dotherightthing

First, if this is occasional, I'd encourage the teacher to speak with the child to find out what's up. And then go from there-to talking with the parent and maybe social services Second, if this is a frequent thing and if the kid is not rousing to his/her normal LOC...being drowsy, disoriented or with unstable gait...those kinds of things, the parent should be notified immediately so they can transport the child to a physician for work-up. If the parent refuses to get the child, I'd consider calling 911. Something is wrong and you probably can't figure that out at school. Third, if this is a frequent thing and if the kid can be roused to his usual LOC, (It shouldn't be dumped on the school nurse), the teacher should report it to the parents-it may be a chronic home/social/discipline issue. How late is the kid is staying up, doing what? What else in going on in that kid's life, etc. If it isn't that and assuming the parents are on their job, they should take the kid for primary a care work-up. If it continues, something is going on but it's iffy whether its a social or medical issue. If they refuse to pick up the kid, I'd encourage the teacher (and help her) to flood the parents with calls and notes while documenting it all to cover myself and the school. The child can't learn much is he's asleep in class, I'd involve the social service people and the principal as well. Lots of unaddressed social kind of issues come up in school nursing....lice, unwashed bodies, dirty clothes, hungry children. It becomes a medical issue when it's longer term, chronic kind of stuff (a couple of weeks of dirty clothes, not washing, etc., is chronic to me). Otherwise, on a daily basis, my job is acute care and diagnosed 504 type care issues, self-medication oversight, health education, etc.

I've heard that it happens at heritage woods of chicago, from someone who lived there once. Don't know for sure though.

first of all, you won't know until you know. it may not have gone as badly as it feels. you'll know when you know. 2nd, many rns fail the exam the first time taking it. i've known at least 20 nurses who admitted it. so imagine how many i may have met who just didn't mention it. i've known rns who took the exam 3 times before passing, this is to say you're not alone, if it is the case. everyone is not a good test-taker. for some people, in general, the stress of test-taking works against them. re-group, study and take it again, as many times as you can or have to. no employer asks if you passed the first time or how many times you've taken the exam. this may not be exactly what you want to hear but in the real world, you have a second or even third chance. if this is your mission, go for it.

as an rn and having an open mind and one who has worked with some experienced but terrible rns, i say give that giving the lpn a chance may not be all that unreasonable. the nurse manager must have some reasons for not wanting to give the position to the rn besides not liking her. as you guys are on opposite sides, she may not feel comfortable sharing those reasons with you. lpns are often painted with a broad stroke, the type of paper received (not a aa or bsn or whatever) being something that is used constantly and the lpn as a group has lots less support (to do pr) than the rn. the one ltc facility that i've worked at and liked the most was headed by an lpn so go figure. (the distance was the problem). so, let her give it a shot, if it doesn't work out, it'll be as evident as any other nurse.

It may not get done, which is why I left LTC, you're still held accountable even though overtime is not acceptable. And even though, facilities are staffed for 24 hours, leaving something for the next shift is also unacceptable. It's very wierd.

i'm an lpn also, i tried ltc because the money is good but the facilities are a mess in the inner city and nearby suburbs. in ltc, it's all about billing it seems, and throwing pills at people really fast - not about health care. i don't want to be too negative because i know some really like it but it's not for me. i've tried but it didn't work out. the facility where i worked had a large population of filipino nurses and the language issues are difficult not only for the patients but for the other staff as well. the culture there is very interesting, they've very honestly shared that they don't allow their elderly to go to places like that. i get the feeling that they don't really respect the patients that are there or the families of the patients. this was my only real experienc with a facility that was straight ltc. i've worked part-time at facilities that had sub-acute care and assisted living and the culture was definitely different. i'm trying to find my way back to ambulatory care or school nursing with a part-time weekend job in supportive living or assisted living. i like to see a positive result through good care and education, that's a rarity in ltc. so, hang for a minute or use your cna to hold you while you find your niche. the job market for lpns is really limited these days so it's tough. i'm still trying to find my spot too.

the assisted living facility where i work operates more like a nursing home and it shouldn't, so i can't really give you much practical advice except: help the residents maintain the adls that they can do. remember not to "assist" them too much. you'll assist them right into a nursing home. try to work as a team with the cnas or front line staff. every staff member is important to the care of the resident. there's probably more but after an exhausting day with a crazy don, i'm done for.

at a school where i worked, the kid - an extremely unstable diabetic, ran out of glucose test strips. we had to go out and buy some, at the school's expense, and try to get the parents to pay the school back. this child really needed to do her bg a minimun of 3 times a day on a good day. on a bad day, we'd get a bg 5 times which should really be overkill. but diabetics really don't die of high blood glucose itself, complications yeah. the parents who seemed to understand the disease process would not supply a reliable glucose source - this kid would be 380 in the morning, she ate choco-something cereal and then 37 after lunch, because she ate only junk food. at 37, she was barely symptomatic and that was really scary. i went out and bought a couple of bags of smarties - a very cheap, empty, reliable, rapid acting carb source - about 6 gms per roll. i didn't always know about smarties. but, i found that about 2.5 packs, 15 or so grams, would knock her bg up really quickly. so, i know this is really bad but think about it, diabetics usually don't really die of high blood sugar, it's the low bgs. and 37 would have me cold and clammy. and the child had an automatic insulin pump so this was happening with the insulin on board. did i say extremely unstable? but the child was otherwise, well cared for. and very manipulative - children with chronic illnesses often are. so not a pretty story at all but there it is.

i agree that she did not do much more than recount conversations. she was not specific about his ongoing treatment at all. i really don't see that as a violation. the insomnia that she did mention was well known and she did not reveal any specific treatment. she was not disclosing anything that was not public knowledge. it seemed that he saw some of the drugs as sleep aids, this type of drug seeking is common, many patients feel this way. we commonly use diphenhydramine as a sleep aid - not it's original intent. i also believe that she probably spoke out as well because of the allegations that are being tossed about in regard to his health care providers and advisers - i'm sure she realized that having worked with him, some of those carelessly tossed about allegations could hit her. she was making it known that she was not a prescriber. not such a bad idea really. in any case, as i've stated before, i'd rather have a hippa violation than a murder charge.

the thrill of taking care of michael jackson went completely sour when he died of questionable causes. though certainly a violation of confidentiality, this np is probably trying to cover her bottom half, as she was involved to some degree in michael's care. if diprivan was found in his home, someone, possibly a healthcare provider, was really out of pocket. i'm sure she wants to make it known that she was not involved in providing any inappropriate medications. i'd rather cop to a hippa violation rather than a murder beef.

male nurses are very common and not necessarily gay. some are gay of course but then some doctors are gay as well. lab, radiology, or techs are gay, too. look at all healthcare providers, some are some aren't. i've not heard of instances where patients take some stand on whether to receive care from whom. i'd bet it's one of those non issues.

If I'm just checking on things, making sure she's properly connected to whatever, stay in the room as long as the patient's privacy is being honored, ask me the questions when I've finished, I love patient and family education. And if I'm doing stuff, larger tasks like repositioning, dressing etc., and you can't/won't help-it's fine, you're not obligated. But since most rooms or areas are only so big...STEP AWAY FROM THE PATIENT. and BE CAREFUL, hospitals, LTC, IN-Patient Substance abuse, in-patient facilities in general are loaded with viruses and bacteria. So tell the visitors about that very serious infection (that's surely somewhere, so you're not lying) and they will probably STEP AWAY FROM THE PATIENT.

If you're starting the liberal arts portion of your studies, the usual stuff for school. If you're starting the clinical areas: be sure to protect your feet and legs. I mean like wearing good shoes with good inserts, support hose, etc. Have about three pairs of shoes to rotate so that the bones in your feet remain flexible, the inserts help with arch support and the support hose help support the muscles, veins, bones, ligaments etc in your legs. Nursing is a lot of walking and worse, sometimes a lot of standing. You'll need and want your legs and feet to be useful for years to come. If you're not absolutely great at math, look into Dimensional Analysis for medication administration; calculating IV drip rates etc. Calculating medication in the form of pills and/or injectables is pretty straight forward. IV infusion rates, X amount of fluid per kg/day at what ever rate with the piggybacks, etc., can get a little sticky and DA can come in very handy. Your clinical facility will probably have pumps, etc., but if they are scarce...Dimensional Analysis. A recorder for lectures, I would say that a laptop would be quite useful for research anywhere but probably not essential, same with a PDA - I happen to work a bit better with both. Mechanical pencils with good erasers. Organizational stuff like index cards. A flu shot as soon as available. A really good grip on the policies of your school and the facilities in which you'll be training. It pays to know where you are. It's a really exciting time in your life. I'm excited for you. Enjoy learning to be a wonderful nurse.

i've commented about health insurance. so, i'll respond to your comment about nurses working together. nurses, all combined, make one of the largest worker populations in the us. there are more nurses than all medical areas of practice. fact of the matter, we work in all areas of practice. i think there are more nurses than lawyers (we are lawyers, too) and many other professions. if we were together, we could contol the healthcare arena, based on sheer numbers alone. we wouldn't do that, just for control's sake but if we stuck together and quit the in-fighting, we could be a major participant in determining standards of care. sure, we participate but somehow though we know the numbers that are good for the patient, his care and safety, we don't seem to control that. we, like physicians, work in every area of healthcare, not just on the hospital floors but in radiology, research, pharmacology...all of the specialities...you name it...even the insurance companies...except there are more of us. our numbers should control healthcare, we should be hospital administrators, along side the physicians. we should write policy along with the physcian. we should be up there with the docs, drug sellers, researchers and insurance companies, we're there to some degree, but we should be equals. healthcare would not the wreck that it is now if that were so. i may sound like an ego maniac but we're the ones who touch the patients with our hands and our hearts...

i feel you but canandian nurses are working in the us for more than the money and definitely not the healthcare. it's that it's the us...immigrants come here everyday for various reasons but if that canandian nurse got sick, if she could make it back home, she'd get the same care that everyone there receives and would only pay that minimal amount. notice that these folks who are citizens elsewhere usually only receive the basics here and go back home for serious health issues (that's when they'd be eaten alive in the us) where treatment is really low or no cost. if they're gone from their country for some extended period of time, they usually have to pay a little more, typically equal to a couple of hundred dollars per year. ask someone.

I'd love to have a government health insurance plan like Medicaid, Medicare, VA...any of them. I'm a LPN having a really hard time finding work. Working for temp. agencies, I never get enough hours to qualify for the insurance that they say they offer, I'm available but I think they try to keep hours down. The market is flooded right now and the pay is very low. I can't afford to pay for private insurance. So yeah, I'd love one of the above. Right now, illegal immigrants have insurance (Medicaid) and I don't. So, I am for a universal type plan - that seems to work very well in European countries. Paying 1.5 % of one's income so that every legal citizen could be insured, sounds like a good plan to me. Nurses and doctors would still earn a good living. Would there be super rich neurosurgeons? Maybe not, but that seems over blown to me anyway. Would television doctors still get rich selling their own products? Probably. Do healthcare providers actually sell drugs in Europe? I don't think so. But here in the US, Walgreens, CVS, and Walmart, large drug sellers, now provide healthcare visits. This seems a conflict of interest. So, that's my stand....for a start, a universal or single payer type of plan that would assure healthcare for every legal citizen sounds good to me. And by the way, I can easily see that a single parent with three children, making 50K a year would have a really hard time paying the 3-4 hundred dollars per month that even insurance through an employer could cost. I had 1 child and it cost $190 per month plus the co-pays, etc. and that was ten years ago.

Insubordinate and rude? Yes. I also wonder just what was said to her along with the note passing. It really seems that something may be missing as the response was so, so inappropriate-even for a nut case. In my experience, when you get an out-of-the-box response to something seemingly routine-there may be a little something extra going on. You could go back and ask but at this point, you'll never get the real answer. You may have been set up-to be the one who escalates an existing situation. And I know I'll get called on the carpet for this next part-when you're working with women, you always have to be careful of being set up. Sadly, you're right to write her up-the chain of command, insubordination, putting a patient at risk, however minor, etc., etc. And she should be careful of the set up as well. It just happens....

Where I worked, past tense, lots of meds were given together. It was not unusal for all evening meds to be given on the first med pass. I personally, tried to look at the meds to see which could or should be given together. As a result, I was always slow and on my feet 7.5 of the 8 hours. Oh well. That wasn't the worst of it, taking time to know who you were medicating and what their diagnoses were-that's what I didn't have time for. Just looking at the MARS list of diagnoses doesn't necessarily explain why people are getting meds like sleeping pills and sedatives. Could 95 degree rooms make it hard to sleep at night? And why is it that practically every patient, no matter what floor I was on, was getting sedatives? or Benzos? Because they lived in a nursing home? I felt like I was just dumping meds into people, hurriedly. There were a lot of Filipino nurses there and they can be hard to understand - language and cultural issues. Filipino nurses don't understand the idea of a parent having to live in a long term care facility so the patients looked like throw a ways to them - their words, not mine. Now I am generalizing, all Filipino nurses can't be like this but I have to say that most of the ones I've met are. I saw them doing things that I didn't have the nerve to do, or the desire, I guess but they always had so much free time - for dinner and chatting....I actually saw them pulling meds at the end of their shift for the next day. I know it's hard to beleive and it's also one of the reasons why I don't work there anymore. The main reason, however, is that you never have any real time for the patients and they need time probably more than they need medication.

Yes, I would. First, I'm not independently wealthy and would have to work. Second, I've learned to take care of myself. Though not invincible, I would rather work with what I know rather than what I don't. I worked primarily with patients with active pulmonary TB for a year and my TB skin test didn't convert. Third, at the moment, I'm working as a school nurse. I feel super-exposed to everything in that setting. There's little equipment, no proper access to handwashing and you're looked at strangely if you decide to use what's there. If I were working with people with the Swine Flu, like in the early days of HIV/AIDS, you know what you know. It's what you don't know that trips you up. Just my opinion and I welcome yours.

first, a school a few miles away (chicago) has been closed because of a highly suspected case of h1n1. second, for the purposes of assessing a student at school, flu-like symptoms are flu-like symptoms. that child needs to be sent home, period. we'd likely not be able to discern the difference in a few minutes at school unless a child was presenting with really severe symptoms. and still, the symptoms are basically the same. the school staff is tasked with following up on students who were sent home or who are not in school - to find out why they're out, if they've gone to the doctor and the diagnosis. this information is then to be forwarded to the main offices of cps and cdph. this school is 99.9% hispanic with a large portion of mexicans so as far as i'm concerned, all bets are off. you just have to do what you feel is appropriate. opinions, please.

ditto for me in-person, as well as on the phone with indian and asian doctors, filipino nurses and others with a pronounced accent. as health care providers, it's always best for the patient to get clear, accurate orders. everyone should be on the same page but....not.

with this patient having already missed x3 doses of antibiotics, basically the damage was already done. it's probably best all around to wait and notify the doc of the missed doses. he could make a determination as to how to proceed. if i know the reason that the patient is on antibiotics and know that it needs to be continued, such as for critical-pneumonia, not only do i need an order but also since x 3 doses were missed, but i need to know how to proceed. for me, it's a matter of the standard of care. i call the doc. to be social, i apologize for the late call and explain why i need the info. if he yells and curses, so be it, as long as i get the information i need. i'm the person there and the patient is in my care. as much as possible, i go with continuity of care. if the doc is a real a**, and i'm not able to get the info and new orders, i notify the charge nurse, chart it and move on with the goal of the day shift continuing the process. the reality is "sticks and stones...." again, i go for standards and continuity of care. i always try to follow up with him if i see him, i smile and speak to him, like hi dr. whoever, i hold out my hand to shake and introduce myself, i'm blah, blah, the nurse you yelled at when i called you about so and so. they've been 100% sheepish and usually apologize profusely. i think they feel pretty stupid and i feel like the adult in the room.

a really huge lawsuit was won in illinois around a med tech allowing a family to beleive she was a nurse. it's a bit easier to accept a poor prognosid and a bad outcome when they're thinking that the professional staff has done all they could. but a bad outcome when a professional staff was not there? uh-uh. would the outcome been different with a professional staff there? just that question equals winning.

fake nails: studies have shown that they harbor all kinds of germs, bad stuff. they already knew this about natural nails, it's why surgeons scrub with a brush. back to the bad stuff, it's passed from patient to patient even when doing a simple task like taking pulses or bps. think about all the things you touch that's been touched by any number of other people, like the med cart and med cards or containers. do you know if they're washing their hands as much as you? and then, you self-innoculate and go home with whatever it is. trying to manage this by using gloves more? you set up the perfect breeding ground for all the stuff between the nails-warm and moist, inside the gloves. all this can happen with natural nails as well, which i have so work on the premise of handwashing, handwashing, handwashing. and self-innoculation-i wash my hands before i use the bathroom, for me and afterward for everyone else. with fake nails, handwashing before you use the rest room is useless. i use a really good hand cream for the cuticles and dry or broken skin-a generic neutragena or aquaphor-put it in a small squeeze container that fits in my pocket. it helps soothe and protect the cuticles and nails. the bad stuff doesn't survive as well in an oil or beeswax medium.

i've seen it work really well, too. "i'm going to give you your sleeping pill (not available, giving a tylenol) but stay in bed because it's really strong and i don't want you to have any falls". fast forward 15 min., the patient is knocked out and slept the rest of the night. i've seen placebos on a med card as well.