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M/S, Pulmonary, Travel, Homecare, Psych.

Content by AutumnApple

  1. 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.
  2. 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.
  3. AutumnApple

    Which social platform are nurses using most?

    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.
  4. AutumnApple

    Experienced nurse turned down several times..

    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.
  5. 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).
  6. 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.
  7. AutumnApple

    Stupid hurts.

    Red wine enemas are NOT sexy............ And your partner lying on the ground not breathing is NOT a "great high".
  8. 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.
  9. AutumnApple

    Say it ain't so...........

    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?
  10. AutumnApple

    Still struggling....

    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.
  11. AutumnApple

    What do you do...

    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.
  12. It's all a symptom of the bigger picture in my opinion. Consider for a second: McDonald's. Super giant of the fast food industry. The measuring stick of every other fast food franchise. Yet, how many of us really think what they are selling is good food? It isn't good food. Not on any level. It's overly simplistic, unhealthy, cheaply made, processed and is generally just not that great tasting. Yet somehow, year after year, they thrive and succeed in the business despite being horrible at the service they provide. It makes no sense what so ever. It's like a sports team who never wins drawing the most fans every year. How do they do this? Simple. Their primary purpose is not good food. It's sales, business and profit. Marketing, convenience and a core knowledge of how to make impulse sales keeps them ahead in the industry...........not good food. Hence, the majority of their leadership is business oriented, not culinary. I don't know any chefs who work for McDonald's in any capacity. I'm sure they have plenty of MBS grads in their administration though. (Actually, I'm willing to bet its primarily MBS graduates). The healthcare industry so desperately wants to be McDonald's. But it does not work in our industry. Never will. I've spoken at length about why the "business" and customer service model doesn't suit the healthcare industry. So, we end up with a healthcare industry that is lead mostly (primarily) by business oriented minds and...................... The outcome is very different for us. The flaws in our leadership and the decisions they make are exposed on a daily basis. Anyone at this point in time care to recall the nursing homes who were shutting off hot water on weekends to save money during the recession? That's just one of a million examples of how our administration and the leadership in healthcare drags us down. Hard to soar like an eagle when you're chained to a bunch of turkeys. Speaking of the recession, at that point in time more than any other, a light was shined in the weaknesses of healthcare administration. Everyone was suffering with low census and having trouble making ends meet financially and no one had an answer for it. They couldn't remedy the problem because they only knew business. They didn't know how to solve any of the healthcare delivery problems they were facing. So, ER wait times skyrocketed, return admissions numbers went through the roof, patient satisfaction scores plummeted and their solution was to........... ...............increase the price of flowers in the gift shop to hopefully make up the difference in lost profit. For McDonald's that style of management is fine. Healthcare requires more than that. McDonald's thrives despite it's goal NOT being good food. The healthcare industry can not mimic this approach and succeed when it's focus is anything other than good healthcare delivery. To remedy the issues the former patient talked about in his letter, you need better leadership. Until the healthcare industry stops trying to be like McDonald's, problems like the ones he addressed will continue.
  13. AutumnApple

    Do I have to disclose mental illness

    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."
  14. AutumnApple

    Do I have to disclose mental illness

    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.
  15. AutumnApple

    Nursing: What it is not

    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.
  16. AutumnApple

    New Grad RN: Struggling With Finding a Job

    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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.