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Joined Aug 3, '11 - from 'Disco Hogwarts'. libran1984 is a Registered Nurse. He has '4' year(s) of experience and specializes in 'Emergency Nursing'. Posts: 590 (38% Liked) Likes: 680

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  • Jun 29

    The best way to avoid the worst nursing homes is to get your RN.

    otherwise you can try asking these...

    Ask what sort of acuity levels you will be working with.

    Ask what the nurse to patient ratio is? (don't worry tho, you'll have TONS of help the management will say. Also add 2 more patietns minimum on to what ever number they give you) I truly feel anything over 10 patients per nurse is ludicrous unless the patients are TRUE assisted living classes- however, most assisted living facilities i'm familiar with still hold residents who need complete and total assistance and no way should they be in assisted living.

    Its all about the money, man. That's why LPNs work in these places because they know we are the "low paid nurses" and they can get away with paying less than they would for an RN.

    ugh....

    just steer clear. Otherwise next thing you know you'll be forced to put an NG tube down a guy with esophageal verices and you'll cause excessive bleeding and he'll expire. Then the DoN will blame it all on you because you should have known he had the esophageal verices, but the patient was non-verbal so how were you to have known? His chart is all paper and its not even mentioned on his Dx's except for 300 pages into the chart where it was inexplicably left out in more recet Dx's....

    Then the medicare charting is terribad. Computerized charting, you say.... no no no... ugh.

    I honestly don't know what to tell you Jasmine other than I can imagine no worse job than being in LTC.

    One guy I dealt with had a terrible MRSA infection in his leg and was at the rehab center to help heal it up. I asked my supervisor why the pt was unable to move his upper extremities and why is Level of consciousness was down the toilet. The nurse responded, "I think he had a stroke sometime". Upon further investigation, the hospital discharge assessment made him out to be A/Ox3 with full RoM except for his affected lower extremity. Because there was no charting EVER in regards to the computer and all the MAR assessments had been put into a storage box no one was able to tell when the pt became the way he is now. So what happened to him? It obviously happened while in rehab!

    My first nursing job was ~$14/hr. That's like 2-3 dollars more than most CNA's and in many cases less.... if these LTC centers could just pay all the LPNs $14/hr and staff extra nurses, then patient safety and satisfaction would go up, and nursing retention would increase (as long as year raises of up to 4% were provided to allow financial growth) because it would offer valuable skills in a safe environment because let's face it, most of us got into nursing to help people.

    I'd always heard how terrible the nursing pay was and then I became an LPN so I wasn't overly surprised when I began making $14/hr.

    /sigh....


    Jasmine, I'll be coming back to this post to see if anyone else has better advice to offer you. I'm sure I'm just scaring you. I apologize, but I've been scarred by the LTC experience as well as most other LPN jobs I've ever had. I love being an ER nurse but I'm not often referred to as a nurse by my co-workers but rather a "non-RN" and that just grates me. At the LTC centers where I am considered a nurse, I feel that I actually harm the patients through neglect since I can't assess them or offer them the emotional support they frequently need.

    Find a clinic job, girl! Find a clinic job!!!!

  • Jun 29

    I hate LTC. I hate it with an undying passion. I truly feel if it were my only resort I'd just leave nursing altogether.

    In my experience, my patients were not "stable".

    I never had proper supplies let alone hand sanitizers.

    Orientation was pointless ( 2 eight hour shifts and ur on ur own)

    The charting was redundant to the point of sheer ludicrous.

    Everything was on paper and then expected to be transcribed to the computer.

    Hours were watched like a hawk for fear u go over.

    You never left the med cart.

    The MARs are illegible.

    The meds are disorganized and u are encouraged to steal from other resident's supply to fill an empty med slot for another resident.

    Med pass should be but a medium chunk of the day, not all of it. If I were actually at my computer and not in my iPhone I would write very precisely every thing, in detail, that is wrong with many LTC settings.

    The environment is toxic and leads to... No, encourages poor nursing care.

    On a side note, this has only been my overall impression of LTC from observation and experience.

    I look at LTC centers where LPNs are few to none and the staffing seems much better. Get this.... In a pediatric LTC center for rehab (and some hospice) there were no LPNs, but instead an all RN staff and QMA's who passed meds. The RN approved PRN meds for the QMA, she did all the charting, VS's, assessments, and treatments. The RN never had more than 8 patients at a time.

    Now why are the RNs making more and doing less? Why are her patient ratios so much smaller? Why does she have someone dedicated to med pass so she can do the appropriate work required of her position.

    I, an LPN, had to deal with brand new strokes straight from the hospital who were total care pts. Ppl in recovery for post op open heart, ppl who would regularly be placed on bipap (srsly), and ppl with god awful infections of varying kinds and at least half are on IV vanc and merripenem (!!!) thru their PICC lines. How am I supposed to deal with meds, new admits, treatments, ADLs, blood draws, daily weights, accuchecks, more meds, and spontaneous colostomy seepage when I, an LPN am responsible for 16 patients and btw, WHERE is the foresaken handwashing station!!!!!????

    That's not even that bad. My friend went to a diff LTC center for her LPN to RN critical care clinicals and some dude was on Levophed- and he was awake!!! Seriously, the same "levophed leave 'em dead" stuff. This is the kind of stuff LPNs have to deal with in LTC.

    Yes yes- someone is going to say that isn't the typical LTC experience. That is correct. Many LTC facilities hold are not SNF's, or rehab, etc. it's just an elderly, frail, person who needs a little guidance and reminder to take all their meds- but that has not been my experience.

    And working in the ER, when I get report from a LTC nurse, it generally results in a lot of eye rolling. Seriously who continues to give Norco's for a fever to a dialysis pt and then wonder why she's become lethargic. /facepalm


    I hate LTC. I feel very strongly on this subject and believe "hate" is sufficient to convey the amount of contempt I have for LTC.

    God bless all the nurses who work there because I cannot.

    Sorry this tangent kept going on and on

  • May 10

    I work with an LPN who is certified to administer botox for her primary job outside of the ED. She loves her other job and her work with the Doc. I wish you much luck. Don't get discouraged by what others say. A certified LPN working in the field may know more than some NPs outside of aesthetics nursing with regards on proper botox administration.


    edit: example of Specialty LPNs performing better than an NP... I was doing ACLS with an FNP who works primarily fast in/out clinics. She kept trying to shock an unshockable rhythm and wonder why the mega-code kept deteriorating. LOL.

    To each his/her own. People go around toting a vast amount of certs behind their name and say this is an example of my education and experience. However, others often over look or don't take the certified individual seriously if he/she don't have an RN somewhere in the title or in some cases, a BSN or higher- then you are pretty much just... well... out in the dust for qualifications, despite your... despite your qualifications!

  • Apr 30

    I am an LPN and worked in a level 2 correctional facility for 11
    months. The Prison's doctor was a wonderfully smart man and lived by a few simple rules, Never trust the offender regarding pain level. There are too many substance abusers who cry out in pain for attention and medication. You can only trust your objective assessment data.

    Chest pain was a daily complaint and between 1600 offenders,
    it was always something. Thankfully, all that drama and my insistence
    to pursue more nursing knowledge, nursing interventions, and perform
    proper assessment skills it landed me a highly coveted LPN position at
    a local Emergency Room where I see and even act as a primary nurse for
    varying levels of acuity. I wish to share with you my success in a
    correctional setting and tell you what I learned.

    1. Perform Immediate Visual assessment
    ---- Look for pallor (think deathly pale) clutching at chest, gasping
    for air, and extremely diaphoretic.
    ---- How did the offender get to the Health Services Unit?

    2. Take control of the situation, this is an offender who may need
    health care but simultaneously poses a safety risk to you.\
    --- Tell the the Custody officer to calm down (if in a panic), to
    release the offender, and not to leave you alone. If necassary ask
    unneeded personal or extra officers to leave to provide you room to
    work.
    ---Tell the offender to stand up.
    ---Tell the offender to get on the gurney.
    ---Tell the offender to take off his shirt in preparation for EKG.
    --- Above all, you must be persistent. Encourage the offender's goal
    of obtaining treatment only should he comply with your stipulations.
    You are in charge.


    Don't help or touch the offender until you have seen and noted what
    the offender is capable of. Measure his physical limitations. They may
    groan and complain the entire time about how it hurts to get their arm
    out from under their shirt but too bad too sad. If they can do it then
    thats a check mark in the "they'll survive category". If the offender
    refuses or honestly cannot, in your opinion, perform any of the above
    tasks then help him and continue to the next steps.

    3. Place on 2L Nasal Cannula ( if readily available- my correctional
    clinic rarely had easy access to supplies due to everything being
    locked up)

    4. Obtain Vitals.

    5. Obtain an EKG
    --- Familiarize yourself with a ST - elevation (STEMI) as would be
    seen on a 12-lead (often the machine will tell you too)
    --- Is the rhythm a regular? (If they have a pacemaker it will usually
    look a mess, but you should see very small notches at regular
    intervals that indicate the pacemaker is firing.)
    --- Is the EKG different than past EKGs? (This usually was info that
    required a bit of chart searching in the EMR, and even at times,
    required me to pull the hard chart.)


    6. Perform Hx with the following or similar questions:
    --- Do you have any other associated symptoms? (do not offer
    suggestions, but look for nausea, pain in L arm, Shortness of Breath,
    etc)
    --- Where is the pain?
    --- When did the pain begin?
    --- What does the pain feel like?
    --- What were you doing when the pain started?
    --- Have you ever had a heart attack previously?
    --- Are you on any Medications?
    --- Do you have any allergies?
    --- Have you ever taken Sublingual Nitro?


    7. Perform head to toe assessment.
    --- a/ox3 ?
    --- PERRL ?
    --- Skin warm, dry, intact?
    --- Respirations even and unlabored?
    --- Breath sounds clear to auscultation anterior / posterior
    --- S1&S2 auscultated?
    --- apical pulse correlates to radial pulse?
    --- bilateral extremities (lower and upper) overcome resistance?
    --- grips strong?
    --- capillary refill brisk?


    8. Give ASA 325 mg or 2-4 BABY ASA of 81 mg / tab - make sure he chews
    --- hold if allergy is present

    9. Give sublingual nitro if offender has on hand and has not already taken.
    --- Sublingual nitro is contraindicated for offenders who...
    ------ do not have their own SL nitro on hand and do not have IV access
    ------ have an SBP < 100, or DBP < 50 for fear of bottoming their
    blood pressure out.
    --- repeat up to 3 total doses 5 minutes apart and assess offender's
    supposed comfort level.


    Now allow me to describe a scenario for you. The exact one that
    happened to me a few months ago.


    The officers call HSU (Health services unit) while I'm working the clinic
    alone. There are other nurses in the infirmary and one nurse in the
    med room. It is a scorching, hot, weekend. The doctor is not on site nor is
    management. An offender is complaining of chest pain and an CO (Correctional Officer) radios in that he'll be bringing an offender up to the clinic.

    Its 1625. The peak of my insulin line. I already have 20+ offenders standing in a single file line outside of my open door waiting for their insulin. I have 30+ more offenders I am expecting to come before 1700. This is just not the time to deal with this CP (chest pain) crap. I yell back to my CO in the clinic, "How's he getting up here?" as I continue shooting my offenders with their insulin.

    Officer Wise shouts back, "They're bringing him up in a wheel chair." I roll my eyes and stab another offender with his Humulin R as she continues, "I'll meet them at the entrance". Little does the officer realize she's now leaving me alone with these 20 offenders. My concerns have been voiced repeatedly for this safety issue but have always landed on deaf ears. The considerations for the nurse's safety by the CO's is atrocious.

    "Hey." says an offender in front me, "While I'm here can you look up what my last A1C was?" he pleads as he towers over me as I sit at my station.

    "No. I've got to get as many people done before this chest pain arrives and we're not supposed to hold up insulin line for requests." I plainly state.

    "Awe, it'll not even a minute." the offender reckons.

    "I'm sorry. I have to get everyone else done. You'll have to put in a health care request where we'll write you back with the information or either you'll need to wait for your next chronic care appointment."

    "I don't see what the big deal is. The computer is right in front of you."

    "I said no. If you do not leave so I can get the next person I will call the CO". I state in my most authoritative voice.

    "Man, you used to be cool." the offender storms off muttering audible, derogatory curses under his breath.

    The next offender steps in and pricks himself with a lancet. He throws it away in front of me to a sharps container. We wait a moment for his accucheck to register when I hear Officer Wise yelling, "Get out! Get out of the way!" Her high pitched voice is chilling and filled with panic. "He's having a heart attack!"

    Not one, not two, not even three officers.... but FOUR officers were around this heart attack guy all trying to talk at once and explain what was going on to me, where they found him, his Hx, etc.

    "Hold on! Hold on!" Their panic is very contagious. I'm feeling overwhelmed already and haven't even made contact with the patient yet. Miss Wise can you move the offenders out of the hall?" She looks at me and eagerly nods.

    "OOHH! My chest. I can't breathe. I can't breathe. OH MY GOD. OH GOD. Its hurting!" The offender in the wheelchair moans. I look at the offender. He's white, in his 50's, and slim. No visible injury or trauma noted.

    ********* NURSING CHECK 1:

    OFFENDER CAN BREATHE
    as evidenced by his ability to coherently express his pain

    OFFENDER IS PROFUSELY SWEATING,
    is that from the awful heat outside or is he truly diaphoretic?

    OFFENDER IS BADLY SUNBURNT
    pallor cannot be noted at this time.

    OFFENDER ARRIVED BY W/C -
    gait not visualized at this time.


    ***********


    I take a deep breath and I hate this next part. I begin to take control of the situation by issuing orders to everyone.

    "Who has this guy's ID?" I ask the three remaining officers. One of them hands it to me with the offender's DOC #. With the officer's own out of breath pants informed me, "He was in the chow line when he collapsed and began screaming for help".

    "Sir," I address the offender, "I need you on this bed. We need vitals and an EKG." I state while simultaneously picking up my insulin sharps and throwing them into a random drawer. Officer Wise only cleared the offenders out of the doorway but did not take them out of the hall. My sharps are still at risk and need to be far out of the offender's reach.

    The offender momentarily just sits there, hyperventilating, moaning, and grabbing his L shoulder. The officers don't bother to wait for him to move but instead grab under his arms and begin to lift him from the wheel chair.

    "Wait! Wait!" I rush forward flaring my hands up to the officers. "No. I need him to do it. This is a nursing assessment." Test? Assessment? Its all the same right? Assessment just sounds better. "I have this. Just watch him..." I purposefully fail to verbalize "In case he falls" for fear of putting ideas into the offender's head. Hopefully the overeager officers will take the hint, but I doubt it.

    I look back to the offender and provide him with instruction. "Now, I need you to move to the gurney. The longer we put this off, the longer we delay treatment" I decide to tack on an enthusiastic, "and you look like you might need it, so let's get started."

    With much complaining, but absolutely no difficulty, the offender leaves his wheel chair and hops onto the gurney.

    "Okay, officers. Thank you so much for your help. Can you have Miss Wise come back in here and help me. You guys can go now, I'm good." The Officers grudgingly comply and are probably thinking about why I'm not calling 911 this very moment. I turn back to the offender and reach for my vital sign equipment. "This will probably be uncomfortable for you but I need you take off your shirt" The offender complies, slowly. His hyperventilation increases and the groans are still persistent.


    ***** NURSING CHECK 2:

    OFFENDER IS AMBULATORY

    OFFENDER'S GAIT IS STEADY

    OFFENDER APPROPRIATELY AND READILY OBEYS COMMANDS

    *********



    Now that this XXL T-shirt and jumpsuit are off of him, I notice he has a small baggy with a familiar dark glass bottle of SL nitro on him, attached by a safety pin to his pant's waistline. I inwardly groan and my level of anxiety jumps a notch. I'm starting to lean to the side that this may be real. I think it might be time for oxygen, at the very least to help his hyperventilating. I also think how odd it is that the offender is allowed a safety pin- I'd have thought such an item would be contraband. Pushing that thought aside, I reach to the cabinet, praying we have even one nasal cannula available. I open it and not to my surprise it was completely empty. I longed to be at my second job this instant in the hospital where supplies were abundant and I always had something I could use.

    Turning my attention to the Offender and getting a set of Vitals on him, I request Officer Wise to retrieve the Emergency Cart from an adjacent room. The gaggle of offenders in the hall are watching with enthusiasm. Others are yelling to get my attention telling me they need their insulin or they're blood sugars would drop, which of course made no sense. An odd few even left, cursed my name, and went to eat without taking insulin.

    Vitals read:

    BP: 132 / 84
    HR: 124 BPM
    O2: 88%
    Resp: 32 / min



    Officer Wise returned with the Emergency Cart. Thankfully, it was stocked with one NC. I put the offender on 2L O2, informed he must take deeper and slower breaths by inhaling through his nose and exhaling through his mouth, and immediately began to proceed with obtaining an EKG. Oxygenation levels out at 94% on 2L NC. As I hook the offender up to the machine I try to get a Hx and quick vibe for what he's going through at this time.

    ************ Nursing Check 3 & 4

    OFFENDER IS ON 2L OXYGEN
    putting someone on Oxygen, even if they don't need it often helps the patient / offender feel more at ease, trusting, and more secure with the nurse. This is something we do in the ER to allay fears and make people "think" we're actually doing something for them

    BLOOD PRESSURE IS SHOWING MILD HTN,
    a BP does not provide much information when experiencing an MI, but it is good to know none-the-less.

    HR IS SLIGHTLY TACHYCARDIC,
    this would indicate a compensatory mechanism for lack of O2 being perfused and/or possible stress.

    OXYGEN IS VERY LOW,
    is this due to the heart perfusing poorly or is the offender hyperventilating so much he's just getting very little oxygen period?

    RESPIRATIONS INDICATE HYPERVENTILATION,
    is this due to the lungs attempting to compensate for the heart perfusing poorly or is the offender just anxious and doing this to himself?


    ******************


    I ask him, as I place the electrodes on his bare chest, "What does the pain feel like?"

    "Its like someone is sitting on my chest. Its a horrible pressure and I can't get my breath, " he gasps. "It just keeps shooting down my arm. I don't think I can move it much."

    I respond back, "Well, have you tried taking your Nitro. You're supposed to take a tab when you begin feeling this way."

    "I've never taken it before. They just gave it to me over at RDC" states the offender. RDC is our sister prison that receives all new inmates and sends them to an appropriate facility for their sentencing.

    "When did the pain begin?" I'm having difficulty getting the electrodes to stick to his sweaty chest. The heat outside has been absolutely horrid lately and even HSU has been without air conditioning for the better part of the summer.

    "I was just standing in line for Chow when it just overtook me."

    "Did you have anything to eat prior to standing in line?"

    "No."

    "Have you ever had a heart attack before?"

    "Yeah. My first one was in September of 2009. I've had about 12 heart attacks since then."

    "How long have you been in prison?" My interest is peaked

    "Since Februrary of 2010."

    "Are you taking any medication?"

    "I'm on Coreg for my blood pressure." he says. I notice his respirations are slowing and becoming more regular. "I missed my morning dose because I slept in today".

    The EKG is ready. I hit the interpret / print button.

    "Do you have any allergies?" I ask.

    He responds, "I'm allergic to aspirin."

    The rhythm appears at even intervals. All components of the the rhythm, PQRST, are present. EKG reads, "NORMAL SINUS RHYTHM. ABNORMAL EKG." Heart rate, per EKG is now at 101 BPM.

    "Are you ready to give me my insulin?" I hear a shout from the hallway, reminding me my insulin line is still waiting.

    "Give me a few more minutes. I need to get this guy an IV. " Hoping those words would strike a profound sense of gravity to the waiting offenders outside. It didn't.


    ********** NURSING CHECK 5 & 6

    OFFENDER'S PAIN IS DESCRIBED AS SOMEONE SITTING ON CHEST
    as is typical with angina

    OFFENDER'S ASSOCIATED S/S INCLUDE SOB AND RADIATING PAIN TO LEFT ARM
    as is typical with classic male MI's

    OFFENDER IS NOT DIAPHORETIC AND COLOR IS INTACT,
    after seeing offender shirtless I conclude he is wet due to the raging summer heat and pigment is of normal color.

    OFFENDER HAS AN EMPTY STOMACH
    so this is not merely an episode of GERD

    OFFENDER STATES HE HAS HAD 12 PAST MI's,
    I find this highly unlikely that he's had 12 MI's and still standing here. Even more so, I wish to point out he is only on one medication, Coreg, a beta blocker for HTN. Most patients, after an MI, are put on an ACE Inhibitor and should take it every day for the rest of their life and the mortician should probably put one in their mouth after death just to be safe.

    OFFENDER'S EKG READS "NORMAL SINUS RHYTHM, ABNORMAL EKG".
    I really don't see what is abnormal about it, and I don't put too much investment in the computerized interpretation being that I'm 26 years old at this point and myself have an abnormal EKG with normal sinus rhythm.

    OFFENDER'S HEART RATE IS SLOWING DOWN AND RESPIRATIONS ARE DECREASING TO A MORE APPROPRIATE RATE WHILE OXYGENATION HAS INCREASED TO 94%.
    this is a good sign with the offender's vitals stabilizing.

    OFFENDER HAS NEVER TAKEN SL NITRO BEFORE AND UNAWARE OF ITS USE
    sublingual nitro can be very potent and the general population have varying sensitivities to it. Some people are so sensitive just coming in contact with it can cause a sudden and dangerous decrease in blood pressure. It is a nursing consideration and intervention to establish IV access before allowing someone to take Nitro without prior experience. Should things go badly and EMS be called, it will save valuable minutes having already established an IV.

    OFFENDER IS ALLERGIC TO ASA
    obviously we are not going to give it. Although, it would have been appropriate should it not have been contraindicated.

    ********************************


    I begin a necessary head to toe assessment to establish a baseline. As I proceed the offender is talking and talking. He is asking me questions about my choice in jobs at the prison. How much experience I have. What he used to do on the streets. What his past cardiac history has been like and what Correctional Doctors and Nurse Practitioners he has seen while in prison and so on. He's talking so much I'm beginning to think he's going to be just fine. I ask him to grab my two fingers and squeeze. He lifts his arms and squeezes well. I put my hands over both of his arms and tell him to raise his arms. His L arm is not overcoming resistance. I lighten my touch to just only the mildest of contact and tell him to lift his L arm again. He is still unable to perform saying it hurts too much. He begins moaning in pain. He says its starting to hit him so hard again. An important observation has now been made. Refer to Nursing check #7 below.

    "Calm down. Remember, just breathe through your nose and exhale through your mouth. That oxygen is going to help you." I calmly say to him, nodding my head.

    "So are you just going to deny us our insulin. This is some ********!" I hear a familiar voice yell. A regular insulin dependent offender has stepped into the doorway. There's another, older offender behind the accuser who speaks up also. "C'mon I need to go eat. I got commissary today and I already know my blood sugar is sky high. I didn't know I was given a death sentence."

    I ignore them. My temper is getting very short. I speak to Officer Wise. "Will you please escort everyone to the cage so I can open up a couple of locked drawers and start this IV without people yelling at me."

    "Alright you guys," Officer Wise begins as she swings her 250 lbs around in commanding five foot two inch height. "You need to give us some room. Get back there behind the cage and wait while we get this finished."

    "But Miss Wise, we need our insulin. This is some serious ****. If we leave and eat, you know the walk officers will tell us to turn around." a new diabetic to our camp says.

    I can't help but chime in, "That's never stopped anyone before. You guys come up here whenever you want like those walk officers dont even exist. I'm almost finished. After I'm finished with the IV I'll start the insulin line again. Its only been 15 minutes."

    Officer Wise successfully herds up the offenders into caged area, allowing me to go from room to room in search of an IV start kit, since the Emergency Cart was fresh out.


    ********** Nursing Check #7:

    -- a/ox3
    shows no difficulty answering or asking his own questions

    --- PERRL
    +3mm

    --- Skin warm, moist, and intact. Color is normal.
    nursing notes / later documentation explain cause of adjective "moist"

    --- Respirations even and unlabored anterior/posterior

    --- Breath sounds clear to auscultation anterior / posterior

    --- Abdomen is soft, nontender, nondistended, and bowel sounds are normoactive.

    --- S1&S2 auscultated

    --- apical pulse correlates to radial pulse
    Rhythm is regular.

    --- The offender was able to raise his hands and arms without difficulty to reach up and grab my fingers to squeeze, but can no longer lift his L arm when specifically assigned that task. This tells me the offender is lying about something

    --- grips strong are strong +2

    -- Capillary refill is < 3 seconds.
    If you are having difficulty judging perfusion on an African American, pull down their lower eyelid. If they're suffering hypoxia the inside of the eye lid will be white instead of red or bright pink.


    *************

    I establish a 20 gauge in the offender's LAC. First attempt. Offender tolerated. I'm beginning to lean toward the offender suffering from anxiety rather than actual chest pain. My notes describe the offender as tolerating the IV attempt, not tolerating well. He was whooping and hollering about how much he hated IVs and how much they hurt while I was I was sticking him, more than he was about his latest recourse of chest pain.

    I think to myself, this guy is faking. He's gotta be having anxiety or faking. He's talking too much and is terrified of one measly needle.

    Now that I've established IV access I administer one tablet of SL Nitro to the offender. "We're going to recheck your vitals in five minutes and I'm going to resume the insulin line. I'll be right here. Just tell me if you start feeling any worse than you currently do." I raise the gurney's side rail for safety.

    I restart the insulin line for five minutes. The offender suffering the chest pains is making conversation with diabetics as they enter the room. Its keeping me calm knowing that he's not bottoming out, but also irritating me because he was acting like he was dying 20 minutes ago.

    I repeat the VS and NITRO two more times with minimal drop in BP and no reduced chest pain per offender, but he has since significantly calmed down. I also recheck his O2 levels without oxygen. It immediately drops to 90% or 91%. I put the offender back on 2L.

    I finish insulin line before I start looking at my scattered sheets of paper with vitals on them and times. While the offender is stable, its to look through his EMR (Electronic Medical Record). I find several EKGs over the last few years that all say "Normal Sinus Rhythm. Normal EKG" in the EMR. I think that is unusual that the offender suddenly has an abnormal EKG. I look to the offender's paper chart in the Medical Records room and find the original EKGs and a few that were not entered in the EMR. Same results as the EMR. The EMR also states no further cardiac Hx beyond HTN.

    I silently curse at myself. I should probably call the doctor to report the abnormal EKG and chest pain.

    I page the doctor to call me back. I receive a call back within 15 minutes. I explain the situation to the Doctor; hi-lighting these things.


    ******* SBAR:

    Situation: I have an offender complaining of chest pain starting at 1620. He has allergies to aspirin. He has his own Nitro. He has taken three supervised doses without relief.

    Background: Only medical Hx includes HTN. He has no meds other than Coreg which he states he missed his AM dose today. Has several EKGs in the EMR, all of which show Normal Sinus Rhythm, Normal EKG.

    Assessment: Today's EKG, in tandem with chest pain show Normal Sinus Rhythm. Abnormal EKG." Oxygen levels started out upon arrival by wheel chair at 88%. Increased to 94% with 2L. When O2 is removed they drop to 91%. Pain radiates to L arm. Describes chest pain as if someone were sitting on his chest. No physical impairment is noted at this time.

    Recommendation: I'd like to send him out for further evaluation.


    ************************



    The doctor agreed with me and Officer called 911. I gathered as much of the offender's paperwork as I tried the best i could to gather pertinent information.


    Two days later I see the offender return to the prison. He had been diagnosed with severe anxiety. He was prescribed Xanax which our doctor took away due to its ability to be sold and abused within the prison. I later went to the doctor to ask if I did the right thing. My gut had been telling me this guy was faking and this was not a heart attack. The doctor said that because of the odd oxygen level and the new abnormal EKG my choices were sound.

    In the end, you must go by vital signs and lab results. Those are the things that will hold up in court. An offender has already proven themselves to be untrustworthy just by being in prison. As the doctor believes, trust only your objective data.

  • Apr 28

    To kind of toot my own horn here....

    I wow patients every single day I work. I'm an amazing nurse (despite my inferiority complex as an LPN). I say I know this because I receive more compliment cards than any other individual nurse at my ER. I put an NG tube down a guy 2 weeks ago, and just last weekend I had another member of the same family. The patient was extremely apprehensive, but the mother of NG tube patient from the week before piped up and said, "Don't worry. He took care of _____ last week. You're in great hands!"

    During the entire septic work up from IV to catheter to ABG the mother of NG guy did nothing but rave about my amazing skills, even when I had to use two attempts for the ABG she still praised me. Now that is something special, and I felt pretty damn good about myself the rest of the day.

    I hope everyone else gets to feel like that at some point.

  • Apr 25

    My hospital has strict policies against any of us even working with PO benadryl on board.

  • Apr 2

    That's the problem tho... we all want to and strive to provide quality care, Lb321. However, in so many places it is just not possible, ie see above libran1984 posts!

  • Apr 2

    Oh and vintagemother had another point.... The call lights never EVER stopped. NEVER!!!!

    I worked in fast food during my teens and early twenties and heard less beeping at the drive thru than I did with the incessant call lights.

    I'm getting so worked up and angry over all of this..... Phew.... Just breathe....

    I hate LTC

    Edit:: heaven forbid someone uses their call light for resp distress, choking, or CP... They might not survive the 20-40 minutes it takes to respond!!

  • Jan 29

    Every sing person who applied to the Lawrence campus got in during my transition from 2013-2014. During that year's time, two other LPN-ASN classes were admitted and there was actually a shortage of LPN-ASN student applicants, so EVERYONE got accepted and then they were thrown into the medic-ASN program b/c the Medic - ASN program had so many holes too.

    So essentially, you will absolutely get in (based on the above cited evidence). When I applied in 2013, I applied to 6 different regions (13 different schools), of which included Richmond, who only takes 6 transition students / year, and I was accepted to every single program.

    Also, as a sidenote the Graduating class of 2013 (ie: the class that ended just as mine began) received a 100% NCLEX pass rate for their ASNs and PNs that year at Lawrence (indianapolis).

    Oh, and another thing... I graduated on a Saturday, I had my authorization to test on Tuesday, I took my NCLEX on Thursday, I received my RN license # on Friday.

    A lot of students complained of the lack of Ivy Tech's planning and organizational skills r/t scheduling. I promise you, I precept several student externs at a local hospital, and the students even in the BSN programs like Marion and IUPUI have the EXACT same problems. So, I beseech you, when you get into the transition program, please try to foster an atmosphere of understanding for the school b/c the grass is NOT greener on the other side. It is all the same problems a student would face at any other (accredited) college. You can't beat the price of $121.15 / credit hour and then immediate NCLEX testing dates - my BSN friends graduated with me or a week or two before me, and they're still waiting for their auth to test!

  • Sep 16 '16

    I'm an LPN in both a LTC and hospital setting.

    To compare, the paperwork in the hospital is incredibly minimal. They use EPIC, most everything is point and click. The pharmacy and patient files are connected. The doctors are connected to Epic. Everything is connected! Not to mention, at most you're only charting on an average of 3-7 patients any given day!! There is so much patient contact that the nurse can do so much and still find time to chart novels when they get hyped up.

    My first and last bit of PRN work at a LTC rehab facility last just 3 weeks. They said they were using computer charting- that accounts for <10% of the charting. There is a book for accuchecks, a book for dr appointments, a book for PT/INRs, a book for treatments, and half of the MARS are barely legible due to the nurse not pressing hard enough to carbon copy the damn thing!

    Now let's talk about the amount of redundancy that is done... A verbal order confuses me to no end. I know that it must be placed in three different boxes (a white, pink, and green copy). It must be faxed to pharmacy. It must copied again and put in the hard chart, and should be documented in the computer (which it never is).

    The morning vitals are charted on the nurse's cheat sheet (bc bedside charting does not exist at the facility), charted in the MAR, and charted in the computer (which it never is). The accuchecks are charted in the MAR, the accucheck book, in the computer(which it never is), and in the nurse's cheat sheet. There are 16 patients everyday, and everyday of the week is designated a specific kind of assessment day such as cardio-pulmonary monday or skin check Wednesday, etc. of course if your pt is there for cardiopulmonary issues, every day is a cardiopulmonary assessment in addition to whatever other assessment is designated to the given day of the week. This assessment is charted as a bunch of check boxes in the MAR. In addition, it is to be free-typed as a progress note in the computer (which it never is).

    The computer is not linked to any other discipline so the doctor and the pharmacy has little to no access. There are no known rehabilitation goals. The med pass is in excess of 2 hours. Treatments, new orders, and new dr appointments are frequently missed due to the lack of time to review all 5 books and the insane patient load for such high acuity patient load. Every day 4-6 patients are receiving IV vancomycin!! This too needs to be charted in the MAR and in the computer.

    I can't do it. I thought being an ER nurse I could handle anything. But this paperwork is too much. My final day was Monday. There were two ladies by the same name and similar last names with similar problems. The nurse who admitted them mixed up the pt mars like a deck of shuffled cards and then cut the deck putting the top half as Jane Doe A and then Jane Doe B. there were no patient identifiers like birthday. Only allergies were listed. The names were very faded as that they were carbon copies done with very light pressure.

    Omg. The MARs... Everytime a new pt is admitted - everyday, the admission paperwork is insane!

    Presuming you can get just the daily paperwork done and charted in your 8 hour there is no more time to chart the unexpected!!

    Example: 8 hours in a given work day

    med pass takes at least 4 hours

    Treatments take 2 hours.

    Mandatory lunch is 30 minutes.

    You now have left 1.5 hours left.

    30 minutes are spent scribbling illegible scratches on the daily assessment log which were all half assed. Did you really strip your full 16 residents down to his/her birthday suit to search for skin breakdown? No you did not. You presume your aids will tell you if so. You know that those that are immobile will be at a higher risk so you may check their bottoms in a rush but forget to check heels! What about the 4-5 cardiopulmonary people? Did you put your stethoscope to their chest and listen? Did you touch all extremities looking for edema? Have you been getting proper daily weights? No no no. You asked the 16 patients during med pass how they feel, if they have a new cough, and eyeball their extremities. You have 16 patients and every single one of them has an unanswered call light going off at all times during the day!

    1 hour left in your day... Did you get any new admissions? How long did it take to receive or give report? Did the doctor give any new orders? Did you have a day where pain levels were abnormally high. Did your daily supply of medications come in and did you actually count and verify all meds that came in? Btw that is a fair amount of paper work! Did your faxes to pharmacy go through? Did a lot of family members come through that day to occupy your time?

    This facility is in the top 200 in the nation for its kind. What do the more squandered or lower ranking facilities look like?

    The hospital is the best place I have ever worked and I will never, ever work LTC ever again. I would quit nursing before I do that again.

  • Aug 30 '16

    One should probably get consider if they have yet to become NLN accredited, or even if hospitals will hire them.

    I would consider the price. Why pay the price if a bachelors degree only to receive an Assc degree?

    Also, it stands to question, if the admissions are so competitive why do u think you would get in there over the local community college?

  • Aug 30 '16

    I work with an LPN who is certified to administer botox for her primary job outside of the ED. She loves her other job and her work with the Doc. I wish you much luck. Don't get discouraged by what others say. A certified LPN working in the field may know more than some NPs outside of aesthetics nursing with regards on proper botox administration.


    edit: example of Specialty LPNs performing better than an NP... I was doing ACLS with an FNP who works primarily fast in/out clinics. She kept trying to shock an unshockable rhythm and wonder why the mega-code kept deteriorating. LOL.

    To each his/her own. People go around toting a vast amount of certs behind their name and say this is an example of my education and experience. However, others often over look or don't take the certified individual seriously if he/she don't have an RN somewhere in the title or in some cases, a BSN or higher- then you are pretty much just... well... out in the dust for qualifications, despite your... despite your qualifications!



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