Flynurse

I am absolutely certian sundowners exsists. Maybe this admin. person doesn't know what it is? As it was said, most of the residents we make comfy in their rooms and they come right back out to the hall because they are too restless. Our residents lie down after they return from lunch and most don't get back up until 3 or 4pm (depending on activity at 3pm). I have even done 1:1 time with some of these residents despite my busy sched. However, we have been told to "fix it!" Documentation might have been the reason these nurses got in trouble when giving the antianxiety meds. As nurses, we'll just have to make sure all avenues of interventions for these behaviors are tried before we give the med. Then, be thorough in documenting the behaviors and interventions. I really don't think there is a solution that will make everyone happy. I'll just keep brainstorming!

The Line Up... in the hallway. The "that's not my job" or "I didn't know I wasn't suppose to do that" CNA. A charge nurse that just can't get it together and then piles it all on the other nurse at the end of the shift.

here's an ongoing problem at our facility, and needs to be fixed for the dignity of our residents (and because i don't like stepping in poo that has rolled downhill ). after evening meal our residents tend to get lined up in the hallway along the wall across from the nurse's station. a majority of these residents are there for safety reasons. some of them are there because they don't want to be alone in their rooms. recently someone from admin. was at the facility during these evening hours and was in dismay about the difference from literally night and day...or evening in this case and then reported this to the don. my concern is not with her because, quite frankly, i agree with her. hallways are littered with residents in their w/c's. some of them who constantly try to stand without help or bend over nearly falling out of the chair, others who scream at the top of their lungs, some who plain are just left there. then there are those who roam the halls doing all three behaviors! the question is: why are all of these behaviors occurring on the evening shift when they so plainly do not happen on the day shift? quite simply, my answer is this: there is less staff after 6pm. yes, even on the weekend. i include all departments in this simple answer. there is no social services staff, no admin staff, no restorative or pt/ot/st to stop and say hello or occupy their time. there is not one life enrichment/activities staff member there after 6pm to do an activity or sit and visit. no volunteers come in to chat or play cards or simply sit and hold a hand. these are not solely my excuses but i think it would be a quite obvious reason for the loudness and the line up!!! so what do we do? well, firstly, those who can be in their rooms, who want to just lay down, who would like to sit in their recliners after meal should be escorted first to their rooms. while other cna's pass out snacks, give them something to do, etc. as a nurse i realize this requires the direction and teamwork of nurses and cna's. but.... here's the "situation" when we have meet the immediate needs of these residents (i.e. toileting) and tried many interventions including pain management, but the yelling and other behaviors what are we to do when these residents are so obviously just plain aggitated or sundowners? some of the nurses have administered prn antianxiety meds but then the next thing they know they are being pulled into "the office" for doing so when it was not appropriate. give me your input...please!

At the begining of the shift I make my expectations known and update my CNA's on resident changes and the DON's concerns. I end this brief meeting with "Excellent care makes HAPPY residents and happy residents use call lights less." Nothing is a greater motivator than not having to listen to call lights :) Second, our facility requires "compliance rounds." This can be and started out as, checking everything they are suppose to do by the end of the shift from mouth cares to positioning devices to low beds, etc. Now, since they know what we are looking for, we do a "focus compliance round" (i.e. call lights in place, mouth cares completed). However, it is best they don't know what the focus will be. We fill out a worksheet with all of the things that need to be corrected (and in which room, bed) before they leave shift, and sign what they corrected. Again, great motivator because no one wants to go back and do what should have been done. Yes, it is TIME consuming for you but believe me it worked when we began and continues to remind everyone what needs to be done. You will find less and less wrong and by the time it becomes routine it will take but 5 minutes or so because almost everything is RIGHT! A "Great Job!" and "Thank You for your help!" are in order at the end of the night when all is well. I think we all forget how simple phrases can make people feel needed, esp. at their jobs. As a whole, our facility also has a couple rewards systems. 1) A "Star Performance" board which is based on our facility's mission statements. If someone writes you a note for something POSITIVE you did and posts it on the board you get a treat with your note at the end of the month meeting. 2) Laminated cards for a job well done. If you collect 3 you can go to HR to get a treat of your choice (pop, candy, popcorn,etc.) Who doesn't love FREE stuff!?

Working in a hospice house we continuously experience these situations first hand. I have so many stories in the back of my mind it's amazing. I never knew these events were called Near Death Awareness, but how appropriately named. I have two favorite stories. The first involves a patient who saw a famous person in his room. Had a lovely conversation with him. Then told the nurse who he had just spoken with and that the man would visit with him again soon. The nurse smiled and talked with him about it. Afterwards, she went to the office and there sitting on the counter was a magazine with this famous man on the cover. He'd just died the day before. What's more amazing? The patient had grown up in the same small town as this famous person. A week later he went to have that visit. The second is my favorite. We had a very young man who had died in one of our rooms. The next patient in that room was an elderly lady. There were many times in which she would ask about the lost boy that was in her room. Or say, "[Young Man's Name] wants to know where he should go." She would very often talk about this young man by name. None of this lady's family had any idea who this young man was. They knew no one of that name. It was such a common name too. She too died. No one since has mentioned this lost boy by name. Finally, one day the nurses put two and two together. They like to believe that when this young man died his spirit didn't know where to go and stayed in that room. So, when the lady came to the room he was there, waiting for guidance. And when she died herself she took him with her. I get chills down my spine just thinking about it. I believe this is a wonderful phenomenon the dying experience. Nothing to be afraid of. Nothing to disregard. My most precious memory. An elderly woman barely able to speak. Many children of her own. One day, days before she died, spoke clear as day, "I'll take care of the children." We all assumed she meant her child who died very young. A week after her death, both myself and another nurse found out we were pregnant. How my heart is full of happiness and sadness at this thought. Healthy children will not fear life if their elders have integrity enough not to fear death. ~Erik H. Erikson

OH, BTW if you look young, then you look young. Don't try to "hide" it. You'll just run into more problems about not being yourself. However, I do recommend being conservative in dress and grooming. And above all be professional in all that you do at work.

Though I am 27 (looking quite like 17) I hear these comments over and over. I've been a nurse for 5 years now. All along I have taken it with a smile and say "Yes, I'm old enough to be a nurse. Otherwise, they would have never given me a license." I had a CNA say to me just the other day, "Are you old enough to be a nurse? You can't have been one very long." I still smiled and replied. All that is fine and dandy, right. All but one incident I had and was severely insulted. Especially given my background as a nurse: 8 years total in the medical field, 1 of those years as a Medication Aide, 5 of those years as an LPN. I am a small town girl who ventured out to Long Island, New York (I don't know what you think, but that's a scary situation for a small town girl) I worked in a large hospital there for 2 1/2 years before returning home to Nebraska. Now... the "situation" ... I had a confrontation with an older nurse at work. And wouldn't you know it she went to the "higher ups" with it. Of course I was called to the Medical Director of Nursing's office (an RN with credentials) and it came down to this, the older nurse was right because she was "SEASONED" and I was NOT. The nerve! I told her that woman had never worked a day outside a nursing home and how could she sit there and say I was not qualified to do my job! I don't care how long the other nurse had been doing it (I tell you it wasn't much longer than I). That doesn't make the older nurse right. But all in all, I was still in the wrong. Que sera, sera! I suppose. I'm glad I believe in karma.:thankya:

i just wanted to take a moment to say, "hey! hi! hello! i'm part of the team!" it has been 6 months since i began working in hospice. it has been 10 months since i spoke the words, "i will never work as a nurse again." yes, nearly a year ago i had worked in enough nursing positions and had been in enough unnerving situations to make me feel burned out from nursing after only 3 years as an lpn. i never wanted to go back to the profession. i left new york with a bad taste in my mouth i called, "nursing" and moved back home to nebraska to "start over" again. after trying out a couple other jobs and not succeeding in financially getting back on my feet i was forced to return to the nursing career. i returned to the last place i was employed in nebraska 4 years before i had moved east. ...a unique retirement community ranging from independent living to long term care. i was hired on the spot! yay me!:yelclap: the catch? there was only one position open... night shift at a freestanding facility, miles away from the community itself... a hospice house that had opened only 2 years ago. i thought, "oh great. night shift? hospice? this spells disaster for me." never had i ever been so wrong about anything in my entire life. never! i am not certified as a hospice nurse. what do i do? i am a nurse who works closely with my coworkers and hospice providers and their hospice nurses to fulfill our mission statement. i have truly found my niche. to be able to give the bedside care i hold most precious. to be able to provide comfort to those who need it in an unrushed environment. to be able to be ... a nurse. there certainly are not enough words to describe my relief and gratitude for the wonderful opportunity a higher power and my employers (whom i have a strong regard for going strong 5 years) had given me to be a nurse again. those words were spoken frankly and with tears during a conference held at our facility provided by one of the many hospice providers we work with and attended by many of my coworkers, my mentor/coworker and my employers. i could go on and on about this wonderful place. i could go on and on about my employers/supervisors. however, there just aren't enough words; only the warm feeling i get in my heart everytime i put on my nametag. this...is my saving grace!

The last place I worked handed out first aide kits to the nursing staff last year. For what reason I don't know. They may have been some part of a promotion package with Johnson and Johnson since they use to buy alot of stuff from them. It was a pretty decent one too. Bandages, tape, scissors, tweezers, ointments for cuts and burns, acetaminophen, ibuprofen, ASA, gloves, uh... let's just say it was loaded all inside a tin case. I also keep a CPR mask in my truck. I keep meaning to get a plastic container to put my blanket, my flashlight, a knife to cut open a seat (for the foam insulation, just in case I'm in the middle of no where and have to wait a LONG LONG time) and some water and crackers in my truck as well. Mostly because I don't wanna be caught in a bliazzard with nothing while I wait for help. Call me overcautious, but I'm not gonna die freezing You never know.

Something is better than nothing. That's how I see it.:wink2:

Boobie Apple-lips? :imbar Uh.... no comment. My corrupted mind went wondering again:rolleyes: :chuckle

*sigh* This reminds me of something one of the Directors of Nursing I use to work for told me once, "There's no crying in nursing." He was a donkey's patoot however. I didn't stay there much longer after that. I say there is crying in nursing, just a right place and time for it, otherwise I wouldn't feel human. :) Cold compress and a nice sigh of relief is best, hon. Hope you're feeling better.

You are so very welcome. It was no trouble at all. Hope everything works out for you!

yum! i'm hazelnut. i always did like the smell of that flavor coffee. i'm extraordinary! yay!!!!

I did a little research, but I'm not sure if you are comfortable buying things over the internet. I found the website to the catalog for Girls and Boys Town and searched under apparel. This is what I found: https://www.girlsandboystown.org/store/products.asp?dept=14&title=Apparel If you would like further assistance I would be more than happy to try and help you out.

We were talking about something like this on our unit the other day when our new Director of Nursing decided to "prepare" us for the upcoming nursing shortage. Her idea was to hire MORE non-licensed people to do unlicensed jobs. We thought!!!HEY! What about hiring ward clerks for the ER to put together the charts, enter orders into the computer, and get the damn ball rolling before it gets to our floor!!! :) Can you imagine how much time we would save just by having those things done ahead of time? Then, it wouldn't be so horrible to take two addmissions in one hour. WoW!!! Melissa

I would love love love to have all supplies readily available when needed. Enough with the, "We ran outta saline flushes, 3cc syringes, and blunt needles. And there aren't anymore water pitchers!" All equipment used frequently, such as O2 meters, suction set-ups, decent IV poles, feeding pumps, IV pumps, etc. etc. etc, at least one in each room or one for each bed, depending on the frequency of use. It really irks me when we have so many aspiration precaution patients on the floor, but um...."Where's the suction machines??" And the Pharmacy??? Well...that's a whole other story. I would have one Pharmacist for maybe a small cluster of units with some Pharm Techs under her. This way they can concentrate on specific units. You would be able to call the pharmacy and know that you specifically need to talk to "Jane Doe" about your need. Orders and medications would be picked up, filled and to your unit within the hour. And to help this beautiful senario out we have a tubing system, fax machine, and phone for each Pharmacist's station directly linked to the units they serve! AHHHHHHHH............Dreams! Melissa

Why do women visitors insist on leavine their "designer" bags or leather bags on the sink in a patient's room? Or under the paper towel dispenser? Or under the soap dispenser? Where it can get WET! Its not my bag lady! I am under no obligation to move or even touch your purse. You are a grown woman, move the darn thing yourself! Why would you buy a purse worth hundreds of dollars only to bring it to a hospital and put it one a germ infested sink or bedside table? Why do they have the nerve to say something under their breath as I leave the room? "WAAAAHHHIE?!?!? WAAAAHHHIE?!?!?" -Nancy Kerrigan :chuckle :chuckle

The first 5 to 15 minutes is the most likely time for the patient to have an adverse reaction to the blood product.

Always take my breaks, even if I shave a couple minutes off...you wouldn't want to be one less nurse because I passed out, would you?

At the facility I work at LPN's can hang blood, but I rather just have an RN hang it and I'LL co-sign. Have no problem with it. We were trained at hire. I'll also hang around and assess the patient for the first 15 minutes, but I ALWAYS check in with the RN about the patient's progress!

No policy here! But even if I wanted to I wouldn't. I have always worn a lapel watch to work. I can't stand water getting under my wrist watch when I''m at work. It feels like a bacteria factory to me!

Of course pain is subjective, untill we can read our patient's minds we will never REALLY know how they feel. When I was in nursing school we had a Med-Surg instructor who always talked with us and the patient when we first started learning how to assess a patient's pain. She had told us that 8 times out of 10 we would get patients who said that they didn't want pain medication. And she would show us how we could respond to their needs efficiently without being overbearing. I walked in with my first post-op day 2 hip replacement patient, upon initial assesment I realized this woman was in more pain than she let on. She stated a level "5" out of ten and said that she didn't think she needed pain medicine just yet. She'll "hold out" for a while. I told my instructor this and here is what I observed. The instructor wobbled herself into the patients room with a chair to sit on while she talked with my patient. She talked a bit about the weather and shared a couple of her PG13 jokes to gain the patient's rapport. After this she says, "I understand you just had surgery two days ago." Patient says, "yes, I did.....It was quite painful." Instructor inquires, "When is the last time you took pain medicine?" Patient, "About six hours ago." (It was really eight) Intructor, "I understand you said you were at a level five pain. I'll have Melissa bring you two Percocet for your pain before you get out of bed today. That way you will be more comfortable throughout the day." Patient says, "Well, if you think it would be a good idea, then, okay. I'll take the medicine." We walked out of the room and my Instructor turned to me and said that she has never had anyone refuse pain medicine, especially if she could tell that they really needed it. Then she said what she always said, "Use your best judgement!" While we do struggle with patients who are drug addicts, we do have to realize that these patients can be in pain too. IMHO, I would rather give a patient the pain medication and observe them for adverse signs, than to have someone report me for not taking care of their pain management needs. Use your best judgement!!!

For those of you whose facilities are used BD products you understand what I mean. Orange syringes are associated with Insulin syringes...or at least they used to be. First it started with the TB syringes...the needle's hub and label suddenly started turning up orange. A couple nurses loused up and gave insulin with these syringes. Then, the subcutaneous packaged needle and syringe started turning up with with the same color orange. Again, nurses are making mistakes. Today I went to grab a TB syringe from the bin CLEARLY marked "TB syringes" and I grabbed nothing but a handful of Insulin syringes. Now, that was a mistake waiting to happen! So, I'm curious...who else is experiencing this insane phenomenon?

I was taught in school that we are not allowed to take any form of gift from a patient. With that in mind I do not accept money at all. I tend to eat only a bite of food a family brings in for the nursing staff. And I don't accept any gifts. My own philosophy is this: I don't know what any individual's income may be, so, to avoid any conflict in my own mind I don't accept gifts. Unless, like you said it is a small gift and because of the person's culture. I once had a patient's husband try to slip me a fifty dollar bill. I had only taken care of the lady that day for a few hours. I told him that I couldn't accept the gift, but if he would like to send a card or something to the unit that would be fine. He continued to insist, but I stood my by my values. He did send a card and flowers or something. Here's where it gets sticky, later that day I came home and told my fiance and his grandfather what had happened. They both gave me the third degree. Why didn't you take the money??? You should have taken it. Nobody had to know! What's wrond with you??? I know who I am and I told them about my values and morals...I wouldn't have been able to live with myself had I accepted the money. I have to confess though...I did receive money once, but unbeknownst to me. It was Christmass time and my last week at a facility. A resident's wife gave everyone on the unit a card. When I opened the card at Christmas, after I had left the job, there was a five dollar bill in it. I couldn't return the money...I live states away now! and I don't remember the resident's last name. Take care and accept only chocolate for the whole staff!