IceDancer

I am sure plenty of people will disagree with me but my personal opinion of people administering medications to anyone, is that they should obviously follow the five drug rights (pt. drug, dose, route, time), and that they should know what the drug does and *why* the person is getting that drug. Additionally, ideally, they should know if the dose they are giving is within a safe range. As a home care nurse I taught patients and family/other caregivers the importance of these things and myself and my fellow nurses did our best to provide them with that info about their own medications. I don't believe that anyone should be hired to administer meds knowing less than that. And frankly, unless you are a nurse, you will not be able to understand/remember the drugs, doses and mechanism of action on hundreds of meds, you do not have the pharmacology and physiology background required to do so. I believe hiring people to hand out pills like you would hand out linens is a dangerous cost cutting attempt that causes all sorts of problems. When my own mother was in an assisted living facility I experienced those problems first hand and working in home care, where I visited many assisted livings, I continued to see the ramifications of people giving medications and not knowing much about them. When you are a new nurse you end up looking things up all the time to start that learning process. I remember having a student nurse on the floor when I worked in the hospital who was working with her preceptor to administer meds, and she made a med error. Now, if she had been supervised properly that should not have happened, but the other aspect of it is, I remember asking her why she would ever give that particular med to that particular patient (he had no diagnosis that would indicate a need for the drug) and she said back to me, "Am I supposed to look up every single drug to find it what it does???!!!". I said, "Um yeah. You are. Until you remember them, you gotta look them up." She looked at me like I was crazy. She got kicked off our floor. I believe that in an institutional setting, the bare minimum to hand out meds should be an LVN/LPN. Anything less is risking patient safety, again, in my opinion.

So, to me, the bottom line is, you asked your charge nurse, she told you to call the CAT, you did as you were told. If you had not called the CAT it frankly would have been insubordination on your part at that point. You are getting flack from supervisors that don't know how to stick up for their nurses when it comes to bratty residents. Sounds like the resident complained and they are scared of him for whatever reason. I had an ER doc write an email to my director once regarding both me and another home care nurse. We had, at two separate times, advised one of our home care patients to go to the ER for COPD exacerbation. Apparently in each scenario with different family members we were asked by them what could be done for the patient there that could not be done in the home at that very moment, to which we replied "breathing treatments and IV steroids". The doctor was mad that we mentioned IV steroids saying we "telling him what to do" I guess because the family asked about it once they came in to the ER (never mind that both times he ordered both IV steroids and breathing treatments). My director basically told him to go pound sand though she did share the emails with us, wanting us to know they had occurred but that we had done nothing wrong. These people should have listened to the doctors complaint, said, "Of sure, we will deal with her" and then privately supported you for caring for the patient properly.

I had no idea. I kept thinking I would find my niche as clinicals went on and the semesters passed by as my peers seemed to be doing, but nothing ever clicked. By the time we were to be signed to our preceptorship that would last our final two semesters we were supposed to request a floor we were interested in. I had no idea so I wrote down "geriatric med/surg". I ended up assigned to a medical oncology floor. I remember freaking out, telling my husband, "I can't work with all these horribly sick people throwing up all the time!" When I first met my preceptor she scared the hell out of me. She decided to quit smoking the week I joined her. In other words, it seemed doomed to failure. After my first night on the floor I was hooked. I loved the patients, my preceptor loved me and supported me (she pinned me, ultimately when I graduated), I was there a year as a student and for the first five years of my career. It just goes to show, you just never know. And unfortunately, my preceptor did start smoking again

When I started nursing, twenty years ago, I was in a similar boat. On an Onc/med floor, with a great preceptor and supportive staff. It was the ideal situation for me to grow, "team nursing" with eight patients per RN and CNA. I stayed for five years. The first year or two were incredibly nerve racking. I worried constantly, I could not go to sleep at night because I would worry I had done something wrong or forgotten something. I would call the floor sometimes after I left to make sure I had not forgotten something. I heard pumps and call bells in my sleep. I asked questions constantly. I dragged my co workers over to look at something, to check something. Even the first death I had.....I could not be sure he was dead! I called another staff nurse in to check him and she took one look and said, "Oh yeah, he's dead." I made mistakes. Nothing life threatening, no med errors, but I made poor choices at times based on my lack of clinical experience. But I got better. By the third year I was orienting new grads. I started teaching chemo classes. By the fourth year I got my OCN. I sat on multiple committees and taught new systems to my fellow co workers. I gained a reputation for being exceptional with palliative care for patients and families. By the end of my fifth year the floor had gone through many changes and a severe staffing shortage pushed me out. I was tired of travelers and registry making twice what I was making while I did their chemo and took care of the issues related to an Oncology floor that they were not trained in, as well as taking the most acute cancer patients as my own. I switched to home care. I had a couple of weeks orientation and was then out on my own. Boy I was grateful for those five years of seeing all kinds of patients and learning from all kinds of professionals, RT, PT, MDs, RNs. In the hospital I had back up. In the home I had me. The first open I had was having a massive stroke when I entered her home and was confused and refusing to go to the ER. I did not know for sure she was having a stroke but I knew for sure she needed to go to the hospital. Despite her protests I called an ambulance who also expressed reluctance to take her and started arguing with me. I managed to use a complaint of chest pain she had mentioned in her confusion to basically force them to take her. The ER doc called my boss later that day and said she would have died had I not known to push for that transport, and being in a hospital for five years taught me my instincts, taught me to believe in them, and taught me to not be afraid to push. Those instincts of mine saved many lives over the past fifteen years. I am not bragging, that is true for any good home care nurse, you will save lives with your decisions and often they are your decisions alone. Home Care is easier in many ways than being in the hospital, but you need to know what you are doing, and need excellent time management just as in the hospital. I feel the same about Hospice. There is an art to bringing a"good death", emotionally and physically to the patient and the family, and palliative care in the hospital is the best place to learn about that. IMO, the reality of the first years of nursing in acute care is that they suck majorily. You will be nervous, anxious, sleepless, and miserable. The only thing that makes them bearable is having good back up support and you had that with your job. Whether you stay and learn to relax into the job or choose to transfer somewhere else in a couple of years, you will never replace that acute care experience. Twenty years later I still remember those patients, those scenarios, I am still a better nurse for it. I think we have a climate now in our society where any level of anxiety is considered unacceptable. It is up to an individual to decide how much they can deal with, but working as any kind of new medical professional in acute care is going to cause a tremendous amount of it, that is the price you pay to gain experience and instinct. Learning to work and make good decisions when you are anxious or afraid is another major benefit to this, it is something that will stay with you the rest of your career. I don't think you gave this job a chance, but that is just MO.

When I worked in the hospital, years ago, low census call off was by volunteer, per diem, then seniority, usually people were fighting to get called off. We did go thorough a couple of really dry spells, census wise, and during those I actually spoke with our director about revamping some of our patient handouts for certian procedures like bone marrow biopsy or receiving different chemotherapy drugs and she was all for it. That fall I ended up writing all new handouts for patients, the other dry spell I rewrote some chemo administration policies that were outdated. The work is a little dry, but many floors are willing to pay nurses that would otherwise be called off to do that kind of extra work that nobody ever seems to have time for. If you are on a floor getting called off frequently, and you know that there is outdated info for the nurses or patients, talk to management about working on it instead of your usual shift. They may well be willing to pay you for your knowledge and expertise.

I was married to another RN for seven years ('96-2002), and I then had a long term relationship with another RN for three years and we have remained friendly afterwards, he was one of the most passionate relationships I have ever been involved with. That said, I used to joke that I needed to broaden my horizons obviously, because those relationships did not work. I ended up marrying a man who is now medically retired from law enforcement. He is an amazing and wonderful person and, if you can believe it, was a nursing major originally and did get his RN after graduating with his BSN. He, who was a Sergeant at two of the most notorious prisons in CA, has told me time and again that being a nurse was too difficult for him. He has a tremendous amount of respect for our profession. I swear I did not know about the nursing major thing when we first met, lol, I was trying to break my nurse dating habit. In regards to women finding male nurses attractive, I would say this: to me, what I find incredible sexy is someone who does their job well, regardless really, of what that job is. My profession is difficult, and when I see a man who does it well, who is smart and savvy, respected by colleagues, loved by patients, that is a turn on for me, I want to know more about that guy. IMO, if you are going to be a nurse, own it, and don't hide it. Our profession deserves respect, and having someone hide what they are doing for a living because they feel it is too "female oriented" just sets us back about fifty years.

You just witnessed bad practice, in multiple obvious ways. As an orientee you need to discuss this with whomever is managing your orientation, it is perfectly acceptable to say in private, " I was orienting with so and so and noticed blah blah blah, that seems contrary to facility policy, can you clarify?". If I actually worked there in a regular capacity (off orientation) and witnessed it, I would write up an incident report as well as have a discussion with my supervisor about it.

I think, as others have said, it depends on your physical limitations from those disorders. I can share my career experience with you, I have a hyper mobility disorder not specifically diagnosed, though I meet the testing qualifications for EDS (constant subluxation of my hip and shoulder joints and hypermobility in other joints) . My actual problem has been my thoracic spine, which is normally more stable and less prone to injury . It seems the connective tissue is just weak back there for me, the assumption has been that the hypermobility is related. I started having pain in it when I first started nursing, though it was manageable. I worked in acute care for five years then switched to home care. Shortly after starting home care I ended up seeking answers to my pain issues and discovered the hypermobility as well as a herniated disc at T6. I worked in home care while in pain management for ten years. Home care was good for me because it allowed me to change position frequently and do charting lying down if need be, though the driving was the biggest challenge because sitting upright was difficult for me. Last year I noticed the pain getting worse, I am now literally unable to sit in an upright chair for more than ten minutes without rapidly climbing pain, and standing still is even worse. I can't drive for long because I have to sit too vertically. I could not sit through a meeting at work. I was sleeping all the time if I was not working, and I did not feel like doing anything . My MRI, which had remained unchanged for ten years is now showing herniations at T3-4 and T 8-9 as well as the T6-7 disc now compressing my spinal cord. The surgeon that evaluated me does not want to go in unless I have paralytic symptoms, which, thank goodness I do not. He said he has not had good luck with thoracic surgeries, not for pain relief anyway. So I am done, at least for now. I stopped working in Nov of last year going out on a medical leave. I slept for nearly two months straight. Unless I was at PT or a MD appointment, I was asleep. I did not know it at the time but my body was simply worn out from trying to work in constant pain. In January, I kind of woke up and began an exercise program that I could do, picked up a new hobby, and gained back a great deal of strength. It is not enough to go back to work, but I have some quality of life now. The moral of my story I suppose is that if you can find a job that works with your symptoms, go for it. There are few jobs that do not require sitting or standing, I have to lie back significantly most of the time, I can only do very short stints in an upright chair. My hardest days are seeing the doctor because of sitting in the waiting room. I hope you are not faced with limitations like that and that if you do have them, they allow you to work. I loved nursing, I was good at it, and I miss feeling useful sometimes. But I am finding new things to do with my life and my time that work within my limitations.

Well, I have never heard of that but I would guess the last three initials are IntraVascular Device. So....if the first letter is also an I, maybe Inactive or Intermittent? We always called them saline locks, so if the first letter was an L I would think Locked. I am also eager to know the answer.

This may have been asked, but can you live at home? Maybe pay mom a rent to help offset the costs and help her out a little, but it could be less than living somewhere else perhaps? Keeping in mind I went to school 25 years ago, I lived at home through most of my schooling (BSN) until I got married while I was in my last year of nursing school. I went to CA state college for my BSN and we are luckier here with lower State college tuitions compared to some other states . A personal loan does not sound right for you, if your dad is on disability you should be able to get money or loans related to that low income status. My mom went on disability when I was 15. She was given a portion of money every month for my schooling until I was 18. This got me through my first two years of college though I worked summers . After that I worked, got grants, and two different types of loans. One I did not have to pay back if I worked in an area of "need" and nursing was one of those , the other I owed $4000 when I graduated and had it payed off by my first year after graduation.. I think I would also get my CNA as others have said, right away. I got mine by working at a nursing home where they trained you as you worked when I was 17. Perhaps they do not have those type of programs anymore, but the job corps thing sounds good too, free is good. The bottom line is... find the cheapest way to live, best way to make current money, and least expensive school to reach your goals, and rack up as little debt as possible. If you have to take breaks in between semesters or less classes per semester to work more, pre nursing is the time to do it. By the time you get into a nursing school you will usually need to find a way to stay in continually until you graduate, at least two years for an ADN program and probably longer for a BSN (ours was 5 semesters of actual nursing school). It took me a total of five years to graduate doing full time units every semester.

If you have proven yourself a long term, faithful and reliable employee, a good supervisor and good co-workers will often reach above and beyond to help you if you have problems outside of work. But that is the caveat......you don't simply get that for showing up and being pleasant, it takes years to build those relationships. I know from having a close relationship with my former supervisor that she and all of us staff watched new hires like hawks, fair or not, we needed to know if that person was not only competent and reliable, but that they fit in with our culture of work. I worked for a very cohesive home care agency. I did work for a union facility and we needed to decide if that person was a good fit in that first ninety days or they could be there for time and all eternity causing conflict. Keep this in mind as well OP, a poor fit is not always a bad nurse. There have been nurses that did not pass their ninety day probation at my agency that were essentially competent and the patients liked, but there was some other aspect that just did not jive with us. I used to do initial employee peer interviews for potential new hires, and I think our director put it best when she told the group of us, " I want an agency full of type A, anal retentive nurses and nothing less. Keep that in mind when you talk to these people" Truthfully, our agency was probably about 95% just that....the nature of home care is timely, correct, very thorough documentation. That is what makes money and keeps away lawsuits. Not all nurses fit that bill, does not make them bad, just not a good fit for us. OP, I hope you are able to move on and find a place where you fit in and feel at home.

Your comment brought tears to my eyes this morning Libby. Thank you so much for those kind words.

I worked in home care for nearly the last fifteen years. My job in our agency was primarily admissions. The paperwork and information collecting for admissions is something like you have never seen, but I had it down to a science. I know that when I had orientees or students go out with me, one of the main things they said they were impressed with was my ability to give the patient and family my full attention, continue to collect all my needed information, and at the same time weed through what is immediately relevant for the RN, what needs to be pushed down the care plan for later, what needs to be directed to another discipline etc. etc. And at the same time I am reassuring the folks that we will be addressing all of their needs but that Rome was not built in a day, we will be back again, first impressions are very important to patients and families. You have to be a very good teacher...not only to you continue to educate the public on disease process and management, you have to teach lay people to do basic medical procedures that they are often terrified off...you gotta be the cheerleader for them. You must sense what someone can and can't learn. You have to be nosy...very nosy. Check every med bottle, reconcile every current order. Nine times out of ten there will be some discrepancy on an admisson....many folks have never had their meds gone over with a fine tooth comb, I have found all kinds of weird stuff in med bottle and boxes over the years. You will be able to load a mediset faster than Secretariat. Communication is huge. If you are a case manager you need to keep in communication with the docs and the other members of the care team. In particular my job was to communicate with the case managers. My reports to the case managers had to be good....complete. I did not want them walking into a mess they were unaware of, or dumping something on them I could have taken care of during the admission process. I think my favorite part of the job was that many people told me it was the first time they ever had uninterrupted time with a medical person. There I am, rocking in their easy chair, and they could ask me as much stuff as they wanted. Usually they ran out of questions before I ran out of time, I could almost always chart while we chatted if I needed to stay a bit. They loved the non rushed attitude...very rare in the medical world. What others have said about weird homes and bad neighborhoods is true...I would say be very choosy what area the agency is in that you choose to join. You must have excellent people skills, be able to diffuse frustration and anger (hey, you may be the first time they have had a medical person around for that long, but they might be furious with the medical system and want you to know it). One of my most difficult cases is a person that really should be in Hospice and somehow the referral missed it's mark and they were sent to home care. I can't count how many patients I have helped guide to Hospice in that very first visit or sometimes even over the phone. Talk about emotions running high. Sometimes it was just briefly mentioned to them, and by the time I call, they are only then ready to discuss it. That leads to the point that, if they are not appropriate for home care for whatever reason (they may not be homebound for instance) it is my job to direct then where they can get help..that might be outpatient, a clinic, etc. I never just leave and say, "Well, ya don't need us, see yuh" there is always follow up communication. Above all, I am a sticker for acute care experience for new home care nurses. I also think they are better to start as a staff nurse like I was all these years instead of case management if possible, to get their feet wet. Case management is a tough job. I personally feel that three years is minimum for the hospital experience, but most agencies will say one year is sufficient. I was an inpatient Oncology nurse for five years before I started, and I still got a bit intimidated when I realized it was just them and me, no back up to call other than 911, no other nurses to run stuff by (at least not right away), no docs.....your assessment skills and "gut feelings" need to be spot on if you are going to be good in home care, and that really comes with dealing with the very sick in an inpatient setting for a while. I have recently retired for medical reasons. I miss it... and I don't, as I am sure other nurses can understand. I was very flattered recently when I stopped by my office to say hello and one of the case managers said, "Nobody does an admission like you, I miss it!" And my previous boss said, "I hate that I cannot put new people with you anymore, they are missing out" Boy did that feel good. I know all those years of blood sweat and tears made a difference. Finally the only other thing I can say is that you should like driving and spending time in your car. It will be your new part time home if you work in home care.

I agree with the other comments about tardiness during orientation. That said, if the main issue was that some preceptor *fabricated* that I missed thirty minutes of report 2-3 times and I got fired as a result, I would run, not walk from that creepy facility. Yuk!!!!

I am not seeing how long you have been in nursing. As others have mentioned, you did not get good orders to begin with to control pancreatitis, especially given what the patient was showing you with her response to the ER/first floor arrival meds. That said, I have two points of advice regarding orders. Firstly, as you get to knew your docs, meds, and disease processes more precisely, you will find that it may behoove you to ask for ranges in prns....for example, Dilaudid 1-2mg IV q2 hours or something of that sort. It allows you room to play a bit and find what really works for your patient. Also, the pain may change as time goes on and the nurse on the next shift will be grateful for the extra wiggle room. Second, just because a doc gives a order for say, piddly morphine when you first talk to them, does not mean you can't have input. Saying, "Hey, she had a bit of a response to the toradal but that morphine she had did not do squat" will usually get them to rethink the order. Otherwise they get called again if it doesn't work....they are fairly inclined to listen if it helps avoid repeated calls.... especially if you have a good case, and even more so if they know and trust you.