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Kooky Korky 21,138 Views

Joined Feb 12, '10. Posts: 3,322 (53% Liked) Likes: 4,507

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  • Jul 20

    Quote from tami2017
    Thank you so much. Your former agency sounds great, very thorough. I wish my agency trained that way. From what i understood training is just on specific skills, such as g tube and trachs, with no training an peds and on paperwork. I will ask to make sure, now that i know what to ask based on what you described is out there as far as training.
    You need to get the diagnoses, the med list, the care plan and get them now, not 5 minutes before you meet the parents. Do your study on your own time in the office (if concerns about HIPAA) if need be.

    Get to the Clin Sup. Today.

    No need to bemoan your lack of Peds experience. Just do this education NOW so you can give good, correct, confident care. Take the initiative and tell the agency what you need and want - info on this specific case, charting, policies and procedures, skills, everything.

    If the agency can't or won't at least get you started on orientation for this case, seek a different agency that will treat you - and their patient - better.

  • Jul 20

    Quote from tami2017
    You are so right i wish this agency was half as prudent as you are. Im afraid i will get very little training and will be thrown in to sink or swim. I have a bad gut feeling and feel like backing out of the whole thing. As a psych nurse all i did pretty much was give PO meds and do psych assessments. Nothing clinical at all except maybe IM shots. This is a whole new world for me and i honestly dont understand how they could have hired me, i think its irresponsible.
    They hired you because you are breathing. They need workers so they can make money. Nothing wrong with that. They're not wrong to hire you but they do need to orient you and train you well. Everybody starts at the beginning. I know how you feel. I was once hired for a job that no one else wanted, although I didn't know it at the time. I stayed about 8 years. It had good pay and benefits and they did give a good orientation and training. Yes, it was scary and painful at first. But I ended up loving it and the people I had come to know.

    Did you do any tubes, IV's, dressings, feeding, toileting, positioning in school? How long have you done Psych? What made you want to switch specialties?

    Get a box of gloves from the agency office to have with you when dealing with the tubes, etc. I once got to an HIV case and there were no gloves! The full-time nurse on the case had taken them with her when she got off work Friday evening and to H with the weekend nurse! The patient's friend ran out to a pharmacy to buy a box for me/other fill-in nurses.

    Think about some other basic supplies you might need and take those to the case with you - if you accept it after orientation. Scissors, tape, saline, alcohol pads or bottle of it, gauze pads - clean and/or sterile, a hemostat, half a dozen working pens, rubber bands, a little stapler or paper clips, all charting forms you might need, flashlights, tongue depressors for mixing stuff, oral med syringes, mortar and pestle or pill crusher. Better to have and not need than vice versa. Some clean newspaper on which to set your purse, your backpack, or other personal belongings. It's hot now but in cold weather, you might leave your coat in your car trunk.

    Get a graduated pitcher, too, in case you have to measure anything. Where's the Ambu bag? Where's the phone you will use in an emergency while you bag?

    Take some paper or a small notebook on which to write your daily plan of action, notes, questions.

    Take your food and beverage, your own toilet seat covers/paper towels/Kleenex, a fan and extension cord if you are hot a lot, charger cord for your phone/tablet, maybe a little bleach for cleaning your bathroom, etc. Is there a comfortable chair and writing surface for your use? Sufficient lighting for you? Clip-on lights in case you need to supply your own light. Take a sweater, feminine hygiene items, and clean underwear in case you need them. You never know. Again, better to have and not need than need but not have. Take some small bags to dispose of your personal trash. Take it home with you and dispose of it there if you'd prefer. Use a rolling bag, such as you'd roll in the airport. Get a decent size and strength roller bag so it will last. You can always use it in other than your work, so it's worth the investiment.

    Make sure you know all of the phone numbers for parents, doctors, a neighbor or whoever the family says is the person to call for immediate, close by help.

    You should also carry a sterile urine specimen cup and suction catheters, also an extra cannula for the trach if there isn't one there already.

    Make sure controlled substances are properly accounted for (count at shift change every time) and stored. Make sure about who handles keeping prescriptions and the supplies refilled/restocked. Mom? Nurses?

    Study procedure for if the feeding tube comes out or if the trach comes out. Study on trachs - cleaning, cuff deflation, speaker button, etc. Do these now.

    Are you a real new nurse? How long have you worked Psych? I think you'll do well if you get them to start your training now, before the interview. You need at least the info about the pt and the case, diagnoses, meds, and what treatments are involved.

    Best wishes. You will do well if you start taking the initiative.

    Their training rate of pay is probably negotiable. It's good you're getting a full shift.

  • Jul 20

    Quote from tami2017
    Thank you so much. Your former agency sounds great, very thorough. I wish my agency trained that way. From what i understood training is just on specific skills, such as g tube and trachs, with no training an peds and on paperwork. I will ask to make sure, now that i know what to ask based on what you described is out there as far as training.
    You need to get the diagnoses, the med list, the care plan and get them now, not 5 minutes before you meet the parents. Do your study on your own time in the office (if concerns about HIPAA) if need be.

    Get to the Clin Sup. Today.

    No need to bemoan your lack of Peds experience. Just do this education NOW so you can give good, correct, confident care. Take the initiative and tell the agency what you need and want - info on this specific case, charting, policies and procedures, skills, everything.

    If the agency can't or won't at least get you started on orientation for this case, seek a different agency that will treat you - and their patient - better.

  • Jul 20

    Get pre-approval. Is that what your boss requires?

    If they don't approve it, just alter your work habits so you have time to do the charting that will cover you in case of trouble. You have to protect
    yourself. Do all that is required of you, just don't do work that someone else can do. If the pt has to wait, it's not your fault. Emergencies are, of
    course, the exception to this. Don't let a pt be harmed ever, if you can prevent that.

    That's what I learned to do - cover your fanny. If it meant someone else had to get the pt a blanket, so be it.

    Our techs would always hide out as soon as their relief arrived. They conveniently forgot that their shift ended 30 minutes later, not the moment
    their relief appeared. I refused to do their late Rounds (other nurses did, which made it hard for me not to, but I stood my ground. Why should I
    do their work?) or answer lights that last half hour because I had to count, give Report, do my end-of-shift Round, finish charting, etc.

    I figured they could damn well answer lights and make their own last Round, not go into the locker room or stand by the clockout clock for 1/2 hour.

    Do not work off the clock. If you get hurt or make an error, Worker's Comp and the employer's coverage might not cover you.

  • Jul 20

    Quote from tami2017
    You are so right i wish this agency was half as prudent as you are. Im afraid i will get very little training and will be thrown in to sink or swim. I have a bad gut feeling and feel like backing out of the whole thing. As a psych nurse all i did pretty much was give PO meds and do psych assessments. Nothing clinical at all except maybe IM shots. This is a whole new world for me and i honestly dont understand how they could have hired me, i think its irresponsible.
    They hired you because you are breathing. They need workers so they can make money. Nothing wrong with that. They're not wrong to hire you but they do need to orient you and train you well. Everybody starts at the beginning. I know how you feel. I was once hired for a job that no one else wanted, although I didn't know it at the time. I stayed about 8 years. It had good pay and benefits and they did give a good orientation and training. Yes, it was scary and painful at first. But I ended up loving it and the people I had come to know.

    Did you do any tubes, IV's, dressings, feeding, toileting, positioning in school? How long have you done Psych? What made you want to switch specialties?

    Get a box of gloves from the agency office to have with you when dealing with the tubes, etc. I once got to an HIV case and there were no gloves! The full-time nurse on the case had taken them with her when she got off work Friday evening and to H with the weekend nurse! The patient's friend ran out to a pharmacy to buy a box for me/other fill-in nurses.

    Think about some other basic supplies you might need and take those to the case with you - if you accept it after orientation. Scissors, tape, saline, alcohol pads or bottle of it, gauze pads - clean and/or sterile, a hemostat, half a dozen working pens, rubber bands, a little stapler or paper clips, all charting forms you might need, flashlights, tongue depressors for mixing stuff, oral med syringes, mortar and pestle or pill crusher. Better to have and not need than vice versa. Some clean newspaper on which to set your purse, your backpack, or other personal belongings. It's hot now but in cold weather, you might leave your coat in your car trunk.

    Get a graduated pitcher, too, in case you have to measure anything. Where's the Ambu bag? Where's the phone you will use in an emergency while you bag?

    Take some paper or a small notebook on which to write your daily plan of action, notes, questions.

    Take your food and beverage, your own toilet seat covers/paper towels/Kleenex, a fan and extension cord if you are hot a lot, charger cord for your phone/tablet, maybe a little bleach for cleaning your bathroom, etc. Is there a comfortable chair and writing surface for your use? Sufficient lighting for you? Clip-on lights in case you need to supply your own light. Take a sweater, feminine hygiene items, and clean underwear in case you need them. You never know. Again, better to have and not need than need but not have. Take some small bags to dispose of your personal trash. Take it home with you and dispose of it there if you'd prefer. Use a rolling bag, such as you'd roll in the airport. Get a decent size and strength roller bag so it will last. You can always use it in other than your work, so it's worth the investiment.

    Make sure you know all of the phone numbers for parents, doctors, a neighbor or whoever the family says is the person to call for immediate, close by help.

    You should also carry a sterile urine specimen cup and suction catheters, also an extra cannula for the trach if there isn't one there already.

    Make sure controlled substances are properly accounted for (count at shift change every time) and stored. Make sure about who handles keeping prescriptions and the supplies refilled/restocked. Mom? Nurses?

    Study procedure for if the feeding tube comes out or if the trach comes out. Study on trachs - cleaning, cuff deflation, speaker button, etc. Do these now.

    Are you a real new nurse? How long have you worked Psych? I think you'll do well if you get them to start your training now, before the interview. You need at least the info about the pt and the case, diagnoses, meds, and what treatments are involved.

    Best wishes. You will do well if you start taking the initiative.

    Their training rate of pay is probably negotiable. It's good you're getting a full shift.

  • Jul 20

    Quote from tami2017
    Thank you so much. Your former agency sounds great, very thorough. I wish my agency trained that way. From what i understood training is just on specific skills, such as g tube and trachs, with no training an peds and on paperwork. I will ask to make sure, now that i know what to ask based on what you described is out there as far as training.
    You need to get the diagnoses, the med list, the care plan and get them now, not 5 minutes before you meet the parents. Do your study on your own time in the office (if concerns about HIPAA) if need be.

    Get to the Clin Sup. Today.

    No need to bemoan your lack of Peds experience. Just do this education NOW so you can give good, correct, confident care. Take the initiative and tell the agency what you need and want - info on this specific case, charting, policies and procedures, skills, everything.

    If the agency can't or won't at least get you started on orientation for this case, seek a different agency that will treat you - and their patient - better.

  • Jul 20

    Quote from tami2017
    Thank you so much. Your former agency sounds great, very thorough. I wish my agency trained that way. From what i understood training is just on specific skills, such as g tube and trachs, with no training an peds and on paperwork. I will ask to make sure, now that i know what to ask based on what you described is out there as far as training.
    You need to get the diagnoses, the med list, the care plan and get them now, not 5 minutes before you meet the parents. Do your study on your own time in the office (if concerns about HIPAA) if need be.

    Get to the Clin Sup. Today.

    No need to bemoan your lack of Peds experience. Just do this education NOW so you can give good, correct, confident care. Take the initiative and tell the agency what you need and want - info on this specific case, charting, policies and procedures, skills, everything.

    If the agency can't or won't at least get you started on orientation for this case, seek a different agency that will treat you - and their patient - better.

  • Jul 20

    Quote from hydrochloro
    I'm almost 25. I want to try out the hardest type of nursing to challenge myself.
    So what do you figure you will do?

  • Jul 20

    Quote from matcha-cat
    ??????

    First off, what kind of "retaliation" would I be afraid of? Her telling on me for doing my job? I didn't want to accuse her of something that other people thought of as "normal", so it would be like a "boy who cries wolf" situation.

    Secondly, this wasn't a "long time ago". This was on Saturday, and it was my first and only time I've been at the facility and worked with my instructor.

    Thirdly, I did say something immediately. Right after she told our resident to go in his briefs, we took him to breakfast, and my instructor was there and I told her that I needed to speak to her privately when we had the chance. On my lunch break I told my instructor about the first resident telling her to use a friendly tone with him, and how she told the resident to go in his briefs. The other stuff happened afterwards, so I came here to AllNurses to see if I should continue talking to my instructor about what I saw.

    Because the responses supported how I felt about the situation, I've decided to do so, and will talk to my instructor with my partner beside me, Saturday morning before my clinical starts.
    I applaud your decision to talk with your Instructor in a few days.

  • Jul 20

    Quote from CNA2016:)
    Yes our union is not good at all. But I'm fairly certain this resident has been put in the MDS but the doc is very lazy and the only other management we have is the general manager and we have a brand new one as of now because our facility goes through GM's like crazy. Then it's just up to the 2 ft nurses on the floor and they are just as lazy in my opinion I really do feel that it's a bunch of different issues together....bad management...bad nurses....and this particular resident. This isn't the first time something has happened where management and nurses needed to step up and they didn't, and it won't be the last. I'm planning to do my nursing in a city a couple hours away next year so I think leaving this facility will be better all around. I know why people always leave haha thanks for response
    Keep trying, friend. Rome wasn't built in a day and all that. LOL but I mean it, it just sounds cliche.

    Leaving isn't always possible, so try to blossom where you are planted for now.

  • Jul 19

    Quote from Euro_Sepsis
    I don't pray, just a turn about of Kooky's post. I hope it never happens to anyone, but more often than not, it's poor personal choices that lead people down that road. My sympathy runs pretty low when you're a victim of your own stupid decisions. It's also pretty easy to hate on addicts in the throes of their disease because of their reprehensible behavior: lying, cheating, stealing, murdering.

    Again, I'll help those seeking help but if you're trying to throw resources at someone whose literally just seeking a drug fix, you're tying up precious ED time, space and staff. Or is this the touchy-feely rehab forum and I'm turned around?
    Have you ever made a stupid decision? If so, did you appreciate the help you, hopefully,
    received with regard to it? Or what?

    I know ER can be frustrating and some resources do seem to be thrown away/wasted but who the devil do you think you are to decide who is worthy of help and who isn't? Today might be the 40 millionth time a particular addict comes into your ER. And today might be the very day that he will, at long last, "get it". This might be the day he turns around. It does happen, you know.

    So don't let frustration or cynicism get the best of you. Just do your level best to help your suffering fellow human who shares this planet with you.

    Think of Mother Teresa. She couldn't clean up all of the suffering, cure those who were literally dying in
    the streets. But she could and did cradle a dying person until that person passed. So the book says. I
    wasn't there, but I think it's believable that this loving and dedicated woman did what good she could
    whenever the opportunity presented itself.

  • Jul 19

    For all who say they would not work in a facility without EMR's and/or phone recorders (and I don't think this would violate HIPAA. It's about the patient in your facility, for Heaven's sake. But stranger things have happened, so who knows? Best to check with your Compliance Officer, but that's secondary to this OP's concerns.) - you can't go quitting a job any time, every time like this happens. Most of the time, we have to think about how tough it is to keep starting over, how we would lose seniority, certain benefits, etc.

    For OP - you have every right to be upset. That said - do NOT confront Dr. Butthead. The doctors win every time. That is how the medical world is structured, although things have changed for the better in recent decades. Things are more collegial than they used to be between docs and other workers, but the do still rule the roost, best I can tell.

    Docs bring in money, nurses are an expense. We all know that it is the nurse on the front lines, but docs still do bring in the bucks.

    In his defense, I'm assuming he was half asleep in the middle of the night. As for the wife overhearing, wow, maybe it does violate HIPAA. I don't know. But it would be plain to anyone who is even semi honest that she is not an impartial observer.

    Furthermore, your facility has essentially sided with you. You are not being written up, so , as others have suggested, it would be best to let this go. Unless you just can't live with the injustice of this jerk doctor being able to blame you. But please try, unless you are prepared for a huge battle.

    Someone suggested she get her colleagues to back her up. She said she has already tried this but two of them are unwilling to get involved. Can't really blame them, although it's a shame they are chicken.

    You can't really refuse to take TO's and VO's all the time. I would refuse to take them from him in anything but the most dire emergency, though, and remind him of this problem NICELY if he gets upset.

    But you MUST make time for there to be a witness. The witness must sign the order right along with you. That will be some protection for you.

    Meantime, as others have said, try to effect change in the facility. As much as I dislike EMR's, they would force a doctor to input an order that would then be in writing, not let him just give a TO or VO. And until EMR is instituted, a fax should help a lot.

    Do you think your facility would go along with requiring a faxed order from doctors after hours? The docs will probably howl loudly against it. But faxed orders will help protect the nurses and patients.

    I wish you the best.

  • Jul 19

    I pray that neither I nor anyone I love ever has to be in the clutches of anyone like this monster you have described. It would be so good to die quietly in our sleep, at home, after no suffering. We can skip the whole concentration camp scene.

    The aide is a miserable person in her personal life, she hates her life situation, she is poor, she might be physically ill, she is mean, she needs to be reported for abusing the helpless people in her care. So does the nurse who told the pt to void/defecate in his briefs. I'm sure there is quite a history there. Maybe someone long ago decided that this pt needs to go too often and is too slow or too heavy or whatever to keep being repeatedly toileted. Perhaps he has irritable bowel syndrome or a UTI or some other malady, like prostatic hypertrophy, and he has to keep emptying bowel and bladder - or trying to.

    Back to the aide - she does not belong in this line of work. She hates it anyway, she is as ignorant as a tin can, she is jealous, she just does not belong anywhere near helpless people. And the nurse is a mess, too. She needs to take a leadership stance, not go along with this approach to "caring " for the patient.

    So, have you spoken with your Instructor yet? What are you going to do, OP?

  • Jul 18

    I pray that neither I nor anyone I love ever has to be in the clutches of anyone like this monster you have described. It would be so good to die quietly in our sleep, at home, after no suffering. We can skip the whole concentration camp scene.

    The aide is a miserable person in her personal life, she hates her life situation, she is poor, she might be physically ill, she is mean, she needs to be reported for abusing the helpless people in her care. So does the nurse who told the pt to void/defecate in his briefs. I'm sure there is quite a history there. Maybe someone long ago decided that this pt needs to go too often and is too slow or too heavy or whatever to keep being repeatedly toileted. Perhaps he has irritable bowel syndrome or a UTI or some other malady, like prostatic hypertrophy, and he has to keep emptying bowel and bladder - or trying to.

    Back to the aide - she does not belong in this line of work. She hates it anyway, she is as ignorant as a tin can, she is jealous, she just does not belong anywhere near helpless people. And the nurse is a mess, too. She needs to take a leadership stance, not go along with this approach to "caring " for the patient.

    So, have you spoken with your Instructor yet? What are you going to do, OP?

  • Jul 18

    Who should be making the care plan?

    When it finally gets made, part of it has to be that the dtr is not allowed to visit while intoxicated. Also, if she starts fighting with her father and it's getting loud and maybe dangerous, she will be removed from the facility. This might involve police, as you likely have no security personnel at your facility.

    The physician, social worker, DON, Administrator, and owner all need to be apprised of this fellow's behavior and of his daughter's behavior. The staff has to
    all get together and approach the powers that be together because if only you or you and only 1 or 2 others do the speaking, you will likely be fired. I know this is a tough situation, so good luck.

    I guess it does get old being compassionate, but try to keep doing the right thing.

    What do they fight about?


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