jadey1

Elopement is when a resident exits the facility without supervision/permission. My facility is weird. I think that legalities are a little funky. We have a resident that is completely lucid, on o2 but knows to remove it from her person before wheeling outside to smoke, but broke the rules by smoking at a non-scheduled time, and was "grounded" from smoking for 2 weeks, as punishment. As for the going in, on my off-day, to take this "test," I didn't go in. I'm going in when my shift is scheduled to start. I never signed a contract saying that I would drop everything in my personal life to go in for ANYTHING, other than my scheduled shifts. They'll be seeing me at 3. I was 1st shift, senior nurse on my Skilled Care Unit, was promoted to Desk Nurse, and was ousted when they hired an RN to replace me. They had me train her for 2 months, assuming I didn't realize that I was training my replacement. I bit the bullet and stepped down gracefully, by giving my notice to quit. They BEGGED me to stay on PRN so I vowed never to work 7-3 again. I took a 2 dollar pay raise and get a $4 shift differential....never worked a first shift since. I've gone back to full time (for benefits) but I'll still never work Administrator Hours ever again. I can't stand being given more responsibility and stress, for less money, plus, I never have to be there when the poop hits the fan, State Surveyers come in, Doctors come in and give a billion orders, and the residents are off the chain. Works well for me. I take my entrance exams for the Bridge Program on the 29th of May for my RN and once I get my degree, in a year, I'm going to be on a level playing field with the ADON and DON so I really won't have to worry about their power trips because they'll know that I'm employable ANYWHERE and I won't have to settle for their demands and bullhockey.

LOL Unfortunately, YES! I just got my eyebrows waxed but a few others had their chins/upper lips waxed. I, personally, would never do that because that's what cream bleach was invented for but to each their own. The night shift nurses all pooled our money and bought our CNA's pizza and supplied drinks. We do that regularly, though. Our CNA's mean a lot to us and I buy them drinks all the time, just to tell them that I appreciate their help. Nurses' Week should be everyday! I thank my CNA's at the end of every shift and throughout the shift, everytime they point out a skin issue or tell me that a resident hit their call bell and requested something. :loveya:

We were offered free facial waxing and 1 minute hand massages with Sea Salt stuff, by our DON's daughter and friend. It was quite nice, actually. I was shocked and awed. You should've seen all the nurses and CNA's running around all night with red, puffy faces. lol:loveya:

I've written about unfair treatment at my LTC facility and I really don't recall writing about anything else, really. This is just going too far, now. I just got a call, on my day off, from the ADON, who is an RN, from a hospital, that's never worked in this kind've environment before, yet who knows it ALL. She informed me that a resident eloped, last night, and that I'm REQUIRED to go in, on my day off, to take a test on elopement. She asked me what time I'd be able to go in and DEMANDED an exact time that she'd be expecting me. Does she have the right to tell DEMAND I go in to take this test? I've taken multiple in-services on elopement risks, interventions, who to contact, the protocols, etc. I really feel like the administrators are "playing house" and are merely wielding power, at this point. Do they have the right to INSIST that we go in on our days off, for stupid, unnecessary "testing." Now, I work 3p-7a, tomorrow, but I'm REQUIRED to go into work BY NOON, to take this "test."

Here is an article regarding these antimicrobial stethoscope covers. Hope it helps. I also found a site that sells them. Antimicrobial stethoscope covers impregnated with silver ions have been developed to prevent surface contamination and potential transmission of bacterial pathogens to patients. To test their practical utility, covers were distributed with the manufacturers' recommendations to a mixed group of health care professionals in a medical/surgical intensive care unit and an emergency department. Seventy-four clinicians were selected from a convenience sample for surface cultures and standard questioning regarding cleaning and cover use. Surface colony counts were significantly lower for uncovered stethoscope diaphragms (mean, 71.4 colonies) compared with covers used ≤1 week (mean, 246.5 colonies) and those >1 week old (mean, 335.6 colonies). After controlling for type of clinician, frequency of stethoscope cleaning, and method of stethoscope cleaning, only the presence of a stethoscope cover was associated with higher colony counts (P http://www.quickmedical.com/drg/diaphragms.html Hope this helps.

The cash slips were pick-up bonuses, given as a perk for picking up shifts. I don't know what the requirements for venipunture is. Honestly, I welcome the opportunity because I LOVE IV administration and phlebotomy. My problem is that staffing is what it is. There's a hiring freeze so we're not getting ADDITIONAL staff, to pick up the slack. To add blood draws to our laundry list of "To Do's" is just shady. When is a floor nurse going to have time to be a Lab Tech, too? I can't complete tasks that I was hired knowing about, let alone MORE. Thanks for the kind words. I take my entrance exam for my RN, in a couple weeks. Hopefully, I graduate, get my degree and licensure and just consult on the do's and don't of employee retention/LTC regulations and how to maximize the full potential of staff to INCREASE revenue. Show how a facililty can have a win/win situation. My theory is that if a facility is consistantly staffed, no matter what the cenus (within reason), a facility will look and smell better. Noone has stuff left undone. The rooms will stay nicer. The residents will look and smell nicer. People will look at our facility and residents and realize that this is the place to trust, to take great care of their family member.

I've posted before that I work in Skilled LTC. Our corporation is going though some budgetary cuts and I'm wondering if all decisions being made are even legal. At a MANDATORY Staff Meeting, yesterday, Administration notified us that as of May 1st, we'll be changing labs. We will be required to draw all STAT labs, spin it, then bag it for courier pick up. I was hired as an LPN, to do patient care; not as a Lab Tech. A lot of our nurses aren't IV certified. How can they draw labs? Are the ones of us who ARE IV-Certified going to be paid additionally, for sticking OTHER nurses' patients, on other units? Are we going to get a raise for being Nurses/Lab Technicians/CNA's, due to staffing cutbacks? Our Baylor's is being done away with. Our yearly raises have been dropped to less than half. We have a weird clock in system that makes you clock in and out for lunch and any discrepencies in forgetting to clock in or out are punishable with write up's, suspensions, and termination, even if a discrepency form is filled out for a missed punch, due to more work for the HR person. Since October, we're on our FOURTH Administrator, third DON, and fourth ADON. Corp. offered little slips of paper with numerical values, for picking up shifts. Cash value was 1/2 of the numerical value; able to be cashed in for movie tickets, Walmart Gift Cards, and other various sundries. During the changing of Administrative hands, our little "Cash Slips" were in limbo. They kept promising us info on what we could do with them. Honestly, I figured they were useless, after a while. A couple weeks ago, they informed us that the Cash Slips were no good, if they were from before October and that we had a deadline to cash them in, or they'd be voided. UHMMM.....Those cash slips were monetary bonuses for services rendered. How can they take them back, now? That's like telling us they want a refund of our paychecks. IS THAT LEGAL???? Mine are all from before October. I have 400 Cash Slips. I always bought movie tickets for my kids, but the tickets were promised but never purchased, by the Administrator. I waited and waited and got nothing. Had I known this, I would've just cashed them in, with Payroll and eaten the tax. I've really got a bad taste in my mouth, after seeing how Corporate greed works, first hand. I'm starting to doubt if I even want to be a nurse anymore. Is this the way it's going to be from now on? Everyone's in a Corp. group: Doctors, hospitals, LTC's, ALF's. It's all going to be the same. We're all just warm "numbers," on the floor, fulfilling State requirements. Corporations don't care about the patients or the staff. Can't wait till next week's mandatory in-service on Abuse and Staff Burnout. PFFT!

If the pump says "occlusion," check to make sure there aren't any sharp bends in the line, leading up to the patient. Normally, that means the patient moved and kinked the lines, somehow. Ask them to straighten their arm, if it's bent, and see if the occlusion fixes; especially in heavier patients, with bigger arms. It could be that the IV spine, itself is bent, within the arm. Sometimes, the roller controller is in closed position or the sliding clamp is still fastened. If the pump says "air," open the pump box, unclamp the tubing and turn the lines upside down (so the patient's end is toward the ceiling) and strum it like a guitar string. That moves the air bubbles away from the pump mechinism part of the line. When there are no air bubbles in the section of tubing that snakes through the box, kink the line to keep the bubbles from going back and snake the lines back through the machine. Lock the box and press START. There are different flush protocols, depending on your particular facility. In our facility, we flush with 5cc's NS and then 5cc's of Heparin, per shift or before and after hanging a bag. Normally, PICC lines don't need Heparin. NEVER use a 12cc syringe, for flushing, on a peripheral IV. The pressure might cause infiltration. Always flush slowly, with ANY syringe. Q shift flushes aren't necessary if it's a continuous flow. Always check for blood return before flushing an IV. Check your facility protocol regarding flushing (ie: what to flush with, amt. to flush with, what kind of IV needs which fluids, how often flushes are required). When priming IV lines, make sure you have the little roller controller tight, so you have control of when to stop the priming, so you don't bleed too much of the med. When you're hanging a med piggy back, spike the PB bag and hold it BELOW the larger bag so the larger bag's fluid will go down, toward the PB bag, and prime the lines. No bleeding necessary and no air bubbles! =) Tops of hands are good for peripheral IV's, if forearm veins are hiding. The vein just over the ring finger is REALLY good....pretty straight. The distal part of the wrist (the dip just above the thumb where the wrist bone is) is good, too. That's a BIG vein. After placing the tournaquette, if you can't find a vein, make the patient pump their hand. Bevel up, poke, when you get the flash, pop the angio release button, and MAKE SURE you untie the tournaquette or when you try to aspirate for blood return, you'll get nothing and think you didn't get it. Hope this is helpful. I LOVE IV's! Sure beats vital signs and charting. A little adrenaline rush always wakes me up. = D GOOD LUCK!

NKY LTC starts new nurses @ $16/hr. With 6 yrs exp., I make almost $18./hr. with a $4 shift differential for 2nd/3rd shifts. PRN is $19.50/hr but you don't qualify for ANY benefits or bonuses. People posted that Rural areas pay less because of lower cost of living but here, you make more because the nurses have to commute and they want to motivate nurses to travel there. Problem is, here, there aren't any jobs available, because of the economy and the 4 main hospitals merged, only hiring RN's. LPN's already on staff have been given 2 year ultimatums to go back to school, quit, or be demoted to custodial workers with the LPN title and the same pay.

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I've been a Licensed nurse for 6 years but decided to try LTC, when I relocated, 2 years ago. I was more worried about the paperwork than the patient care. As a new nurse, you'll have all that information you learned in school FRESH in your mind. Normally, brand new nurses are the best (in my experiences with them). You guys have the mindset of a student, so you just absorb the information so much more quickly than us old birds, who have been out of the loop for a while. The best nurse we have, right now, is a youngun that preceptored at our facility, before she ever even took her big bad test. She was a CNA, here, for a few months, while she was going through school. She knew her patients better than the nurses that worked with the patients, everyday. Since she's a full-time Baylor nurse, SHE helps US! We just help her with what forms she needs, if something arises. Congrats on graduating and passing THE TEST!! *JAWS music* Good luck!

See? I can't stand that when CNA's sit down, right when their shifts begin. Or the ones that clock in and get on the flood, only to inform the nurse that they're taking their break. That irks me. It seems that the CNA's, who've been practicing longer, are the ones that're the cockiest. They're the ones that sit around until last round to start their FIRST round. Then, they lube their patients up with some EPC cream, which is white, and make it look like they've gotten proper care. Nurses, themselves, are ultimately responsible for checking up on the CNA's and the patients. If there's not a privacy bag on a resident's f/c bag, if the call bell is forgotten, out of reach, if a bed isn't put back to low position, after care, or a side rail isn't put back up. Whether it's state/federally regulated, isn't it important to make sure your patient's safe and well-taken care of? You're responsible for your patients. We're so short staffed that 8-10 patients, per CNA, sounds FANTASTIC! We have 2 CNA's per 45-50 patients, on 3rd shift. I don't see how that's legal but whatever...what do I know? The Corporate Gods said that's the way it's supposed to be.

We had a nurse, who made a HUGE med error, once. She's no longer a nurse, r/t to this med error. I'm a float, so I worked that unit the day before. A resident said that she was on a prefilled insulin syring, at home, and that regulated her blood sugar well. At the time she was in our facility, her blood sugar was all over the place. So I passed it on that we needed to obtain an order for Byatta, from our house MD. We got the order, the prefilled syringe came from Pharmacy. No disposable needles came with it. The packaging that the syring came in had "DO NOT DRAW MEDICATION FROM SYRINGE WITH ANOTHER SYRINGE" (or something to that effect). The individual dosage was written on the package, along with "30 day supply." The nurse didn't call pharmacy to double check dosage or search, online, through the manufacturer, for dosing. The nurse took a seperate syringe and drew up ALL of the medication and passed it to another nurse to administer. They injected ALL 30 days worth of Byatta at ONCE! They sharps'ed the syringe and moved on. On 2nd shift, the following nurse noticed the resident was short of breath, diaphoretic, irregular pulse, VERY low bp, and sent the resident out 9-1-1, with cardiac symptoms. 3rd shift came along and the nurse on duty saw the syring in the sharps container. She fished it out and saw that the med error occurred and notified the hospital and DON. HUGE MED ERROR! The woman went into cardiac arrest but she came through it. State was notified. The nurses involved were put on suspension, pending an investigation. The one that drew the med up, ultimately, lost her license because she already had strikes against her. The nurse who administered it was also terminated. 5 RIGHTS!!!! We have armbands with names, room numbers, admission date, red dot for DNR, green dots for thickened liquids, and pictures in the front of the MAR. You can never be TOO careful!

Like someone before mentioned, you know which of your CNA's are really working and the ones that have time to take multiple smoke breaks and sit in the lobby, flipping channels, on 3rd shift. We ARE responsible for our CNAs' work. If there is skin breakdown, we're then, responsible for the hassel of the paperwork, involved in documenting and reporting the skin issue. That should be extra motive to keep a close watch on our aids. Since I'm a floater, in our facility, and I work with ALL CNA's, I need to test my CNA's, to know their "M.O.'s." I pick random residents, stagger rooms, and time and date the briefs, in inconspicuous places. If the CNA does a round, I go back and check my times. If those residents are in the same position and their brief is wet, with my marking on it, I educate the CNA and make them change that resident. I, also, check that my CNA's have the creams available to them. I give report to my CNA's, after I get report, letting them know that certain residents have orders for special creams, and make them write it on their cheat sheets. If I have to remind a CNA to do something more than twice, and they're just not "getting it," I write them up. That being said, I always end my report, to my CNA's with, if they need help, let me know, and I'd be more than willing to assist with turning, repositioning, and changing. I NEED my CNA's and I'm going to do anything in my power to help them, for the sake of OUR residents. Some nurses, I work with, are complacent and feel that CNA's aren't on our level, therefore it's the CNA's job, and they're "above" it. That's completely untrue. Our CNA's are with our patients more. They know the patients, point out changes in behavior, mental status, skin issues, dysuria, dyspnea, dysphagia. Without CNA's, we'd be lost. Treat your CNA's well and they'll treat you well. As someone said in this thread, TEAMWORK IS KEY! Thank your CNA's at the end of your shift. Bring them in a treat, everyonce in a while. Spring for dinner, on occasion. TALK TO THEM! I avoid reprimanding my CNA's, at all costs, but sometimes, it's required that we put our foot down and take some initiative, because ultimately, the responsibility falls on us; their supervisors.

I posted another thread, describing my workplace and it's shortfalls. I forget what the title was, but if you search my posts, under my profile, you'll see it. I'm in Northern KY and I work Skilled LTC/Rehab. As for the RN, with the Master's Degree: She's already been terminated, r/t a huge med error, where an ENTIRE pre-filled syring of Byatta was injected and the patient went into cardiac arrest. She's, since, lost her license, altogether. I didn't mean that she was only going to be as good a NURSE as I was training her to be. I meant, she was only going to be as good a DESK NURSE as I trained her to be. Paperwork, Physicians' Orders, MD/Family communication, admissions....ANYONE can do those things. LPN or RN. I've only been doing LTC for 1.5 years. I've always worked in Dr.'s offices. Triage, med audit, PT/INR's. This is my first hands-on patient care position. I've moved up the ranks VERY quickly. I've been offered a Unit Manager position, on a non-skilled floor. Being mostly LPN's, at my facility, I don't find it fair that we have no say in anything, but a newb RN can come in an push us out of our jobs.