kitty=^..^=cat

If you're near Nashville, I know of a great job in the quality management department of a hospital that's "big and good"... They need someone to do OB chart reviews, provide inservice education to the staff in Women's Services and liason with the OB/GYN physicians.

I think a lot of the problems with "customer service" programs are administrative "knee jerk"-reactions, like the escort program described above. I posted somewhere on another thread that upper managers, those that drive the insanity inherent in some of these programs, are mostly bean-counters... They look at numbers and bar charts and understand what those things mean - it's their comfort zone and the only way they know how to analyze performance. Lucky for clinical people, those same upper managers are beginning to get more measurements that are a lot more meaningful to us as caregivers. Core Measures results are becoming a bigger deal at my hospital than our Gallup results, which is a good thing because the indicators reflect on the actual bedside care and patient management by nurses AND physicians.

One of the worst things that ever happened in my supervision of employees was when one of my very best RNs -- long term employee, great guy -- got hurt at work and had to have a urine screen. Positive for THC. He's just gotten back from vacation on one of the more free-wheeling islands, and I KNOW he wasn't under the influence at work. I managed to help him keep his job and minimize the professional damage, and the experience really made me reconsider how I feel about drug testing. If narcotics are missing or there are major breaches of professional conduct indicative of drug use, maybe, but even then the relevance is shaky (Nurse stealing Lortab has a prescription for it -- what does a drug test tell you?)... We've had so many rights taken away post 9/11, I'm beginning to feel very possessive of my pee...

'Fake' nurse to appeal huge fine By Associated Press January 3, 2007 CHATTANOOGA-A woman fined $717,000 by Tennessee's nursing board for falsely claiming to be a registered nurse and nurse practitioner said Wednesday she is a victim of "falsehoods" and will appeal the penalty. "I want these falsehoods retracted," said Marketa Barnes, 50, who formerly worked as administrator at a Caring Senior Service USA franchise in Chattanooga. "I know I am going to appeal it." A state Board of Nursing order said Barnes was fined for dispensing medicine and directing other employees without a license. Jeff Salter, the San Antonio, Texas-based company's founder and chief executive officer, said Barnes "at all times was an employee of a franchisee which is independently owned and operated." He said the company "had no supervisory authority over her." The former franchise holder, Jerry Batson, could not be reached for comment. From about October 2004 to April 2006, Barnes repeatedly called herself a "registered nurse" or "nurse practitioner" despite not having been licensed, the order says. While purporting to be a nurse, Barnes gave medications about 72 times and gave instructions to workers about 75 times, according to the order. "The action of Marketa Barnes poses such an imminent threat to patient safety that it requires maximum penalty," the order says. Barnes also could face legal problems from the Tennessee Department of Health's investigation. The department attorney is referring the case to the Hamilton County district attorney and "any other appropriate legal authorities," according to the Board of Nursing order. The order, issued after a Dec. 7 hearing, is the "culmination" of the department's investigation, department spokeswoman Shelley Walker said. The order also said Barnes gave one client drugs such as liquid methadone and later pronounced the same client's death. "That is a falsehood," Barnes said. "These people self-medicated. They did have nurses in the home." Barnes said she was a victim of a business dispute "vendetta" and was preparing an administrative appeal. Salter said he was denied inspection of the independently owned and operated Chattanooga franchise and went to court to terminate the franchise agreement. Salter said his company does not provide nursing services. "We feel pretty confident that had we been given the right to inspect this location, we would have caught some degree of (those) actions," Salter said. More details as they develop online and in Thursday's News Sentinel.

I've had two close friends become pregnant during nursing school... One dropped out because she was having so many problems with nausea and sciatic nerve pain, and one made the decision to wait until later to start a family. The latter was in a very competitive MSN/MHA track, and at that level it's not like you can say, "Oops, I need to come back next year."

In my neck of the woods, the more times the term, "bless her heart" is used, the worse it is...:icon_roll

FireWolf, my only suggestion as one of those much-maligned administrative types is this - don't use your new position to try and push any specific agenda other than preventing infections. From personal experience I can say say that those personal campaigns for more staffing or money or compliance from MDs can lead to failure if you don't handle them in a manner that's PC at your facility. Good Luck - Infection Control can be a fun gig. =^..^=

Incident reports aren't meant to be punitive -- an IV infiltrated. It happens. You aren't saying anything about the nurse, you're just reporting something that needs to be passed along to the manager, quality and risk management. What if, say, within a month 18% of your IVs infiltrated? All different people taking care of them? Wouldn't you want someone looking to see if there's a problem with the device itself, a specific shift, or group of circumstances and following up to see what's really going on? Incident reports are just part of the job. They SHOULD be no big deal. =^..^=

Back in the days when I was interviewing people for nursing positions, I always asked where a new grad wanted to be in five years. If it was ICU or ED and things seemed "right", I went ahead and encouraged them to start there. Same deal with those that wanted to go to anesthesia school or into flight nursing -- start in ICU or ED. (NICU is different - you have to start with the basics there, and there are probably other exceptions I'm not thinking of at this late hour.) I'm a big believer in starting "champions" early - like athletes and musical prodigies... If potential, drive, determination, guts, will and belief is so evidently there, why not go ahead and put that person on a faster track "to the pros" like novice tennis players, golfers, and violinsts? It's the same concept whether you apply it to sports, academics, music or professional aptitude.

I'm certainly no nursing newbie, but I firmly believe that if a new grad wants to go directly into a specialty unit, that's where they should go. Sure, additional orientation and training may be required to establish clinical competence before the "cutting of the cord", but the payoff in the long run is that the nurse is more easily retained. When I got out of school I went directly to work on a specialty floor -- I'd worked as a CNA at my community hospital on school breaks and had absolutely ZERO interest in working the floor as a staff nurse. I knew I probably wouldn't be as good there as doing something that I could "dig my teeth into" intellectually. Now almost twenty years later, although I have supervised and managed med/surg floors and provided plenty of assistance in those environments, I've never worked as a staff nurse in one, and that isn't such a bad thing. In some cases I feel that med/surg experience can do more harm than good when it comes to developing necessary work habits and a good professional attitude. If a graduate nurse is already highly organized and has clear priorities, why make them take a step or two backwards?

Garden Dove, Are they "cooking" in your house or just using there? If they've been preparing the meth there, you could have big problems with cleanup. Meth production creates some nasty by-products and can leave a lingering residue behind. I saw a special last year on TV where a child's toy (like a teddy bear) that had been taken from a "meth lab" had so much alkaline residue left behind that if a child had placed it in his mouth, he would've been burned. I also know that there are even some EPA standards for clean-up... Good Luck to you - sounds like a bad situation.

Communities all over the place are struggling with meth -- from what I've seen locally, rural and poverty-stricken areas have a much bigger problem than some. The state of Tennessee has developed an initiative, and there's lots of information at this website -- >> MethFreeTN.org | Fighting the Tennessee Meth Problem And the picture at this link is startling! http://www.cityofwaynesboro.org/tues-methuse.jpg

I posted a response to a similar thread almost a year ago -- and it goes something like this... A number of research studies (I don't know specifically which ones - I have the info somewhere from a customer service workshop) have found that most "patients" actually prefer to be referred to as "customers" or "clients", because those are considered neutral terms that don't imply illness. I think it's pretty darn funny (and ironic and so unsurprising) that nurses are more offended by the terminology than the "patients" involved.

If the mom doesn't want to answer any questions, she isn't obligated. The only time a mom has surrendered a baby in a facility where I've worked, one of the OB/GYNs intervened and facilitated a private adoption for one of our employees that had been on a waiting list for a long time. It worked out great for all parties involved.

I worked for a rural hospital one time that had to do that during Christmas because of a terrible flu that was making the rounds, not just of the hospital staff - Lord, it was awful. Those people that were well and were scheduled to be off during the holidays were all, "H#ll no, I don't want to come to work and catch that nasty stuff to bring home to all my relatives." Four hours later -- "The CEO said you could pay me TRIPLE time and give me eight hours of vacation time to make up for missing my Christmas off? Hmmm... OK." It was a lot of money, yes, but the people who worked earned EVERY penny.

That's pretty much it --:yeahthat:

I was in a rural area with a HUGE coverage area. Some of our patients were 80 miles away (one way) with no other patients anywhere nearby. Scheduling was a nightmare, and because I was salaried, it was expected that I do those visits to keep the per visit folks that worked for me in the immediate service area. It KILLED my car, literally, and wore me to the bone. One day it took me 4 hours to get from my last visit for the day back home. This agency only reimbursed $0.35/mile for mileage too, which was a huge rip-off. I hear what you're saying about those people with the "shifty eyes"...

I don't feel that the "new approach" to pain management in acute care is anything but positive. The risk of creating addiction problems is really low - like some have mentioned, That isn't to say there aren't some huge loopholes and "drug seekers", but I think those are the exception rather than the rule. In my own limited personal experience as a hospital (o/p surgery, if that counts) patient, the fear of being in pain produced a lot more anxiety than any actual pain I felt.

What are the things about oral care put it so high on the list? I know that when I was doing ICU nursing years ago, having an adequate supply of GOOD oral care supplies was a problem sometimes. What else?

I think it's insane to expect someone to work a holiday schedule like that... Poor planning and poor leadership in my opinion --

Great post - you're obviously the kind of nurse that's the Quality Management Department's best buddy! I've done QRM for well over ten years, and I love it when people have ideas like that - bam, bam, bam... I agree that patient satisfaction scores are no real indication of quality of care. They serve a purpose, but too much emphasis has been placed on what is merely a small piece of the puzzle. I think that the "big players" in hospital care are finally getting the picture. Keep in mind that CEO types and bean counters like Press-Ganey and Gallup so much because charts and graphs and ratings and numbers are the things they know best - that's their comfort zone. Finally with Pay for Performance coming into the picture, there are some numbers on the table - outcome measures/core measures - that DO reflect clinical care and has $$ attached to it. The Institute for Healthcare Improvement has rolled out a whole new set of initiatives for the next two years that have components like oral care. Yes, it means that a lot of measuring has to be done - data collection and chart abstraction - and additional paperwork for folks (like me), but it really is worth it when you consider that this is the chance to really overcome the impact of patient satisfaction scores with ones that are really meaningful in measuring how good (or not) patient care and outcomes are. This way when scores look bad, it's evident when lack of resources/lack of staff is an issue... Check out Institute for Healthcare Improvement: Home - =^..^=

I'm sure that LTC is different, but in my experience with hospitals, it's like Jabra posted - the patient is encouraged to come back if he feels that he needs/wants to... =^..^=

I very briefly worked in home health as the director of an office. I was salaried - everyone else was pay per visit. Hated it...

JCAHO says NOTHING about clogs whatsoever...

Soap and water are actually more drying and damaging to your hands than the disinfecting gels/foams. Aside from that, the alcohol products are more effective at killing germs and preventing the spread of MRSA than traditional soap and water. Perhaps you should have some dialogue with your facility's ICP and she could provide additional information to you about the differences in efficacy between the two methods (i.e. why it's better for your patients for you to clean your hands with the alcohol products) as well as ideas for taking care of your dry hand problem.