. This process would be repeated anytime new orders were added, including finally discharge or admit orders. The key to this process is verbal communication of anything urgent, as well as a constant awareness of making sure you're putting the chart in the right place to get it to the person who needs it. Much like we now do with various computerized alerts now. Hope this helps, it's fun reliving that time and I truly enjoy reading these comments from the nurses who have more experience with it than I do! Word of advice, your facility should do a trial down time run some time. We once had to do it for an entire day when the power was off after a storm (the generator powered all the crucial stuff but somehow the computer system didn't come back up). It was crazy all the things we didn't know how to handle! By that time all the OGs had retired and I was the only one on my shift who vaguely remembered it! Although since I'd come in between phase 1 and 2 of the transition there was a lot I didn't know either! So we were truly winging it. After that we did drills every year.

While I don't necessarily disagree with those recommending counseling, I have a different question. You mention feeling older and being sad knowing you won't have babies again. Are you potentially going through menopause? If so, then these feelings could be hormonal. I'd schedule a visit with your PCP or OB-GYN to assess and have labs drawn. Hormone levels, thyroid panel, etc. If any are off then they will need to be addressed before this will get better.

This is my assumption as well. I'm curious what the medicine in question was. Assuming it was for a narcotic, then it becomes not only a scope of practice issue but also a diversion one.

I had an older charge nurse in the ER who had started an IV on one of my patients. When I asked him where (he forgot to chart it), he said hand/ac/etc but didn't specify left or right. I asked which side, he said "the not wall side.” I laughed out loud because it was one of the smaller rooms where the bed was pushed close to a wall and if they didn't have a good vein on their right arm, you had to not only move the bed but first the trash can and biohazard bin. So when he said "not wall side" I instantly knew!

Wow really sorry you're going thru this. You've gotten plenty of great advice, so I won't add to it. But just wanted to share that something similar happened to me. A decade of great evals, then a new (under-qualified and insecure) manager got defensive when I questioned a new policy decision. Thankfully I was able to resign, but I did so because I was afraid it would end in a similar way. I won't get into the specifics but there were also specific actions taken that I believe were in violation of employment law. Like you, I'd planned to retire from that job. It was actually the only nursing job I'd ever had and it was a small facility where the entire staff throughout all departments felt like family. I grieved just like you did. My next job wasn't an ideal fit for my preferences but was a great work environment. It was only then that I realized just how toxic my old job was. And the job I got next was even better - great work environment, a job better suited to me, and significantly higher pay! With the opportunity to travel to some fun new places to boot! I honestly laugh when I look back at how sad I was to leave my prior job, because in hindsight it was one of the best things that ever happened to me. I don't say this to make light of your situation but just to offer hope that life can be just as good (and likely even better!) somewhere else. You mentioned your workplace is toxic. I'm not sure if you meant in general the whole time you worked there, or specific to this situation. But quite frankly, even if this is an isolate incident it doesn't sound like a place you want to spend the rest of your career! But it's truly hard to see that in the moment. I hope you get a much better position in a much more pleasant work environment, and can one day be thankful for the change! Good luck and keep us posted!

Interesting point about reimbursement. I'm curious, since home office expenses are no longer deductible do they also reimburse for any of that? For example if you had to get a dedicated phone line or upgrade internet speed?

I haven't worn scrubs in many years but some of my favorites were the Purple Label collection by Healing Hands and the Urbane Ultimate collection by Urbane Scrubs. I also found Jockey comfortable but the designs were plain. I agree with others that Infinity by Cherokee were good (I especially liked their "luxe" line), but if I remember correctly they can get hot. Same is true of any of the poly/rayon type fabrics, but I think that collection may have been more tightly woven and less breathable. Also IDK if you can still find them but I had a pair of scrub pants from Elle (like the magazine) that I loved! As to colors, make sure to check with your new manager before buying. Many units require a specific color. And when trying scrubs on, try to replicate job tasks. For example lift your arm over your head like you're hanging an IV bag. Then bend over like your reaching across a patient bed (when I worked ER, I'd actually pretend to do CPR in the dressing room - a code is not the time to find out your scrubs don't allow movement!). Squat as if picking something up off the floor. And finally, walk! I once bought a pair of scrub pants I loved in the fitting room. Only to find out they made a terrible swishing sound when I walked! Finally, while I fully recommend trying on scrubs before buying (either in store or at home from an online scrub site with a good return policy), don't discount sites like EBay and Poshmark. You can often find new scrubs with tags still on at a fraction of the price. But only do this after you know what brands, collections, and styles work for you.

Agree with what everyone else is saying, assuming I'm understanding this correctly. But to clarify, what do you mean by "intercepted from the printer"? Did this nurse actually open your chart and print the documents in question, or did someone else who was authorized to do so actually print them and this nurse picked them up? If it's the latter, is it possible that he or she was printing something else and your paperwork happened to be mixed in? I'm by no means excusing a potential HIPAA violation, but just trying to make sure I understand exactly what occurred. I agree that a nurse who wrongfully opened your chart or even intentionally looked through your discharge paperwork should be investigated and disciplined. But I'd hate for the same to happen to a nurse who inadvertently saw your paperwork. Especially if like my old job the printer collates three different patient's documents at the same time!