Latest Likes For SDALPN

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SDALPN 11,773 Views

Joined Apr 10, '07. Posts: 1,043 (50% Liked) Likes: 1,394

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  • Jun 26

    Quote from chickengirl1977
    Hi! I am currently working for a HH agency that deals with pediatric patients. I have worked for them for 8 months. I consider myself to be a "new" nurse as I have only been practicing since November 2011. I am with the same patient on a full time basis. My patient is medically stable, but at risk. His primary caregivers are wonderful but are his grandparents so there is the mom and dad that are divorced involved as well. I'm needing advice on my charting, etc. My patient is 7 and has state and federal agencies that are involved in his care who are stating they want more charting. I chart every 2 hours as required, but also when we do walks etc. I do not chart his every move, and he is an active little boy. But apparently they feel that all he does is sit around watching TV and playing games. Any advice I can get on charting would be appreciated!!! Thanks in advance!
    Without seeing the 485 or other details its hard to be specific. But every two hours is the least amt of charting allowed by medicare/medicaid. You would benefit from a documentation class...better if the class is specific to PDN.

    My notes always start with received report from.... Then I document what I observe walking in. That includes what is/isn't connected to the pt. I document that the emergency equipment is checked and functioning properly. After that, I do my assessment. The assessment is supposed to be done in the first 30 min according to medicare/medicaid. Then that is documented. I document meds/feeds given and if the tube flushes easily (to document patency and placement checked). Any diaper changes and if it is urine or BM. I include color, odor, quantity, etc as it applies. I document that the skin is intact or whatever applies. AM care is documented. I document activities throughout the day. My favorite note that always sounds great is "developmental play encouraged" and insert therapy "____ therapy exercises reinforced per therapist instruction". I document changes. If the pt requires sxn, its required to document each sxn. My sxn note (change words as it applies to pt) sxn x2 for lrg amt of thin, white secretions from trach. O2 sat ^ to 99% after sxn. I document transfer to wherever the pt goes or moves to. The nursing hours are decided on based on the number of skills done in a time period plus the pts diagnosis/condition. At the end of my shift I document to cover myself. I write NAD. VSS. Trach midline, patent, ties secure per agency policy. Resp even, unlabored. O2 sat 100% (or whatever it is). Pox probe on left foot. GT patent. Diaper dry. Denies pain. End of shift tasks completed. Equip plugged in, charged, and working properly. Emergency equip at bedside. O2 tank full. Report given to...., who assumed care.

    You can also ask your boss for an example so you can see how it should be done. National agencies usually give you am example when you have orientation. Look at the other nurses notes and compare. The other nurses may or may not be charting correctly, but you will get the idea. I hope that helps! :-)

  • Jun 22

    It's typical. It sets up nurses with boundaries for failure. The agencies only care about the money. So if the family is happy, the agency turns their heads. I've lost plenty of cases for keeping boundaries.

  • May 3

    I've seen this a few times. Same with the hard chair. I blame the agency. The agency needs to speak up. If all agencies did this, families would have nowhere to run and there would be less nurse turnover.

  • May 2

    The only commitment you have is the shifts you agreed to work in advance. I request my days off before the next schedule is made. My agency does 6 week scheduling. You don't need to worry if the parent doesn't have 100% coverage. When someone has a child, they make a choice to have that child and to take on that responsibility. There is no guarantee the child will be born healthy. There is no promise that they will qualify to have a nurse. Their child is their responsibility. Scheduling is the responsibility of the agency. Your responsibility is working the shifts you have agreed to work. You cross boundaries when you are concerned with issues that aren't your problem. What happens when a parent has a healthy child in daycare that gets a fever and has to go home until afebrile for 24 hours? Or the babysitter that gets sick or goes on vacation. Most parents have a back up plan for that and it should be no different for a parent with a special needs child. You work for the agency, not the parent.

  • Apr 24

    They should want us. We're the ones that have mastered the art of dealing with the difficult/nutty parents. We could raise their satisfaction scores dramatically! On top of that we work well independently as well as a team. We are resourceful because we have to be. We have great respiratory skills since we border into the respiratory therapy area. We can and will do total care and may be the type to actually help the CNAs. Our assessment skills have to be top notch being that we are the doctors eyes and ears. If they can't see that, its their loss!

  • Apr 24

    I've seen this a few times. Same with the hard chair. I blame the agency. The agency needs to speak up. If all agencies did this, families would have nowhere to run and there would be less nurse turnover.

  • Apr 24

    I have the same personality type. It surprised me when I saw the post since its not very common. I've run in to some of the same issues as you have mentioned. I have done mostly private duty work which allows me to work one on one with a child and be more independent in my work (besides having an RN available by phone). It does get old and boring. But when the family of the patient are out working or whatever I don't have to worry about the social stuff as much. I'll be interested in seeing what others have to say. Right now I'm looking for work and wondering where to go next and what will go well with my personality.

  • Apr 23

    I've seen this a few times. Same with the hard chair. I blame the agency. The agency needs to speak up. If all agencies did this, families would have nowhere to run and there would be less nurse turnover.

  • Apr 23

    Quote from tcooks7
    My agency told me it was up to the Nurse of we wanted to do light housekeeping duties. I would wash whatever dishes I used for my client & do another client's laundry, ONLY because I had down time. Another client, Im always on my feet doing something for her, the entire 10hr shift. I seriously don't have enough time to do my notes and would often leave late! One day, the mom asked me if I could put away 5 boxes of supplies that came. I told her I didnt think I would have time to seeing how I still had so much to do. She got upset and said, well so & so always does it. When other nurses do that, it puts more of a burden on the fellow nurses, which sucks! So, now, I just stick with totally taking care of the client!
    Wow, just wow. It is our job to do these tasks. Read medicare/medicaid rules. It's not our job to do tasks not related to the pt or their care. I would never tell a parent I didn't have time to do my job. It is part of our job to put up patient supplies as well as order supplies if the family wants the nurse to do it

  • Apr 23

    I'm on my phone and the page I pulled up is in pdf format. I can't post it from my phone (if I can, I don't know how). I won't be home this week to use my laptop to share it. But I'm sure someone else can post it. Or ask the agency you work for and they can show you. But we are responsible for all care that the patient needs. Its a task that CNAs would typically do in the home, but since we don't have a CNA with us, its our job to do it if asked by the family. But doing family laundry has nothing to do with the care of the pt. Just as cleaning the patients room is necessary, but its not our responsibility to clean the rest of the home except for any mess the patient makes.

    Also, just plain old common sense would say that if a patient has a massive BM and soils their clothes, that you would clean it. Otherwise it would sit there making everything stink and then you would be leaving that work for the parent when they get home. If I had nursing in my home and walked in from work to see a pile of clothes soiled with BM just sitting there, I'd let the nurse go.

  • Apr 23

    I think sometimes they just don't know what we do. I get the question all the time (what hospital) and I explain not all nurses work in hospitals. Then I go on to explain what I do.

    I've even had people react surprised when I explain what I do. They don't realize that there are medically fragile kids. They seem to think that stuff only happens to "old" people. And since many parents keep their kids in, that means even less people see medical fragile kids.

    I think most take for granted that their kids or the kids they know are healthy.

    I've even been asked what Dr I work for when I've said I don't work in a hospital. I think it also says a lot about how little people know about nurses and the wide variety of areas in the field.

  • Apr 17

    Its interesting that the nurses posting haven't worked private duty or have only worked a few cases. Not all parents are like that. But the ones that are like that act entitled and unappreciative. It does make a nurse frustrated. A lot of parents like this type if parent are the ones living off the system and taking advantage. Then they get mad if they don't get their free services. Some of these parents get 20 hours a day. 4 hours is not too much to ask the parent to do. If they can't handle that, they need to out the child in a facility. Saying these parents are scared is an excuse. I've seen the type. They aren't scared, they are lazy. If they are that scared, they have no business taking care if their child. I watched 2 parents in a case who stayed home all day with 20 hours of care. They also took a nap every afternoon after an exhausting day of watching TV. Then they got up and watched more TV. Then would sleep for 12 hours. As long as they slept they were happy. If they were interrupted from even watching TV, they let the nurse go.

  • Apr 14

    Quote from JustBeachyNurse
    Agreed. But for some reason in education/schools crossing boundaries is encouraged. If I'm working and my kiddo has a fundraiser or a school show I'm happy to support. But Im sorry I have a life & a family, not much of a life, but I'm not letting work impinge on my family time. However school thinks nothing of staff showing up at non-school events with no personal connection other than a student or students.
    I think it depends on the school/teacher.

  • Apr 14

    I've seen where nurses document when they aren't there. Yep, that's crazy.

    And just because something is policy doesn't make it right. My company (and others) say they won't pay until they get nursing notes per policy. However, the state I'm in says they can't trump the states laws with their policy. Same goes for state board of nursing. Facilities/agencies can't change how we do things if its how the BON states something must be done. I'm thinking we may be with the same agency and some supervisors will come up with stuff that isn't true. On the other side of that, my agency has outdated policies on things like equipment. But since policy hasn't changed to keep up with the times, they want us to do damage to new equipment by following old policies. So policy isn't everything. Ultimately we can all get another job, but we can't get another license. So I'll follow BON rules and state/federal laws over a workplace policy any day.

  • Apr 13

    Quote from inmyshoes1
    What do you have to hide? Almost everyone has cameras on them these days.. restaurants, grocery stores, drug stores.. You are the type of nurse I wouldn't want working for me. That's why we have cameras. Found out a nurse was YELLING at my 12 year old. A child that can do nothing, cannot even talk .. but he yells at him. We have to protect our kids. Im sure you would do the same if you were in our shoes.
    I agree that's uncalled for. No nurse should be yelling at a child. Talking loudly to a hearing impaired child could be different though. Most nurses are good people that parents have nothing to worry about. One bad experience can forever ruin trust though. I'm sorry you and your child went through that. At least we aren't all the same! But it is awkward to be watched as you adjust your bra strap at work...maybe not do bad if the mom sees it, but not so good if the dad sees it. So I see both sides. I'm sure telling the nurses a camera is there or having it out in plain view is a good enough deterrent from behavior like yelling at a child. Plus, I'd probably fix my bra strap out of view if the camera :-)


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