RN1989

You will NOT look like a jerk! You are so awesome! It takes a lot of courage to do what you did, particularly when you are not in a large facility where you can duck under the radar. If people think you were wrong and are ugly to you - they obviously are not the ethical professionals they claim to be. I have noticed that so many people are doing things and don't even realize that what they are doing is illegal or unethical. They compromise in one thing, then another, and before they know it, their sense of right and wrong is so distorted that they believe they are doing people a favor. Hang in there and keep fighting for what is right! As a Christian, I believe that the road to heaven is narrow and difficult to follow - and I remind myself of that when I am in situations such as yours. Feel good that you did not compromise just because it was convenient.

Most facilities don't have a time period for something like that, compared to switching units. But there must be an open slot for you to take on another shift or day, etc. And often times there must be someone to replace you on that shift as well, as all weekends can sometimes be difficult to get a replacement.

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Any advice YOU feel like giving this poster has nothing to do with MY specific experiences. You are free to give any advice you wish, whether it contradicts someone else or not. I don't desire to get into specifics with you regarding my personal experiences. If you disagree with me - fine. But I'm not in the mood to give you any specifics just so you can tailor your comments to my comments and start down a different road on this thread because you don't agree. Some threads just are not worth getting into passionate discussions over.

Obviously nursing IS like this, or there would not be many posts on allnurses telling tales of this very nature. Perhaps you have not experienced it - but it is becoming the norm and no longer the exception. I have yet to see any employer give an employee the orientation they demanded, as you are telling this novice to do. It is unlikely that a new nurse would be able to know what a "proper" orientation is, since she has no experience. If she were to come up with her own idea of orientation, with no idea whether it would be feasible or not, she likely would never get a job if she walked in demanding it. New employees are terminated quickly for making demands unless they have an iron clad contract. While I am a person who is willing to document the unsafe/unsuitable conditions - I have also lost jobs/been unable to get jobs because of this. A new nurse needs to get experience and likely cannot risk termination or never being hired by being so forthright at this time. There are times it is better to walk away and live to fight another day, than bring to light all the ugliness that is healthcare - that the employers don't want to see anyway.

PCA/PCT is the name hospitals use for an untrained, unlicensed person that does CNA work. Working in a hospital/NH will give you more experience as far as the technical skills of caring for people's ADLs (activities of daily living - feeding, bathing, changing linens, peri-care, etc) as well as prioritizing. Psych attendants do not generally do all that a CNA would do. They are often left in even more dangerous staffing situations than a CNA would be - particularly at state facilities. You should be looking at speaking with financial aid counselors. There may scholarships you don't know about aimed at more mature college students.

You will find this type of situation repeated all over the country every day. You need to be very selective when you choose a job to be sure that you don't get in over your head and feel the need to keep quiting. This is real life, not nursing school.

I've never heard of any "stipend" doing agency work. I'd want more info on all that, how it works, where does this thing come from? Considering that the last agency I worked for paid $26/hr at a horrible hospital.....I might go to to work for an agency that paid $35!

While I think Jolie has some good ideas, I still don't have a belief myself of how to fix this mess. Various hospitals that I have worked for, always had policies in place that had the bottom line numbers for surgeries, etc. for private pay patients. And the cost was significantly lower than what the insurance companies were charged and what the insurance company would pay. Now I have a friend without insurance who is being charged MORE than what they charge the insurance companies. The explanation given was that the insurance companies won't pay the actual cost of the services, so they increase the private pay rates to make up for losing money on insured patients! The hospital is also billing her a special charge because her physician rents office space/equipment from the hospital. Most MDs, dentists, veterinarians, and other professionals set their fees to help cover the cost of things like rent/equipment. Or they consider it an overhead cost as a part of doing business. I think it is really bad form to have someone bill you a separate fee and then let you know that it is to pay your rent! Not sure of an absolute answer, but it is going to be hell trying to get there.

Ours is way more than a measly $1K to keep it affordable. Such is the nature of healthcare today.

Yes, anything you take with you could be called into question (depending on what answers you give in questioning, if someone sees you with "something" they think they can use against you) and you could have to produce it - even normal purse contents. Trial testimony is like a deposition - except there are a few more people. Since you have been through depo - you have a good idea of what will happen and what you need to do to remain calm and answer questions succinctly and professionally. No, it does not look good to make a nurse look bad in front of a jury. I think you will do just fine!

Here in the US, insurance fraud is a big problem for many nurses. I have been asked to give treatments to pts that did not need them, simply because they were more expensive. I have friends who were told to lie about the care the patients needed in order to get insurance money. I have been instructed to not report abuse and neglect - partly because it would have made the facility look bad that it wasn't reported sooner, and also because the pt would no longer receive treatment at that facility if the person was removed from their home and placed into state custody - which would decrease the amount of money coming in to the facility. I have been instructed to disregard the nurse practice act in various ways to save money and/or keep a pt alive because someone without proper education was given care of a pt. You'd be surprised at all the sneaky things that employers due to try to involve US nurses in schemes that are not on the up and up. There are times that the nurses don't even realize what is happening because it is is so sneaky and seemingly normal.

The opposing side will always try to make you look bad. If they didn't - they could get sued for malpractice. Don't take anything with you except ID and anything they tell you to bring. Anything you take with you could be subject to being shown to everyone. I've seen some stuff that was seemingly innocuous in someone's pocket be used against them. Be calm. Wait a few seconds before responding to questions. That lets attorneys have time to object to any questions. It also gives you time to comprehend what they are asking and to formulate a coherent answer. If you are confused, unsure of exactly what is being asked, ask them to repeat the question. Don't get angry. They may try to bait you. Once you get it into your head that they are SUPPOSED to do this, because it is in the best interest of the attorney's clients, it is easier to chill and not let them rattle you. Relax and you will do fine. I was deposed once for a suit against a doc. At the time I thought it was the worst thing in the world. Turns out - it was a piece of cake compared to other things that have happened to me since then.

Someone was prescribing the sleeper. Just because one doctor didn't know about it doesn't mean that your grandmother did not see another doc to get the rx. And a doc obviously would have had to order it while she was in that swing bed. I don't see where anything illegal occurred. Unless your relative is forcing your grandmother's mouth open and shoving the pills down her. That might constitute battery. If the RX isn't in your grandmother's name but she willingly takes meds given to her - there isn't anything you can do about it. I'm sure you have shared tylenol, etc with people who complained of a HA before. No, sharing RX drugs isn't a good idea but again...if your grandmother was a willing participant... If your grandmother is confused and taking meds because she doesn't know any better - then why are you and your mother allowing her to live alone if she is not competent to make decisions about the meds she takes? That could be construed as being as bad as your relative giving your grandmother meds that aren't RX'd for her. There are obviously some family issues that need to be worked out. There isn't anything that APS or the police, etc. will do about this situation. If you don't like what is going on, then your family needs to have a sit down and work things out.

Don't these people have NTG ordered? Generally, NTG is given 3 times, 5 mins apart before calling 911.

As far as you wanting to be more natural and simpler - what you do at home is fine but as a nurse instructing the public - this doesn't fly. Hospitals practice Western medicine. Most doctors are not interested in anything other than "scientific" treatments, etc. You will be putting your job and license on the line if you make any attempt to share your thoughts on more natural/homeopathic lifestyles with patients. It isn't about you, it is about the generally accepted way of caring for patients in this country. I have been asked numerous times to do things I considered unethical and illegal. Did I do them? NO! Did it cost me jobs? YES! Would I do the same things again? Absolutely! Unfotunately, these issues are coming up more and more often. As far as people believing that keeping little old people alive being immoral...I don't consider it necessarily immoral. I don't like it but it isn't about what I like or want, it is about what the patient or their next of kin wants. That doesn't mean that I won't try to show them that quality and quantity of life are vastly different, it just means that I am caring for a person that has different views that I have and must respect their desires, even when I think they are wrong.

Never take originals, put the originals in a page protector to keep. You may need them later down the road as well. Take copies with you. Chances are you won't even need to give them out since most places will just drag you inside and ask you to start work. But if you are in a place that has a high number of schools, you might need them, wait for a good spot to bring them up, unless the recruiter asks you for them first. Toot your horn but don't be pushy showing them. Take whichever recommendations you think are the best. Time period they were written in doesn't really matter - unless you goof and say "I have more recent ones written but I liked these the best" - otherwise they'll never know.

If you put xeroform on areas that are not broken down, the wetness of the xeroform will cause in increase in skin breakdown. If things are scabbed over now, it may be time to stop putting xeroform and simply a dry dressing to protect the scabbed areas from getting ripped open by environmental factors. For things of this type, my fave wound doc taught me that being dry is generally better than being wet. Have you considered fungal/bacterial cultures for these wound?

Just because the wound depth is shallow in your opinion does not mean that this wound cannot benefit from a VAC. The VAC will help keep this wound much cleaner than a regular drsg. With nec. fasc. hx, you don't want any crud buildup in there because it could suddenly get out of control in the hours between drsg changes. It is very possible that the person became infected with the bacteria at home in the first place. Nec. Fac. can kill someone within literal hours. Unless your agency will have someone staying with your pt 24/7 and checking the wound every 1-2 hours for a problem - better to suck anything out of there and have a closed wound drsg than risk getting reinfected and having exudate buildup with a regular drsg. A suture is not going to hinder your VAC unless it is poking through the clear drap and not allowing a good seal.

Sounds like this person has a lot of misconceptions/issues that are hindering care. With the significant illness/surgery she has had, the fact that the breast area is involved, refusal to take pain meds....this person needs to see a psychologist and work out these issues. It also sounds like a need for control. Most likely, nothing that you do will work as this person has deep seated psych issues related to all this stuff.

This forum is for nurses to discuss nursing issues among colleagues. We cannot give medical advice. Please discuss your concerns with your caregivers.

The hospitals that I have worked for usually went by chronological age. The peds nurses know the correct interventions/meds/dosages for children, the adult nurses know the correct stuff for adults. These interventions have nothing to do with whether or not their brain functions as an adult - they go by size/wt. I think it is asking for errors to go by developmental age.

There is not an absolute type of uniform that should be worn by any particular person/skill level. I see two problems with the public's inability to distinguish who is who at the hospital. First, is improper identification. Hospitals often go to mandated dress codes and name badges that have a person's title in very small letters, or even change their title, to cover up the fact that the skill mix (licensed vs unlicensed personnel) is wrong. Hospitals don't want the public to know that they hire lots of unlicensed, untrained people to work for peanuts instead of hiring a licensed professional. Another problem with identification is the staff themselves. They hide their credentials by turning their badge over/covering with stickers, etc. because they are afraid of a "stalker" or a lawsuit - neither of which occur very often considering the thousands of nurses that work every day. Then you have the nurses that do not readily introduce themselves as the "RN in charge of your care today". You also have aides/unlicensed people that try to act like a nurse and do not correct the patient when they address them as "nurse" because they like being mistaken as a licensed professional. And of course, I have rarely seen a lab tech introduce themselves as "Joan, lab technician". They usually just state "I'm here to draw blood". So both hospitals and the staff are guilty of perpetuating the confusion. Most state boards of nursing have requirements that a licensed nurse is required to be able to be readily ID'd as a nurse while on duty. Secondly, the patients don't care to pay attention to what is told to them. A nurse can introduce herself and they don't pay attention because it doesn't matter to them. Patients do not take responsibility for asking questions and they just assume that everyone that walks into their room is a nurse. Hospital staff can wear what ever clothing that is allowed by their employer's dress code. The only misrepresentation I have ever seen is the hiding of credentials by staff and hospitals. As long as a person dresses appropriate to the situation and doesn't show up looking like they belong at a nightclub, I don't have a problem with nurses wearing lab coats or doctors wearing scrubs. I am much more concerned about the professional behaviors of those people.

Writing off a hospital bill or settling in the face of a lawsuit does not imply any negligence or guilt on the part of the facility. It simply means that the amount of money to write off the bill is cheaper than trying to fight a convoluted case that would take months/years to finally determine an outcome. It is unfortunate that your father has had longstanding issues after hospitalization. Many bad things happen in healthcare and this may be the case with your father. However since I am not privy to every fact of your father's case, but I do know that you do not have any experience as a licensed nurse - I believe that there is much more that should be examined as your actions as you have stated them were not appropriate and could have exacerbated the problems.

Most pharm/equipment sales jobs are given to people with business/marketing degrees and proven sales backgrounds. This is much more a business oriented job than a job that requires nursing judgement and most nurses do not have the ability to push the sales quotas required by the company.