1st edition

Well, girls apparently no one is going to squeal! :) I have decided to do the Lower Columbia online program. I need to work as much as I can and can work PT if I do it online. I am not crazy about doing nsg online but a girl's gotta eat (and so do her kids)!

You don't have to be a DNS to give me an opinion here guys! :)

I work w/ many GREAT CNA's! I could not do my job w/out you guys. My only complaints are not getting VS on time (w/in 3 hrs after shift starts) and aides not writing down I&O's. I make rounds to make sure ankles are floated, everyone clean and dry, f/c's emptied w/ bags on about an hr before shift ends and I rarely have to remind them to clean someone up. But I do have some complaints. I do not like aides that worry about all the other aides jobs. They need to worry about their own job, not the aide on the next unit unless there is abuse going on. It is depressing to have someone complain about their coworkers nonstop. I have noticed that aides tend to over-react to N/V/D etc. Just stay calm when you report something and lets us do our assessment before you panic. I love my aides. I could not do my job well if they didn't do theirs well. They are my eyes and ears.

I have wanted to write a book just for this topic!!!!!! Maybe now I will!

Professionals are humans too! Just because you work in the medical field does not mean that you don't feel the same emotions as people in other fields. Putting on that uniform everyday does not turn me into a robot and it shouldn't. Who a coworker is sleeping w/ is not your business, it is their life, not yours. Ok you don't approve. I'm sure you do some things other people may not understand or approve of. I do not agree and cannot ever imagine sleeping w/ a married man but those are my personal ethics and values. I don't have the right to hurt or upset other people because I don't approve of their choices. If the pt's are being harmed that's a different matter but they are hurting only themselves (and they may not even see the harm that will eventually come to many b/c of their affair) then no one should interfere. They are grown'ups and can/do make their own choices in life.

I am currently licensed in 4 states. I did not have to take any additional tests for any state. Just pay the fee and apply. There is no limit to how many you can have that I know of. You just have to be in good standing w/ each board.

I need advice on what to do since I do not handle office politics well. One night a CNA witnessed verbal abuse of a rsd in our LTC by another CNA. The witness did not report this to anyone the night it happened. Second night, again the witness still didn't report the abuse. Third night she reports it to me. The witness begged me not to tell anyone cuz she didn't want to "rat" on the other CNA. I encouraged her to make an anonomyous (sp?) report. The next day my DNS calls me at home. I tell her "Oh good, I'm glad you called because I wanted to discuss this aide/abuse incident w/ you." She tells me to come to the facility to discuss this. I do. I tell her everything. She gives me a written, not verbal warning, and does not write the CNA up that witnessed the abuse. No verbal or anything. The CNA that was guilty of abuse was terminated. I was the charge nurse the night the actual incident took place but was not informed of it until 3 days later. I didn't report it the night I was told because I didn't know how to handle the situation because it happened 3 days prior but was going to call my DNS the next day. Do I ask my DNS why the witness wasn't written up when she didn't report it when it happened? I am confused why my punishment was harsh and there was no punishment for the CNA that failed to report the abuse in a timely manner. My DNS knows I wasn't informed until 3 days later. She asked the aide why she told me instead of her charge nurse the night she decided to report it. The aide said she wanted to talk to a nurse she trusted. What do I do? Let it go? Talk to my DNS? Talk to admin (who is a really nice guy)? I am new to the company but have already been singled out from admin for my good work and leadership skills. I want to keep my good reputation w/ this company because I truly love working there. I am sooo upset I can't sleep. Need advice!

I have 33 and I work gladly take your 20! That would be heaven!

I would like to have clarification also on the BS. One would not admin ANY insulin w/ BS 21. Liver is on the Rt side, pancreas on Lt

If your nursing program/college only allows you to take a pre-req x2 then perhaps you should w/draw. That way there is no grade to consider and you can re-take A&P 2 more times if you need to. The highest of the 2 grades will be the one factored.

It has to be one RN and another nurse, LPN or RN, witness. Haldol is a narcotic, I believe a sedative/hypnotic.

How long has the fatigue been this extreme? Was it gradual? I was exp extreme fatigue awhile back as well. I had suffered from sheer exhaustion for >2 yrs. It was untreated early menopause (I don't know how old you are), early endometriosis, and bil ovarian cysts. I had a total in Arpil and feel great! I have not had a day off since Oct 15th and won't get one until sometime in Nov. and I'm doing fine. Yes, I am tired but not exhausted. Some of my shifts are 12 hrs as well. Go have a check up. It sounds like something may be amiss. I do not believe the fatigue you describe is normal. Don't let the docs tell you it's all in your head either.

Oh yeah! Keep copies for yourself of ALL your notes that you use for report. If you forget to write down a BS you can look at your notes later and write it in the MARS the next day or whenever. Also, I make copies of all labs, TO's, and such to give to the oncoming nurse so she can refer to the orders and stuff later and doesn't have to try to remember what exactly I said in report. She has word for word copies of orders and such to refer to. That way she can pass it on to day shift (I work 2nd). Keeps the confusion down for her. I also have a notebook that I keep copies of every form we use (everything from rx orders, to CNA assignment sheet, neuro check form) because trust me you will need a form one day and there won't be one single copy in the house. I just pull out my notebook, choose the form I need, make a copy to use and put the other copy back in my notebook. Saves time.

I have 33 rsds. I stay busy and I do all the things in your list. It is very hard and I never sit down except to do my charting at the end of the 2nd shift.

You will develop your own routine after about a month on your own. At first do things exactly the way they tell you. After awhile you'll figure out who should have meds first. On my shift I know who to give meds to before right after dinner or else they'll be asleep. Figure out if it is best to do tx between med passes or after you're done w/ all your med passes. It takes time but if you are naturally organized you'll be fine. Organization is the key. There will be times when you will HAVE to do your own VS such as when the CNA reports an abn BP reading. Then you'll want to check it again yourself. Find out who needs BP readings before they get their meds and have the CNA's check those people first. If I think of anything else I post. In the meantime good luck! You'll be fine!

I sent out a memo to all my CNA's. VS must be done by such and such time, I & O must be properly recorded, etc and that I would be making rounds at such and such time, about an hr before end of shift to make sure all rsd were reasonably dry and clean and if things weren't done on time (unless there is an emergency) then they would be written up before at end of shift. It is working great! All the CNA's support me and understand I just want the rsd taken care of and that I depend on them to be able to do my own job. I cleared the memo w/ the DON ahead of time. I never spoke to the admin about it but he came to find me the day I handed out the memo and thanked me. He said this was the leadership he had been looking for and that it could mushroom "into bigger things". I have never been in a leadership position before so this was a scary step for me. But w/ 3-7 women working in one hall someone has to lead and it is our job as charge nurses on the unit to lead.

I'm crying to! What a wonderful thing you did. Most of us in LTC are so busy that we sometimes forget to take the time to care. Thanks for the reminder that we do more than pass pills!

Try not to judge why families don't visit. Walk in a mile in their shoes . . . the mom or dad may have been great but they can't visit d/t work, coping skills, etc. Sometimes the grown child that is sooo attentive may be so d/t guilt, ie they didn't appreciate their parent before they went into LTC.

Gotta go bed, ladies, but will check for more replies tomorrow. Thanks for the GREAT feedback! That's why I love allnurses.com!

Nothing was mentioned about the mg/d limit. She just told me I couldn't give both w/in a 4 hr period. I said, "Well, the orders don't say that" and she said it should.

She recently fractured a rib. She doesn't like to take the vicodin d/t N but occ does. I offered the pt vicodin bc I had given her tyl 1 1/2 hrs earlier and couldn't admin more tyl for awhile. When I told the oncoming I gave her tyl at 2030 and she was still c/o pain that I offered the pt a vicodin but she refused. That's when the oncoming nurse informed me I couldn't give tyl and vicodin together in a 4 hr period. I disagreed w/ her in spite of her yrs of exp.

So she can have 2 vicodin and 3 tyl/d max so as not to exceed the 2000mg/d. She has been getting over the 2000mg/d for at least a wk now between the 3 shifts. This lady is 91 yrs old. Should I ask the MD about the daily limit allowed for this pt?

During report tonight the oncoming nurse told me tyl and vicodin cannot be admin w/in 4 hrs of each other. The order reads Tyl 650 mg 1 po q4/prn/pain and the vicodin order reads Vicodin 5/500 1 or 2 po prn q4/prn/pain. There is nothing in the MARS that says one must wait 4 hrs between doses. I took the vicodin order myself from the MD. He didn't mention anything about waiting. I am a new nurse and the oncoming has been a nurse forever. Is she correct? If so, why isn't it specified in any pt's MARS? I know there is a daily limit for acetiminophen (sp?) dosing. How much/d?

After you advise her to ask for help by way of using call lights and whatever other methods your facility uses chart that she was advised to not transfer self w/out assit and verbalized understanding. CHART that every time. Cover yourself. If she contiues to "fall" then you are protected and your butt is covered w/ documentation.

I want to thank everyone for their confidence and support. I was curious how normal hearing nurses felt about working w/ hearing impaired nurses. So far I do fine but I worry about missing things, ie, breath sounds. Your comments give me hope that I can move to ER eventually.