mel1977

wow-I really appreciate the feedback. I think the reason I even asked is because we DON'T have a ban on them. And, being around others who have them makes my mind start to wonder....but, I really DON'T want them to be honest. I am going back to evening shifts next week after a year of 11am to 11pm. I am two classes away from applying to the RN program and they will not be an in class course, but online. Being back on Eves will allow me to get back on a regular routine-meaning my eating will be on schedule, my sleep on schedule, I'll be able to work out at the sAme times every day. I think as the anxiety calms and so forth, I'll be able to get my nails nice again. I used to pride myself on not needing acrylics. I totally agree with all the arguments-but you have to look at the one regarding bp cuffs, stethescopes etc... I guess the main difference is that the cuffs and so forth are on dry open surfaces, not closed off warm possibly moist ones. Think about blood sugar machines and kits too-I can tell you this, in all my years of nursing I haven't found one time where using a BP cuff between pts caused any infections. Then again, I guess it depends on the patient. OUr infectious ones have disposable anyway. Thank you all for your feedback. I am going to try and try to get past this-I know I can.

I have had fake's a couple of times, usually they are off in a week. I realized they cost too much to maintain, I had great nails, and I was in nursing and knew they weren't great for that ( I was a CNA at the time). I lived in Vegas as a CNA and there was some big lawsuit regarding a woman who got an infection and blamed it on her nurse who had acrylics and wore no gloves when removing a dressing (not sure about redressing...). Vegas hospitals (not all) banned these nails for obvious reasons-they are a breeding ground for bacteria. I am an LPN now, working towards my RN. I am no longer in Vegas, but back in MO where I had previously been. Here, acrylics are neither here nor there. We all know the bads about them-still, nurses have them. I quit smoking when I was in Vegas, and now I am destroying my nails and cuticles on a daily basis. I am so unhappy-there are other issues and personal issues (divorce, weight gain, school AND working 12's, etc...) I know, woe is me....BUT, one day my infection control nurse pointed out how bad bitten nails and torn cuticles are as well-I can't win. I want fakes to boost my self esteem. not long ones, no longer than Sport length- I don't want the cost but I have to feel better somewhere. SO, the question-how bad are they now??? If a person is conscious of the need to be diligent with hand washing, does that make a difference? Are they as big of an issue as they were five years ago??? I also loved my nails, but they are just crap now-four years of badgering them has hurt the nail bed and I can't get them back. Nail polish isn't good either! Please, some feedback. I know the concerns and issues with the acrylics and infection control.....I am not necessarily going for the acrylics either. I wanted to point out-I have an oral fixation and an obvious anxiety issue. I am medicated with zoloft for the anxiety. I sucked my thumb when I was little til 12, then bit my nails, then started smoking, quit smoking, starting attacking the SKIN-the nails not so much, but cuticle area. WIth the weight gain too, I could so easily just start smoking again-BUT, that is looked down on more than the fake nails where I work-they don't want you to even SMELL of smoke. I don't need a big discussion again-I think I know the answer anyway. can't win.

other HealthSouth facilities I have worked in have RN case managers. They are the primary nurse and case manager/social worker wrapped into one. My mom is one of the TBI primary nurses. She will have roughly 1/2 of the hall, but is assigned to only one team. So, depends on the number of patients that doc has. She could have up to 11 patients she follows at any given time. So, she would go to the weekly meeting. I like this concept bc she has every idea of what her patient is doing week to week. This doesn't work for every place though. Our docs specialize and that is the only way it works. Other places don't have docs that take one kind of patient. One takes stroke, two will do TBI, two debil/ortho, one spinal cord. It is a stressful job but I think it would be harder if you don't know your patients as well. Like the way you do it. On the other hand I'd hate following patients OFF the unit while taking care of insurance and stuff as well. I like the way we do it. Seems more personal, ya know? But, you do what works for what you do. does that make sense????

We are a full rehab facility. Our corporation is HealthSouth. We used to be owned by the university of missouri hospital and clinics but HS bought Rusk where i work, and now we are a joint venture with the university, but we are healthsouth employees. So no, not LTC. We do the same thing pretty much-very cool. We have three wings: TBI has 21 beds, stroke 12, and the other wing is debil, sci, etc..with 27 beds. we have 8 private rooms. Though not attached, we are very close to the hospital. We also have the 3 hours of required therapy and so forth. Do you do team nursing? (like our TBI team has two physicians, one case manager, two RN's, and team therapists special to the TBI team. The RNs have primary patients and do all the weekly paperwork and go to the case conferences held once a week). One HS I worked at didn't do that, it was very very different. Same goes for SCI and stroke and so forth. Well, gotta hit the hay

I think for us, it is a hard transition. We deal with pretty heavy patients-my hall is mostly brain injury. They come straight from acute to us-mostly at the lowest level and stay with us as long as they can. Trachs, PEGS, foleys etc.... South hall is spinal cord, debil, ortho and east hall is stroke. I am an LPN and I do take orders off-I wonder why some places allow the LPN to do so and others are restrictive? Anyway, I am glad this is working well for you. Of course, we have nurses who haven't really touched a med cart in 15 years and they are used to doing just assessments, dressing changes and TL duties and now they are picking up meds and JCHAO has decreased the med window from one hour to 30 mins. Now, I used to pass meds FT so for me I can TL and pass meds with my eyes shut. I think the harder part is getting all the documentation down now that has been thrown on us at the same time all this changed. If we can't show the patient needs 24 nursing care and makes improvements etc.. they can deny pay from now all the way to Oct 2007 and of course to the future. Thank you for your repy btw!

I haven't read all-but it is in our policy only to use insulin syringes to give insulin-We never substitute and I would think if you didn't have the correct syringe you would call a physician and get an order to either hold the insulin and or give in another syringe. I wouldn't just make that decision and if you work in a place that doesn't have on-calls, I would call upper management. What about a nearby pharmacy? I'm sorry but my license is way to important to me to make that call. Just my opinion.... also, just read first two pages then put my two cents in.... Isn't morphine usually given IM and not SQ?

we switched to a concept called PFC or patient focused care. What we used to do: for one hall with 21 beds-day shift. 2 RN's/LPN team leaders, 1 med nurse (RN/LPN) 3 techs. The TL does the orders, assessments,dressing changes, the med nurse all meds and related, and techs all general hands on care. Now: same number of patients: 2 teams: Each has a team leader which is an RN or LPN and the TL has a tech (8-9 patients per team). The TL is to do all meds, dressing changes, assessments, take off physician orders and assist with patient care. And one Total Patient Care nurse, usually an LPN-who will have 4 patients and will do all care for that patient including meds, total care, orders, dressing changes and assessments. In either case there is usually one admission nurse but that nurse will be split between all halls for a total of 60 beds. We feel we are too stretched. I do all parts of the job-I personally love TPC with 4 patients, but even then, since our acuity is HIGH, I run the whole shift and tend to stay up to an hour after to finish all our documentations which now include FIM information on EVERY patient as well as notes regarding co-morbidities. (and I mean FIM information in addition to the FIM SHEETS!!!!! we have to write out how much care that patient needs since medicare doesn't acknowledge FIM numbers (Medicaid???)) I over heard a patient say we were good and he liked us but we were "too busy". What do you do where you work, and does IT work????? If I remember, a HS I worked at previously: tech had 10-13 patients and those were split between two nurses.....

I really appreciate the feedback and what you say makes sense. I am a chronic pain person (two back surgeries, knee injury, yaddyyadda-but I only take ultram) she is a unit secretary so that would almost even make it less of a big deal, unless that policy of nothing at all is part of it. Thank you again!

that is a new way to put it! Yeah, def less people-for 17 we would have had 1-2 Rns, 2-3 techs and a med nurse.

At some point if I really need an "official" answer I will consult my HR department, but right now I am just getting general info as this really doesn't pertain to me personally. If you have a prescription for pain meds and don't abuse it, can you take them at work? I have a friend who had knee surgery and was told she cannot return to work if she is actively taking narcotics. Just very curious. thanks

I work in rehab-stroke, SCI, TBI, etc...and we just started this new way of doing patient care-well, new for us right now, not new for others. We used to: have a team leader, usually an RN sometimes an LPN. Then that nurse would Team lead over a group of patients and that group would have nurses aids or techs. Usually you would have a tech with up to 10 patients depending on the hall, same as the nurse. The nurse would do orders, dressing changes etc...The tech everything else with help from the nurse. We also had med nurses and each med nurse gave meds from 10-21 patients depending also on census. So now: RN or LPN Team Leader with 8 patients. Then a tech or LPN paired with the RN. If it is a tech then the RN does all team lead duties including meds and assisting with patient care. If an LPN, can do the same or they can split the assignment and each take 4. The other option is if you are an LPN you may have 3-4 patients and you do total patient care-you do all duties but have no tech. And technically, you are not team leading since you are not paired. I am wondering if 8 patients is too much-the purpose was to give our patients more one on one time with the actual licensed staff, but it seems like we just run around all day playing catchup and hoping we get our meds out on time. Don't forget, since we are rehab, we don't have many foleys, our patients have to be up and dressed by 0900 at the latest, can't stay in bed all day, have appointments and get showers-anywhere from independent to carts. Does this seem much? Oh and we typically do all our own discharges and may have an admission nurse. This is new for us, in the old days they did this but never had more than 4 patients. This is taking a little getting used to.

I used to smoke, have been free for four years, so I can understand all aspects. BUT, come on. That is taking it too far if you ask me. I can understand asking employees not to smoke while working-to keep the smell down for a patient's sake (like with close patient contact, they can't smoke...), but outside of that, I don't agree. Odd.

I truly do appreciate the feedback, and I am even more happy to see everyone seems on the same page. And you know, you are right about watching out for each other. (as long as the patient doesn't suffer, of course)

I have had to write numerous incident reports on others for mistakes and have made a few myself (many I blow the whistle on myself). As long as you understand and accept responsibility then it is okay. I have cried HARD over one, been bewildered by one and felt stupid for not paying better attention on two. I have been an LPN for 2 years. The things you have to worry about is not documenting or calling the doc on call, letting the DON or charge nurse know or whatever. I read the probation and revoked stories in my NB newsletter and most are usage of narcs, being under the influence and then simply not documenting errors or taking responsibility. You'll know by your facility first if you are in trouble. If you don't hear directly from them, your state board probably isn't even involved. I mean, the state board is the last resort, ya know? CYA-cover your ass (can I say that?) that is my motto as a nurse. I should get that on my license plate :) I take errors hard btw and if you don't and don't take them to heart-you may find yourself in your board's newsletter.....that is my take on it anyway.

oh it was LONG. 11 months almost split between two rooms in a very old elementary school house (the next class got the new building). Mon thru Thurs from 0700-1600, starting with 34 and ending with a graduating class of 15. We had wonderful instructors and I learned so much. I am already moving forward in school finishing up pre-reqs to get into an ADN program. I didn't think I would be ready so soon to get back to school, but I sure was :) Good luck to you!