mazy

I'm old and I never want to leave bedside nursing. Hopefully I won't get pushed out by someone who thinks I belong at a desk.

I absolutely agree with the point that management needs to be supportive of nurses disciplining CNAs. Unfortunately, I have worked with CNAs who wouldn't have any problem being sent home, even knowing that they won't get a paycheck. Add in a dramatic confrontation with a nurse in front of everyone and the day is a total win. If they are allowed to come back, even if they have to jump through a lot of disciplinary hoops to do that, the only thing they understand is that the nurse did the most extreme thing possible to enforce discipline and they still got to come back to work and now what is the nurse going to do? I have seen this kind of thing happen too many times. And seen good nurses go because of it. The problem is a CNA with a history of insubordination that has gotten so bad that the only way to get the message across is to have them sent them home. If all disciplinary measures have been exhausted that it's come to this, then it's time to find someone else. There are plenty of perfectly good CNAs out there looking for work. I agree with sunny, the most important thing management needs to do to support their nurses in disciplining CNAs is to go that extra mile and weed out the bad ones and nurture the good good.

Doesn't sound like a good facility, especially if Medicare is ranking them poorly. If it's a rehab facility, and not just long-term care, you will be drowning with only a 1 RN to 20 patient ratio, especially if you only have two CNAs. GrnTea makes a good point, you could pick up some per diem shifts and see how it works.

Someone on this site once pointed out that all the highly dramatic things that we see doctors doing on TV as they are supposedly doing patient care are actually the meat and potatoes of the nurses job. For whatever reason, people find it more appealing to watch a doctor obtain a urine specimen or place an IV than a nurse. Things that make me go Hunh? Watching a doctor on Grey's pull out a packet of sterile gloves, open it up, pull out the gloves, flap them around, blow on them, smack them up and down on the table for good measure and then put them on; hospice patients on tele; critical patients without lines or O2; people freaking out when someone pulls off their EKG leads -- as if it's going to kill them; people pulling out their IVs without any mess; and patients waking up from year-long comas completely rested and able-bodied. MASH was definitely a great show though, I loved Major Hoolihan.

To me it sounds like they are putting the nurses in an untenable position. Why is management making you do their job? It seems like a set-up that will create an adversarial environment between nurses and CNAs, when they should be problem-solving and finding ways to make the units go smoothly. You guys are all front line staff and the management should be doing whatever they can to promote a healthy team environment. If that can't happen it is on them to look at their staffing and hiring practices, and additionally address discipline problems and find ways to create a positive working culture. Making the nurses do their dirty work is just wrong. Not to mention the fact that if you send a CNA home, now your unit is working short. No one wins with that. Except management -- one less paycheck to worry about; they've got a unit that is drowning and understaffed, but now they can just blame the nurse for sending the CNA home. I wouldn't want to be in your shoes.

I agree with nursel56. This is not a big deal. Agencies keep a long list of potential staff, much more staff than they even have work for. You can put yourself on the inactive list and if something else comes up that looks interesting you can make yourself available. On another note, Maxim is not a very good or reliable agency anyway. If you do accept a case make sure you nail down the salary before accepting.

I had a job interview back when I was first starting out where I went in to interview one person, then another, then got in to talk to another, and so on. Every person I talked to asked me how I felt about conflict in the work place. I had been a CNA so I knew all about personality clashes in healthcare so I kept giving decent enough answers about how to navigate conflict situations. But then I started getting really frustrated, because I was thinking "why do they keep asking me this?" And I kept trying to give articulate responses, but I was getting tired -- it was a really long interview and was starting to feel like an interrogation -- and finally the last person in the chain asked me again "how comfortable do you feel with conflict" and I just blurted out "I'm not comfortable with conflict AT ALL." Well. I didn't get the job, but by that point I didn't want it. Forty nine patients per nurse is an absolutely insane ratio and you are better off not being in that facility. There's a lot to be said for knowing your own limitations and being able to advocate for your own best interests.

You don't get your LVN license until you pass the NCLEX, so if you complete an LVN program you will get your certificate or diploma, then proceed on to take your licensing exam, and then you will be a Licensed nurse. Make sure, when looking into the programs, that they are accredited and if you want to continue with your education I would suggest you look into whether the credits you get can be transferred over to another school. First place to start is on your Board of Nursing website, which should have a list of all accredited nursing programs in the area.

I'm a happy LPN and I understand the sentiment of the OPs post. I don't like the way it was presented. It does come across as whine-y to write what seems like a sonnet about why "I'm sorry you don't like me because..." and then to make it seem like one is being victimized by certain perceptions from another group, which then serves to make belittling generalizations about the group that you are complaining about. I have had experiences where RNs have looked down on me, or it could be CNAs or other LPNs, but every where you go you can find someone who is going to look down on you for one reason or another. More often it's an issue with the general public being unimpressed, and what can you do about that? There's not much I can do except to make it a point to treat the people around me with respect for the jobs they do; wherever that job lands them in the hierarchy of healthcare, we're a team. I'm also out there in the world daring to exist as a "woman of a certain age." Talk about feeling looked down upon. Life isn't fair. You do the best you can to be the best person you can be and try not let it get to you -- live by example and treat others with respect.

Agreed. I am actually shocked by these posts about facilities where clean caths are acceptable. In all my years I have never heard of such a thing. My mind is boggled. At first I was kind of conflicted about how the OP handled this situation, but after reading all of these posts I think she did the right thing. Management needs to be reminded that if they are aware of these practices, the issue needs to be addressed, not just because of one nurse, but because the facility is promoting a culture where infection control is not being taken seriously. We nurses should never resign ourselves to a situation simply because that's the way things go and there is nothing to be done about it. If I were working in a facility where there were no resources to do sterile caths, I would be asking a whole lot of questions about it. I'm not sure I would even be comfortable staying there.

It probably would have been best to put him to bed and cover the site well with a towel, and place some additional chux under the patient. A colostomy change is not life or death. And it was late and the patient was probably very tired and should have been put in bed. Nurses are under enormous pressure to transition both in and out of their shift and get report done so that the incoming shift can take over. Sometimes a colostomy change takes a few minutes, sometimes a complication can come up and the nurse will be stuck there for a lot longer. As a result the incoming nurse will not be able to assume the floor and will not be able to handle any other urgent issues that come up during that time. Nurses rely on CNAs to be able to take the initiative in situations like that. So it sounds like you wanted to do right by your patient, but were not aware of what the nurses were thinking or coping with. Sometimes what looks like a nurse charting is something a lot more urgent that requires immediate follow up. Hopefully next time you will know better.

The case could be made that the posting did not violate HIPAA but that doesn't mean the poster should not be disciplined in some way. She seems to be OK with that and willing to learn from the mistake, so kudos to her. As much as our employers -- and in this case the school -- would like to govern and micro-manage our professional and personal lives, the fact is that they can't. So the onus is on us as professionals to govern ourselves and to know what kind of behavior crosses the line, even if it is allowed or not expressly forbidden. Even if no one has written a rule or laid out consequences for this, that, or the other. No one can come up with a policy that explores every single possible type of behavior that could possibly be construed as inappropriate or in what way. We would have to sign off on a thousand page legal document if that were the case -- every single time we walk onto a new job or new study program or a new clinical rotation. We're already drowning in paperwork as it is. We're human, we make mistakes. We're also in a profession that requires us to have a heightened sense of accountability and a lot less wiggle room to be our naturally flawed selves -- at least in public. That's the nature of the job. Our patients need to be able to trust us to be looking out for their best interests, our employers need to know that we are up to the task. There are hundreds of applicants out there for every nursing job, so best strategy to survive in this market is to keep private lives and thoughts and impulses private. May not be fair, but it is what it is.

Danskos. You can't wear them to dance though...

From the behavior you described I have a feeling that even if you were an RN, or a BSN, or an MSN, or any level on the nursing spectrum she would have found a way to put you down -- from your level of education, where you went to school, years on the job, what department you work in (ICU? Med-Surg? ER?, L&D? Geriatrics? which is more hardcore?). Don't lose any sleep about it. She wanted ownership of the experience and was being a snot about it. Most people aren't like that.

Judging from his posts on this site I'm going to say that he sounds lonely. Lots of ideas but not a lot of people to talk to about them. Good thing that this board is open to everyone. But. There are ways to engage with others and there are other ways.

Don't ever apologize for wanting to work in an environment where you can actually be an effective nurse. Don't cry that you have failed, don't worry that you have let people down. Your alternatives were to either stay there and sink, and not help anyone at all, or move on to something better where you can be a good nurse and provide your patients with a fighting chance of surviving the experience of being caught up in the healthcare system. The way healthcare works these days we need nurses who are willing to take a stand, and you have done that. Hopefully in the future you can give yourself a thumbs up instead of feeling like so bad about yourself. In the meantime

Glad you clarified that one. Especially in the same thread where the CNA is using mouthwash for her "other mouth.":snurse:

The Roxanol and Ativan would be administered sublingually so should not be squirted into the mouth, but rather the meds should be placed under the tongue where they are absorbed into the system. If it is possible to control pain and respiratory issues that way it is preferable to an IV, which can be very invasive for a dying patient. At end of life it is common to see Roxanol given Q hour; I have not had the experience of being told it must be given every hour as a scheduled med, usually it is PRN and is given according to nursing judgement. In my own experience, usually when the dr. orders NPO, the order refers to PO medications, which are d/c because they are not useful to a dying patient, and cannot be swallowed anyway. I have not had an order to specifically withhold fluids, and use my nursing judgement as far as that is concerned, but other hospice nurses might have a different experience. It can be very uncomfortable for a dying patient to receive liquids and not at all helpful. However, it does depend on where the patient is in the dying process. I would never withhold liquids from a patient who was alert enough to ask for them, although would probably provide sips or ice chips and good oral care.

Perfect nurses do not have bodily functions.

You say that you don't care what anyone thinks, that you like the sound of your own voice, and that you don't have any problem speaking your mind regardless of how it effects other people or whether it crowds out their own abilities to say what they want to say. In a sense you have summed up the essence of the characteristics you will find from a nurse who "eats her young." So God bless and good work. But if you are interested in discussing the subject you can do a search on this site and find thousands of conversations about it.

It...?

Allrighty. So back on track. Here is an example of a situation that happened to a friend of mine. She went to the pharmacy to refill a prescription for a narcotic. The pharmacy announced in front of everyone what she was taking. As she then went about her shopping she noticed that she was now being followed by three men. She started to leave the building to go to her car and they followed her. She ended up turning around and going back inside and having to call security to escort her to her car. Which did little to alleviate her fears because the other guys had cars too and could have followed her home. She finally did get home, but shaken. And then filed a complaint. It is not possible to know what is going on in the minds of the people around you. A pharmacist asks your name, your birthday, and announces your prescription, maybe it means nothing to the person behind you, maybe it does. I cannot imagine a training course in which pharmacists are told that you don't have to follow HIPAA if someone is getting Vit D or synthroid because no one cares about those meds, but you do have to follow HIPAA if they are taking bc pills or ABX. That puts the pharmacist in the weird position of judging your lifestyle and making determinations about what should and shouldn't matter to you. Pharmacists are not some elevated species of individuals, they are human beings, and flawed in the same way as everyone else. I do not want anyone making judgments about what should matter to me. I don't care what they do for a living.

I'm surprised about this too. Pharmacists are bound by HIPAA. There is no list of meds that are "acceptable" to discuss in public. It is not OK for someone to disclose medical information about someone in public. In the case of it happening in a professional capacity, there are professional regulations and consequences for violating HIPAA. This needs to be addressed. I don't understand the argument that it's best not to say something because by making a fuss you draw more attention to yourself. To create change you need to make a fuss. The OP can complain about this in private, later, after the fact. No one needs to know but the pharmacy. If privacy areas do not exist, then they need to be set up for patient confidentiality. The OP is describing a scenario where the pharmacist took out her med, announced it out loud, pulled out the instructions and counseled her in public. Whether it happened in front of everyone or in another area, either way it's not going to affect the wait time for the other customers. Wherever it occurs, they're still going to be waiting while someone is being counseled. So if it creates problems for other customers that pharmacists are consulting in private, then the pharmacy needs to find a way to accommodate privacy issues. Customers shouldn't have to be in a situation where they say, oh well, I have no choice but to let this happen because the pharmacy doesn't want to adhere to HIPAA. Just because something happens in another area of health care, that doesn't mean it's OK to happen somewhere else. Privacy may be hard to come by in the ER, however up on the floors it's a completely different story. Same as in my doctor's office, or in the pharmacy.

You got a raise, which is good. If they really felt you needed more improvement you would not have gotten a raise. You did not get docked, you got a raise. Not the raise you were hoping for, but it was a raise. A lot of people, myself included, have not gotten a yearly raise because in this economic climate facilities are cutting back on things like staffing and hours, and they can get away with murder when it comes to compensation. We have been told flat out at my job, there will be no raises. For anyone. Now. I know full well that some people are getting raises. But mostly that is because they are taking on responsibilities that no one wants, or they are able to negotiate taking x shift or y unit or some such other weird thing into a bump in pay. But that's life. It's the politics of the work place. It's the same everywhere. I would not stress about this too much. People are not always honest about compensation, even with themselves, and every facility can be counted on to have layers and layers of secrets. You may think you know something to be true, chances are you have no idea of all the back story that is behind everything you hear about.

I would be very upset. To me that seems like a violation of your personal health information/HIPAA. Usually when I go to the pharmacy, the pharmacist shows me the med without saying what it is, and asks if I want any counseling about it, if I say no, then that's the end of that. The one time I had a question, there was a separate window away from the main area so there was some privacy. It doesn't matter what the med is for. The pharmacist may not think it's a big deal that I'm taking whatever it is that I'm taking but that isn't his or her decision to make. I was in line at the pharmacy once, and the pharm tech came out and asked the young women he was helping if she was pregnant. She was standing with a young man who may or may not have been a boyfriend, and with whom she may or may not have wanted to share that information; and I'm sure she didn't want everyone in line at the pharmacy to hear about it either. I was stunned that he did that. And if it had been me I would like to think I would have complained but I think I would have been so mortified I would have just skulked away as fast as possible. I think you have every right to complain. I am angry on your behalf.