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M/S, Pulmonary, Travel, Homecare, Psych.
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AutumnApple has 12 years experience and specializes in M/S, Pulmonary, Travel, Homecare, Psych..

BSN with a wide variety of patient care experiences. I currently work in psych, which I never thought would end up being my niche. Avid movie watcher and reader who may contribute an article or two..........

AutumnApple's Latest Activity

  1. My hospital just put in some new regulations. Biggest change is 16 hour shifts are simply not allowed, at all. Even if you're staying to help or cover, you can only go up to 12. Once you reach 12 hours, you're not an option no matter how dire it is. They also put in some funky limits on how many 12's you can do in a row. Two is the most, but "exceptions will be made for weekend hours". That I don't get. You either allow it or don't. People get over tired and make mistakes on the weekend too. Seems to me they're picking and choosing where they want to be careful, and where they don't. And then there is the new policies that agree with me. They are cracking down on what we call "doubling back". As in, you work evening shift one day, go home, sleep at night then return for day shift the next day. Technically, there was a shift between your coming and goings. But it's not 8hrs off the clock. Basically the new policies are designed so that one can not schedule double backs, but if they're asked to stay by the nursing supervisor, then it's allowed/overlooked. Again, that smacks of picking and choosing where to be careful and where not to. I guess you have to weight in........at what point is the short staffing more dangerous than overworked nurses?
  2. AutumnApple

    RN to BSN or straight to BSN??

    I think for this question, flipping conventional wisdom on it's head works best. Usually I believe in looking at the long term goals and making appropriate short term goals based on them. If I like outcome A, I make a plan with goals that will steer me towards that outcome. If I like outcome B more..........same thing, different goals along the way. For this situation though, I think letting the short term goals be your guide is more helpful. *To me* there really is no outcome A and outcome B here. Either way, the end point is a BSN. So, choose the path that suits you best. The one you're most likely to finish and/or the one that will cost you least..............all sorts of variables to consider. Prioritize said variables and pick the path that accommodates your priorities best.
  3. AutumnApple

    Time to step down from management?

    I've been in management roles three times. First: This position ended because I moved. It would have ended eventually for other reasons not at all unlike the ones that made me step away from management in the future. Lack of autonomy (nurses on the floor think this is a problem.........whoa it gets so much worse in management roles) in decision making, lack of staffing (this place simply refused to admit their short staffing was leading to bad outcomes..........it was always someone else's fault) and a general comfort level with poor outcomes by those above me that turned me off. Second: This was the one I wanted to work. It did not. I stayed in this position much longer than I should have. Same things I mentioned above were the problem: People above me were too comfortable with poor outcomes, facility refusing to staff itself and not being able to make my own decisions on too many things. Third: I'm not one to keep walking into the same wall and expect a different outcome. I was begged to take this position, and it was a temporary position. I did it for nine months, a month longer than I was supposed to. They had trained my replacement before I left. Left on good terms but......... .......everything I mentioned above was going on again, and had I not known it was temporary and going to end..........I'd have ended it. Most admin. in medical facilities like to hire, what I call "lever pullers" into middle management. They want people who pull whatever lever they're told to pull without question or regard for how it affects the patient outcome. They do not want out of the box thinking or anything else. Just pull they lever you're told to pull, and pull it well. And throw a nurse bellow you under the bus when pulling said lever ends up being the wrong decision. For me, medical leadership has too much of a "Can't have it any way but my way, but it's everyone else's fault when my way doesn't work" approach for there to be improvements on the system made. So, knowing this, I don't join the song and dance with them. I'm not much of a lever puller. I have self will and independent thinking and all sorts of other things that just doesn't mesh with that role well.
  4. AutumnApple

    Why ? Just Why ?

    Because we are surrounded by "Can't have it any way but my way, but when my way doesn't work, it's your fault" types. Gotta have someone to throw under the bus when that parent/spouse/whoever realizes Pepsi is not good for their diabetic loved one even though they swear they read differently on wikki..............(of course they deny saying this after the fact).
  5. Other nurses pea-cocking, trying so hard to look like the new age F. Nightingale. It's always "that nurse" who does it more than anyone else. You know, the one who never gets their duties done...........but somehow thinks their obsessing over one trite detail of some patient's care makes up for that.
  6. AutumnApple

    Stupid hurts.

    Red wine enemas are NOT sexy............ And your partner lying on the ground not breathing is NOT a "great high".
  7. AutumnApple

    Nurses that “only do it for the money”

    Ah, the old debate about "for the money vs calling" nurses. I have a problem with this debate as a whole. Actually I have a handful of them. Ok, it's more like a truck load. * Not many nurses actually fall into either category (for the money or for the calling). While we may associate ourselves with one belief system more than the other, the truth is we're all a bit of both. In short, while we may debate one side or the other, we tend to be more alike than different once the talking stops and we have to go to work. In my experience there really are no pure "for the money" or "for the calling" nurses. * The whole debate is obese with assumptions. Biggest one is that the "for the money" crowd is lazy, and the "for the calling" crowd is harder working. This is so not what I've witnessed. In fact, this assumption is the polar opposite of what I have seen. My experience shows me, more often than not, the loud "for the calling" crowd (or at least the ones who claim to be, me.......again, I don't think the two sides actually exist) is just covering up their work performance shortcomings with this "God says it has to be this way" attitude. Another one is that the "for the calling" crowd are less likely to practice critical thinking or that they can't prioritize their day. How about the one that the "for the calling" crowd is more in touch with their people? Heard the one that people "for the money" call off more? I could keep going. None of them are fact based. * I don't know a single volunteer nurse. Not one. Not one that does direct patient care anyway. Sooooooo....................... We are all doing it for money. If you accept a paycheck, you've done it for the money. * How is the argument from either side even slightly valid? Umm...........nursing doesn't make us rich (as many have pointed out). So, how is it "for the money" or not? I don't know what to say. Truth is, I just find a debate about two teams who don't exist and which one is more right a bit on the pointless side. Reminds me of the comic book fights the boys in grade school used to get into. "Who would win, Superman or Mighty Mouse?". And they truly got in fist fights about it.
  8. AutumnApple

    5 Reasons Nurses Get Fired and How to Avoid Them

    Good article. I most certainly agree that things like charting accurately get blurry when we're working with our noses to the grindstone. Sometimes it's just to easy to sign those rounding boards blindly when we know we didn't really lay eyes on that patient. This is a mistake I see a lot of new nurses making while they're learning time management and prioritization. I will point out though, the article seems, to me, to be written from a viewpoint of the "ideal work place." In short, this means it assumes all firings are justified and done with the intention of protecting the patient. This "ideal" workplace is not common though. I've said it for years that MOST disciplinary actions taken by medical facilities are motivated by personality, not policy. We've all seen it. A certain nurse rubs the wrong people the wrong way. Suddenly they can't breathe without attracting a write up. Every other nurse working on the very same unit does the same things they're being written up for but...........it's always *this* nurse that they catch doing it. Tension builds, they do something out of anger (become confrontational with the manager, begin calling off etc etc) and they hang themselves. This is the reality of most medical facilities. Personality trumps policy. So, it seems to me, in order to keep from being terminated, we nurses must not only professionally adhere to ethical standards, but we must on a personal level be well equipped for dealing with "difficult personality' superiors. The above most likely contributes greatly to burn out. Just say'in.
  9. My advice is to go into the specialty that you want. Dismiss any inclinations that you must "Learn your basic skills on a general floor first." I did M/S to start, but I did so because I wanted to. Not because I saw it as a stepping stone towards something else. Once you're on the M/S train tracks, it's very difficult to switch rails to go another direction. Lots of my peers went into M/S just for "basic skills" and were BITTER once they realized they were railroaded into staying right there. Once a hospital system has you trained for a unit such as this, they're not going to ever see letting you transfer elsewhere to learn a different specialty as a "good thing". It's MUCH easier to go from a select specialty to M/S than the other way around. It's just the culture of things.
  10. AutumnApple

    Mandatory Uniforms

    I prefer "general guidelines" with regards to uniforms. Without some boundary in place, people just go too far with what they wear. I can sit here and give example after example of this but most will respond "Those are just outlier bad examples." But said outliers are invited in the door when we adopt a policy of no boundaries. Plus: Is it truly an outlier if it happens every time nurses are given free range to choose for themselves? I've just seen too many insane uniform fails that the nurse will defend to their grave to believe in not having some boundaries. I prefer places that give choices: * Either wear the chosen color for your job title OR white scrubs. (Being one who hates white scrubs, I think it should always be the alternative option). * Company/hospital logo should be optional as long as your color choice adheres to policy. BUT........offer a small uniform bonus/stipend to those that get scrubs with the logo on them. If you want to bypass the logo......it's your choice to do so and pay more. * A homecare company I worked for did something similar with shoes. They liked simple, completely white shoes. Of course no one was doing this though. So, they had a local uniform company they worked with. If you bought a pair of shoes, pre selected by them at said store..........you got a discount. Again, your perfectly free to bypass this and pay more for your "autonomous" uniform selections.
  11. AutumnApple

    LTC nurses having to do CNA work all day

    Yes and no. Some nurses can do this and some can't. Be the one who can. It's not about refusing to help, it's about prioritizing your duties and drawing the line where it needs drawn. "Up to and including termination"..............not if you exit from the situation before it gets there. That's how I handled it the one time I made the mistake of accepting work in a long term facility.
  12. AutumnApple

    In the ICU, do you get a tech?

    A lot of ICU's don't have techs/CNA's at all. Or, if they do have them, they aren't allowed in the rooms.......they just run for supplies and make deliveries and such. If a nurse needs help, another nurse has to go in the room with them. From what I understand, this is the more "insurance friendly" approach.
  13. Just a little side note of advice: Don't show this "I want to do pt care and this is not it" side of yourself at work. Even if it's true. Things are bound to get taken to a place you don't want to be if that's what people see from you. I used to precept. I can tell you for a fact, I had just as many new nurses hate me as I did who loved me. It's the nature of the position. You can't be in it to be liked. Some of the new nurses hated me so much....if they had come here and posted about me, you'd think I was evil personified. Of course, you'd only have their side of the story. I've written numerous times about the one who couldn't understand that spending the last hour of every shift in the bathroom puffing herself up for that night's date was not going to hack it...........yet, when she quit the position you'd have thought I beat her with a cane on a daily basis for no reason what so ever (according to her exit interview anyway). I'll add too: It's so hard to take a new nurse seriously when they have this "I just want to do patient care, not all this other stuff" mentality. Are you that confident in your definition of "good patient care" already that you're judge and juror of whether it's going on here or not? Just say'in: I've had many a new nurse tell me I wasn't "patient focused" because I was more concerned with drawing their PTT (after lab had given up) than with fluffing blankets.
  14. AutumnApple

    Sitting out another station

    It's not about whether anything has happened (yet). It's about them having to explain that no nurse was directly on the unit when something (and it will) does happen. It's like wearing the seat belt. The fact that you've never been in a wreck before the one that kills you matters not when it happens. For me, I'd want to be able to say I was *there* when an incident does occur. EVEN IF the incident has NOTHING to do with you being 20ft away........if you are when it happens........that'll be the variable they focus on afterwards.
  15. AutumnApple

    LTC nurses having to do CNA work all day

    There's a large gap between helping and "doing for" that often gets overlooked in situations like this. You're not helping, you're doing the work for them. Not the same thing. They're "helping" you. Not the other way around. And if your facility looks at it as enough, move on. Trust me, they won't change their approach. Me, I've been in this situation before on out of control M/S units. It sometimes helps to suggest a change in staffing....such as going with more nurses (hence, less med pass and documentation per nurse) and less nurse aids. In the mean time, stop "doing the work" for them and get into more of a "I'll help as soon as my duties are caught up" approach. Yes, quality of care will suffer and yes, complaints will go up up up........... Usually that's the only thing that triggers admin. to look at the problem. Just be warned, usually their solution to the problem is to say you should be doing more, not to fix the staffing issue.
  16. AutumnApple

    DON on cart

    When I managed a unit, I never took cart (specifically). I did other things to allow the floor staff to have a more manageable task load though. Admits, QC rounds (the fridge temps and such, the ones that never get done), crash cart checks, discharges.......... I picked tasks to do that in the end helped me more. A med pass is either done right, or not. On the other hand, with admits and discharges..........you can do a lot of things to help yourself (as a DON) out later on. I had to audit every admit and discharge so, doing them myself meant less audits later on. Work smart, not hard. I'd never stick with a facility that had to "pull" management to do floor nurse duties on a regular basis. They get on a roll with it and before you know it.......it becomes the expectation. Considering that I was salary and already doing fifty hours/week......I was not going to get out even later due to having to be a floor nurse too. They'll always be *in a staffing crisis* if they know Superman (woman) is coming in and will let them get away with it. Best not to get trapped into a situation like this.

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