oldladyRN

Call the Dept of State Health Services for the state in which you work. I'm a Nurse Surveyor for the State of Texas. The State regulations for Texas hospitals (and this applies to acute care hospitals, psychiatric hospitals and critical-access hospitals) contain an entire section devoted to specifics on the "Nurse Staffing Committee". For Texas, this nurse staffing committee must meet at a minimum of annually. The committee must consist of AT LEAST 60% registered nurses who spend at least 50% of their time providing direct patient care. There is also to be a nurse present from PI or Infection Control. This assures input from more than just the paper-pusher nurses who look at a grid, compare it to the census and # of nurses staffed and say "Mmmm, yeah, looks okay to me". Specific topics are to be discussed in these meetings, and the recommendations are then to be presented to the Governing Board and the Performance Improvement committees. Too many times I have investigated a complaint of "unsafe staffing" only to find that the hospital considers these meetings superfluous and doesn't even have them...has the meetings but the committee is made up of nurses in management positions...the findings and recommendations of the committee are never to be discussed again or any combination thereof. There must be formal meeting minutes taken along with a roster of the attendees. Many facilities are under the misguided notion that these meetings are optional because they have no intention of taking ANY recommendations to the GB or PI committees. A hospital can be met with a pretty stiff civil fine (at least here in Texas) for not following the regulations that pertain to the Nurse Staffing Committee. Once presented with the findings and recommendations (which are, unfortunately, accompanied by an increase in medication errors, patient falls, hospital-acquired infections etc), the GB and PI committee take action. I hope this information helps. oldladyRN

OK. I'm gonna chime in on this. In the early 80's, when we had just lost our mom to leukemia, there was a television advertisement for a mobile home company. They displayed a standard wooden coffin on the screen (a la Frankenstein's bed) and said, "Don't let this be the only home YOU ever own!!!" I do remember that I dropped the glass I was holding and then called the TV station. The commercial was yanked not long after that, and I'm sure I wasn't the only one offended by it. I guess advertising hasn't changed all that much. oldladyRN

I also worked @ ASH. The pay is as good as anywhere else, and you get out of work on time. The benefits are excellent. I worked with adults and would never have dreamed of working on CAPS. In my opinion, there were a lot of kids there that suffered from ADD (Absence of Discipline Disorder) and needed a more direct hand at home. I never had any problems with staffing. They have a float pool...basically a group of people that comes to work every day to fill in the holes where people have called in. I thought it was a whole lot easier than working med/surg, the ER...you name it. Hope that helps.

thank goodness i'm not the only one this bothers. "she's been orientating for a week now..." or "i have a new nurse orientating with me..." grrrrrrrr! a nurse orients, and when finished, is through with orientation. not through with orientating. there. i feel better now. between "orientating" and "phenergran", i can just work myself into a tizzy. oldladyrn

There are so many things wrong with this situation. What does your pharmacist have to say about cutting and saving? My guess is that their hair would either turn gray or turn loose. Think about it this way - do you snap a Lortab in half and place the other half in the drawer to be used during that shift? No. Regardless of whether you use a manual system (med cart) or an electronic system (pyxis, suremed, omnicell), you WASTE the unused portion. Of course, this is what you do if it IS okay to half a tablet, as when the tablet is scored. Personally, I would not use an altered portion of the film that I found in the drawer. I checked the manufacturer's website (suboxone.com) and didn't find any useful information either way regarding cutting/not cutting. However, I would be inclined to err on the side of caution and assume that the medications are NOT equally dispersed across the film, and that cutting the film may cause either an overdose or an underdose of the medication. Because this is a Schedule III controlled substance, your pharmacist (along with written facility policies and procedures) should be your guide on proper administration of 4 mg and 6 mg doses when the medication is only available in 2 mg and 8 mg films. Speaking from a State surveyor's standpoint, you are doing the right thing and I would continue to refuse to cut the strip. I would faint dead away (not really) if I opened a med cart and found little pieces of suboxone film lying all over the place. Get it in writing. If they won't put it in writing, follow the pharmacist's recommendations combined with your nursing judgment, which seems pretty sound thus far. oldladyRN

Dear RNaddict: Although I have nothing profound to add, I did want to say a heartfelt "congratulations" for coming this far. I can only imagine the struggle that being clean for 43 days has been. My own dear brother has been sober for one year and our entire family is getting together tonight to celebrate it (he gets to pick the restaurant, so who knows WHAT we'll be eating). I am thinking of you and will keep you in my prayers. Send me a message if you want to talk. There are lots of people out there who are wishing you the best. oldladyRN

I am a registered nurse and a State surveyor. I love-love-love my job. I enjoy the different experiences, and no two days are the same. I love meeting people and learning new things. There is a lot of travel involved, so it's probably not a position for someone with small children at home or someone who's afraid to fly. Yes, the benefits are great and I don't wish to do anything else. oldladyRN

I'd like to share a little bit of info from "the other side of the fence", if I may. I hope that some of it will be helpful to you if and when you hear that surveyors are in your facility. The second you hear that surveyors are on-site, there are simple and easy things that you can do that will streamline the process (and possibly earn your facility less citations). If your medication room is supposed to be locked, please lock it. Same thing with your medication cart(s). If I can walk right into your unsecured medication room, I have no choice but to cite for it. Once I'm in the room, I'm looking for unsecured meds out on the counter, controls mixed in with regular meds, and pill residue on surfaces. Please remove your Lean Cuisine and Diet Coke from its place next to the insulin vials in the refrigerator. I'm going to check that someone has been documenting patient med/food refrigerator temps daily (every facility has a policy on this) and that you're following your facility's policy on dating, initialing and tossing insulin when the vial is first accessed. I do indeed look for stained ceiling tiles, as a water leak poses an infection risk. I know it seems petty to a lot of people, but I don't want to breathe in mold dust every day and neither do you or your patients. Please make sure your crash carts and related life-saving machinery are checked according to policy. Please make sure your crash carts are locked (and the little plastic lock is fine). If I walk up to an unattended crash cart and start opening drawers without having to break a lock to do so, I have no choice but to cite it. Please check and make sure your stock meds are not expired, and that there is not an employee lunch (yes, it actually happened) somewhere in the medication cart. I have actually found a moldy peanut butter and jelly sandwich complete with a moldy apple in the control drawer. The less errors found, the easier it is on everyone. If you know a surveyor is in the building, do a few checks before I come to your unit. oldladyRN

A gait belt. Don't think I've seen one of those used as a restraint before, although I see something new every day. Yes, definitely a restraint. Instead of focusing on the gait belt, focus on what you're doing with it and substitute other items, asking yourself the same question. Would it be a restraint if I used a necktie instead of a gait belt? Yes. What about if I used a bedsheet? Yes, still a restraint. Restraints have gotten a bad rep over the years because people were using them as a babysitter and not assessing the patient on a regular basis. Because of that, people scooched down in the bed and strangled in their posey vests and got their heads caught between bedrails and were not found for a long time. Sometimes they were used to prevent falls but some progressed to being a convenience item. Many, many facilities talk about the patient's "right to fall". I'm not sure I agree with that way of thinking, because it flies in the face of safety when you're talking about a frequent faller (confused, impossible to re-orient). My dear sister has been a nurse for 30+ years. She has worked LTC for most of those years and often tells stories about patients being tied into their wheelchairs with a sheet (so that they wouldn't tip forward and fall out of the WC) at the nurse's station while the nurses finished their charting. The patients would fall asleep, be put to bed and that was the end of that. No one called it a restraint. Getting back to your original question, I don't know where any sort of comprehensive list can be found. oldladyRN

Dear luv2yoga: I was a charge nurse @ ASH for a while, so I can answer your question. Because ASH is a "State" facility, they don't do "per diem". I'm sure it has to do with the State's budget. The closest they come to that category is a position that requires that you work 1, 2, 3 or 4 shifts per week. I was full-time, so I'm not sure what kind of benefits those part-time positions come with. I can say that I really enjoyed working there. You need to either apply on-line or go to the campus and fill out an application. They are always in need of good nurses, so you should quickly get a phone call following submission of your application. I originally filled mine out on-line. I frequently heard of nurses filling out an application at the hiring office (on campus) and being told "wait right here". They would be interviewed immediately by a nurse manager or shift supervisor authorized to hire. I was hired originally for the 7-3 shift, which (at most places) you usually have to wait until someone dies to get. I wish you the best. It was a challenging but not at all difficult job. There were always plenty of staff, and I never felt unsafe. I always got out on time, with the rare exception being if someone fell and split their head open during shift report. Also, it is a 100+ year-old campus, so it's nothing fancy to look at. The insurance benefits and retirement benefits are fantastic. PM me if you want to know more. Good luck!! oldladyRN

The only thing I can think might be going on is that the child's behavior, even if not "combative", may be disrupting the unit to the point where the safety of others might be compromised. If the child is seen as a leader by the other kids, or the the child is idolized by the peers, the child holds a lot of power and control over the other childrens' behavior. This is the cornerstone of gang mentality. Sometimes, you just have to remove the controlling child from the receptive audience. Theoretically, you should move others, but often (due to staffing or the layout of the room) it's easier to just move one person. I was a psych nurse for a long time, so I am just giving it my best guess. You always want to work with the other children to build up their self-esteem, but sometimes you have to act quickly when the situation could get out of control. I hope this helps. Feel free to send me a private message if you want to talk more about it. oldladyRN

At a State psychiatric hospital where I used to work, we had a patient that was to be secluded d/t her inappropriate behaviors and it was written into her care plan. She had bipolar disorder and when she cycled, it was pretty bad. This particular unit was both males and females, and they spent the majority of the day interacting with each other in a common dayroom. Patients were encouraged to attend classes and outings, but those that chose not to attend stayed on the unit. When this patient would cycle, her temper and resulting physical aggression were difficult to handle. She would throw things, injure other patients, overturn and throw (heavy) furniture and generally disrupt the unit. Timid and scared patients would hide behind chairs and male patients would clench their fists, ready to fight. Things would go "to hell in a handbasket" quickly. Even if she was not acting out in a physically aggressive manner, she would strip mother-nekkid and throw her clothes at people. Either way, we ended up with a roomful of about 30 pi$$ed-off patients that would become unpredictable in a flash. As soon as she would stand up from her chair and start acting out (usually by sweeping a magazine onto the floor or throwing a cup of water onto someone), staff would swarm in and walk her to the seclusion room, where the RN would lock the door. The walk to the seclusion room was generally uneventful, as any and all available staff (from nearby units as well, if need be) were walking with her and she didn't feel up to fighting 6-7 of us. The RN would close the door, which automatically locked and had no doorknob on the inside. She would scream and yell for a few minutes, pound on the door a little bit and then she was finished. We'd let her out, the doc would come and assess her, and she'd swear to never do it again. She'd finish up by calling me a b**** and everyone went on with the rest of their day. It was actually very effective in taking the wind out of her outbursts. Her goal in acting out was to get attention, which we removed when we removed her from her audience. We rarely had to give her any emergency meds, which would have required several staff to restrain her (during which, someone could have really gotten hurt). She would read her magazine for a few hours, and then we'd do it all again. This would go on for about 2-3 weeks at a time. If she wasn't cycling, she was someone you'd want to invite over for coffee. Please look at the big picture when you see treatment plans such as these. Although the goal is always to use the least restrictive means necessary, you always have to look out for the safety of the other patients and the staff. I hope I've given you a different perspective on things. oldladyRN

I am a surveyor with my state's Department of Health. I just returned today from some survey training, where I had the opportunity to meet surveyors from all over the U.S. Many of the nurses stated that a BSN was required to be a State surveyor in their state, while others lived in a state that required a Master's degree. I have an associate degree RN with 10 years of nursing experience in varied clinical settings. Although postings for this position in my state say "Masters preferred", it just ain't gonna happen. I live in a state with a high cost of living and low state wages. The salary range offered will not attract a registered nurse with a Master's degree. Bottom line, different states have different requirements. oldladyRN

In my mind, there are a couple of things wrong with this picture. First of all, was the order for 0.5 mg or for 5 mg? With the patient population I've cared for, 0.5 mg would be the amount you might sprinkle on a mosquito. That seems a terribly small dose to me, but there may be kidney issues, liver issues or other medications on board that necessitated a dose that small. I just can't imagine a dose that small being effective. Second, I would have never given another dose just because it was after midnight and the sun was coming up on a new day. I would seriously question the other nurse's advice. Check your facility's P&P on medication administration parameters. It could mean that the medication is to be given every 12 hrs as needed, or twice daily as needed while the patient is awake. The policy and procedure for that situation is what's going to cover you if something happens. Please continue to advocate for this patient's safety and healing. oldladyRN

I work for the state as a surveyor. More positions are being created, so I'm not concerned at this point. I worked for many years in the private sector, for more $$ and all that good stuff. Although I'm not rich by any stretch of the imagination, I make a decent wage and the benefits (insurance, retirement) rock. I can always pick up a weekend shift somewhere if I need extra $$. I also have the freedom to work independently and do not have anyone constantly looking over my shoulder, which is a huge plus to me. I work M-Th (and a Friday every great once in a while) and have all weekends and holidays off. I am happy where I am and have no desire to return to the private sector. I hope this helps. oldladyRN

The replies to your post thus far really concern me. One even goes so far to suggest that you might want to withhold this information from your state's licensing board. You state in your post that your doctor has determined you to be a danger to yourself and others. Please do the responsible thing and get your mental health situation stabilized before you consider anything else. Nursing (and the healthcare field in general) is a very demanding, unpredictable and stressful career and may not be the right one for you. I do not wish to come across as mean or cruel, just realistic. With the recent tragedy at Ft Hood, this is no laughing matter. I do wish you the best and I hope you are able to get the help you need. oldladyRN

I see that you are in New Jersey, and I'll just start by saying that I'm not in the same state. With that being said, I'm a State surveyor (I know, one of those people), and this may well be a violation of New Jersey's State and Federal hospital regulations (it is where I live). If this lovely institution actually has a staffing grid and is dumb enough to not follow it, that's a violation of their own policies and procedures. They can be cited for not following their own policies and procedures. There are some other regulations (again, in MY state) that pertain to providing enough nursing staff to provide safe care to patients, etc. Please, please, please make a complaint to your department of state health services. You can remain anonymous. Try to give specifics regarding dates and include anything bad that may have happened on the dates you were under-staffed (med errors, patient falls, elopements) that would help to substantiate your complaint of being under-staffed. Your facility will get a nice little visit from some friendly surveyors that will have the higher-ups pulling so many reports and documents, their little heads will spin. Good luck to you, and please feel free to send me a message and let me know how it goes. I really hate to see nurses getting the short end of the stick when all we're trying to do is help people. I hope the situation improves. If I was technologically advanced enough to figure out how to drag one of those little smiley faces over here, I would. oldladyRN

Why, thank ya. I'm always feeling creative when I get home from work.

I have the answers for you!!! For the nurse that takes 5 hours to pass meds, say that "she/he takes extra time with each and every resident"...because it's true. For the one that had oral sex with a patient, say, "she/he goes the extra mile to make sure our patients are happy and comfortable"...because she/he did. I challenge you to stand at the podium and say it all with a sincere smile. oldladyRN

I don't know how those of you who work at the bedside do it, but my hat's off to you. You are a remarkable group of people. The original poster's frustrations are the exact reason I'm not able to do it. When I was in nursing school, everyone had the same question for us..."What hospital you gonna work at?" (I live in Texas, so that's really how the question was worded, by the way). I never had any interest whatsoever in working at the bedside in a full-time capacity and I felt like there was something wrong with me for feeling that way while I listened to my classmates excitedly chat away about where they had interviewed. I knew that bedside nursing was not my calling. I have been very happy working in a variety of settings including case management, urgent care clinic, ER, psych and QI. The "few and far between" times when I have worked a bedside shift through agency, I've darn near crawled to the car at 0730 the next morning, trying to remember (through my exhausted haze) exactly where I parked it. Thank you to all the excellent nurses that efficiently, skillfully and compassionately deliver excellent bedside care. oldladyRN

I just want to add something here. Please don't apologize for "making her upset". You didn't "make her upset". You can't "make someone" anything. She chose to react to the fact that you stated the call-in policy to her by becoming upset. I've found through the years that the more I don't raise my voice, the less credible the other person looks when they do. Stay calm (I know, easier said than done), stand your ground (literally and figuratively, as I've actually had a couple of CNAs advance toward me as if to strike me) and use simple language/terms. Practice in front of a mirror or with a friend if you find yourself getting flustered when this type of situation arises. This is a hard job, but we're all helping each other. oldladyRN

I have to agree with the other posters. If a patient complains of pain and does not have an order for anything to relieve it (and if the pain cannot be relieved in a non-pharmacologic manner), good judgment and nursing practice would dictate that you would call the treating physician to make them aware of their patient's condition and the need for some pain medication. More than once I have received a glib response or an outright refusal. I chart the doctor's response objectively, using the basic facts and direct quotes. I will be very detailed if I feel the situation warrants it. I most certainly will chart "Spoke w/MD @ 0300, MD aware that patient is experiencing stabbing pain in right temple, duration 30 minutes, rating it as an 8 on a 0-10 pain scale. Attempted repositioning, additional pillow, dimming of the lights and cool compress to temple area without relief of pain. No new orders received." or "I'm not giving you an order for anything right now. She can wait until I see her in the morning." When push comes to shove (as the old saying goes), I want to be able to show that I tried to do right by my patient. Doctors should be well aware that they're going to be held accountable for their actions (or inaction) in the nurse's notes. oldladyRN

I think you mean gold"digger". The kids need to have a talk with dad. He is in a very vulnerable position right now. He lost his wife, is probably very lonely, and has now attracted a companion and her opportunistic daughter. If he is still deemed "competent", then it's his money and he can throw it out the window if he wants to. Because this money is ear-marked to help pay for his stay and his expenses through the end of his life, his living relatives would need to do some research and possibly consult with an attorney to see what the best course of action would be (assuming that there are any other options). I believe he would need to be declared "incompetent" in order for a POA to be appointed and limit his access to $$$. I hope this helps. I know that it can be frustrating as well as heartbreaking. My own father met and married a "golddigger" within 3 yrs of my mother passing, and he was completely in his right mind. There was $100,000.00 in the bank when my mother died (from all her scrimping and saving), and it was all gone within 2 years after he met the new wife. They're still married, 23 years later, but they live in separate cities and in separate houses. He's 80 years old now and still in his right mind, so you just have to scratch your head and wonder. I really am sorry about your situation. I hope you are able to get the help you need. I really despise people that prey on those that are vulnerable. oldladyRN

Anyone? Anyone? Ferris? Ferris?

This was a nursing leadership conference for nurses employed by the State of Texas in one capacity or another. It was held at the Doubletree Hotel. As far as conferences/seminars go, it was enjoyable and informative. Some speakers were better than others, as is usually the case. Specialties from psych nursing to quality improvement were represented. I met a lot of interesting people from all over. Were any of you there? What is your area of expertise? oldladyRN