Content That NRSKarenRN Likes

Content That NRSKarenRN Likes

NRSKarenRN, BSN, RN Moderator 111,378 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,261 (22% Liked) Likes: 13,285

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  • Sep 23

    You can't put much stock into such newspaper articles. You can find one that says almost anything you want one to say.

    If you really want to be a nurse because nursing is what you want to do with your life -- then be a nurse. Just make sure you get a good education from a highly respected school and get the proper clinical experiences along the way. If there is ever a surplus, the nurses with the best credentials will be the ones favored to get the jobs. That's the way it is in every field. The people with the best preparation tend to be OK and it's the people who are not as well prepared who struggle the most. Don't put yourself in the "lower levels" of education, experience, and credentials and you should be OK. People will still need nurses -- just maybe not in the same ways or jobs as they need them now. Be prepared.

  • Sep 23

    I don't know the articles you're referring to, but if an RN is required to check on a patient i.e. assess a patient every thirty minutes, this is a nursing function that requires the knowledge of a licensed nurse and should be performed by a licensed nurse and documented accordingly. The nurse is the trained observer/examiner who is responsible for recognizing patient conditions that require medical/nursing interventions and for carrying out any necessary nursing interventions in response to their assessment findings, not the CNA. In my state the Board of Registered Nursing does not permit an RN to delegate assessment of patients to unlicensed personnel.

  • Sep 23

    Quote from Cat365
    i would have a large issue with the fire in the middle of a code. You had a better response than I likely would have.
    The joint Commission team told my manager that they didn't think I was taking their presence seriously enough. When I was called into the office to comment, I said I didn't think they were taking my code seriously enough and that a REAL patient trumped a FAKE fire every time.

  • Sep 23

    When the Joint Commission arrives, the whole facility is under enormous pressure. And that's just if it's a routine visit. If it's a follow up visit because of some issue that didn't quite pass muster the first time, it's even worse. Instead of lobbying to be there while the floor is under such pressure, why not lobby for an extra clinical day at another time?

  • Sep 21

    Quote from nurseyblues
    If I could set up my idea of consistent and practical nurse education, it would be structured something like this:
    I agree with some of your ideal structure ... but disagree on a few details.

    I would keep the ADN as an acceptable entry-point -- but I would encourage the BSN as an entry-level as well. There is much to be gained from the "traditional 4-year college" experience and it should remain an option for those who want it. Without that option, the profession would lose a lot of talented people who want to "go to college" like people do in other professions.

    I would limit the ADN role to the entry level roles -- not including charge functions, precepting, unit-level leadership, staff development, etc. Those types of things would be BSN level functions. BSN programs would focus on producing a well-rounded general nurse with coursework consistent with a liberal arts foundation -- some physical sciences, social sciences, and humanities -- so that graduates would be well-prepared to face all aspects of human existence. BSN programs would also include some electives so that individual students could focus of their favored interested in more depth.

    Specialty certification exams would be offered at 3 levels -- the ADN, BSN, and graduate levels. That way, all nurses would have a way to show that they had specialized knowledge in their focus area -- appropriate for their level of education. Like now, the specialty exams would require at least 2 years of work experience in the field at the level being certified.

  • Sep 21

    I can't speak to inpatient nursing though there seems to be a consensus that bedside nursing is mostly task oriented.

    In home health however, the common Case Mgr position is changing and requiring more leadership than ever to be effective in managing the increasing number of higher acuity patients coupled with complex psychosocial issues. It requires the nurse to literally direct all aspects of care, not simply perform assessment, teaching and procedures. It requires a strong understanding of regulatory and reimbursement criteria to manage the care within budget and maintain compliance while also meeting the objectives of the entire continuum of care.

    I do not understand why there is a difference between our BSN and ADN nurses in their ability to understand and master these responsibilities as my BSN program sure didn't teach them. I don't know if it's personality or institution preparation but home health nursing today demands much more than simply straight forward tasks of our nurses, the tasks themselves while seemingly overwhelming to many of our new hires are really pretty basic in relation to the leadership responsibilities. And teaching leadership to those not inherently inclined is challenging.

    Now I wonder if the mindset of inpatient nursing came more from a perspective of directing care, would the current climate change at all?

    ETA We pay more for BSN and/or a nurse with significant and relevant experience. Our nurses' decisions have a direct impact on our revenue, it's much more than there being no difference how a foley is placed.

  • Sep 21

    Quote from smartnurse1982
    Let's say by 2030 80% of nurses have Bsn Degrees.
    What happens to the Lpn's and ADN Rn's that do not have one?
    Some ADN's will notice no difference - especially if they live in an area without a lot of BSN's. Some will simply stay in the current jobs and be fine as long as they never want to leave that job.
    Most will have problems getting a new job -- moving to another place or wanting to transfer to another department, etc. because they will have to compete against BSN's. So, many will be stuck having to stay where they are, or accepting jobs that are not very popular -- the jobs that most BSN's don't want.

    I've had friends in that situation already. Their jobs were secure and the ADN was acceptable to the employer -- but they wanted to leave and couldn't get another good job because they lacked the BSN. They were stuck.

  • Sep 21

    The author states that .... "Most BSNs end up paying around $240 per month for their student loan after graduation, so bear in mind that you’ll need to make at least that much more per month just to break even." Where did that come from? I question that statistic and the author cites no sources for this article.

    While the author makes a few valid points, she doesn't cite any references and I question some of the content. "Buyer beware."

  • Sep 21

    Quote from LanaEl
    I'm not sure if they will orient me on day shift, but they said I will have about 5 days of orientation on the floor
    There's your red flag. No new grad should be expected to function ANYWHERE with 5 days of orientation. You need experience with med-surg skills and assessment before you can be the only RN in the building. Ask yourself WHY is the facility so desperate for a nurse , that they will hire a new grad. Also ask, why/ how the last one left.

  • Sep 19

    Watched the Lawrence Welk show with a dotty aunt last month.....she said, "oh, this must be a rerun, his hair is still brown!" Didn't have the heart to tell her that Lawrence is leading the band in Heaven.

  • Sep 19

    Strange timing. I just posted this on FB:

    I have come to realize how much I'm enjoying my Saturday afternoons on a closed Memory Care unit. I have always been a people watcher (just ask my husband - he thinks I'm weird), and this is people-watching at its finest. You must suspend reality, as reality on the unit is a fluid concept. There may be 30 different realities occurring all at once amongst the 30 or so personalities. If I'm lucky on a particular Saturday, a dancer will be dancing, or a singer will be singing. Sometimes both, and they are never on the same page of the playbook. There are earnest conversations occurring between 2 people, and one side of the conversational thread has no relation to the other. Today, I saw a magical moment when the soundtrack of the big-screen TV movie included a 1940's big band number. Conversations ceased abruptly, faces lit up and hands lifted into the air to clap, direct the orchestra or to simulate dancing. A woman who had been crying out "Help me! Help me!" for a solid 2 hours suddenly raised her hands in the air and began to dance in her chair. Her smile lasted for the next hour and her anxiety was gone.


    I witness amazing exchanges between residents and nurturing staff:


    R: "Why did you just hand me a cigarette?
    S: "I didn't - that's a piece of cake."


    R: "Where are you?"
    S: "I'm right here at xxxx. Where are you?"
    R: "Well, I'm right here in front of you! Can't you see me?!"


    R: "Who's dead?"
    S: "Well, I'm not dead and you're not dead, so I guess we're all ok."


    Every Saturday afternoon, I take away something new about being human. Every Saturday I give thanks for being human.

  • Sep 19

    The only experience I have in Memory Care is as the daughter and daughter-in-law of Alzheimer's patients. You guys rock! I know that I could absolutely not do your job. Taking care of my mother at home for a month after my father died and before we could get her into Memory Care nearly finished me.

    I can identify with so many of your comments. Mom flushing her dentures down the toilet. ("I found them in my mouth and they didn't belong there. Now I can't find my teeth."). Taking her to the dentist to get new dentures, which she then put into the garbage disposal ruining both the dentures and the disposal.

    Mom trying to take a huge bite out of my arm -- at which time I was grateful she had already flushed her dentures down the toilet.

    When my husband accompanied me on a visit to her, she looked him over and said "Fine. Now we can get started." And immediately started taking off her pants. That was the LAST time he went with me to visit her!

    Constant complaints that other residents and the staff were trying to steal from her. She was convinced that "someone stole my glasses." We looked for them for two days before finally finding them in the bottom of her waste basket.

    Constant attempts to leave to go home. Then there were the times she actually got out the door (someone else's helpful visitors). It was a small town. People left their keys in the car. She took the car and went to the bank to withdraw all of her money because she was sure they were stealing money from her. It was a small town. Fortunately, the bank manager knew her and knew her situation and called my sister. It wasn't the only time she "borrowed" a car from the ALF parking lot . . . Until staff learned not to leave their keys in the car. One time she spied a horse and buggy in the "Amish parking garage" across the street and decided to take the buggy home. The sheriff's deputies were amazingly good about her stealing cars, but after the buggy incident we were asked to find her a higher level of care. (I think they probably kept her far longer than they should have, but it was SUCH a wonderful place that I cannot be sorry for that. Besides, I have stories to tell. She would have loved that!)

    Sorry this got so long. I only meant to say thank you for working in an area that is so needed, and one in which I could never manage.

  • Sep 19

    Many LVNs/LPNs know the struggle. This is a shout-out to the angel CNAs too.


    "Is this chocolate... or poop on my shirt?"


    "Where are your pants?"


    They're looking for a parent, or a deceased spouse.


    "WHERE IS YOUR WALKER?!" For the 100th time "What walker?"
    s/he responds


    "Lets get your arm out of the garbage disposal..." Its unplugged, but still...


    Person has two different shoes on.


    "What is that on your face, friend?" Looks like scene from Mommie Dearest. It could be lotion, it could be butt cream, it could be toothpaste


    The entire basket of chips, cookies, and other snacks are found in someones room. They have no idea how they got there. They put it there.


    "Maybe we shouldn't climb OVER the recliner."


    They ask to see a picture of my husband and I pull up a picture of Brad Pitt. They say 'Oh, he's nice looking'.


    A person is desperately looking for a way out of the building because they want to go home.


    Sees a diabetic with their second, third, or more sugary dessert or drink... Its ok, we're palliative but it gets concerning at a point.


    "Ok, here is your medicine..." puts meds in hand "now put them in your mouth... yes, these here pills in your hands... yes, in your mouth... yes in your mouth... in your mouth.... mouth... mouth... ok now swallow before they start to melt and taste bad... drink water and swallow... drink... drink... swallow... swallow... now swallow..." Person doesn't swallow and makes a bitter face and spits out onto the floor. Sometimes a 15 minute or more process that should last a minute or two.


    Person has pants/shirt on inside-out.


    Its 10PM and person gets out of bed, gets dressed, and says they're going out for their morning walk.


    "Who pooped on the floor?!" Obvs we wouldn't say this TO a person or group of patients/residents, just a general exclamation.


    Person completely wrecks their room, then gets mad because they think someone has been rummaging through their things. And they stay mad for a really long time because they won't let you help them rearrange it to help forget it ever happened.


    "Please let go of my wrist(s), you're hurting me"


    Someone just threw a bread roll at me... or they threw it at the person they find annoying who is sitting next to me that I'm trying to help eat... we'll never know.


    Someone is flushing briefs, paper towels, wet wipes, and any other paper product they can find down the toilet for no obvious reason.


    "No one is trying to kill you"


    Person smacks cup of meds out of my hand, in which I have to find each and every one of, regardless of where they rolled to or which crevice they fell into. Couch, skin fold/ fat roll, whatever the crevice that may be.


    Someone is crying inconsolably and they can't get the words out to express how they feel.


    "The pharmacist and doctor are not just trying to make money off of you. These are not everyone elses leftover pills "


    "Please don't bite me"


    Someones cereal to milk ratio is wrong and they burst into tearful frustration.
    "I see you have socks on your hands"


    "Ok, lets not eat the dog food... or the flowers..."


    I tell the same joke a hundred times and they still laugh.


    Someone comes up to me and says they love me, give me a big hug.


    I give someone their medicine, and they hug me.


    I give someone a beer/ ice cream/ sandwich, fix their TV, give their cat or dog attention... they give a great big hug and unfortunately sometimes kisses.


    Its all good

  • Sep 19

    When I worked on the cardiac floor, we had a lot of patients admitted with chest pain/rule out MI. They were on cardiac monitors, and we kept them on bedrest with bathroom privileges. They were treated with oxygen, NitroPaste, Quinidine, etc, while we waited it out.

    Now, we send them straight to the cath lab, and open up the arteries! They can come in with an acute MI and leave with no damage to the heart.

  • Sep 19

    "The hardest truth to take in is that some business, clueless, worthless education individuals set rules for hard working professionals like nurses and don't give a crap about them."

    The truth is, this isn't just in nursing. I think it's in almost every type of business & profession. It was true in my previous career.


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