peter73

I believe you would have had to be in a multiple exit ADN program to stop out at the PN level (which would not be allowed in a situation similar to yours). Traditional and multi-exit programs are set up slightly different to allow for adaquate basic skills for exiting PNs. I have not heard of any "challenge" type programs that you could use to become an LPN other than Rn graduates who are unable to successfully complete RN boards. You could attempt to transfer your credits into a PN or multiexit RN program, but most likly you would be better off waiting and repeating your courses in the current program in the interest of time. IMO

I thought that I had learned my leason about believing managment, but then I wouldn't be in this little mess. When I was hired at my current facility they really wanted me to work days d/t past experience but I refused and held out for nights as this area has NO am before school child care (that is for school age children to include dropping them off at school)and even though I have been a day nurse for several years I HAVE TO work nights for my kid. I explained that issue to them many times. Well a month ago I was asked about days again with more pressure. I went through the whole no daycare issue again and was told that they would work with me for my schedule if I couldn't get care for my son and move the shift start back an hour so I could drop him off on the way to work. It wouldn't be an issue as I would be the desk nurse and it was only an hour. They really needed a nurse with my background to straighted some issues up. Well I bought the story. So after talking it out at home I agreed to change to days. Well, suprise of suprises there still is no am care that will bring my son to school. So i went in and told them that I could not get childcare before school but I had everything else covered but that one hour.. They looked at me like I was stupid and said "don't try to make this my problem":eek: I was quickly informed that they had replaced my night shift and I either show up Monday at 7 am or there is no hours for me here and I had better go home and work the phones to get childcare set up. I could have choked the B****. I mean it was not like I never told them this before, they brought up changing the shift not me... i guess a lie is the only reason I finally gave in to work days. Needless to say this little _say one thing do another, just get 'em to do what you want thing is my biggest rant (being expected to almost flat out lie to staff is why I left my last office job for a staff position). And if they think for a minute they can win in a decision between work and child they have another thing comming. I went right home and set up some interviews. I have never, ever not given at least a three week notice when i quit a job, but I think I just may call them up monday morning and say ...umm still no daycare, so ...I got a different job that fulfills my families needs as well as thier own. ADministration is always trying to figure out why turnover is such an issue......could it be lack of respect, common courtisy, and professionalism.:zzzzz

Hello, I don't know where you are located at but at least in the states I've worked the nursing hours PPD are a formula of: A) straighttime- X hours per patient in the facility. B) wieghted- hours per patient acuity (ie. the higher the care for a resident the more hours they require, set up by case mix/rug scores) Some states have a set number of hours required by law for each resident, or general staffing guides. They can be set to include all nursing (licensed and CNA) or split hours (xhours for licensed and x for CNA) or even set just by licensed staff. None of these hours include staff that is not invoulved in direct care in some way Ie DON doesn't count, nor does the other "desk or clip boarders". Dependant on your location these staffing factors can be found in the regulations for your facility type, or averages for the area can be found on the CMS website in nursing home compare. Most of the time these numbers are set to be the MINIMUM staffing allowed. Facilities tend to "shoot" for the closest to these numbers without goining under to save $$$$$$. (at least that is what I and the other managers had to do or get the budget lecture) I hope this helped, peter

Don't forget you will ahve to have a finger print card sent from the BON. They will only accept thier own stamped card. Also apply EARLY, DO NOT WAIT. The BON is very slow, and it can take well over a month. pete

LPNs can take verbal and written orders. It is the facility policy that sets the limits. The FL nurse practice act is VERY vague, like most states,with the exception of basic differences in practice, supervision in SNF, IV infusions that are outlined very well in FL. Except for the issues that are adressed by the BON, all else is left to the facility and individual nurse to decide if they "should" do a task. If in doubt check with the BON and nurse practice act. If it is not addressed there, check you facility policy. Also, always remember that just because the BON and/or facility says a nurse *may* do the nursing function, that does not mean that specific nurse *can* do it. To my knowledge all BON have the knowledge and experience clause that can result in loss of licensure if you go above and beyond "your" knowledge and experience and make an error. Most of the time these issues are decided by a facilityon a liability/risk managment train of thought rather than is the skill is allowed by the BON. pete

Although many children with Downs share alot of the same behavior, physical, and personality traits, they can not be lumped together as a whole. This is just like the typical COPD, FTT, add your own dx here, are all alike. Children may or may not have defects in every body system (in any combination), have the physical downs look, or the palmer crease. OR to add more confusion any one of the different genotypes of downs (trisomy, mosaic, translocation). The degree of disability will directly influence behaviors, as well as past experiences (just like with anyone). The degree of MR results in the child like sunshine personality, but also the agressiveness. Just think of any 2y/o you come up to with a needle...they are goining to fight esp. if they have had a shot recently. A child of 12 may be in the same comprehension level as a 2 y/o and not be able to understand the need for the shot other than that HURTS me --> it is BAD. A child that has experienced alot of pain from healthcare providers as a result of the many possible physiccal defects will react totally differently from the child that is in the hospital for the first time. The scope of MR in downs is HUGE. One child may be profoundly MR/DD, with little independant function. Another may be so mild that they drive, attend college, and funcion almost at a normal level or have none of the common or major defects seen in downs. The setting you pratice in may cause you to see more of a certain type of downs. For example in an ICU you may see the worst of the worst with severe and or multiple congenital defects, in early intervention you may see the whole specturm. Overall downs is a very diverse and extensive dx to deal with. I like to think of it like snow. Every one has the mental picture of a snow flake and it is pretty close to the same image for every one, but really no two snowfalkes are identical. just my two cents. Peter

Value is in the eye of the beholder. our hospital will spend more to recruit one doctor than on all nursing recruitment. After all, people go to the hospital for expensive services provided or should I say ordered by the doctor. They make the money for the hospital. Nurses are the necessary evil. Hospitals can not function without nurses, but we are all expense and in some cases treated as such. Doctors are tied to a nurses value. Sounds funny but I think it is true. I have worked with Docs who treat nurses as dust under thier feet and the managment follows the leed. I have also worked with Docs that got the concept that in some cases all that stands between them and a huge malpractice suit is a NURSE, balancing condition, treatment, meds, etc. (after all, a nurse may have 8 patients and a doctor may have 100+ beteen clinic, in house, consults, etc on any given day). When the doctors recognized our value to them, they put the pressure on the hospital to keep the nurses happy, well educated and continuing to protect them from error. I have seen doctors go to bat for nurses in wages, hours, etc. The reason may be totally selfish, if you were the MD would you rather keep the experienced nurses in your specialty or have all new grads or floaters monitoring your patients? You have never seen anything as angry as a surgean who just realized that the unit was staffed with new grads and OB nurses floated to the unit. The surgeans banded together, cut back elective surgery, and put the pressure on to give bonuses and incentives to get experienced nurses in the specialty, on the floor. (not to belittle OB nurses or new grads. New grads need guidance from experienced nurses. Specialty nurses are highly effective in thier specialty, and I think we all realize that bieng floated to unfamiliar territory puts patients and our license at risk) When the doctors value the nurse judgment, experience and performance the hospital is forced to take a bite in the bottom line and treat the nurses better, or risk MDs changing practice setting costing them revenue. It is just the flow of power set up by $$$$. admin. -> MDs -> nurses : nurses -> MDs -> admin. After all, money maskes the world go round. Doesn't it? peter

When I was A student I was performing incont. care on a elderly woman who had soiled herself with loose. Under the watchful eyes of my instructor I was trying to do it by the book. Needless to say, my little lady was having to good a time...she started to moan, gasp and shake. I dropped the wash clothe saying all done. And almost knocked the instructor down getting out of the room. I was laughed at all year for that. The the time I was working as a CNA in a nursing home. I got pulled to the young adult unit (16-60y/os). I was happily starting my tioleting when I found what was a big problem upstairs, lady partsl bleeding. I went right to the nurse, who happened to be a good friend of mine and reported the large amount of bleeding and clots...as I talked in my concerned i found a problem vioce she smiled then laughed. I was like what??? what's so funny? in between the laughing she said, Peter, you moron it's her period. :imbar I thought I was going to die This was also the resident that I asked to roll towards me. She replied "I would but I'm a quad" Which color shirt do you wnat?, replied, "I'm blind what color are they" and the best in the shower...Gee, You have a big indent in the top of your head...replied "yeh, that's from the gun when I tried to off myself" Or the time as a charge nurse when I was helping a CNA transfer a REsident to bed and tripped. The resident and I fell on the bed and the resident proclaimed "I finally got you in bed with me, I hope you don't break my hip":imbar :imbar the list is endless peter

This sort of thing is why my friends at work call me evil... top of the list.. had a patient in restraints while up in w/c. She attempted to escape and almost strangled herself, flipped the chair and all... so the next night being April 1st... I put the patient to bed early, stuffed a pair of stockings with washclothes, placed them in the pants she had been wearing, flipped her wheelchair over on its' side right next to the bed, wrapped one "foot" in the frame in a rather very broken way. I then put a slipper on the other "foot", dropped the other by the chair and poured and splattered thickened cranberry juice on the floor and rubbed some on the w/c and bed with my fingers. I pulled the curtain halfway, turned off the light and pulled the alarm. A few seconds later i ran to the desk frantiic for the nurses to all come help quick and call the supervisor... After the shock, they loved it and have repeated the stunt... I also had a patient expire, after the bed was empty, it was padded with pillows, sheet pulled over the "head" I reported that the body remained in the room and family was on the way to view. After report i snuck back to the room and turned on the call light sitting next to the "body" I then crawled under the bed and lay in wait. The night nurse came in mumbling somthing about the light must be shorting...when she got right up next to the bed to turn off the light I grabbed her by the ankles and gave a little tug toward the bed. Thank God she had on her depends:eek: I also like the chocolate stunts.. I usually put it in a damp washclothe or towel and smear it around. I walk out in the hall and say to the next staff I see, can you put this in the bin and toss it at them. Doctors freak out the most:D Unfortunattly, everyone is on to me now and I can only get the new hires. peter

You can know for sure with a CXR showing changes to the density of the lung tissues, esp the lower lobes or left lobe in the case of aspiration, elevated WBC is also a good clue, also, the character of the sputum if any may lead you to an idea if it is pnuemonia or CHF. Sputum C&S can be done but is difficult in elderly pts. due to frequent difficulties with cough/deep breathing. Often you must suction for a good sample and this causes increased secretions and can make resps more difficult, I try to aviod this unless MRSA or VRE is suspected. Some Docs also order blood culture. The s/s of pnumonia are often atypical in the elderly but once you see it alot, you can pick up on the differences found on assessment in CHF and pnumonia rather quickly. If further tests are not ordered, the MD is relying totally on your assessment info for the DX or going with her/his best guess. No CXR = No confirmation of pnuemonia. If you are just flying on S/S I would look for cough, fever, purulent sputum first, but, these may all be absent. Next would be change in mental state, chills, chest pain, dyspnea, tachypenia, lethargy and loss of appetite or vomiting. Other conditions may exhibit exacerbation in major infection also, ie- blood glucose goes through the roof. Any or all vital signs may change form base line. It is not uncommon for a resident with a normal temp of 97-98 degrees drop to 95, or have funky B/P and/or pulse. peter

stprdi_01, Lung sounds are a tricky thing to get the hang of until you have actually heard the abnormals with another nurse who tells you the lable that goes with the sound. I can give you the definitions I have been taught, crackles: are the sounds made by the aveoli as they pop open or closed when made sticky by fluid or exudate as in CHF or consolidations of pnuemonias. The thickening of the bronchi as in bronchitis. crackles may be heard on insiration or experation. ( crackle and rale are the same thing) The sound of crackles is like the sound of hair being rubbed between fingers or a large amount of bubble wrap being twisted. They do not usually clear with a cough. May be positional. Wheezes: are the sounds made by the narrowing of the internal diameter of bronchi and smaller branches of air passages. They may be on insiration or expiration. They sound like a sigh, sick whistle or musical tone. They usually clear with coughing. Wheezes are auscultated in ashma and COPD. Also known as rhonchi in some regions, in others rhonchi are wet gurguly to course sounding wheezes. Lasix would be prudent if the Resident is in distress, has CHF, does not have pnuemonia. Oxygen should be applied for o2 sats below 90% and is symptomatic for hypoxia; confusion, SOB, cyanotic lips/nail beds, etc. Also for comfort, sometimes just the O2 and cannula on a distressed Resident is enough to calm them to normal breathing patterns, increase comfort. I hope this helped some. peter