Recently interviewed: I said: "No, no, no, no...."

diligent-trooper · Mar 11, 2012

Thank you for the comments thus far. What I was most concerned about this particular unit was the retention rate. I also found out through my own questioning is the "day-shifters" seem to be more concerned with their own work, and could give only two-farts about what else is going on around them. I do not roll like that! I do not understand if a "call-light" or IV pump is going off, and you are going down the hall, why don't you take the few minutes and do something about it. I mean really, or is one too busy gossiping and stuffing their face to gain more weight around the buttocks and thigh. Oops, I just vented.

Anywho, I do have two interviews this week: One interview is a combined medical-surgical floor with telemetry. And, my understanding this unit is adjacent to their ICU, so I might be able to poke my head in ever-once-in-a while. It has an interesting job description, due to the fact they do treat children on the floor too. The other job interview is a "step-down" unit that has patients who are still recovering from Cardiac surgeries 'gone bad?'; I mean having complications, and in addition other acute/chronic medical problems, which they are continuing to have issue. Most likely fall out from the advances of modern medicine, if you know what I mean... Wish me luck~ :yawn:

Aurora77 · Mar 11, 2012

It is obvious you do not know, therefore appreciate what I am conveying.

What exactly are you conveying? Other than the fact that you've never worked in a hospital environment, and probably never as a nurse.

diligent-trooper · Mar 11, 2012

What exactly are you conveying? Other than the fact that you've never worked in a hospital environment, and probably never as a nurse.

dudette10, MSN, RN · Mar 11, 2012

You can't articulate your points clearly, and your attitude sucks.

There, I said it.

PMFB-RN, RN · Mar 12, 2012

this is the idea i am attempting to get across. thank you!

*** what!!! _that_ is what you have been trying to get across!!!? ou have got to be kidding me. if you are being honest then it has to be one of the poorest attempts to get one's point across i have ever seen.

CompleteUnknown · Mar 12, 2012

I see/hear this idea that if a patient arrests it's because the nurse wasn't monitoring them properly or didn't see the signs of a problem just often enough to wonder if perhaps that idea is somehow being taught or hinted at. Or perhaps because there often are signs of a problem developing for some time before it actually occurs, people are thinking that those indications will always be there.

I don't know if it's an experience thing or what but it amazes (and disheartens) me that anyone could think that all you have to do is know your facts and assess your patients properly and nothing untoward or unexpected will ever happen. If only that was the case!

martymoose, BSN, RN · Mar 12, 2012

ok- i guess the one thing to realize is that pts are much more sick/acute than they used to be on a m/s tele floor.Alot of pts have so many co-morbidities that they are all codes waiting to happen. And the one's in the ICU are just one step from death, but since so many people want their family member to be full codes and "do everything" possible, there is no room in the icu's for the floor pts that really should be there.

This is something I absolutely hate about floor nursing. If I wanted to work in the icu, i'd go there. :-(. we are expected to take care of these pts cause there no beds IN the ICU.

maybe working in an out pt surgical setting may be good- those people usually are failrly healthy going in. I would do it, but I suck at iv's lol.

Altra, BSN, RN · Mar 12, 2012

Before you continue your Job Search in acute care (and you seem to have expressed an interest in critical care), it would probably be beneficial for you to wrap your brain around two points.

1. People are in the hospital because they are sick. If there was no dysrhythmia, out of whack lab values, infectious process or whatever going on ... they would be at home.

2. People code, and die. They do. Human mortality is 100%. People code on med-surg floors, in the ICU, in the ED, in the middle of Wal-Mart, and while sitting at home on their living room sofa.

Good luck to you.

diligent-trooper · Mar 13, 2012

Good luck to you too!

hiddencatRN, BSN, RN · Mar 16, 2012

I recently interviewed with a Nurse Manager of a medical-surgical floor combined with Telemetry. From what I gathered, these patients would be admitted with an acute/chronic condition related to the heart, in addition to another medical/surgical issue. I am fairly new nurse with one year's experience, and I am eventually wanting to work in one of the critical care areas (ICU, CCU.) I was willing to give this job two years, to gain telemetry experience with less critical patients.
A) Job description presented" "No experience is required, but 2 years is preferred."

Ok? They'd like 2 years experience but will consider new grads?

B) What are you looking for in a candidate? "Someone who has integrity/honesty, Someone who will be here everyday, on time. Someone who wants 'to do' the job."
(Code: Warm-body) These are nice traits of a hard worker, but will this ensure someone's success?

I don't get that from the quote. They're looking for desire and willingness before a skillset, so sounds like they are happy to train the right person for the job.

C) NM: "You will be given a 8 to 12 weeks orientation. You will work with the same preceptor throughout your orientation, unless they are absent. Then, you will be placed with another Nurse for that day." (Why would they not show up for work?)

Preceptors aren't allowed to get sick? Or have any personal issues come up within an 8-12 week period?

D) NM: "During your 8 to 12 weeks, you will complete the telemetry class. Upon completion of the class, you will have an examination. If you do not pass the telemetry examination the first time, We will help you to pass it the second time." (a...a.. do what?)

You don't pass the first time and they will support you the second time around. Perhaps there is extra support, perhaps the class is seen as a formality with your real learning to come on the job in real patient situations? They'll give you assistance and help you learn instead of just firing you?

E) NM: "I will not lie to you, this is a fast-paced floor." (what medical floors are not fast-paced.) Majority of the "day-shift" Nurses are having difficulty getting their medications passed on time." (Oh, that's bad!)

I know everyone thinks their job is fast paced, but to quote George Orwell, "some animals are more equal than others."

F) NM: "Nursing culture around here can present one with a challenge." "Night-shift nurses seem to assist each other, and support each other." "Day-shift nurses seem to not help each other out, and stick to completing their own work." (Great, new guy on the floor with no co-worker support.)

I'd want to follow up with this. What does the manager think influences the cultural difference between day and night shifts? Is it structural (day shift nurses pulled in more directions with all the 9-5 goings on making it harder to look outside one's own assignment), personality (folks who happen to work days just happen to not help each other out), experiential (is the average experience level different between the two shifts)? And then I might want to ask about openings on the helpful night shift.

G) For an entry-level person what acuity level should I expect, less critical?.
NM: "Oh no, you would have the same patient acuity level as the experienced nurses." "And, we get several admits during the day." 4 to 5 patient ratio. Total of 3 nurses on the floor. (Nice!)

After orientation I was given the same acuity assignments as the experienced nurses. You have a year of experience and are being offered a decent orientation. I don't think it's out of order to expect you to jump in and do the best you can do.

H) What is the Nurse retention rate for this floor?
NM: "Actually, it is low. Approximately, 26%.

This is pretty low. I'd want to hear what they said about reasons for this (is the unit a stepping ground to ICU? it it burnout? is it the aforementioned culture?). On the plus side at least they were open about it. Better to know than to be told it's low and find out after the fact that there are major issues.

I) What heart dysrhythmias are Nurses presented with on this floor?
(Are we talking afib?) NM: Oh, no... V-tach, heart blocks, anything, and we run "Codes" too! (Three Nurses on the floor, and 'we' run codes, with the combined Nursing year's experience around 10 fingers.)

Well, it IS telemetry.

J) NM: The Nurses do narrative charting at the present, but a computer system is on
the way..to do Electronic Charting- Maybe by June." (Critical patients, and the Nurses are still doing narrative charting...no wonder the Nurses are unable to complete their Med- pass on time.)

That's a bummer. Paper charting sucks and is so time consuming compared to computer charting (at least ime).

K) The unit also has 16 rooms with double beds. Total census is kept around 16. This enables the patients to have a "private" room. That is nice, but the work ergonomics is destroyed. The nurse is forced to walk a great distance between the 4-5 assigned patients, not congruent with time management. Then, if another patient is admitted to an occupied room, the nurse has to deal with the fall out of a disgruntled patient ." I WANT A PRIVATE ROOM!"

Eh. That wouldn't be a dealbreaker for me. Patients get ****** about the darndest things sometimes.

NM: "Would you be interested in this position?" ME: I think I will pass... where is the elevator, I am really distraught right now. Where is my truck, I got to get out of here!

Definitely a few red flags there for me, but some of the things you seem to be worried about don't sound that horrible to me. The biggest concern I would have is with the retention rate and the lack of teamwork on day shift. And perhaps there are issues on the unit that could be an opportunity for an up and coming nurse to be involved in fixing. I do like that the NM was open about those problems, and seemed to have a sense of the culture of both shifts.

Oy, I just read the rest of the thread. People shouldn't code on telemetry floors? Ok. Why do they need to be on telemetry if they're not AT RISK FOR CODING? And you want to do ICU? What kind of patients do you think you'd have on an ICU?

I think you made the right decision turning down the job- I don't think you would have been a good fit.