Bigwave108

If you want to be an educator, I would go ahead and start ASAP. My understanding is it takes a MSN in education to be a nurse educator at a good paying gig. If you start your grad program soon you would have that 3 yrs experience by the time you graduate. On your immediate issue, you may be identifying too much with your patients' suffering. Everyone deals with this in their own way, but if you are worried about your patients when you are off shift, you are taking too much of their situation on yourself. As an ICU and ICU step down nurse you will see a disproportionate amount of human suffering, and if it is overwhelming, that is something to pay attention to. You may want to consider a specialty where patients are more likely get resolution to their issue and go home healed without too much drama. If you only need "3-5 years experience" I would think you could get that on any unit. There are always options out there, and you have chosen a particularly grueling specialty. Keep in mind that according to the WHO, about 75% of acute and chronic illness is due to preventable factors. I am not saying that all your patients necessarily deserve their lot, but in our country, as nurses, we are seeing an aging population that has gone decades without adequate sleep, little to no exercise, questionable food choices, etc, or a combination of lifestyle factors. Again, not judging anyone, but this is a very unhealthy culture; as caregivers its important to have some distance from work, however you can manage that.

I think you actually seem to understand nursing pretty well. It is true: anything can go south at any moment. Of course, it may be the work environment. You have invested a lot in your career and education already, so also consider there are RN jobs out there that are more office or clinic oriented, with more routine through the day, and patients/clients that are far less likely to crump on you. I don't think the hospital is for everyone. It is a crazy work environment, and very different from any other type of career. Before I was an ER nurse, I was studying to be a mountain guide/avalanche professional, so I am accustomed to work environments with high stakes and factors out of your control. This is an extreme example, but I fall back on this experience when managing risk and decisions in the ER. So my point with this anecdote is that hospital nursing is high consequence and to like that type of nursing you need to be comfortable with a "reasonable degree" of risk and have the skills to manage risk to the best of your ability. Another approach would be to be more organized, like incorporate a custom, comprehensive checklist into your brain sheets, so if you are concerned about missing something, you can always look at your notes. If you are prone to anxiety generally in your life, also consider modalities to help with your mental landscape, like therapy, hobbies, meditation, etc.

I don't think a manager should have to jump in and take an assignment. If they are managing well and have support from their leaders, they shouldn't have to work two jobs. The reason I say this is because managers who take patient loads have a very high turnover rate. Sure, the staff may admire it, but it does not promote longevity in the manager. Managing is a tough job and if your manager is not burned out and exhausted the whole unit will benefit. I think it really depends on the unit in terms of bedside technical proficiency vs leadership qualities. Emergent and critical care units need managers who are technically very proficient with the medical and nursing aspects of their patient population, because these are life/death considerations. At the same time, leadership skills are essential to maintain a healthy culture in the staff so they feel supported and can focus on their roles. So leadership is essential for long term health of the unit culture, and lack of technical knowledge can be a serious liability. I would not want to have to choose between the two.

Unfortunately, your preceptor has given you very very bad advice. Anyone who thinks a hospital protects nurses should check out the recent case of that Vanderbilt RN who gave a paralytic instead of a sedative. Statistically, the best malpractice insurance is actually to build rapport with your patients and make sure you avoid catastrophic mistakes. These two approaches are mostly in your control. But yes, malpractice insurance is very popular with RNs for a reason. What your preceptor told you makes her sound naïve or inexperienced, no judgement.

A few thoughts. First, I would definitely not give a PRN to a patient that wasn't mine without checking with the patient's nurse first. You mention trust is an issue, and if one would to do this, trust would be pretty broken. Also, this nurse may have a reason why it is not charted yet, like they haven't gotten around to charting, or they do their charting in spurts, not as they complete each task. Be careful assuming this person is not doing their job (without actually knowing this person, I am saying). There may be more to the story. Perhaps the order is not updated and to a current plan of care like if the RN and MD have a plan to make PRNs less available, which is not uncommon with addictive medications or medications that yield a secondary gain. The nurse may also think that the patient doesn't actually need it (see secondary gain with opioids, benzos, etc.). Since it's their patient, you should respect their judgement unless they are doing something dangerous or unethical. Maybe communicate with this nurse, tell them why you think they need it, and let them know you are concerned. Communication is really helpful for building trust. Big picture, and I know this is an idealized statement, but I would not work in an environment where I don't trust the majority of my coworkers. I try to work in places where I can rely on my fellow staff, because nursing is too much of a team sport to not trust other RNs. People who work in units where they can't trust their coworkers inevitably get burned out and carry stress home with them. It ain't worth it in my opinion.

That is a frustrating situation. Unfortunately, what you describe (coworkers not being attentive enough to patients and not doing their jobs; management interventions falling short) is not uncommon. In short, you may have found yourself in situation that compromises your practice standards. So, you can try and change the culture, which is very difficult (probably impossible) as a new employee, or leave. Without knowing all the details, my advice would be to work at a unit and facility that would appreciate your practice standards. There are a lot of very good places to work out there, and a lot of very toxic and stressful places to work. You may have landed in the latter. Also, keep in mind that as a newcomer, you may not fully understand what the unit has been through. The coworker behavoir you describe is emblematic of burnout. If management's solution is more paperwork (this approach is usually ineffective and demoralizing, frankly, disengenuous), chance's are that the management style has a lot to do with the burnout

So I got a rant here and need a little support. I am just finished my fourth semester or BSN school with one to go. I cannot believe how these professors conduct themselves. Where do they find these people? Its like the dregs of the nursing profession decide they can't function in a clinic anymore and then decide to teach. Between the professors who can't teach, can't coach, are just plain vindictive, grouchy, disorganized, or just plain know jack squat about their topic of their class I just can't believe this is passed off as a legitimate college education. Don't get me wrong, I'm learning a ton. I like nursing and am gonna stick it out. I'm getting confident and skilled to begin my career. I just can't fathom where these degenerates come from, they drive me batty. Supposedly I go to a really good school; the lowest GPA in our entering class of 20 some people was a 3.8. I came in with a prior, highly technical science degree with the intention of a career change. I am so shocked with how unprofessional the average nursing professor is compared with those in other academic fields. What a joke. The academic workload and clinical is not even that bad for me. By far the hardest part for me is dealing with these grouchy, stupid people who run my life while I'm in their class. Getting good grades is never enough; one mess up on some highly subjective criteria and before you know it, BAM! You're now officially on their bad side, as if that should even matter in a learning environment. If anyone has some words of encouragement, I sure could use 'em. Cheers