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ladybyrd's Latest Activity

  1. ladybyrd

    Saving your back in Rehab

    Worked in rehab for over 12 years with no injury, 'cept the usual aches and pains that go away after a good nite's rest. Our secret: USE CONSISTANT TRANSFER TECHNIQUES FOR EACH PATIENT! My biggest suggestion: go to the gym with the patient and watch PT teaches that patient for a couple transfers. While many techniques are the same, sometimes techniques have to be revised for patients specific disabilities. Transfers for quads are totally different than stroke patients. However, left stroke patients and right stroke patients can have different cognitive abilities and their techniques and cuing can be different, even though they both have had "a stroke" ------------------------------------------------------------------------------ RATIONALE: To learn a new technique, you first have to learn "the rules" then the variations on those rules. Remember what it was like in Nursing school when you first learned how to give an injection? It was a new skill that you had never done before, and there were certain key safety elements to master before you could be successful. Did you have different clinical instructors who used different cues and conflicting instructions, or were you taught the "right way" to do it FIRST...then learn how to adapt the technique for different situations (ie obese patients, emaciated patients, children, combative patients) If nursing uses a different approach than therapy does, or each nurse says "do it this way" or "that way" the patient will learn inconsistant techniques. Instead of promoting independence and mastry of technique, the patient may learn sloppy habits which can lead to falls when they are in an unsupervised or unstructured environment. If you can continue to help teach the patient to do the transfers using the same constant approach that therapy is using, the patient is more likely to do the bulk of the "work" of the transfer which will keep both you and the patient from getting hurt!
  2. ladybyrd

    suspended license

    Similar thing happened to acquaintance who was a fairly new nurse. The narcotic count was off, and due to his inconsistant documentation (due to understaffing and overwork) there was no way to *prove* he either did or did'nt do "the drug-misdeed". He was told by board of nursing that if he pleaded "guilty" he could go to drug rehab, and if he followed all their rules for rehab and aftercare and follow all the restrictions on his license, he would be treated as a "recovering addict" and could maintain his license and continue to work. However, if he continued to deny that he did the deed, and pleaded "not guilty", he would loose his license permanently and could be prosecuted, even though his "only crime" was shoddy charting practices NOT misappropriating narcotics. He said he would NEVER plead "guilty" for something he didnt do, and if it meant he couldnt practice nursing, it was THEIR loss, not his. He now working in the construction field. Follow up: several months later, the REAL culprit (a co-worker) was apprehended and admitted that they had "done the deed" and taken the drugs, and further that to cover their tracks, they had let this unfortunate man "take the fall" rather than fess up and admit that the man was an excellent nurse and was only guilty of "not charting as well as he should".
  3. Again, my question was not necessarily to discuss the current situation with Terri Schiavo, but rather to ask the bigger questions facing nurses who report potential abuse. Would discussing the things in the news that they were required by law to report then open them up to legal recourse due to the newly enacted HIPPA laws? Whistleblowing is usually a "thankless" endevor...even if you are right! The harrassment by those who are trying to keep "whatever-the-information" from coming to light can be devastating to the reporting persons mental, emotional state and financial resources. Then to have to further worry that you may be prosecuted for revealing information now covered by the new HIPPA laws may mean that honest people have a real delema when making a decision to whistle-blow or just to keep quiet...and let the "other" person put their neck in the noose first!
  4. I thought nurses were supposed to report any abuse or potential abuse of patients, especially children, elderly or handicapped patients, and that as long as the nurse reported the information in good faith, (ie not maliciously harm the person being reported) they were protected. Today on the news, a nurse who had taken care of Terri Schiavo claims to have been fired the day after she reported to authorities some suspicious activity by pts husband. If true, this seems kinda scarey as any of us who are required to report abuse could then loose our jobs for doing so. This is the affidavit by an LPN (now RN) who took care of Terri: This is the affidavit by a nursing assistant who took care of Terri: After reading these documents and seeing the interview of the RN on national news programs, I am curious now, if the new Hippa law could/will be used to prosecute this nurse (or ANY nurse in a similar situation) She has now gone on public record and discussed this patients medical information and interactions that she witnessed when she was an employee of a health care facility. I realize that her affidavit is a document required by the legal system, and would probably not get her into trouble, but her appearance on the news programs is what I am wondering about. Any thoughts on this subject...?
  5. ladybyrd

    Patient falls

    Rehab patients DO fall more...but many of the falls are because the patients are attempting to practice their newly learned skills without waiting for appropriate supervision by the staff. Look at a baby who is learning to walk...They fall, not because their legs are weak, but because they have not yet fully developed the art and skill of "balance" versus the "effects of gravity". They must first learn to balance themselves in a sitting position, then creep, crawl and toddle BEFORE they walk. How many times do they actually fall before they take that first independent set of steps? The patients assume that because the therapist had them "up walking" in a 1:1 therapy session, they are now able to go to the bathroom by themselves. What they forget is that it took 2 people to get them up, that it was a mod-max assist to stand and that after only 3 feet, they were ready to go back to their bed!
  6. Never take one to work that you wouldnt mind loosing!!! Had a friend who took her "top of the line" to work... had it less than a week before it came up missing Whether it was borrowed,lost, or just plain stolen was never determined. However, since she couldnt afford a second "top of the line", she settled for what she could replace if it came up missing again!!
  7. ladybyrd

    A nurse is a nurse is a NURSE???????

    Curlytop said...."I even had one MD who had the AUDACITY to say "it doesn't matter what you chart in your notes besides vital signs"!!...." CurlyT...which floor do ya work at my hospital?? The first words outta the MD's mouth in the morning is "wheres the vitals" and "how much was the i/o" .....Both of which are taken by the techs!!! The patients usually mostly care about about "baths and bedpans"....Both of which are usually delivered by the techs... The hospital & public thinks nurses are "overpaid & lazy" because all we do is "push pills" and "sit around chatting & doing paperwork" They should ALL have to "walk a mile" in our 12 hour shoes...(about 2 hours on a SLOW nite!)
  8. ladybyrd

    Nurse Tracking Devices: Whats Your Opinion?

    The feeling among the most of the staff has been: "keep an eye over your shoulder, and your back to the wall"...Recently, I spoke to a former middle manager, who said our perseptions are correct and that she couldnt take the control from up above anymore, so she left. In simple terms, the top people are "obsessive coumpulsive controlers" & the middle management's response to this control is to attempt to control the staff even more! Now with this "new system" going into effect, its as though 'BIG BROTHER' will be clocking in with you and watching your every move...waiting for you to screw up and then OUT you go!!! Living in a dictatorship that (honestly) calls itself a dictatorship is "easier" than living in one that (dishonestly) calls itself a democracy, but exibits ultimate control at every turn...then says "you" are the one with trust issues!!
  9. When I was a Rehab nurse, the evening shift was in charge of the bowel programs and showers...We would put the patinet in the shower chair, gave them their suppository, push the shower chair over the toilet, let them make a deposit, then give them a shower... I had a 60 year old male patient who was on the board of directors at the local university. Unfortunately, his CVA had taken his balance impaired so that when sitting in his wheelchair, he usually was falling over to one side & unable to get himself upright. His swallowing was impaired to the point of not being able to swallow his oral secretions...so he drooled severly! The speech therapist (who thought she was infallable) said she had done extensive testing and that because he both receptive and expressive aphasia, his prognosis was very poor. One evening, I found his suppository would not insert easily, so I checked him for the dreaded impaction. Finding one,I began to manually remove it...Picture this: him sitting in the shower chair, bent over and drooling and me bent over with my gloved finger stuck up his rectum.... Realizing how rediculious this must look, I looked up at him and said..."betcha didnt know that I went to college to learn how to do this!!" He began laughing so hard I thought he was going to fall out of the shower chair...I began crying tears of joy because I realized that he COULD understand what I said!!! Of course, the next day, ONLY the nurses truely appreciated the story of how I proved that the speech therapist "didnt know shit!"
  10. ladybyrd

    A nurse is a nurse is a NURSE???????

    per Dr. William Goodall, vice president for regional medical affairs for Allina Hospitals and Clinics: quote: "There is a national standard for physicians and nurses, and the nurses, whether I'm drawing on a pool of nurses from Minnesota or California or Texas, it shouldn't make much difference," Goodall said. OK, lets see....if hes an MD and has passed the same "national standards" as every other MD, then he should be able to handle "everything" from newborns to NEUROSURGERY...without the benefit of specialists, or consultants.... ...and his patients who need "organ transplants" should stay at their local hospital cause they will get the same treatment and results as if they went to one of those biggger hospitals in Texas or New York... ...sorry gotta take a bathroom break...
  11. ladybyrd

    Nurse Tracking Devices: Whats Your Opinion?

    To those of you who currently use these devices, a few questions: Does your hospital/floor have "standards" for minimum or maximum time in a patients room? Does that minimum/maximum standard change for shifts? IE: you would naturally spend more time in a patients room that needed a procedure or personal care,(day shift) and less time if they were sleeping had no iv or meds. (night shift) How long do you have to be "IN" the pts room before it registers that you were there? Do staff members "leave their badge in a patients room" for a few minutes extra time off for a smoke break? (asking this question as unfortunately, I actually work with several people who would do that!)
  12. ladybyrd

    Which Shoes Are Best?

    My rule is: the shoe MUST be 100% comfortable from the first minute it's on my foot! Tennies makes my large feet seem enormous and with a skirt I look a bit like Minnie Mouse in white! I have found SAS leather shoes come in "D" width and I can buy a new pair and wear it for 16 hrs with no "break in" time! I also have painful flair ups of "plantar fachiatis" and have developed a trick for dealing with it! Using 3 inch "foam tape" to wrap around the middle portion of my foot, I start at the base of my toes, two overlapping wraps and ending just past my arch/instep. I used to have to horrid foot pain the day after working. Since taping my feet, I havent had to take any more Naprosyn!
  13. ladybyrd

    Nurse Tracking Devices: Whats Your Opinion?

    "...when you have a cna who spends a total of 75 min in patients rooms in a 12 hour shift you have good reason to be looking into this..." I agree that this system can be benificial for dealing with "problem employees". However, for arguments sake, lets say you work night shift, have several "well patients" who only have a few IVPB meds and dont require more than mimimal care... You have several who require "more than their fair share" and are in their rooms more than you are out and barely sit down the night. The confused patient who is on the call light every 10 minutes (because they mistake the nurse button for the TV button) needs restraints to keep their IV and foley intact (and all that "new monitoring" that goes along with it these days); One patient is a suction prn and "turn q2" and although you have suctioned him as needed, you only turned him 4 times in your 12 hours instead of the usual 6, You have been in with someone who is bleeding and needs your 1:1 monitoring; have restarted 3 iv's Been on the phone with 5 separate family members of one patient who dont understand why you cant give them a detailed explanation of their loved ones condition... Also you have been on the phone with 3 doctors and the lab trying arrange the details of the transfusion as the lab has had a difficult time getting the 2 units of rare blood type so you have been using the volume expanders till you can arrange for their ultimate transfer to ICU. Additionally, the "mystery meat" served in the cafeteria has been at war with your GI system and you have been answering the "shouts of nature" between your other duties. Normally, we accomplish what we can... HOWEVER, 2.5 weeks later, your new nurse manager (and the worse one you have ever had in your 15 years as a med-surg nurse) has just returned rested and refreshed from her 2 week vacation) returns to review the new "NURSE TRACKER"... She calls you into her office to ask for a detailed explanation for why your "perfomrmance sheet" for the nite looks like you spent an exorbitant amount of time with a couple patients, ignored others and were at the nurses station or using your moblie phone much more than any other nurse that nite. And most outrageous of all: in the bathroom 6 times once for 10 minutes!! Suddently instead of the focus being on all that you accomplished...it turns to WHY: "the q15 minute checks wern't done on the patient with restraints" (thankfully she fell asleep watching the test pattern on the TV) "turned the patient 4 times not 6"....(didnt matter you suctioned him 8 times...and he was in a different position everytime you were in the room) "you spent only 1 minutes every 3 hours in 3 rooms"...(you stuck your head in, acertained they were sleeping peacefully, the iv was running, hung their piggy back and emptied the urinal...and got it all acomplished in less than 1.5 munutes!!) "those bathroom breaks"...(thank gawd that stress incontinence forces you to wear pads...it made the cleanup easier, but needing your stomache pumped and washing panties at work was definatly NOT what you planned when you wolfed your meal in 10 minutes...) Well, you get the idea...
  14. ladybyrd

    Jury Awards $1.5 M in Pain Case ...excessive?

    We have been instructed to evaluate the patients complaint of pain as the fifth vital sign and to document it along with the vital signs. This sounds reasonable...right??? Recently, I had a patient who had been out of drug rehab for 3 weeks and was in our acute hospital for an arm abscess caused by him grinding up Vicodin and injecting it into his veins. We were medicating him with 50 mg Demerol IVP q 3 hrs around the clock...(the order read 25-100 mg q3 hr) One new nurse, decided he needed 100 mg and from then on, he demanded the 100 mg dose...After 4 days, he was discharged & went home on PLAIN Tylenol. About 2 weeks later I saw him visiting his dad who had a CVA. I asked him about his arm...He aid it was much better and then he bragged to me about how easy it was to "stay high" when hospitalized, and how he could con the nurses into giving him the bigger dose by faking his pain... Wondering now what to do in the future if a patient is exibiting "drug seeking behaviors" and merely wants the insurance company to pay for his "legal high"?
  15. The hospital I work for has changed our classification to "associates" and "partners in healthcare". They are redoing our evaluations to reflect "objective criteria" for evaluations rather than the current "subjective criteria". They have instituted a new computer charting system, which only the RN/LPN's can chart patient care and education. We must also chart all of the care given by the CNA/tech's. The system is very labor intensive to learn & use. It took me 20 minutes to chart 12 vital signs and I/0's for 6 patients; 30 minutes to do an admission on a new patient. (I could do ALL this in about 20 minutes on the paper system) The hospital will soon be installing a "tracking system" for employees which is a device attached to your name tag that sends information to a centralized display (like "telemetry" cardiac monitors). They will be able to see where the staff is, how much time is spent in each location and who you are with (ie multiple employees are in a patients room providing care vs in the lounge) They will be providing a "quality service satisfaction guarantee" to patients. It has not been fully explained to the staff, but it seems to be that if a patient has to wait longer than "x minutes" for anything, they will recieve a financial renumeration by the hospital. The administrators are saying all of these changes "will improve health care delivery" by allowing "location of staff" and "quick communication patient needs to the appropriate staff member" and "monitor the documentation of care" Two references about electronic monitoring: http://www.graduateresearch.com/buswell.htm http://www.light1998.com/faceit/Tracking.htm If you work in a hospital that uses these electronic system, what is your experience with them? MY OPINION: the potential for the employers to abuse exists when they reduce professional nursing to a "time and location study" and they "do the monday morning quarterbacking" system of evaluating your whereabouts and time your every move. WHATS YOUR OPINION?

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