nursekare

:heartbeat :redpinkhe I am an RN. I've been an RN for 15 years. For 15 years prior, I was an LPN. In LPN training, we were told by our instructors that if we didn't continue our eduction, we would eventually be phased out by the ANA. This was in 1979. LPN's continue to function in nursing and will always have a place in rendering care to those in need. With the nursing shortage in many states eliminating LPNs will only add to the problem in those states. I live in a state where the shortage is so low that the ANA doesn't consider Mississippi as having a shortage. And, LPNs continue to render care in acute and long-term care settings in spite of the dire predictions of my LPN educators. The hospital where I work no longer hires LPNs but has in house about 10. I have worked with many of these nurses and they have years of experience and offer care comparable to most RN's. The main problems most RN's have with them is that they are not allowed to do the intial assessments on their patients and are not allowed to do IV therapy, even if they are certified in IVT, leaving the RN to do all their IVF"s and IV medications and their initial 12 hr shift assestments along with those of their own assignments. If management and the ANA allowed the LPN's to function to their abilities, the problem here in this state with LPNs in acute care would be eliminated. If LPNs are able to assess LTC patients with professional skill then they most assuredly are able to assess acutely ill patients with the same proficiency. IMO, LPN's are a vital part of nursing and should be allowed to function to their full capacity in both the long-term and acute care settings. I've worked with RN's of lesser skills then many LPN's I've had the pleasure of working with. :redpinkhe :heartbeat

I have felt the same way at one time or another, squawmeemaw. I've read a few of the repsonses to your post. And, I personally don't agree with some of them. The ANA likes to talk about the nursing shortage, yet the administrations in many of our nations hospitals and healthcare facilities suck and holding a job is primarily contingent upon playing office politics even when that office is in a AC facility, LTC facility, urgi-care facility, or any healthcare realated facility where the goal is to care for the patient not suck up to those who control the purse strings. Sometimes, those in authority abuse their power over peoples lives. I've heard the old adage said, many times, that "nurses eat their young", which only goes to show that there is a certain amount of problems with nursing interaction with each other and with those in authority towards those who actually do all of the work. Some have implied that it could be a matter of attitude on your part. Not knowing the full circumstances, I can and will say only this, The shortage of nursing is due in part to ineffiecient and to inappropriate management destroying careers due to their inablity to mange well and the middle management staff having to take the fault when something goes wrong because of it. If there's some other career that you'd rather go into, consider it. But, I say, if you want to stay in nursing, do so. There's someone in management somewhere who'll appreciate the nursing knowledge and care you have to impart to your patients, your fellow nurses, and to your choosen profession.

i've seen many nurses get fired for doing one thing wrong. not long ago, in a hospital i was working in, a new graduate recieved the results of a positive drug test on a patient and a container of an illicit drug had been found in the room. the nurse thought that she was supposed to notify police of this and without notifying the house supervisor and/or security made a call to the local police department. she had a detailed conversation with the police about the patient and was informed by the officer to call the supervisor. at the end of the incident the admininstration said that she had violated several policies, hippa violation, calling without notifying the supervisor, calling without notifying security,... and the nurse was fired. so, things don't always happen as we might think.

security should have called the police after the first couple of times that the visitor began throwing things. not only was she putting the staff at risk of injury but other patients and their visitors as well. someone in a prior post indicated that hospital policies are there to be followed but most facilities have policies allowing security to call policing agencies when patients & visitors become unruly and make the patient care environment, in which they find themselves, unsafe. if security and the house supervisor had been called multiple times previously and if this visitor was given preferential treatment in spite of policies giving the supervisor & security the authority to call the police, the nurse was within her rights to call the police and provide a safe environment for the patients & other visitors, not to mention a safe work environment for his/her coworkers. the lack of a hostile work environment is federal law. the nurse really should see a lawyer, if what was posted is factual. she/he might be able to get their job back and recieve compensation for time missed from work related to the firing. this is one of many reasons why burn-out is such a problem in the nursing profession. expecting staff members to endure the tirades and physical assualts of patients and visitors should not be an expected requisite for the position. if they act like a psych patient they should be treated like one and a take down performed and medication administered or they should be given the option of leaving never to return or going to see the local jail. i applaud the nurse for taking such bold steps. unfortunately, the hospital administration holds all the cards in regard to employment until the case is settled by a judge and/or jury.

tiij, I wasn't offended by your remarks and I concur with your thoughts on nursing in this country. American nurses are some of the highest paid in the world and we whine about how hard the work is. If U.S. nurses went abroad to work maybe we'd better appreciate how well we have it here in this country. Unfortunately, most of us never leave the country. I've stated on my job that I'd be willing to make less money if it meant that everyone who needs healthcare recieved it. My co-workers thought that I had lost my senses and requested that I keep that tidbit of info to myself, as they were afraid that management might here it. If nurses trully went into nursing for the right reasons, salary wouldn't even be an issue. The real issue would be having the proper equipment and the proper staffing to do an adequate job in caring for the sick and infirm.

[color=brown]personally, i feel that this obsession many have with grammer, spelling, and pronunciation, is a perfect indicator of why many poor people and people from certain cultures, races, and/or ethinicities don't recieve the same level of healthcare as others. what difference does it make whether a person spells, or pronounces a word correctlly as long as the intended message is conveyed. when i was a little girl, my family moved to the northwest, i had started first grade in the south where the starting age was 6. when we moved, the starting age was 7. so, i was a year younger then all the other kids in my grade. the teacher resented this and made lite of my southern accent. so much so that she forced me to take phonics because she said she couldn't understand a word i said. i spoke perfect english except for the southern accent. persecuted for my accent alone; and, it made me feel different from all the other students and ashamed of my heritage. many years before becoming an rn, as an lpn in training, i was taught that grammer wasn't paramount when charting. i was taught to use a few words as possible to convey the message on the chart to conserve space. when doing this, grammer often flies out of the window of syntax. and, when i went back to school to obtain my degree, many of my instructors praised my succint method of charting. presently, with this computerized charting, there is only so much space to chart. therefore, we are encouraged to use as few words as possible, making proper language useage impractical. as for a nurse's poor grammer making them look unprofessional or a lawyer utilizing the same to make them appear less professional to a jury, it's simply false. if the president of the u.s.a. can speak with poor syntax and mispronunciation, i seriously doubt that a jury would consider a nurse less of a professional. as a matter of fact, many of those same people who use improper grammer are jurors. were a lawyer for a plantiff to utilize such a technique, it wouldn't serve his clients best interests.

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i believe that the first thing that you need to do is obtain and read the hospital policy/protocol for heparin administration. if you can determine from the policy that you indeed violated it by your action or inaction, you must take the write-up like the professional that you are. if it is determined that policy wasn't violated, when asked to sign the write-up document refuse to sign it and ask for a copy of the document, if you intend to seek legal representation, to give to your attorney. if an attorney isn't in the cards, write your reasons for refusing to sign it somewhere on the document and return it to the manager of the unit. that way your side of the story is available for anyone examining your employee file to see and understand your side of the situation. this will come in handy if you transfer to another area of practice within your facility. start the written refusal to sign with something like this; i, [insert name here], refuse to sign this document. then proceed with your version of events. i hope this gives you some clues as to how to handle the situation. it is good nursing practice when performing a proceedure or task for the first time to determine if there is a protocol that must be followed and/or a hospital policy that one must adhere to. ask your fellow staff members. if you don't feel comfortable with their advice, look up the policy yourself and read it. if you still don't feel comfortable, call the covering house supervisor for further advice on the situation. often times nurses in the specialty areas [ed, or, icu, ccu...] can be helpful in certain situations, use all available resources when not sure when performing a proceedure for the first time. keep your chin up. the only nurse that doesn't make a mistake is one who doesn't report their mistakes and/or hasn't been caught making a mistake by a staff member who would report it to those in authority.

I have been a nurse for 28 years. I have seen people die of many varied diseases and for many varied reasons. I too have issues with the administration of of drugs by nurses to make the dieing comfortable. The issue of taking part in what seems to me an act of euthanasia causes me a much painful moral delimma. I feel that if the patient and/or their family wishes the patient to be kept comfortable the use of PCA(Patient Controlled Analgesia) pump would be quite useful in administering the requied dose of morphine needed to maintain, what some have termed, a comfortable death. It can be administered by a family member simply by pushing the button on the PCA pump, utilizing bolus dosage, it can be administered by continuous infusion, or both methods can be used, low dose continuous infusion with bolus doeses. Some argue that for a PCA pump to work, the patient must be conscious in order for the analgesic to be patient controlled. But, when we have orders on a terminal unconcious patient to administer MSO4 and ativan at very frequent intervals at the behest of the family, I am unable to see the differnce in allowing them to push the PCA pump button. Then the issue of a nurses actual participation in this act of euthanasia is minimal. The argument that the nurse is assisting the patient to a comfortable death doesn't set right with me, because as your patient can attest death is neither comfortable nor painless. That is my belief.

i believe that the facilities that employ nurses shouldn't be so hung up on the color or kind of uniform a nurse wears as long as the uniform covers the appropriate areas of the body, the nurse performs their duties, comes to work on time, and performs their job according to facility policies.

A similar occurance once happened at a hospital in which I worked. During a code in ICU, a nurse thought that the ET tube wasn't working properly in the coding patient and after several strong pulls ripped it from the patient without deflating the cuff. It was quite possible that she could have caused trauma to the patients vocal cords. It turned out the patient survived the code and the vocal cords weren't severely damaged. As for the recommedation that someone call the police, if that were done, you can rest assured that the nurse making the call would not be employed at that facility much longer. As the call not only implicates the staff member in liability but the facility that employs them as well. My suggestion is to go up the chain of command, all the way to the CEO if necessary. Hopefully, one of those in management will see the hazard that her behavior caused to the patient and staff, not to mention the liabilty of the facility. BTW, always make copies of anything you turn into managment. Sometimes documents have a way of disappearing after you turn them in. That way, if you must go up the chain of command, you always have a copy of the original document for reference.

Nitara is a beautiful little girl! I have always known that leaving the g-tube site open to air is quite helpful unless the area is bleeding or draining excessively. I wish you could find out the name of the steroid cream used so that I could find out if it's available at my facility. Thanks for sharing. Nursekare

well said!! couldn't have said it any better. this woman had a history of psychosis and was instructed to reconsider her desire to continue to have children in light of her considerable struggle with reality. yet, her husband, who made her the monster that she has become, allowed her to continue to give birth knowing that each subsequent pregnancy with the possibilty of post partum psychosis an ever present catalyst into the abyss of madness was allowed to walk away from his complicity in this entire matter.

[color=sienna]i've felt the same way about some agency nurses. they make much more than most of the hospital staff; and, many times they require more supervision than the regular staff. however, i've worked with many agency nurses who knew considerably more than i and had much more experience from whom i've learned much. the real problem in most hospitals, as i see it, is when the staff nurses are incompetent and don't want you questioning their care of the patient. for instance, i worked with a staff nurse who had a patient walking the hall bent over in pain and the nurse was ignoring the situation. i asked the patient, "what's wrong?" the patient replied, "i'm having this terrible pain in my side and my medicine doesn't seem to be helping. i had hoped that my doctor would have increased my pain medicine this afternoon but since i was asleep, from lack of sleep the nite before, i didn't get the chance to ask him." so, i went to his staff nurse and asked her, "your patient in room 65 is in the hall bent over in pain, would you mind if i called the doctor after i examine him?" the staff nurse replied with her head rocking to and fro and with much sarcasm, "uh, yeah!!" so, since this was the 3rd time that the patient was in the hall exhibiting signs and symptoms of pain, i said to his nurse, "well the patient is in the hallway and appears to be in pain. what's going on with the patient?" the staff nurse responded, "he wants more pain medicine." i stated, "well, i'm concerned that the patient might make a complaint about having to wait until the morning for anyone to address his problem." the nurse became very irrate, so, i walked away. this staff nurse then changed the assignment and put her pain ridden patient on my assignment list. i told the nurse, "no thanks, the patient is yours." she responded, "well, if you think that you're going to do my job, then do it." my only concern was for this chronically ill patient, who seemed to be having immense pain that wasn't being controlled by the medication that the patient was recieving and that the nurse might get in trouble if a formal complaint was made, thereby making the night shift staff look bad. if the nurse had already addressed the problem, all the nurse had to do was say so. if not, what was the harm of calling the m.d.? the worst that might happen is that the physician would chew me out and not prescribe anything further for the patient. as a patient advocate, i thought that was the purpose of a nurse, to ensure adequate care of the patient. i reported the incident to my nurse manager. imho, nurses who have issues with questions concerning their patient care are trying to cover up their own incompetence, be it laziness or outright lack of skill. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ the patients name was witheld and the patients accurate room number, gender, actual conversation, and diagnosis was changed to protect the right to privacy. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ nursekare

my story. i never really wanted to be a nurse or a teacher, as they are female dominated careers. i wanted to be a trailblazer. i wanted to go into a career that no woman had ever been in. i wanted to be anything but a nurse or a teacher. nonetheless, i was young, hormonal, and in love. in love with a man who my parents felt wasn't good enough for me. being confused about what was right, i spoke with my pastor. he listened intently to my plight and advised me that parents aren't always right. he asked how much education i and my boyfriend(he is now my husband) had. i told him that we both had hs diplomas. he advised that i go to school and continue my education, as it is hard to make a marriage work, especially when finances are in short supply. he told me to look into the lpn program at the local community college. after graduating in 1979 from the lpn program, my husband and i were married. after a while, my parents grew to love him as much as i. in 1995, i completed my degree in nursing, and i'm now working as a staff rn at a local hospital, as i find management a bore and too demanding. when asked for advice, i always encourage people to go into the medical profession in any capacity, as there is always work, the pay is adequate, and the work is very rewarding. so, if a person were to choose to continue their education, they can afford the tuition and still help out with the family, with the rest of the financial responsibilities, and it will give them a warm and fuzzy feeling helping those in need. thanks for the thread. it's quite interesting and often humorous. nursekare:nurse: