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Monday, November 23rd, 2009
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8:17 pm - about to become "one of them"!!!
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anghelmahal
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Hello to the most wonderful nursing group ever.
I am faced with a daunting event in my short nursing career. . . .the opportunity to enter management. I've been a nurse for 5 1/2 years and a hospice nurse for 2 1/2 of them. I was approached two weeks ago by our assistant director asking if I was interested in pursuing a job as nurse manager. I will be honest in saying that I had never considered it prior to that. It always seemed a job that everyone gets stressed out because of, and you are faced with inordinate amounts of needs with not enough staff to fill them, thus everyone becomes cranky. Not interested in cranky people.
However, I do have to say that the organization I work for right now is really exceptional at taking care of their nurses. I feel like our needs are really heard and that management puts forth a serious effort to support the staff and make sure we feel appreciated. I love hospice and I truly believe in the work that we do. I also think that the people I work with are really exceptional.
This doesn't mean that our organization doesn't have its shortcomings, just as any other place.
I interviewed for the position late last week and am currently waiting to hear back. It seems that the director and assistant director of the hospice feel that I have good qualities to be a nurse manager (something they told me outright). I feel a little nervous just because I'm fairly new to the field and am a fairly young nurse. I do think those two things can work for or against me, depending on how I choose to use them.
So my question to all of you cynics out there is. . . .for anyone in management, do you have any recommendations for getting into management, or suggestions for someone new to management? I don't want to become "one of them" as it were. And for seasoned staff nurses, what is something I need to avoid at all costs if I become a manager?
Thanks all :)
current mood:  content
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(11 comments | comment on this)
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| Wednesday, November 18th, 2009
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9:20 pm - Bugs
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pokygirl2001
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So we had a patient in who had a Dx of bipolar. Has medicare and Title XIX for his medications. Saw him on an emergency basis because his medical doctor was gone and Dr. 5 the internist was on call.
Well he has gone way, WAY off the deep end of the spectrum. He was seeing and feeling bugs crawling his body. He 'knew' sort of that it wasn't true, but on the other hand, he feels them! Help him!
He's been getting his very expensive fancy med for free out of sample supplies from a psychiatrist from who knows where who's now out of business. I don't know how long he was with this physician or if he's been off his meds, but out here there's a real shortage of psychiatrists. There is no local psychiatric hospital, and I don't think he wanted to be hospitalized yet in any case. The only psychiatrist I know who's less than a two hour drive away is a geriatric psych practitioner. But this (almost inappropriate referral) doc very, very graciously agreed to see this patient right away. Meaning the Monday following this incident. Which was pretty fair, considering.
Well, to try to keep this man more stable until he is seen by the psychiatrist, Dr. 5 prescribed him some fancy ass medicines. My co-worker then spent thirteen minutes and 37 seconds (after being on hold, dunno how long that was) actually talking to someone about getting his medications authorized to be paid for. Despite him being a danger to himself or others (that's what we told the Title or Medicare or whoever, he's not far from it), despite the fact that he is clearly going bonkers and in misery, despite having failed risperdal, zyprexa, and a handful of other meds, he cannot get his medication. Unfortunately we don't have the records to prove that he failed any of those things, because he isn't our patient. The prior authorization person even asked my coworker why we didn't just give him samples. Well duh, if we had some samples we'd have loaded that guy right up. We eventually got told that he had to get rispedal, zyprexa, etc, and take those and fail them now. Basically told a big fat 'NO' and given a list of medications that would be paid for, all of which he knows don't work well, but we can't prove it >.<. There would be no approving to, you know, keep him from getting more psychotic and maybe doing violence that makes the evening news.
You know, psychiatric care in this country is so shit right now. It's absolutely crazy. So right now he's running around unmedicated somewhere. HOORAY! How the hell do people in emergency rooms ever get any of the medications that are prescribed to them? Do ER nurses have to do prior authorizations or does the hospital pharmacy just dish it all out with a smile?
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(12 comments | comment on this)
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| Sunday, November 15th, 2009
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10:52 pm - What if
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stouthunter
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we were paid and treated like professional ball players?
Since the press is full of World Series, college football bowls, NFL yadda yadda I was imagining if health care were run like pro sports.
Just imagine if people who saved lives got paid like men who play boys games.
So:
Play by Play" Here she comes, She's got it, She's got it! OH NO! The bed pan's been Fumbled! It's all over! The E Choli's win the game on a last minute fumble at shi(f)t change!
Nurse managers become coaches:
"Hey coach, wuzzzz up!"
"I'm sorry Tom, we had to make room in the salary cap so you've been traded to the expansion hospital for two new grads, a fourth semester student nurse and a unit clerk to named later"
"but but"
"I know it's rough but the new hospital needed experience and at 19 years your salary makes it tough to bring in rookies. Our malpractice can cover their rookie jitters so we had to make space."
"I knew I should of become a free agent."
current mood:  silly
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(6 comments | comment on this)
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| Wednesday, November 11th, 2009
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8:11 am - The blogging patient
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darthtunaqueen
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We have a patient whose friends and family are blogging about his progress. So far they haven't mentioned the nurses hardly at all, but I noticed this morning that they had named me specifically. I don't give a damn about being named, because it was in response to how much they like working with me. But, the context in which I was mentioned made me out to be the doctors handmaiden. There was a situation arise where one of his many tubes (this kid had 5 different tubes on this particular day, this particular tube was an NG tube) was causing so much pain that he couldn't swallow or even talk anymore. Since it was the weekend, normally the team who deal with this weren't around, and the resident on call only knew this guy vaguely. I had tried a couple different interventions and nothig worked, so I chatted with both my charge RN and the resident about removing the tube, allowing healing time, and reassesing in the morning. It was my advocacy of this patient to get the ball rolling, but it's blogged as that I "pleaded my case" to the doctors... Um, ok. Anyone else ever dealt with a situation like this?
And we do like to keep an eye on whatever blogs patients use if it's a public domain to ensure confidentiality and that they're not defaming us, so it's common practice to scan them every so often. Frankly I wouldn't want to see myself or my coworkers get screwed because a patient was posting shit about us!! Anyways. Thoughts on the situation? Thanks!!
And happy remembrance day, too!!
Posted via LiveJournal.app.
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(9 comments | comment on this)
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9:51 am - Dear Dr.
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yurtgirl
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When you want to read progress notes on patient, why don't you sign in and read them online like the rest of us? When you ask me to print this shit for you, it takes away from my patient care time. My times is as if not more valuable than yours as I actually take care of patients and not just make judgement calls based on 5 minutes with them. Next time you ask me to print 25 pages of progress notes, I'm going to ask you, right in front of your fellows and students, why you can't log in and see it online to save us both time. I'm tired of your shit and so is the rest of the nursing staff. We all dislike you very much. And really hate it when you condescend us in front of your harem. You suck.
Sincerely,
me
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(3 comments | comment on this)
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| Tuesday, November 3rd, 2009
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7:30 pm - EHR
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pokygirl2001
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We are switching now to Version 11 of our electronic medical records system. I was really, really hoping that things would be better on this system but I think we've taken a giant leap backwards.
Dr. 5, the internist, is a very proper, strict, fussy sort of doctor who's very careful about what he says and does around his patients and the staff. Today he was having an argument with the EHR representative who was trying to convince him that he had no choice but to convert to the new system and that his job would be in jepoardy. Dr. looked straight at her and replied "Then they can bite my ding dong and fire me." I really needed that laugh.
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(4 comments | comment on this)
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| Tuesday, October 27th, 2009
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10:02 pm - wtf?
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yurtgirl
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so, is it really possible to have a patient on hospice w/ a trach/vent, a gtube w/ tube feedings and IV antibiotics? am i missing something here? if so, can someone please point me to the real hospice unit? thank you.
also, he keeps asking us to turn the vent off but his wife won't let us.
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(6 comments | comment on this)
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| Saturday, October 24th, 2009
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9:30 am
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dirtylittlefly
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The past few days I've had a patient about my mom's age with terminal cancer that will kill her much faster than thought a week ago. Her daughter is about my age, shares my name (right down to the "correct" spelling), is about to start nursing school where I graduated, and has such kind eyes. She is dealing very well considering. I really hope her mom makes it until Monday when she's supposed to go home.
I cried on the way home & this morning I called my Mom to tell her that I loved her. ;(
I don't usually get too sad about these type of patients- and generally I just feel relieved when they finally pass. But this one...this one was a little too close to home. Hopefully next time I'm confronted with a situation like this I can still give the supportive care that I love but keep my head on straight about distance.
current mood:  depressed
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(5 comments | comment on this)
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| Thursday, October 22nd, 2009
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12:19 am - Bitchy McGriperson, RN
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dancingstrength
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Don't get me wrong, I know I'm lucky to have a job. Home Hospice care, in my limited experience, is an extremely rewarding field. I love the very personal level of care. I also know that after completely fucking my world a month ago when my manager quit, by changing my job description completely, having both of the RN's I started with quit since then, as well as the loss of two more RN's, who had been with the organization for a few years, I am seeing that something is not right in this company.
I went from having three patients (I was still orienting to the new position) to having 10 when one of the older nurses left and I picked up her assignment. I was told that I am going to have to train to take palliative patients as well as hospice patients. After telling me I would have a month or so to acclimate to having a full assignment, they set up palliative training for the following week (I told them I wasn't ready and had been counting on the time promised to get used to having a regular case-load). While I was out sick with flu-death last week, I got TWO admissions. One of which was palliative (uhm, I said, no, kids, but if you're cool with getting dinged by Joint Commission because my charting sucks - I'm not trained to do it yet, after all, ok)...But that's not the worst of it.
The acting manager of the hospice team, the VP of the organization, who I liked quite a bit when I first met her, has taken to complimenting my good work. During which, she will manage to throw in some back-handed bullshit about how "people like me" (type A / perfectionists), don't tend to last very long in this field (home care). Or, I should be careful not to take on too much at once (!? - like, tripling my case-load over a WEEK-END, you mean?). That I should leave the psycho-social issues to the chaplains and the social workers (so, I'm supposed to interrupt my patient / family member in the face of dying, while they're giving me information that's going to help me provide care for them, and tell them I'll have a social worker come see them? Seriously?). Come on.
I am beginning to think the digs on my work style are a lame-ass attempt at reverse-psychology. How do you get a type-A personality to work themselves to death? Tell them they aren't capable of doing something. I'm a perfectionist and an idealist, not a moron.
It's time to start looking for employment again. Before I hate it so much my quality of care suffers. Damn it.
After 10 years in the medical field, I am starting to wonder if it's where I really belong. My idealism, empathy and desire to help others seemed a perfect fit in nursing school. But theory is often so different from practice. Is there a happy medium?
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(11 comments | comment on this)
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| Tuesday, October 20th, 2009
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1:10 pm - Just when you think you've seen it all...
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dirtylittlefly
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Super old male patient in his on comfort care but still alert and oriented most of the time. Turns ok but can't get out of bed. Wife is a retired RN who is also super old. Hubby hadn't had a BM in a few days and decided to try so we put him on a bed pan. Naturally, I said "Call us when you're done and need help." Call light comes on about five minutes later and I answer the phone.
Sidenote: I hate those damn intercom call systems. Lights might actually get answered and my co-workers might actually take care of a minor issue if they were forced to walk into a patient's room. That, and half the time you can't understand what the patient's are saying and you have to walk in the room anyway.
This time however, I could understand her perfectly- yet hoped I had misunderstood. I answered the phone and clear as day I hear a female voice:
"Yes, I got two hard chunks out but I can't reach the rest. He needs a suppository."
8O
After talking to a co-worker, gathering my composure, and grabbing some biscodyl, I walked into the room. Sure enough, there he was- on his side with his loving wife up to her wrists in poo. And yes, thankfully, she was wearing gloves. Her response to why she took it upon herself to disimpact her husband? She knows we're busy. Up until this point I had been called into the room every hour or so for water, pillows, position changes, etc.... (which I don't mind at all) yet of all those things she picked THIS to do herself?
Bonus: I got to write a fun progress note in the chart about the "incident" and the following education on staff availability to assist patient with ADL's. I pretty much had to what with the risk of bowel injury from "digging for gold."
Which leads me to the question: How old will you be when you do this for your husband/miscellaneous family member? This couple had likely been married for 60+ years. Nurses I've found go either way.... they either jump all in with their family member and do everything- or they go the opposite because they care for people at work- not at home.
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(7 comments | comment on this)
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2:16 am - online applications: FAIL
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yurtgirl
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Geez,
I just spent 30 mintues filling in an online application. The application itself wasnt' bad but the "required" survey at the end was a killer. Of course, I answered the questions they way they should be to make me seem like the best employee ever.
For example:
When it comes to dealing with bodily fluids:
I prefer not to deal with them
I don't like to deal with them but know that it's a part of the job
It doesn't matter to me either way
I refuse
So, would any nurse in her right mind say "I refuse" and expect to get the job? just asking.....
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(4 comments | comment on this)
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| Monday, October 19th, 2009
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7:50 pm - Letters not written
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tudorpot
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Dear patient,
Your call to tell me that the cream, I suggested to heal the skin on your leg which looks like this (not too icky) , cost $10.00 was a poor use of my time. You buy organic everything, surely you can splurge and buy a product that is not mostly water. In the long run it wil be cheaper.
no love
Dear Nursing Home Director of Care,
Your policy of not allowing portable infusion pumps, creates the need for two visits every day for seven days instead of one. We have 90 year old's living alone who manage quite well with them some for several weeks. So why can't your well paid nurses take on the responsibilty of callling us if there is a problem. We aren't asking them to manage the infusion. There are only so many home care RN's and we are only paid $1.00 an hour more for going out after hours. This nurse is not going.
no love
Dear Fellow Home Care RN,
Why do we get paid the same? Our job description calls for the ability to start an IV. You won't even try. You have not done anything to develop your skills. It really burns me up to see that a patient has missed two days of IV therapy because of this. So when you call me to go and do a visit that was assigned to you because an IV is needed, I'm not going until you have at least tried.
no love
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(comment on this)
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| Thursday, October 15th, 2009
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9:58 pm - Still a tech, w/ an RN license
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yurtgirl
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so, I graduated a while ago and got my license in August. I am working as a tech, where I've been for 4 yrs while in school. I cannot get a nurse job in the big company i work for. they have 3 hospitals and numerous clinics in town. I have had 6 interviews since summer and still can't get a job. HR rep said I need to sell myself better. During my review last month my mgr asked how the job hunt was going as "they" would probably only give me 60 days or so "working as a tech w/ a license". WTF? are they gonna fire me as a tech if i can't find a nurse job?
I have contacted 2 HR reps in teh past week and no return emails or phone calls. I don't want to leave my company as I've been there 4 1/2 yrs. I kinda wanted to stay with them for a while.
My manager said she is giving me excellent references so I don't konw what the problem is. I always get the same, "they found someone else that fit the qualifications better". Most of they jobs I apply to want experience and won't hire new grads. Im about to go postal but thought that might hurt my chances. haha
anyone else out there know any new grad nurses who can't find work?
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(27 comments | comment on this)
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| Wednesday, October 7th, 2009
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12:36 pm - I learned today......
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yurtgirl
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That I cannot get a suppository in with my left hand and the gentlman with alzheimers who received it didn't like me going there. The joys of being a new nurse.
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(4 comments | comment on this)
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| Sunday, October 4th, 2009
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11:27 am - ~trauma~
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| Friday, October 2nd, 2009
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1:23 am - What your ER nurse REALLY thinks...
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| Tuesday, September 29th, 2009
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10:01 am - Life is cruel
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| Wednesday, September 23rd, 2009
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5:14 am - Dear God what did I get myself in to?
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dirtylittlefly
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Our Med/Surg floor is splitting next week with the expansion of a new floor in our hospital. Surgery will be going up stairs while Medical is staying put. I decided to stay downstairs but make the switch to days to liven things up a bit. I feel odd saying this; but even though our patient population is diverse I'm getting really bored with my job right now. I figure day shift alone will be like a completely different job and I'll learn a lot more.
Our manager is also going upstairs. Overall he's been great but after he didn't work towards getting me the raise I was promised last year I've been more than a little bit disappointed with him. But, he thinks I'm awesome and has rarely said no to any other request of mine in terms of days off/FTE/shift preference. For that reason, I've bit my tongue so I can continue to use him for a reference in the future. Also- he has managed to communicate my awesomeness to our new manager- a woman I've barely talked to but seems competent and nice enough. It's weird though because she acts like we have this instant buddy relationship and she makes it obvious to other people what her opinion of me is- today she called me: "the Queen of Quality" with this swooping motion of her hand. This bugs me for 2 reasons: 1- I've never really figured out what to do with a compliment. 2- The last thing I want is for people to think I kiss her ass.
With the split our Shared Governance Council is also separating- a welcome change several of us have been looking forward to. While it's nice to have a say on unit-specific policy, a lot of us have become burned out. The 2 hours of extra pay each month does not typically cover half of the amount of work you put into it. However, since the "divorce" from our more catty surgical counterparts- a lot of us have felt somewhat renewed and re-energized.
So today at our first Medical SGC meeting, positions were redefined and I was chosen to be the new chair. Which I don't really mind taking on since no one else wants it. I really enjoy the idea of policy being developed at the bedside- where it should start. At least for me, it's hard to wrap my brain around doing something Corporate says you need to do because of a new policy that was developed by someone who hasn't touched a bedpan for 10 years, if ever. We're nurses, we've gone to school, we can read research articles- we have the ability to say what's best for our patients and implement new policies. Why not? This is the direction I see for us in the future. We've already had a major impact on the entire organization with our last project. Part of the burnout we experienced was due being forced to preach some of our old manager's causes which trickled down from corporate and to me it was such a waste of time. The most effective things for us to work on are the things that we ourselves are passionate about.
But- everything has it's price and this extra position comes with mandatory hospital wide meetings on corporate BS about what they think is best and how important it is to improve customer satisfaction and YaDaYaDaYaDa. As if that wasn't bad enough there needs to be presentations every so often on how your unit is implementing said BS and the outcomes. At first I didn't mind the idea of going to these things to hob nob with big wigs... but now I'm afraid I'll be forced to preach their cause. Ick. The thought makes me nauseous. I just want to help my floor be better, improve patient safety and empower my fellow nurses. Why does the man gotta hold me down?
current mood: drained
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(2 comments | comment on this)
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| Monday, September 21st, 2009
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9:31 pm - you know it's gonna be a good day when....
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yurtgirl
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your first patient conversation starts out like this:
me: so, how did you break your arm?
him: beating on people like you.
and then the day ended with moving a patient to another room becuase the bedbugs came out of the couch and crawled on the visitors. i even got them on my trying to move it out of the room.
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(2 comments | comment on this)
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| Thursday, September 17th, 2009
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11:12 pm - Woooooooow
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pokygirl2001
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Just saw a guy's leg today that totally blew my mind.
He's a long term very uncontrolled diabetic, big guy, six foot 300 pounds, you can probably picture him. Showed up one night at the ER with his leg swollen and red, tight, no wound to drain it or anything.
Well he got packed up and sent to the university hospital and today I saw him at the clinic. They must of thought he had necrotizing fasciitis or something because his skin is GONE. From mid-thigh down all the way to his foot is nothing but a big red expanse of musculature.
It's swollen to about three times it's normal size as well, and there's.. well I dunno what they are! Looks like little tumors poking out all over, maybe it's fascia full of fluid?
But wow. I will not be forgetting that leg for a while!
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(comment on this)
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cynical_nurse