SolosGirl

I follow you as relief. You seem to think I am not going to look back and compare or....as its known in Nursey World.....ASSESS whether a treatment or regimen is effective over time?? G*#^#%#&#ned right I check your charting. The fact that you are getting defensive and trying DARVO....attacking someone and becoming defensive over a practice that SHOULD BE HAPPENING and implying they should somehow feel guilty for checking your roll.... yeah, no. Someone should have been doing just that to RV...because I will betcha my next paycheck she was one of those holier than thou nurses that can assess lung sounds from the nurses station. I had a preceptor in nursing school.....an Emergency Department preceptor....at a Level 1 hospital....smugly boast that he "never needs a stethoscope and doesn't carry on". He was besties with the charge nurse on nights....who also never carried ears. but they sure as s#%t had the basketball game on at the nurses station and relied completely on tele to pet them know how thwir patients were doing. I told my preceptor, after i was off of orientation and hired at that same hospital... how about get off your fat a$$ and check the patients before you chart that you did it...because i never saw you get up once in 4 hours yet hourly checks were completed. i see nurses like this all the time...and i am brutally in their face. i have and do tell them that they are not to touch my patients or my faily members...and i have reported them on the internal systems for that. i have seen some quietly asked to leave or be terminated. smug-o preceptor was one of such asked quietly to leave or be fired. do i care ? nope. do your d$%^&d job. the one the patient trusts you to DO.

Something you aren't mentioning. The hourly pay is $22-26/hr. The average rent is >$1000/mo for a decent 2 br without having to commute an hour each way through the worst traffic you've seen since....L.A. Raleigh traffic is a nightmare---and if the rent's cheap---you're living in a dangerous place. Schools are so awful that most move to Wake Forest and pay for private education for their kids. So---wanna know why the jobs are open? Not because Duke, UNC and Wake are horrible places to work. They are great places. The pay is substandard for an area that is "very expensive" if you are making that crappy hourly wage. They collude to keep the wages exactly the same for all levels, so you cannot just "go down the street" and get a better paying job. Be careful what some here tell you about areas of need---they forget the biggest priority---paying your bills and having some type of work/life balance.

I understand your argument. There is also another side to it, that I believe is legitimate. "Practicing Outside Your Scope". Nurses in my ER do it all the time. They pull something and then tell the resident what they did--and the resident orders the med and signs it long after the drug was pulled and given. EPIC has a "link" function to correct these things--it's done that often. I don't have the expertise to override a med without a verbal order, and I think that is a problem with some facilities...where nurses are being allowed to pull things before an order is established, verbal or otherwise. A friend works in an ICU where "emergency meds" are in a lockbox inside every single room. Epi, benadryl, and others that the ICU deems so crucial to be bedside--that a trip to the pyxis to "override" a med would cost a patient their life. I am a hardliner when it comes to order sets. Either that drug is in there, approved by the pharmacist and ordered by the physician---or you don't get it until those things are there. If the patient is emergent---as in, the pt is seizing or in crisis---there is the crash cart and there is a "limited order set" that you can retrieve via override, such as 2mg of ativan. EVERY DRUG should not have the capability of being overridden. This is where RV was sucked into the vortex of hades. She should not have been able to even SEE "vecuronium", let alone pull it on override. Vec should be in an ESI carriage, separate and under the heading "ESI PROTOCOL", along with the drugs for an ESI. I don't feel sorry for her. Simply reading the label would have prevented her life from imploding.

what? Are you actually a nurse? There are the Six Rights of Medication Administration. This is what we're talking about. 1. right route 2. right time 3. right patient 4. right medication 5. right dosage 6. right documentation Patients have these rights for a reason. There is no "pledge" or "printed on the back of the nursing license". This is NURSING 101.

I was gonna say---"reading the label" is also another function that is to be used in medication administration safety checks.

It's been studied and documented to a ridiculous degree that cannabanoids not only decrease gastric secretions, but they also inhibit peristalsis: "Cannabinoids inhibit electrically evoked contractions of isolated small intestine The ability of cannabinoids to inhibit electrically evoked contractions of isolated preparations of small intestine mounted in organ baths and the underlying mechanisms have been the subject of many investigations over the past 30 years. These have involved experiments, mainly with guinea pig tissue, in which contractions have been produced by electrical stimulation of prejunctional neurones rather than by direct stimulation of intestinal smooth muscle." https://gut.bmj.com/content/48/6/859 Just one example of one study. Let's follow this critical line of thinking then, to it's conclusion. Basic nursing principles teach the novice nurse that "checking for bowel sounds", particularly after surgery or in the possibility of obstruction---is essential. If the bowel is obstructed in any way or peristalsis is suspended because of anesthesia or other medications---it then becomes difficult or impossible for food to traverse the intenstines. What then, is the outcome of sluggish or paralyzed (densensitized receptors due to consistent and constant cannabanoid intake) bowel? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972088/ This dysfunction causes many things---especially malnutrition, obstruction of the bowel, possible perforation of the bowel--- Many of which----lead to the death of the patient. Does the death of the patient include the bowel as well?

Cannabanoid hyperemesis is not rare. I've seen it almost every day in the one teensy 30 bed ER I work in---and the users are insanely adamant that "marijuana eases nausea!!!!! idiot!!!". It's been the only time I've seen stoners become unhinged---when you tell them that their kush, the God Given Ganja---is slowly killing their gut.

I agree, but there are a lot of other reasons I am leaving after my residency is through. Not Nursing per se, but definitely the department I oriented to, the "hospital life" and the geographical area (see Chiro's response for this one) NETY is alive and well, and I think everyone here knows it. Whether you PRACTICE it, that's not the issue. I had an exceptionally lengthy orientation, 6 months. After one month, it was clear that my preceptor was in it to get his CNIII and climb the ladder, nothing else. He set me loose and would literally leave the unit without saying a word (I'm ED), getting his co-workers to "watch over" me. (80+ bed ED here, folks. just putting a little context out there) When I was asking to get some trauma experience, which is what my preceptor was supposed to be teaching me---I LITERALLY was told (by preceptor) "Well, get in there!" Oh. THAT'S all I had to do? Just "get in there"?! I know I truly would trust a trauma RN that had that kind of teaching under her belt! How about a girl who graduated a cohort behind me, who had the CNIV come to her 2 days after she got off of precepting, he sat down, crossed his legs, and slid a piece of paper across the desk to her. They had "studied" her first self schedule as a brand new "on your own" RN...and determined that she had not opted to take >2 days of OT per week....and on that slip of paper were the dates/shifts (some not her regular shift of 2p-2a) that THEY decided that she should take. That same CNIV, who told me that I was not permitted to take any classes on my off time---even if they had everything to do with Nursing---because if I had "spare time", I should be using that towards chipping away at the short shifts in the dept. And that is just an everyday run-down. The pay sucks. That's geographical, and I am doing something about that at 1 year. I don't get lunches or pee breaks (common), but I also don't ever get a single word of guidance. Know why? Because the "senior RNs" feel that since I will "probably" be gone after a year, like all the others, they aren't investing in me fully. It's not a marriage, folks. It's a job. Putting your "heart and soul" into training someone? That's nonsense. It's a job. If you are precepting by choice, then it's a job YOU signed up for. Do it. And act as if that person you are precepting may be taking care of your parents or your kids. If you are being tapped to precept against your will? Still do the best you can. Again...that RN may be in a position that they're taking care of YOUR loved ones. It's a JOB. Not a popularity contest--your personal opinion of any other employee is irrelevant. If their skills are up to par, then you need to keep your "personal" opinions of them to yourself. That's where the "lateral violence" comes in. One of my cohort made a simple mistake in putting a foley cath in a female pt and inserted the catheter into the wrong orifice. yeah wasn't that just hilarious? especially being the patient, i'll be she thought that was just so funny to have her hoo-haw out there for the senior RN to snicker at the new grad.....and then, not to be outdone by her disgusting behavior at bedside embarrassing the NG, senior RN goes and spreads the story around. Classless and gauche. Oh, but dark humor! No. It's lateral violence, and it's showing your butt to the patients as well. I wouldn't EVER allow that RN, senior or not...to EVER touch one of my family or friends. There's just no line with some RNs. Oh, but I'm senior and I'm having a bad day. Well, I'm an NG and I'm having a bad day. We're even. I don't get to act like a classless jerk, neither should you. Respecting each other in the workplace isn't a function of how LONG you've been there. THAT is what NETY is all about. Senior RNs feeling that they have "earned the right" to act like jerks. I wasn't told in nursing school that I would get a preceptor that sits on his phone all day while I do his pt load, and when I ask a patho question I get, LITERALLY, a dumb stare and a comment like, "i have no idea. i don't keep those things in my head." To complain to management....preceptor's longtime friends? LOL. Yeah. I'll do that. Which is why I am of the Robert Downey Jr school of thought..."Listen, smile and agree...then do whatever the **** you were gonna do anyway." Which is learn what I can, read everything....and then bail. Go to someplace where the pay is 3x what I make now (same experience level)...there is a union that protects my rights and my pee breaks....and let the NETY senior nurses sit around and wonder "why oh why" the NGs aren't interested in staying.