Mama Val

The nursing home here lets CNA pass meds after they take a mini-med course. But who knows...the dementia pt can't tell you that she has been getting Bayer (asprin) with her Coumadin for her headaches from that nice nurse in the afternoon. Its too risky, and I am sorry I known in the end the admin will blame the LPNs (Lowest Paid Nurses) because we are easier to get rid of. I don't care if its a Med Tech or an RN. I would hope that the first time anyone does anything that there would be an instructor or supervisor there to assist them. If she is shaking that bad then I don't need her tapping my eardrum with the catheter then flushing my ear like she's washing her car....yes that does hurt. This is after she's looked in your ear first to know the area she is working on ......right. Sorry to be so sarcastic. I do know some great techs out there who have the brains and common sense to be LPNs.

Yes those are so awesome. They have a lot of different subjectrs to choose from. I collected everything from just one page that focuses on the hand or dental anatonomy to a page that has info on basic nutrition facts and I use them for patient teaching. Its great when you can show someone what doesn't work and why. I also use it to clarify my documentation when I chart. I punched holes in mine and keep them at the desk, eveybody uses them now and then. And they last...thank God for lamination. Also try quickstudy.com and Permacharts.com I use those too, I found those up at the bookstore of our University here in town. I am looking for one that has lab values, have you seen anything like that ?????

Thanks everybody Yes I want to leave and their have allready been a few nurses who have quit. But my concern is the ones who will be left here when I am gone. I am sending a letter to my boss and her boss expressing my concerns, no plausable deniability there. My big question I guess is there any rough standard to use for these places. How do you guys run your detox units down in America (the lower 48).

This week a mental health client got into a disagreement with a Residental Aide. It ended with him chasing her out of the building into the parking lot beating her down, slitting her throat and then stabbing her multiple times. She was on the night shift, alone, by herself with at least 6 mental health clients. Now this man has past convictions of violent acts with a knife. How can any administration justify this staffing. I work at the Detox Unit here in town and I work alone with 10-12 clients who are comming off drugs and/or alcohol and 1/2 of them have a psych history also. No relief. No security. No cameras or a video tape so they can catch my assault on tape if it happens. They are started back on their psych meds as soon as they are sober for us, never mind that they have been non-compliant for months prior and they will be again when they leave here. What a yo-yo effect that must have on a serotonin level. I have told my boss how dangerous this place is, can get but she doesn't get it. She tells me "this is not the jail" (my other job). I feel safer there. I can count on one hand with fingers left over how many times I have seen her work the floor. I just wonder what the $ number is that will make the admin people figure out that its more cost effective to put in a security system or hire another warm body than to pay off a family and their legal fee for a death. After all its obvious its all about how much money they will have to spend, not about the lives that will change because of it. Do any of you work in a Detox Unit and how do you operate. Does this sound to far fetched or am I really making to much out of this. I do not know the woman that was killed but my heart and prayers go out to her and her family. Her husband had just returned from Iraq 2 months ago. So sad in so many ways.

Yes cardiacRN2006 thats my friend Ebola, all dressed up for Christmas in red and green. :Holly2: FA LA LA LA LALALA :monkeydance:

I love how some facilities support their staff. Never mind that its Christmas.. How can you expect anyone to pull 2 12 hour shifts in 2 days and then turn around and pull another shift less than 8 hours later. I work 12 hour shifts 7 days on then 7 days off, but thats my regular schedule that I have gotten used to, planned out with 12 hours in between for sleep. Come on people even pilots aren't allowed to work those crazy hours without so many hours of rest. Now they don't want to tell you what your schedule is until 3 days prior to a holiday because they don't want to hear the complaining. Simple solution Get the leave requests in 30 days before the requested days off and you won't have to worry about it. Leave request not in on time..no leave given. Gee how simple does that sound, its been done at every other place I have worked at. If these people can't straighten out the complainers by setting a sensible policy that works for everyone (and sticking to it) then mabey they should come in and work that shift or find work elsewhere

2 years ago my 10 year old son was caught in a rock slide. Multi lacs to face and hand resulting in 2 reconstructive surgeries. I picked him up and took him to the ER rather than wait for the ambulance. They called in every department for their eval and opinion. I didn't leave his side even when they said it would be better if I just "took a seat in the waiting room". I told them that I was a nurse and I wasn't going to get in the way and I would let them do their job but my job was to stay here for my son. He was awake up until they took him into surgery asking me questions when he could and I answered as best I could. He was a strong man that day. When my best friend went to go pick up his father to bring him to the hospital to see him he slammed the door in her face. Some parent6s react in different ways. You could not and would not have gotten me out of that room for anything!!!

I agree!!! File charges of assault, she placed you in fear, thats at least 4th degree Assault. File for destruction of property or criminal mischief for destroying your phone. If you see her again after you file the restraining order charge her with harrasment. I know this is a little much but your better to send her the message now that you are not going to put up with any of her BS.

When I work at Detox we use the CIWA and it allows for a lot of wiggle room as needed. We use Librium unless the pt is allergic or not responding then we use the Ativan. The pts up here like the Ativan a little tooooooo much. We can give up to 600-700mg qDay of Librium with an ANPs order. We use it for the anxiety and HTN assoc with the withdrawl. When I work at the jail we used to have a P&P that just assesed the VS now we have this new guideline that we follow and we use Tranxene- I hate the stuff and there is no acomidation for those old tymers who Detox harder than the newer drunks. Its just done by paper not by patient so that leaves our hands a little tied unless we can get hold of somebody for an order. Its like they don't trust us to make assessments and decisions ...and thats another story all together.

Please tell me you told Admin to shut up and you filed assault charges anyway....you did do it........right????? Sorry big advocate for nurses safety...because we really don't have any. Seen to many injured nurses that didn't need to get hurt. How many of you were trained in school to deal one on one with a schizo meth head in withdrawals. Or did you learn on the job how to talk fast while you and duck and weave. If you let any patient assault you and they do not have face the consequences of their actions then your telling the patient its ok to hit the next nurse who comes on duty or the patient in the next bed. Would you want your child laying in that bed...scary but think about it. This time a bruise and you don't do anything so next time its a skull fracture and its too late for that person. It all starts somewhere. If you did nothing to stop it you are also to blame. File assault charges!!!

I had a Doc at the ER write this on the discharge sheet of a male patient that we had received at the jail for a 12-hour Sleep-Off. 1. STOP drinking alcohol 2. Drink more water 3. Eat good food 4. BE KIND TO ALL WOMEN Now that is what I call wishfulllll thinking :roll

Rob Sorry this sounds like a load of BS to me. I have worked with plenty of nurses that were on a controlled drug at one time or another and some who take it daily like you. Some of these nurses have had a UA every few months and other never get tested but none have been told to go home until they were off the med. A few had to take some time off to get used to the drug or a dose change but come on. Remember your military training when somebody would give you an answer that didn't quite sound right... SHOW ME THE REGULATION !!!!!!! or I'll call my lawyer and start an ADA lawsuit faster than you can spell it.:flamesonb

Question for any records people out there. ??? If you request your records from a hospital or clinic does the hospital have to provide everything that you asked for (checked off on the ROI, etc). Can a healthcare facility choose to hold information and not give it to you. Even if the informnation came from another source but is is not a part of your chart now. I say no but am I wrong??? I am thinking that if they do hold stuff back they have to tell you what and why unless they are just trying to cover their own a$$. Thanks

No issues at all with patient care. Never any incidents or write ups where patient safety was at risk. Thanks for your help.

I called the BON and Dept of Labor for my state and they both have told me that there are no set rules or guidelines for anything like that. There is no liomitations on how long a person can work. Scary when you think about it really. Who wants to fly in the airplane with the pilot who has allready been for 20 hours. The employer can adopt federal guidelines if they want to since there are no state rules. I was thinking about something along federal guidelines. If anybody can give me an idea where to look I would be ever so greatfull.

:angryfire I am having a problem at work and I hope you can help. A couple of the nurses at my job, myself included, work a second job. Now we work a second job in the nursing field because it pays more than working at the Texaco down the street, or why bother to work right? My boss has told me that I might have to quit my second nursing job because I work to many "nursing" hours and I can lose my license. He is telling another nurse the same. :angryfire How he found out my hours I don't know. He knows where I work but no specifics on when, I don't give him my schedule. He wants my time sheets for there and is looking at the time sheets for here. :angryfire :angryfire SORRY BUSTER, not getting anything from my other job from me. I allready called them and they are not giving anything to him. They are telling me they will give it to the State Labor or Nursing board if asked but not him. No problem from me there. I am the unioin steward for this place so he is really gonna love it when I tell him this is turning into a union matter and it will need to be dealt with by the union. Its boarding on harrassment. Alaska has no set rules on nursing hours except when it comes to overtime. Does anyone know where I can find any type of guidelines or standard for the hours a nurse may work before thet have to take a break. I have heard everything from 12-18 hours with a 4-8 hours break in between. HELP please.

Nat I know what you mean, but don't be scared about nursing. What you do now will only help you and your patient more later. Experience can't be bought only learned. I'm a Doula too (and an LPN, although that doesn't help sometimes either) some Docs who just don't care... It "me me me me...now now now now!!!!!!!!" I have been know to let my mouth get me into trouble 1 too many times. Now I ignore them until I am finished with what ever I am doing and then I will ask what they wanted ....with a smile :wink2:

Had a 13 y/o come in from a drug treatment facility, she didn't even know who trhe Dad was. In the 2 days that she was there 2 men and 1 boy (wasn't even shaving yet) were given the tour by her to see her baby. While she was waiting on the DNA she was comparing the baby with the possible Dads to see who looked close enough to be the grand prize winner. What a freak show....:uhoh21:

It used to be that you could sit for RN board, not now. That was when they had a long Charlie and short Charlie course (what LPNs/91C used to be called, before they were changed to 91W, I just dated myself). You still have to get credits for the required classes for what ever nursing school you apply for. I can tell you from experience that the 91W course doesn't give you a lot of individual college credits. Even with your ACE transcripts and your DD214 it doesn't add up to a lot. Your gonna have to get a lot of outside core credits that the military doesn't teach. ANd then take the nursing courses. If you can afford it or can handle the workload, take an online class for any core credits or nursing credits that you need. Look into something like Excelsior Nursing>

We go thru spurts of policy changes: This client can come in only once every 7 days then once every 14 days, and so on.. Then we tried, if the client leaves AMA we ban them for 30 days, .. Now we are on contracts, the client has to sign a contract as soon as they are sober. They will agree by written contract to stay until certain criteria are met, for that client, if they leave before all objective are addressed then we can restrict them twice for 7 days, then twice for 14 days, then twice for 21 and finally they are restricted for 1 month periods after that. We only have 1 nurse and 16 beds, our regulars / frequent fliers suck up the bed space and have no intention of trying to change. We don't use Valium or Haldol or they would never leave. Those people that have never been to Detox and really want to change/ still have a chance of recovery, can't get in. Since we take federal money per policy we have to take everybody that come to our door, except sex offenders that is. I printed out your reference packet, thanks.

Aellyssa, I agree with you people misuse the phrase "DTs" as catch all for ETOH withdrawals. I have nurses who tell me "The patients is having DTs but not shaking" or "they have a history of DTs and they get the shakes".They are the same thing, tremons/tremors= shaking or twitching of extremeties ( or a positive tongue wag). Hallucinations, diaphoresis, agitation, anxiety and increased BP/HR are not DTs, they are co S/Sx. You wait until 13, we start at 10. What about their BAC/PBT levels do you have a certain criteria? If the client is intoxicated, BAC/PBT above 0.125 but in active withdrawals, above a 10 on the CIWA, and has a HX of seizures we will start medicating them ASAP. If not they have to be either sober and in active withdrawls or in active withdrawals and with a BAC/PBT of 0.125. I am intrested in what you do down there. What about your freq fliers who know the CIWA by heart and answer 7s for anxiety and agitation but are sitting calmly, hands in lap, resp @ RRR. How do you deal with those clients?

Detoxing a ETOH abuser is rough not knowing if they are playing the game to get drugs or if they really do see snakes crawling out of their bellybutton. CIWA scales are a big help when they are used properly, esp for HCPs who don't deal with drinkers to often. My first dealing with a full blown ETOH detoxing older lady was horrid, I was not prepared at all. I was 6 months pregnant and she was mentally GONE.. alcoholic psychosis, having audio and visual hallucinations, 4 pointed to the bed because she kept tring to pull out her IVs, catheter and she would claw her ABD dressings. She ended up getting out of her restraints and running down the hall. She was tackled by security. I felt so bad afterwards, I was only giving her 25mg Librium every 2-4 hours. The order was 25- 100mg Q 2-4 hrs. I was way under dosing her, not that it would have amade a huge difference but she may have calmed down a little, her BP may have come down sooner. I've learned a lot since. We use Tranxene at the jail- set dose on a set schedule- lets be honest it kinda sucks if your that patient and its in between med times. At Detox we do the Librium dosing with Ativan or Atarax mixed in as needed. We can go up to 600mg Q 24hrs in our patients but if the ANP oks it we can bump it 800mg Q 24hrs. Our ANP will tell you that you can never overdose somebody on Librium, I beg to differ. The problem I have is when you give a person their meds and they go out for a smoke walk off, then come back 4-5 hrs later drunk as a skunk and wanting back in. How much medication do you give the person who is in active DTs, extrem tremors, tonguing waging the whole 9 yards who you know will just walk outta here sooner before later, and yet give them enough to keep them from having a seizure in the bathroom. Clonidine at both place for increased BP as needed.

Boobie Applebuns Trust me it fits, of the course the apples are a little old and bruised

We have 1 nurse day or nights for over 225 inmate at our facility and over 100 at our half-way houses. We do pretty good, our problems are with the half-way houses, they have no medical staff on site at all, all medical needs return to jail.

Don't give in and stick to what you want, it is your body and this is all about you and your daughter, but you can make a compromise with him. Tell your hubby that when he has the next baby he can invite his mom, make your friend wait outside and then you can take color stills, video and digital cam shots of the entire birth from rupture of waters to placenta delivery. P.S. All of his friends will get copies, true to life size.