mountain_biker_88

Thanks everyone, for your replies. Good call Hygine Queen. Now that I thought about it, a personality disorder is most likely what is going on. I do understand that having a large bedsore on your buttocks is going to be painful, but this patient refuses any decent pain medicine. She is just on Neurotin and Tylenol. She states the last time she took narcotics, she slept for 3 days and almost died. I don’t really know if this is really true, but no doctor is going to prescribe anything for her when she tells them that. Another thing I wanted to mention, I am not new to long term care. I have five years experience in it. I have dealt with difficult patients before, but I will not accept anyone who makes lies about the care she receives from me, or makes malicious personal attacks on me. We are not talking about a patient with severe dementia. We are talking about a grown woman, who knows where she is at, and what time it is. Mental health problems are a poor excuse for bad behaviour. Chinup, I think you are wrong. I reserve the right to refuse any patient I please.... but I also understand that a home has the right to end my employment because of it. I have had one other patient with borderline personality disorder, and I quit my job because of her. In retrospect, I was much happier not having to deal with that person on a daily basis. Just because someone life is miserable, does not mean I will let them take it out on me. Wish me luck.

The dictionary defines compassion as: sympathetic consciousness of others' distress together with a desire to alleviate it With that in mind, I would have to say that the ability to understand and relate to the distress of someone who is sick or wounded, while having the desire to heal him or her, is a very important part of being a nurse. With that said, I don't think you will make a good nurse. You don't have to cry and be get emotional with every patient, but a desire to help the sick and injured, is what this profession is about. Two other things I would like to point out: 1, You religion is irrelevant to how good of a nurse you are. I consider myself a good nurse when I was an Atheist, and I think I am good nurse after I found Christ. 2, A lot of illnesses are beyond ones control. I never chose to have asthma. My nephew never choose to have DiGeorge Syndrome either etc. I am not saying you're a bad person, but based on what you have written. I think you will be very unhappy as a nurse.

Good evening everyone. I have a situation at my job and I would like you all to give me some advice. Three weeks ago, I accepted a position as a charge nurse in a skilled nursing facility. Most of the patients are good people, but I have one lady who is verbally abusive and she routinely slanders me. For example, she has told the care plan coordinater and her psychiatric nurse practictioner that I come into her room every morning, and shoves all of her pills down her throat without telling her what it is. What really happens is, I put each pill, one at a time, on a spoon and place them in her tongue (She has MS and is unable to use most of her limbs, yet her mouth works perfectly fine). This woman also has her medicine memorized, however when she asks I am able to tell her what it is, and why she is taking it. She also has large wound on her buttocks, which is unstageable, but most likely a stage four. And everytime I change it, she says I am „hurting“ her „like I always do“, and not doing it right. She has called me a lousy nurse. Has made personal insults, which I don’t care to repeat. It’s gotten to the point, where I have a witness with me whenever I have to do something for her. At this point, I have come to the conclusion that, I am not going to jepordize my license because this horrible shrew of a woman wants to make up stories. I also not going to be insulted everytime I have to give this lady a pill or provide care. I decided that I am going to refuse this patients for the above reason. I refuse to accept the fact that people who are alert and oriented X3 can speak to me anyway they want to. Has anyone been in a simular situation? If so, what happened? Anyone have any advice? I don’t really want to have to quit my job over this horrid little woman.

Unfortunately there are no laws in my state that set an actual numeric limit on how many patients a nurse can tend to. However it has to be "safe". Now what is "safe" is very subjective. The only staffing requirements in Missouri has to deal with the fire code... 1 person to 10 patients during the day and 1 person to 25 patients at night. I'm not sure how many have to be there during the evening shift.

Well long term care is a bit different then med/surg. Now keep in mind, the only experience with hospital nursing I have was clinicals. My patients tend to be a lot more stable then the ones on your typical med/surg floor. I also have a med tech pass out most routine PO medicines. They can't pass out scedule 2 meds or Coumadin. I also don't have to do a head to toe assessment on each one of my patients every day. Pretty much, all i have to do is accuchecks, treatments and dressing changes, assessing people who are on incident followup and/or having condition changes, taking off orders, and documentation. I know i am missing somethings, but i can't think of it right now. In my opinion, 30 is an optimal amount of patients in long term care. 40 is doable. But 50 is way too much.

I'm going to assume that you just got your license, and if that's the case, I would not accept that job. 52 patient's would be hard for an experience nurse to properly care for, much less someone new to that kind of work. Remember, most nursing homes don't really care about your license, all they care about is making money. Should, god forbid, something go wrong you're going to be the first one that they try to pin it on. If you lose your license, you're easily replaced. I've found that in my job the quality of nursing care is often dependent on staffing ratios. Poor ratios equal substandard care. Do you really want to be part of that. Unfortunately this seems to be the norm at a lot of LTC places. However there are a few good ones out there. I work for a decent one, and usually i am in charge of no more then 30. The only advice I can give you is keep trying. Keep sending resumes, even to the same people. Be persistent, a door will eventually open up. Maybe find a job in a different field until a position opens up. I wish you the best of luck.

I even use military time at home :) I've only worked at one nursing home that used a 12 hour clock, and I still charted in military time.

Good morning everyone. I just got offered a promotion to a PRN nursing supervisor at my nursing home. I've been a manager at a previous job (ISP Tech Support). Other then supervising CNA's, I don't have any experience being a manager in a healthcare setting. I've been licensed as an LPN for 3 years, and I feel pretty confident in my role as a nurse. I was just hoping to get any advice from some people who have been doing the job. Any words of wisdom for a new nurse supervisor? Thanks in advanced

Hello Everyone. I am currently in the middle of planning a possible move to Norfolk or the Hampton Roads Area, and I was wanting to ask a few questions. I'm from St Louis and I just want to move a little closer to the beach. 1, Are there alot of job openings at skilled nursing facilities in that area? Is it pretty easy to get a job there? I'm not to interested in a job at a hospital. 2, What would be a resonable salary to expect in that area? I'm an LPN with 3 years of experiance. 3, What state department regulates nursing homes, and do they post the results of surveys? I like to read the surveys to make sure i don't take a job at a horrible place. In Missouri, the Department of Health and Sr. Services post the results of all state surveys and complaints. 4, Does your state utilize CMT's (Certified Medical Techs) or anything like that to pass pills. I really hate med passes. Especially the 0800 one 5, Is there anything that an LPN in Virginia can't legally do? I know in some states LPN's can't do certain things. 6, Is there anything else I should no before taking a job out there? I really appreciate anyone who took time out to answer these questions. I would also took be interested in hearing any general information about the area. I've been there on holiday and I was really impressed with the city. Thanks in Advanced

I've seen several patients with the ability to go over siderails, so i don't believe they will stop him from getting out of bed. I don't disagree with their use, but they are not witout risk. There has been incidents where confused patients have gotten limbs and necks stuck in them. I think a pressure sensitive alarm would be more appropriate in this situation. I would also recommend putting a mat on the flow next to his bed. You can also get him a low bed as well.

Originally Posted by ChristineN I agree that the CNA overstepped his bounds. However, as far as going through the pt's chart, CNA's have as much right to assess the chart as any other member of the health care team. If you are too busy to explain the effects of Prednisone to the CNA, maybe he'll find a doctor's note that discusses it.A CNA does not have a right to the chart, only the information neccesary to do their job. At my SNF, each aid has a spreadsheet with the information he or she needs to do their job. If there is a change that the aid should be aware of, we change the CNA's spreadsheet. There is alot of information in the patient record that is irrelevent to a CNA. Now things might be different where the original poster works at. But where i am employed, a CNA has very little time to sit around and read charts. They are better utilized tolieting residents, answering call lights, etc. If it is a slow day, i would rather they make small talk with the patients rather then go through their chart. Just my opinion. Mr. Brandon LPN

Wow! Sounds like you have your hands full with this CNA. First I think you need to address this behaviour immediately. If you don't, it will be harder to change as time goes on. I know you don't really want to, but you are going to have to take this CNA aside and "put him in his place". Part of our duties as nurses is to monitor our subordinates and make sure they are performing their jobs correctly. In regards to the situation regarding the water pitcher... I would suggest that you don't "ask" your CNA to get one. You are the nurse on that hall, floor, or ward and you should not "ask" the people who work under you for anything. I would have said, "Will you please get Ms. Soandso a pitcher of water. Thank you". If you phrase your request like that, you've removed his option to not do it. If the CNA does not follow your instructions, your only option at that point is to follow your facility's procedure on writing him up. I would also explain to your CNA that his primary role in the patients care is helping them with ADL's like eating, dressing, bathing, etc. and that should be his main focus. I would sit him down and tell him that he is not qualified or licensed to discuss medications with the patients. If he has any concerns he should inform you, and let you deal with it. I don't know what your facilities policies on his access to patient's chart is, but most places i've worked at would not allow an aid to read them unless he has a specific need. Tell him that he is in violation of hippa, and you will report him to your supervisor if he continues to do so. In my first year of nursing, I had several CNA's act this way. I remember I one rudely tell me in front of a patient, while I was drawing 30 units of Lantus Insulin, "I know you're not going to give that patient all that insulin". My response was, "I am licensed and capable of doing my job, you need to focus on yours. Needless to say, she never questioned my competence again. You as a manager and you need to be firm in setting boundries with your aids. Anything less and they will walk over you. Good Luck, and let us know how it turns out. Mr. Brandon LPN