AutumnApple

Well, you've put much thought into how you think it will go at each job. And put even further thought into the pros and cons of each as well. This is good, that tells me you're already beyond the common mistake of simply looking at cash compensation and nothing else. I tend to prioritize commute, parking, schedule, and overall compensation (as opposed to just take home money and nothing else) when job hunting. While it is good to make educated guesses about the work environment and what you will gain from it, how often are we right about such things anyway? Read through a few posts here. Many times we go into something and find it, the job and the atmosphere are nothing like what we were expecting. So our predictions on how satisfying the position will be and which is more or less stressful, only has so much value. On the other hand, commute will not change unless you change it yourself. Parking matters more than people tend to believe. It's one of those things we say "Oh, I'll just deal with that part" when the job is new. But given time, inadequate parking will become like Chinese water torture for you. The schedule (probably my highest priority when job hunting) also is one of those things we think we can be OK with but given time, a schedule that doesn't suit your needs will go from mole hill to mountain quickly.

I worked lung transplant for 3.5 years. Before that, I was on a pulmonary floor that was so very tense. You do know, any patient with breathing problems and especially those that have chronic pulmonary disease, tend to snap out on people and bite their heads off. For the chronic patients, years of roids make them like that. For the more acute ones, well........hold your breath and tell me if you're in the chippiest of moods after (just kidding, please don't do that). Some of the most grand, Florence with a Lantern level nurses that I've met in my time.......have been fired and even put on another unit for a short time till the patient who has a problem with them is discharged. That's just how things are in this field. I'd be less concerned about the patients reaction and more concerned with yours. Can't sleep, sick in the stomach. Not saying you're over reacting but, this is the sort of thing that happens to nurse's. Like I said, even to the best nurses. If you end up having to call off every time a patient doesn't adore you........... Find a way to vent, to destress and to help put things in perspective. Make sure you have a circle of trusted (non gossipy) coworkers who you can rely on to give objective points of view on whatever is going on with you. When something happens, if they don't seem concerned, neither should you be. If they seem to be questioning your performance or bedside manner, then you know to "get hard" on yourself about it.

That's a loaded question. Whose fault is it is only a concern for the facility after the fact. An elopement is a sentinel event so, yes, the powers that be will be in administrations office. And no, "It was the CNA's fault" will not be enough for them to exit said office. There should be "layers" to the daily operating procedures that make multiple people responsible for avoiding such events. The CNA's doing four hour rounds is one layer. Making sure doors that should be locked and indeed locked, usually is the nurse's duty. Having alarms and such installed where they should be, the facility's responsibility. If she's a known flight risk, are there protocol in place for dealing with it? If a person continues to "escape" whatever precautions are in place, was it addressed by direct caregivers and the facility? Point is, those who decide what is going to be done about it (and that'd be the people in your administrator's offices, not the people working for the facility) don't care much if it's the nurse's or CNA's fault. Even if it's known who or what caused the problem, they'll levy their "penalties" in such a way that everyone feels the pain, even those less involved. Now, after, much finger pointing and attempts at throwing one specific person under the bus will take place. But that's all just a product of your facility.

Just as a side note, something I witnessed while everyone was rushing to "go computer". From what I saw, secretaries became more necessary. You say "Doctors put orders in themselves." You're the exception then. Many doctors resisted putting in their own orders. It took being able to give verbal orders away from them and said privilege being highly abused, they didn't like "going computer". More than a few were absolutely violent about it. As many have stated, most facilities became "hybrid" with their electronic charting. On one hand, you're have the people (us) doing everything in the computer. Then you've still have paper charts for doctors to see print outs of all the patient info and to write reports/orders in. So they still have to keep the chart going, just as they always had been. On the other hand, everything had to be put in the computer as well so that the facility appeared to be in compliance with the mandate to become electronic. So, in essence, the work was doubled. There was a constant coexistence of the two worlds taking place, the old way and the electronic way. And both had to be kept up as if it was the only way. Many facilities still are stuck in hybrid mode. The electronic charting is just another side task to be done. And in hybrid facilities, secretaries are a must.

From the original topic post: "I am not one to complain about extra help, but in an age where they're cutting costs right and left, I feel like the money is better spent elsewhere." Even if you were "one to complain" it wouldn't make much difference. Healthcare facilities do what they want, when they want. Not often does input from an employee sway their (finances are the priority driven) decisions. While I was in college many moons ago, I worked a "work study" position for my school. Do they even exist still? Anyway, my specific job was with the department that handled things for students with special needs. One of my many tasks was to take things to the main office for copying. Sometimes, they'd need hundreds of copies of whatever flier I was working on at the time (the dept office had no copier of their own, their fax machine doubled as their copier and was not sufficient for jobs of that size). Whenever I went to the main office, the two secretaries would be there doing their own thing. And let me tell you, these girls shot daggers through my back while I was working, with their eyes. Those girls were bitter, bitter bitter. Twice I turned around to ask if they had been planning to use the copier and if I was perhaps in their way. Even offered to come back later if I was in the way. That wasn't the problem though. The problem was: Their dept head (as with every dept in the school) was giving only minimal annual raises. Not sure what that was for the facility but, long story short, it's the raise they give to people on discipline or part timers. These were (over) full time workers who always received high score performance evaluations and had good attendance records. You see, to justify the toilet worthy annual pay increases and instead give the disciplinary raises, their bosses had to justify things on paper. So, behind the scenes, their bosses were telling these girls the school was "unable to afford anything more" because of rising overhead. I bet you guessed it already but yes, the department head of this specific office I was sent to in order to use the copier, specifically sited the rising cost of toner for said copiers as "a big part of the rising costs for the school". So on, so forth. So these secretaries were bitter with anyone using the copier, gave more than a few instructors lectures about not giving "hard copy" hand outs in to classes and everything else. You see.........they had drank the kool aid. They honestly were under the belief that, if less toner were needed for the copiers, they'd get a more fair raise (yes, this stuff still makes me roll my eyes). Same thing is happening with the secretaries on your unit. Your facility is likely cutting costs and doing whatever it can get away with and claiming their overhead is out of control and "things will get better soon. Once the toner prices stabilize." Whatever cuts and underfunding your facility is doing, they're doing it because that's what they want to do. And your manager will support it because, they don't want to end up being the one who has to absorb it. End of story. They could have Fort Knox worth profits and trust me, they will still claim to be broke and give you that substandard raise. Summary: Don't worry whether your secretaries are completely necessary or not. It's not as if their being let go will lead to any improvements in how they fund the facility. Just be glad for whatever help they give. I mean, unless you're on the facility's board of directors and balancing their budget is a concern to you.........Seriously, if those secretaries were told "there isn't enough work to justify your wages" and they are gone, they'll still underfund your unit in other ways despite their wages being off the books.

Diversion is diversion in the facility's eyes. They, the facility, are liable for penalties and fines for allowing it to happen and for not properly monitoring medications (controlled or not controlled). The thought process will be something to the effect of "She took Zofran today, what does she take when she has a back ache or migraine headache?". Some facilities let taking a Tylenol from stock meds slide. Some don't though. Whether the med was "patient specific" or stock med will matter too for, if it is patient specific, they are being charged for it but did not receive it. Most facilities I've worked for would just terminate your friend. Some will escalate it though and what the board decides is simply a matter of the mood of the person receiving the submission. That too is what my experience has shown me. How the BON reacts to such things varies much state to state (with diverting narcotics being universally shunned). It also varies much (different from state to state I imagine) depending on what other things are going on at the time she is reported. One day, your friend could get nothing, other days more. You just never know. Always best not to put them in a position where they have to make a judgment call on you. Doing so can be a roll of the dice.

So much not mentioned here. In my experience, neither HR nor your manager can do anything to help you. It's just that way. If rotations are the expectation for everyone else, then in the absence of formal documentation that you can not perform said rotations (ie...a doctors note saying you can not work rotations), it will be the expectation for you. Next thing I would mention to you is, if you are truly in fear of falling asleep while driving then this is likely not just a problem with working rotations. Part of the problem, perhaps, but far from "the only problem" I'd venture to say. You also mentioned fearing for patient safety. If that is the case, there is more to correct than working rotations. I do believe part of the reason your request for help was met by deaf ears is, you took no formal documentation of there being a problem in with you. I do realize obtaining that takes a good while but, you needed that to be taken seriously. Otherwise (pretty sure this is what happened too), they will just assume the problem lies with you and leave you on rotations till you correct the problem. Either way, get checked out, report your symptoms and see what the doctor says. You'll probably end up needing a sleep study (two things you've already mentioned here, the drowsiness while driving being one, qualify you for it). Most likely will have cardiac testing too. Your nutrition and lifestyle (drinking, drugs, staying out late etc etc) will be questioned. In the end though, it will be worth it. You'll have documentation of whatever the problem is and/or that you're doing something about the problem. More importantly, you'll know for yourself if there is a major health concern here. Lastly, think long and hard about requesting special treatment your coworkers aren't getting. This too is likely part of the reason management is being so obtuse towards your request for help. If you are taken off rotations while everyone else is working them, the likelihood of your coworkers protesting to managment (and HR)is a guarantee. This is why you need formal documentation of there being an issue. You being treated like an outcast is a concern, and retaliation hasn't even been mentioned yet. Don't be surprised if their answer to not working rotations is to decide to place you on full time nights as well. That may or may not be OK with you, I wouldn't know. To summarize this as I realize it's rather verbose: When you ask for help, have your part of things done first. Simply dumping it in management's laps and standing back with your arms folded waiting for a solution you like will get you.......well, pretty much what you got. Ignored.

As evidenced by.....

I hate to come off as harsh but, unfortunately you're asking the wrong question thus, will find no relief. As with most things, while we often believe "If only this one person would get with the program....." all our problems would disappear, the truth is the problem lies with ourselves. This is not an issue of delegation for, no matter how politely and nicely you delegate to these aids, the problem will continue. The fault does not rest with you or the way you delegate. But there is more. The problem does not rest with them, the aid, either. Lets be honest here, every person on every level of the chain is going to get away with whatever they can get away with. That's just how it is. The aids you're dealing with are no exception. The problem is actually the leadership on your unit. You said the manager and people who could do something about it have washed their hands of it all and willfully overlook it all. So, as I see it, you have two options. Follow the ever loved "Chain of Command" and report the issue to whoever they answer to. At least then, the message that such indifference is not acceptable will get across (hopefully). Your other option is, should you decide going above their heads is not going to be beneficial (it often is not, and perhaps causes more problems than it solves), is to move on. You said so yourself that when you get floated, it's better for you. Maybe putting in for a transfer is your best option. Maybe moving on to an entirely different facility is the best option. I don't know. But I can tell you, allowing yourself to believe you have any power over these aids or the situation, is not healthy for you. Often with impossible situations like yours, voting with your feet is the only viable option.

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?

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.

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.

For both social and for nursing related content, it's chat forums. Forums like this one here at AN, some online book discussion groups done in forum style..........etc etc. FB. God, gag me already. People are still using that? lol I hated FB from day one. Still waiting for everyone else to catch up...........lol.

Another point that seems not to be coming up so far: I hope you do understand that not all interviews HR (in any field) conducts are.............actually for the purpose of filling the position. What I mean is, these HR people have quotas to fill. They have to interview at least "X" amt. of people before finalizing their decision on who to hire, have to prove they interviewed a diverse population..........etc etc. So, it's not uncommon at all for an HR person to fall in love with a candidate (or have one in mind from day one) and decide they get the job. But oh! No! (gasp) They've not interviewed anyone else yet! What to do? Easy fix. Just invite three or four people in and interview them..........highlight the negatives of their resume and interview.................presto change-o.............they've now conducted enough interviews to have "done their job" and (gasp, again) what a surprise! The candidate they wanted from the word Go still got the position. We've not even discussed yet how sometimes facilities post jobs they have no intention of filling. They just post it, interview a few people then write things up so it looks like there were no qualified candidates. So, I guess my point is: This could very possibly just be bad luck. If I were in your shoes, I'd take a look at the geography of it all. If these jobs that turned you down with no explanation are all in the same general area.............. Could be that the facilities in this area just are not hiring.

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).

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

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. Soo....... 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.

Yes. They don't know. And no matter how much the instructors at my nursing school tried to educate the students on this reality, it never sunk in. I think people don't want to know. L&D, as I understand it, is NOT the stress free island of nursing that everyone thinks it is. Some of my classmates did actually break into the specialty and only one of them still remains there (almost 15 years later). Most jumped ship either during orientation or first year. The rest before five years in the field. Then the one stayed. It'd be interesting to know where this myth that L&D is somehow..........immune to all the stresses in other specialties........comes from. In my limited talks with people who actually work in L&D, what I find is: It pretty much mirrors every other unit. Mostly the same mix of happy vs unhappy.........mostly the same complaints................ That's just my experience through the eyes of others though.

I do have down time, but no enough that I can immerse myself into anything. Honestly, I've stopped playing phone games that can't be paused because as soon as I think I'm about to have fifteen minutes down time and start playing........... "Can I have a wash cloth?"........................"Why did my doctor change my meds?"..........."Is my husband cheating on me?"........................ I work on a psych unit and most of our patients have sleep disturbance. There rarely is a time when ALL OF THEM are in bed comfortable and happy. So I guess that's my answer. I humor patients.

Just a for fun topic. We as nurses see a lot of things during our careers. I know I am considered that person at social gatherings who always has a great story to tell that'll get the chatterbox juices flowing for everyone else. Having seen so many things, and seeing people at their worst, can make us jaded though. Yeah. I said it. Jaded. That buzz word used much too often to describe nurses who are fed up with................well, whatever. But there are instances where it is true. So, I want to pick apart a statement I find myself saying to myself (and yes, I of course have heard it stated openly by others too) that might be considered jaded. Or is it? Consider for a moment when that patient appears in the ER once again and you just know they're going to be admitted. Probably to your unit, again. It's their second visit to the hospital this month, and the last time they were an inpatient was no more remarkable than the ten (eleven, twelve, thirteen.............) times before that they were there. The frequent flyer is about to become YOUR patient again. When this happens, often we say: "Oh, they're just bored, coming in for someone to pamper them a bit again." Or we say something to the like of that. In short, we accuse them of just being there for social reasons. They're lonely, bored, poorly adjusted or whatever else and have no idea where else to take their problems. Do you truly think people check into hospitals just for social stimulation? Or are we jaded?

And now we get to the heart of the matter of why perspective employers ask this question despite it being borderline unethical. If I choose to keep my past private, then have, as you called it, a "mental health crisis" post hire............... More aggressive, penny pinching facilities will use the fact that you did not disclose your history as a means to say: "Very sorry, we can't help you with this issue. Had we known before hand we could have placed some protective measures in place but you kept us in the dark and that is, in our opinion, why things have gotten where they are now." Then comes the questions of whether you believe you are safe to go to work presently and/or if you want to take a leave of absence until things "are safe for you to return to work". And yes, things are very different for you after you need accommodations than they were before. This I know from experience. I've had a handful of people I know whose "past" and mental illness became inconvenient for their employer and most of the time, the end results are not favorable. I also volunteer twice a week at a suicide hotline. It's not uncommon at all for someone in the office (three or four times for me personally) to receive a call from someone in a mental health crisis who is upset because their employer found out about their problem and are reacting poorly to it. Yes, we have a right to our privacy. Yes, the decision to accept said privacy comes with a price. If we choose to keep things to ourselves, the attitude from others tends to be "keep it that way when problems come up too."

As one who had to seek treatment post rape, I can share my experience with this topic with you: The answer you seek doesn't exist. It's in that proverbial gray area. One person may decide to reveal their history, and have no regrets. The next person who does reveal their history could very well likely end up wishing they hadn't. What I find it all boils down to is: Will not knowing ever become a problem for the facility? If yes, be certain they will point out that you didn't tell them your history after something happens. If no, then no harm in not telling and probably best not to give others a front row seat to the theater of "my life". That rule, in general, applies to life universally, not just with this specific issue. I've never revealed the history I mentioned above to any perspective employer. I never regretted not doing so. BUT the reason it never became a problem is because..........my past never became a problem for them post hire. The little dirty secret about not revealing you past is (whether asking you in the first place was appropriate or not has no weight on this): Once we decide to keep that part of things to ourselves, it's ours and ours alone to manage. If problems arise post hire, it's up to you to handle them without any accommodations from them. I did once, after my incident, find myself slipping back into depression. I had gone into travel nursing and it was great for me in a lot of ways, but not in others. Being so far from home, away from the familiar and comfortable, had more of an effect on me than I suspected. I had not revealed my history to the company I worked for (and yes, they asked specifically, just like your facility did) nor the hospital they placed me in at the time (yes, they asked as well). So.........I was on my own. I had to seek help but at the same time keep things under the radar. That's the reality we accept when we choose not to give perspective employers the whole truth.

Oh, one that came to mind for me right away that might not be popular with your instructors: Nursing is not about "customer service." I could drone on and on about this: They're patients, not customers. No one chooses to be in need of nursing care (One does not drive through the hospital curb service and order a week of COPD exacerbation, with a side of GI upset). We push health, and being healthy often includes not getting your way (No Mr. Diabetic with a 415 rapid glucose, I won't fetch you a ice cream)................. Don't get me started.

I'd have to second the motion to move elsewhere if the market where you are at is that bad. Where I am at, it's a different ballgame. Hospitals are competing for nurses, and to be frank.......they love new nurses who come to them with no "habits" from other facilities. Sign on bonuses, job fairs and all sorts of perks that are hard to find (weekend program, free parking) abound. It must be geographical because I see a lot of posts on here that, with regards to the job market, are complete polar opposites. Seems there is no middle ground..........the market is either totally in your favor or not. I will admit though, just as you'd probably expect......since there is a shortage of nurses here.........once you're "in there"........it's not always pretty. I could work seven days a week if I wanted, doubles.

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.