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Slowone

Slowone

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  1. Slowone

    absenteeism

    really sick, child ill, babysitter cancels, g'Ma is ill....all legititmate excuses. I think over 75% of all call in are legitimate. BUT, I don't think it's what the excuse is as much as WHO it is calling in. I know my staff, it is the repeat offenders that get me steamed. They call in sick monday, thursday and Friday with a dx of "I don't know what it is but I have been throwing up all night and have a fever of 102.7!!!" As for childcare issues, a babysitter cancelling here and there is one thing but if the fact that you can't hire reliable/consitant help , will not become the facilites problem...get it together or get out. our NAC's run 10:1 on a high accuity floor, they work there butts off and do a great job, so if one person decides they want to sleep in or take a "mental health" day without getting coverage; it's just is plain unfair for those who actually care about their jobs and their patients! I love the idea of weekend call in's going through administarator at home!! I may bring that one up in our next manager meeting!
  2. Slowone

    writing policy and procedure

    Thats the problem is getting that "somebody, somewhere" to share. In this area the competition is stiff and nobody wants to help anybody else. I was hoping someone may direct me to an easier place to get it. It really isn't anything terribly difficult, more time consuming than anything. Bowel and Bladder Policy and Procedure... we have not had one to date and putting it together is more detailed than originally thought. I haved always been able to pull from prior P&P's or even used Briggs on occasion, but I guess its time to just dig in and get it done.. Yuck!
  3. Slowone

    writing policy and procedure

    here's another one for ya! When you are writing a new policy from scratch. Do you use any particular "template" or do you just start writing. We are trying to develop and implement and new program, but the policy development portion of the program is coming along very slowly. In the past we have always used existing writen policy and just modified it. Any suggestions? thanks
  4. Slowone

    siderails

    thanks for all the responses! It is interesting, siderails are such a damned if you do damned if you don't issue. Our facilty is attempting to be siderail free, but many residents want to have rails as a comfort measure. According to our state regulations, resident safety overrides resident rights as it relates to siderail usage. The facility has the final say as to whether or not they are used. We have many mattreses on the floor but i can't stand the way they look when you walk by. (reminds me of my college years when I couldn't afford a "complete"bed) I also think the personal/bed alarms are a joke. They do not prevent falls, only alert you when they have occured...I find that so frustrating. I feel restraints, if used properly, have a place in long term care. I don't know about you all but I am sooooo tierd of filling out incident reports I can hardly stand it! Anyway, thank you all again for your sharing. If any facility has found the "answer" to all of this, please let me know!
  5. Slowone

    siderails

    I'm sure this is a topic that has been brought up before however, I was just curious how different facilities around the country are dealing with the changing regulations on siderail usage. Here in Washington we have had two deaths in the past year due to siderails and it has become a very hot topic for surveyors. Siderails are no longer viewed as a "restraint" issue. It is now a safety issue. What is the policy and procedure in your facility for siderails? What kind of beds or adaptive eqiptment are you using in lieu of siderails? Just curious. thanks in advance for your responses. SLOW:)
  6. Slowone

    Patient Falls in Acute Care Setting

    Personal Alarms can help if you can get to the pt. quicky enough after hearing it go off. Otherwise, consistant assessments of risk level for falls. Initial assessment done on admit then repeat Q 24hours/PRN. Assessment of amount of narcotics/psycotropics used. Just a few thoughts for ya. Good luck, this will forever be a problem unfortunately. If you come up with 'The answer" let us know! :)
  7. Slowone

    RSV precautions-How does your facility handle?

    So my son was admited to Childrens for an URI. as a standard precaution they did the nasal culture and placed him in isolation. He was DC'd to home before the results came back and we were called the next day and informed that he was indeed positive for RSV and to just watch him. Unfortunatley he got worse so I called the ED to let them know ahead of time that we were on our way and that he had confirmed RSV. We got there and they triaged us in a common triage area, did his weight, took vitals etc... everything in this common area. They then placed him in a private room where everyone was gowned and gloved and masked prior to entry. They toted him across the entire first floor to radiology for a chest film, where no one was gowned or masked and of course he was coughing and crying. They walked us back again throught the hallls to go back the ED. When he was admitted, they again walked him through the hospital, even shared and elevator with another child to the 4th floor. We were being escorted by a volunteer who herself was gowned etc... Not really sure what you can really do about transport, perhaps mask the patient. And to do a portable x ray into an iso room means sterilizing everything afterwards. I'm not sure of the policy in this hospital but it sure felt like my guy was spreading his "stuff" all over the place!
  8. Anybody tried Metabolife356 for "energy" or weight loss? Just wondering, I have a friend taking it and swears by it. HMMM?
  9. Slowone

    this nurse is REALLY ticked

    Not sure if it was a a joke or not, but an earlier posted made reference to bypassing the whole workers comp if injured on the job. FYI for anyone considering doing that..If you injure yourself at work and do not file workman comp and you have your insurance company pay for medical care, that is insurance fraud and the insurance company will seek repayment if they find out. Not to mention the fact that if you have on going medical complications..you don't have anyone to sue!
  10. Slowone

    Nurses Motivation

    I read the posts here over and over and I just do not understand what Christianity has to do with the "suffering"or "complacency" iin ones working conditions. I am a relatively new nurse ( Regarless of religious background, whether nursing was a"calling" or just all you know how to do.... I hope to never be the kind of nurse that views nursing as a "business". To me it is more than that, yes I have suffered with my patients and I don't think it has damaged me or my spirit in anyway nor has it affected my ability to stand up for what is right or to fight for the profession. The issue being discussed here is not religion, it's now just misguided anger, what are you mad at? And why can't a nurse acknowledge a problem and STILL hop around looking for utopia? Works for some.......just not all. To go back to the original thread topic.. Someone told me once that "all nurses go to Heaven", I thought it might help my chances!. Thats how religion fit into my career choice.:)
  11. Slowone

    Resident rights vs. Employee rights

    As a former director for an AL, I can completely understand and sympathize with this situation. There is always one difficult family, that no matter what you do, you still aren't doing enough. I know you mentioned the ombudsman as being a resident advocate, however I found that if used properly, they can be of help to you in the long run. The ombudsmans primary responsibilty is to the resident. However they can also be used as a mediator. They must remain neutral, especially if the allegations and demands are baseless as deemed by your state regulations. They can't make up the rules as they go. They must inform a resident of demands that are not the facilities responsibilty to provide. just because a resident loves filet mignon doesn't mean they have the right to have it served 5 nights a week, just for them. You are obligated to provide a well balanced, nutritonal meal working within thier MD's written dietary orders. I suggest talking to the ombudsman and pleading for thier suggestions in handling this situation. I found that if you give them the impression that you are speaking to the "all knowing", "God of all Ombudsmen" and that "they are your last hope", they tend to be more responsive. really butter them up! :) You have rights as a caregiver and if a client or clients family interfers or sets standards of care guidelines that are beyond the abilities of your facility, you have legal grounds for discharge. Perhaps it is time for a care plan review, can you really still handle the care level for this resident in a safe manner? if not, you must discharge her based on that. Of course you must be prepared for a battle including a discharge appeal. In Washington State however, private pay residents do not have that right to an appeal, only State $ assisted resident do. In Washington, if they pay privately, you can discharge on any grounds and are only required to give a 30 notice of discharge. This resident needs at home one on one care. Lord help the Home Health Nurse that gets that assignment. BTW, why can she not have skin to skin/glove to skin contact? Does she bathe her self? I would also talk to your state surveyor, they love working with situations like this! It will also continuosly be on record that you are being proactive in her care, which will look good if/when another complaint comes in. My experience also has shown that if you let them complain enough, sooner or later DSH will catch on. You know the story about the little boy that cried wolf! I would also talk to the DSH about going to an employees home. That is way out of line and there must be some protocol on investigation prcedures. I can't imagine that this is acceptable! if they showed up at my door, they would soon be on the sidewalk or being charged with trespassing. That is harrassment! Good Luck! Sad part is, despite all my ramblings and best guess advice...fact is, you are in a no win situation and you will just have to wait it out. Sorry!
  12. Slowone

    Survey: Should family be present for a code?

    I would like to share the one experience I've had with family in the room during a code. 70 ish yo male, s/p MI, was very stable and was goign to be discharged that day. PT came to do a discharge evaluation and had the guy do a couple flights of 5 steps. He went up and down twice at his own request and tolerated it fine from what we could see and his tele showed NSR as well, family was there cheering him on. He was being walked back to his room which was about 100 feet away and he collapsed in the hallway and the code began, we lifted him up and took him to his room which was only a couple yards away and the code team showed up. The code only ran for about a minute or so until the primary care RN informed of the DNR status. The family refused to step out of the aleady crowded room and was yelling out the door at the Physical Therapists "you killed him, what do you think you were doing? You killed our father!" They yelled at one of the RT's for dropping his denture by accident stating that he will pay for those if they were cracked! When the code was aborted they flew off the handle and demanded it continue or they will sue the hospital. The gentleman was very lucid and has his own POA, his wishes were respected and he died. it is a siuation where you can never tell how a family will react, but saving the patient is the primary focus and if family is in the way, out they should go, social services should be there to pick up. It should be based on a case by case situation. Imagine if your child or parent were dying and you were not allowed to be there! Scary!
  13. Slowone

    Just Plain Lazy

    There is always one is the bunch! You will see the "lazy social butterfly, RN" just about everywhere, if she in with the boss well it may be a lost cause. HOWEVER, if she is indeed allowing unlicensed personnel give meds, that is dangerous and illegal. Forget the supervisor, go to your state licensing board. Document everything that you may witness, as stated before....knowing and not telling can get you in just as much trouble.
  14. Slowone

    LPN/aide

    You are defnately NOT being a baby! You furthered your eduacation for what is essentially a carreer change. There is a big difference in what an aide and LPN do. Likewise RN vs. LPN. My advice would be to go to your supervisor and tell her what your concerns are and ask for an LPN job description. Go over it with her/him. of course all nurses have an obligation to high patient care standards, no matter what the duty may be (shower/change incontinent pad...etc.) But that should not be your primary focus in your job anymore. Now it comes down to nursing care, you are no longer "assisting" the care, your job is to direct that care. You know as well as we all do that good aides are hard to come by and I'm sure the supervisor knows that as well and is reluctant to lose you in that role, but you need call her on it in a professional and calm manner. In the end it is up to you, if you are not doing what you want to be doing and what you went to school for, then perhaps a new enviroment is what is needed,.... you'll know. Good luck to you.
  15. Slowone

    injection technique

    Dart style, quick, count to three but give it on two. Works for me. I don't feel comfortable pinching the skin personally, I prefer to keep myself as far away from the needle as possible as I am a big weeny when it comes to getting poked! Yes I admit it, I actually fainted one time. My first time ever giving an IM injection was awful. We gave flu shots at a LTC facility! My patient was an 80 pound lovely lady, very confused. I will never forget the shiver I got down my spine when I accidentally hit needle to bone. OH MY GOODNESS, makes me cringe even now. She was adorable, looked at me and said "dear, is there a door open somewhere? I think I was just stung by a bee!" Gotta love it!
  16. Slowone

    Pregnant while an RN

    I worked though all 3 of my pregnancies, universal percautions obviously still apply. As for HIV proph for exposure, speak to the infection control nurse at your local health dept or at your school, that would be a good place to start. Another consideration is insurance, if you don't have it through you hubby/signif other, you will probably have to wait through the 90 day probationary period. The pre-existing cond doesn't appy w/ pregnacy but the prenatal care is essential as you already know. These are the only problems I experienced. 1. My annual PPD was waived because there is no data to its' potential effect on the fetus one way or the other. 2. I barfed in a patients room because of a smell that didn't sit well. (it was the lunch!) 3. Had to be much more careful taking care of confused patients, got kicked in the stomach by a 50 yo ETOH'er going through withdrawls. (baby was fine, but it was terrifing) Good luck. Keep in mind that you will be working in a profession that is predominantly female and many will understand your fears and work with you to keep you and baby safe! And of course the men will as well! again,good luck. S