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Finallydidit 4,047 Views

Joined: Nov 15, '09; Posts: 142 (37% Liked) ; Likes: 132

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  • Aug 27 '15

    In case anybody is interested, I'm currently working a travel contract in a NC state prison. I have met nurses who only travel at correctional facilities and seem to make a good living.

  • Aug 25 '15

    I work in MO at a jail, but I call my patients....patients. I love my job and the challenge of the population that I choose to work with. I do pass meds in Pods, and I go to the patients. I take a med cart with my MARs and patient specific meds. We also have a large selection of stock medications. I check every patient's mouth regardless of what they are taking. I received a $2.50 raise from what I was receiving at the hospital. What I did not realize that I would also would be gaining is autonomy. I am trusted to use my nursing judgement everyday, and I believe that this job is preparing me for becoming a FNP in the future.

  • Feb 7 '12

    i mentioned to him that she was becoming lethargic and not herself. he snapped at me that her sugar wasn't low enough to cause these symptoms. then i mentioned to him that she usually runs around 200-250 so that is low for her. then he snaps "well then send her out if you want" end of quote.

    first of all i would like to applaud you for your efforts in addition, over the years of my career in nursing, i learned that in order to get what you need for your pt. is not only to inform a doctor of a problem. however, also you have to present the solution to them; and suggested it, in a manner that makes them think that they came up with the solution themselves. trust me i know it sounds like we are playing to their ego, but we have to think was best for our patients. lastly, i'm certain he has had time to rethink his actions regarding this incident, and also your don although, don't expect a thank you note, you will get those from us nurses~ great job!!!!

  • Apr 10 '11

    Quote from westieluv
    Thanks for your replies. I do condense my 4pm-6pm pills into one pass, as well as my 8pm-10pm pills. If I didn't, I would never stop passing meds and I wouldn't get anything else done. And yeah, I hear you about everybody wanting their meds at the same time. Once in a while one of my patients will say, "You're late!", to which I reply, "Well, I do the best that I can, but they give me a lot to do." Our aides get the same thing, because they all want to get ready for bed at the same time too. It can be so frustrating working in LTC!

    And when things have lost control at the desk (admissions, piles and piles of orders, consults, labs and charting).. I make it 1 pass. I have to. Or else I'll be leaving at 3am instead of 1am.

    As far as treatments go.. the CNAs at my facility are so good they even tell me when to have the treatment ready for Mary's bottom. So when I do finish the meds the only treatments I have left are those who get a clean dry dressing to a leg/arm skin tear. So maybe coordinate your treatments with the CNAs .. saves time and you get your treatments done.

  • Mar 27 '11

    Quote from nightengalegoddess
    Hi. I have never worked in an LTC before. Just hospital acute care. Orienting, I noticed there is not assessment going on, there is not proper documentation going on, nor infection control. There are not even readily used anti-microbial wipes nor proper sized gloves in the rooms. Patients have MRSA and there are not infection control measures being enacted. The system is completely askew, and the charts are completely disorganized. There is not system for lab retrieval, and I wonder what the clerk is actually doing? When the physicians come, it seems like the LPNs don't know what to discuss with them re: SBAR. How can you discourse about the patient if you have not even physically assessed! I am an RN. Is this the difference? Are LPNs educated to such a less degree about the thouroughness? Or is this place uncommon. Much prefer the nitpicking hospital environment. Please tell me what the heck is going on here?
    To answer that question you asked in bold... the answer is no. LPNS are NOT educated to have a less degree to thouroughness. I think each individual nurse should be responsible for his or her actions. Also, at my facility the RN is actually responsible for setting the assessment guidelines , infection control, and proper documentation so thus maybe the RN may have contributed to this as well.

  • Mar 27 '11

    Quote from Finallydidit
    Hosp vs LTC totally diff. In LTC there has to be team effort, there are far too many residents on a unit to otherwise give proper care. As an LPN, I could never do my job without my CNAs nor could my RN supervisor do her job without her LPNs. We count on each other, and we help each other, we question and advise each other. But most important we TRUST and RESPECT each other. It has so little to do with the initials that follow our names and so much to do with the attitude that is in our hearts.

    As an RN at a new facility, you should calaborate with your team, they know the facility, the residents, the family members, the Drs etc. learn from them no matter what their title, and allow them to learn from you. Together develop trust and make a plan, then you as the RN lead by example. The other units may continue be in chaos, but you may soon find that your unit runs like a fine tuned engine.

    Good luck to you
    AWESOME advice.

  • Mar 27 '11

    Quote from Aly529
    Hi everyone. This question is mainly for already licensed and working RN's but students are welcome to answer as well. I like hearing "inside" info from those with experience so my question is what are some things that you found out along the way that you didn't know and weren't told about working as an RN.

    Thanks in advance for any insight.

    What about LPN's. I think we have some good insight too

  • Mar 27 '11

    I disagree. I have been LPN for over 25 yrs. I started out on med surg, then did over 10 yrs on skilled nursing facilities, which is fast paced with very sick complex patiients who are admitted from the hospital for rehab and recovery. Some may be admitted to recover and then go to LTC. Just because skilled nursing facilities are in a nursing home, many nurses consider us not important. I have had RNs, come work with us from hospitals, and always end up saying they cant beleive how hard it is. Skiled nursing units deal with patients with anything from a hip fx: to Coronary bypass surgery. We hang IV'S , TPN'S, done it all. I am so tired of of people looking down on the LTC nurses. I have since worked as a Primary Care Nurse, then to a RCM. I now work in an office all day, attend meetings that involve discussing my patients care ie; nutrition, safety, skin, and care conferences. I do the MDS'S, which is a complete assessment of the resident and implementing thier plan of care. I deal with the staff concerns, complaints, families and so much more. Tell me I am not a nurse because i now sit in an office? So to those who decide after working 20 yrs as a floor nurse decide someday to work as a educator in nursing or as a nurse manganger as myself, remember this makes you no longer a nurse. How rediculous, people. My license still says I am a Nurse! I still interact with my patients, and jump in when needed in emergencies. So untill you end up changing your role in nursing some day in the future, dont judge what TYPE of nursing others may do, you just may change your mind some day too.Think about it for a moment, if every nurse wanted to only be a floor nurse, and no one wanted to work in the OR, ICU, LTC, and as DNS, RCM, Nurse Educator, preceptor and so on, nursing would have some serious problems. Thank God for all the different nurses we have out there. RN, LPN, wether its in LTC, or critical care, we all work together as a team and make it work. if you have been hired as a nurse, you are a nurse period.

  • Mar 27 '11

    I can't of course say what LTC facility I went into yesterday as an agency nurse but......THANK YOU!!! To the nurses, aides, housekeeping, dietary and even the one OT guys are the S%$T! What team work and great attitudes!, the facility you are at doesn't even deserve any of you! You were all helpful and hardworking as hell! That place is crazy nuts....I had 27 residents and jeez, it really felt good to try and actually assess people b/c I have been doing private duty, but trying to assess put me VERY behind on an already horrendous med pass. I probably will never go back there, b/c I felt I could not give the care these residents deserve...but maybe I did make a small difference...the staff liked me and they said of all the nurses(RNs and LPNs alike)they have not seen anyone ask about a skin breakdown protocol. They were actually amazed I tried assessing some of the residents. They say the turnover rate is so high, agency is the norm! If I were the administration, owners, or whatever I would do whatever it took to hold on to these regular staff people!

    When did this all start happening? the bare minimum staffing???, I was thinking if everyone had a reasonable workload, wouldn't there be less turnover and better patient/resident care? After working in med/surg, rehab, mh/mr, private duty, under the right circumstances I think a LTC facility would be a perfect match for me, b/c you do need strong assessment skills and how to communicate effectively, which I have. But I don't think, I will go again as agency or regular staff at a minimally staffed place. I will keep looking though:-)

    The staff yesterday were saying that there isn't any sense to go anywhere else, b/c it is pretty much the same everywhere, so they stay....luckily for the residents! I wish that I were ready to open up a very ltc facility and hire everyone who worked with me yesterday! I would take less income as an owner to have it well staffed and my staff happy and residents safe!

    thanks for listening fellow healthcare advocates! I think, I will use now instead of nurses, b/c there are so many people in healthcare that are not nurses, but feel just as we do!

  • Mar 27 '11

    In all likelihood you saved a patient's life. I believe you did exactly the right thing in following the doctor's order. I would recommend re-familiarizing yourself with the facility's procedures, protocols, and standing orders for hypoglycemia. I would also recommend a sit down face to face visit with the DON, for complete clarification of her specific objection to your administering the glucagon. The DON owes you an explanation and should be very specific in her clarification.

    Please do not be too upset or at all discouraged by being reprimanded. Please know that everyday, good nurses who are caring and work with great integrity are reprimanded for the most ridiculous and nonsensical reasons. Everyday somewhere someone fires a damn good nurse with excellent skills, an impeccable record of excellent care, and nothing but the best interest of patients at heart for NO legitimate reason. Some people are threatened by competence and integrity. They can't tolerate those admirable traits in others. This is happens in other fields besides nursing, but it seems to happen more often than you would imagine in the field of nursing.

  • Mar 27 '11

    I am confused according to the op this is her great grand father and her grand mother is the POA? That means it is his daughter not his wife who said that the nurse could keep his ring. So he is not married.
    I do not feel the OP has any say into what her grandmother and great grandfather do with their personal items. Most corporations/facilities have policies against accepting gifts but I do not think it is illegal.
    Having said this I do think it is unethical.

  • Dec 6 '10

    I am seeing many, many misconceptions about methadone treatment here! I feel I can answer from an EXPERT point of view, as I have experienced this issue from both sides: I am a nurse, AND an addict being treated with methadone maintenance therapy.

    I have been a nurse in the areas of critical care, emergency, flight, labor and delivery, and pediatrics for 20 years. I have been monitored by the board of nursing's diversion program. I have been in intensive outpatient drug treatment, and NA/AA for 10 years! Now I am participating in methadone treatment. NONE of the other treatments worked, at all. I vigilantly tried, over and over, to comply with everything that was recommended by all the professionals, yet I kept relapsing. I knew in my heart that I have an organic disease, one that could be treated. Yet, even though I was a nurse, I did not know that methadone was that treatment! In desperation I sought treatment at the local methadone clinic, and my life has been changed.

    People with opiate addiction have a genetic, physiologic disease. Whenever I took opiates, I did not feel "high," I felt normal! Instead of feeling depressed, numb to the world, isolated and dysfunctional, I suddenly felt organized, calm, and wanted to be part of the world around me. And not in a way that caused me to be high, or unable to perform my functions as a professional nurse, mother, and friend. Opiates, for me, acted just as an anti-depressant works for people that are depressed. Just as insulin works for people with diabetes. Just as blood pressure pills work for people with hypertension. You get the idea.

    When I began methadone treatment, I got my life back. Today, nearly a year later, I have used NO drugs or alcohol in any form, and don't miss it. I DO NOT feel high from my methadone, EVER. I am not addicted to methadone. My BODY is dependent upon the medication, but that is NOT addiction! I do not seek, abuse, misuse or otherwise use methadone inappropriately. That is the definition of addiction: use of any substance in a compulsive, damaging way. Methadone, used properly, is just another medication. The misconceptions that everyone who has posted thus far are DAMAGING to people that could really benefit from methadone treatment. Most of the people in my clinic are like me: a history of abusing mostly pharmaceutical opiates. We do not sell drugs out back, we do not use our medicine to get high, and we are not low-life scum seeking free drugs. We are normal people, going to a medical clinic, to receive the medicine that allows us to function as normal, responsible citizens. There are certainly people that do use the system in a dysfunctional or illegal way, but those are the minority. The majority of us are benefiting immensely, and thus, society is as well. Methadone has allowed us to return to a productive life where we can serve others (I can go back to saving lives, bringing new babies into the world, helping people in pain and sickness get better. I am VERY good at my job!). Please to not allow the stigma and misinformation about methadone delay or prevent people that would really benefit from getting into treatment.

    Methadone is just one part of my recovery. At the clinic, we are seen by therapists, psychologists, nurses and physicians on a regular basis. We go to classes and group therapy. We are given UAs regularly to ensure we are following the treatment recommended for us. There are other ways to recover from addiction, and this is just one way. This is the way that works for me. It might not work for you, but then again, it might save your life just as it saved mine. We are getting better. Don't perpetuate ignorance.

  • Nov 26 '10

    Quote from Finallydidit
    As we all know HANDWASHING is the most effective way to prevent the spread of infection...
    If given the choice, I would choose the caregiver with fake nails that washes her hands each time/everytime over the caregiver with real nails that doesn't wash after each/every patient hands down!!
    I agree with you and I'm going to be completely honest here.

    I had acrylic nails (less than 1/4 inch above the fingertip) put on for my goddaughters christening in a clean pink color. Since I have gotten them put on I wear gloves every time I touch a patient. And of course wash my hands vigorously afterward.

  • Nov 25 '10

    Okay. This is a discussion. So, I'm basing my answer on my understanding of this particular situation.

    With that said, I believe "choking " is the key word here. If there is no exchange of air, then the Heimlich manuever is attempted. If there is an exchange of air (e.g. coughing), then basically nothing is done. Aside from alerting EMS, monitoring the Individual, etc.

    To my recollection, back blows are used only on infants.


  • Oct 22 '10