gettingupthere

Aren't your CNAs and LPNs working under the license of the DON? Or am I mistaken?

OMG! That was a long time ago! $1.50 in 1968!

Congrats!!!!!!!!!!!!

OMG! This is ME! I am ALWAYS ready to help my pts and coworkers, WHILE I'm at work! Once I get home, I don't want to talk on the phone evn. I check in with my kids, quickly find out if everyone's OK, make dinner and either go knit and watch TV or iron, do laundry, when I do laundry I get "lost" and just don't think at all! My husband gets annoyed with me, I just don't feel like talking. I DO help take care of my mother in law though. She is a nervous nellie and is always asking " can I take a tylenol"? But she's a grand lady and loves me. I was on vacation one time, this man fell and had a seizure, I thought" oh crap", when a young nurse went running up to help him. I said " great", cops and paramedics came and I walked away!

Non of those were wet to dry! wet to dry is not done 3 times a day. The reason for wet to dry is to debride a wound. If it's done 3 times a day, there isn't enough time to allow the gauze to dry. That being said, this is cruel! Think of it, it's meant to debride. The dressing is left in place until it drys out, then the nurse comes along and pulls this dry dressing out, supposedly debriding as it comes out, causing bleeding and further tissue damage! Would ANYONE want this done to them????? If the dressings are too wet, then there is maceration! This treatment is archaic!(sp) sorry for such a miserable response, but that type of dressing makes my knees weak!!!!

I graduated in 1968. I started working in a LTF for $3.50 hr. Whem I got married in 1969, I moved to New Mexico and started working in a small hospital making $1.50 hr! I make $34.00 hr now at a LTF, the same one I started at back in 1968!

Ahhh, now THAT DID happen to me many years ago! The cath wouln't deflate, my supervisor said to "cut the cath and pull it out" Guess what? I wouldn't come out!!!! Had to send her to a urologist! Bad thing to do! Never did that again!

I have been inserting foleys for 40 yrs! I have never pre-tested a foley bulb! Never was taught this practice in school! BUT, yesterday I was placing a foley in a pt with a new graduate assisting me. She asked me if I was going to pre-test the bulb? I looked at her, and told her "no, I've never heard of that" She too tells me it's a practice being taught. I have NEVER had a problem ( and hope I never do". When did this come into practice? Have I been living under a rock?

Thanks CMARM! As a matter of fact, I did have a KCI rep come in, she really had no more suggestions than what we were already doing. BUT, I really never thought of the condom cath! DUH! As it turns out, we had wound rounds today and the doc I usually go to for advise in these matters suggested that we D/C the wound vac ( as I thought she would) and suggested that we try using a calcium alginate to pack it lightly and cover it with a dry dressing. I am going to apply the condom cath tomorrow though! Otherwise we'll be changing this dressing several times a day! Thanks so much for your input! I really do appreciate it! Debbie

I have a client who arrived at my facilty with a stage 4 wound to his ishium. After a few weeks of the wet to dry dressings he arrived from the hospital with, we decided to try the wound vac. It has healing well up until a point. We are now having more trouble than ever keeping it from sidding off of the wound and interupting the treatment. We have had and OOB schedule of only 2 hrs a day to keep him off the area. He had previosly been on a hoyar lift. Now though, he is stronger and able to get out of bed with 2 assist. Still is on the same OOB schedule of 2 hrs. However, NOW the vac is slipping off the wound on a much more frequent basis, and due to the site, it ias impossible to reenforce it. The sponge at this point is already out of the wound and pulled up. Also, I have noticed that there is no longer grainage in the cannister. Let me try to explain what we have been doing to apply the vac. The area is irrigated with N/S. Dryed. Skin prep is applied around the wound and up the entire area where the bridge will sit. Because of the moistness of the area ( the client is also incont) I have been putting a small piece of duoderm near the peri area ( the very thin duoderm), and a bit of stomahesive to help it stick.then use the white sponge and cut it to put into the tunnel. I then cut a piece of the plastic tegaderm and put ot over this and cut a hole over the area where the white foam is. I then cut the black sponge and make a bridge to either his hip or thigh. This worked in the past, now, no longer. The wound is about 3x2.8cm and has a 2.3cm tunnel. Previosly was a bit wider and 6 cm tunnel. So now I'm asking for any expert opinions. Is it time to remove the vac? If so, what now? The Doc I have is really not that experienced with wounds and takes my advise or those of us who work with wounds. BTW, th wound is clean with nice healthy tissue, not really any maceration, and he has little or no pain. Again, there has been no drainage in the cannister for a couple of weeks. I'd appreciate ANY suggestions. Would really love to give this man the opportunity to be up and out for longer periods of time and take advantage of PT! Thanks!

Only every three days????? I never heard of calcium alginate dressings being changed so infrequently! Ca alginate is for draining wounds, so why would this be ordered q3days? That's neglectful! If this pt is on hospice, they are at the end of life. The body is breaking down, a wound could " take off" in no time. Poor nutrition, poor hydration. poor thing, does she have adequate pain control? I think ca alginate is not a poor choice, just needs to be changed more frequently!

I work in Long Term, I understand the need for Agency Nurses and the need for nurses to work for agencies. I don't feel positive about them at all! I find MANY medication errors, I see how some do treatments ( if they actually do them). They don't do any of the routine things, like PPDs!They spend alot of time out smoking!They don't take direction from regular nurses on the units. I have even seen them on their cell phones WHILE they are giving meds ( thus the med errors!). There have been some who come in from one job and work a double shift at the facility!They use poor judgement and are too tired to do the job properly! Frankly, they frighten me!

In our facility nurses are not allowed to remove staples!

If you have patients on Med A, you need to be very specific in your documentation. For instance, should this resident have a hip fx, then you need to document on pain level, meds given and effectiveness. How they transfer, do any self cares, self feed, coninence, how they toilet, how much assistance is needed. Identify the reason that they are in the facility and document anything pertinent to their stay. Good luck! It will come easier as time goes by.

I personally don't like " NURSE JACKIE" ! It has this nurse Jackie as the charge I believe of an ER, she has a back injury and pops pills that she gets from the pharmacist, his pay is that she screws him in the pharmacy behind a shade, however, she has 2 yound girls at home and a very handsome husband ( much younger than she). I don't see this as very realistic! At the same time, she is a wonderful advocate for her patients! You watch it and judge for yourself! I find the show insulting to "normal" hardworking nurses!

You are just the type of nurse I want to take care of me. You can't " turn off " your brain because you are consciencous! You CARE! That's why you can't sleep at nite. I have been working long term for almost 40 yrs, I have no trouble dropping off to sleep, but around 3 am, my eyes open, and all the things I did for the day before come playing back to me. I analyse everything, " I should have done this" or " I shouldn't have done that". I try to answer call bells, answer questions, I make promises to get a resident a toothbrush and at 3 am I remember that I forgot to do it, and then lay there and worry about it! It is stressfull, it's a hard job and you really feel like you don't make a difference in someones day, but you DO! Believe me, you DO! Long term is hard! But you need to love it! If you don't, it won't be for you!

We have had residents come into our facility with a pink MOLST form from the hospital for awhile now. Does anyone know how they work? We haven't been given guidelines and I don't think anyone at my facility knows how to use them. We still have DNR forms and the MOLST are only good for 48 hrs in our place. We had an incident today that brought these forms to the forfront. Now administration is scrambbling to figure them out!!!! Anybody???????????????????

Actually, the residents in our facility DO wear name bands AND we have pictures on the MAR! Our arm bands have Name, Rm # and if they are a DNR there is a yellow dot on the band. There are things we are NOT allowed to do because it is " their Home", like overhead pageing. I think it's rediculous, when I need a supervisor, I NEED A SUPERVISOR, I don't need to call all over the place or use a walky talky ( that never works properly). A little after note regarding this med error originally pasted about. The state was called, the investigater came in and reviewed the chart, care guide, care plans, MAR for this resident AND the other with the same name. Haven't heard back on the outcome yet! Will keep you posted!

I have a story, there is a lesson to be learned, it was a hard one for an LPN I worked with. A few weeks back, this LPN was giving meds on my rehab unit, we had 2 pts with the same last name. They are sister in laws. We had them on 2 different halls and 2 different med carts. The LPN was a float on the unit. She knew only one of the residents from the last time she was on the unit. She gave the wrong meds to the wrong resident. There were several different B/P meds, the resident is confused, so didn't question the nurse and took them. The other rsident was programed to say " I'm Mary" when she was approached for meds! We immediatly contacted the MD, supervisor and DON. Started monitoring her V/S every few minutes. After about an hr, the B/P began to drop, we called an ambulance and sent her to the hospital. She returned about 6 hrs later, OK. In the meantime, the nurse who gave the meds, of course was upset! She explained that she knew THAT resident, but didn't know there were 2, even though she sat for report on both sides of the unit, she didn't read her armband. Well, she was fired! Besides being a terrible nurse from day one, there were other med errors in the past. I know errors are made, I have made my share too, but there is always an opportunity to pass a lesson along. More to the story! Almost a week later, this poor woman fell getting out of bed in the middle of the nite and suffered a subdural hematoma! she is back to us once again, but she's just not the same.

I have a 20 pt med run on the 7-3 shift on a rehab floor. It takes me from 7 am til about 11 am most days. I find that this is a good time to get to know the residents. I take their B/P, Ap, sometime a pulse ox, they ask questions, I stop and answer them. Sometimes a shoe needs to be tied, a footrest put on the wheelchair, sometimes someone has to go to the bathroom and can't wait! Sometimes I come upon a resident who is sick and I need to call my supervisor, check vitals, call the doc and sometimes send them to the hospital. There are lots of tasks to be done during a med run, I can garantee you, if all you do during a med run is give meds, you are not doing your job, and you certainly don't get to know your patients. I see nurses all the time who just give meds and nothing else, that's NOT nursing! So, be kind to yourself! I'm sure you are doing an excellent job!!!!!

Hi Alabaster! I have been an LPN in the same facility for over 35 years. I have found that the best way to work with CNAs is to have mutual respect for one another. I work hard and expect that they will too. I don't tell my CNAs that I will roll up my sleeves and help if they need me. They know I will, because I DO! I never ask anyone to do something I wouldn't do, I love my job and they know it! I treat them with respect and let them know I appreciate what they do and how hard they work. As a matter of fact, a few months ago, we were short an aide for the 3rd or 4th time in a week and had an extra nurse to do " paperwork". I told my supervisor that we can't ask the aides to work short again and can't ask the pts to deal with it again. So, I told her I wanted to take an aides assignment, to hell with the paperwork. I tell you, it was such hard work( as I knew it would be). But at the end of the day, the aides came to me and told me that they always had respect for me, but they were now Over the top! So now, when I ask them to do something that may take them away from a break or a shower that isn't on the schedule, they say to me " for YOU we'll do it! It takes awhile to gain the support and respect by all, but I believe that I have, for the most part! There are some that you just can't make happy! Good luck to you! By the way, I did start as an aide at my 1st job, went home on Friday an aide and came to work on Monday and LPN. the people I DID have a problem with was other LPNs! They were just MEAN!

Actually, I believe you can get your CT license if you have a NY one, BUT it requires more hours. So, if you get your NY license and work a few months in NY you can then get a CT one. I think!

In our LTF, we had a Doc who was asked not to take admissions due to his behavior. He had other docs cover his patients. He did however take call for them, he was abusive to the nurses. The nurse would tell him the problem and his responses ranged from " let me mull this over" to"what medical school did you go to?". He often sounded as though he was under some influence. He became angry with me one time for calling his service. When he came in to see the patient, he said to me "do you know every time my service has to call me it costs me 50 cents". I happen to have 2 dollars in my pocket, so I pulled it out and told him " here, consider this credit for 4 calls" He laughed and was always nice to me after that. What an *******!

As a nurse, RN or LPN, you are doing assessments on your patients throughout the day! If an LPN sees something that requires further assessment, she calls the RN. Assessments are part of the job!