peter73 2,289 Views
Joined: Jul 3, '01;
Posts: 45 (11% Liked)
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I believe you would have had to be in a multiple exit ADN program to stop out at the PN level (which would not be allowed in a situation similar to yours). Traditional and multi-exit programs are set up slightly different to allow for adaquate basic skills for exiting PNs. I have not heard of any "challenge" type programs that you could use to become an LPN other than Rn graduates who are unable to successfully complete RN boards. You could attempt to transfer your credits into a PN or multiexit RN program, but most likly you would be better off waiting and repeating your courses in the current program in the interest of time. IMO
I thought that I had learned my leason about believing managment, but then I wouldn't be in this little mess.
When I was hired at my current facility they really wanted me to work days d/t past experience but I refused and held out for nights as this area has NO am before school child care (that is for school age children to include dropping them off at school)and even though I have been a day nurse for several years I HAVE TO work nights for my kid. I explained that issue to them many times.
Well a month ago I was asked about days again with more pressure.
I went through the whole no daycare issue again and was told that they would work with me for my schedule if I couldn't get care for my son and move the shift start back an hour so I could drop him off on the way to work. It wouldn't be an issue as I would be the desk nurse and it was only an hour. They really needed a nurse with my background to straighted some issues up. Well I bought the story.
So after talking it out at home I agreed to change to days. Well, suprise of suprises there still is no am care that will bring my son to school. So i went in and told them that I could not get childcare before school but I had everything else covered but that one hour..
They looked at me like I was stupid and said "don't try to make this my problem"
I was quickly informed that they had replaced my night shift and I either show up Monday at 7 am or there is no hours for me here and I had better go home and work the phones to get childcare set up. I could have choked the B****. I mean it was not like I never told them this before, they brought up changing the shift not me... i guess a lie is the only reason I finally gave in to work days.
Needless to say this little _say one thing do another, just get 'em to do what you want thing is my biggest rant (being expected to almost flat out lie to staff is why I left my last office job for a staff position). And if they think for a minute they can win in a decision between work and child they have another thing comming. I went right home and set up some interviews.
I have never, ever not given at least a three week notice when i quit a job, but I think I just may call them up monday morning and say ...umm still no daycare, so ...I got a different job that fulfills my families needs as well as thier own.
ADministration is always trying to figure out why turnover is such an issue......could it be lack of respect, common courtisy, and professionalism.:zzzzz
I don't know where you are located at but at least in the states I've worked the nursing hours PPD are a formula of:
A) straighttime- X hours per patient in the facility.
B) wieghted- hours per patient acuity (ie. the higher the care for a resident the more hours they require, set up by case mix/rug scores)
Some states have a set number of hours required by law for each resident, or general staffing guides. They can be set to include all nursing (licensed and CNA) or split hours (xhours for licensed and x for CNA) or even set just by licensed staff. None of these hours include staff that is not invoulved in direct care in some way Ie DON doesn't count, nor does the other "desk or clip boarders".
Dependant on your location these staffing factors can be found in the regulations for your facility type, or averages for the area can be found on the CMS website in nursing home compare.
Most of the time these numbers are set to be the MINIMUM staffing allowed. Facilities tend to "shoot" for the closest to these numbers without goining under to save $$$$$$. (at least that is what I and the other managers had to do or get the budget lecture)
I hope this helped,
Don't forget you will ahve to have a finger print card sent from the BON. They will only accept thier own stamped card. Also apply EARLY, DO NOT WAIT. The BON is very slow, and it can take well over a month.
LPNs can take verbal and written orders. It is the facility policy that sets the limits. The FL nurse practice act is VERY vague, like most states,with the exception of basic differences in practice, supervision in SNF, IV infusions that are outlined very well in FL.
Except for the issues that are adressed by the BON, all else is left to the facility and individual nurse to decide if they "should" do a task.
If in doubt check with the BON and nurse practice act. If it is not addressed there, check you facility policy.
Also, always remember that just because the BON and/or facility says a nurse *may* do the nursing function, that does not mean that specific nurse *can* do it. To my knowledge all BON have the knowledge and experience clause that can result in loss of licensure if you go above and beyond "your" knowledge and experience and make an error.
Most of the time these issues are decided by a facilityon a liability/risk managment train of thought rather than is the skill is allowed by the BON.
This gets to be a sticky issue invoulving ethics, personal belief, and regulation (HCFA/CMS and JACHO both have regulation regarding pt rights and pain control).
I would give it. That is, if the "lethal" dose was within the normal dosage given to onc. pts, acceptable for the amount of tolerance THIS pt has, and after educating on risk/benifit of giving med. I say this because a routine MS dose for say a pt with CA with mets IS most times a leathal dose for the general public. I have had pts beg for MS, with resps at 10-12 and recieving an MS drip that could kill a horse. I have given them a bolus because they requested it for pain, they had observable s/s pain and family wished for thier comfort. I have followed nurses not used to taking care of terminal onc. pts who refused to med for pain due to the high doses and "what if it kills them". I found a crying, wrenching, heartbreaking sight of a dying pt in extreme pain with no shred of dignity or comfort and a family ripped apart at the sight of this horrible death experience. Pts have a right to have pain controlled.
*I would not give any dose that was not prudent and acceptable practice for THAT pt.
*I would not follow a "brown bag" order (some MDs do write these).
*I would not decide on dosage without consulting with nurses more familier with the pt, and/or review of MAR/chart.
*I would not give a dose I felt in my experience/and experience of nurses whom I have consulted to be potentially leathal to a pt that is not activly dying and in pain. (in other words a onc pt that is terminal, <6mo-1yr, who wanted to end their life prior to complications from CA, or other term illness or an obvious MD error in dose while writting order).
Although many children with Downs share alot of the same behavior, physical, and personality traits, they can not be lumped together as a whole. This is just like the typical COPD, FTT, add your own dx here, are all alike. Children may or may not have defects in every body system (in any combination), have the physical downs look, or the palmer crease. OR to add more confusion any one of the different genotypes of downs (trisomy, mosaic, translocation).
The degree of disability will directly influence behaviors, as well as past experiences (just like with anyone). The degree of MR results in the child like sunshine personality, but also the agressiveness. Just think of any 2y/o you come up to with a needle...they are goining to fight esp. if they have had a shot recently. A child of 12 may be in the same comprehension level as a 2 y/o and not be able to understand the need for the shot other than that HURTS me --> it is BAD. A child that has experienced alot of pain from healthcare providers as a result of the many possible physiccal defects will react totally differently from the child that is in the hospital for the first time.
The scope of MR in downs is HUGE. One child may be profoundly MR/DD, with little independant function. Another may be so mild that they drive, attend college, and funcion almost at a normal level or have none of the common or major defects seen in downs.
The setting you pratice in may cause you to see more of a certain type of downs. For example in an ICU you may see the worst of the worst with severe and or multiple congenital defects, in early intervention you may see the whole specturm.
Overall downs is a very diverse and extensive dx to deal with. I like to think of it like snow. Every one has the mental picture of a snow flake and it is pretty close to the same image for every one, but really no two snowfalkes are identical.
just my two cents.
not many facilities will come right out and hand over the $$$, unless you are firm in requesting it, have your ducks in a row as to why you should get credit for your experience and what you are willing to do for them. This means lay your loyalty on the line. Let them know you really like your job, see yourself there for many years, and that you would hate to have to look elswhere when you are already know the p&p's, chating systems, doctors and thier different little requirments for thier patients, whould require less training and are a member of thier team. Ask highier then you really would be happy with and negotiate down, know the $-figure you would work for and stick to it.
And if all else fails, and you are really not happy with the wage, politely and professioonall turn down the offer and look elswhere.
Managment knows a new grad RN with several years LPN experience is worth more than new grad pay, but they are more than happy to take your knowledge and experience for free if you let them do it.
I had suspenders for all my pants. Some built in some snapped on and what about bibs and bib shorts.
Of course only one strap could be worn over my shoulder and the legs had to be cuffed in just the right spot and very tight. I could never wear anything but white ankle or foot socks, or in a pinch spend 25 minutes folding down the tube socks my Mom bought to look like ankle sock. the shame of it, tube socks!!!
I work 7p-7a and hav e a 3 y/o son. It works out great. He goes to daycare the mornings after I work. Terry leaves for work at 6:45 am. and drops him off. Chase gets picked up by Terry in the evening on the way home. That gives me time to sleep and I get Baby free time to do my thing, make dinner, and generally get the house in order.
I used to work days. Set my own hours at 8a-5p at my desk job. I was really upset over the whole night thing and didn't know how it was going to work. Well I was very suprised that it is BETTER. Instead of Chase in daycare 5 days a week and a mad rush for dinner and family time when I got home from work, Chase only goes 2 or 3 days. ( work 3 12hr/wk, m-t-w/w-th-f)I have way more time at home and way more energy when I'm at home.
I don't feel like someone else is raising my child anymore, and Chase still gets to go to "school" with other kids (He's an only child)
Now if Chase had to be up and gone at 4am that would be another story. I wouldn't do it. I was lucky how the shifts worked out. Keep looking if you really want a change, something will always turn up.
We use the same type of IV cath. Took a while and some practice to get the hang of it. I usually tend to remove the needle then punch (or mash, when here in the South) the button to retract. I found that if I retracted the needle right away my hands had to do too many things at once and I lost the stick. Also, it helps to spin the cath arond the needle to break the seal before you start(spin it till it clicks back into place). Just what works for me.
Good luck and practice, practice, practice! In no time you will be a full fledged vampire like the rest of us.
Value is in the eye of the beholder.
our hospital will spend more to recruit one doctor than on all nursing recruitment. After all, people go to the hospital for expensive services provided or should I say ordered by the doctor. They make the money for the hospital.
Nurses are the necessary evil. Hospitals can not function without nurses, but we are all expense and in some cases treated as such.
Doctors are tied to a nurses value. Sounds funny but I think it is true.
I have worked with Docs who treat nurses as dust under thier feet and the managment follows the leed.
I have also worked with Docs that got the concept that in some cases all that stands between them and a huge malpractice suit is a NURSE, balancing condition, treatment, meds, etc. (after all, a nurse may have 8 patients and a doctor may have 100+ beteen clinic, in house, consults, etc on any given day).
When the doctors recognized our value to them, they put the pressure on the hospital to keep the nurses happy, well educated and continuing to protect them from error.
I have seen doctors go to bat for nurses in wages, hours, etc. The reason may be totally selfish, if you were the MD would you rather keep the experienced nurses in your specialty or have all new grads or floaters monitoring your patients? You have never seen anything as angry as a surgean who just realized that the unit was staffed with new grads and OB nurses floated to the unit. The surgeans banded together, cut back elective surgery, and put the pressure on to give bonuses and incentives to get experienced nurses in the specialty, on the floor. (not to belittle OB nurses or new grads. New grads need guidance from experienced nurses. Specialty nurses are highly effective in thier specialty, and I think we all realize that bieng floated to unfamiliar territory puts patients and our license at risk)
When the doctors value the nurse judgment, experience and performance the hospital is forced to take a bite in the bottom line and treat the nurses better, or risk MDs changing practice setting costing them revenue.
It is just the flow of power set up by $$$$.
admin. -> MDs -> nurses : nurses -> MDs -> admin. After all, money maskes the world go round. Doesn't it?
My expectations are simple, I think.
I expect no less from my CNA then I expect from myself or any other nursing staff on the floor.
1. Professionalism. Treat the patient/resident as a person, be available to questions and concerns. Know when to refer them to another team member for answers outside your practice area (even if you know the biopsy was malignant it is not for a CNA to break the news). Carry yourself as the vital part of the nursing team, and never refer to yourself as "just the CNA" If you say/believe that, expect others to as well.
2. Responsibility. Accept and act on your duties as assigned and/or outlined in job description. Know your duties and plan your shift accordinly. If somthing is found outside the "normals" bring it to my attention. If you miss somthing or do not fully complete it, tell me. Do not "cover things up" I will find it. Every one gets bogged down at times and gets behind.
3. Duties. Ask for help. If you get behind tell me and ask for help. If you are ahead of schedule offer help to others. If you do not understand somthing or don't know how to do it ask. Know one knows everything or can do everything unassisted.
4. Conduct. Behave as a professional. No talking about other staff, MDs, patients at the desk or in a room. Arrive at work on time and in uniform. Breaks as assigned or as allowed (I don't care how many breaks you take if your work is done and done well and I know where you are), and let me know when you go. Don't fuss when I ask you to do somthing, there is a reason for it. Do not think that the nurses "sitting" at the desk are just in social hour. We are charting, calling MDs, reviewing labs, planning care, or looking up information etc. Even if you do not like someone personally, always be polite and professional. You are not here socially, you are here for the patients/residents.
5. Knowledge. Ask questions about conditions, proceedures, history, etc. The more you know about your patients/residents, the more you can understand why they may behave or respond in a certain way. That will help you to get your duties done, let you know what to expect and how to interact theraputically with them as well as avoid potential problems. The more you know the more effective you are.
well, I think that is the basics I have learned so far in my travels as a CNA, LPN and Rn student (nursing home and hospital)
Beverage of chioce daily..coffee. Coffee from 5:30 am to 2 pm. After that, since I'm now in the South, sweet tea.
If I'm kicking back I like beer or 7-7, I used to love vodka and cool aide (berry blue made the best drink but they stopped making it and I'm saving my last pack for a special occassion). If I gnaw off my leg and escape out with friends I like to order somthing with a wild name like a slow comfortable screw up against the wall with a twist, windex or any other oddity.
It wasn't the DX that was wierd for me but the TX.
I was on my med-surg rotation in school and had to give the worst "med" ever.
This patient had come to the ED, presented with pnuemonia and was started on ABX. The treating resident did not take into account her renal failure of decreased liver function. She went to toxic levels of her ABX and it killed all and I mean all of her natural flora in her intestines. She was being treated after a long search for a donor, a stool donor.
I went into the room with 300cc liquified stool and proceeded to put it down her NG tube. This was of course after reading the order multiple times. I new it was not a joke when the "Med" was sent up to the floor followed by the MD, who explained to the nurses then to the pt what was about to be done.
I also had a post-op pt that had an 8inch vibrator removed from transverse colon. It had sort of climed it's way up. Surgean said it was still giong when removed...I have never thought of the energizer bunny in the same light since.
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