squaw nurse

We have always used standing orders at our facility and they have been wonderful. They were developed by the LTC nurses and the team of physicians in our community and are updated annually. However, the Louisiana State Board of Nursing recently issued a statement as follows: "it is not within the scope of practice of a registered nurse to initiate standing orders without contacting a physician for patient specific orders in accordance with the Law governing nursing...". The whole purpose of the standing orders is to enable the nurses to administer a Tylenol without having to contact the physician. Have any of you out there had similiar statements issued by your state boards? What alternatives have you used? Help! I feel like I'm in quicksand and need some answers. I just sent out the revised standing orders for 2002 for MD signatures. Not only will my nurses be livid, but the doctors are going to scream when I break the news we can no longer use standing orders. Please help if you have any suggestions.

I am a DON who values all my staff- charge nurses as well as CNA's. I am very familiar some of the above situations. The facility where I work was once labeled as one of the facilities where CNA's rule. As a previous CNA I understood the philosophy of many charge nurses that CNA's are merely "butt wipers", and as a previous LPN I also understood how it felt to have my write-ups trashed by the DON. I was determined to make teamwork my priority. I started by purchasing a set of videos called "Nurses Aides Are OKAY", which help to build self-esteem and self-worth. I watched them with my nursing team (nurses aides and nurses watched them). My next step was a workshop on how to be a charge nurse for LPN's. They were taught the importance of the nursing assistant and ways of improving performance like talking to your staff the way you would like to be addressed. I even asked the most domineering LPN to teach the specific segments of the workshop. Though after 22 months we still have problems from time to time, all staff respect each other as human beings and caregivers, and all understand the chain-of-command. The LPN's realize I will not tolerate abuse of the nursing assistant any more than I will tolerate abuse of a resident; the nursing assistants realize they are a valuable member of the team with a valuable contribution. As a team they will not tolerate new persons who do not buy into the team concept. Though time consuming, it has overall been a success. My goal this next year is to work on dietary and housekeeping departments so that all function as a team for the good of our residents.

We also had a problem in our facility with constipation/ fecal impactions. Part of the problem was inaccurate documentation by the CNA's and the nurses not taking time to review the daily documentation by the CNA's. To resolve the problem I changed the responsibility of documentation of BM's to the nurses. I just added a line to the MAR for BM's and as the nurse makes her last med pass of the shift, she asks the resident or CNA about BM's, documents this on the MAR and then administers the PRN laxative. Our standing protocal is for MOM & Cascara q3d if no BM, (unless the resident has another ordered routine laxative) and Fleets enema if no result from the laxative within 24 hours.