ArizonaMark

Thank you all for your constructive comments. I spoke with my immediate super. She attempted to bring the young buck to his senses, and it didn't work. He simply accused her of playing favorites. So, despite my distaste for documenting others behavior, I wrote a fact-based account of what transpired and sent it to my DON and ADON. I also requested a copy be placed in my personnel file. The young man won't even speak to me, acting as if I don't exist. Very strange behavior that I wish I could understand better. Apparently, he told super that I just don't take well to his "advice." I suppose given his penchant for not counting narcs, I think I'm ok with that. I will play nice. Not going to lower myself to childish behavior. I'm sure in time all things will work out... Again, thanks to all who responded, Mark :redbeathe

This nurse is an LPN. I didn't want to mention it in my original post as I don't want to go there. But, truth be told, he does seem to have an inferiority complex about that, always trying to demonstrate how knowledgeable he is. The count was off by 10 pills. It is a PRN medication. According to the nurse, he used 24 pills. That is what he charted... I don't trust this guy as far as I could throw him, which is not very far :-)

I work at an out-patient mental health clinic. On a day off one month ago, a fellow nurse covered my clientele. One of my clientele come in for med boxes to be filled with assistance by the nurse. This client takes Lorazepam BID PRN. The count was 45 pills when the nurse filled client's med boxes. Afterwards, the nurse documents the count at 31 pills remaining. Two weeks later, when I prepare to meet my client, I count my narcs and discover there are only 21 pills remaining, not 31 as other nurse noted! As the client may use up to 24 pills, this leaves me short for her visit. Not good. I call the nurse in who incorrectly documented amount. His excuse, no excuse. He states, "Oh, well, you gotta order your pills sooner." Nurse doesn't even acknowledge his error. He states, "Well, I was really busy that day and didn't have time to count them..." Incredulous, I tell him to correct count sheet and he does. He then begins to tell me how I need to handle my meds in the future! I tell him to leave my office as I now must rush to pharmacy and get missing meds for my member who is patiently sleeping on the sidewalk in front of the clinic! Subsequent to this incident, this young nurse has not spoken a word to me. He walks by me and only acknowledges me when I make the effort to say hello, boo, anything. All I had wanted from the beginning was for this nurse to accept responsibility for his error, acknowledge his actions. Now, he has taken it to a new level, telling our super that he was only trying to "give Mark some advice" about how to handle his meds..." I am very disappointed in this nurse. He has said inappropriate comments to me in the past, but I've let them go due to his youth. But, 10 missing narcs and no accountability has me spooked about him. I no longer I feel I can trust him and am starting to wonder if he may have tried to set me up with missing meds. Given his childish behavior subsequent to this event, I am now considering my options. Would it be prudent to take the matter to H.R. and let them sort it out? My ADON now knows, but doesn't seem to concerned. He only says, "You guys gotta work it out." How do you work out a nurse that doesn't count his narcs and will not accept responsibility for his actions? Would this issue be a matter for the BON? I dread to go there, but this nurse's behavior has gotten me rattled. How in the world do I know those benzos didn't go down his gullet?? How do I know this hasn't happened before? How in the world can I trust this person again! Any advice is so appreciated, thank you kindly in advance my fellow nurses, Mark :heartbeat :redbeathe

To all the posters, THANK YOU for your responses, each and every one. I read as many as I could prior to going to work this morning. And, based upon a steadfast desire not to allow myself to be tread upon, as well as strength from your support, I called my lead nurse into my office to have a little chat. I told her she made me feel very uncomfortable with her comments. She immediately apologized (perhaps fear of HR), and said she should have spoken to him and not me about her feelings. We had a nice chat. Likely didn't accomplish much, but at least we cleared the air, and I was able to concentrate on work and not her inappropriate comments. Not 15 minutes later, she brought me "extra" work, outside of my responsibilities. I wondered if she was beginning her passive aggressive response to our chat early in the game. She did leave me alone after that however. Yes, she is very insecure, and I seem to spend enormous amounts of time just listening to her drone on about how unfairly she is treated. I do appreciate her trust in me (I will not violate our private conversations). Yet, she is doing with me the very thing she accuses our big boss of doing, blurring the lines. To the poster regarding sexuality. For the record, the ADON and I are both quite heterosexual, thank you. I am going to let things cool for now. Neither one of them like each other. And, I am sadly in the middle. It's a tough dance, but I do believe I am keeping the peace for now. Hopefully, won't get caught up in the crossfire... You're all the best! Mark

I have a great boss. We worked together in a correctional facility, and when he came across my resume in his current position, ADON, he gave me a call. Now, I am working in a behavioral health clinic. Great autonomy, benefits, etc... Only problem is, he and I get together for lunch about once a week. As well, he will call me at will throughout the day just to shoot the breeze. We are both males, so it is kind of like a "Good ole boy" relationship. My immediate super, my facility lead nurse is becoming more and more irritated at this cozy friendship. She cut into me yesterday about it. She stated, "You know, he (my boss) shouldn't be asking you and only you out to lunch like this. It smacks of favoritism, and the other nurses won't like it!" My lead nurse made me really uncomfortable. If she had a problem with HIS actions, I don't know why she wouldn't address him and not come at me. I really like my job and don't want to make waves. I also don't want to alienate my ADON. Any constructive criticism would be really appreciated :heartbeat... Thank you in advance any helpful suggestions... Kindly, Mark

Hallelujah !

There are likely two reasons why the nurse(s) aren't interacting. 1. There is so much documentation and paperwork, little time is left to actually "see" the patients. 2. The nurse may well be afraid of the patients. I worked in an acute psych unit previously. I did see nurses avoid even eye contact with their pts till med pass. The pts were often acutely psychotic, and threatening in behavior and mannerisms. As well, the pts were in a way, in charge of us. They didn't ask for their meds, they demanded. And PRN was a joke. 1 mg of Ativan PRN q 4 hrs meant exactly 3 hrs 55 min later, that pt would be banging, not knocking, banging at the unit window demanding his Ativan. And so it went. Was crazy! Think hard about what you are about to get into. You may feel like I did. Less a nurse, more the Candy Man! Good luck, Mark

Wow, it is tragically amazing how life can take a sudden U turn. I'm sorry for your troubles GalRN. Here are a few suggestions to keep you active, which is what you need to be doing right now. 1) Apply for unemployment insurance ASAP. Document everything that occurred with your sup. Names, dates, witnesses, etc... 2) While you are at it, apply for state assistance as well. Food stamps, rental assistance, insurance, whatever you qualify for. 3) Look on you local Craigslist for RN jobs. If you can do home health (which I loathe), there are usually lots of opportunities there. Careerbuilders.com is very resourceful as well. 4) Reach out to family, friends, clergy for moral, financial support. You need ppl around you right now who care. 5) Do what you can do. Then, rest, and leave this in the hands of God. You are an educated, articulate, and experienced nurse. You will persevere and overcome this.... God bless and keep your chin up, Kindly, Mark

Good for you to go the extra mile. Seems like we have both seen nurses who take every opportunity to annihilate the new guy (girl)! Kudos to you for stepping up and giving a new nurse a hand! Kindly, Mark

Hi GalRN, Yes, you are expecting too much too soon. If she's spent all her time in an OR, how in the world would she know about all this psych stuff. She's proven she is a good nurse, she has a license. For goodness sake, give her a chance and work with her. If coming on to this board and reliving each and every faux pas she has committed while under your tutelage has brought you relief, so be it. I only hope you have been professional enough not to carry on as such with your fellow "experienced" nurses. As you said, if you were in an OR, you would feel like a fish out of water as well. Look for the good, orient her, help her along. Please don't belittle her in front of others. Simply smacks of one-upmanship. And really, haven't we had enough of that already in nursing. With all due respect, Mark

(i confess i also use the lancets more than once) hmm, i would suggest this is not a good idea. not using alcohol wipes is one thing, but driving a dirty needle through your skin into your bloodstream is probably not a good idea. remember, little buggies like to grow on those dirty needles. don't give them a free pass through your body's initial line of defense, your skin. just my two cents, kindly, mark

First a caveat, I DO use alcohol wipes prior to every FSBS with my patients. Having said that, there was a study recently regarding the efficacy of using alcohol wipes vs not. The study demonstrated no difference in rates of infection r/t wipes or no wipes. Now, tell that to your patient and watch them hit the roof. I tried it for a bit, but gave up as patients are accustomed to the wipes. So be it. Nonetheless, wipe or not. It doesn't matter. Kindly, Mark

I too work in a correctional setting as a RN. Like Dixiecup described, we too have a clinic-like setting where I have opportunities to work side-by-side with MDs, NPs, and PAs. As well, on the weekends, I am responsible for the nurse sick call. My NP really pushes me to come to him with everything done and ready. I assess, diagnose, and choose a tx plan. I must be able to support my plan and defend it. If he agrees, he simply signs off on the orders, and we are on our way. This arrangement has really forced me(in a good way) to stretch my assessment skills and helped refine my medical knowledge without stepping outside of my scope of practice. My co-workers know I am in a FNP program, so they are taking the extra steps to help stretch my skills and knowledge base. I am very lucky to be in an environment such as this and recommend it highly. Kindly, Mark

Remember your ABCs, and get as much info as you can via vitals, FSBS, lung sounds, etc... before you make a dx. A lot of arrestees do malinger in the hopes of getting cited and released by arresting agency. Also, easy access to meds and phones in a hospital setting. Many of these folks are pros at the jail setting. They will have an initial advantage over you (lower/lowers, extra meals, meds, special shoes, etc...). You will be taken advantage of, especially initially. After all, we are supposed to be kind, compassionate. But soon, your sixth sense will develop and you will spot these folks the moment they make their presence known. Best of luck! Kindly, Mark

I am in a similar situation. I have an ADN and a BA. I am going to take a bridge program through the U of Phoenix toward my MSN NP program. The bridge will take four months or so I am told. The program I will take is a "on-campus" program though we will only meet once every two weeks for all-day classroom sessions. As of today, the cost will be in the 25k to 27k range for the entire program though I am confident inflation will drive up the costs along the way. I would suggest you see if there is a U of P near you and consider this as one option. Best of luck to you, Mark

Ok, this is really quaint. I do see a parallel between your inquiry and perhaps someone who has gone through nursing school and never actually saw a real patient. For the sake of argument, I will answer your question as asked. I too speak Spanish very well, though I am self taught. There is nothing like simple experience with Spanish speaking people to improve and refine your skills. If you seek out those who speak Spanish only, you will succeed beyond your wildest expectations. You might take a trip down to Mexico for a few weeks. Or, hang out in primarily Hispanic commercial areas. If you are in the medical field and serious about your skills, choose a location where you will incorporate your Spanish language skills each day. Good luck, and really, an interesting post.

Inmates can misbehave in many ways, including verbal intimidation and exposing themselves and whatnot. Most likely won't, but yes some will from time to time. Goes with the territory. As well, like the other commentator, I concur the LPNs can be pretty rough on a newcomer. You've got 17 years in so you've likely encountered this type of attitude before. Nonetheless, to be absolutely sure, I would consider going PRN to get your feet wet first. Remember, "Fools rush in where Angels fear to tread"

Diaper change, you are the first called. Urine catheter bag full, empty it. Grandma gotta go pee again, you will likely help her to the bathroom. Mr. Jones in room 7 looks really pale and appears in distress, you will likely be the first one to notice. If you are good, you'll pick up the change and notify your nurse ASAP. It ain't business by a long shot. It is perhaps the most vital, yet under-appreciated position in the hospital or long-term care setting.

Should you decide to take the position, dress the part. In other words, I would not go into a sketchy area of town dressed too conspicuously. Blue jeans, a simple top, so on. Perhaps a personal protective device of your choice, mace, a loud horn perhaps. Definitely a cell phone with auto 911. And, go with your instinct. If you feel unsafe for some reason, if your hair stands on end, leave first, ask questions later. My two bits from a former bounty hunter, correctional officer, street urchin as a youth. ps You'll likely know if your patient has not been compliant with their meds the moment you walk in the door. Mark

I am picking up a few shifts in my psych dept. at a correctional facility. Going to get orders at some point for B-52s I/M now, or the equivalent (Haldol 5mg, Ativan 2mg, Benadryl 100mg). Can someone with exp. with this order tell me if you are combining any of these meds for deep I/M? I don't want to draw up 3 shots, but I do see Ativan doesn't mix well with many meds. Thanks so much, Mark

I did work psych there for a short while. The staff was overall friendly and helpful. However, we were chronically short of staff, and consequently overworked. As well, they had instituted a very liberal hands off policy toward violent patients. We were "educated" on how to use the least amount of force necessary to, for example, extricate someone trying to choke the life out of you or someone else, LOL! Not very effective in my opinion. The patients would come up to the fishbowl and bang on the windows if they didn't get their Ativan at the very earliest time allowed PRN. Overall, really a demoralizing place to work. While I was there, it was staffed with primarily travel nurses. Oldest nurse there made it 2 years, and she was a ROCK! I'm not, so I moved on :monkeydance:! Hope this helps a bit, want to know something more specific, let me know.... Mark :smilecoffeecup:

Soap and water Carl. Alcohol will actually impede the healing process and prevents a fresh wound from coagulating. That and I have actually found soap and water remove dried blood much more effectively. Mark :smiletea2:

No Carl. Mild soap and warm water will do just fine. Why do you ask, are you in the piercing business? Mark

I work in a detention facility. We have a virtual epidemic of so-called "spider bites". The practitioners have seemed to have decided not to argue the point with the inmates. I suppose it gives them a little more comfort to think they were 'bitten' by something rather than having been infected by someone, LOL... Nonetheless, antibiotics, I & D, wound care, and they are on their way. By the time we would get the cultures back, most have gone along their merry way... Scary that I see this each and every day... Mark :sofahider

No, I don't believe any nurse is going to receive self-defense from a facility. Having said that, there is an upside. If you are not trained by the staff, you cannot be held accountable to how you might react if threatened/attacked. For example, most law enforcement agencies forbid choke holds, overwhelmingly the single most effective way to STOP someone who might be attacking you. Choke holds are relatively easy to learn, effective, and not too difficult to apply. Check out a good martial arts school nearby, I would recommend Krav Maga, this Isreali self defense course specializes in helping those who are unaccustomed to even consider violence to counteract violence. BTW, nurses in general are treated more favorably and you are less likely to be attacked than say an officer. But, never say never. And if the attack comes, you would likely NEVER see it coming. Violent criminals are not in the business of fighting fair. If they decide to go for the kill, they will take every advantage, including diversion. Goodness, didn't mean to sound too negative. I do work in corrections and really enjoy the challenges, the autonomy. But, I am very cognizent of the dangers each and every day... Some advice, always ensure there is an officer nearby. Their mere presence should deter any nasty thought some nerdowell might entertain... Mark