As health care professionals, we have a first row seat to the drama as it unfolds.  We know the stories of patients who have insufficient or no coverage.  Who have not received the care they needed because it was too expensive.  Who don’t take their prescribed meds for the same reason.  Who are denied coverage because of a pre-existing condition.  We also know the stories of the doctors, hospitals, and clinics who can barely keep their doors open because reimbursement is so terrible.

It’s a mess, everywhere you turn.  Unless you’re the CEO of a big insurance company.

My goal for this post is not to tell you what I think about this topic, it’s to hear what you have to say on the issue.  It’s each of our jobs, as nurses and as health care consumers, to stay informed.  The problem is, it’s hard to feel informed if you have to count on the media to give you the information. 

Maybe we can help each other get a handle on this important conversation by sharing our knowledge, questions and ideas.

So, tell us what you think.

I, on the other hand, am not panicked.  I am annoyed.  The phones of every doctor’s office in the country, and possibly a few other countries, are ringing off the hook.  Every person with a fever, every kid with a cough, every kid who sat next to a kid with a cough: They are all worried to death (or at least their mothers are) and looking to the medical profession for answers.

Unfortunately, the answers I want to provide are sarcastic.  “Do you know how many people die of influenza every year in the US?  36,000!  And do you know how many have died of H1N1 flu in the US so far?  One!  That’s how many.  So go home and take some Advil, get some rest, and drink plenty of fluids.  Trust me, the chances are pretty good that you’ll live.”

Fortunately for my patients, I never actually say what I think.  It doesn’t actually matter what I think.  What matters is that people are scared.  My job is to care for them.  In part, that’s relieving those fears, but it’s never dismissing them.  The term pandemic is scary.  It causes a low-level hysteria that rapidly grows into a high-level hysteria as news pundits discuss it day after day.  I can share my personal opinion with friends, but not with my patients.  I have to handle each person and each concern like it matters to me.

My best friend is an advice nurse in California.  She told me yesterday that they have received thousands of calls in the last couple weeks about the Swine flu.  The other day they were 6 1/2 hours behind on answering calls.  Of course, people were calling with “normal” stuff, too.  They also had to wait to be called back because of the flu calls.  It’s completely overwhelming.  But one call at a time, they go through the protocol, giving advice, making appointments as needed, and talking people off the ledge.

I guess what I’m saying is that it’s okay to feel frustrated about stuff like this, it’s just not okay to show it.  At least not to our patients.  They deserve to feel like their illness, real or perceived, is important to the ones they have entrusted themselves to.

Their relationship was close, and rightly so.

At work, the emotional bond between this man and this woman grew.  Before long, it appeared closer than the bond each had with their respective spouses.  Then it happened.

One wanted to take the relationship to the next level, a physical level-but the other did not.

The nurse who refused the relationship divulged everything to the spouse at home. The guilt was enormous, and animosity between the two at work grew.  Soon management entered the picture.

Even though nothing had occurred at work that would have been perceived as inappropriate, management asked the nurse who refused the overture to move on from their position.  All the while the other nurse involved kept their position.

How is this right?

If both had engaged in something physical at work, obviously they would have both been fired.   But their work was never a factor. Why was one nurse-who seems to have made the right choice-forced out while the other was allowed to remain?

Ethically, what do you think should have been done in this case?  Has your unit faced a similar scenario? How did your management respond? How did you respond?

I am really struggling with how to deal with some of these difficult patients. I just cannot understand the nerve of some people! Just last night, I was discharging a patient and the curtain wasn’t completely closed. The wife of a patient from the room next door peeked in and told me she was going home for the night.

As she began talking and asking for help, I interrupted her and said, “Excuse me, ma’am, but I’m with another patient right now. Please ask one of the other nurses for assistance.”

I have even had patients’ families actually come into other patients’ rooms while there is a code situation- or while I am doing CPR-and repeatedly ask me for pillows, test results, food trays, etc. How do people not understand that we’re in the middle of something?

I have struggled with trying to be polite, but I think in a way that only will encourage this behavior. I just don’t know how to be assertive without getting so upset at patients and their families.

I am an RN who has been licensed since 1990. In 2008 I got arrested for petite theft, a Class 2 misdemeanor.  I went through pre-trial diversion and later had my charges nolled processed.

I researched every day for hours trying to find peace of mind that I would regain my license.

I moved from Florida to Arizona and applied for an Arizona license. I self-reported the arrest to the board.  I was worried for months.  I had to send in the arrest record and all the court depositions; I even had to meet with a board investigator.

I was so scared and stressed for months.  I even took a voluntary drug screen for the board.

Let me tell you some good news: I got my license in Arizona with no discipline, but it took much longer than it does for most (4 months).  Follow my advice, don’t lie to the board! If you don’t self disclose then you violate the Nurse Practice Act and will at minimum get a civil penalty; this is a discipline against your license.

Always cooperate with the board and be honest. It may work out for you like it did for me.

1) Always be the needy one. If you’re always the one needing help with getting everything done and never offer to help someone else, the other nurses will eventually resent you.  Now, that doesn’t happen right away. New grads will always need help, and that’s fine.  But as soon as you have a spare minute, don’t keep it to yourself; offer it to someone else who may need a hand.

2) Don’t own up to a mistake. If you mess up, AND YOU WILL, confess the problem before someone else brings it up.  A good learner recognizes a mistake and takes responsibility for it before it’s called to their attention.

3) Get involved in the drama. Once you’re in, you’re in, and it’s very hard to extricate yourself.  Just try to avoid getting involved in whatever soap opera of the month is taking place.  Don’t comment on it.  Don’t ask questions about it.  Don’t go to lunch with the people involved in it.

4) Externalize. Do you know the kind of people I’m talking about?  The kind who always blame all their problems on everyone else.  They never take responsibility for their own stuff, be it time management issues (”I got caught by a train!” “So-and-So needed help, so I couldn’t get my meds passed on time”)  or relational issues (”The charge nurse has it in for me,” “The PCTs are never helpful with my patients!”), or nursing skills (”That’s not how I was taught by my preceptor,” “The patient wouldn’t let me”).  Just be responsible for your own actions, behaviors, and words.

5) Talk about other staff behind their backs. Do I really need to say anything about this?  It will ALWAYS come back to bite you.  Just don’t do it!

6) Cop an attitude. As a new grad, you need to be confident yet humble.  Nobody likes a newbie who thinks they know everything.  In fact, nobody likes a seasoned nurse who thinks they know everything either.  Acting like you’re better, smarter, prettier, or anything else that ends in “er” is just plain annoying and will put you on the hit list.

7) Stop learning. This is as much about you as those you work with.  It’s not good all the way around.  You’ll stop liking what you do if it gets boring.  And it will if you stop learning.  Always be on the lookout for new things to learn.  Read the journals, take classes, volunteer for committees, ask the docs questions.  It will not only make you a better nurse, it will make both your job and you more interesting!

Now, I’m sure there are a hundred more ways to ruin a job; these are just the first I thought of.  What are some others?  Do you know from experience?  Personally, I’m trying out number seven at the moment.  I haven’t stretched my brain at work in a long time, and my love for the job is waning.  Frankly, I’m bored.  I’ll let you know how I work this one out.

In the meantime, fill me in on your ideas of ways to ruin your job.

It wasn’t until I worked all night with any EXTREMELY agitated RN that I realized how MY bad mood affects everyone I work with.

It was so contagious! I came in to work in the ICU that night in the BEST mood. I was happy and excited about tackling my shift and ready to start the night! Then….she walked in. She came off the elevator griping and complaining. And it continued all night long, accompanied with negative comments directed at co-workers, snide remarks under her breath, and a constant state of negativity on her face.

Pretty soon I found myself being negative. Eventually I talked about this wonderful nurse with other co-workers. Negativity had really sunken its nasty claws into our team that night.

I understand fully that she must have had some underlying problem eating at her inside that she didn’t share. But then I also realized that I had been like this a time or two, too. I have personally apologized (privately of course) to several individual staff members for the negative vibes that I know I have given off in the work environment.

The point I am trying to make is that even when your home life is crashing down, at the point you enter the doors of your job you must pick up the pieces, put your “big girl panties on,” put a little sunshine on your face, and set out to be positive and upbeat for however many hours you have to be there!

It is no one’s fault that your world is collapsing, so don’t make them pay. You’re not only hurting yourself and how others see you, but you are also affecting the attitudes of those around you.

Your attitude is contagious. Make it a good one!

The head nurse was one of those power-hungry, self-important people who used her position as a stepping stone, not to improve the unit. One nurse – who graduated from nursing school six months before I did – seemed charming and welcoming…at first.

As time went by in those early months, the head nurse was demanding and would dress you down in front of everyone if you didn’t step up your game. It’s kind of difficult to do that when you are the least experienced person on the team with the most difficult assignment on the floor!

But, she left for another department, and our next head nurse was a great advocate for our team and made many positive changes. I felt I grew as a nurse; it was a positive experience with her at the helm. Unfortunately, she left after having a child and another head nurse came on board.

The next head nurse was a nice person, was a year ahead of me in nursing school and everyone liked her. However, she was NOT management material. She would pander to both sides of the fence (her staff and her superiors). I did not feel supported or encouraged and found it difficult to have any respect for this person in her position.

As for the “little darling” who was on the floor when I got there – yeah, sure, she was fun and exciting and pretty darn smart. But watch out: if you out-shined her in any capacity, you had to watch your back. She was the one who got all the rich patients, barely showed up in the poor patients’ rooms, and was the master at back-biting and sabotage. She got me one time by calling me hours after my shift to let me know that I did not take any care of a person all day that was on my assignment. I could swear that person was not on my assignment. When I got in the next day I looked at the assignment sheet (done by hand in pencil); sure enough, the assignment had been altered and that patient’s room number was under my name. Hmmmm….

When that person left to go to an outpatient department, and her little shadows went to other facilities or departments, things brightened. I was told I was one of the best nurses on the floor, was sought out to preceptor senior student nurses, assisted w/ administrative stuff, and mentored new staff/agency workers. My confidence soared.

But, it was painfully obvious in that facility that the only way to better your position was to be someone’s pet or leave all together. It wasn’t what you knew, it was WHO you knew that got you a place in another department.

Unfortunately, I left that facility because I cried when I got up to go to work, cried when I was at work, and cried when I got home. I was no longer effective. I now work for a major health insurance company where nurses are a valuable commodity—and opportunity abounds.

As for nursing being a “profession” – it is a profession. It’s just dragged down by those who act in an unprofessional manner. I wish they’d grow up and get a clue!

One issue: They feel insulted if I ask them if they did something. Of course I trust them–I’m just checking because SOMETIMES (especially with my post-op patients who need vitals a lot) things get left undone/uncharted. And that reflects on ME.

So I check nicely. One of these PCTs told me that it did not matter how nicely I asked. It was that I asked at all.

Another issue: When a pt needs medicine, they come find me and tell me and I appreciate it. But if a pt needs to be changed and another pt is crashing on me, or I just plain need help changing the pt because they are heavy, they feel insulted. Like I feel such work is beneath me and I expect them to drop what they are doing.

I clean up plenty of poop and feed patients without ever bothering the PCTs. Don’t they WANT to know what is going on?

They say, “Don’t you trust us to make our rounds?

I want to say, ” Well, yeah, but you can’t catch everything on a round.” But I can’t say it because I don’t want to seem like an arrogant new grad.

This hospital has a very high new hire turnover rate, and we already had a new grad on this floor quit after only three or four weeks on orientation. The hospital is always having me meet with people who ask what they can do to keep new graduates. But I really can’t say that you need to ask your PCTs not to say things like “You would never make it in a big city hospital,” or “If you need that much help, you can’t handle your patient load so you should work somewhere else.” Coming from someone who could be my mom, it really hurts.

Not sure: Am I doing the wrong things? Is it that I am young? New? White? (Both these PCTS are African-American.)

One of the most important things to remember is that there will be at least one person who you will annoy no matter how hard you try not to. Accept this fact and move forward.

Smile, extend a hand to greet your new co-workers, and be warm and friendly. Most of all, be yourself. Don’t try too hard or put on a fake smile, but be genuine. You will be nervous, so try to manage nervous habits, such as giggling until you snort. Relax. Relax. Relax.

You will never have another chance to make a good first impression, so do all you can to demonstrate professionalism.

Although the established nurses should be grateful for a new staff member to help assume some of the responsibilities, many are concerned the new nurse will mean even more work!

Stereotypically, the older staff members are usually tagged as the most difficult to build rapport with. Today, these are the Baby Boomers. Many are approaching retirement and have lived through many nursing shortages, but none as severe and challenging as the present one.

Older nurses typically will be more set in their routines and ways of doing things. The young new nurses come with their fresh energy and idealism, ready to change the world. The differences can be startling.

So how do you build rapport with other nurses—of all ages and backgrounds?

• Be a professional from day one. Don’t be a burden and make more work for the staff to have you there.
• Be punctual. That means be ready to work when the clock strikes the start of your shift. Work your assigned shifts; don’t call in sick unless you are sick!
• Be well groomed. How you look is important. You must be neat, clean, and look like a professional.
• Be prepared. Make sure you have a PDA or notebook, the appropriate colored pen that works, scissors, a clamp, and a penlight.
• Pay attention. Learn quickly where the basic necessities are and how they work. These include the linen closet or cart, the crash cart, the medicine cart, the narcotics, the pharmacy, central supply, the kitchen, the nurses’ station, and the charts.
• Ask for and offer help. When you need it, don’t be afraid to ask for help. And don’t forget to offer to assist the person who helps you. Remember, if someone has to stop and help you, they will get behind in their own work. Be prepared to proceed when the other person is ready to help or supervise you. Have your supplies ready. Know the steps and rationale. Have the patient mentally prepared.
• Don’t leave your work undone. Get your own work done and don’t leave it for the next shift to have to do. If you’re overwhelmed, speak to your supervisor and get some help early on.
• Absorb on-the-job training. Older nurses can be a wealth of knowledge and expertise. Don’t ever assume they know nothing because they went to school a hundred years ago! They usually know what you know–and how to do it better and more efficiently.
• Don’t engage in gossip. Listen politely, but make it clear you are open-minded and will form your own opinions. Respect your co-workers and command your own respect in return.

A few more quick tips include: Don’t brown nose. Don’t point fingers. Take responsibility for your own actions. Be a good team player. Expect that you’ll get stuck with the worst shifts and work the most holidays until you have a little seniority.

And lose the line, “This is the way we did it in school (or at my other job)…”

Then smile–and always say, “Thank you!”