Latest Likes For Anna Flaxis

Latest Likes For Anna Flaxis

Anna Flaxis, ASN 22,158 Views

Joined Oct 15, '10. Posts: 2,852 (67% Liked) Likes: 8,530

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  • Aug 24

    Quote from Learningtobenurse101
    The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

    So Yes, I am CERTAIN the preceptor went outside her scope.
    In some settings and under some circumstances, medication administration can be delegated to a PCA.

    "Borrowing" medication from another patient is common practice in some settings.

    also it was not prescribed yet either.
    Since you used the word "yet", this suggests that an order was forthcoming. While it is discouraged to administer a medication without an actual written order in place, there are situations where it would be reasonable and prudent to do so.

    Real-world nursing is not as black and white as nursing school nursing. When you see a nurse doing something differently than you learned in nursing school, it behooves you to assume nothing and ask questions.

    While you are on orientation, your job is to keep an open mind and ask questions about the things you don't understand.

  • Aug 24

    I think that the failure to recognize early signs of deterioration is a worthwhile issue to explore, but before you implement process improvement measures, it is important to find out what is at the root cause. Many different variables can factor in. What is the staffing matrix for the unit? What is the skill mix (RNs, LPNs, CNAs, Techs, ancillary staff, etc.)? What about experience; how many veteran nurses and new grads are there? How many RNs hold certification in their area of practice? What about education; does the facility provide inservices on a regular basis or offer classes either on the company intranet or in a live format? What about relations between nursing staff and physicians; what is the typical communication process and what, if any, barriers or glitches occur? At what percentage are core measures being met? And lastly, you should compare the rates of sentinel events/poor outcomes/code blues etc. at your facility with that of a few other facilities similar to yours. Is this really a problem, or are you doing better than you think?

  • Aug 24

    Quote from canoehead
    Is it bigger than a bread box?
    I love that! Gonna have to remember that one...

  • Aug 24

    I think that the failure to recognize early signs of deterioration is a worthwhile issue to explore, but before you implement process improvement measures, it is important to find out what is at the root cause. Many different variables can factor in. What is the staffing matrix for the unit? What is the skill mix (RNs, LPNs, CNAs, Techs, ancillary staff, etc.)? What about experience; how many veteran nurses and new grads are there? How many RNs hold certification in their area of practice? What about education; does the facility provide inservices on a regular basis or offer classes either on the company intranet or in a live format? What about relations between nursing staff and physicians; what is the typical communication process and what, if any, barriers or glitches occur? At what percentage are core measures being met? And lastly, you should compare the rates of sentinel events/poor outcomes/code blues etc. at your facility with that of a few other facilities similar to yours. Is this really a problem, or are you doing better than you think?

  • Aug 24

    Quote from canoehead
    Is it bigger than a bread box?
    I love that! Gonna have to remember that one...

  • Aug 24

    Quote from Learningtobenurse101
    The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

    So Yes, I am CERTAIN the preceptor went outside her scope.
    In some settings and under some circumstances, medication administration can be delegated to a PCA.

    "Borrowing" medication from another patient is common practice in some settings.

    also it was not prescribed yet either.
    Since you used the word "yet", this suggests that an order was forthcoming. While it is discouraged to administer a medication without an actual written order in place, there are situations where it would be reasonable and prudent to do so.

    Real-world nursing is not as black and white as nursing school nursing. When you see a nurse doing something differently than you learned in nursing school, it behooves you to assume nothing and ask questions.

    While you are on orientation, your job is to keep an open mind and ask questions about the things you don't understand.

  • Aug 23

    I think that the failure to recognize early signs of deterioration is a worthwhile issue to explore, but before you implement process improvement measures, it is important to find out what is at the root cause. Many different variables can factor in. What is the staffing matrix for the unit? What is the skill mix (RNs, LPNs, CNAs, Techs, ancillary staff, etc.)? What about experience; how many veteran nurses and new grads are there? How many RNs hold certification in their area of practice? What about education; does the facility provide inservices on a regular basis or offer classes either on the company intranet or in a live format? What about relations between nursing staff and physicians; what is the typical communication process and what, if any, barriers or glitches occur? At what percentage are core measures being met? And lastly, you should compare the rates of sentinel events/poor outcomes/code blues etc. at your facility with that of a few other facilities similar to yours. Is this really a problem, or are you doing better than you think?

  • Aug 23

    Quote from canoehead
    Is it bigger than a bread box?
    I love that! Gonna have to remember that one...

  • Aug 23

    Quote from Learningtobenurse101
    Yes, my managers sided with me on the out of scope of practice, but did still choose the preceptor over me and it makes perfect sense, they've invested a lot of time, money and energy into them more than me and human nature tends to value the those opinions we've built a relationship with over a newer relationship, just part of our nature. Also I would be the most expendible due to being the most new and less skilled of the two. While it may not add up to you, that is okay. It is what it is, and I do need to move on. While I do feel that I would have thrived with a different preceptors whom I worked with side by side in different situations and they taught me well on certain skills, that doesn't really matter either since doesn't change the outcome now. The reason I had written the original post is more due to trying to figure out how to move on, and figure out how to pursue my next job since it was already difficult to get a job as a new grad, let alone someone who was let go.
    A simple incident as you described wouldn't normally result in management having to choose between you and your preceptor.

    It really could be a matter of a simple corrective action- or not. If they value that employee as much as it sounds like, then no formal corrective action absolutely has to take place. Verbal counseling is an option at the manager's discretion. And had you shown potential to be an asset to the unit, they would have held on to you and found a way to make it work- whether by assigning a new preceptor (even if they are few and far between, that does not equate to impossible) or keeping you with your current one, working with the two of you to develop a plan, and scheduling frequent check-ins with you both.

    The fact that they chose to fire you instead of working with you tells me that your rigid, inflexible, and challenging behaviors were red flags signaling that the likelihood of you fitting in and being a part of the team was slim, so they saw the writing on the wall and decided to let you go before investing any more resources in you. This wasn't a matter of choosing anyone over you. They let you go based on your demonstrated behaviors.

  • Aug 23

    Quote from Learningtobenurse101
    The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

    So Yes, I am CERTAIN the preceptor went outside her scope.
    In some settings and under some circumstances, medication administration can be delegated to a PCA.

    "Borrowing" medication from another patient is common practice in some settings.

    also it was not prescribed yet either.
    Since you used the word "yet", this suggests that an order was forthcoming. While it is discouraged to administer a medication without an actual written order in place, there are situations where it would be reasonable and prudent to do so.

    Real-world nursing is not as black and white as nursing school nursing. When you see a nurse doing something differently than you learned in nursing school, it behooves you to assume nothing and ask questions.

    While you are on orientation, your job is to keep an open mind and ask questions about the things you don't understand.

  • Aug 23

    Quote from Learningtobenurse101
    Yes, my managers sided with me on the out of scope of practice, but did still choose the preceptor over me and it makes perfect sense, they've invested a lot of time, money and energy into them more than me and human nature tends to value the those opinions we've built a relationship with over a newer relationship, just part of our nature. Also I would be the most expendible due to being the most new and less skilled of the two. While it may not add up to you, that is okay. It is what it is, and I do need to move on. While I do feel that I would have thrived with a different preceptors whom I worked with side by side in different situations and they taught me well on certain skills, that doesn't really matter either since doesn't change the outcome now. The reason I had written the original post is more due to trying to figure out how to move on, and figure out how to pursue my next job since it was already difficult to get a job as a new grad, let alone someone who was let go.
    A simple incident as you described wouldn't normally result in management having to choose between you and your preceptor.

    It really could be a matter of a simple corrective action- or not. If they value that employee as much as it sounds like, then no formal corrective action absolutely has to take place. Verbal counseling is an option at the manager's discretion. And had you shown potential to be an asset to the unit, they would have held on to you and found a way to make it work- whether by assigning a new preceptor (even if they are few and far between, that does not equate to impossible) or keeping you with your current one, working with the two of you to develop a plan, and scheduling frequent check-ins with you both.

    The fact that they chose to fire you instead of working with you tells me that your rigid, inflexible, and challenging behaviors were red flags signaling that the likelihood of you fitting in and being a part of the team was slim, so they saw the writing on the wall and decided to let you go before investing any more resources in you. This wasn't a matter of choosing anyone over you. They let you go based on your demonstrated behaviors.

  • Aug 23

    Quote from Learningtobenurse101
    The preceptor delegated medication administration to a PCA, and also used medication from a different patient on their current patient, also it was not prescribed yet either.

    So Yes, I am CERTAIN the preceptor went outside her scope.
    In some settings and under some circumstances, medication administration can be delegated to a PCA.

    "Borrowing" medication from another patient is common practice in some settings.

    also it was not prescribed yet either.
    Since you used the word "yet", this suggests that an order was forthcoming. While it is discouraged to administer a medication without an actual written order in place, there are situations where it would be reasonable and prudent to do so.

    Real-world nursing is not as black and white as nursing school nursing. When you see a nurse doing something differently than you learned in nursing school, it behooves you to assume nothing and ask questions.

    While you are on orientation, your job is to keep an open mind and ask questions about the things you don't understand.

  • Aug 22

    Quote from Learningtobenurse101
    Yes, my managers sided with me on the out of scope of practice, but did still choose the preceptor over me and it makes perfect sense, they've invested a lot of time, money and energy into them more than me and human nature tends to value the those opinions we've built a relationship with over a newer relationship, just part of our nature. Also I would be the most expendible due to being the most new and less skilled of the two. While it may not add up to you, that is okay. It is what it is, and I do need to move on. While I do feel that I would have thrived with a different preceptors whom I worked with side by side in different situations and they taught me well on certain skills, that doesn't really matter either since doesn't change the outcome now. The reason I had written the original post is more due to trying to figure out how to move on, and figure out how to pursue my next job since it was already difficult to get a job as a new grad, let alone someone who was let go.
    A simple incident as you described wouldn't normally result in management having to choose between you and your preceptor.

    It really could be a matter of a simple corrective action- or not. If they value that employee as much as it sounds like, then no formal corrective action absolutely has to take place. Verbal counseling is an option at the manager's discretion. And had you shown potential to be an asset to the unit, they would have held on to you and found a way to make it work- whether by assigning a new preceptor (even if they are few and far between, that does not equate to impossible) or keeping you with your current one, working with the two of you to develop a plan, and scheduling frequent check-ins with you both.

    The fact that they chose to fire you instead of working with you tells me that your rigid, inflexible, and challenging behaviors were red flags signaling that the likelihood of you fitting in and being a part of the team was slim, so they saw the writing on the wall and decided to let you go before investing any more resources in you. This wasn't a matter of choosing anyone over you. They let you go based on your demonstrated behaviors.

  • Aug 22

    Quote from JWFeeII
    I do not wish to complain I have found most nurses the most kind, sensitive, caring, people I have ever known. I want to know if I'm being overly sensitive or if my nurses (this time) were a bit out of line? I was in a rehab hospital for a hip replacement. Getting from bed to commode to toilet was an issue, but once there I had grab bars and felt myself quite safe. I assured the nurses that I would obey the rules and not get up on my own. I was extremely constipated and wanted some time and privacy to force a bowel movement. Time and again I had to specifically ask that the nurses leave and close the door. Often I was popped in on and asked how I was making out. Quite frankly the interruptions stopped the process in its tracks, I had to ask the nurse to leave, to close the door and begin my efforts all over again.
    Am I being an overly sensitive prude or did I deserve a little more consideration?
    Hi there! As others have stated, it is reasonable and prudent to check on a patient who is on the commode. However, I would knock on the closed door and ask how it's going through the closed door. If I didn't hear a response, then I would open the door to visualize the patient.

    I'm more concerned here that you were constipated and wanted to force a bowel movement. One should not force a BM. As others have suggested, this can cause a vaso-vagal response where you lose consciousness and fall to the floor, potentially complicating your surgical recovery or suffering new injuries. You should have been receiving stool softeners and other interventions such as Miralax, glycerin suppositories, and if those things failed, an enema.

  • Aug 22

    Quote from Learningtobenurse101
    Yes, my managers sided with me on the out of scope of practice, but did still choose the preceptor over me and it makes perfect sense, they've invested a lot of time, money and energy into them more than me and human nature tends to value the those opinions we've built a relationship with over a newer relationship, just part of our nature. Also I would be the most expendible due to being the most new and less skilled of the two. While it may not add up to you, that is okay. It is what it is, and I do need to move on. While I do feel that I would have thrived with a different preceptors whom I worked with side by side in different situations and they taught me well on certain skills, that doesn't really matter either since doesn't change the outcome now. The reason I had written the original post is more due to trying to figure out how to move on, and figure out how to pursue my next job since it was already difficult to get a job as a new grad, let alone someone who was let go.
    A simple incident as you described wouldn't normally result in management having to choose between you and your preceptor.

    It really could be a matter of a simple corrective action- or not. If they value that employee as much as it sounds like, then no formal corrective action absolutely has to take place. Verbal counseling is an option at the manager's discretion. And had you shown potential to be an asset to the unit, they would have held on to you and found a way to make it work- whether by assigning a new preceptor (even if they are few and far between, that does not equate to impossible) or keeping you with your current one, working with the two of you to develop a plan, and scheduling frequent check-ins with you both.

    The fact that they chose to fire you instead of working with you tells me that your rigid, inflexible, and challenging behaviors were red flags signaling that the likelihood of you fitting in and being a part of the team was slim, so they saw the writing on the wall and decided to let you go before investing any more resources in you. This wasn't a matter of choosing anyone over you. They let you go based on your demonstrated behaviors.


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