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Rehab, LTC, Peds, Hospice
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withasmilelpn has 18 years experience and specializes in Rehab, LTC, Peds, Hospice.

withasmilelpn's Latest Activity

  1. withasmilelpn

    Med aid problems!

    Doesn’t seem to be your medication aides are the problem but the expectations of the facility on the RN. To have one RN cover both a skilled unit of 20 and be responsible for assessments, treatments, orders and insulin on 3 other units - for a grand a total of 80 is asking for things to be missed. She’s juggling too many balls, it’s that simple. Follow her for a day, look at her acuity on the unit she’s on, the acuity and behaviors overall, what tasks she’s responsible for (treatments, IVs, wound vac, nebulizers, bladder scanner, EKG, admissions/discharges, teaching, Medicare charting, Care planning, mds, - all the paper/computer work she’s required to do) do a time study of how long it takes for her to do her tasks, paperwork. Remember that tasks change often and remember that even a simple pulse oximeter check can take time if it’s with and without O2, with exertion, or the patient has a low reading. Or the patient is slow and uncooperative. Allow for unexpected emergencies, Falls, skin tears and families needing reassurance,Education etc. Be sure to include how long it takes simply getting from unit to unit seeing patients (remember if there are patients requiring insulin or prns at the same time on different units that is going to add to the inevitable inefficiency and length of time to get things done.) How accessible and stocked are supplies? If you have a computer system, allow for time to log in, freezing, total clicks to get from page to page and other frustrating system hiccups. Look at how things are communicated to the nurse - how is she notified of new orders? Does she have to do rounds with the MDs? If so, how generally time consuming are rounds and how disruptive to her responsibilities? Does she get behind? If she doesn’t do rounds, do they simply leave orders on the units she is not physically on? If so, who notifies her the doctor was here. How many staff are assigned to her on her unit and on the other units? Are they reliable, caring, kind, well trained, efficient and can recognize when they need to speak to the RN? Or do they actually add to her workload? And finally, what do you as a charge nurse do to support her, the caregivers and the facility? Do some investigation and you might find out why.
  2. withasmilelpn

    Knaves, Fools, and the Pitfalls of Micromanagement

    If in every day situations most nurses are failing to meet what the hospital has established as their goals, then the breakdown is on the organization not the staff. The hospital is failing in some way, not enough staff, inadequate equipment, inefficient protocols, inadequate training or unrealistic goals. It goes both ways when it comes to quality checks that not only the staff should be examined but the hospital's policies as well. Your best defense is to band together and challenge the data then eliminate one by one each possibility. Organizations often take the first step, looking at staff performance then education but often don't go further than that.
  3. withasmilelpn

    Husband is not ready for me to go to nursing school!!

    I am glad you are going to counseling, however I think no matter what happens you should go ahead to school. If he sees that this is important to you he will come around. If he doesn't he's probably not the right partner for you. It also bothers me that you say he criticizes you about not doing anything with your life and is setting you up to be blamed for not completing school that he hasn't even started yet. Red flags for me that he may be somewhat of a narcissist based on things I've experienced myself😡. Of course I only have a little info and it could be a maturity issue as well. Just to be safe, maybe look up on google "husband is a narcissist" and see if any of the info you identify with. (But please don't call him that or say that to the counselor as only a professional would be able to diagnose that.)
  4. withasmilelpn

    Are nurse's all that and a bag of chips?

    You are making me laugh describing what the "majority of what they do" to us. Sounds like a piece of cake job. Where do I apply? I also have to say the majority of aides I've worked with that seem to hate nurses the most or have 'no respect' for nurses are the ones constantly making nurses jobs harder because they aren't doimg theirs. And the ones not doing their jobs are more likely to have their nurses constantly on them but seem surprised and angry that a nurse would tell them to their job. It's definitely a no win situation for all involved when this is the case. Especially the patients. Hopefully you are not one of these people. Perhaps it is just where you worked? I know lots of wonderful nurses and aides myself.
  5. withasmilelpn

    Are nurse's all that and a bag of chips?

    At first I thought, yes that shirt is dramatic and over the top and I would definitely never wear it. Then I thought about it it a bit more and realized that we do in fact have nurse colleagues that have given their lives -nurses in war zones, nurses exposed to communicable diseases (remember Ebola?) etc. And those nurses that suffer on the job career ending injuries without hope of compensation may not find the t-shirt as dramatic as I did... Then there is the sacrifice of weekends, holidays, vacations, which in my opinion is probably the most annoying translation of the shirt because most of us know and accept this as part of the job. But still it does stink sometimes, right? Anyway first impression still was "drama" so this was def after much thought. Thought that most people probably wouldn't do and therefore would find it pretentious and annoying. Mostly though, I don't really care what someone wears, I'm really a live and let live sort of person. :)
  6. withasmilelpn

    Negligent CNA?

    We just do education. Silly that they reported it as negligence. Doubt that anything will come of this unless it's a serious injury.
  7. withasmilelpn

    LTC has changed-How do you give out 5pm meds now?

    Actually quite a lot of them always took their meds at their meals. Some people actually have insisted I give them to them on the toilet no matter how much I protest I can come back. (Yuck.) Most people are very casual about their meds (sometimes too casual taking when they feel like it or not and that's how they end up on our skilled unit.) I can manage not to give them at mealtimes with the fact that I know my Residents because I'm the regular day nurse. How the heck a float manages to do this I don't know. So inevitably I'm not the one violating policy - so care plans aren't going to get changed. Float nurses really have it tough though. But I do unfortunately violate policy anyway as management wanted no meds given anywhere but rooms which is impossible and ALL the nurses violate it. I never do anything invasive ever though. They don't ever even comment on meds being given in the lounge anymore. Should be interesting though when the state comes, because it's still our official facility policy. As far as the home like environment- such a disappointment. I was all for the changes, kitchen on the unit, activities by staff, less medical driven, and stayed put through the frustrating building process for two years. The result? A homelike environment sort of in looks but now every unit has multiple rooms for short term Patients along with our true LTC Residents. More patients that are short term with increasingly more medical needs that could care less about activities taking all the time from my actual long term patients that now have LESS activities because the 2 aides for 20 can't manage to do it, and even if they did have time are too burnt out to care. (Used to have 3 because the units overlapped but now have to make do with 2 and a sometime float that does showers because of how the 'households' are arranged.) They also gave the aides housekeeping jobs and laundry to do - because that's how you'd run a 'household.' Now we never have supplies when we need them and the place is always dirty. (It gets done but only when there is no patient care) Then with the influx of former med surg worthy patients, Nurses are swamped with time consuming tasks. Nurses now do bladder scans, EKGs, IVs, wound vacs, juggle PT OT, and multiple appointments and copious charting of course. I like the medical aspect of it, but I think the government and industry itself needs to face facts and commit to one direction or the other. I don't think the two types of patients mix well. Short termers don't take advantage of our kitchen like our long term, the LTC Residents scare them.
  8. withasmilelpn

    Unpaid orientation LTC

    No. It's not legal. Can I hold a 1 day unpaid training for new hires? | Human Resource Blog After you find a job notify the Department of Labor
  9. withasmilelpn

    You are NOT allergic to...

    Autocorrect plus up too late í ½í¸Š
  10. withasmilelpn

    CNA's not doing vitals & slow to answer lights?

    I get my own vitals. Fastest way to do so for me is to put them on an automatic cuff then pour their meds. I keep a manual on my cart for rechecks and only do the most necessary during med pass the rest I do when doing treatments. If I'm running behind, I ask my CNAs to help out - and sometimes even PT or OT will grab them for me. I find it's easier honestly to keep on top of changes in my patients if I do it myself and I know they are accurate.
  11. withasmilelpn

    You are NOT allergic to...

    interesting. Maybe not all insulin though? Just aspartame? Thought you might appreciate this article: The Human Insulin Analog Aspart Can Induce Insulin Allergy
  12. withasmilelpn

    You are NOT allergic to...

    Sometimes Items get entered as allergies because the families or patients insist on it and won't take that medicine, despite the fact that they aren't really allergic. No amount of education ever changes their mind, and it saves us a lot of grief when the doctor orders that med to be able to say it's not an option. It would be better if there was a category as to 'Patient's preferences' though but I don't see that happening anytime soon.
  13. withasmilelpn

    Nurses forced to work as aides

    Patients need care. If your short staffed, you may be needed to do 'CNA' work. Even managers need to be able to pitch in in my opinion. In fact you get a more accurate picture of your patient when you spend more time with them doing care. You might catch the fact that your patient is getting short of breath simply ambulating them to the bathroom, or have increased pain with movement or even may be constipated from the narcotics they're on, etc etc. Things that sometime get missed by CNAs can become apparent. During care, you can really teach and get to know your patient. I like it. It can be very rewarding. Though I will say, too often I'd probably get bored. By the way, when I was hired many, many years ago as a nurse where I was a CNA prior, there were no full time jobs available. I worked as both - for different pay rates! This still happens to new grads I know. So count your blessings you get full pay.
  14. withasmilelpn

    Elopement and LTC

    I would've stood my ground, said their accusations were baseless and unfounded, and that I would not be spoken too in such a manner. I would reiterate that I am indeed happy to work with them to determine what happened, however I can not tolerate such speculation on their part. As such accusations can affect my professional reputation, if administration chooses to take this matter further as in documenting these false beliefs in my personnel file, I would have no recourse but to protect myself. Accusations like these can be considered defamation, and I will proceed accordingly. Are False Statements in a Personnel File Libel?
  15. withasmilelpn

    Why are LPNs allowed to supervise RNs in Long-Term Care?

    Most of the facilities I worked at you were required to call the doctor when PT INRs obtained except for one Doc where we had standing Coumadin orders based on the range. Protocol for loose stools varied, sometimes it was just based on the hysteria of the nurse working at the time. (Have cared for MANY with cdiff - agree 24 hours seems reasonable but reason may not be applied always when it comes to loose stools. And btw in my history, it was always one particular nervous nelly RN that would always make me nuts with putting people on precautions. And she was ALWAYS wrong.) As to medicating for behaviors, I'm very conservative on that front and can't say I care for how she handled the situations you described. Sounds like this is a battle of personalities really, the "I make clinical decisions - not you" argument is a load of hooey though. And the fact that you said she gives LPNs a bad rep - more hooey too.
  16. withasmilelpn

    Thread spinoff: denied time off and vacation approval notice

    Ridiculous. Would find another job.