Slackers: The Ethical Divide of Nursing

The ethical divide between professional nurses with morals and accountability, and the others, becomes clear just as soon as a newly qualified student nurse becomes a professional. As in many occupations, nursing has its share of sour apples. And, as in many professions, some employees work to find a way around the system. Some nurses commit timekeeping violations. Others goof off and text on the job. Some chat too much with other workers, ignoring monitoring and auditing tasks. Slackers send a message that nursing is not serious business.
Sooner or later many nurses developed a career path. Many nurses begin with small slips, like writing inaccurate representations of events to favor their colleagues. And some others gang up on certain patients, to teach them a lesson. it’s human nature in some people to become predators against others and take advantage, but better nurses withstand the temptation to abuse those vulnerable and in their care.
Many times advisors and instructors will stress the importance of contacts within the industry and joining new network of friends. But this can backfire. Nurses cherish the bonds of friendship between each other, and sometimes too much. Would a friend ask you to risk your license putting false paperwork into a patient’s chart? Would you report a friend who removed records from the chart and shredded them? Would you realize if a future supervisor didn’t hire you because they remembered the deeds of a nurse clique or “posse’ you used to be with in the past? Being able to choose the company you keep may be the last true luxury nurses have. You may pay a price in the future for fun times today.
Nurses starting their first job take their license as proof they have studied hard, mastered all materials, and learned the necessary techniques and skills to provide positive and meaningful care to benefit all patients. Yet after a while, newly licensed nurses will start to notice something. Not all nurses share their same commitment. Some are lazy, some never finish the job right, and some just find ways to do things that are sloppy and incomplete. Every nurse must find the way they choose to deal with this.
Some nurses view a nursing job as a part time paycheck an avenue to another career. They want to be an actor, or an artists, or even have another job. Maybe they found their way to nursing through family connections and it didn’t seem all that hard to do. But they really don’t like the work, and they don’t mind if it shows. These nurses use their phone a lot when they are supposed to be working, and spend a lot of work time goofing around, looking at take-out menus or chatting with vendors and providers who come by to visit. But the medical world does not smile on this kind of slacking.
This kind of nonchalance leads to many nursing errors, such as too much or missing medication, skipped insulin doses, erratic chart-keeping, and missed shifts due to inability to copy the schedule. These type of employees perhaps showed more promise once upon a time. And many facilities can‘t afford to let such nurses go because a shortage of qualified and experienced nurses keeps them reliant on current staff. They arrive at work and hang out, looking for ways to skip the work and get coffee, hide in closets and rooms to talk to others, and just hang around.
Usually for nurses like these, the big attraction to coming to work is to socialize with the people working there. This can be a problem, because the bonds between nursing co-workers should not be more important than the professional commitment as a provider. Often, many nurses can prey upon the weaknesses of others. They can use peer pressure to cause one nurse to treat a certain patient or even a co-worker nurse badly or with disrespect. This is slacker peer pressure.
Yet so many nurses convince themselves that coming to work late doesn’t matter, that calling in sick for entertainment and social reasons doesn’t help co-workers, and that unclocked breaks just don’t really count as infringements. These types of nurses can contribute to an entire downturn in morale, because nurses working hard observe their peers slipping by with doing much less. Why should work hard, a nurse might say to themselves, when if ‘so and so” was here, they would just watch the clock until the small hand clicked at the top?
Sadly, many types of people use nursing to abuse the system. The steal medications, overcharge insurance companies, send false bills, and sign invoices for amounts of supplies much larger than what was actually used. Nurses may not realize that when they are asked to sign a bunch of audits, or when other staff convince them to sign many orders the did not witness or to even file papers in the chart that are not legitimate, they are risking their license. And showing new nurses whom to trust on the job is not something you can teach in a textbook.
Insurance fraud usually starts in small to medium sized businesses where slacking off and discovery of errors puts some people at a disadvantage. A nurse who has noticed a serious error made by one of their co-workers can choose to report it, or instead leverage this information for better shifts, a raise, or even a promotion. Nurses should be vigilant to review their state nursing board website and keep updated on the regulations governing their license. Maybe some employees notice that an employee takes off work an hour early every day their manager is not in the office. A new nurse trainee observes that not every staff member has t clock in and out per timekeeping regulations. Maybe they notice that the physical therapy staff bill for more sessions with their patient clients that actually occurred. Any omission of reporting such things can build a situation where nobody has ethics and finally some incident brings the whole situation to light. And at that point, nobody is a winner.
Many slacker nurses or people who are just too burned out to care adopt a philosophy of “say nothing, do nothing” at work. They think this keeps them free from blame when situations arise on the job for nurses to commit dishonest acts or abuse patients. When the nursing employees have this many compromising issues on the job, the patient care comes second. Soon, going to work in really a tripwire into unethical behavior that could lose them their job, let alone their license. And many nurses later confess to horrible infringements of patient rights simply because they got strong-armed on the job from the director of nursing or the administrator.
It is so much easier, in nursing, just to keep a clean slate and make sure that the nurses you choose to associate with are the one most admired and emulated by all. The nurses with authority are the ones who should provide a leadership example for everyone. As a new nurse, any nurse who questions why a felow employee is performing a certain action or declaring certain statements or giving orders, should be vocal to their superiors about just what is going on. Just the knowledge that one person had noticed this might be enough to form a correction plan and sever “bad apples” from a healthy tree.

3 Myths About Long Term Care Nurses

3 Myths About Long Term Care Nurses

1. Nurses Have Adequate Training

Low cost nursing homes typically hire new grads for nurses with no nursing experience. Fourth-rate nursing homes will hire at the lowest pay possible, guaranteeing only nurses of very little upward mobility will fill the position. In many cases, new nursing school graduates have very little experience and little to no maturity as a practical nurse. Young nurses are very dependent on community standards and peer advice in nursing situations, most of which they have never faced before.

Patients who want good nurses or friendly nurses usually get dour, overworked, non physically fit or otherwise employed nurses looking to fill their time with shifts at the lowest possible end of the labor spectrum. A low cost facility looking to shave every nickel will not hire any nurse with long term records of gradual pay raises and salary increases. Not only do many new hires have little to no experience with any job, their practical nursing experience may be limited to a textbook or a private nursing situation. These nurses lack even a modicum of case history

2. Nurses Are Adequately Rested

Many nurses and nursing assistants routinely work double shifts and overtime as a matter of course. Since many low-rent long term care facilities save every dime, they will likely not pay overtime if an employee waives their requirement. If they want to keep their job, they will likely waive the requirement.Older nurses may have physical impairments that prevent them from sleeping or moving about at work except for slowly.

Many nursing facilities with poor records and many validated health department complaints will simply not be able to hire anyone because the hiring pool has no individuals willing to work at such a place.

Often a low-rent nursing home will not want to risk “new” people without proven loyalty (slavery) to the current administration. Such facilities will not place paid ads or even list the openings at the employment development department, because of the current claims of abuse, poor management, physical abuse, and overwork attested to by previous employees.

Nursing homes running at a low ebb will only find labor outside their desired low-cost zone, or not lacking enough in experience for their needs. Such nursing homes do not want any more whistleblowers and use “short-staffing” as an excuse simply to not do any hiring. Hiring and training takes times and money, and drains effort from already overworked resources.

3. Nurses know how to function in a working environment

Some of the growing pains a first time nurse has on the job is growing accustomed to work. Many younger nurses may not have held other jobs. Without experience getting through a work day, domes nurse may become irritable and patient. They may never have had to put in a full day delivering services to anyone.

Functioning as a full time nurse for the first time can be daunting enough, but learning new skills, new patient cases. and how an office works can make them face all the things they don’t know how to do.Working a fax machine, computer, copier and printer can make the day ho much more smoothly. Learning how people work together may be the biggest shock of all.

When Nurse Training Fails

Nurses lacking training dealing with general population, the public by phone, patients specifically and staff can lose their performance rating or even their jobs by letting their “slips show”. There are some examples where proper training, research and learning might have saved the day. In many cases the motivation for a patient to care for themselves and look forward to recovery can be affected. Assertive nurse supervisors may care to review the following real-life scenarios.

1. Proper Device Maintenance

Recently a patient approached the ward office and asked for a blood sugar reading. But the patient was made to wait 45 minutes while the lost battery to operate the device was found. But it was never found. A line formed in the nursing area while the incompetent nurse floundered around asking other nurses what to do. The nurse responsible could not make the blood sugar machine work because they did not know what a “C” battery looked like. This is evidence of lack of training.

They didn’t know how to replace the battery. They didn’t know how to find a new “C” battery, replace it in the device, and return it to the ward counter. The patient stood there in shock. No other nurse could do it either. The blood sugar count machine, the reason for their admission actually, was never derived upon discharge because the nurses were not sufficiently trained to replace a required battery in a critical piece of hospital equipment used on the recorded vitals for every single patient on the ward.

True Story. They couldn’t find the key to the room with the battery in it. The nurse went twice to the room but could not identify the correct battery. The nurse got bored attending to the task and went off to do something else..

Now, imagine you are the patient. Is this chronic ineptitude at a crucial moment? Poor nurse training or laziness? Or merely habitual inattention to detail that costs a patient time and energy? These things matter. Proper nurse training is a needed element for contemporary hospital care that patients need.

2. Backing Up New Admissions

Emergency rooms all over the nation are overfilled. This is due to administrative shortfalls in overall hospital design and throughput which cannot be addressed fully in this arena. Yet the only route almost all patients have is through the Emergency Room, and through general care and primary care admissions to the a hospital or wards. Nurses must process these admissions. Nurse without proper training and support to do the best job possible do a disservice both to themselves and others.

Unprofessional nurses stave off new admissions because they are lazy and do not want the additional responsibility. When an administrator calls the ward to see if they can accept a new admission, the charge nurse must assess the condition of the wing. Poorly conditioned equipment and nurses creating patient/nurse disputes put their ward at risk for lowered ratio caregiving and lost hours. Supervisors tend to assign less effective, poorly trained nurses fewer hours and shifts,

The admission process involves a careful review of all needed medications and the programmed timing of each. Patients who are admitted are dependent on the nurses to fulfill their medical needs via pharmaceuticals in a capsule. Therefore as time passes, properly trained nurses are on a time clock from the moment a new admission is announced. Better trained nurses address their patient admission tasks promptly. Poorly trained nurses go smoke cigarettes and delay patient tasks as long as they can.

Nurses must submit the medicine orders for each patient in time for them to be administered to the patient on time. The patient may not have any other medications on them and be in pain or distress without this assistance. But the attending or resident physicians may not be the same primary care physicians familiar to the case. And many of the medications the patient needs require physician approval due to their qualities and restrictions(narcotics). Sitting on these orders and coordinating poorly with the pharmacy is a sign of poor nurse training.

In the incidence of the above example, a nurse the ward had tasked with restoring batteries to the devices on the ward was never completed. This had not been done overnight on the night shift. (We’ll call her Sue). When the new nursing shift came in for duty, all of their patient vital statistics recording were delayed until the battery issue could be addressed. This extended hours of all the nurses on shift, a further cost of inadequate nurse training.

This was not part of the nursing handoff report because it did nt accord to any patient records. But many blood sugar readings were not tracked because the machines were not working. The nurses (though their ineptitude) made sure that enough machines were offline to delay any incoming admissions. This would give them a break between new admissions and handling current patient cases.

3. Patient Baiting

The removing any standard of case with or without ward notice constitutes patient baiting. Since the onus of treatment ends when a patent discharges themselves, malicious nurses or simple even careless ones can harass a patient into leaving by providing care that is substandard enough to make a patient believe they are better off out of a hospital or doctor’s care.

Patient Baiting takes place largely while doctors and physicians are out of circulation. Since the current staffing model of any healthcare facility is spread so thin doctors are rarely hanging around, the patient can be long gone before the physician has noticed there is any problem. Since an onsite nursing administration faculty is prone to covering up the problem, only the patient loses.

Except in this era of online reporting, increased institutional oversight, and streamlined problem solving, a nurse’s performance may come up for review. Nurses cannot pick and chose which patients they want to be nice to, or respond to handsome or pretty people in preference to others. Nurse training should orient the caregiver to apply best nursing practices and standards to every patient, not just the “favorites”.

If two nurses, (Let’s call them Cynthia and Neemar), decide not to administer standard care to a patient and make them all a doctor or come to the nurse’s managerial wing to address problems, they have been guilty of patient baiting. It speaks to the poor training of a shift charge nurse that they let this happen. This drains nurse power because the attention of other nurses and the supervisory staff is distracted from care issues.

But this places more of a burden on other nurses, who must make up the shortfall if the charge nurse assigns them to the patient or if the patient is moved to a new wing. The time and energy this drains from other personnel can never be repaired.

4. IV Maintenance

Intravenous therapy was invented to deliver treatment to the vein. The IV machine is now used for everything from infection to hydration. The care treatment plan for any patient now requires in almost every state an IV plug/PICC line so at any time emergency administration of fluids or other medicine can be transmitted this way.

An IV machine placed in a patient room is under the operation of the nurse at all times. Visitors, patients, and family members must be made to know this. Dehydration drips are administered for patients even not under the care plan because changes in their condition may require it. Nurses who are poorly trained cannot handle the responsibility of checking the IV line periodically so that shifts in patient arm or hand positioning may change its effectiveness. Properly trained nurses will instruct patients how to rest their arms and hands so as to not disturb medical product distribution.

The administration of an IV line is the charge nurse’s alone. If the nurse observes a technical problem with the device, they should report it or exchange for a properly working one. There variable settings for IV usage that a nurse should be trained to use. In nursing practice, where patients are lodged more than one to a room, the noise should be kept to a minimum to afford proper rest for others.

Alarms on an IV machine go off when the power is disconnected or battery winds down, or the treatment product runs its course. The alarm setting on an IV machine is usually denoted by a small bell, which should be set to “off”. IV fluids can run concurrently. Set an alarm for when it will finish!

But when a machine is not running properly the noises and alarms can buzz in an annoying manner and create a need for the nurse to constantly return to the same room. Setting one or all of the medications to “Gravity drip” can assist in providing rest for all the patients in the room and reduce the need for technical review of the equipment through the night.

5. Inability to Admit/Report a Mistake

If a nurse notices they have made an error or committed a breach of institutional or care treatment policy, their best practice to to report it or advise a supervisor who can take action. Patients can report this to nursing administration. Simple mistakes can be rectified by peers if necessary. More important errors concerning medications, treatment, or patient interaction can be addressed by a supervisor. Without this accountability nurses should think of working in other professions.

 

The Nurse’s First Day of Work

The first day of work as a nurse introduces a new student nurse or newly licensed nurse to the complex world of professional nursing. Occupational nursing, working for a living in the field of nursing and medical care, is a different challenge than merely answering test questions and performing nursing tasks for a limited number of patients and cases in a minute capsule of time. Putting on a show for a teacher or clinical preceptor is not as tiring as doing nursing tasks all day for inconsiderate or indifferent patients.

For new nurses, all too soon, after their first day, the workday becomes a repetitive chain of days that some new nurses find daunting. Nursing school wasn’t this much work!
Practical experience is what makes the most difference, in career nursing, because people are behaviorally trained to do what they have done before. Therefore, a nurse is best qualified who has done the same thing, medically speaking, for patients, over and over again.

Volunteer nursing experience and even intern duty at clinics can count. A nurse seeking work will want to demonstrate the most diverse and complete work history they can. The most complete medical knowledge level, and the most important skills are the accomplishments that nursing facilities and hospitals look for. A nursing home or hospital ward has enough of one thing, they are looking to fill a gap in skills, time schedule, or bedside manner.
A nurse coming into their first shift or first week of work, must understand that they are now the question “answerers” than the question-askers. people depend on them not only to do the right thing, but to say the right thing, and write the right thing in the chart. Nurses should get the knack early of writing vitals details of patients on little memo books or remembering case details all the way to the end of the shifts when it comes time to chart the patient responses. Keeping track of several different projects a day, even per patient, is a norm that new nurses must acclimatize themselves to. No nursing day on the job will be the same.

The new nurse should take in the data and treatment information they are given. Follow a single patient until you learn their medication schedule and care approaches. Nurses should use this time to observe all the things they can’t know from a patient’s medical chart, such as patient personality, manner, typical responses to questions.

The new nurse should show a minimum of argumentativeness, resistance to the process, or possession of too much superior work knowledge. The new nurse should understand that all the nurses she or he is working with have all gone through the process of getting to know the workplace and getting to know the patients and the staff procedures.

A new nurse should be watchful or ways they can improve on present nurse performers. The facility has hired new staff for a reason. Either they have worked the present staff to death, or you many nursing personnel have left. Local hiring pools give rise to dips and valleys in talent, and nurses may be working other jobs and not be available for all the shifts they are scheduled to work. The new nurse should make it look as attractive as possible for the facility to schedule them as much as possible.

The myth of a “nursing shortage” has come about for a reason. The fact is, nursing work weeks are set up to give nurses a break between long and arduous shifts. The anxiety and stamina that takes its toll on a nurse during the work week needs to fade away. A nurse needs time, sleep, and relaxation to unwind. The biggest advantage that a new nurse can bring to the table is their youth. The fact is, new nurses with strength and stamina to withstand long shifts of repetitive tasks and minute details are in demand. These nurses don’t come around every day. The best nurses get snapped up.

But the mistake most new and experienced nurses make is to try and fill all of their time with the most number of shifts. And nursing directors know that a nursing job candidate may not be as frank about their availability as they would want. The result is a kaleidoscope of co-workers instead of a reliable schedule of teammates.

A nurse should not assume another nurse will always be there to do a certain tasks or them or deal with a certain patient so they won’t have to. So, nurses cannot rely on a close set of friends on any nursing staff to function as a crutch. Social niceties like chatting, telling stories, or having lunch together should come second to attending call light systems and patient monitoring. A new nurse should be able to perform their duties no matter who is supervisor or charge nurse per shift. Long-term care can often be lonely and hard.

The hiring manager for a long term care facility or nursing home is trying to improve services to the public at all times. It is for them to review your skill set and decide how many nursing hours you can handle. Overworked nurses get sick, lose retention, and have mood swings. Often, nurses have second jobs whose work shifts do not complement well with the ‘primary” work assignment. For the respect of your nursing co-workers, try reporting your availability as honestly as possible. And don’t make a habit of coming late and missing the endorsement handoff.
The new nurse should treat the first day at work as the first day of the rest of their career. This is the last day their time is all their own. The patients now come first. The first time a new nurse punches in the time clock, all their focus and attention should be on patient directives and medical care objectives. From this beginning time onward, the nurse’s hands and mind are there to function for the good of the patient. This is the vocation of a career occupational nurse. Anything less of a commitment lacks the merit of a fully dedicated professional nurse.

Looking For a Nursing Job

Looking for a nursing job involves really evaluating your own personal job strengths. Applying at the same places as your friends or peers doesn’t always work. Working from newspaper ads only ads you into the mix with a huge bank of competitors. Occupational employment in nursing is an ongoing challenge for even the most senior and highly paid RN and LVN workers. Building  a lifetime network of people to consult and exchange information with about job opportunities and local trends starts now. A decade from now these will be peers working in places with new openings or new departments.

One strategy is to apply for weekend or part-time work at a long term acute care facility or long term care facility, to put some nursing hours and experience on your resume, without burning out from a heavy schedule and the stress of a full time work week. Limited interaction with key players can allow a new nurse to learn the job responsibilities without getting caught up in the vortex of a facility or nursing institution out of step with the nursing world at large. By limiting the scheduling availability, a nurse can allow for ongoing interviews during their off-hours in the full-time nursing employment space.

The first job of a nurse should be to absorb as many skills and workplace nursing abilities as possible. Making the transition from nursing student to nursing employee is not always as easy as the textbooks would suggest. The nurse candidate may interview with a Director of Nursing, or Human Resources Director, who has little or no idea what terms and in actual nursing job for an average shift is really like. The job description may not tell the whole story in a nursing position. Only the training preceptor can get a feel for what the new nurse is actually capable of doing.

Working part-time to start allows a nurse more time to evaluate if a new working environment is right for them. It takes time for a new nurse or new nursing school graduate to understand which parts of the working environment are fixed and which can be changed with experience and skill improvement. And the gradual build-up of skills and orientation will length the learning curve and leave a new nurse less likely to be overwhelmed. Thus a nurse can investigate what a facility or nursing department is like before committing to full-time availability.

A part- time schedule can allow you to burn in to a new place and absorb their rules and standard operating procedure, without trying to perform a full week of work at the same time. This kind of stress can affect how you learn all a facility’s rules and how you interact with all the staff. instead of burning bridges by becoming a moving target, start slow and begin to learn the ways of a new place slowly. interaction wit staff can remain minimal, so as not to get involved with any personality conflicts.

Part-time work generally begins with assignment of a preceptor. Today, nursing people call this “shadowing” a worker to learn their job. Nurses need to learn their preceptor’s ideas and functions before allowing a full time work schedule to break down the lessons and training. And sometimes a preceptor may not “fill in the blanks” as well as they should. But a part-time nurse can observe others at a nursing department and long term care facility and select whom they want to imitate in practice.

If a new part-time nurse blends in with the group and adheres to the institution’s policies and procedures, the director of nurses or nursing supervisors will schedule the candidate in for more hours and shifts. This is a good time to set limits for the availability. A nursing employer will not always respect the availability limits a nurse gives, and this is the best time to set the rules in stone. The ongoing battle for a nursing supervisor to staff the facility fully must co-exist with respect for a working staff of nurses and their need to rest and conduct their life in the off-hours.

The nursing job search includes a lot of phone calls, a lot of emails, and a lot of application forms. Job fairs and newspaper sections for jobs available aren’t always going to be the pathway to the best jobs. Many nursing homes and long term care facilities don’t have time to post individual job ads, and don’t have the staffing to vet the responses. If there is an area you want to work in, or a specific place you want to work, walk in and directly submit your application. By bringing your resume, three letters for character reference and your nursing school transcript , you will complete the application without the staffer having to do any work. The nursing supervisor or the director of nurses may decide to do an interview right then and there, and keep your application on file.

Newly minted nurses can’t always rely on the people at the other end of the line understanding nursing terms, medical courses, and departmental specialties. Many recruiting firms now do a lot of the screening for key posts. It’s best to get your dates and information about past work places straight, in the format of a general work application, because you’ll be filling them out almost constantly. Make sure your version of these events remains consistent, and be sure to have at least three character references from business and personal life at all times. If you feel that your contacts are being mined for marketing purposes, mark them “available upon request”.

If you feel your work experience is thin, write a cover letter describing your strengths on the job.  Talk about your individual abilities that make you unique to the nursing desk, hospital department, or long term care facility floor. Keep a list of the agencies, companies, nursing homes, and facilities you have applied to. You may want to look for older positions advertised or wait for another cycle or hiring to begin. Some larger companies wait and restart a cycle of interviews and training at the beginning of the first quarter and second , certainly not at year-end. if you are flexible to moving to begin a work assignment, say so on your voice mail message or the last sentence of your cover letter.