Who does the initial admit ?? the RN or LPN ? who initiates the care plan ?? oh and we now need a physicians order to use our nursing judgement. i.e. We can't hold a med based on nursing judgement if the order doesn't specify. we have to have an order that would say something like "Hold if sedated" i have seen bp meds without parameters. would i give a bp med to a res. who has a bp of 110/60 ??? i have to call the dr and get an order to hold the med. and our facility will not, WILL NOT, let the Dr write standing orders. The only thing i have seen that does have a hold (other than insulin) is Dig. but not all of them are written that way. I know you never give dig if heart rate is under 60. but i will have to call the dr to get that ordered. I have to call dr for tylenol, tums, ect. And we can't get a standing order for it. now they are talking about having the lpn's do the UDAs...I HAVE NO IDEA WHAT THAT IS !!! And we are suppose to triple chart now i guess, chart on the mar, in the nurses notes and now the UDAs whatever that is and update care plans. and its not a team effort with those care plans, you can make a suggestion for additional pillows to prop legs/feet ect and it gets questioned and if you update care plan to enforce that then you didnt do it right or its not relavent to the care plan AND IT'S YOUR LICENSE. i'm so tired of hearing that, i'm ready to give my license back.