Catedi

Unfortunately for me, I'm considered 'intitutionalized', when it comes to working in a hospital setting. I'm also 61 years old. So, there's that. I have it on good authority, getting another job after working in corrections for so long would be unbelievably difficult in the Cleveland market. I was hoping someone could steer me towards the correct agency to report my employer for 'practice intimidation'. If not, I'll file a grievance with the union.

Not sure if this is the correct forum, but I need advice. I'm an RN who's been working in a state run prison for 11 years. I recently found myself in a situation where an inmate presented to the Med-call window with an ID that was so worn out, it could no longer attach to the inmate's wrist, had most of the face torn off of the 1/2" sq photo, the full name was no longer visable, and the inmate ID number was no longer on it. I told him I could not accept the ID, but his staff may print out a face-sheet and I will accept that. The inmate tore up his housing unit and the Corrections Captain (CC)- an unlicensed person - demanded I give the inmate medication. I explained that I couldn't do that without ID. Ultimately, the CC returned with a face-sheet and the inmate who received his medication. The state agency investigated the matter and found ME guilty of not providing medication to an inmate who presented "a legible id". The investigator (another non-licensed person) determined that the partial name and the photo that showed the inmates eyes and top of head was adequate. The Ohio Nurse Practice Act provides for autonomy and that only an RN can evaluate a nurse on whether a practice violation was committed. My disciplinary hearing with the employer is next month and I'm at a loss on what to do. The nursing board only provides oversite of nurses, not agencies that disregard a nurses protected duties to practice nursing. Any help on where to turn would be greatly appreciated.

All the medications are owned by the state, regardless of who they are given to. The inmate is never charged for the medication. We have very little in stock as our clinic med room is very small. The state pharmacy services every state facility (hundreds of patients, if not thousands) and with a combined crew of 15 or so pharmacists and pharm-techs, is unable to process things as timely as it should. I was merely attempting to meet the need of my patient and relieve his discomfort. All I ever wanted to do was be a good nurse. I could not find a law in the state pharmacy law book. My agency has no policy barring this practice. I read NursBlaq's posting of Federal DEA law, twice, and could not find where it included non-controlled meds in it. It clearly gave a definition of what a controlled med was for purpose of that law - schedule I - VI. Hydroxyzine does not fit in any of those categories and in some countries is OTC. I attempted to reach out to my state BON weeks ago through phone and then via email, but received no response. Allnurses was not my first attempt to get an answer. This is the first time I had ever done this and given, what seems, what a murky area it is, I will probably never do so again unless it is to save a life. I just wanted to know if I should prepare to lose my license and put my home up for sale to avoid foreclosure!

No offence, but this rule only pertains to controlled medications. Hydroxyzine is a non-controlled medication. There is no DEA oversite of non-controlled medications. Although I get your point - it is not standard nursing practice.

I did not mean that prisoners were void of nursing standards, I just meant it is a residential type facility and where there is an off-site pharmacy and the client would have gone without his medication for maybe a few days. Thank you for your feedback.

Is this your opinion or is your answer based on law or do you have any indication that this violates a standard that I can't find? I'm not being snarky here, I just want to know for sure. This is a prison setting and there are also many drugs we keep around that aren't necessarily specifically RX's for anyone that we give if there is an order and the inmate needs it - such as anti-biotics or Inderal, until the pharmacy sends their medicine. The inmate has episodes of self-harm and violent acts against other inmates and staff. Given his agitated state, I thought it appropriate to give him his first dose so he could go to sleep, for his safety and the safety of others. But, of course, I don't want to do so again given that it may be a violation of the law. It was a one-time situation where I thought I made the right call in the best interest of my patient.

My question is: If a physician writes a valid order for a non-controlled medication in a prison setting and the medication (Hydroxyzine) has not yet arrived, is it beyond the nurse's scope of practice to provide the inmate with an available dose of the medication not specifically RX'd to him, from a sealed and sterile blister-pack that was scheduled to be returned to pharmacy services, if this action is safe and appropriate to perform for the patient at the time, and it is verified by a second RN that the medication is unexpired, the Right Medication, the Right Time, the Right Dose, and the Right Route? I could not find any nursing or pharmacy laws or policy to prohibit such an action, as provided in the Ohio RN and LPN Decision Making Model. This act is also not prohibited in my facility's current policy.

I don't know where you get your information at, but I work for a union protected facility and we have plenty of flexibility. If we want a day off, we can trade a day with a coworker and we don't have to use our personal time. But we do get lots of personal, vacation, and sick time to last. Also, if we work an overtime shift, instead of getting paid overtime we can get straight pay at our regular rate, then get the overtime hours worked as comp-time. I know one nurse who's at the top of seniority who parlayed her leave to nearly 6 months off of paid leave a year. The hours are the best. The pay and benefits are the best (I'm making $49 per hour in a market where the rate at the local hospital is only $29 per hour), and I can take every single day off I'm entitled to without a hassle or a cross look. My vacation pay is 3 weeks a year @ 7 years, and my personal time is 60 hours a year, and I have an additional 80 hours a year sick time. Why would I ever want anything else, and why would I ever care if someone thought it unprofessional to join a union? I hope their measly paycheck keeps them warm at night.

I don't think I've ever met a lazy or stupid nurse. Nurses I've worked with at ALL facilities that did not have a union were treated horrific and blamed when things went south when it was truly management's fault for under-staffing. The nurses whom I've worked with, in unionized facilities, were able to safely meet a realistic goal. As I said before, no union existed that wasn't sorely needed!

I've worked for them. When they took over the hospital I worked for they dropped an RN and an MHT on each unit, which meant I was the only RN left on the Acute unit of 12 patients, with one MHT. I lasted 6 months when a patent beat the MHT so bad they were in a coma for 2 weeks with a broken jaw, a broken orbital, and 3 fractured ribs, along with the skull fracture the poor woman endured. I quit a week later, when right after it happened, I told the nurse manager I was concerned that the 1:12 ratio was dangerous, and she pointed to the door and said, "There's the door if you don't like it. Don't let it hit you in the *** on the way out"! The following week, a patient grabbed my face and threw my glasses down the hall. I finished my shift and turned in my badge.

First, I must congratulate you for having the opportunity to work in the most glorious of situations - that of a nurse in a state that employs safe nursing/patient ratios. To say I'm envious is an understatement, as 300,000 patients a year die due to RN understaffing. Right to Work laws essentially gives the EMPLOYER the right to let you work ON THEIR TERMS. They are not worker-centric laws. I live in Ohio. I belong to a Union. I am a nurse. What I've learned is, no workplace has a union simply because the thought it a cute idea. The union was sorely needed. Be supportive and pay your dues, and know that without that union your paycheck would be so much lighter than the dues you pay and your back would be so much closer to retirement than you could believe. Good luck with your career!

Your role as a PMHNP will be much different than the role of a psychologist. I'd stick with the nursing track. You will need advanced medical education more than psychology. Generally, you will be Rx'ing meds more than counseling patients.

I'd go to the meeting, but email then a resignation before the meeting. Here in Ohio, we are an "At-Will" state, so just like they don't have to give you 2 weeks notice to can you, you don't have to give 2 weeks notice to quit. UNDER NO CIRCUMSTANCE, should you sign anything!!! They already plan on reporting, so let them and deal with the BON on their terms with your attorney.

20 years ago, I had a TBI and other injuries associated with falling from a vehicle on the Highway, doing 60mph. Long story short: Coming home late at night, from visiting friends, I hadn't closed the passenger door properly and was not wearing a seat belt; fell asleep against the door and when the driver hit a pot hole, the door flew open and I fell out. Yes, I certainly learned my lesson about seat belts. I sought to enter nursing school 10 years ago, because my prior work was too physical and I had been on SSD. No one can live on SSD with any degree of comfort or dignity, especially raising two children. The counselor at the Community College I went to told me that d/t TBI, I should forget nursing. I slunk away with my tail tucked between my legs and went to counseling for depression and was encouraged to go back and enroll. I am proud to say, I finished nursing school with a 3.9 GPA! I was employed last year by a Behavior Health hospital. Anyway, now at 50 yrs old and many therapies later, the only signs of disability i display is I move slower d/t having a knee replaced, chronic back pain, and some thought blocking, which to me, is the most troubling side effect because I have to allow what is being said to process before I can respond and I have some difficulty with spelling (thank goodness for spell-check). So, despite having a very high intelligence level, and I demonstrate critical thinking skills, I notice that when I talk to coworkers or colleagues they slow down the conversation to match me, which totally unnerves me. I'm also starting to experience some discrimination at work. I never acknowledged my disability to HR when I applied because I was advised I'd never get hired. I actually had a manager approach me recently with veiled threats about documentation fraud, stopping short of telling me I was lying when I verified a pt's medications with a pharmacy as being the correct dose being issued, because the pharmacist questioned the amount of a medication a pt reported as being Rx'd AND reordered by the physician assigned to the pt. Essentially, I've been told, in no definitive way, "Find another job, no one has confidence in you." It's hard to be disabled in the nursing profession. I'm finding that out, first hand, in a job that is not that physically demanding, that employers and colleagues do not like or trust a nurse who recovered from TBI.

In Ohio, there is a bit of confusion. There are two MA designations. One, like this person I am reporting about, goes to school for 6 mo. and leaves the technical school with a certificate. The other, goes to College, takes a year of prereqs and enters a two year MA program. They leave school with an Associate's Degree. The confusion is, they have different scopes but nothing like a separate suffix, like RN opposed to LPN, to identify them. I have a family member working in a hospital who has the Associate MA degree, and they can do allot of what an RN can do, like assist with surgeries, dressing changes, post-surgical monitoring, etc. But, they are not allowed to start an IV or give medications through an IV. I am determined to not drop the ball on this. I appreciate the input, and use it as a start.Thanks.

Also, @ Dogwmn, LPNs can start an IV in Ohio if they've received a certificate to do so. They can be delegated to give medications through an IV, under the licensed RN.

Just to be clear, she is not my friend. She is an acquaintance I met through my sister, who used to do her nails and is now her friend. We were visiting my sister on the same afternoon when we had our conversation. She truly believes the patients are in no danger, stating she feels the doctors trained her very well. I do not want this on my conscience, and will report it as soon as I know who I can report it to. I was hoping a more experienced medical professional could direct me to where I needed to go with this. It's so crazy, I can hardly believe it!

I'm not sure what to do here. Someone I know told me this week that her employers allow her to work beyond her scope of practice. I always thought she was a Surgical Tech, although, she never went into details about what she did, other than assist in surgery. I just found out she went to a school for medical assisting. Her program was 6 months long and she graduated with a certificate. She's not even registered, as in Ohio, registration is not required. Essentially, she is an unlicensed medical assistant. She stated to me that her employers, a private dermatology and cosmetic surgery practice, have her assist in surgery, such as starting IVs, injecting medications into the IVs, monitor patients under anesthesia and do post surgical care. I was floored when she told me this. I calmly questioned her on why they don't have an RN doing these things and she stated, they only have one nurse on board because the 'practice' feels it's too expensive to pay RNs, when the physicians at her practice can just train MAs to do what she's doing. I'm a newly licensed RN, so I'm not sure what to do or say about this situation. Nor, do I know who to turn to to report this. I just know this is beyond her scope and this is endangering patient' safety. This person understands what she is doing is beyond her scope, but doesn't care, since she is compensated beyond what an MA would ever make with a certificate. She also feels the risk of getting caught is minimal, as she asked, "How could anyone possibly find out?". I'm wondering, does a patient death have to occur for this to stop? Any advice would be welcome.

I have used Marrell mocs for nursing school and liked them very much. I need good shoes since i have back and knee issues. I've worn Birkenstock for everyday wear, for about 20 years. Love them. I think I'll get a pair of white Alpro c100, by Birkenstock. I love the orthotic foot bed. I also have a pair of Dansko shoes, but don't like them as much as the Merrell brand. I really am a believer in well made shoes if you are on your feet all day.

I don't think her education is any of your business, period. Focus on your own issues and don't be such an envious busybody. I've been in nursing school with people like you and it's a real drag. I've been a good student and on the deans list. I can get an A on tests without barely studying--thank God. My personal life is very hectic with a disabled child. If I was offered someone to write my papers, I'd jump on it. I'd still be a great nurse at the end of the day. So, get off, and worry about yourself. She's either going to be a good nurse, or a rotten nurse, regardless of if she's writing those papers herself. I personally think the writing's a bore and a time waster. I think it's just filler--stuffed into the curriculum to kill time.

I am in the RN program also. I wouldn't fret about he wait list if you have prereqs to do. I know the outline in their catalog shows how to take the prereqs with the nursing classes, doing it all in four semesters and a summer, but don't set yourself up for failure, here. That is totally misleading. You really need to get them all done before the program starts and during summers, because it's a very intense program. I was on the Deans list, with a GPA of 3.97, and I know I wouldn't have been able to do it. If you fall below a 2.5 for any program class, it's an automatic failure. If you fail one class, you need to appeal to the dean for permission to retake the failed class AND permission to reenter the program. If you fail a second class, you are OUT! No appeals allowed! Wasted time and money. So, get those prerequisites done before and then you'll be free to study your butt off doing the endless, incessant, unnecessary paper work they have for you, every waking moment you have. Good Luck!

kl2010, stated... hmmm, i've noticed that too. although, i can't care what their motive is for going into nursing. i've got my own stuff i need to focus on. i look at the first two semesters as the "weeding of the weasels", semesters. i don't have much faith that the truly uncaring students will be here, come third semester. if a few do get through the cracks, there are stop gaps to poor performance that isn't actually caused by poor employment conditions. i can't say my reasons for attending nursing school are entirely altruistic. lets face it, i'm 40-something with no retirement savings, so i'm playing catch-up. i highly doubt, kl2010, you'd have chosen this field if the paycheck was $30k, instead of $60k per year. i consider myself very compassionate, but i surely wouldn't be dealing with the responsibilities of an rn degree for anything less. so, realistically, you could say i'm in it for the money. surly, you're not suggesting there be some sort of personality 'weeding' process prior to actually getting into the nursing program, are you? yes, that waiting list is grueling, and at my age, i can honestly say, i probably have more at stake for having to wait than the traditional student, but that's really my fault for not making the decision to begin the process sooner. everyone has the right to be 'clueless' as to whether the career they've decided to pursue is right for them, until they're actually experiencing what it entails. it would be fascist to remove that right. the real problem lies with the fact that nurses are in a shortage, making the wage so much more attractive. again, one of the very reasons i'm here, in line. also, the reason the wait for a slot was tolerable. most likely, if he's that obnoxious, it's doubtful he'd be able to contain it beyond the interview process, much less, the 90 day trial period. so, may i suggest you quit focusing on 'the weasels', as it's a negative force sucking precious energy from your journey.

JAW0172003, Wow, 4 years--I'm betting you don't even remember not feeling fatigued. Anyway, I would say, first, does your health carrier require you to have a referral to see a specialist? Surprisingly, most carriers do not. Referrals are an impediment to good health care, as patients are shy to offend their current care-givers. It's been determined patients will receive a more timely (i.e. cost effective) solution to many of their issues if the requirement to get a referral is removed. Second, I would say, until you’re established on the right meds, or right dose, see an endocrinologist if one is a reasonable distance to you. The fresher out of school, the better, as it’s not as likely an older endo would be up on latest trends and not doing it “Old School”. It's not really the ent's area of expertise. But, if you find you can’t see an endo, stick with the ent. Don’t let your family guy decide the meds or the dose you need. He/she just doesn’t have the in-depth understanding the specialists do, as evidenced by the unnecessary and expensive order for an ultrasound. Positive labs for antibodies are the definitive confirmation of Hoshimoto’s. If you have Hoshimoto’s, there is inflammation, regardless of if it’s palatable, or not. Third; once you are established, which may take a year or so of tweaking meds, then take your order to your family doctor. He/she is perfectly capable of monitoring your levels of TSH and Antibodies. He will not question the specialist’s orders. The sooner you are settled into your proper ranges, the sooner you’ll feel better. Good Luck.

I'm starting my first semester for my ASN in the spring. I'll be 47 by then. I started in 2005 with pre-reqs, but the waiting list at the College was crazy. I just kept taking classes and now have pre-reqs finished for the BSN. Although, I'm not sure if I'll end up going for that. There are a few things I'm having trouble with. House work LaundryI have two boys at home--a 16 yr old and a 9 yr old. Both have disabilities, so it's all I can do sometimes to get dinner on the table, work with them on homework, and herd them into bed. I usually don't get to study till after that. Somehow, miraculously, I've maintained a 3.67 GPA. But my house is a wreck and it's driving me nuts. I know I'm obsessed with getting As and Bs but I'm worried if I let up I'll miss something and won't understand what's going on by third semester. I'm already afraid I can't cut it, but I'm willing to try. Anyone with advise for me would be really helpful.

Just curious; why on earth would you want to work at CC??? That place is the stank hole of the Cleveland hospital community: the poorest wages, the worst benefits, their infectious disease protocol and post-surgical bowel protocol.... er, what protocol?! They haven't one!!! ...and they have the cojones to make employees pay for parking? Ugh, CC's the pits. Go work for UH, down the road, or Lake Hosp.System. So much better if you really want good pay and a high standard of health care.