MarisL

Excellent advice. First and foremost: Thank you for all you do. You definitely are a valuable worker, and the job you do matters greatly. When the CNA in my area is working as hard as I am, it makes things so very much better for our patients. A nurse sitting at their computer is likely a very busy person. If you go the RN route, you will get a first hand look at that one real fast. I hope you choose to go all the way to get your RN, as your prior education and experience will be invaluable to your facility and patients. From your post, I read you as a person who has a high ethical standard for doing your job. The nurses around you do too, but what they do can be less obvious. I'm sorry that you haven't been told this more often, because you deserve to be, but Thank You for your contribution to the team. It makes a world of difference in your patients' hospital experience. I've seen a single interaction by a non RN change a patient's C+ hospital experience into an A+ experience, through use of AIDET. Since you have mentioned RNs sitting as an irritant, I'd like to share from my experience, if I may. A nurse who is sitting at their computer is almost always working very hard indeed. He or she also has to be able to drop their computer-sitting charting etc. at a moments notice, for prn requests, toileting, IV pump error messages, bed alarms, tele calls, and what I'd call 'the works. Some examples include: Aside from the reams of mandatory charting (including charting at least 9 descriptive markers regarding the quality of the patient's pain for each pain med given), additionally the nurse is responsible for knowing and monitoring what the patient is there for, what symptoms to be especially vigilant for, what the doctor is aware of and what s/he needs to know but doesn't (yet), whether all the doc's orders are being done, getting new orders as appropriate, what the patient's trend is on each of the conditions they came in with or developed, making sure that critical labs are getting done timely and evaluated timely, assessing standard vitals and labs and imaging (and all the rest), tracking down the physical location where a needed medicine is, doing mandated dual hand-offs on meds per policy, ensuring that standard things like reasonable food and fluids intake and urine output is in the appropriate range, keeping an eye on the pt's IV sites and seeing that they get new one IVs as needed, blood draws, researching whether the patient got sun-downy the night before too, seeing if their HR runs low at night as a baseline, checking out anyone who has a non standard VS and if needed taking action to fix it, making sure the pt's at home med list lines up with their hospital list appropriately, staying on top of IT's interface changes, doing quality checks on machines, doing narcotic counts, documenting what med/intervention you gave where and why and what effect it had, finding missing necessary equipment, trouble shooting it, juggling admits, transfers and discharges, making sure the patient is heading to the right kind of place (home, SNF, rehab, etc) with the right follow up ... We are also expected to know how to contact doctors as needed (can be a research project) and following through, making sure that all the orders are appropriate for the situation. We have to look out for med interactions, and compare labs to the pt's meds and diagnosis. We are out patient's advocates. We have to answer calls from family members (with Hipaa correctness.) We have to document all of this. We have to keep an eye out for orders popping up unannounced, and ensure set up and appropriate completion of all orders. We have to be constantly looking ahead as well: We began working on discharge from the moment the patient came in, appropriateness, safety, and getting everyone on the same page for that time.We must meet the pt's education needs. The things listed here are literally just the beginning of our responsibilities to the patient. That list may be informative the next time you see a nurse "just sitting" at their computer. Which is all perhaps informative, but not really what you need to hear. That list doesn't address the feelings behind your post. I hope that this does: If you are getting more requests for assist/vitals/etc. than you can accommodate, definitely try just letting the requesting nurses know what you are doing, and when you'll be free to help them. Stick to what is realistically possible. Prioritize stat needs. If you are just too busy for a stat-request job, just clearly say so. The nurse will do it herself, or ask another floor nurse or helper to do it, or call the charge RN for help. If you are catching flack for not being able to be everywhere always for everyone, and calm explanations haven't eased your situation, I think you should talk with your manager. I think that with a forthright 'request reply' such as "I' doing x and y, I can do those vitals for you after that in about z minutes" you will (I hope) find the job becomes more tolerable. Good team members are priceless. Your extra achievements are so valuable to your floor you are on. Wishing you all the best, congrats on your accomplishments, and Best of Luck.

Yes. Exactly. OP: Reading your post, it seems to me that it is an almost classically exact description of self sabotage. You express that you are puzzled about why you have done things that have led to multiple job changes in a short time period. I wonder if the job is the only part of your life where you find yourself puzzled by your behavior. Self sabotage usually extends into many aspects of a person's life. There may be other reasons for self sabotage, but the one I have heard of is that the person involved has somehow gotten used to things going badly for them, and come to believe that things should go badly for them. So that if things are going well, like they are being given a raise, cognitive dissonance kicks in and they feel uncomfortable. As a result, because the world isn't turning out the way they have come to expect, they proceed to mess things up, until they can be sure that the world will go back to the "I don't deserve for things to go right, and they don't go right for me" pattern. That is indeed a sad situation. When the sad situation takes patients down the "bad things happen here" rabbit hole also, it must be changed immediately. I don't know you, so I could easily be wrong about the causes of what you are doing. What I do know is this: Whatever it is that caused the thing inside you where you don't understand your odd choices, you can not let that damage extend into the lives of vulnerable patients. I think you should step out of nursing, now. I know this bluntness may not go over well, but consider: you could end a life, the way you are going at things now. There are consequences if that were to happen, that would make the sting of blunt words trivial by comparison. My words will mean nothing to you in an hour (likely less), but if your troubled decision making was to make you responsible for a patient losing their life - that would haunt you the rest of your life. It could change your life completely. Not to mention what it would cost the patient and family involved. I think you need help. If you have tried counseling and it didn't help, switch counselors until it does. Until you understand what is going on with you, until you have fixed it: for your sake, for your patient's sake, find a different line of work. Individually, one incident of most of the multiple- incident things you have related could have happened to people who could still quite reasonably continue a career in nursing. However, the pattern of repeating the same mistake over and over, when you knew it was a mistake, and not knowing why you did something, that is not par for the course. Much more importantly, the part where you didn't treat patients who needed treatments, AND you charted that you had treated them, AND that fact didn't keep you up at night ...... that that is a major outlier. That is a flashing neon sign saying "You need to change careers, now."

" It doesn't sound like you "get" it but I'm not really needing you to get it. This post is for nurses that have had any experiences with BONs. You don't have to understand how I worry or even what I worry about. I'm not you and we are two different people. " This forum is a place we can give each other caring suggestions, and support. When bad things happen, we need and deserve support, not judgement. Telling someone to just stop worrying doesn't usually come across as supportive. OP: By all means if you can possibly afford a lawyer, do so. Securing your physical safety comes first. Assuming this sick person is out of your home, I'd suggest you not answer the door to anyone you don't know to be a friend, for a while. If you don't already have a wide view lens in your front door, consider getting one, along with your new high quality door locks (you want locks that are not susceptible to "bumping". Just ask the hardware store manager for advice in choosing.) Most rental property managers allow installation of wide angle front door view lens, and upgrading locks, if you leave the stuff in when you move out, because its an upgrade. Do check with management 1st. They may be willing to have maintenance put your stuff in for free, or a reasonable fee. Going the extra safety mile, you could have any packages sent elsewhere (to friends and family, or a locker if that service is available) so you can get through the holidays without ever opening the door to strangers. Doing what you need to do to restore your personal sense of your home as a haven is important. Friends, family, spirituality, and an enjoyable home can give you the emotional energy to heal body and soul, so you can pass it on to those in your care at work. I had to get a TRO against some one for a non-nursing issue. I talked to our local police first. If your situation causes you to have any concern about your personal safety I would highly recommend talking with the police. Its free, and they gave me over an hour of really excellent practical advice. Some of it would be relevant to the BON threat. I'm sorry you are going through this. Its inevitable that it will cause you some concern, just as it is that in the end this too shall pass, and that you will emerge even stronger for having won out over this.

Started my career many years ago as an aide in LTC. Strangest thing I have seen happened there: Very elegant aristocratic elderly woman, pt was let's say in her mid 90s. She'd moved several lovely pieces of furniture into her TLC room and it looked like an (admittedly small) room in a castle. She seemed in her usual good health when she rang for her morning tea - an hour early that day, and drank it while gazing over the photos in her room, no signs of a condition change. She then carefully set the cup down, folded her hands, smiled, and said "That, was wonderful." And closed her eyes and immediately, peacefully, just expired. Graceful to the end.

Don't you hate it when you have to call a new doc in the middle of the night and he sleepily mumbles an order, the entirety of which is "Hunh? Humm, well, OK, why don't you order him some Haldol." (MD line clicks off as he immediately hangs up.) Oh, "some" Haldol. In that case, the answer to his question is "Because I don't have a medical license, and I'd prefer to keep my nursing one if its all the same to you, doctor." Thinking: great, now we can do all this all over again. Preferably before we have to call the Code ___ (insert agitated - pt/ show of force - alert color of your facility here) Perky secretary at their group's call center "Hello, what can I help you with?" And you have to say something like "Yeah, see, you'll probably remember I called here about 10 minutes ago. The doc just now gave me a call back and, well, I need to to ask him a couple follow up questions about the 'order'."

HD may give us a closer view than the consultant was expecting, but yes, it drives me crazy to see the guy in NCIS or whatever that is about to undergo any autopsy CLEARLY still robustly breathing. I keep thinking "Ekkk....well, this isn't going to end well for some one...."

" My patient population is mainly chronic non-complaint people and I'm so used to being verbally abused at work on a daily basis by patients that you develop a shell. You almost have to in order to survive. " Yes, that happens. More readily to those who truly care. We get such a mix of patients. Most manage to be civil even though they are hurting, ill and frightened. Some others have made a lifestyle of being abusive to anyone they can be. If a nurse is overtired, over stressed, or financially pressured, it can all challenge your compass and perception of yourself. I've seen nurses lose the knowledge that they are caring, giving, special people who deserve to be treated well. You deserve to be treated well. Whatever happened in the "choosing a room mate" or "following up on overdue rent" part of your life is done. Berating yourself even in the slightest for being caring and giving outside the hospital as well as in, misses the point. Which is: allowing someone to live in your home requires careful screening, and even then can go wrong. None of us is born knowing that. This ex-roommate will do what he will do. That is out of your hands. You do have control over yourself. Protect yourself: Change the locks, add new locks, add an inexpensive alarm that lets you know when some one enters your home ....whatever it takes for you to feel safe again. Personally, I'd do my best to get a restraining order (temporary restraining order aka TRO). They aren't hard to file on your own, just tedious and unpleasant. Victim-witness groups may help you file for free, but if they are busy and a lawyer is too costly, you can do it yourself. I'd do this not just to get the TRO order (because unless you have more proof than you have mentioned here, or unless you get an unusually perceptive judge, I'd guess you may not get that order- on the other hand, maybe you will, which would be very nice.) The main reason I'd file the TRO request is because the paperwork you file for a TRO all gets saved. Meaning: Your ex-roomate would then KNOW that they would look at him first and foremost if there were to be any bad behavior vs your home or you. Take a friend with you to the TRO hearing for moral support, and if your state allows, being them into the hearing. They will serve as witness if the ex-roomate gets nasty in the halls on the way in, and they will support you throughout. No one likes a bully, your friends know you and won't think anything but "wow, that guy was one sick person, I hope I can help take the fear out of this and help my friend get back on track enjoying life again quickly ." Document everything that has happened as best you recall it, including any incidents with proof/witnesses names, save any texts and get photos of those texts. If yours is a single party consent state you can tape record all calls - good proof for a TRO hearing if you are harassed by phone. This isn't legal advice, its common sense: Do what you need to do to feel safe in your home. Redecorate a bit. Once the safety precautions are in place, make your home a nicer sanctuary from work. Make the place warmer and fuzzier, a true haven from stress. Take extra time for you to relax, pursue hobbies, spend time with friends, whatever makes you feel stronger spiritually. This turns the ex-roomate's sick behavior into a motive force to actually improve the quality of your life. As for the BON, they aren't in the business of being used by every twisted person who wants to waste their time by trying to use them as a way to hurt caregivers. Lacking REAL proof (not a bizarre picture of oh my gosh, a bottle) they are very unlikely to rain on your parade - however your understandable fear of them allowing themselves to be used that way IS a burden you don't deserve. If you still feel threatened, get letters regarding your character from those you trust. However, I think that time would best be spent relaxing with a good book on that awesome Egyptian cotton duvet you've had your eye on - or whatever else you can do that makes you feel happy and relaxed. That's my opinion, anyway, drawn strictly from living on this planet. You've been through a really unfair situation, and deserve to have good things come of this. Everyone who posted here, everyone in your life that you have spoken to about this, your family, the students you went to school with, knows you are a quality person, and wants you to be able to have a more fair life. Best wishes.

While I am glad that you gained great spiritual growth through your ordeals from your religion, I am sorry that you had to go through such pain and distress. Your values gave you a framework for your choices. I'd guess that you would not have wanted some one else to step in and tell you how to decide matters in such a personal situation. I don't know if things have been different for you than with me. In my surgeries, there has been a point where suffering has been a source of growth, and then beyond that, there has come a point when the suffering became more like torture. I am very grateful that there was workable nonlethal pain relief when it got that far along. I no longer need the pain relief, and have been able to resume life. I can understand that things would look different to some one else with dimmer prospects. /*This seems like a decision that should be made by the individual. I'm not very comfortable with others directly assisting a choice for end of life in a terminal situation. Oregon's standards seem more appropriate and reasonable. I feel more comfortable with the right of the individual with a certified terminal disease, who has undergone extensive counseling about alternatives, and been offered those alternatives in a realistic manner, choosing to end their own suffering via a med supplied by an MD who has met stringent conditions filtering meeting that patient's request for an end of life med that the patient themselves takes at the point they choose. /* I also share the concern others have expressed that we must be vigilant to ensure that this does not become a way for insurance companies to cut costs. We need to ensure that emotional support and pain management are given early on, so that people don't feel that ending their life is the only option.

In the hospital I used to work in, ICU was right down the hall from our unit. Several of our unit's (experienced) nurses eventually tried working there. Despite any level of prior experience, I never saw one of those nurses who did not find the first year in ICU to be profoundly challenging. Put another way, everyone seemed to have a really rough first year. There was a lot of drop out before that 1 year mark, as well. Maybe it was just the facility I was at, but I'm guessing not. Seems like "experienced nurse, new to ICU" is a place that can be very rewarding. It also seems like a place to put the seat belt on tight before starting, because it is probably going to be a bumpy ride. One of my nursing school classmates (top of our class) went the ICU route, and she was working very hard to stick things out. Bright side, she stayed in ICU for many years and has said it was one of the most rewarding parts of her life.

I take it as an attempt at a compliment. It doesn't land that way for me, but I'm pretty sure it is usually meant that way. That said however, Nursing has fought for a long time for recognition as a career worthy of respect (and dare I say pay) more commensurate with the the job we do. Not glorified handmaidens, rather skilled professionals. So my go to response is usually smile and reply: "I'm glad to be a nurse." And I leave it at that. I think our profession has a ways to go to get the respect we are due, but we have come a long way also. Most days I AM glad to be a nurse. A very few days, not as much. Still, I'd never trade the one to one time we get working with patients, for the student loans and training years and malpractice fees that bind docs to their career choice.

Priorities: Nursing license fees. Second, driving and auto license. Third, rent. And I hope to never have to choose using that list - that must be a really rough situation. My sympathy to anyone who has had to choose. A few years back our state developed a multi-month lag in processing RN license fees. I was biting my nails, although I'd sent in my fees 2 months early. Now I send in my renewals months ahead, allowing at least double what I'd guess the worst case lag could be for slow bureaucracy. Always.

Thank you for the useful feedback. I've seen things change a lot over the many years I have been in nursing, and you are spot-on that an organized, articulate presentation can open closed ears. Any other specifics jump out at anyone (regarding what it takes to overcome a unit culture that dissuades calling codes etc.)? In the specific event that led to this post, it was fortunate that after some push back, I was able to make myself heard, or the patient would have expired that night, within the hour. No question. I'm working on sussing out specific things in presentation that can lead to getting some one a needed intervention faster. As you have noted, with experience we come to know things instinctively. What I'm looking for is moving that instinctive knowledge into specific suggestions. Organization, articulateness, knowing the background answers that you'll need - these are all exactly the kind of specifics I'm looking to have contributed here. Thanks. Any others come to mind?

If people were perfect, the nurse you spoke about would probably be out of a job. Hospitals everywhere would close because so few people needed them. Sounds to me like that nurse is really hoping to draw a line, one that divides "people with a right to care and compassion" from "those that should be excluded from care because they are unworthy of being cared about." And then she is hoping someone will reassure her that she, of course, belongs on the "deserving of care" side of that line. That mindset is draining to work around. Most folks are very aware that humanity is imperfect, and we could all use some polishing up here and there. Nursing is a privilege. We are given people's lives to hold in our hands. I'm not saying its always easy, because we all know it definitely isn't, but the truth is that we are given a sacred gift when we are entrusted with the lives of our fellow humans.

OK. Slip-sliding to more useful question, then: Disregarding the specific circumstances of the prior post, how about a broader question: Have you ever had difficulty calling a code, OR more broadly, getting your patient what they need, because of your unit's culture? If so, how did you overcome it? If not, what do you attribute your success to?

You know how once you have been nursing a very long time, you often know early on when a patient is going critically bad? Some of the clues you can articulate, others are harder to put into words. I was wondering if anyone else has ever had an occasion where they KNEW their patient needed to go to the ICU, so they called for a rapid response (or the local equivalent)... only to find their another nurse actively inserting herself into the team's assessment to guide them away from viewing the patient as critical (why is a different topic). The patient was tripodding, elderly, stridorous respiratory rate closer to 50 than 30, AMS, pallor, accessory muscle breathing, and had developed severe tachycardia from misfocused interventions. ICU had beds, but the team choose to leave him where he was: as one of my 8 patients. I'd appreciate advice on staying clinically cool when you aren't being heard and you know your patient's life depends on it.