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LadysSolo 8,083 Views

Joined: Dec 17, '06; Posts: 422 (73% Liked) ; Likes: 1,126

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  • Mar 21

    Update! I talked with my manager, who went into the patients record and saw that the nurse had put the order in and administered the dose a few minutes after the incident. She thanked me for letting her know and for not giving the med without an order, and said that this nurse is very experienced and knowledgeable but this wasn't the first time something like this had occurred with her.

    Thanks all for the advice and support, this has definitely been a nerve wracking but valuable learning experience for me.

  • Mar 21

    You did the right thing. It would be one thing (but still risky) if you had a longstanding relationship with a coworker and totally trusted her. But you're new and still proving yourself and she's not regularly on your unit and you didn't know her from Adam. Way too many red flags and I wouldn't have touched that with a barge pole.

    Bringing her patient a beverage or an extra blanket? Sure. Administering morphine without an order? No.

  • Mar 18

    I am an RN case manager for a Home Health company. LPNs make up a large portion of my team. Those women make me look good everyday. It's one thing to tell a client you are going to provide them with services. When the LPNs go in and blow them out of the water with their care, commitment and professionalism it humbles me beyond measure. These are not "just" LPNs. They are nurses. They are amazing nurses practicing at the top of their licenses and making the team work for the benefit of the patient.

  • Mar 16

    Quote from bossfrog
    Thanks Davey. But what are those appropriate outside agencies? And the write-up really just pissed me off more than anything. My DON said if I'm not comfortable bringing in a pt without talking to doc, that's fine. But the administrative people are the ones insisting we do this. They say the doctor's wife (she owns the hospital) complains when the doctor doesn't get enough sleep. So administration doesn't want him called. Either way, I'm sticking to my guns.
    You're supposed to violate the Nurse Practice Act and practice medicine without a license so the doctor (who is most likely compensated for his call time) can get enough sleep? This is why nepotism is such a poor way to run anything.

    Yes, complain to the BON, your state medical association, the hospital risk manager, if there is one. Drop a dime to JCAHO. This is the stupidest thing I ever heard of. Keep us posted.

  • Mar 16

    I agree, unfortunately. There are VERY few situations in which I would quit without notice and accept times will be tight until I find another job. This would absolutely fall in that category for me.

    I am rooting for you and praying you get out before the poo hits the fan. It is coming, that much is certain.

  • Mar 16

    Quote from bossfrog
    Thanks Davey. But what are those appropriate outside agencies? And the write-up really just pissed me off more than anything. My DON said if I'm not comfortable bringing in a pt without talking to doc, that's fine. But the administrative people are the ones insisting we do this. They say the doctor's wife (she owns the hospital) complains when the doctor doesn't get enough sleep. So administration doesn't want him called. Either way, I'm sticking to my guns.
    Oh dear lord, I'd get out of there ASAP. I'd work at McDonald's until finding a new job, that's how intolerable that would be to me.

  • Mar 16

    Yeah, that's one of the reasons I no longer work inpatient psych. Calling the admitting for admission orders at night. For some reason, we had a medical group covering who decidedly did not want to do anything psych related. This resulted in a lot of poor behavior... hanging up the phone, ordering 1:1 sitters for every suicidal patient, etc. And if you called the psychiatrist, they tear you a new one...

    Anywho, a death occurred on said psych unit. People (nurses, ancillary staff) were fires or quit... I had quit.

    Anyway, I don't have any success stories but will just encourage you to CYA. Management will not side with nursing staff if something goes wrong, much less any regulatory agencies. If the physicians wife is willing to risk that, then there's not a whole lot you can do.

  • Mar 16

    Quote from bossfrog
    As for being a "mom and pop" hospital, no. They're the largest privately owned, free-standing psych hospital in Indiana. So there is no ERP to write admitting orders here. It must be the psychiatrist.

    I feel like this crap needs to be reported somewhere but I don't even know where, or even if I should. I don't want to hurt my staff that I work with.
    I'm not trying to be argumentative, but, regardless of the size of the hospital, if you're telling me the wife of the attending psychiatrist is the owner of the hospital, that sounds like a "mom 'n pop" operation to me. I've never heard of such a thing.

    I would not be willing to work under the conditions you describe. One of these days, something awful is going to happen there that will involve the lack of a proper, legitimate admissions process, and the higher-ups are going to go looking for someone other than themselves to blame. I would not be hanging around waiting for that to happen.

    Best wishes!

  • Mar 16

    Quote from JKL33
    Not to be overly-dramatic but I kinda think a CNA "accepting" a patient for admission is one of the more insanely wrong things I've ever read here.

    There is no patient hand-off or proper transfer of care taking place. Absolutely none. Not to mention everything else...
    Yep. You're right. I mean, yes, the doc's name always goes on the order form in the morning, but that's NOT the way it's to be done.

    Just to clarify, in case it hasn't been to this point, I personally NEVER do this. When a referral comes to me I do not accept them until I can talk to the doc. If I can't get him on the phone, the patient sits tight until I finally do get hold of him. That's actually part of the flack I got. They said I let a patient sit in the ER somewhere for 6 hours without giving them an answer. And I told them that's how long it took to get the doc on the phone. I mean, in the end, what are they going to do? Oh, right... they gave that decision to a CNA.

  • Mar 10

    Quote from Meriwhen
    For what it's worth, I'd rather have a nurse who was competent and skilled even if he/she needed to work on the human touch element a bit, than a nurse who is so wrapped up in the human connection that they don't realize they are to give me potassium by IV push.
    A-MEN!

    Boy how infrequently do I come across someone who shares my thinking on this!

    When I'm a patient, give me a "meanie" (aka quiet thinker) who knows exactly what she's doing anytime she comes near me. PLEASE. The people in my personal life will cover the rest, thank you very much. Speaking of MBTI....

  • Mar 10

    Quote from drkshadez
    To add to this: if I have a choice to sit and talk to a patient for an hour about their anxiety over a new diagnosis, or make sure someone's protonix po is given exactly at 11:30 at night, and it is 11 pm- I'm going to choose the former
    And you will be spending time in your manager's office explaining why you sacrificed the care for one patient in preference for another in a non-emergent situation. Although to be fair if the patient's med is ordered for 1130 giving it at 12 is within the window so you wouldn't be wrong but you have to remember each patient has the right to receive the same level of care as the others. Trust me all of us would love to have time to sit with our patients and provide them that personal level of care you describe but modern nursing does not allow for it in the way you think it should. You will learn how to connect with your patients and perform your nursing tasks at the same time. Believe me it's just as satisfying. My current job is pretty much task oriented and all about through-put but my patients do not feel like I am a robot and they know that I care for each and every one of them. I know this because they tell me how cared for they feel. Believe me, it really is possible.

  • Mar 8

    Quote from QuietIsntAWord
    You just went all psychology on us, negative reinforcement. And who said pre-req's weren't important?

    Added: If above works, then when he responds in a good way then you go out of your way to be super nice despite his past... it's a transition into positive reinforcement
    Again, positive reinforcement doesn't stick ... negative reinforcement has produced more results so we are sticking with that until he calms down ... then we go in and do what he asks.

  • Mar 8

    Quote from bugya90
    Document document document. Point blank tell him that his language/behavior is not appropriate and you will not tolerate it and that you will return when he has a more appropriate attitude and then walk out. Document word for word what was said. Go back in a little while later to check on him and be nice but firm. If he is still acting like that, repeat again and walk out. Continue doing this. Either he will figure it out and stop or you will only have to spend about 5 minutes with him each time instead of 45 before you walk out.
    You just went all psychology on us, negative reinforcement. And who said pre-req's weren't important?

    Added: If above works, then when he responds in a good way then you go out of your way to be super nice despite his past... it's a transition into positive reinforcement

  • Mar 8

    Document document document. Point blank tell him that his language/behavior is not appropriate and you will not tolerate it and that you will return when he has a more appropriate attitude and then walk out. Document word for word what was said. Go back in a little while later to check on him and be nice but firm. If he is still acting like that, repeat again and walk out. Continue doing this. Either he will figure it out and stop or you will only have to spend about 5 minutes with him each time instead of 45 before you walk out.

  • Mar 7

    You are looking for a thank you? Nursing is a thankless job so what are you going to do? Stop living your life for thank yous. If the come they come, if they don't they dont. Life is too short for all of that mess. Just do good and good will come to you. Your bad attitude isn't good, your inability to accept responsibility isn't good. I am not saying you are a bad person because even good people have some faults (not that faults are bad always) Life isn't going to coddle you. Stop looking to be coddled. You are a grown up now, so put on those big girl undies and keep it moving. Wallowing does you no good. Be a WARRIOR NOT A WORRIER. Learn to take positive criticism and stop acting like a child please. You have it in you. I know you do. Don't just look at things so negatively. I challenge you to start saying positive things to yourself everyday (even if you don't believe it) Just make an effort to say positive things. For example if you are thinking " I am worthless" then say out loud " I am very worthy" every single day. If you start eventually what will happen is you start changing your narrative, you start changing your own mind, you will start believing in yourself and you will start noticing your life changing. Give it about a year and see what happens.


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