mrnurse2

I have only been working at this place for a month. I am not one to jump ship when things are not my way. However it is a hard day when you don't have the philosophy of the administration. I work PRN for another facility and when I posed the question above to them I got the best answer yet. I was told that we had to meet both needs. The patients and his right to safety. I was told we would not admit a pt. unless we had the adaptive equipment/ and or lift to ensure safety of pt. and staff and we would also have to be able to accommodate his needs. Wow, I thought a place that cares for their staff and their patients. They don't pay a lot but they sure give you a warm and fuzzy feeling inside when you work for them.

I was reprimanded today at work by hospital administrator. I thought this might start an interesting debate of thought. Basically I had a heavy set fully hoyer transfer dependent gentleman who in no way can bear weight with assaultive history, fall history and periods of confusion. Pt. did have Stage II ulcers on coccyx and was soiled. When CNA attempted to care for him he was striking out at her and demanding to be taken to the toilet for BM. I told the CNA to offer bedpan because of safety, his fluxuating mentation and animated behavior it was unsafe to hoyer transfer to high rise toilet. CNA did not like my answer and went to administrative nurse who took two other CNA's in room and took him to toilet in the manner described above. I was upset for not being consulted as to why I chose the action I did and I was in charge of that pt. The pt. in bed was in no eminent danger and my plan was to re approach and negotiate with pt. when he settled down. Yes I was going to let DOC know but I was trying intervention first being going right to chemical restraint. The administrator told me that the administrative nurse had every right to superceed. The patient had a right to choose to be taken to bathroom over my judgment that he was unsafe. The administrator told me that all the patients are ours (meaning the clinical staff) and that her license hangs on the wall too. It was not my patient but all clinical staff have a right to intervene and care for patients. So what is everyones else's opinion and have you had similar situation?

Well Thank You For The Reply. I don't mean to seem that money is everything. Right now I live in a somewhat secluded city that has no nursing homes and no hospitals Nearby are 3 nursing homes and 3 small hospitals. I am driving over 50 miles one way to work just to get a fair wage. I am putting in 10 to 12 hours a day plus one way drive time of an hour minimum and sometimes with traffic 2 hours. The remaining kids are older and doing their thing and the wife well she looks somewhat familiar . My brother in law moved to Texas a little over a year ago. He has been telling us how friendly everybody is. My wife is a skeptic and we have been arguing about a year now that life is the way it is everywhere. She is finally letting me go and if everything is better she will move out here with me. Would be nice to still work hard but have what really matters time with family.

Hello, I am moving in with family in Denton at the end of the month. Want to see how the Texas life will be versus California. I have my LVN and also am a wound care specialist (WCC) with over 10yrs experience. I expect salary will be lower? I am in the $20Hr range now. I saw one place JPS Healthcare is anyone familiar with them? What does an average LVN make and is there job opportunities? Hope this will be a good choice on a move.

I have a friend at a work Christmas party that toasted wine with fellow workers. She was pulled over by police minutes away from the party and was considered over the limit and charged with DUI. This shocked the heck out of me. Now I know you should not get behind the wheel if drinking. . . period. I agree their should be fine and or punishment so that a person will be aware in the future and never let this happen again. To say someone is a "criminal" based on one incident to never be licensed as a nurse, this is wrong.

I find in general that RN's don't hate us. In honesty as one that has two classes left to sit for my RN boards their is a lot that can't possibly be taught in an initial LPN/LVN program. As an many years experienced LVN I can recognize and intervene in tasks that new grad and only a few years out RN's have not experienced yet. What I found in my LVN/LPN program their was a lot of clinical skills and hands on. I was taught to do tasks and get things done that new grads in general are still learning to do. My RN program repeats and builds on a body of knowledge as to "what if's" and "critical thinking" Because of the intense sciences of A&P, Microbiology, Chemistry you are able to understand how a molecule is processed through the body. It is important at times to understand this molecule process and negative feedback loops that if your patient is presenting in a certain mannor then their must be a disturbance in a process or processes. The next step in this molecule process is knowing whether your nursing interventions can restore or maintain this balance or if critical physician intervention is needed. I used to think that the RN was only a title that after my years of experience I could do exactly what they could do. There is really a lot of in depth knowledge that a typical one year LPN/LVN program can not cover and that visual hands on experience can not substitue for classroom learning that an RN receives. The main thing that I find is missing at times is remembering we are all nurses! It is a big messed up healthcare system out there. So many sick patients and all of us are needed to care for them.

As a new nurse I had developed an interesting technique to insert foley catheters into females. When I grabbed an insertion kit, I would also grab three cotton tipped applicators. I would prepare the patient for FC insertion then I would open up the applicators and stick them in to all the holes. The hole on the top I knew was the one I had to insert FC in. I had done this for a little over a year and no patient every said anything. No one every questioned my technique. One day I had a 30 year old or so female patient who needed FC inserted. I went through my routine and inserted my applicators: meatus, lady parts, and right at the last one the lady sat up and said, "Hey what are you sticking in my butt?" Needless to say I don't use the cotton applicators anymore !

This is proably a new topic in its self.In a simple nutshell it really needs a demonstration. The same sterile FC technique is implemented, the difference when going from behind is your initial insertion. From the front when the cath is fed in to the meatus there is a slight upward advancement when inserted. From behind its a downward initial advancement when inserted. The rationale is patient's with large skin folds, painful joints 2nd osteoarthritis can not open legs wide enough to facilitate front insertion without pain/discomfort. I have also found this the case on some with MS and those with contractures. A posterior approach does not require as much bone movement because the perineum can readily be exposed by moving the cheeks of buttocks with the non-dominant hand. I can not find any clinical evidence this is an acceptable practice but if its done with sterile technique I can't see any harm. I always try to do what makes the patient most comfortable. As you know when the patient is comfortable its a good shift.

Sorry but I can't stand by and read and not post. Initially when I went to school I was not allowed to take care of female patients. A lot of the old time instructors were uncomfortable having a male nursing student. Finally in the end semesters the policy had been established and I was allowed to care across the gender spectrum. I saw in early years sterotypes of "gay" and being "feminine" if you were a male nurse but through the years I don't see those sterotypes anymore. Work with a fair amount of male nurses. To show you how dumb I was at the time. My first med surg female patient was semi-comatose. I did total patient care. In doing my cares I observed my patient had a white discharge from lady partsl area. I was so scared to report condition of patient. I kept the patient clean but the white discharge seem to return. At that time the only thing I could think of was . . . here I was trusted with my first female patient and someone was going to acuse me of violating her. I was so relieved to find out she had a yeast infection. What I have found through the years is I explain everything I am going to do (stop the busy schedule for a moment this is a teaching/training moment!). If I am to expose or touch a sensitive area I wait till I have a CNA to assist me. When I show the patient my confidence and professionalism I usually have no problem. Don't fumble around have everything you need to do the intervention safely with care and be done with it. Occasionally I have a patient who will make a sexualy comment to me, I attempt to be polite but will have another staff switch patients with me. Too much risk in this environment to joke in that manner. When I have had to float to L&D and do the BUBLE assessments and observe babies latch on I tend to get more resistance. No big deal I have to remember I am there to meet the patients need not mine. Now, I have found other nurses asking me to help. Somewhere through the years I have developed a nack for cathing patients from behind. There is a population of patients who with RA, contractures, obesity that to cath from the front is painful or too difficult and will fight you everytime. I lay them on their side with a pillow and of course I explain to them what I going to do and I insert the FC from posterior approach. Your professionalism, careing heart, and your ever learning mind to be better at what you do will erase most biases, and stereotypes people have.

Unfornately when you work in area for a long time employers assume you are a nurse who can only do the area you have been doing. What I have done is sometimes take a job I didn't like but then look for another job to work part time or PRN to fill in then you start getting experience in that area. Check out hospice agencies, home health agencies, registry's. A lot will say recent "acute experience" tell the interviewer or cover page on your resume that you want to fill in and are willing to learn. In California the latest thing in ER is employed to cover RN lunch relief. The other things I found is look for classroom CEU's that offer certification in a field that interest you. When you go on the interview or apply for job bring/copy your recently obtained certification. Usually facilities no matter how bad they are offer some type of documented review of performance, I ask for copies. You want performance reviews that show you are a dependable, hard worker, willing to go above and beyond. I started out initially in LTC that I hated, then I covered for the TX nurse on her days off. Next thing you know the vendors Hillrom, Pegasus Airwave needed a nurse consultant. I told them I really didn't have the training. They sent me to training for wound care in exchange for my services. Eventually, I accumulated a lot of experience and was being paid good. I visited facilities and put my name out and was giving the opportunity by the networking to do other things. Hang in there and don't give up! Nursing is a great profession, one that has always had some type of job for me especially when I needed food on the table.

Thanks for all the posts. To me the $20 hr is a good wage if that comes with benefits. In California working for the State a monthly LVN salary at top range $3200, RN $5200 month. Add for RN about 10 % more for BSN. After 20 years its lifetime medical coverage. Only takes 5 years to be vested for retirement. Retirement is based on your clasification from 2 to 2.5 % multiplied by years of service, then the last two years of work you get that percentage of pay. Example at safety retirement 2.5 % every 10 years is 25 percent. After 30 years you would get 75% of pay per month based on what you averaged for last 2 years worked. I have seen LVN positions (Loma Linda Medical Center) as low as $16 hr. I took some side work this flu season doing shots for $30 HR for Berry Medical (RN's were paid $40 HR). LTC for LVN's 5 + years experience $18-$22 HR. Home care I have seen RN's get $75 visit. You are right about staffing ratios but I have not seen staffing ratio's in LTC I have cared for 30 to 40 patients at a time. Each patient about 10 meds and have to do 2 passes with a limit of 2 hours to do it in. Then in LTC most of the time you do your own treatments. Thats why I moved out of LTC. Hospice or Home Care is better but is sticky at times because of the difficulty to get hold of Dr. when situations are bad. HMO and a lot of times the MD that are with the HMO's dont want their patient admitted back in hospital and you are faced to take care of situations that were traditionally handled on med surg floors. I feel the reason people are getting out of nursing in California (the only state I have practiced) is because nurses have all the responsibility and no control.

Hello, Seems like a bunch of nice people who post here! :) To make a long story short my brother in law just moved to Denton county. I could not believe the difference from California. Seems like a great place to move with real friendly people, low cost of living compared to California. My dilemma. Currently I have a California State job as an LVN, fully vested with a job for life with full everything; retirement, benefits, vacations. I am only 35. Do the "Nurses" of Texas like working in Texas? Would you give up a job in another state to work in Texas? Does there seem to be a need for LVN's in Texas or is it difficult to find a job? I have been an LVN since 1997. It seems like its going to be a little headache to endorse to Texas plus the whole moving adventure. Look forward to your postings!