JKDON

See also the responses in the Long Term Care/geriatrics forum.

I agree with One Lone Nurse. Don't burn bridges. Your reputation is on the line, and if you choose to become an instructor, get offered a big promotion or position, it could come back to haunt you. I can't imagine any nurse, with the shortage being what it is, not giving 30 days notice. The patients deserve our professionalism. This is not factory work. Most professionals should give 30 days at least. Having said that you gave your notice back in Dec 05, I think you said. So if you have the other job already, and your new employer can't wait, you aren't going to lose anything unless you ever want to go back, or you use them as a reference. I would also put you on a do not rehire list if you did not give notice. As an employer I have had to wait for people and even if they offer to stiff their previous boss on the notice, my next question is "so when you decide to quit here, does that mean you will do that to me?" That usually makes them work out their notice. I want to remind them that as of now you are rehireable and in good standing. If you don't work your notice, you would not be leaving your previous job in good standing and that would change the way I feel about hiring you. For some reason nurses think that they are in such high demand they can get away with anything. I would not think much of an employer who would not let you work out your notice. Do the right thing. You may need to go back to that place sometime.

Sorry I must have clicked reply already. Here's the rest. I would suggest that a couple of nurses try to form a group who will be willing to meet with your administration on a solution. Honestly look for solutions, not just complain. Bring some of your own solutions to the table. Perhaps get other professionals involved, docs, lab, etc who may have insight. Would you get more aps if people knew the place was run better, and staffed better? It takes time. I'm surprised that the census hasn't dwindled as well as the public surely knows your staff feel this way by now. Otherwise, if you've lost faith in your facility, yes by all means move on as it will be reallly hard to stay objective and be a part of the solution. It takes positive attitudes by all involved to change that culture and get nurses to come and stay. I wouldn't want to apply if I knew all the staff were unhappy. Good luck.

It sounds like the original poster is fed up but committed enough to want to stay and make it better. That is tough. I see that in my facility as our agency numbers climb and the lack of "qualified aps" dwindles. (I mean those who are not limping when they arrive, have no criminal history, problems with their licensure, worked their 30 day notice and showed up to work at their last 10 jobs) These people are hard to find, and my staff as short as we are feel they'd rather have someone worthy to train than someone to fill a hole who will be gone as soon as the place down the road offers 50 cents more. We don't get near enough applications so we used agency. Not the best scenario but our residents mean that much to us. No matter how many staff we have on hand, we feel these people are worthy of our care, the best we can offer with what we have. I admire all of us who are working short and making it work, but it is tiring and scary. I would not be allowed to keep anyone who "refused" an assignment but that's in a nursing home and I do have to go in from time to time to help. Of course our census and acuity do not change like the hospital. I would

We do have a progressive discipline program for med errors but i developed a new tool that helps the person filling out the form, identify what the possible causes were. (overtime, new to assignment, med packaged differently, poor communication, Written wrong on the MAR. Lots of info and helps by having the person finding be a part of the solution. Of course there is a place for suggestions. It breaks my heart to have a med error come in as I remember having them. LTC is hard with the amount of meds to give. I also helped my nurses by doing a study of the actual number of doses given in a month and the rate of erros was .002% or some infinite number like that. However the focus is not on the employee but the process. We try to correct the problem that caused the error, and yes many times it is not actually checking the MAr against the label with every dose. So several of those would lead to termination.

We used the brand "Glowgerm". It came with a gel and powder you can use adn then several sizes of lights. We borrow the large one from our local clinic for health fairs etc. I used the powder at Halloween time and placed some in the bowl of candy we handed out at the anual IC inservice. Before we adjourned, we had everyone stand by the light to show how the powder had spread. People were amazed to see where the glowing showed up (lips, eyes, hair, clothes etc.)

Anyone willing to share wages for new grads outside of Omaha and Lincoln? I'm talking more rural areas, and in both hospitals and nursing homes. You can PM me if you are willing to give this out.

Anyone willing to share wages for new grads outside of Omaha and Lincoln? I'm talking more rural areas, and in both hospitals and nursing homes. You can PM me if you are willing to give this out.

I'm in NE and find that several clinics allow Medical Assistants to do this. In our local clinic, the MA gave injections. I wonder if you are talking about administering meds such as giving the med to the patient, or are you talking about dispensing, such as packaging for them to take home, or handing out samples which should reallly only be done by the physician. I'd check with the board of pharmacy.

At our last DON conference there was one facility that was piloting a skin tear prevention practice of having high risk residents drink 1tsp of olive oil daily (I believe). They saw a significant decrease in skin tears, sheering, breakdown all together. I'm not sure how many got on the bandwagon, but several have reported similar results. We've not implemented this yet. But have any of you heard of such a thing? Not sure where the idea came from but no literature yet to be found. What do you think?

Who takes care of the other 33 residents? Is there another charge nurse on duty? Make sure that you aren't just assigned a cart on one wing and not in charge of the entire place. My evening nurse is responsible for the entire building, but does have to pass the med cart on one wing. (the easier wing) In a nursing home that size, i'm surprised there would be two nurses on evenings unless acuity is high. Good luck, I'd hate to be on my own on 4 days orientation, but agian if there is another nurse one, may not be so bad.

I would want to see the job description, and find out what kind of support you would receive from your supervisor. What would be your fill in responsibilities if short staffed? sounds like you have what it takes, or you wouldn't be asked. I would be flattered. Go for it.

Send those nurses to Nebraska, we seem to be in great need right now.

I like my CNAs to go to report. There is no way they can give safe care without it. Have to know who has changed, who is sick, who's going out, and what to look for. I think 80% of what my nurses chart on comes from the CNAs and the housekeepers. I can't imagine a facility discouraging open communication between levels of nursing staff. How would anything get done and done safely?

How sad. I am so thankful that we use the dot system on our room plaques. Next to the resident's name is a blue dot for full code, and a red dot for no code. Interesting that years ago, we'd have about 2 full codes, and now we have about 20 out of 72 who want to be resucitated. I agree with Daytonite about the fact that there is no confidentiality if you get sued. You will be deposed, and asked all of the uncomfortable questions. It IS the responsibility of the state and fed agencies AND the facililty to get to the bottom of this. Too bad they had to learn about the poor orientation and its results the hard way, but hopefully they will take it seriously and work on it. I know what it is like to need a nurse so bad and want to put them on the floor early. It always comes with a price.

Interesting reading, I don't feel so bad. If the pt is gagging, I'm gagging. My big thing seems to be trauma and bodily harm. I don't work in that area, but have dealt with lacerations and so forth, minor stuff. I walked out on two surgeries in nursing school afraid I was going to pass out. Not my thing, but I think I'm a good nurse. I am also an EMT, and am sure that first bad tangled wreck with massive body trauma will do me in. In 17 years I have missed each of these in our little town. I've not done it, but the thought of it makes me ill. Or suicide by gunshot. Body fluids themselves don't bother me, and once the gag is over I'm ok. But the fear of a mutilated body or part, I'm not sure yet. Been a nurse for 15 years, and still worry about it. I don't think anyone should be ashamed of what makes them squeamish, as it has no bearing on what kind of nurse they are.

I don't mandate that my nurses come to all meetings, but after awhile I feel any professional needs to have input and know what's going on. I think calling to tell your boss you won't be there is the only professional way to handle it. I wouldn't like to be counted absent if I didn't show up on my day off. But as nurses we know that the world won't turn if we don't keep our act together and I think nurses should try to make an effort to be to most of the meetings offered. JMHO

It's been awhile, but we were told before taking boards (computerized), that the first 15 or so questions are designed to assess your reading competency level for questions. When you miss a question of a particular level, other questions will come forth that are at a different reading level. If you shut off at 75, the minimum #, you got enough right to determine minimum competency, I think we were told 60% correct answers. Throughout the test as you miss questions, the computer continues to change the reading level of questions and as it does and determines the level of questioning you need it shoots more questions to determine competency until you reach 60% correct answers. Hence the rational for people having all kinds of numbers of questions. I just think it is scary to imagine getting my license to practice based on only 60 questions.

Impairment on the job may very well be the case in question here. Of which there must not be proof. But the fact that this nurse is bragging about doing something illegal and morally questionable is unbecoming of a nurse-period. We are not talking about jaywalking here. Professionals do not engage in this kind of behavior. The original poster is distressed over the behavior of a so-called professional colleague. If the co-worker is just trying to get a rise out of the poster, then maybe the threat of reporting to "someone", BON, the boss, or whatever would shut her up. I drink on occasion and would not be able to come in to work if called in, whether or not I felt drunk. But it is legal and an accepted practice in our society when it does not affect others and is not brought to the job. "getting high" on drugs, no matter how potent the agent goes against what we are taught as nurses. We are supposed to help people who do this, not brag about it at work. And once is enough if she wanted to get a reaction from the new person. She needs to be confronted about her "behavior". She may not even be getting high at all, but she isn't acting very professionally. On the other hand could it be a cry for help? Who knows why any nurse would do this, let alone repeatedly to a co-worker.

As a DON, I encourage you to go to the Administrator whether or not you stay. Your heart is in the right place, and confronting these people on your own could be worse than what it's worth. You are probably dealing with deeper problems than the management even knows. Or this may be the standard there. I would suggest that if you otherwise think you'd like to work there ask for orientation on days so you know the nursing ins and outs of the job. But insist that these unsafe and unethical practices stop. Sometiems nurses hold facilities hostage until the leader steps up to the plate to get rid of them. This is no excuse for the poor performance. You are really obligated to report the sleeping nurse to the BON. Don't hesitate. Perhaps report the nurse who falsified the record too. If you don't get satisfaction from the administrator, you may want to notify the owner of the facility. Depends on if you stay or not. Could be hard for you after you do this. Does your clinic do business with this home? Difficult situation, but reporting is mandatory. You've told people about it, so you are liable.

I can tell you that Nebraska is having trouble. In my area we can't even get enough agency staff to cover. For some reason, many of our agency staff are either not qualified or not competent to be in charge either. Yet many nurses working in other jobs, like coding, medical records etc. I think there are nurses out there but not enough who want to do patient care.

My treatment nurse does a med cart, and all treatments not done by a medication aide. The charge nurse does charge nurse things. That way I have two professionals on the floor as well. All of my nurses are expected to help with lights and cares if need be, but unless there is an emergency we do not pull her to the floor. We'd pull rehab, or one of our other people first. Our treatment nurse is also the wound care coordinator, but not like the above post where she is responsible for th aides not doing their job. Any nurse on duty takes responsibility for what happens on their shift. The charge nurse however is IN CHARGE of the outcomes for her shift. So the ad is probably just what you thought.

When we had some questions about this kind of thing, the mandatory reporting requirements somehow got posted on the charge nurses door and the topic never came up again. One nurse became very quiet and eventually quit. I would think that the next time it comes up, even as a joke, I'd mention that she would want to be careful who she talks to as her co-workers could get the wrong impression that she is doing it at work. And just because she hasn't been arrested for it yet, or reported doesn't make it ethical. Kind of like child Mediaography, it's wrong even if you don't get caught.

Your complaints should be voiced in person with the DON able to ask clarifying questions. However I think you should be able to do this over the phone. Or is a conference call a possibility? I would ask that. You've brought up your concerns on paper, and have been in there already. Is she aware of your continued back pain? is it possible that the conversation going on by the other person was work related? It could be that she has sppoken to the other person and now needs clarification, or to have you work it out with the other employee. I am familiar with some of the FMLA issues from our facility and at time others do not understand and even harass (if I may use such a negative term) those who are on light duty. Do you feel this was done to you on purpose due to using FMLA? If that would be the case, you should report it as such, and that may be something your boss wants to find out. Ask for a conference call.

I would not think you'd want to explain in the record about not having time. Not a good idea. Yes it may be questioned why had time to write it down etc. Also, you could circle and pass on in report that some of them may be done on the next shift (say the monthly foley change) You don't want to draw attention to yourself in the record by saying you didn't have time. I agree with Siri, it does happen and even in skilled facilities. If you have Med aides and nurse aides some items like vitals can be delegated if the pt is stable and it is routine checking. It probably won't be like that after you've been there a few times. We almost ran out of insulin syringes once and had many TB syringes. Ours were single unit like the insulin syringes and 1cc with .1cc increments. We did not have to use, but would have if needed. It was the next safest thing we had and a temporary situation. Would have followed doses with HHG checks and made sure the doc was informed so he could advise if need. We asked our medical director and she said in a pinch (like a snowstorm) could be done, but not the best practice.