A few well-timed vacations...

Nurses General Nursing

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One of the units I work on has a day nurse who is, uh, something of a martinet. She pretty much runs that unit, forget about the NCM or the doctor, this woman runs the show. She also has a pathological dislike of any kind of narcotics. So, it tylenol all around for her patients. Headache? Have a couple of tylenol...Back hurting? Here's a couple of tylenol. Orthopedic surgery, spinal stenosis, dying of bone cancer? Have a few tylenol...You get the picture.

This is a LTC unit, so these folks are here for the duration. Several of them have real bad arthritis, and that stupid tylenol doesn't do squat for them. But, the Lord works in mysterious ways...Recently her 2 week vacation happened to coincide with the doctor's time off, and the NCM's vacation, so there was a whole new crew. Thank God for a thinking fill-in NCM, a NP with some brains, and a few well-placed float nurses. After checking things out and speaking with staff, the NP decided to put several of the residents on a stronger med, and made it standing order, q 4 hours.

What a difference! When I went to that unit the other day, there was such a different mood there! Residents who almost never got out of bed for more than a half-hour or so were up, in their chairs, socializing with others, and they stayed up for dinner instead of crying to be put back to bed. I think they were comfortable for the first time in years! No one was "zonked" or "out of it", just comfortable.

Miss Regular Nurse is certainly going to be surprised when she gets back! Now, if only the powers that be stick to their guns and refuse to melt in the harsh light of her steely disapproving glare...But, for now, it's a Golden Age for these folks!

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that is awesome right there. let them enjoy some painless days. i hope i catch your updates on this after their vacation is over, it'll be interesting:)

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Specializes in Utilization Management.

No going back now-- all you have to do is document and attend care plan meetings (hopefully with family present) and request continuation of the meds that kept them comfy.

I know I'd support you if it was my gramma. ;)

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Specializes in ICU.

Thanks for the post - made me smile today, esp the "Golden Age" pun. :D

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Specializes in Hospital Education Coordinator.

I am glad you were paying attention to the situation and could intervene

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Medication for pain good, pain bad!!!-perhaps you could write this somewhere. Get the families involved and let them complain to management, customer service is key!!

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Specializes in LTC, assisted living, med-surg, psych.

You know what they say about what the mice do when the cat's away........;)

I've been having a ball this week while our resident care manager is on vacation---I changed around some med times so that residents aren't getting Remeron at 0800 and Lasix at 1700, got an MD order to leave briefs off a resident at night who has chronic skin issues from being in plastic and paper 24/7, and talked to the PCP about starting some psych meds on a resident who is physically and verbally abusive to other residents and staff. In addition, I've just about healed up a pressure ulcer on one diabetic gentleman who's still waiting for a surgical consult (my secret weapon: QD wet-to-dry dressings) that our CM never followed up on.

Now, this CM and I get along just fine, mainly because I've done her job and I know what it's like, and I don't want it. (I do wind up advising her every now and then.) However, she's the type who sits in the office all day making rules and issuing edicts rather than interacting with the residents and KNOWING what's really going on with them, so her care plans tend to be wrong more often than not. I also know that she isn't very creative and really has never learned to think outside the proverbial box, so let's just say I'm doing some of her thinking for her while she's gone. :D

She may not exactly like all the interventions I've put in place, but they were in the residents' best interests, and I can take an @$$bite if I have to in order to sneak in a few commonsense solutions every now and again.......hehehehe!

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Specializes in ED, ICU, PSYCH, PP, CEN.

Thank you for taking care of these people. Be sure and fully document the changes for the better, IE, increased time able to sit up, wounds healing, increased social interaction with staff and peers.

Be sure you discuss and document the discussions with patients families so there is no going back.

God bless you

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