NEED HELP to rid the Nurseing Home Blues - page 2

First off let me say that I already know their is a nurse shortage in the U.S. but may we need to get some nurses with motivation in the state of PA. We have a situation here in the nursing home I... Read More

  1. by   NurseKimberley
    I TOTALLY agree with Arwin...the difference is between individuals, not initials. I just wish there was a way for me to be compensated for it!
  2. by   GreytNurse
    I would like to know where Arwin is working? I'm an IV certified LPN, I hang IV meds and can even mix some meds. I have also pronounced about 25 deaths in my career.
    As for the other comments of the 'RN' who stated that she felt she wasn't 'learning all she could'.......honey, you haven't been at the job long enough. You will do just as much as in the hospital plus alot more. I'm not putting down hospitals, but a majority of the time, we send out a patient to the hospital for an emergency, they come back in worse shape! Decubs galore....or, if we were in the process of wound care, they hospital seems to forget to do wound care. One of my patients came back 10 days later with the same dressing on her foot. I know this because it had my initials and date on it.
    Your not just a 'pill pusher'...people depend on you, everyday! You must be sharp as a tac and watching, listening every second you are there......even during your med pass! Hang in there and keep up the great work!!!!!
  3. by   blondie
    Yes, I perform a multitide of tasks: I do meds, treatments, admissions, picking up orders, faxing the pharmacy, the ever-popular CHARTING, etc.

    What bothers me may be peculiar to my workplace. I am an RN. I have been trained in many areas. Yet it seems everytime anybody so much as sneezes, I must contact the supervisor.

    The other day one of my residents had a seizure. I called the supervisor STAT. About four white coats (one of them the Assistant Director of Nursing) showed up. Though I got the oxygen and tubing as instructed, I was not instructed to take vitals. One of the white coats did. Someone else phoned the doctor, someone else phoned the ambulance, someone else monitored the resident, someone else charted the incident. What I was instructed to do was, "You can go back to giving your meds now."

    There are more options than just nursing homes and hospitals. There is also home health. This is an area I might be interested in.

    Also, I have always been into education. I could become a health educator and run classes. If there is nothing available in my area, I could develop my own program.

    I work on a heavy diabetic unit. It amazes me the number of people who hold out their fingers for a fingerstick without knowing what the numbers mean. I am always sure to educate them. They know I want to see at least a 70, and they're all instructed as to what their cutoff is for needing insulin--for some it's 150, for some 180, for some 200, and I even had one resident for whom it was 250.

    A pharmacist friend once told me of the triangle to insure the accuracy of a doctor's order: doctor, pharmacist, nurse. I think it should be more like a square, with patient being the fourth checkpoint. We need all the help we can get.
  4. by   NurseKimberley
    Well I think that is the facility you're in. In my facility, we are in charge, meaning in charge of everything. There is no calling in a supervisor, we do it all. Maybe it's because I work in a small rural facility, I don't know, but we do all the calling, VS, charting, etc. The only person we would call in would be the doctor if we decided it was necessary. I would encourage you to find a facility that lets you use all your talents/experience/education.
  5. by   blondie
    I've thought of that, but as I've said, I've enjoyed getting to know my residents.

    Do you need to call the supervisor when:

    The new admit arrives? The pharmacy calls to verify an order so that the supervisor can then, in turn, phone the MD? A resident falls with no apparent injury? A resident complains of dyspnea, but you know for a fact it's simply another anxiety attack and you will have her calmed down by yourself in a few minutes?

    Do you have to give a supervisor's report at the end of shift (besides the report given to the oncoming shift)? Do you feel like you're giving report twice?
  6. by   NurseKimberley
    We don't have to do any of those things! We call the MD or pharmacy and fax the orders, we fill out incident reports if anything out of the ordinary happens, and we just somehow handle everything else! Please don't get mad at me for saying this, but I think your facility does not appreciate you, and does not give you the autonomy and respect you deserve.
  7. by   Arwin
    Blondie-does everyone have to call the supervisor for all these things, or just you? It sounds like somebody there is a control freak.
  8. by   blondie
    Everybody does. It's facility policy. It's like the supervisor is the charge nurse and the charge nurse is the aide (who just happens to be licensed to give meds).

    I wonder whether is has to do with liability. Someone else once told me that for the best legal coverage, assessments should be done by a BSN, not an Associate Degree RN.

    But what kills me, is the charge nurse knows the residents much better than the supervisor. I KNEW the one resident was simply having another anxiety attack. I took her vitals. I tested her blood sugar. I got her to calm down, and 10 minutes later she was just fine. I charted the entire episode. Yet the supervisor told me, "Just to cover yourself, you really should call the supervisor next time."

    And after charting and reporting the resident who had fallen without injury, I was told told, "It is facility policy to call the supervisor whenever anybody falls."
  9. by   Arwin
    Originally posted by blondie
    I wonder whether is has to do with liability. Someone else once told me that for the best legal coverage, assessments should be done by a BSN, not an Associate Degree RN.
    That's new to me. Anybody else ever hear that? I thought an RN was an RN.

    When managers are insecure about their ability to run things they often resort to this kind of micro management. If that's the culture there, it is likely not to change until a whole new group is in there, if ever. You will find much more autonomy elsewhere.
  10. by   Michelle_nurse
    Where I work, The RN is in charge of everything that RN's are responsible for (meds, VS, charting, admitting, assessing etc.), but in the case of a fall /c or /s injury, death, or an emergency etc., we have to call the supervisor, or MD (depending).

    After the nurse has assessed, intervened and filled out the necessary paperwork. The supervisor or MD comes and usually doesn't do much, they check the pt and they sign their name on the report, and that is about it.

    The nurse does the work, but we still have to call. It doesn't bother me really, cause I know I did the work, I am capable, and there is someone there if I do need help. It is just a hospital policy.

    RN's are the main care givers in my hospital, the doctor is there for minutes a day to do occasional exams, prescriptions etc. and they are there in case of an emergency. Orderlies help a lot, they do most of the feeding, washing, T & P, etc.
  11. by   Cubby
    JBARGER
    Please don't say "Just an LPN" ever, ever ever!OKay?
    It's a pet peeve obviously!!! Stand proud.

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