Latest Comments by expltcrn

expltcrn 1,761 Views

Joined: Mar 19, '09; Posts: 36 (50% Liked) ; Likes: 38

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    Have you explored the ability to keep both while making a decision? Just a thought. The other thing to consider, is that once your are in the Kaiser system, you can request a transfer if advice nursing is not your cup of tea.

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    My very smart young daughter, who has ADHD and had some trouble in focusing at school, blossomed and excelled in a class taught by one of the best elementary school teachers I've ever met. She was BSN trained, but found teaching to be her passion.

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    Koalified, HHLinda, and Genista like this.

    You go through an intensive 6 week training with set algorithms that are proprietary information, and you do test scenarios with other students/nurses and the instructor. Toward the end of the program, you may start being able to take precepted calls (live call with instructor on the other line) before you are checked off as competent and released on duty. It is an excellent training program, and excellent job if you like it (I liked it for the short time I was there, but due to family issues had to relocate out of State where there was no Kaiser to transfer to).
    One of the greatest values I picked up from it is doing triage mentally when faced with any patient care issue (including dealing with my own children's accidents and such at home), and doing the quick rules outs of an "emergent situation" (i.e. chest pain, severe facial swelling) vs urgent situation, when to call 9-1-1 or call the doc stat, etc.
    They have statistics for calls, they vary. Some are just calling for appointment resetting, some for general questions, some for lab results, etc. but I believe the target was no more than 8 minutes per call. There is always an MD available (I am not sure on noc shifts), pharmacy too (by phone), supervisors you can flag down when you get the "suicide threat calls"
    PROS: Its a sit down job great if you have physical problems, great benefits as Kaiser is known for, no overtime is expected unless you are asked or you volunteer, great pay
    CONS: As soon as you log in, you take call after call after call after call until your break, lunch, break, end of shift. There are a few minutes of down time, but rarely, because since Kaiser goes with seniority, when volume is down, there is already a list of people who get to go home first thus sustaining the productivity all around.
    That's a quick low down from me

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    CapeCodMermaid likes this.

    Have you tried buying him a ticket to Hawaii? I've heard some stories

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    rancin98 and twinpumpkin like this.

    i just ordered this gadget myself. waiting for arrival
    hc1022spoasis compliance compassthe oasis compliance compass is compatible for use with the new oasis-c.

    information contained on the oasis compliance


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    You did the right thing by calling the MD. Yes the patient does have the right to refuse, agree/disagree with medical care/medications, etc. - especially when they are self-responsible. However, had you not called the MD (who unfortunately sounds like a a*****e) and simply followed the patient's request, you were jeopardizing your license. There are regulations in notifying the physician when you are unable to follow a doctor's order. If something had happened regardless of which direction it went, you'd have been the one to suffer for it.
    Your other options would have been to follow your chain of command - Supervisor, Director of Nursing, then there is also the Medical Director of the SNF who the DON can call should the need arise.
    One advise though for long-term diabetics who have self-managed their insulin for a long time - they usually know what their body can tolerate. I've have worked with many who if their blood sugar drops below 200, they go through the whole hypoglycemic symptoms. It presents a harder picture to manage after illness, hospitalization, new MD, change of MD, etc. But it always behooves you to listen to them and work in partnership with the MD to help the patient.
    Sadly, with LTC staffing in recent days, noone hardly has time to do spend to do these extra steps.

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    sharpeimom and LPN_2005/RN_10 like this.

    Wow. A hard topic. I've had my battle with weight too and have felt frumpy and dowdy many a time. But, I did find that when I wear my suits on those days, I feel the immediate power pick up, which then translates to confidence and looking like I am put together. I agree fully with going with the company culture. Since you admit that you do need help, set aside all others around you who you think should be re-done as well. Focus on the you.
    Some style tips, some of them from What not to wear and other fashionista's, if you do not like the matching pantsuit sets, always wear something structured - at least 1 piece of your outfit. Example: If you are wearing a flowing shirt, or flowing skirt, pair it with a structured jacket. With a large rack (which I work with as well), do not base your pick on the size tag of the Jacket when you go out to get your key pieces. Try them on. You will likely need a larger size with room to move your shoulders in the jacket, while still being able to button them up front when the need arises. I've also had better success with blouses that have a square or scoop neckline with plenty of room for the breasts and then flow out loosely, paired with tailored pants. You could also pair solid shrugs or bolero type jackets (the ones that don't close) with patterned shirts.
    I don't do heels - I stick with the low heeled dressy loafer shoes or the oxfords since I have flat feet.
    I stick with classic cut pieces, dresses and shirts. They make me look more put together, and have a slimming effect.
    Good luck! I am sure you will find personal pride in your style at the end of this journey

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    They are beautiful in person, but unfortunately will not guarantee loss. Any good looking Littman gets taken from me I've lost 3 special editions, cardiology, etc. and they even had my name engraved on them.

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    rukiddingme likes this.

    It is indeed challenging to try NOT to bring work home when you are an LTC Manager or someone who is non-floor as one of you mentioned. Unfortunately, I am one of those who DO take work home whether or not I planned to do it. However, whenever I was the DON or Manager, and I requested my right hand person to do some tasks for me, I either compensate them for the time they did it (regardless of where they did it, such as employee evaluations), or let them exchange the time off for the time spent type arrangement.

    The fact that we in LTC Management still in general take work home (Aside from my personal experience, I have numerous DON friends, whose husbands complain of the same thing), is a symptom of poorly funded eldercare resulting in budget cuts, resulting in cuts in facility budgets and positions, resulting in high Nurse Manager/Director burnout, resulting in high nursing turnover and VIOLA - Nurse Management/Assistants wearing too many hats working longer hours, 8 days out of 7, and being on call 24/7, while having to come in with a "let's get it done" smile every day! Oh and covering the floor when someone calls out and there is no one else to pass the meds.

    The DON or the ADON, who happens to also be the QA Nurse, the DSD, the Infection Control Nurse, the Risk Manager Nurse, the Case Manager/Admission Nurse/Discharge Planner, Care Plan Coordinator, Wound Nurse - Tell me that doesn't describe you? (or a variation thereof). It's the residents who keep us coming back, huh?

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    Sorry, it's been a while since I have been on. It may just be a California nomenclature. It is usually either the DON or Administrator who is designated as the Abuse Prevention Coordinator, as part of the required elements by regulation for an Abuse Prevention program. Someone is designated, and the residents are informed upon admission and as needed during Resident Council Meetings, it is also posted (person's name/title/phone number), and the staff must also know who it is. This is to ensure that they all know who to call directly to report any allegations, instances of, actual abuse occurrences. When I find that article, I will share. Thanks.

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    etaoinshrdluRN likes this.

    It sounds like by this time you've already had your meeting. I hope all went well. If there is still time to give you some advise, this is what I would say - having personally experienced the horrors you've had with not so good outcomes after speaking with the supervisor (I ended up resigning soon after, as I did not want to jeopardize my license, but I had more options because during that period of my transition, I already had about 14 years of nursing experience):

    Focus on patient outcomes, and it sounds like you are with your reasoning. So, in essence, approach the issue from a patient safety standpoint. By all means, speak up about your concerns, but include the fact that you want nothing more than to put the patient's safety first. Explain that you personally feel that your own skills would be best honed, and that the outcome and success of your orientation program would be greatly impacted if you were given the opportunity to shadow someone who is a consistently safe practitioner (nurse). Perhaps even post it as a question to your supervisor/educator. Orientation programs are supposed to be dynamic and interactive, not dictated and one-dimensional, especially the on-the-job part. Perhaps take it to the next level by saying, "Put yourself in my shoes, what would you suggest?" and emphasize how much you love the unit, the job, the hospital, etc., and how much you want to succeed as a team member.

    So, lots of luck to you. Regardless of the practice of "covering your rear", the other 2 thing to remember
    1) "The only one who can protect your license (which you have worked long and hard to obtain) is you!"
    2) For anything that you are a part of, will you be bullet-proof in the witness stand?

    Food for thought. Congratulations on landing a job in the ER being a new grad (not the norm!).

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    Simba&NalasMom likes this.

    If your company is Medicare-certified, it needs to comply with the Medicare Conditions of Participation. This is what it says:

    [FONT=NewCenturySchlbk-Bold][FONT=NewCenturySchlbk-Bold] 484.18 Condition of participation: Acceptance of patients, plan of care, and medical supervision.[FONT=NewCenturySchlbk-Bold]

    Standard: Conformance with physician
    Drugs and treatments are administered by agency staff only as ordered by the physician. Verbal orders
    are put in writing and signed and dated with the date of receipt by the registered nurse or qualified therapist (as
    defined in 484.4 of this chapter) responsible for furnishing or supervising the ordered services. Verbal orders are
    only accepted by personnel authorized to do so by applicable State and Federal laws and regulations as well as by
    the HHA’s internal policies.

    Of course it doesn't state that LVNs cannot accept verbal orders, but it only specifies the RN.
    I believe the logic behind it is that it is pretty specific that an RN be the coordinator of care in the Home Health Arena, and when any orders are received, it is usually because something needs to start happening, stop happening or happen a different way (clarification), which then translates to Care Plan review and revision/initiation/coordination as needed, which must be conducted by the RN.

    My 2 cents - I am new to Home Health and had to read and re-read all these guidelines many times over!

    Now, in the Long-Term Care arena where my expertise is - things are different state to state as I've discovered having practiced in California, Texas, Wisconsin and Illinois as a consultant!

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    lp_825 likes this.

    You are most welcome. Glad to help!

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    Some of them yes, so they relish picking on the DON especially.

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    lp_825 and BEDPAN76 like this.

    The other thing to remember is that the State Surveyors are people too. So, we are talking 1) Plenty of room for error/misrepresentation; 2) They have their own agenda (we don't always know what it is; 3) They will respond to your body language and demeanor, and may follow your lead with how your survey is going to go - meaning if you are hostile, and unfriendly, you may get the same response from them. Although watch out for the nicey-nice ones because they may be happily writing down all your little comments that you thought were harmless.

    I have been through many surveys as my specialty is turning around troubled facilities so to speak. Part of running survey readiness, is readying the staff with a mind-set. This means aside from actual preparation, continuous audits, rounds rounds rounds, leadership will "mock interview" staff from all different levels and all difference departments. We made jeopardy games, pop quizzes, things like that.

    Some staff/companies are opposed to this type of prep because they think the surveyors should see reality as it is. While there is truth to that, it would be akin to having your kids say you as a parent should see how they keep their room "all the time as it is without prep work" knowing you could withhold their allowance if it didn't pass your standards. If you are lucky enough to have a well-run facility, then the survey should only be once a year. And since this once a year snapshot is publicized, wouldn't you want to be ready for your "photo-shoot?"

    Prepping staff includes: Quizzing them on their feet regarding fire/safety response - RACE - PASS, what to do if a patient elopes, how to slow down and ask the survey to clarify the question if they don't understand, where all the manuals are (once again), not to hand anything over to them without checking with your Supervisor first ("Let me check with my Supervisor just to make sure I am handing you the right thing,").

    Okay, that's it for now. And by the way, it is a well-known legend that those who join the state surveyors were those who failed in management of a nursing unit of hospital elsewhere - don't get me wrong there are those who are brilliant and love what they do as a cause for improving senior care. And then when they don't do well as a front line surveyor, they don't get terminated, they get promoted!