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!

So the complaint is not only anonymous but also from someone who's never even witnessed it themselves? I'm sure the board will take that lack of credibility into consideration. I do agree with the previous poster that you should get an attorney on retainer and consider it an investment in your livelihood. Also, while I don't blame you for being reluctant to bring it up, you probably should let your employer know about it. In many jobs not notifying them of such charges is grounds for termination. I'd hate to see you prevail over this frivolous claim then lose your job on a technicality! Good luck and please keep us posted!

Look at bigger hospitals near you, they may have more flexible scheduling. For example, one I'm aware of has a weekender plan that requires two of four possible "weekend" days - Fri, Sat, Sun, and Mon. They require that one be either Saturday or Sunday. In your case, you could easily commit to working every Sunday and Monday, which would leave your Fridays and Saturdays free. I would call around and ask to speak to nurse recruiters at various nearby hospitals and see what allowances they can make. If you find one that is accommodating, try to apply for a PRN job while in nursing school. In addition to some great clinical experience, it'd also give you a foot in the door after you graduate. Hopefully this would increase the odds of getting a job in that hospital. Good luck, and I'm proud of you for putting your faith first!

Disclaimer, I don't have either of these degrees but have considered both in the past. Here's a few things I've noticed, although be aware this may vary greatly regionally. Nursing ED jobs tend to be easier to get, but often don't pay much more than staff nurse (especially if you have several years experience, specialty certs, night/charge diff, built in overtime, etc). Definitely something to consider if you'll be taking out $20k in loans for the degree. Although with the schedule being so good, you could easily keep a PRN job. But just be aware it may be a big up front expense without an immediate return. Nursing admin jobs, especially VP level and higher, are harder to come by and may require waiting a few years until one becomes available, or moving to a different area. However, they're more likely to be a bigger pay increase. Finally, some (not all) schools of nursing are not so picky about which concentration you have, so long as you do have a masters. Some list nursing ED as a hard requirement, while others only list it as a preference and would consider any MSN (especially if you get a post-grad certificate, which is usually just a few more courses). Meanwhile few high level admin positions will consider a nursing ED masters. Again, this may vary greatly based on region, but I hope it gives you an idea of things to consider. Ask around in your area to get a feel for all these different questions. Finally, look into programs that offer joint specialties or a concurrent post-grad certificate in the opposite. Hope this is helpful!

Check some of the bigger home health agencies websites, they often have work from home case management positions. I know I saw one recently on Amedysis. Hope you find one with a better work/life balance, life is too short to spend it all at work! Good luck!

This varies by facility. In every one I've ever worked in, RN's and other licensed professionals are required to give 30 days. In these cases, only giving 2 weeks would result in not being eligible for rehire. This may vary by facility or even region, but just make sure to follow your employee handbook to a T. Even if you think you wouldn't want to go back, you always want to leave the door open.

I agree with the points everyone else has made and agree clarification on your schedule might help us give you more specific suggestions. I have another question as well. When your coworker wants to take off, do you cover it? If so, stop. At least until an arrangement can be made to reciprocate. If not, who is working when she takes off and why can't they work when you take off? My first thought when reading this was that it sounds like your manager needs a PRN nurse to cover when either of you goes on vacation or is out sick. If there already is one then I'm curious as to why they are covering her days but not yours. And if you're covering her days off, then you need to have a discussion with your manager and coworker. Covering each other should work both ways not just one. If your manager is making you cover her days off, she should make her do the same. If your manager is not willing to make her do that, she needs to hire a PRN.

One thing to consider is that if you take it, you don't have to stay full time forever. You'll have 12hr shifts either way, but you could work PRN later if the full time schedule was overwhelming (unless you need benefits). If you do take it, I would recommend making sure you try to leave your current job in such a way that leaves the door open. Then if you ever need to go back you have the option. Here's a thought. Don't know if your current job would go for this, but hypothetically they could let you go part time and hire a part time person to work the other half with both of you working two days. (They should be willing to consider as they could forego benefits by doing this). This would allow you to work full time at the new job long enough to train and see how you like it. If you absolutely love it and want to go full time, quit the hybrid job. If you find that you love L&D but are hesitant to do it full time, you could stay on part time at both. Probably with regularly scheduled days at the hybrid job and on a PRN basis at the L&D job. I've always enjoyed having two different jobs and have found that often these opposite jobs supplement each other well. For example, you won't be as bored in the hybrid job if you have the L&D job to look forward to. But the L&D job won't be as tiring if you're not doing it full time. And honestly after several busy days on L&D, you'll probably enjoy the slower pace of the hybrid job for a day or so! The important thing is not go burn a bridge anywhere so you do have these options.

I agree and am curious why you feel guilty. But I see zero reason you should. If your guilt is a misplaced feeling of loyalty to your former employer, consider that if they'd fixed their toxic culture you wouldn't have had to leave. However, having made the switch to nonclinical myself, I would hazard a guess you're feeling guilty over not providing hands on care. I struggled with this too at first, especially since I initially made that switch at the beginning of the pandemic. I felt guilty that I wasn't "in the trenches" with my old ER buddies, and that I wasn't "saving lives" by providing hands on care. But then I looked at it a different way. My position then (which was infection control focused on preventing the transmission of Covid as well as providing case management of infected patients) was equally important. For one thing, I realized if I could prevent the spread of the disease I could keep people out of the ER and off the vent (versus intubating them knowing they probably wouldn't make it off). Then I looked at my case load and realized I usually was overseeing the care of 200-300 people. In the ER I would've just been taking care of 3-4. Looking at it this way helped me realize that not only was my job equally important but that I actually had an opportunity to make a difference on a larger scale. (By no means downplaying clinical nurses, both are equally important). I'd encourage you to look at it the same way. First look at how many patients you're "helping" in your current role versus how many you took care of on a typical day in your previous one. And secondly, look at how you prevent illness. Hope this mindset shift helps you as much as it did me. And most of all, I hope you absolutely love your new position!

I agree. I think some employers (typically the unsafe ones) like to use the threat of patient abandonment charges as a bully tactic to get people to keep working there. Ultimately it comes down to whether or not you took reasonable precautions to ensure your patients would be taken care of, as Nurse Beth lined out. The DON may not like having to take care of them, but if she is capable of doing so and presumably doesn't already have a patient load then it was reasonable to expect her to be able to do so. The only time that wouldn't be the case is if for some reason your manager was not a nurse or otherwise couldn't take care of them. But I agree, it sounds like you covered all your bases. Best of luck in your job search, hope you can find a new position that is not only safe but rewarding. Be aware this manager will likely give you a bad reference so be considering options to avoid listing her (for example if they require a "supervisor" reference you can likely list your charge nurse). Good luck!

Double time is great, but be thankful you at least get time and a half. My old facility didn't even do that. (And they never could figure out why nobody stayed there long?? LOL). In all seriousness, holiday incentive pay is probably the easiest way for hospitals to ensure they have coverage. Especially in situations like my old one that depend on PRN staff picking it up. We had all our full time employees on either day or night shift but had two mid shifts (10-10 and 12-12) that were entirely staffed by PRNs. Unsurprisingly these spots were never staffed on Christmas. The PRN staff were required to work one holiday each year but by Christmas they had long since worked another one. One of the young guys told admin if they'd pay more on holidays he'd work every one. I'm sure others would have too.