Roggae

Hello all, I am in a PMHNP program at Gonzaga University and I find myself in a bind. I had a preceptor who graciously agreed to precept me but had to pull out at the last minute due to the organization she works suspending preceptorships for the term. I am licensed in both Oregon and Washington, and I am seeking a preceptor for at least 60 clinical hours or up to 120 clinical hours this semester. I live in the Portland area. I am going into my third year as a Psychiatric Mental Health Nurse Practitioner student at Gonzaga University. I have been practicing as a nurse for eight years, mostly in Medical-Surgical inpatient departments throughout Oregon and New Mexico. At this time, I have completed applicable courses including advanced pathophysiology, advanced pharmacology, advanced psychopharmacology, and advanced nursing assessment. I have a very flexible schedule. I am a motivated and engaged learner and hope to meaningfully contribute to the professional environment. Here are the details of what is needed for the clinical. · This is an introductory course to advanced psychiatric mental health nursing · All patient population ages are applicable · Emphasis is placed on practicing interviewing and assessment skills · Emphasis is placed on building therapeutic relationships, assessing, and diagnosing major psychiatric disorders, mental health promotion/prevention strategies, and formulating differential diagnoses · Less emphasis is placed on developing a treatment plan, as this will be further developed in future courses · This course can be completed in either inpatient or outpatient environments · Patient encounters can be in-person, via telepsychiatry, or a combination of the two · Clinical hours will be accrued between January 24 – April 24 · I am seeking between 60-120 clinical hours I will likely have to withdraw for the semester if I cannot find a preceptor soon :( . If anyone is willing or knows of any leads, please send them my way! Thank you!

Hello! I'm in a PMHNP program and I'm exploring if opportunities exist outside of the United States to practice in this (or similar) role. So far I can't find any other countries. Does anyone know of other areas with this type of advanced practice role? Thank you!

I've been feeling a lot more empowered as a result of this thread! It looks like, per our organizational chart, that the charge is not above me in any way. It appears she is exercising false authority. I'm relieved to know I should never have to, "obey," her. In the meantime while investigating other work opportunities, and while I wait to talk to the boss and ultimately to the charge, I will be a lot more direct going forward in similar circumstances in letting her know that what she is asking me to do is a violation policy/protocol/NPA, etc., that what she is asking of me is also unsafe, and I absolutely will not compromise that in my patient care. I will document and follow up with my boss. In the past I have taken a more passive approach when not doing what she asks by pointing out policy and simply saying I'm not comfortable, or by discreetly going straight to the doctor myself. I've anticipated her wrath in these circumstances and have attempted to alleviate the tension by being too nice to her in the aftermath. I'm ready to stop cushioning my defiance in an effort to protect her ego. I will also file an incident report each time she is aggressive toward me/yells at me/undermines me in front of staff and/or patients under workplace bullying/violence. It's really interesting because day shift is a whole other world. The nurses on days have loads more resources available to them. They also place huge value on following policy/protocols/guidelines and providing safe and sound nursing care. They are tremendously thorough are an incredible wealth of knowledge and expertise. There have been times when I've shared brief synopses of some of these situations with them at report at shift change and they are appalled. They've also been working there for decades and have no plans on going anywhere, so it would be a long time before I ever made it to work days with them based off my seniority. I feel like the majority of the crap I've dealt with at night would not even have the chance of occurring on days. It seems like everything falls apart at night, and it's become a pervasive culture perhaps as a result of a few domineering bad apples along with a lack of resources.

Yes, this is true.

Oh no, I never did anything without a physician order without getting an order from the actual physician, even when pressured to not contact the physician. The time I referred to regarding stepping outside of policy and being overrided by charge and house supervisor was allowing a dog to stay in the patient room. When it came to things that involved pressure to practice outside my license I either straight up refused or I contacted the doctor and got the necessary order. Either way yes, I know it's a mess. It's ridiculous and I generally don't feel comfortable working there. It's good to have feedback to help me feel more validated, thank you! I've been looking at other employment opportunities in the meantime and I'm thinking of how I will communicate in an effort to perform my duty to allow higher ups to be more fully aware of this mess and document what I did to make ensure they are aware.

I have not practiced outside my license. I have refused when the charge has told me to order and administer meds without talking to the doctor. The only times I have gone along with anything outside of policy is when the charge and house supervisor overrided me, in which case I documented the circumstances heavily. The charge took my review as an opportunity to make her disatisfaction with me known for "disagreeing," and, "not following her advice," in these situations. Which is surprising to me since it demonstrates she doesn't seem to have insight that she is self incriminating. But yes, I hear everyone on the getting out of dodge, it is sound advice. I'm looking into options while also documenting and preparing to disclose everything to the boss to see if she handlings the situation more directly.

CanadianAbroad - Thank you for sharing your mom's story. I'm sorry she went through something so horrific! I'm so pleased to hear everything ended in her favor. I'll remember her story. I know I haven't been in the field all that long, but this is the first time I've ever had conflict in the workplace. It really dismays me how people can behave toward one another in a professional work environment. The charge and I are the same age and she's been a nurse for a shorter amount of time. This is her only nursing experience. I don't see her treating other people this way, but most of the people who work there have been there a long time and are from the area. I knew this kind of behavior existed, and realize I may face conflict again, so perhaps this situation is a good learning opportunity for me to address people who try to push me around (with cowboyardee's advice in mind). How can anybody get mad at anyone else for simply trying to abide a very appropriate policy? It kind of blows my mind. This is interesting because yes, this hospital pride's itself with its "family feel." And no, the dog's records weren't checked as she didn't have any records - the patient and her dog were homeless. The argument was the dog had nowhere else to go and therefor my charge (not the one in question) and house supervisor permitted the dog to stay per the patient's request. Of course I had to remain the nurse, which was very uncomfortable for me, so I documented how that decision was made and did my best to limit my time in the room for the remainder of my shift. But as far as my boss not knowing, I believe it's possible she doesn't understand the full breadth of the situation. Her eyes became wide when I told her my examples and she said, "oh boy, maybe I need to spend some time working with night shift." I didn't share my stories about the charge yelling at me to get out of the patient room while I was performing the dressing change, or the few times she's undermined me at the patient's bedside over ridiculous things that she was wrong about no less. I think it's important I share that with her too. I agree with documenting - I've made a commitment to start documenting more thoroughly, and at least I can now add that I notified the manager and when. I have a follow up conversation with her scheduled for tomorrow and I'm going to tell her everything. I am going to confront the charge, but honestly I might prefer my boss to be involved while I do, so I'm going to see what she thinks. There is a wealth of good advice in this thread, thank you! I wasn't aware of how easy going agency work is, and it's a good idea to perhaps take that route until we move next June. I'll look into it more. I will also look into transferring to the bigger hospital our community hospital is affiliated with - they have a tremendously better reputation. I wish I would have just applied there to begin with.

Thanks for the feedback! It's true, it's very tempting for me to try to find another job. I'll keep other prospects on my radar in the background in the meantime. Cowboyardee - thank you for the extra thoughtful response, it was very helpful in allowing me to cool down a bit and think of how to approach my co-worker going forward. I've been going over the entire situation in my head for the last day and I'm curious if I should follow up with my boss a little more before approaching the charge. That way I can also determine to what degree the charge's feedback effects my raise potential, and how much true obligation I have to follow the direction of my charge. In my review I didn't want to come off as dramatic; I tried to state my point of view as succinctly as possible, but i fear I may not have effectively conveyed my true feelings or the whole story. Confrontation makes me very uncomfortable and I tend to try to avoid it altogether. In some ways I feel like I'm being bullied, and I wonder if my boss would be more involved and provide more feedback if I divulge more information. The more I think about it, the more I think she should be aware. I just don't want to appear like I'm being reactive and can't handle constructive criticism.

Hello! I'm six months in as a night RN in a small community hospital on a med-surg floor. The majority of my first three years nursing experience were at a large level one trauma center in another state. Transitioning to a 20-bed hospital with limited resources has presented a fairly steep learning curve for me. Most of my coworkers have been welcoming and supportive as I navigate through the process. Even though we're small I've been surprised with the higher acuity of our patients. In my limited time we've had about five codes, all with poor outcomes, and multiple rapid responses. At night it's basically just us nurses, a respiratory therapist, and phlebotomist. Our doctors usually leave the premises to go home to sleep and are reachable by pager. Our ED doc is alone with one RN in the ER and usually does not come down to our codes during night shift. The rule at night is all calls to the doctor must funnel through the charge nurse. With this I've perceived hesitance/reluctance to burden the doctor in the middle of the night, although 9/10 the doctors are polite and helpful. This has contributed to, in my opinion, a lot of cutting corners. Since starting, there have been a countless incidents where I've been more or less told to do things clearly outside of protocol/policy (and sometimes my license). This includes ordering and administer a medication without communicating to the doctor; not call the doctor when a two-stage spine surgery patient fell; a patient left the building for three hours and came back intoxicated with her pit bull and the dog was permitted to stay in the room; to keep a full-code patient with new-onset chest pain, chest pain protocol ordered, off telemetry and without an IV. This has resulted in me being extra careful when told to do things I'm not comfortable with by taking extra time to consider and investigate the policy myself, or just go straight to the doctor for him/her to address what I perceive as outside my scope. I try to follow up politely and professionally while advocating for my patient. These scenarios have contributed to some tension between myself and a charge nurse who has tried to convince me to proceed against policy in a few of the situations above. Beyond all that, she has undermined my patient care at the bedside on a few occasions, once while was with training a preceptee. On my last shift she busted into a patient room while I was in the middle of a dressing change and loudly demanded I, "get out here right now!" to tell me one of my other patients pulled out his NG tube. She was irate because as he pulled it out some of the contents got on her scrubs. In addition to above, I've seen her make a serious, careless, and potentially fatal medication error - and pushed me away when I attempted to intervene before she made the error - while she lead a code. In summary, I don't always have the best confidence in her judgement or care approach, but I consistently try to lighten our relationship by expressing a lot of gratitude when she is helpful and keeping things as positive as I can. So fast forward to yesterday. I had my review. The charge performed a peer review on me along with a few others. Overall my review was positive, however her's stood out as quite poor. 2/5 on all categories, with the only explanation, "we've gotten into arguments and she doesn't take my advice." She said I'm anxious and talk about my old job too much (I approached her months ago with that self-realization, owned up to it, and apologized and have since made attempts to improve). Her review contributes to my merit raise. I took the opportunity to express why I don't always take her advice to my boss - and in doing so brought up a lot of what I mentioned above when she asked for examples. My boss seemed alarmed and backed up my approach of following policy and my nursing judgment. She ended the discussion stating she believes we're both great nurses and asked that I talk with my charge directly. So here I am now. I need to talk to the charge. Does anyone have any words of advice to offer in dealing with confrontation? Especially at a new job and with the charge nurse nonetheless? **Added later*** I moved here a year ago, worked six months per diem at another hospital I also wasn't terribly impressed with before taking this job, and my partner and I plan to move next June. If I leave this job to work somewhere else I will have worked three jobs in two years, and I'm afraid that might reflect poorly to future employers. In some ways I feel forced to stick this through. I just don't want to create an even more miserable/hostile situation with the charge in the meantime. Thanks for listening and for your input/feedback!

An update: I decided not to complete the grievance process with the union. I went on two job interviews and received an offer for both. In the meantime, the manager was demoted and a new unit director was established. I put in my two weeks, and have basically been called off due to low census for every shift since. So glad to be getting out of this place.

Also an interesting point - however out of 10 external new-grad hires, five accepted full-time employment, and five accepted on-call positions. I figured it'd be easiest and more cost-effective to hire an experienced unit nurse into a full-time position. She'd save a lot of time and money versus investing in a new grad. I talked with the union rep. She was pretty fired up. She is double checking, but she says I am covered for union representation in this scenario and she is urging me to move forward by first initiating a conversation with HR with her assistance. She pointed out an article in the contract that indicates I cannot be retaliated against for filing a grievance, as covered by sections involving discrimination. She said if I had violated actions against the hospital that resulted in discipline or termination - the union is not available for me. But in the case were actions were violated against me, I have a case and protection.

The positions were definitely not posted anywhere for employees of the unit to see, nor did I notice them listed on our internal website. Very good advice. Since I'm keeping an eye open more carefully for jobs either way, I'll see if next time I can beat her at her own game and apply if I see something posted on an external website.

Thank you for the continued feedback! :) Last week I made it a point prior to asking my manager if she hired anybody full-time, to ask directly if my continued on-call status amidst being called off so frequently was any reflection whatsoever of my performance. I asked specifically if I was fulfilling her and the hospital's expectations, and if she thought I was doing a good job. She responded, in writing, that I was indeed doing a good job, and it would be in the unit's best interest to let me know way ahead of time of open full time positions. She had an opportunity to give me a direct feedback if she truly doesn't like me, think I'm fitting in, or doing well on the unit. I have additional positive feedback in writing regarding my worth and contribution to the floor. Which I wonder might help me in a wrongful-termination-based-on-retaliation situation. With all that said, I'm not taking this situation entirely personally, since I don't feel particularly singled out. Nobody on the floor was given the opportunity to be aware of or apply for the positions. Per our union contract, she must make effort to communicate open positions to the unit via commonly used areas of communication, and internal applicants are to be awarded the position over external applicants. She failed to fulfill her end of the contact in multiple ways with this situation, therefor I feel it's a strong case to get the attention of people above her that she is neglecting integral and even legal components of her job. Lastly, she is filling a temporary position... It seems she should be called out prior to being offered the job permanently. Other nurses have stated they believe this is a reflection of her hiring a specific group whom she can pay less, and because they are new and green, there's a less chance anyone will challenge her continued tyranny. It's not necessarily that I really wish to continue working for this woman. I'm in the process of seeking other employment. All I truly want is for her to be held accountable and to move forward fulfilling her obligation to the union contract. There's some really great people who work on the unit, and the unit itself could be so much better solely if it weren't for her. It's difficult for me to watch somebody get away with things like this entirely unchallenged. I'll respond shortly with an update regarding my conversation with the union rep. Based off the feedback here, however, I believe I've received good advice that I should consider waiting a few more weeks to open this can of worms.

Thank you to those who have taken the time to chime in. Very helpful feedback, perspective, and support. The union rep surprised me by scheduling a phone conversation tomorrow morning, so I'm in the process of compiling a list of questions. I will first establish what level of support I currently have, if any at all, before hashing everything out. I will certainly clarify the time-limit stipulation, great call, thank you. I agree, my manager is pulling some unethical, dirty moves. I'm not the only one she overlooked for these positions, there's a few other on-call nurses who indicated they would have liked the opportunity to apply, in addition to a couple full-time night nurses. I'm the only one who hasn't completed the probationary period. The rest of my colleagues have appeared to lose faith in her and the system, and a reoccurring theme I hear in response to this and other offenses - including aggressively grabbing a coworker by the arm and demanding she "sit down!" in front of other employees - is, "I can't report it because I can't lose my job." It's disappointing and discouraging. However, I feel something must be done to break the manager's pattern of proceeding above policy and union contract. The articles in the contract are in place to be utilized, right? Is it really not worth the time to file a grievance, even if I wait for union protection? Even if I am disciplined and or terminated, would the grievance at least potentially bring some positive change for the unit going forward?

Hello! I'm writing with the hope of helpful insight and feedback in effectively and safely addressing violations of union contract by my current manager. I'm a nurse with a few years experience who recently relocated to another state and was immediately offered an on-call position with a local hospital. I was reluctant to accept the position due to its on-call status, and explained to the unit manager I was seeking full-time employment. She assured me on three separate occasions prior to my acceptance that the unit had a very high need for nurses and I would have no problems receiving full-time hours, with the added perk of an attractive differential if I took the position. She also stated, on multiple occasions, that I would be eligible for consideration of official full-time employment as soon as a position came up. I took her word for it and started the position last July. By October, and since, I have been called off one-to-two shifts out of three each week due to low census. I have mentioned to my manager multiple times that I'm really hurting for hours. She provides a sympathetic smile, shared that I am an asset to the hospital, but she usually finds a way to exit the room or change the subject. At one point, she stated she would make a strong attempt to find a full-time opportunity for me. In attempt to better my situation in the meantime, I have become an active member of unit-based counsels and have cross-trained to all other units with the hopes of receiving additional hours. Recently, I learned we have had at least 10 external new hires, all new-grads relocated from other areas, with five of them provided with full-time positions. The manager notified me that I am expected to help train four of them. When I asked my manager directly if she had hired any of the new hires full-time, she said no. When the schedule came out, it was apparent she lied, their 0.9 FTE hire-status was listed for all to see. I have asked for further clarification and she has not responded. Per our hospital's union contract she has violated approximately five separate articles. Essentially, she kept the positions hidden from internal applicants, particularly potential applicants on our unit, barring them the opportunity of being awarded the positions over external applicants. I have discussed this situation with other nurses, many of whom are upset, but nobody wants to talk with her directly, or file a grievance, because they are afraid she will retaliate. She has a reputation of vindictive tenancies by firing or demoting nurses who have spoken up against various offenses in the past. I am within the introductory probationary period of employment for three more weeks. However, per union contract, I must file a grievance within two weeks of becoming aware of the violation. I am paying full union dues. My union contract has verbiage stating I am free to file a grievance - however "discipline and continued employment of an introductory period nurse will be determined exclusively by the medical center and will not be subject to this article." I interpret the statement as alluding that I am welcome to file a grievance, but if I am fired in retaliation I am not protected by the union. Furthermore, I must submit the grievance directly to the manager - who in this case is the offender - along to HR. The contract does not instruct me to file the grievance with the union itself. All attempts at consultation from my actual union rep have so far been unanswered. They too have a poor reputation of being available and timely in their response. I am currently looking for other employment opportunities outside this particular hospital. At the same time, I care deeply for my patients and thoroughly enjoy my coworkers. If my manager were more of a leader and the union contract were actually upheld, I believe I would fully enjoy the opportunity for continued employment. I also believe my manager must be held accountable, and our union has a responsibility of being available to its members. I find it important I move forward with reporting the grievance for the greater good of the unit, even if it risks termination. Can anybody offer insight? What happens if I file the grievance and I'm indeed fired?? Would I potentially have a case of retaliation and wrongful termination? Thanks in advance.