brsharky

I don't know what your facility policy is but at mine there is a formal process that a patient or POA has to go through to get a copy of their chart. The medical records staff has them sign paperwork for it and makes them a copy. We never let them look at the floor chart. They are entitled to the information but have to go about it appropriately. They cannot just demand to see the floor chart. Additionally, legally they may not be entitled to all of the information in the chart, such as certain psych notes, etc. I think that there may also be a procedure to request that certain information be withheld, psych related, if it is felt that the patient would potentially harm self or others based upon the information. As a Nurse Manager, I would not want any of the staff nurses being responsible for supervising or explaining the chart contents to a patient/family. As it was said earlier, they have more important things to do like ensure patient safety.

I live in New Mexico and not Texas so I can't help with the accommodations but I do work at a larger VA facility and I think you will enjoy the benefits. I am not familiar with the Temple VA but the Dallas VA is well-known in the VA system for being innovative. Most VAs are at the forefront of technology (not counting contracted facilities ran privately). Our charts are electronic so that I can access patient data from other VA hospitals, the meds are barcoded, etc. The benefits are also great compared to private sector facilities. Good luck and congratulations!

Subee made an excellent suggestion. I would suggest an externship of some sort or even working as a NA so that you can see what the nurses do. I think that hands-on learning is the best way to go. I have know too many people who based their decisions on the opinions of others and this prevented them from making "their" choice. One of the nice things about nursing is that it is like 20+ careers in one. You can work in a hospital, homecare, school, administration, research, legal, etc. The possibilities are endless and there is a niche for nearly everyone. Good luck!

The NA scope varies between states and facilities. In many cases the state may allow certain tasks that a facility policy requires a licensed personnel to do. As a general rule, basic patient care such as hygeine activities, transferring, lifting, toileting are in their scope. Medication administration and other skilled nursing procedures (wound care, IVs, etc.) generally are not. However, this varies depending on where you work. For example, we train some of our NAs to become Health Technicians. HTs can perform urinary caths, blood draws, EKGs and a few other tasks in addition to the basic NA tasks. I would say check your facility's policy and/or clarify with your supervisor.

Wound dressings are definitely changing! Salaries have also increased as well as sign-on incentive and benefits (largely depending upon your area). I have also seen an increase in BSN graduates and RN to BSN students. Increase in unlicensed assistive personnel (at least in my area over the years). Need I mention NANDA diagnoses!

26 bed unit, SCI Rehab and Medical (probably closest to medical floor or LTC) Generally 5-6 RNs on day shift with 4-6 NAs and 0-1 LPN Evenings usually has 3-4 RNs, 0-1 LPN and 3-4 NAs Night shift usually has 2-3 RNs, 0 LPN and 2-3 NAs Our census is rarely at capacity. For example we had 6 RNs, 1 LPN and 3 NAs on today and 19 patients. The rest of the hospital, about 144 beds, tries to stay at a 1:5 ratio but is more commonly 1:8. The Critical Care areas use a 1:2 (max) ratio

Luckily, I have never made a medication error (or at least not that I'm aware of). My facility uses bar code technology to help prevent errors. We complete an incident report and notify the provider. What action is taken depends upon many factors. As a Nurse Manager I try not to use incidents, such as med errors, in a disciplinary fashion. I think that usually they should be used as a learning tool and that staff will under-report if they feel they are likely to be punished. That said, it is my supervisory responsibility to take disciplinary action in some instnces to enforce policy and ensure patient safety. It is my job to make sure that the staff under my supervision have received adequate training and are competent at performing their job duties. A first-time medication error would be handled much differently than a nurse who repeatedly makes medication errors because he/she is not following med. admin. guidelines. Also, the severity of any adverse effects are considered along with whether or not the nurse was acting negligently. Rarely is it ever clear-cut and accidents do happen.

I have worked on a SCI Rehab unit for several years and I love it. I started as a student extern, then new grad and Assistant Nurse Manager. I am currently Nurse Manager and even though I sometimes get frustrated all in all I love my job. I know that management is not for everyone but I like developing programs, advocating for my staff and feeling like I make a difference for both staff and patients. The M-F day shift schedule with weekends/holidays off is hard to come by in nursing and so that is definitely a plus. I have also done home healthcare and that was a nice part-time job as well. Everybody has their own niche so you'll find yours. The beauty of nursing is that the possibilities are endless!

BSN, then MSN

I also sat through long, 4 hour, discussion on the bird flu this week. I live in New Mexico and I don't know what the state is requiring. Our facility has been brainstorming on how to be best prepared. Luckily, our facility is rather large and has plenty of storage space, and many items already stock-piled as it is a federal facility. However, if the bird flu arrives then items such as ventilators will be scarce. Utilization of local radio/news stations to alert patients to stay home if they are healthy enough, telephone triage, increased bed capacity and essential personnel were also discussed. It is hard to compare federal vs. private plans though because there are so many differences (red-tape). MREs were one thing that we considered and they can be stored for other disasters as well if the bird flu doesn't come.

I forgot to mention that the other reason I have asked and only if an employe is willing to discuss the matter is when I am concerned that there is something contagious involved that I might need to inform our providers to watch for in our patient population or among other staff members. For example, I recently had an employee who had to have Chicken Pox ruled out. This employee was upfront with providing the information and was luckily not positive for Chicken Pox. However, I need to be able to inform providers, etc. just in case patients are exposed to potentially contagious illnesses.

I agree with you that you should not have to say why you are calling in sick, generally speaking. I am a Nurse Manager and when staff requests Sick Leave I grant it if they have it. The facility where I work has a policy stating that supervisors cannot demand an explanation for SL requests (except with certain exceptions). However, if the employee begins the conversation by telling me that they are have difficulties other than illness, such as car trouble, etc., then requests SL, I do not have to grant SL. Also, in certain instances where there is a prolonged usage of SL or a pattern of leave abuse there are exceptions to the rule. We have a process to put leave abusers on medical certification and require a doctor's note for each call-in. For most employees who call in occasionally due to a legitimate illness this isn't an issue. I wouldn't want any staff member of mine coming in sick and then making patients and other staff ill. However, with a probationary employee who is on orientation I would definitely keep an eye on the leave usage. Sometimes it is a legitimate illness and sometimes it is a sign of whats to come. When I hire a full-time nurse I need a full-timer not a part-timer...as do the other nurses who are working short-handed. Sorry, I got off on my soapbox again. I would just say that you don't feel comfortable or want to discuss it and leave it at that. I think most supervisors would understand. If not just frankly remind them that you have a right to privacy as well. If the leave requests are excessive then they can deal with that in other ways.