CoffeeRTC, BSN 14,356 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,522 (23% Liked)
I'd even recommend another way. "She doesn't have cards yet. Isn't it against policy" or "can we borrow meds from other patients?" or "I don't think I'm supposed to borrow meds from other patients." We use that near deflection technique in the military as a gentler way of telling those who outrank us - hey dude, you're dead wrong, but I'm giving you a chance to save face and look good. Then if they persist - then zing with "I believe that's against facility policy". (Where our answer would be, 'according to the Air Force Instruction blah blah blah'.)
I think this situation could have been handled better by all parties. OP, I would advise being very direct in your communications with your charge and others, and lose the snark. Instead of "I didn't bother looking," how about what you told us? "she does not have cards, and I believe it is against policy to borrow from other patients." And if your charge knew that you a new grad as well as a new hire, she could have been more supportive.
Agree with previous posters about narcotics: be very deliberate with checking, verifying, administration. This can get you fired and reported, even if you are totally innocent of any wrongdoing.
The ARNP could have picked a better time and method for coaching. In the hall, in a public place, and during a med pass is not conducive to learning! Perhaps she meant well, but I think it only added to your frustration.
My first job was at an ECF, and I studied meds all the time on my days off. My pharm training at that time was limited, but I was exposed to a lot of meds and learned a lot that first year. Looking back, those patients were probably overmedicated, but it was an amazing learning opportunity for me.
I work LTC so it is some different than a hospital. I can tell you that a patient may be checked, changed and cleaned up and by the time the day nurses and CNAs check them, they can be soaking wet. That is what incontinent people do.
I am wondering what you use for patients who are incontinent. Any type of soaker pad and incontinent pads uses? Those do help minimize cleanup. I have also seen where one will miss the soaker pad and still get sheets wet, thought that is not normal.
When I come on at night, we sometimes have to finish what the previous shift did not get done. Sometimes days find a patient wet, they just need to do what is necessary and continue on.
Believe it or not, night shift can get pretty busy and we usually have a smaller staff than the other shifts. As has been said, unless this is what happens with every patient she has every morning, then just take care of the need and continue on your day.
Just my view from the night shift.
Any threads by Viva. You are a shining example of keep on trucking no matter what.
Can I be totally honest?
I like reading the threads started by nurses whom have somehow gotten themselves into a hot, hot mess. I like to think about, what would I do in this situation? I like reading the replies. I like offering advice, if I can.
I enjoy the posts that have a patient that the Nurse is looking for input on from the other nurses on this board. I am always amazed and fascinated at the clinical knowlege that the many different posters have and how there are so many aspects to patient care. I think that is why the psuedo articles that disguise themselves as clinical facts frustrate me so much. I love nursing and respect the knowlege of my peers and do not like to see this disrespect to the intelligence of nurses.
I wouldn't give a "daily" medication that had been documented as already given. As for who's at fault, I'd say everyone who should have clarified the order and time of day with the pharmacy/MD and didn't.
Passing meds shouldn't require solving complex puzzles or trying to read each others minds.
I haven't met a physical therapist that regretted their decision. They out earn me and have a better schedule.
Something I have learned from my experience in the diagnostic role: you miss some. You do your best but some will still surprise you.
An I&D is a sterile procedure. The patient does not need another organism entered into their bloodstream during the procedure. The doc does not need pus all over their hands. The culture would also be contaminated and useless.
You don't need a policy specific to your facility. This is evidenced based protocol. In the future , let this doctor ( ? )know that . Be firm that you expect them to don sterile gloves. Doctor also needs to wear full PPE to assure the PUS does not squirt into their eye or any other place.
Now.. go do some serious teaching.
I have had a coworker call out for not enough sleep. She wasn't punished... it was her PTO...
...but none of us felt very kindly towards her after absorbing her shift, her excuse spread through the gossip channels, and people stopped being willing to trade shifts with her, cover for lunch, etc.
You had time to sleep.
The order probably should be rewritten with an Action Plan. Many RTs, Asthma Educator RNs and Asthma educators will instruct patients to take their Albuterol or Levalbuterol inhalers 15 minutes prior to exercise. This is pretty standard per the EPR 3 Asthma guidelines and should be listed on an Asthma Action Plan. Actually, the Asthma Action Plan should accompany any script to be used as a guideline. This is extremely important. The plan should fit the child and the activity and not some tired old only q6 prn and only if wheezing order. This just limits the child and enforces poor coping/management techniques.
The number of puffs will be determined by the child's severity (see the EPR) and response from an Exercise Test which may have been done in a PFT Lab. Again the old 2 puff orders do not fit everyone. It is not uncommon for kids to be discharged on 4 puffs of albuterol and tapered as their maintenance medications are regulated. In the hospital, asthma protocols start at 8 puffs of albuterol q 2 hours.
Take an Asthma educator class. I think the AE-C should be required for all school nurses since asthma can kill and is so poorly understood by several health care professionals and EMS providers.
You sound like a wonderful caring LTC Nurse who knows how to get the job completed. As a LNHA and BSN I can tell you I have had my fair share of employees not wanting to do their job...I have even had my car tires slashed (had to tie my two Akitas up to my car to keep those employees away.
Holding people accountable what I call follow through is very difficult, time consuming and sometimes I just want to give up but do not.
When I give difficult people assignments I break it down into chunks of time. So for the first 2 hours I want them to completed the following tasks A, B, C... I am organized so for the last 10 mins of their 2 hour duties I will actively search them out so they can show me their work. I then give them instructions for the next two hours (this even includes a break and I really watch them during that time. If they abuse it I ask them to come and tell me they are going on break and come tell me they are off break) Micro managing...YES!!. Most people do not like this type of leadership and I find that the good ones like it because all of us are held accountable including me. The ones who just want to slide do not come back after about a week (if that). They want to be reassigned, they quit, they complain to upper management. I have had employees call the 1800 I hate my Boss on me.
I follow the rules; the time and attendance policy is with me at all times. The written directives for what they do on 2 hour increments that include built in breaks is within policy/procedure and usually is welcomed.
Usually I find that it takes a couple of months to have a decent running shift and then I treat the employees to pizza, crock pot of stew and home made bread on a monthly basis...I save those daily assignment sheets so when we have our pot luck I can tell/show them how hard they are working (if they are still here).
If the management staff are not behind you in this endeavor then I would look for another place of employment as this type of environment is difficult to change and you must be supported by them. Invite management in early AM or late at night when you are following through with your tasks list this shows the employees you are supported and follow through and have management buy in. Have your DON include this as part of a QA improvement. This is a much better way then a shift meeting turns into a grip session with employees complaining of too much to do and the charge nurse riding them.
I'm an LPN who has worked for geriatrics almost 2 decades. LTC setting. Need a change. Physically and mentally. Saw a job post at different company for UR and thinking of applying. Trying to look online for any info as to what you actually do. I get reviewing/collecting info etc but WHAT do you do? Read nurses documentation? Doctor prog notes? Anyone willing to (if it's even possible) walk thru a typical day/case review? Physically my body is feeling the effects of the job but mentally feel like I'm just getting started and am looking for new challenges, if that makes sense.
Thanks in advance. ANY info would be helpful from anyone....
I was orienting there. Red flags all over. I agonized over it for 2 days and realized there was NO WAY I wanted to work under those conditions, so I let them know that. Feel so much better. : )
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