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kbrn2002 ADN, RN

Geriatrics, Dialysis

RN from WI

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kbrn2002 has 19 years experience as a ADN, RN and specializes in Geriatrics, Dialysis.

RN experienced in geriatrics and wound care. Now with Dialysis.

kbrn2002's Latest Activity

  1. kbrn2002

    What I Hate About Nursing In 2021

    All of it you mentioned. For me the most glaring problem is the multi-million dollar salaries of the top brass. It made huge news when some volunteered to give up their raises or even donate back some or in a couple of cases all of their salary. So Frenching what! Not like giving up a little of their already many millions is a horrible hardship that'll put them on the welfare rolls. Did the front line workers reap any benefit from this whatsoever? Umm, that would be a big fat no.
  2. I didn't leave my LTC job because of difficult residents/family but that was another factor I considered when I finally had enough. It honestly wasn't even the super difficult residents or their families so much as managements response to those horrible people. For the couple of residents/families with the worst behaviors the most management would do is care plan the resident for two caregivers to be present so there would always be a witness to refute whatever off the wall accusation the resident or their wackadoo family would come up with next. This of course came after a few CNA's were written up and in a couple of cases even suspended pending mandatory investigation. One of those that was suspended quit instead of coming back after the investigation cleared her, not that I blame her at all. Frankly if I were in that position I'd probably have done the same. Requiring two staff members for one super time consuming resident at all times was a heck of a way to basically punish an already stretched thin staff who then had to scramble even more to get their own assignment done. So it wasn't necessarily the PITA resident or family that got to me so much as the bend over backwards to please these impossible people that management expected. All the risk for write ups and even terminations fell on the already overworked and underpaid staff who it was made clear to that they had to keep these people happy no matter what while those residents and their overbearing families were allowed to behave as badly as they wanted with zero consequences.
  3. kbrn2002

    What’s a Crusty Old Bat?

    I found the link to the jello thread. It was buried...and I mean buried deep in my followed topics! Here it is, enjoy! Another classic thread if you have a bunch of time to kill is this one, The Mockery of Nuursing:
  4. kbrn2002

    What’s a Crusty Old Bat?

    I remember the origins of the mean biter nurse and the COB's well. I was involved in that thread and found the whole thing pretty hilarious. Years later it still is! Sadly many of the original COB's are no longer with us and AN is the worse for it. Honestly I can't think of a single thread that has risen to the level of an instant classic in years. I miss the days when a thread debating the correct color of jello or offering admittedly tongue in cheek advice to a student afraid of being attacked by deers could drag on for literally hundreds of pages!
  5. kbrn2002

    Tired of Being a Nurse

    Have you considered looking into jobs with insurance companies? I've noticed more openings lately for the chart review and claims processing positions where a nursing degree is utilized but there is zero patient contact. Another good option is looking for a position with a law firm specializing in medical malpractice, they often have nurses on staff for chart review. Those are somewhat entry level jobs in legal nurse consulting and a good foot in the door position for progressing to a full Legal Nurse Consultant career.
  6. kbrn2002

    Scope of Practice and medications?

    This is where we diverge in our interpretation of this. Your scenario continues to assume that the medications are dispensed from the pharmacy directly to the facility as "stock" meds to de distributed as needed to the residents. In that case you are correct. Many facilities, including the one I worked for changed to a system that allows this. All meds are stocked in and dispensed from a machine, similar to the PYXIS most hospitals use. However many if not most LTC facilities don't utilize this technology, heck there are plenty of LTC that are so behind in technology that they are still using paper charting. In those cases the pharmacy dispenses meds in blister packs that are labeled for individual use by the resident they are prescribed for and those can not legally be "borrowed" for use by another resident. Those resident labeled medications are considered the property of the resident they are dispensed for, much like any med dispensed for home use. They are not intended to be converted to facility stock if not used for the resident they are prescribed for. Depending on facility and pharmacy policy and procedure the unused meds in the blister packs are either returned or destroyed with the exception of controlled meds which can't be returned after they are accepted by the facility per Federal law.
  7. kbrn2002

    Leaving dialysis?

    Do you see a path for improving the workflow? If you have the ability as coordinator to implement changes that will help it would be worth sticking it out for awhile. Imagine the personal and professional satisfaction of making changes that actually improve a chaotic system! On the other hand if you have no power to implement changes or your input isn't at least considered seriously nothing is probably going to change no matter how much you complain. I understand this leaves you with a difficult decision, hoping it all works out the way you would like.
  8. kbrn2002

    Scope of Practice and medications?

    Nope, that's exactly what I am talking about. I worked LTC for 25+ plus and I am very familiar with the rules and regs, at least in that industry. When a particular med, say your Metoprolol 25 mg is ordered and delivered by pharmacy that med has been paid for by that patient's payer source. It's just like if you went to your local pharmacy and filled a prescription. You pick up and pay for the entire ordered prescription, it's not like CVC doesn't charge you until you take the pills. Of course for the average person if the med is discontinued you should just destroy any unused doses but in LTC the rules are a little different. In LTC if that med is then discontinued any remaining supply is supposed to be returned to the dispensing pharmacy for credit or destroyed depending on facility/pharmacy polices and procedures. Either way any remaining amount of the med is credited back to that resident. Borrowing that leftover metoprolol for another resident is considered insurance fraud and possibly diversion if the state wants to push that as well. LTC facilities have been disciplined when this borrowing is discovered. Does that mean it doesn't happen? Nope, I'm sure it still happens all the time but some facilities including the one I used to work for were very strict about enforcing this with discipline at the least being a write up and the worst termination if a nurse is caught borrowing leftover meds. The proper procedure to follow for obtaining a needed med was contacting pharmacy to fill the prescription ASAP. If the med wasn't able to be delivered in time for the ordered administration the MD had to be called and updated. Then we would usually just get get a verbal order to start the med when available.
  9. kbrn2002

    Scope of Practice and medications?

    It is certainly based on law that you absolutely can not administer a medication to any patient that is not specifically prescribed for that patient. That's true for any setting but especially pertinent in settings like corrections, home care or LTC when the med might just be available so the temptation is there to just use it. Don't give in to that temptation! Using a med prescribed for another patient even if it is no longer needed for that patient not only violates the basic rights of med administration it is also insurance fraud since the med was paid for by the insurance of the patient it was prescribed for. While it's not common facilities can be cited for Medicare fraud and potentially lose their ability to accept Medicare patients, receive massive fines and worst case scenario lose their operating license if insurance fraud is pursued in these cases.
  10. kbrn2002

    What Was a Highlight of Your Career as a Nurse?

    Having the courage to change career paths after 25 years at the same job. Turns out that was an even better decision than I anticipated since I left my job in a SNF and COVID hit about a month after I started my new job. While there were of course still a ton of COVID related changes, the impact of those changes in dialysis was a whole lot less than in LTC
  11. kbrn2002

    Burnout or Boredom?

    Despite your obvious connection with and devotion to this patient you are definitely being taken advantage of here. As much as I hate to say it you allowed this to happen when you made your employer aware you had other options that paid more and offered better benefits but then didn't leave when your employer refused to exceed or even match that offer to get you to stay. After your employer realized you weren't going to leave despite having a much better offer they decided that jerking you around would now be OK since you are likely to put up with it after you proved you were willing to put up with lower pay and fewer benefits already. As much as you enjoy this patient and family I think it's time for you to move on. Take that better offer if it's still on the table, or go out and get a better offer again. Not only for your professional growth but also because if you are unwilling to sever ties with this patient despite having an obviously better compensation option and you are now seeing negative impact on your home life you are too close, too personally involved. This time put in your notice, and mean it. Don't get guilted into keeping this position just because of your connection with the patient and family. Even in the unlikely event your employer decides you are serious and matches another offer it's probably in your best interest to make a change anyway.
  12. kbrn2002

    Can you share your experience in dialysis?

    I switched to dialysis nursing a little over a year ago after 25 years in a SNF. I left a job I truly thought I would retire from so the idea of such a drastic change was a little traumatic for me but I took a leap and am glad I did. I don't work for Davita so I can't offer insight there, I work for the other big company in dialysis. I was impressed with their extensive training, in my experience they do support new nurses and new to dialysis nurses. I never felt pushed to proceed at a faster pace than I was comfortable with. By the time I was able to practice without supervision I felt reasonably comfortable doing so. I still have plenty of times I run into questions I just don't know the answer to and help is always available. If my manager isn't around that day I know I can always reach out to another clinic so an answer is always just a phone call away. I've found it to be an overall pretty supportive work environment. I've worked in two clinics after transferring to one closer to my home. Both clinics I have experience in have good teamwork and equally if not more important good clinic managers. I realize that may not be the case everywhere, maybe I've been lucky in that regard. A big pro for me in deciding on dialysis when I made a career move is the schedule. The clinic opens in the morning and closes at end of day. No more mandated overtime when the next shift calls in! My clinic is strictly days though, I do know there are clinics out there in bigger cities that operate 24 hours, even a few that are nights only. Also no Sunday's as we are closed with the rare exception of adjusting schedules for Holidays, at this point the only Holiday's we close for are Christmas and New Years so the schedule will adjust then. Thanksgiving is an optional closure, the clinic I worked for was open Thanksgiving last year but the clinic I am at now has always closed that day. Though the staff I am always scheduled with is willing to work that day so we may talk our manager into running that day. Too soon to make that decision yet. I don't know if it's the case everywhere but our district does do block scheduling which I love. So easy to plan around a set schedule! We do a week on week off rotation. My particular schedule is 4 days on, 1 off then 2 on followed by a full week off. This also means taking a week off gets me 3 weeks off so extended travel is real possibility again! The typical day is between 10 and 11 hours in my current small clinic but I was usually working 11 to 12 hours at the bigger clinic I transferred from so it's not based on a 40 hour week.
  13. kbrn2002

    New nurse. Where is my passion?

    That's actually an incredible job opportunity for an RN with limited bedside experience. Seems like the norm for those coveted away from bedside jobs is they are offered to a nurse with a lot of experience, a background in the relevant field which in this case is legal or a combination of both. Since the position is open to replace a retiring nurse who had been there over 20 years I am guessing it is probably a decent place to work for. Turnover is certainly not an issue! Good luck!
  14. kbrn2002

    Social Skills Should Be a Bigger Focus in Nursing School

    Agree 100%. Dealing with personality conflict starts in pre-school and never stops. This is all training to deal with future co-workers, customers and bosses. There are always kids that don't get along. Everybody has also had teachers they couldn't stand. If a person makes it all the way to college and beyond to a career without learning how to deal with people despite personality differences they aren't ever going to learn it.
  15. kbrn2002

    Should I give a two weeks' notice?

    If you've stuck it out for over a year unless the current situation is actually dangerous you can stick it out for two more weeks. There's very few situations where leaving without notice is acceptable. Even if you leave with no notice for a good reason getting to the point where you can explain why to a potential employer isn't guaranteed as being on their do not rehire list will very possibly knock you out of the running for for other jobs before you even get to the interview stage where you'd have the chance to explain yourself. Especially in the current environment of huge health care conglomerates owning everything leaving without notice if you work for a big company could definitely have a negative impact on your future employment prospects. Being listed as not eligible for rehire takes you out of the running for any job at any facility the employer owns. Even if you don't work for one of the big companies leaving your current job without notice will definitely cause them to give you a negative reference. As you have been there over a year and this is your first nursing job you'll need to put it on your resume. Having a negative reference from your one nursing job won't leave a good impression on a potential future employer. Unless you already have a firm job offer in hand leaving your current job without notice could definitely have a negative impact on your job search. Even if you have an offer on the table leaving a job without notice could still affect your future employment prospects. Even years down the road every job application will want your employment history. Even when your job history is stable and has enough longevity to leave this job off your resume you'll most likely have to disclose it your employment history where there's still a possibility of leaving without notice affecting their hiring decision.
  16. kbrn2002

    Working Less Than 8-Hour Shifts?

    I doubt if you will ever be able to find a nursing job that checks all the boxes you are looking for in a schedule. The closest you are likely to find is definitely going to be away from acute care. There's not a hospital that exists that would be willing to accommodate all your scheduling needs. Especially as most of them do not ever do block [fixed] scheduling and many require rotating shifts. You might be able to negotiate Saturdays off for religious purposes but the rest of your requests will be a hard no. Your best bets will be LTC, clinics and schools. A bigger LTC may be willing to work around some of your scheduling requirements but certainly not all. Many clinics are not even open Saturdays and schools aren't typically open weekends at all. I work in dialysis and the clinic manger is fairly flexible with scheduling requests but again I doubt if even the most flexible manager will be able to give you everything you want. Honestly the hardest part of your wants is going to be finding a schedule that consistently allows for a six hour shift. The scheduling nightmare that would create for trying to ensure complete nursing coverage is way more than any employer would be willing to attempt. There's only two possibilities I can think of where that might work. The first is per diem only work which would essentially let you set your own schedule but then would not allow you any kind of benefits or even guaranteed hours. The second is Home Health/private duty nursing where a full eight hour shift is not always required but that is certainly not a setting I would suggest for a new nurse nor do I think I will be an easy get for the rest of your scheduling requests.