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LTC/Rehab, Med Surg, Home Care
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SunnyAndrsn specializes in LTC/Rehab, Med Surg, Home Care.

SunnyAndrsn's Latest Activity

  1. SunnyAndrsn

    Palliative Patients Who Are Full Codes

    I can understand the confusion, it seems to be contradictory to be on palliative care and be a full code. Do the patients actually understand the gravity of their illness? Do they understand the futility involved if and when they code? What is their reasoning for wanting to remain a full code if they have a terminal prognosis? It seems to me that the patients are in denial, which is a stage of the grieving process. Until they are able to accept their prognosis, they likely will want to remain full code status. My primary job is in long term care, and when we have residents and/or families who are unable to accept their loved ones terminal situation, we ask our MDs to discuss this with the family/resident. We have a really great staff MD who is able to have very realistic discussions with families and pts. Most of the time, this works. We do still have a few who remain completely unrealistic, despite the fact that we would break virtually every rib if we did CPR on them.
  2. SunnyAndrsn

    Former co-worker reported to BON

    I know, that is what I am struggling with. I really do want to help her, but if I can help her anonymously I would rather do that, if that makes sense.
  3. SunnyAndrsn

    Former co-worker reported to BON

    I do not doubt that the letter is genuine. I did not see it, but she said it was from the BoN, had the address, etc. She was shocked since it has been well over a year since she was fired. It doesn't seem right to me that this can come up after so long. I want to know when she was reported, and how long it sat at the BON before she got the letter. Essentially, it was for unprofessional behavior but the letter laid out the three instances that she was written up for, the last one caused her to be fired.
  4. SunnyAndrsn

    Former co-worker reported to BON

    I have not shared any identifiying details. I posted here to see if anyone could give any insight about if I could or could not help her, seeing that I still work for the company that fired her. Second, I was wondering if anyone knew of limitations on how long the BON has to investigate, and/or how long an employer has to make a report to the BON. Can my employer find out if who the people are who stand up for her? Finally, I'm looking for info on if my emplyer would find any information on how this works out for her.
  5. SunnyAndrsn

    Former co-worker reported to BON

    I just got a call from a former co-worker who is asking me for a character reference. We were both new-ish nurses when we started working together, and she had numerous problems at the facility. She was very boisterious, and had a potty mouth at the nurse's station. She's not the only nurse known to swear at work, but she tends to be loud. She had a write up over the swearing. No compliants were made by staff, residents, or family--she was heard by a manager and was written up. IMO, this was likely unfair d/t the fact that most of the staff have heard swearing by virtually every manager. I've never heard another manager write up staff for swearing even though it has happened. Her second write up was about her treatment of a CNA. The problem, IMO, was that this CNA's mother got her the job (Mom is also a CNA, has worked at the facility for a long time), and the daughter CNA was very insubordinate. The nurse asked for help from other nurses (myself included) on how to handle the situation with her. She asked management for help in how to handle the situation. She was told that the CNA was not the problem, that the nurse was the problem and that she needed to correct her own attitude first. For the record, the CNA was eventually fired for insubordination, poor work ethic (calling in a lot, showing up late, etc). From what I saw, the CNA was insubordinate and needed the write up, not the nurse. The nurse had asked for help and ended up with a write up! The final write up that resulted in her firing was an incident between her and a combative, resistive resident. She offered to let the resident hit her if it would make her feel better. It was reported by the CNA (the mother of the insubordinate CNA) that she was shaking her butt in the face of the resident. She also stated that the nurse said something about the resident's attitude. There are a few details that I'm leaving out but that is the gist of the situation. I have no first hand knowledge of the incident that resulted in the firing. It's now 18 months later. She's working as a nurse, she's back on her feet, and she gets a letter from the board of nursing. She needs to respond within 10 days. The letter lists the swearing, the write up for treatment of a co-worker, and the incident of shaking her butt in a resident's face. She would like a character reference, and I want to help her. However, I am now a manager at this facility and am hesitant. Any advice for her or for me? Any potential conflict with me writing a personal (not as a manager of our facility) type of reference? Will my employer find out if I do? Is there a time frame on this sort of thing? How long do employers have to report to the board of nursing? Is there a statute of limitations on such things?
  6. SunnyAndrsn

    First batch submission for 3.0

    as of this Friday, I've been able to submit but the Casper report still says 'waiting'.
  7. SunnyAndrsn

    mds 3.0 - what WERE they thinking??

    I thought we only had to restart the med a schedule if the person was actually admitted to the hospital? If they are kept as an observation pt. and then return the next day, I was told by my supervisors we do NOT restart the med a schedule. It's in section 2 of the RAI manual, I can't remember the page right now. I also thought that for a death in the facility, it's just the death in the facility record, not the discharge assessment, which is absolutely pointless for someone who is dead.
  8. SunnyAndrsn

    vitamin D

    Interesting, what was the response of the MD? So there was no improvement in the lab values?
  9. SunnyAndrsn

    IV Questions from a New Nurse

    Phenergan is a big one, as everyone else has said. The vials that we get have a reminder to dilute further, with at least 10ml of saline. I push phenergan very, very, very slowly...much to the irritation of pts. who like their "power hour" with dilaudid. Sadly, I recently cared for a youn (just out of high school) bullimic who had managed to get some dilaudid and phenergan ordered. Very sad, as she was drug seeking. Her friend in the room asked me why I was taking so long to give the medications and my pt. commented on the fact that they 'don't work as good' when pushed slowly. I called her out and she admitted that she liked the high :-(
  10. SunnyAndrsn

    vitamin D

    What do you expect it to be doing, and why do you think it's not doing anything for anybody?
  11. SunnyAndrsn

    Mds obra scheduling tool

    we got our rates today too.
  12. SunnyAndrsn

    Who is your software vendor for 3.0?

    We also use pointclickcare. I'm not liking the format changes from 2.0 to 3.0. It's a lot to take in at once to have the 2.0 to 3.0 changes, and then to have the look of the software change is a great big PITA, if you ask me. As the week has worn on, I am feeling better about things, like everything else with the transition, it's been a lot to get used to but I do feel like my management did a ton of training and supported me. I like that the manual is right there too.
  13. SunnyAndrsn

    mds 3.0

    I admit, I'm jealous. We've been approved for as much back up as it's going to take. I have 17 *extra* assessments, and unfortunately, my regulatory schedule is ugly during the first two weeks in oct. I pushed as many back as I could, but it's still nasty. ugh.
  14. SunnyAndrsn

    Medicare stay

    I don't have everything here at home, what does 1 refer to? what is the question for A2400B? if it's the question about the medicare stay start day, it is the admission date if they are entering on medicare.
  15. SunnyAndrsn

    Does anyone else find this offensive?

    What is frustrating is the pay difference. In my facility, any RN on the floor is automatically the charge nurse. Thus, an additional dollar an hour differential. A starting RN makes approximately $3.50 an hour more in base pay than an LPN in my facility. An LPN with say 2 years of experience will make approximately $17/hour, and a brand spanking new RN will start out at $20.50, plus the charge differential and will likely be 'delegating' all of the charge duties to the more experience LPN who was doing it the week before the RN started. Very frustrating to suddenly lose a dollar an hour because hospitals are not highering RNs and the LTC's are. I avoided the frustrated LPNs as I was one first, so when I graduated with my RN, there was less contempt for me as there has been in the past for other RN hires. In Minnesota, LPNs can start IV's and manage IV fluids if they have had additional training. Our contract pharmacy provides the training, and also has IV nurses available if we can't get an IV inserted. The IV nurses can also insert PICCS at the facilities. RN's can draw blood off of PICC lines, LPNs can't. RN's can do IV push meds, LPNs can't. Wound care is overseen by RN's, but day to day wound care is done by the floor nurse, regardless of RN or LPN. We do not have the set up to do EKG's in our facility, however my school did not train LPNs to do the EKGs. RNs do have this as a part of the curriculm, as well as basic tele interpretation. On very rare occasions, we've had issues with the public regarding RN vs LPNs. Some families have been upset with LPNs caring for their loved ones. We set them straight on this :-)
  16. I was able to obtain a part time position in a hospital, with one year of experience in a subacute setting. Honestly, I think many of my subacute pts. have been sicker than my med/surg pts! I highlighted my experiences when I applied--just as some of the other poster have suggested. PICC line cares/central line cares, administration of TPN and other IV fluids; PEG tube cares, wound care/surgical wound care, trach cares from my homecare experiences...you get the idea. I've loved my subacute nursing experiences, and have had a very wide variety of experiences in a short time (2 1/2 years now). You might find you really like it and don't want to go to a hospital :-)