unworthy of an RN

Rick-Wood · Jul 6, 2004

Hey guys I have a question. I am an extern at one of the hospitals near my home, and I will be graduating from a BSN program in may. During my time as an extern I have witnessed a lot of acts done to patients that I feel are wrong, but I don't have a better way of handling the problem. I also have a LPN/RN issue if you guys could give me your help on these problems I would greatly appreciate it!
1. There is an LPN who has worked on my floor for probably 20 years. She does stuff that she is not allowed to do (IV push drugs, and so forth) as an LPN. I am new to the floor I have only been there 6 months. How do I handle this?
2. I was waiting to clock out, and I heard an RN ask a tech if she had turned someone in another room. The tech said she couldn't remember, and she went to go see who it was. The RN continued to say to me that she didn't turn the person because she has been in the same position since she came in! SO doesn't that make the RN just as bad?
3. We get a lot of Alzheimer patients. And we get our share of beatings and spitting and cursing at. Is there another way to settle these patients and not use restraints? I mean I understand when someone is hitting you with her cane and trying to break your arm you have to do what you have to do, but I feel that there are other options than to use restraints on some of these poor patients. Anyone have any ideas on how to calm a pt. or help them stay safe without the use of the restraints when they are in a rage?

Reply to Question #1. Hands down, I would want to talk to the Standards Committee in my hospital about this, or to the DON, or the Risk Assessment Team, or someone who will listen. There are legal ramifications which need to be brought to the attention of those who deal with the legalities of how nursing is practiced in the hospital and in the state. If there is no positive response, it might be well to take a look at what your 'exposure' is... in California, as an LVN I work under the license of my supervising RN, hence if I work outside my scope of practice, I jeopardize an RN's license as well. Something to think about.

Reply to Question #2. First off, it's a HIPAA violation to be talking about patients where you might be overheard. Hushed tones at the nursing station is how the idea was presented to me. Never at time clock, elevator, or cafeteria. But that wasn't the question. The RN bears some of the blame in my view, since she is a supervisory person on the floor. The RN has the right and the duty to insure that adequate care is given. She risks her license if a legal action proves that anyone she supervises has, with the RN's knowledge, given less than adequate care. In my area of practice, we turn our patients at least every 2 hours. Less than that is negligent. It doesn't matter who does the turning either; I've turned other nurses' patients and they've turned mine. I'll turn a CNA's patient if it helps get the work load done. RN might do well to have a similar attitude.

Reply to Question #3. Alzheimer's is a hard one to deal with. So often they seem to be hallucinating to the point that they are literally living somewhere else and are interacting with someone else when we have contact. Yet, I don't see restraints used, nor do I use restraints very much. What we do use is anything that works. I had one patient who went ballistic when the TV was turned on. Calmed down when Beethoven or Mozart was played. We played classical music. Another was brought to relaxing with nature sounds, others with tapes of favorite movies, and so on. There are things short of restraints that work, provided we can find them in the limited time we have at hand sometimes.

This stuff is off the top of my head, more than anything else. As is said in the car commercials, "Your Mileage May Vary" to which I add, "and it probably does, and that's OK."

ERHack · Jul 6, 2004

As a nursing extern, youre going to be exposed to a lot of new things, experiences, personalities. People in the medical field are not perfect, after all, they are people. Your job is to act like a filter at this point in your career, and take the good stuff that you find as your own (professional behavior, caring, knowledge, coping mechanisms), while making it a point to exclude the bad stuff (unprofessional behavior, negligent habits, etc). Remember, things unfortunately do not change. Wherever you go in your career, there will be good and bad. Remember, it is YOUR responsibility to do the right thing.

LisaG21 · Jul 6, 2004

Reply to Question #2. First off, it's a HIPAA violation to be talking about patients where you might be overheard. Hushed tones at the nursing station is how the idea was presented to me. Never at time clock, elevator, or cafeteria. But that wasn't the question. The RN bears some of the blame in my view, since she is a supervisory person on the floor. The RN has the right and the duty to insure that adequate care is given. She risks her license if a legal action proves that anyone she supervises has, with the RN's knowledge, given less than adequate care. In my area of practice, we turn our patients at least every 2 hours. Less than that is negligent. It doesn't matter who does the turning either; I've turned other nurses' patients and they've turned mine. I'll turn a CNA's patient if it helps get the work load done. RN might do well to have a similar attitude.

Just so you know...the time clock is in the nurses station :) And it was midnight so there were no visitors around!! :)

Dr. Scully · Jul 6, 2004

:coollook: I defintely agree w/ ERhack when she said "it was simple"... Each and every day we are faced w/ major decisions and minor decisions. I know that I have had my share of worries over what is right for the patients, and what is NOT right. We have all had to work w/ bad nurses...the ones where you knew they were doing things wrong, and not by the book. I tried to confront the nurse involved in a non-threatening way about what they did; and made it known that I would be there if they needed my help or had any questions. Of course, this did not always work, and I have had to go to the nurse manager or higher when necessary.

I have worked with wonderful LPNs that knew so much more than I when I began nursing, and taught me so many things. AS RNs; we must be responsible for the staff we work with, and that means giving the best care to our patients.

I always wanted to go home at the end of my shift and Know that I did all that I could to help and care for people in my care. I may have been upset, frustrated, angry, etc.; but....."what mattered most where the good things I did during the shift."

:)

brenzgrove · Jul 6, 2004

find out whether the lpn is able to perform these tasks...there should be a manual on the floor for these policies, but if not ask charge or another lpn. Definitely report this person. You shouldn't think twice if they are practicing out of their scope.

graybar hilton · Jul 9, 2004

The LPN issue is one I am researching now. I have found many states that allow LPN's to get IV certification and perform that task. Most do it with the utmost professionalism. Check out the nurse practice act for your state. Or ask her conversationally where she obtained her certification. Be sure of the facts before you act.

The RN that did not see that her patient was turned is responsible, she was negligent pure and simple. If she does not want the role of supervisor then she should pass on it. The Med tech deserves to be disciplined, as does the RN. Perhaps a better solution would be to put them in bed, and leave them for several hours in one place.....I have found that as an educator any thing that you can do to make the student feel "like they are there" is the best teaching tool.

There are so many little tricks you can do with the dementia patient to help them during an agitated episode. The best one, can sometimes be giving them some small little goodie to eat. Fingerfood, tasty and tempting. It is a symbol of trust and fills one of the most basic needs. Watch carefully for choking though. I have found that if you put a snickers bite in your mouth, then offer one in the spirit of hospitality, it works.

I am with the others though, figure out the indicators and identifiers, watch for time, event and instigating factor. Then act accordingly. The little old lady in the post, who was afraid of the towel men.....was probably put off by a male orderly taking someone to the shower. Bless her heart. The way the nurse described his action was great.

I hope that you continue on, prosper and move others to join the great profession of nursing.

mattsmom81 · Jul 9, 2004

New nurses in particular must learn when to choose their battles and to do so carefully. You are new to the field and green to the culture of nursing., as well as politically naive to some of the games played. Since you're 'new' you're fresh meat for the sharks. If you are working in a toxic place YOU may quite likely be seen as the problem. I don't mean to discourage you, but rather to warn you to be cautious.

I too applaud your interest in improving your working conditions...and i remember well the 'reality shock' I experienced as a new grad. But the sad truth is sometimes one nurse alone cannot change a culture that is tainted, and instead ends up its victim. You may wish to look for somewhere else. If you wish to stay and become a role model/help change things; you will need the support of your peers and the blessing of your manager specially... so be very sure you have that. Good luck.

One other thing: when managers play favorites with the aides and LPN's over supporting the RN's in leadership roles that has always been a huge warning sign for me....this is somewhere I don't want to work.

dbscandy · Jul 15, 2004

I only have one thing to say. This RN allowed the patient to lie in one position for her shift. I don't care what kind of point she was trying to make with the tech...she is, herself, lazy and unprofessional.