danvet

I understand that of those suffering from collembola, nurses and teachers make up a high percentage of them. Because of the growing emergence of this disease, the lack of research, understanding, and treatment for this terrible disease, what becomes of those nurses? What happens when it can't be proven it's work related? Are those nurses getting jobs? If so, where? What becomes of the nurses? I am shocked to learn about this disease and that doctors are readily available to label patients as "delusional". What a shame that in a time of such a horrible nursing shortage that is likely to get worse and adding on the rapid spread that this bug seems to have, we are going to have big trouble. On top of physical suffering and feelings of despair and isolation, these patients are then misdiagnosed and ridiculed by the healthcare community. I feel like we need to do something about it. Who is currently doing research on this and it's impact and possible management/cure? For those of you out there wanting more information look the health section of ktvu, san francisco online. Very interesting and scary.

Well, this week isn't better by much. Today I was told I was a "dawdler" and picked up three additional patients in addition to my one scheduled. I arrive at 0800 and my assignment isn't ready and then have unassigned. My first patient looked like a classic dvt, but no way to tell at home. Had to make arrangements to get to MD. Saw two more patients and made up time. Had to get more gas, oh that hurt, but not too bad this time, and proceeded to my 4th pt. Bad situation there, I'll just say neglect issues and was dumped in my lap so had to send to ER but of course, MD line was busy. Work number for me just kept me on hold. I left office at 1025am and returned at 1645. I was told I should've returned at 1500 and that my preceptor wants all my timecards to review. My first line supervisor said that I should't be having overtime and that the load I had was totally doable. I feel like I'm going to be openly ridiculed for time management in the morning. Talk about eating their own young!!!! I'm a strong person with excellent clinical skills and good judgement. To subject me to ridicule over time management seems ridiculous but I am only human after all. And, now I will be case managing my preceptors patients while she is out for couple of weeks. I'm feeling dumped upon. I seem to get all the patients that something is wrong with. Is it because I"m being assigned patients that other nurses are looking to pawn off because they are a problem or can one nurse just have that much bad luck? I've never had anyone treat me so juvenile and unprofessionally and have never been made to feel so inadequate and disorganized in my life and just feel so truly disappointed. I really love the job itself, but these attitudes are turning my usually very positive "can do" self into something meek and insecure. I guess I'll head in with my resignation and also a request to transfer to another unit if the supervisor isn't responsive. You've given good feeback so far, but would love to hear how experienced H.H. nurses weigh in on this issue and past experiences.

I am new to home health but have been a nurse for nearly 10 years and have worked in various settings where I am able to manage my time in the most efficient way. Since taking this new HH job, I am about 3.5 weeks out in the field and I am taking appx. 4 patients now. I actually started with this company about 4 weeks ago and have been taking patients on my own for about 1 1/2 weeks now. I am all over th place. 48 miles yesterday between three patients (was going to be 4 but one cancelled), and all in-town driving. I left out of the office at 0940 and did take a 1 hour lunch. I give up lunch all the time, but did take one yesterday but no breaks. All of my patients had issues such as: seen a week but didn't know anything about their care or meds, and my other patient was only taking a half dose of her prescribed coumadin so her pt/inr was pretty low. I made sure that the problem was taken care of but patient states that she didn't write things down properly. I returned to office at 1750. Any suggestions about how to better manage time and moreover, can you tell me exactly what my responosibility is in making sure everything is correct. These were all weekly summaries and nothing had been updated so I made sure that everything was complete. I am finding things that don't get updated, and I wonder if it's because the CM's aren't always seeing the patients. I just couldn't bring myself to leave something done half way or a patient to screw up her coumadin and get a dvt or worse yet PE. How do you all manage your time???? They say they give 6mos to 1 year to get this job down, I have been very thorough and wonder if I am doing too much? I just don't see that they expect me to be at the level of a HH nurse that's been with the agency for 2-15 years. I am new to home health altogether and love it, but they keep stressing time management so I want to get better ASAP because I love the job otherwise. Coordinator hung up on me yesterday and left bad taste in my mouth, received page demanding to know when I would be back to office. I sincerely see patients, don't go shopping or sleep in the car. HELP!!!!!!!!!!!!!!!!!!!! I need to get better!! Thanks!!!

Just an update for everyone. Things are pretty much the same. I have taken another job, filed a greivance to the CEO and naturally, no response. State was in and apparently they are under scrutiny for failing to report a sentinel even...and finally, heard the words I longed to hear, and unfortunately they weren't "I'm sorry" but that they are in the proceess of becoming more aware of their abuse policies and procedures and they will need to follow taht. I am pursing legal action through governmental agencies. I just know that I have to stand up for the nurses behind me. Just think, if I hadn't reported that incident, what would I do? It'd be my license. I feel as though I have really done well, but I'm still sad for leaving my co-workers and residents. Though, where I am at now, they are like a breath of fresh air and are absoluely wonderful!

Thank you all for the comments you have posted, positive and negative. I'd like to clarify some of the questions you had: 1. The patient stated that the nurse told her to call for herself. There was an entry from a nurse that said they had received a call from a doctor in response to a patient calling for herself. So yes, the nurse received the order from the doctor that the patient called in response to the nurse's comment. 2. I just want you all to know that OF COURSE, I called and notified my superiors. Unfortunately, I got told to begin the investigation which is when I happened upon the forms that were required. Unfortunately, the DON was out on leave and unavailable period. The administrator wasn't any help. I absolutely followed the policy and procedures within our Hospital which they have tried to dispute with me. I actually copied the p&p and gave a copy to the management team. The reason it said to do what I did was because to say anything else would be unlawful and against regs. 3. The state required form when you are doing an investigation is VERY clear and simple to understand. It is in fact an individual responsibility and don't you all think for a minute it is not. Perhaps if given more help or support from management, this would have all been avoided. It was a very difficult position to be in. I still work there and have no intention of leaving. I filed a complaint with the CEO and quickly thereafter, all harassment has since quit. The management has even been "nice", overly nice to me. Wierd kind of nice. My legal counsel says that they likely have been informed by their own attorneys that what they have done is wrong and are now trying to avoid a lawsuit because no other explanation could be ascertained. After having been pulled into many meetings with key top level management, after being harrassed and made to feel stupid, the only thing they could come up with was an issue on rating the pain level which I hold to be the responsibility of the nurse assigned. Amazingly, the nurses I work with were AWESOME support. Nobody has pulled away, though I don't feel it's something that I have to drudge up at work anyway. I had an ex-employee (since all of this occured) come up and say that I had earned the respect of the nurses. My intention was never to cause a problem with the facility, but to do what was required of me from the standpoint of the patient and for my license. I can't imagine that anyone would think I thought half-heartedly about something like this. I actually called the state first to find out if this was even considered a reportable event and have spoken with an obudsman as well. I am very meager and never want to draw attention to myself nor make waves. The LAST thing on this earth I would want is for the state to come in. I didn't think it was that big of a deal after hearing from the state and from the ombudsman that I was REQUIRED to do so. The reason for mandatory reporting being an individual responsibility is to protect patients from having problems of questionable abuse hidden and either partially or if at all corrected. I do believe that these issues can be handled internally, however, even if handled internally, the facility must still report the entire case to the state as well and their findings. The state doesn't do a knee-jerk response either. They allow the facility time to complete their investigation and submit it as well. Apparently, most facilities have issues that are reported and all should be aware and not be so critical. It's part of being in this business. If any of you have a chance, please look at the state required form. The front page is crystal clear on your responsibilities as an individual and as a facility. The bottom line is: Administration/management has a responsibility to be sure that they have adequate resources for the supervisor to consult with. A NON-RN is not appropriate. While the non-RN may be aware of the state regs, they are not aware of the ramifications to the RN license. I would rather defend myself on the actions I took rather than sitting in defense of my license. In my opinon, the facility should have give MUCH more training in regard to this issue if they are going to treat their staff like this. All staff should know what is required, what is expected, and what the ramifications are. No human being should have to be put through this much huimiliation or stress for doing what is required. The facility can take their own course in investigating and disciplining, but it's imperative that employees know that your responsibility is not the same as the facilities responsibility. Each has a responsibility and the punishment can be harsh for failure to report. I fully believe that the reporting party should be cooperative with administration, and I surely was! I had not grudge or issues against this employer. I know for a fact that the reason that I have my job today is because I did in fact follow procedure, and I followed the law. What I know is that I would still report, but it would be handled altogether different and I don't think I would be inclined to give the facility a "heads up." Just for fear of this type of stress. I still know that they did get the "best" of me. My spirit is truly broken and my self confidence is gone. I'm mostly upset that I had to be placed in this position to beging with. This facility has accomplished one thing for sure. Not only would I NEVER tell them I was going to or did report something, the employees that have witnessed this have told management that they would not because of what they saw happen with me. They all say they would do the same thing but not write it down and call from home anonymously. I ask you: Would you rather your employees do it without telling you they did or just be hit with it when the state walks through the door? I feel that this has really taken me down, almost enogh to want to leave the profession altogether. I have since been asked by non-nursing employees considering a career in nursing if I would recommend it. Hard as it is, not only did I say I would despite my experience, I actually said that the employer was really a good employer with a few misguided individuals making it difficult at times. And I do firmly believe that we give the best care possible and I am proud of my work there. I know all the staff works hard and I do to. I refuse to run because they don't like to follow their own policy and procedure. Please let me know if you have further questions. I'll keep you updated, though I think that aside from filing a complaint with the EEOC, I intend to let it go. I mean, I don't want to go to court and get lots of money. What I want is a: staff to feel that they can report what is reportable if doing so in good faith without fear of retaliation and B: To change their practice on punishing employees because they did their legally mandated obligation. I can't help but wonder what the CEO was thinking about all of this. Time wil tell though. For me, this is a total loss of respect for management in regards to fairness, ethics, and the law. I respect them as professionals in their areas, but I wouldn't trust them as a manager any farther than I could throw them. I feel that's what has been crushed. I held the utmost respect for them prior to their retaliatory actions. I'm sure over time, and the process has begun, I will mend, but it will take time. At least when I lay my head on my pillow at night, I can rest knowing what I did was right, ethical, and fundamentally correct. I wonder how they sleep at night. Oh, by the way, the nurse that was involved in this case and myself are very sociable and talk, laugh together a lot. I truly didn't think that it was that big of a deal, and neither did the nurse involved. We've discussed it and she agreed that she would've done the same. And, of course, knowing her, I know that this was not her intent. I'm willing to bet she had a day from hell on that particular day and no maltreatment was intended. She's a very sweet nurse and I do respect her. Thanks!

I work in a California LTC facility. Supervisory responsibilities. I had a really bad weekend and it was extra busy. Patient had nurse send me into room where quite a few allegations of verbal abuse and withholding of pain medication were made. Worse yet, it was substantiated in the chart. The nurse told patient to call for pain med change herself because she was busy so patient did. This resulted in a surgical MD giving an increase in frequency of pain med with acetaminophen product which resulted in >1000 mg of acetaminophen over 4000 mg max dose for more than 10 days. I informed NHA because I couldn't reach DON and was told to begin investigative process. I found state required reporting forms and followed the directions and called/faxed state, and called ombudsman. DON and NHA are infuriated with me. I've been pulled into 3 meetings and have been made to feel stupid, told I didn't follow p&p, and that I used "illegal documentation". Since then, I've been being tracked by individuals in management (you know, all whereabouts must be reported by other nurses as to where I am at all times). I have lost pay which is attributed to an accounting error, and am looking at a demotion from weekend supervisor. It's very difficult right now. I'm feeling awful. I looked at company policy and didn't see where it said to write it up seperately and submit it to management so they could decide. I followed the directions on the forms. Furthermore, the documentation in the chart was nothing more than exactly what the patient stated. No subjective info, no opinions, and no inferences. Simply what the patient stated. Further in the charting I of course had to reveal the discovery and disclosure of the tylenol error to family and on call MD. I know it's retaliation and I'm actively trying to get a lawyer. I've got some concern that somehow they will go to the BRN and report me on frivilous charges. I did check the Nurse Practice Act for California and they say there will be no action taken on any licensee in connection with an abuse report. I don't know what to do. Lawyers are slow to get back to me. I'm documenting what happens at work, but I am not a confrontational person. I'd have given anything in this world to have not come across this. I've never EVER been through an abuse reporting before. Any comments, suggestions? I can't stop having anxiety attacks and they are about to paralyze my ability to fuction. All the upper management and DON suddenly got quiet my last day I worked and it was too quiet. Like they were totally ignoring me on purpose (which I was glad for). Please help!!!! They are making me crazy at this point!!!!

I am a RN and have been working full time for about 8 1/2 years. I have done acute care as in med/surg, LTC, Sub-acute, Rehab, and NICU, and now I am at a 115 SNF. I work with Many LVN's in California. We work 12 hour shifts. In my case, I specifically didn't want the RN superviosor position (EOW and for fill in). I just have that flaw of wanting to please everyone and it's not possible. Anyway, my advice to any new RN grad would be to really get to know your nurses. I'm ashamed to say that I supervise two RN's on days and 3-4 LVN's at any given time. One of the RN's is very thorough and a good nurse. The other RN is basically non-motivated in regards to customer service and nursing practice altogether. I have followed my LVN's enough time that I can say with certainty that I have the BEST LVN's out there. Their assessment skills, documentation, and attention to detail are incredible. They are much more qualified than the RN I have to suppervise. Bottom line, don't assume that the RN with years of experience working next to you is qualified because he/she has the letters RN behind their name. And, be VERY VERY good to your CNA's regardless of what setting you work. They truly are your best friend, your eyes, ears, and you will rely on what they tell you. Don't just ramble off orders of what you need (other than an emergency), but explain the reason why behind what you are doing. Teaching a CNA and encouraging them to go on to become a nurse is wonderful and I don't mean asking them to do things out of their scope of practice. You'll get much more cooperation with a CNA that comes to know that you are competant and that they can also trust you to take them seriously. I've seen nurses that just run them to the ground, treat them poorly and as if they are dumb. One example was that I had a patient that was seen by me about 1 hour earlier for meds. She seemed just fine. The CNA approached me and said "hey, there's something wrong with this patient, she's not acting like herself". Knowing my CNA, and that she knew this person very well, and that she found it necessary to let me know there was a change from the patients baseline, caused me to reassess the patient and take action. As it turned out, the patient was in the early stages of stroke and this CNA probably saved this patient from further decline because of early intervention. Just some great words of advice and I'm sure that there are other nurses out there that share the same experiences. Other staff you work with aren't grunts, but your co-workers and dedicated health care providers. Treat all like you would want to be treated...from the housekeeper all the way up to the CEO. You will not go wrong and find yourself enjoying your work in that you've given the best care possible.

[Yes, this is definately a workers comp issue and HR was notified. HR says no, can't work on vicodin, Occ. Health doc says "it's been done before". But never gave a straight answer. I guess what I need to do is if I get in that much pain, tell them I have to go home. Thanks for the input. I really appreciate it!!!!

Ok, long story short, I dislocated my knee at work on Thursday and went to the ER for treatment. They prescribed bextra and vicodin. I don't have to take the vicodin often, but tomorrow is my first day back at work (yeah, they gave me 1 day off so I had to call out on Sat and Sun) and I'm afraid with the swelling, knee spasms, and increased movement of my leg that I may need to take vicodin to deal with the pain. Is it legal for me to do that? I'm not providing direct patient care, but will be making calls and doing "sedentary work only" per occ. health orders. I don't want to sit in pain if I have it and don't want to go home and loose time and money, but also don't want to jeopordize my practice, license, or have it called into question. I think I've used vicodin one other time post op and that was it, but I'm really in a lot of pain with this. Advice on this subject would be greatly appreciated. I've searched everywhere on the web as to the legality of taking vicodin or pain relief on the job, but I found nothing. Thanks in advance for your help.

I am concerned and unclear about the new minimum staffing law in California. I work in the NICU and of course, we are taking, routinely 1:3. Our intermediate nursery is seperately licensed and upstairs and consists of "growers and feeders" and can go to 1:4. I have questions regarding the breaks: First of all, what are we supposed to do if we are not relieved for breaks? The continuing practice since Jan. 1 has been to have the other nurses (with full assignments) cover your assignment. No effort has been made in getting another body in to relieve us. We are a large hospital in a metropolitan area with a population of >200,000 people. Does that qualify them for "flex"? If we go ahead and take our breaks leaving the other nurses in the room with full assignments to watch our patients, are we in violation of the law? Can we be disciplined by the BRN? I want my breaks, but I also want to keep my license. I am concerned that this issue has not been openly addressed. Please advise on what we should or should not be doing. Thanks!!!!!!

Just wanted say that I did not get dnr'ed from the hospital I love so much. That was a relief. I am still very upset with my agency's handling of the issue that it has prompted me to make a change. I will no longer work within a hospital setting. I am burnt out and fed up with the way staff nurses treat their agency nurses. I have to say, I was upset that I had been labled "that big nurse with the black hair". How rude. Perhaps my perceived attitude was in relation to their attitudes, which of course, never need adjusting, lol. I am going to pursue home health with a vengence. One on one care and I can concentrate my energies on my patients, where it belongs. Maybe in the long run, this is a door opening wide with many more opportunities. I always wanted to try Public Health. I know how hard agency nurses have to work and how difficult some settings may be. I wish you all the luck in the world.

Thanks for your replies and support!!!!! I agree, nurses as a whole need a union. I don't know why we all aren't unionized. Particularly agency nurses who are stepped on by their very own colleagues. What a shame. As for double shifts, never, never again. It's just not worth the stress or aggrevation.

Thanks for your input. It's good to hear someone just starting out will think of this if ever in a charge position. I know when I went to school, one hospital we went to the nurses were mean. Didn't want to teach anything and were not very nice in dealing with students. I have been a charge nurse in the past and I have always been very good to my students. I know having been agency now, I will always be good to my agency nurses as well. It's better than having extra patients!!! Just some info, spoke with my mother, a nurse of 23 years and she recommends I put it in writing and submit it to my agency as well as request that a meeting be held so that I can call them on their accusations (not answering call lights... I actually stopped one nurses medication error while she was at lunch. Hard to do without answering a light!!! lol.). Hopefully it will be a favorable outcome for all sides. If we punished every nurse for talking loudy to a charge nurse, we'd probably have no nurses left!!! At least I had the courtesy to do it in the med room and not in the hall or patients room.

I just wanted to know if any other agency nurses have been put on a DNR list in the past. I have been an agency nurse for 3 years and go mainly to one hospital and once in a while to their sister hospital. The one hospital I work for I've have no problems with in 3 years of contributing 16-40 hours/week consistantly. I went to the sister hospital last Saturday for a double and I was beyond dumped on. My assignment was split between two halls (of course I was the only one). I had 6 patients that were "problem" patients per the other nurses. Between 7am and 7pm I was given a 30 minute break, thats all. Finally, at 7pm when I was thinking of going to lunch, the charge announced that she was giving me an admit (after being told agency doesn't take admits). I had just finished discharging one patient and was down to 5. I was upset and didn't yell, but said "you're giving me an admit? I have to go to lunch first. I'll take it, but I'm telling you I am leaving here at 11:30pm and whatever isn't completed, the other nurse will have to pick up". The admit was cancelled. Then the charge was upset because I was on a remote tele floor and had a problem pt later that night. The doc ordered labetalol IVP 10mg now. If no drop in SBP, double and give 20mg. If still no drop, double and give 40mg. I of course being a med/surg nurse and not tele certified said I was not comfortable with this. The house supervisor was called and said to have the charge nurse (who consequently did my eval) give it. The charge was not happy and ended up giving it. By the end of the night I apologized to the charge nurse and I really did feel terrible. I think I was overwhelmed to say the least and this led to my most unprofessional behavior. First ever in 6 years of professional nursing. I am embarassed and ashamed to say the least, but know my agency says that the hospital I've been going to for 3 years without problem won't take me because they go off of the same list. I guess my only other alternative is to go to another agency, since my agency services a different area than what I live in. I guess it'll be better to work closer to home, but still, it's not a black mark I wanted. If you've ever had this and can offer any advice I'd appreciate it. Thanks for reading!!!!!