busy-bee

They have yet to bring this up again with me. I think they understand that by bringing this up after I have told them I am uncomfortable with their request would not be in their best interest. The person they terminated was terminated unfairly when the facility knew this situation and they are at fault for allowing it to go on for years without doing the right thing from the first incident. I wish I could just tell you all what it is cuz it would put a different light on it. And the person terminated was a victim as well of their denial. Not only once, but many of times. I feel very sorry for this person, it is not fair this has happened. They say only unemployment is what this person could get but I disagree. When I turned this in verbally it was to say "look this is happening", "you need to be honest" but they instead said "this person is the cause of it all" "terminate"! I wish I had some balls, I feel terrble.

This is a non union facilitly. I have done nothing wrong and I am not quiting my job just because they think they can force me into doing something I told them I do not wish to do. If I write what I know, the heads will roll and they should know this. They said "don't be elaberate with your statement". I am not writing anything to help the facility dig themselves out of hot water...nope....not me.

I have been requested by the facility I work at to write a statement that I verbally reported. When I verbally reported the situation, to my knowledge no action was taken. Several days later, after a series of events...they terminate this person. Now they want me to put my verbal report in writing. When I verbally reported what I had seen, the DON stated to me many reasons why my verbal report was basically not credible. I do believe this will go to court...and I do not wish to put anything in writing for many reasons. I know this is very vague...but I need to be very vague. This situation has been going on for several years at this facility, and many staff have been affected by this. The facility is trying to blame this one individual for the final outcome of their denial of the situation and not taking the appropriate measures years ago. If I put anything on paper in will be the truth, the WHOLE TRUTH. This will be very bad for the company. I explained I am very uncomfortable....but got the dagger look. What should I do, I have been told my job is in jeopardy if I do not write this.

Maybe I should know this..but I don't...and I can't find any literature on this. If a patient has a triple lumen feeding tube...first g-tube...second J tube...and I think third is BAL...Which site is used for the feeding. I have always been told the J tube, due to this type of tubing is used when a patient has difficulty with gastro feeding. And the G-tube used for the medication and the BAL is to left alone. NO MD order present...which should be...but none. And not my patient but overheard the other nurses talking about which one to used...and they all told the nurse in charge of the patient to use the G-Tube. I disagreed stating what i did above....but more importantly said to call the MD to get an order. I guess she decided to use G-tube. So.....does anyone have correct answer other than the real one which is to get an order. Patient has been in facility for over two weeks and it seems funny to me no one has clarified this.

No sure what the final outcome of the patient. The rapid response doctor did not write an order to send him to ICU, why I am really not sure. This was the second rapid response that was called on him within 12 hours so one would of thought the plan would of been ICU. I asked the supervisor what the plan was, and she said she just did not know. I have only been in the hospital setting for a short period of time so all this was very new to me.

Had an elderly pt with A flutter with RVR. History of two MI's, one a year ago or so. PT respiratory rate like that of cheyne stoking and rapid response called on him several times without change in condition. Blood pressure bottoming out, desating, pt anxious trying to get out of bed so he could breath. We wanted pt to be transferred to ICU but it never happened. Pt is a full code and the pit in my stomach was terrible. I was having chest pain from worrying myself to death and from running myself ragid. I had seven pts all primary care. When I asked if he could be transferred to ICU the supervisor stated he was not a candidate, even though that is where he was transfered from. I felt so useless.

"I'll help" but the help never comes

Thanks for your replies, it is frustrating due to the the time that is wasted prior to getting permission to notify. They say you can't put what the doc actually says if he is rude for that is called negative charting. I would never call unless it was important and always have everything in front of me prepared for the doc. I think the system is broke if you have to spend time tippy toeing around people who are suppose to be professionals. The next time I call for a BP that is sky high and I have nothing to admn and the doc yells at me and gives me no orders I will just call a RRT and then he can deal with it later.

I work night weekends on a med-surg unit. I have been there for about 7 months. When I first started, the LPN's prior to calling the doc, had to discuss the reason for wanting to call the doc to the RN/PCC or the Supervisor and they would decide if if the nurse could. Then after three months, we were informed that only the PCC was allowed to call the doc. Now it's the LPN runs it by the PCC, she decides whether LPN calls or she calls. And every since I have worked there, I have been informed of how this Dr. is going to "chew your butt out when you call him so be ready". Not for something you have done wrong, this is just for calling him. Hell before I even call the doc, I am so damn stressed out it is unreal. First for having to run everything by the PCC....then wait to see if she/he gives me permission...or if she decides she'll do it or will I...and then wait to get my butt chewed. Understanding the PCC must know at all times what is going on with the patients. And then if I am told not to call....where am I protected as a nurse. And if I get to call and the doc yells at me and gives me no new orders except DON'T CALL ME....then what? All the other places I have worked....I just called....I didn't have to jump threw all these hoops. I would really love to chart "{Dr. informed of change of condition and no new orders except he states "don't call me again!"}

Thank you all...tonight I had a great night, I hope for many of these.

I have been a nurse for seven years, all in LTC. I recently took a LPN position on a med surg unit. It is pretty overwhelming. The patients are fine, it's the computer I am having problems with. It just takes me so dang long.......all the other nursing are done with their assessments before I even get done with my first assessment. I am so use to looking at paper MAR's, that the medication administration list on the computer confuses the heck out of me. I am so cautious not to make any med errors which takes me a great deal of time administrating meds. I just want to make sure I do things correctly/accurately. And the reports are taped and the nurses go so fast...and sometimes you can't even understand what they say. I am being really hard on myself and thinking about going back to LTC, but I want this experience. I know I can do this if given time to get in the nich of things. Need some encouragement.

Write each and every occurence up. I know taking time to do this is aggrivating as all h*ll, but you need to do it. Just write it quick, simple, and to the point..hand it to the CNA and be done with it. No long discussions, or going over what is written....it is written and she can read. If you give her a verbal...write...progressive disciplinary action on each occurence. That should take care of it...and if she continues...then move to the next step....even if it is the next day...and give her a written warning...writing...progressive disciplinary action on each occurence...after a few of thes progessive actions she will either quit, be fired, or get her head out of her...ya know.

I have just accepted employment at our local hospital. I have been a nurse for seven years all in which I have spent in nursing homes/rehabs. I am feeling a bit anxious and hoping I have made the correct decision. I feel I am a good nurse, but my skills are poor related to nursing home experiences doesn't give many opportunities to start IV and there are many procedures I am not familiar with. I feel this is the best thing I can do for my career. I will be working 6p to 6a weekend op on the med surg unit. Has anyone had this transition and if so will you share your experience with me? The pay is good too, which I was shocked.

DX MRSA in urine...tx macrodantin....no cath placed....is this common? At all the other facilities I have worked, we always placed a cath. No a private room either, and both patients use the same toilet?

Today my intent was to put altered nutritional status as the nursing diagnosis related to a patients low albumin level. Suggestion was to put...."low albumin" as the care plan since this was the problem. Low albumin is not an approved nursing diagnosis. In this facility every order, there is a care plan, that is for labs draws, xrays, everything...not one order should not have a care plan. I am a bit confused. This is a nursing home, and all the other places I have worked upper management took care of the careplans. I don't object to doing them....just need a bit of help. I thought altered nurtritional status....was much more appropriate than low albumin....what do you think...or do you have better nursing diagnosis. The order I received was "full dietary evaluation related to low albumin level". Help....how about nutrition, imbalance. :bowingpur

I went to an interview the other day at a LTC facility, everything sounding very well and I have been offered a LPN position. On a return call, I asked if there has been a big turn over at the facility (during the interview I picked up that it might be). The administrator stated yes indeed there has been and he contributes this mostly to having no current DON or ADON. When I asked for how long he replied "for some time now". He states the unit managers are acting as the health care advisors at this time. This was not mention during my interview. Ya know, I am really uncomfortable with this. I have never worked in a facility where there has been no DON nor ADON. What do you all think? I currently have a job. This is not the only job I have been offered but it is the best paying job, but as we know, money isn't everything. Let me know what you think?

A patient sick for more than a week with pneumonia, took a terrible turn for the worst. We called in hospice and all. The last few days she was drowning in white thick mucus. Terrible thing to watch and to listen to. She really looked so uncomfortable struggling to breath due to the secretions were so thick and copious. We got an order to suction PRN (already had atropine, Roxanol, and Ativan Intensol as well)from hospice. She appeared much more comfortable after suctioned. Anyhow, the night supervisor came in and really got upset...stating suctioning her was cruel. The family might I add wanted us to suction and I guess the supervisor was told this, the supervisor told the nurse on duty, "then the family needs education". I guess she directed the nurse to remove the suction machine from the room but the nurse would not do it ( she told her twice to remove it). Later the supervisor called another supervisor telling her all about it. I took report and was told about the supervisor comments. I suctioned the little lady x1 prior to her dying several hours into my shift. Ya know I worked with this little lady for months and would of done nothing CRUEL to her. And if the supervisor really thought this was such a big issue, why didn't she call hospice and get the order DC'd and go "educate" this family herself. This really burns my behind. I think this is her OPINION, and her opinion/how she feels about it should of taken a side seat. I guess she never even went in an assessed the patient, nor had any communication with the family. If the family wanted this done, and it made the patient more comfortable then what was her deal. I really hope she does not speak to me on this matter.:angryfire I had an order, the family wanted it and the patient appeared comfortable....get over it.

I work in LTC Facility and have 29 residents. There is not one resident that I do not pass the bulk of the medication to. I work 6a to 2p, which I absolutely HATE. Anyhow..I can't get done. I get the floor work done, pass meds, tx, etc. But I can't get NO desk time. They are starting to give me a hard time about staying late to get the charting done. I really don't know what to do. A different unit has 32 residents and the nurse does not chart AT ALL. On Mon, Tues, Wed a nurse comes in at 10:00 to chart for that hall and to do whatever else needs done. I take no breaks except my lunch, and it most often is not a full 30 minutes. Today, I had 7 people on antibiotics related to pneumonia and URI's which 3 have nebs twice on my shift. Two G-tubes, 3 IDDM's with accu check at 12P, one patient actively dying (can't believe she made it thru the shift). I have to be in the dining room and am responsible to feed one table. Not to mention, I most often have to get residents to the dining room, pass out the clothing protectors, and pass out the trays, prior to actually feeding my table. I found two skin issues on two different residents which required, occurence reporting, and a bunch of other paper work and notifications.. ..and at 1:50 p.m. I had an admission. And then I get harrassed about staying over to do paperwork. What would you of done in the same situation? I really am about ready to walk. :angryfire

Just the other day, CNA told me "I am not getting ____ up!" I asked "Why not?" her response, "I said I am not getting her up, if you want her up, you get her up!" So I did, along with an CNA I pulled from a different unit. I wrote her up....she refused to sign the write up and then they moved her moved to a different hall. I think she should of received at least a three day suspension...but what the heck.......just leaves room for another CNA to do the same. Moving her to a different hall does not teach her anything. They made this like a personal issue verses what it actually was which was gross insobordination.

In the facility I work at.....you must be off four days to begin you sick pay. If you are hospitalized then your sick pay may begin from the first missed day. I haven't heard of this either. Most places...if you call off ill then you make take a sick day if you have sick time available.

That will get someones attention.

I have been smoke free for 14 days....my husband as well. I took Chantix for 3 months and was able to get my cigs down to 8 to 10 per day. Once I ran out of Chantix, I hit the smokes again for about two weeks. Then again took Chantix, for one month this time. I have not smoked for 14 days now and have not had any Chantix for about 6 days. To let you know, I had very vivid dreams with Chantix. I would wake up feeling like I actually ran the marathon that I dreamed I was in. I know also my mood has changed....I am very easily upset and more opt to tell any one about how I feel...not good. Hopefully this will all subside soon. I am dying for a smoke but I am not going to do it.

The therapist wrote the order: PT to decrease left hi pain on 1/28/07. The xray order was written on 2-1-08 by the Dr. because the therapist stated the resident c/o left hip pain. The therapist told me she doesn't need to talk with the nurses....very matter of factly. Obviously the therapist doesn't even have to speak with the family either. I just don't think therapy should of bypassed nursing like this.

I took an order off last week for a resident to receive PT to decrease left hip pain. I tried to call the therapist to ask...when did pain start, etc, resident has dementia? Unable to contact PT, but needed to still notify family to let them know of the new order. I called family to let them know (they visit several times a week) of new order. Family member states she is unaware of hip pain. I suggest to her to speak with therapist, for I am as well unaware. I am off for the following two days and return for the weekend. When I return to work there is an order for xray to pelvis, left hip, knee and femur. I ask in report why and none of the nurses on the unit knew. The xrays come back negative...mind you nothing is charted in the nursing notes related to any type of pain, reason for xray, etc. Today I make a point of finding PT and asking them about this...oh yes, the therapist states resident c/o left hip pain so she asked for xrays. I asked if she talked with the nurse regarding this and she states noooo, she doesn't have to go through a nurse. I told her I asked her only if she spoke with a nurse....and she stated no. She went to walk away and I calmly asked her if she would like the results in which I told her they were negative. I have never heard of nursing being bypassed like this before. Not to mention, if PT thought there might of been a fx, the PT should of been placed on hold..not continued....what the heck? Am I wrong thinking like this. From the time PT was odered to the results of the xrays was six days...something isn't right with this. The order actually read..... Xray to pelvis, left hip, femur, and knee to rule out fracture, not an emergency........ I would think any of those would be considered an emergency to know. I guess you all get the meaning of all this....it just isn't right. What do you think?

When they walk by to go to break I can hear them say "Gosh, it stinks terrible down here." I am the only nurse on the hall and it makes me feel like they are saying I am not keeping up on my unit. I can't really control the smell. I know my patients are clean, it is just that I changed a colostomy. I am going to try talking to the doctor about the aspirin and try the coffee grounds. Now you are saying coffee grounds already been run through a coffee filter, correct?