LegginMF

Facility is LTC Resident to sent out to E.R. Flu going through the facility like wildfire. Resident readmitted with Dx of dehydration. D.O.N is insinuating that admitting Dx of dehydration should NOT have been in the admit paper work. I did not do admit....but... was there the following day and seen order for STRICT I&O's. I spoke with D.O.N and told her to the best of my knowledge that since resident was incontinent and wore a brief that we needed a scale to do strict I&O's. Am I correct in thinking we need to weigh the brief to calculate output? Was told by D.O.N to change order to just monitor how many times we had a wet brief per shift. State is coming back to further review this case. Was nurse wrong to put Dx of dehydration on paper work? It's clearly written on the hospital paper work. If she didn't put it would it be considered hiding info or falsification? Also at that time the Administrator had staff pull ALL of the bedside water pitchers from the rooms. Operating on the assumption that because we have a lot of ambulatory (and very confused) residents this would prevent the spread of the flu even further. Any feedback would be appreciated. Thanks.

What we do is pass all meds as much as possible at dinner. Except for ... ATB's, Narcs, Cardiac meds, etc.... We will usually call md and get med times changed with the explanation that after dinner most residents race for the room to go to bed and are very resistive to taking meds after they have gone to sleep. The doctors tend to think in alert, oriented terms when assigning med pass times. I HAVE seen nurses pass double narc and B/P meds at the same time. After seing the after effects they tend not to do it again! LOL I don't know if you have ever tried to wake up a grumpy 90 yr old at 9:00 p.m. to give them a scheduled vitamin, but realistically it ain't gonna happen! And don't forget the is book nursing and real world nursing. There is a big difference between the 2.

When I apply for a job I put a copy of my license in my resume and list the web site address for BVNPT. This is MY license I paid for it, it was issued to ME! I need it to have the option of working at other jobs. It is my understanding you are supposed to keep it in YOUR posession. I would have never let them keep it in the first place. I mean if you work 2 jobs what are you supposed to do. Go to the office when you clock out and ask for license everyday because you your other job needs it too?

Last night I had to contact the Dr. for a patient who is not eating or drinking. Pt has been sent out 2x's for dehydration in the last 2 weeks. Dr. asked to me discussion options of G-tube or hospice for pt with family. I called home # of family Jane (not real name)answered and replied that responsible party was not there, but she is the pt's daughter. I explained to her that since she is not listed as someone I could give info to I couldn't tell her anything. She got VERY nasty with me. I apologized and suggested she contact responsable party and have them add her on the list. I then called resp parties cell # and left a message. Approx 40 min l rcvd a call from person identifying them selves as the responsible party. I have never spoke with her before. I proceeded to tell her everything that was going on and her options. was on the phone with her for approx 20 min. 40 min after that i rcvd a call from a person who identified themselves as the resp party. I was like Ummm....I just spoke with you. She said no, I just went to lunch as I am at work. It turns out the mother of the pt had a friend call and impersonate her daughter ( the grandaughter of the pt)in order to obtain info on pt. Resp party is trying to care for her mother (alcoholic, beginnings of dementia) and her grandmother (alzheimers) by herself. The poor girl is so overwhelmed! Thankfully she has decided on hospice. Our hospice up here is wonderfull. They will step in and get her the support she needs to take care of her mother and grandmother. But am mad I was fooled like that. I had to call DON at 10 p.m. last night to report it. DON will speak with resp party so we can add mother as a contact person.

I would talk with her privately. I ask her if she is specifically looking for fault with me, If she felt I was unable to do my job. Basically I would ask her why she is always finding fault with me. Tell her it makes you feel uncomforatble and that you feel she is picking on you. I would also keep an eye out for small mistakes that she makes to show her that no one is perfect. No nurse is perfect. Then bring it up in the discussion. It may just be the way she talks that comes off wrong and she doesn't realize how she sounds. If she is doing it to be nasty I would take my complaint higher up the food chain. I have a nurse where I work who is just plain nasty, she is constantly in the DON's office with a complaint. But... when I get called into the DON's office I am not in trouble. She will sit me down and go through what I did step by step so that next time I get it right. No harm no foul is her motto.

Found a vent class given by Rt's going next month. That should clear up a lot of my question!

I am an LVN. I am currently taking, chemistry, algebra and a health class (instead of p.e.). The health class is an online course. I just logged on today and was checking out the tools and resources provided for the class. Now, this course covers mental, physical, emotional health, diet, exercise, drug use and STD's. Under the class resource button (which we are encouraged to check out multiple times, during the introduction, in the forum, in the syllabus) are literally 50 or so links, all antiabortion. I'm talking live videos of abortion, from D & C to partial birth to the delivery of a malformed fetus, the result of an incomplete abortion that went to term. There are no links for proabortion and only three links that actually provide tools to help with the course. I am not asking if you are pro or anti. I am asking if these links put under course resources are appropriate? I really don't like being misled as to what I am going to view under a link. A live abortion video is not part of the course. There is only one short part in the book for the class that covers abortion and it's possible effects. What do you think?

Let's see NAFTA send this Darn job to Mexico!, Happened to me and I lost everything. The retraining program is a joke. Actual agreement statesthat I am supposed to get training in a job that will give a comparable wage in regards to what I was previously earning. Turns out they were only giving me six months to go to school. Where can you go to school for 6 months and get enough educatin to earn close to $50, 000 in a year?

MINA, Pt 16, LMV set at 0.1. Pressure control at 20, pressure support at 12. insp time 1.0, volume 500, Hi pressure alarm 40, Low pressure alarm at 6. LMN 0.1 Breat rate 12, increase to 18 when sleeping and SIMV, not AC Still getting inverted I:E in early a.m.'s usually starts at about 3:30 -:4:00, 4:1.1, 5:2.1, 1:1.1. Is 1:1.1 considered autocycling? On staff R.N. says no, R.T. says yes. R.N. says breathe rate in the high 30's o.k. R.T. says breath rate should be in mid to high teens. Also Breath rate is elevated up to 50 at times. Usually stays at 28 -35 during deep sleep and heart rate will drop into low 50's. When awake heart rate is inthe 70 - 80"s range and breath rate is usually around 16. We use cont Sp02 monitoring at night, If heart rate decreases or breath rate up, I will ususally reposition. Repositioning will always change his breath rate, heart rate and breathing pattern to more normal values, Shiley #6 cuffless. Use safety strap to help avoid decannulation. Wish they would just put him on LP10. The vent they are using is way over kill. Pt can sprint up to 9 hrs a day without showing signs of decreased Sp02 or elevated heart rate.

I am trying to quit right now. I am using the gum. I seem to be o.k during the day. My worst times are in the morning when I am having coffee and right before I go to bed. I am quiting because I am 40 and have been smoking since I was 11. And because the love of my life who is 10 yrs older quit 5 months ago and is starting to snitch cigs from me. I don't want him to start again. The weird thing with me is I hate to smoke when I drink. So, If I could just stay drunk for 6 months.............:chuckle

Hi guys, I currently work with ventilator dependent MD patients. The pt is new vent pt. We have been having problems with I:E Ratio and low minimum volume alarms. I:E inverted, ex: 5:1.1, or we are getting 1:1.1. Breathe rate is 32 to 50 during sleep! I called RT during night as was told to bump sensitivity from 2 to 9 and by pass LMV and put him continous Spo2 monitoring. Charted it. we were doing this for about a month, then I get pulled into office and told not to touch vent again. So for last 2 months have been answering LMV 20 to 30 times a night. Kept noting I:E ratios and breath rates on every shift I worked. Then RT comes in and is upset because we are not changing sensitivity as instructed. RN tell him that she spoke with another RT and they decided that the rapid breath rate was a normal sleep patten for pt. Alos during this time they did Co2 trending and client was staying at about 12% t\o nite. Now new orders are to increase breath rate to 18, sensitivity to 9 and by pass LMV alarm and use continous spo2 monitoring during sleep. QUESTION. Does anyone know of a web site that has an explantion of I:E ratio, and what is normal range, what inverted signifies and the ramifications? I have been searching for weeks. Seem all I can find is results from studies on rats and mice or it involves cpap. Would like to better understand this, so I can knowledgably argue with RN about settings, and intelligably talk with RT about problems encountered.

Scallywag, I graduated in March of '06 and by the time everything was said and done I didn't get my actual license until July 12th. You posted a while back that on the Board of Nursing site they had lists of schools with a ! next to them to show the LVN to Rn Programs. Can You post that link. I am desperately seeking an RN program because where I live there is a 2 year wait just to start the prereqs for the bridge program. I am in the High Desert. Jody

I have been charting everything I find/fix in residents charts, including the fact that I notified the DRS. And yes I am looking for another job. What is the anonymous whistle blower number?

California, I would hate to beleive it is like this every where.

Hi guys, I work in a alz/dementia assisted living facility. It currently has 52 residents with room for 66. The problem I am having is the other nurses not doing what they are supposed to do, making huge mistakes and it is scaring me to death. The facility is one building three different locked courts. 1 LVN per shift for the entire building. 6-2 shift has 2 LVN's but the second one is the DRS, she doesn't work the floor. These are the examples just for the last month. All a.m. meds are marked on the MARS to be given at 8, how can you be in 3 different courts at once? Not all meds are being given, I find cups of meds from the previous shift sitting in the top drawer of the med carts, and it's not being charted on the MAR as held or refused. They are signed off as given. No orders for treatment are even gotten. If you are off of work and someone gets a s/t it stays on the alert charting form for three days. If you are off for 3 days or more you never see it and never know it is there. I have found three residents in the last 2 weeks with bandages that have not been changed in who knows how long. I found them by smell! Why? because no one bothered to get an order and put it on the MAR so everyone would be aware of it. A resident had an order for Lamisil p.o. x 30 days. who ever copied it to the MAR forgot to put x 30 days. So she got the med for an extra 24 days. I discovered it by accident, because I was doing 30 day order updates to be faxed to M.D. for signatures. A resident was given Rx for bactrim, I was off for 3 days and when I came back I saw it on the MAR. The problem? The bubble pack for the a.m shift was unopened, but 3 were missing from the p.m buble pack and the order date was from 3 days before. Meaning she did not get her a.m dose of ABT for the first 3 days she was on it. I noticed a residents Zyprexa pill count was really low. I know when the family delivered the medication and how much was delivered, because it was given to me personally by the family member. I left a note on the MAR asking where is her zyprexa. It turns out the a.m nurse was giving meds by memory not MAR and was giving her zyprexa in the a.m. when resident is only supposed to have it in the p.m. So resident was double dosed for approximately 13 days. When I confronted said nurse she said "oh, just don't give her any for a few days she'll be fine" I found phone orders from 8-o6 that had never been mailed to M.D. for signature. I found 30 day orders from as far back as 4- 06 that have never been updated. I find meds in the cart, usually cough medicine or vitamins that have been brought in by the family for resident use that are not on the MAR and there is no P.O for them and they are being given to the resident. I found new phone orders for a resident who is now actively dying stating that he is NPO, all meds d/c'd except MS elixar etc..that were written 8 days ago and never transferred to the mar. The staff has been getting him out of bed for meals! When I left for my 3 days off a resident had exactly four pills of ativan left. I told oncoming shift in writing that the family needed to be contacted for more. When I came back the med had never been ordered and there were exactly four pills left. Meaning that they were never given. This is a standing order. I keep going to the DRS and she keeps telling me to fix it! I don't want to spend all of my fixing things. I hate confrontation and because all of the other nurses are experienced and have worked ther for a 1-2 yrs ( I have been there for 4 months) they tend to blow me off. I have threatend to quit several times and my DRS begs me to stay, (guess they need somebody to clean up the mess). Now mind you, these are just the mistakes I have found in the last thirty days! What do I do to make these people get with the program. I am scared to call the state as I am sure I made a a few mistakes in my first couple of weeks, (mostly charting, somebody forgot to explain to me about charting procedures, I was told that because it is assited living that they don't chart. So I didn't chart for the first 3 weeks I was there.) I am scared of losing my license but I am more scared of what may happen with the residents, I truly care about them and want to do my best to help them, this kind of treatment and uncaring attitude makes me mad!