PoppaD

Every hospital that receives federal reimbursement must comply with CMA regulations. The privavcy provisions per HIPPA are are prime concern to CMA. If you recall your own hospital orientation...there were people there from not only clinical services, but also your security officers, maintenance guys, kitchen folks, etc. The fact that the hospital is dual hatting it's maintenance staff to serve in "extended roles" does not mean that the facility is not complying with HIPAA.

All hospital staff and volunteers have to comply with HIPPA...

ditto

Like he said...different places have different slang terms for things. Heck, we call the saline ampules that we use to irrigate/lavage ETT's "bullets"...go figure! "Hey....somebody throw me a bullet!"

I would have instructed the NA to stop what she was in the process of doing and leave the pt's room immediately. There is not one thing that she can do that you cannot do; however, there are tons of things that you can do that she cannot. The Nursing Assistant's job is just what the job title says" she's there to assist you in caring for your pt's. Unfortunately, you sunk to this individual's level when you engaged her in discussing what she has come to expect of you. This NA needs to receive some counseling from the Unit Manager STAT. BTW...I was a NA before I became a nurse...and I do kow the value of a good NA.

I TOLD all of them that she was a difficult stick. They proceeded to stick her about 20 TIMES... As a parent I am sure that it must have been traumatic for you and your child to have been stuck so many times; however, as an ER RN I know that often a sick patient...especially a small sick child can be very difficult to obtain IV access and/or successful venipuncture on. The fact that you "told" them that she is hard to stick does not make the RN's task any less difficult. At one point, they had 3 people trying to stick her at the same time! If three RN's were sticking your child simultaneously in the ED the question that should be raised here in this forum is just how sick was this child at that time? It sounds as if she might have been critically ill. Finally they gave up and that is when I became furious since it was OBVIOUSLY not needed. I am curious as to why you think that it was not needed. Your child was admitted to a PICU with PN...IV access and multiple lab draws would certainly be indicated. Should she have been stuck 20 times...I honestly cannot say because I was not there...but it sounds like this child needed some sort of IV access fast. BTW...I would expect her to be bruised having been stuck that many times. "...my daughter had pulled her oxygen away and wrapped it around her neck, her g-tube feed has completely leaked all over the bed, her diapers is soaked with urine and coming out all over the bed and that her alarm is going crazy. He proceeds to take the oxygen completely off, clean her up, put a new diaper on (btw, her little bottom is bleeding from sores)..." I hope that this scenario did not play out as you have described it as a result of neglect. I do know that pt's will remove their oxygen...they will urinate and it sometimes will soak the bed...and g-tubes do become unconnected...in as little as 5 minutes or as long it takes for things to happen. At this point, we do not know if the RN was trying to keep the kid in the room next door from crashing, or if he/she was outside smoking...or anything else in between the two... I hope that your child recovers...and that you will think about attending Nursing School. It ain't as easy as it looks.

Psych waiting areas: "Do you hear what I hear...?

I was going to mention the same book!

Lol....

Folks...PLEASE!!!!!!!!!!!! The old us and them argument continues to divide us and it keeps our attention diverted from advancing our PROFESSION. Do we really need to have the BSN's acting s if they are so much more knowledgable than the ADN/Diploma RN's...Can a MSN prepared nurse who is not engaged in advanced practice care for a pt any better than a Diploma nurse? How many Ph. D's can actually perform acute care at the bedside? Folks...we need to wake up and realize that there are multiple entry points into our profession. The LTC industry depends upon LPNs to care for the needs of the chronicly ill...hospitals depend upon diploma/ADNs to man the bedsides...and yes...BSN nurses can more readily rise up from the bedside to ADMIN. Advanced practice requires a MSN or doctoral degree....but guess what..............everyone of these nurses must have a basic license to practice Nursing. We get too caught up in trying to be better than the next nurse as we acquire new pieces of alphabet sphaghetti to place behind our last names. Ya know...I had a pipe break under my house this past weekend...I called a plumber out to fix the break for me...I had to pay this professional almost $200.00 for an hour's worth of work...he had the skill and training to do for me what I could not do for myself ....very Virginia Henderson dont you think?

Medic04... that's a big 10-4! We are absoloutely agreeing with each other...PoppaD is clear!

Two of the most important variables are the individual's occupational background and their work ethic. I know of one disaster of a nurse that graduated from Excelsior...she was a former EMT who could not make the transition over into nursing. I actually wonder if she was an effective EMT as I think about it now. This woman could not perform a physical assessment, hang a IVPB, or chart effectively after 4 months of orientation. Another point to ponder: I have been considering an online MSN...but, I have been told told in no uncertain terms by Nursing Faculty at two institutions in my area (both are 4-year universities) that the applicants having "online" degrees are not even considered...

First of all...I can only imagine what you and your husband have gone and are going through...I am sure that you have a terribly stressful situation. I pray that you and he will find the strength, courage, and faith needed to see you through the coming days... Now...I am going to play the part of the Devil's Advocate...how can you be certain that for a period of six days not one nurse actually performed a physical assessment on your husband? I am wondering if the stress of having your husband hospitalized and suffering from a serious illness might be clouding your perceptions of the care that was actually delivered. If the nurses in question were only performing on the most minimal levels as you have described...would you not have reported their actions or lack thereof to Nursing Management? Again, I am not accusing you...I am merely asking these questions. I pride myself as being a very conscientious nurse...and, I have been fortunate enought to be ecognized my peers and my facility as a good nurse...yet, I sometimes have a family member swear that I have not done something that I know that I have done. I am willing to bet that you have experienced the same...

My wife is/was a PNP...she teaches in an ADN program...she did the NP thing for a year....but she was in a bad practice where the MD's hated each other and she was caught in a catch-22 situation. She loves teaching and has little desire to return to clinical practice. Good luck...I hope this helps!

I don't have much to add here except to say: THANK GOD FOR CHICS WITH HIPS!!!!!! :devil::devil:

My first job out of Nursing School was at a Medium/Maximum security state facility. On my first day there we had an inmate come into the medical unit after he had been stabbed with a lawn mower blade! My preceptor turned to me and said, "welcome to the pen"... Corrections is not always bad. You will need to take a personal inventory of of your own feelings of self worth and seek ought ways to mask your reactions to hot topics. For instance, the inamtes have nothing bit time on their hands...and they will probe your for weaknesses every chance that they get. If you are not careful you will give up tidbits of information about yourself that the inmates will share and compile a virtual file on you. It is possible that they will learn not only your name, but also where you live...what kind of car you drive...how many members there arein your family, etc. Your best line of defense is to perform your job professionally and empathetically, but without sympathy and and fratinization. Do not ask the inmates what they are " in for". Always provide your services professionally and show the inmates the same degree of respect that you demand from them. Never get to know them on a first name basis...always refer to them as "mister/miss" and yourself as either "Nurse _____" or "Mr/Ms/Mrs ____". I hope this info will help you...feel free to PM me if you need anything further.

The interested LPN might consider completing a paralegal course if this indeed is wthe type of career that they are considering.. Just my two cents...

IN SC it is indeed illegal for a person who is not a nurse to represent him/herself as one. This law was passed years ago by the State Legislature and is enforcable, albeit rarely done.

It's interesting how MD's always seem to site their concern for pt's safety as their primary motivation for suggestion/demanding oversight of APRNs... How many RNs would actually make this kind of mistake???

I'm going to play the part of the Devil's Advocate. In my home state, the Good Samiritan Laws really only applies to lay persons. So, if your are a RN, you are held to the same standards that a RN with similar training and experience would be held to in your given situation. So...you might want to really sit back and ask yourself, "do I really know enough to help this person rather than harm him?".

Be very careful keeping pictures and copies of the MR...you could find yourself on the wrong end of a privacy violation investigation not only by your facility, but also by your BON. This type of information might be of value to your attorney, but I doubt that it would be admissible if the case went to court because it was obtained illegally. I would definitely seek the advice of an attorney regarding this strategy.

Who exactly did the LTC report this to? You Ombudsman or to your state's Licensing or Certification agency...or to your Board of Nursing? I certainly do not mean to suggest that an injury is a minor detail, but if a pt is aggressive (i.e., kicking at the footboard) then he might harm himself. By the way, I do hope that you are carrying your own Nursing Malpractice Insurance...do not count own your facility to cover you in the event of civil action.

I fail to see the rationale behind the practice of giving each med seperately f/b a flush (except in the case of incompatible meds of course). If anything, you are more likely to clog the tube after flushing it with only 5ml water. And...let's consider the pt who takes 15 meds. We check our residual, return it, and flush, then we give a 5ml flush in between each med...so we end up giving a total volume of 75 ml of flush plus whatever volume that was required to actually dissolve the meds into solution (easily 10ml or more). So, our final volume introduced to the resident might very well be on the order of 150 - 200ml. Now we have a pt who is in danger of aspirating! :angryfire And let's not forget that the Joint Commission is requiring us to label any type of solution that has been poured from its original container. I feel sure that the Joint Commission would apply this logic to us carrying meds mixed with water (or whatever) down the hall because "you MIGHT just have to stop AND set you meds down AND someone MIGHT come across your meds AND they MIGHT not know what they are AND take them mistakenly because they weren't labeled..."

The only con that you forgot to mention was the psych holds waiting for placement!

I have practically thrown in the towel. If a pt c/o pain, AND has ok VS...I med 'em and chart 'em. I now operate under the premise that their pain is what they say it is. The only things that I am not flexible on is admin. Narcs to pt's who I have found to be overly sedated, yet are requesting more in the way of meds...and, I do not give meds just because a family member is requesting it (you know, the concerned son/daughter at the bedside).