nursenow

If you made copies of a patients information and kept it you would be as guilty as the DON. You would be breaking facility and probably federal rules. This is another great example of why everyone nees to go to electronic charting. If your DON deletes something there is a record of him/her doing that and even if something has been deleted it can still be recovered.

I am sitting here wondering what situation would cause me to use two pages charting about a slow MD/pharmacy taking four hours to supply pain meds. I really can't. If it was that bad, I would call an oncall MD and tell him/her I need to transport a patient to the ER because we are unable to control his pain. If the MD refuses, just make a short entry about it in the nurses notes, transcribe it as a T.O. on the physicians orders page and be done with it. In order to throw away your entry in the physicians orders the DON would have to throw away all the other orders on that page also. If you are not allowed to write T.O.s where you work just make a one paragraph entry with only the relevent facts and call it quits. Only twice have I been unable to get hold of an oncall MD. When I demanded to be put through to another doctor and told the aswering sevice I absolutely have to talk to an MD (after they insisted there was no one available) it took about 60 seconds for another MD that wasn't even on call for mine to call back. I have never made a two page entry for anything including work place violence, elopements, abuse, --nothing. It is possible removing that entry protects you as well. did you really take ALL action available to you to provide for your patient? Did you call your supervisor (the DON) about a situation you were not able to resolve?(), how many times did you call the pharmace/ MD. What did you tell them, What else did you do to relieve the patients pain? In your charting were you blowing off steam or sticking to actual facts and not perceptions and opinions? I have had my DON ask me to rewrite two different entries and after she explained why I was happy to do it. Those rewrites included other nurses having to redo theirs also. My entries made both me and the facility look bad were we to go to court. But in the end I have to say I totaly agree that what the DON did is illegal. It does happen in LTC/SNFs though. Find another job BEFORE you report it because you are going to need one.

Nothing is free. Your hospital is taking those services into consideration as a cost of business and billing appropriately. They just don't itemize them. Somewhere they are adding the hospital cost of the sevices to the patients bill, maybe by adding a few dollars somewhere else...

It is sad someone attaches so little importance to such an important and neccesary part of the modern nursing process. There is alot of difference between "just paperwork" and charting.

Charting and the "paperwork" you do IS nursing. One thing that makes modern healthcare/nursing so effective is the charting and record keeping which allows us to keep track of a patients progress and gives us a history. I am always amazed at how many nurses didn't learn in school about why/how charting is part of nursing. Nursing is alot more than standing by the bed doing "nursy" things. It is a team effort that includes people you don't even meet in person but they use what you chart to make changes to your patients care. I suggest people stop complaining about charting and focus on becoming more effective at it. I regularly find myself reffering back to other people's chart entries as I provide care. What you do and don't chart can be as important as the things people consider "real nursing".

I work in a SNF currently LVN still going to school dreaming of BSN. I am at my current postition in the facility because a BSN was clueless so my boss replaced him with me and gave him an easier job (fewer critical thinking skills needed). I have seen both good and bad RN/LVNs and have learned that just because you got through nursing school doesn't mean you are a good nurse no matter how much alphabet you have after your name. There is a BIG difference between a good nursing student and a good nurse. There are many RNs out there that can(and do) learn alot from experienced LVNs.

I believe you will be OK but could you post the online addy of the photos so I can evaluate them more closely for you? :)

Someday, doing all those things wlithout an order will catch up to you. A not very nice MD or someone you work for/with with with cure you of doing that.

Gosh. You sure showed them. I dont know how those schoolsl are going to get along without your attendence. Every class on every subject I have ever taken had an exit exam. Usually they are called a final.

Considering it is not infected, it is safe to assume the antibiotics are doing what they are supposed to do. I would remind the MD, dietary and anyone else you can of the situation and document that.(cya) It is interesting Dietary did not order vit-c and zinc from the start. What is the actual depth of the wound?(not the tunneling) I have noticed in the past that for some reason tunneling can heal alot slower than depth even with a wound vac. I dont know why. I have used wound vacs and they are absolutely incredible for healing. I currently have a stage 4 in the coccyx area with ALOT of tunneling. We flush with 120 mL of NS and pack it with wet to dry tid (clean not sterile), give vit c and zinc and do nothing else. (lots of prn pain meds of course) Even though the tunneling has not decreased the wound has become very clean and healthy looking. that is typical of what we do for most wounds of that nature. I came back to edit this and add we also give Prostat and Ensure bid. One last thing. Did you do the original measuring of the wound a month ago or did someone else? I regularly measure a wound and find that the other person/people doing it is not accurate with their observations. The first person gets it wrong and everyone seems to stick with that until someone comes along and corrects it. The first time you measured it was there a big difference between yours and the original nurses measurment or has it been gradual by YOUR measurements?

I noticed some posts here where people claim to do a legal med pass with 60 plus patients within the legal two hour limit. That is physicaly impossible. By the time you pull the med out of the cart, do your three checks, check BP... (depending on the med) crush the meds that need it, mix them with sauce, walk in the room, greet the patient, tell them each individual med, raise ther bed, pour some liquid, (add thickner for those that need it) spoon feed the patients that need it, watch them swallow. lower the bed, walk back out and sign the MAR, and do all the other things I neglected to list(like sign out narcotics...) it is IMPOSSIBLE. If you spend 120 seconds per patient that is only 60 patients but the thing is you can't correctly do a patient in two minutes Include the time to move your cart down the hallway, deal with all the interuuptions... Add in breathing treatments, the PRNs you are interrupted to give... I have enough experience to know it CAN'T BE DONE. You may have 60 patients but not all of them are getting meds for sure. That is why the state doesn't follow you on your entire pass. They know it can't be done. I talked to the state employees that were at my facility this year and two of the three had LTC/SNF experience. We weren't fooling them.

Considering there isn't alot of formal education required the pay is pretty good. Um, oh yea I also like helping people.

Yes there are advantages to ISU but I feel the price disadvantage is starting to outway the other advantages(for me) but that is a decision every person has to make for themselves. If it works for someone I say go for it. Just because someone is paying too much somewhere else doesn't make ISU any less over priced. Another example of how public colleges are really in it for the profit before anything else.

I was at the ISU site last nite and saw they are raising their prices AGAIN. Now it is over $1,000 just for an out of state 3 credit hour class.(not including books and other fees) Pretty obscene, in my opinion. I am still taking classes at the local JC and it costs about $80 for a 3 credit hour class and then the cost of books. I am starting to look at other options for my BSN because of their prices.

No you do not have to use TCN and I suggest talking to the University rep about the program before signing on with them and go to ISU's site where they have great and easy to understand info. The problem with this thread is that there are many questions asked and very few real answers especialy from people that have done it. I met with TCN and came very close to signing but in the end decided to go to a local school for gen ed classes.

Telling a nurse to do something because you are "pretty sure" it is allowed is a risky way to go. Call the BON if you don't KNOW and ask them or research it. Yes, in my state it is an invasive procedure and I am suprised a nurse would have to ask about letting a CNA do it.

I just have to post again on this subject. I have to say it! WHO- WHY-WHAT in the world would someone that has been to nursing school be thinking to do this!!?? Someone please tell me it is a moderator that posted this trying to drum up interest in a thread. How could you possibly get through school and then do this? That person should not be trying to figure out how to get another job in nursing; She should be looking for another career because she does not have the judgment to be a nurse!

Wow! Taking a photo of a patient under any circumstances without their signed consent? Then sending it to a friend? That is a perfect example of that old saying "Just because you get through nursing school doesn't mean you have what it takes to be a nurse". (Yep, another lecture)

If you are giving a med once a day and your MAR shows it is due at 0900 and you are giving it at 1100 you are not giving it at the ordered time. The state will ding you for that. You can not day by day decide what time you want to give a med. Your facility may have a protocol that you are required to follow but I am very sure you are not changing times meds are given on your own day by day. You and I dont have authority to decide on our own whether or not the two hour rule is old and should be discarded or if it is still relevent. If you doubt that, call the state and tell them you have decided not to follow that rule. That comment is a perfect example of why the state inforces those rules in spite of what a particular nurse thinks about it. I am curious what state allows you to give a med without a time listed? I am sure it is not mine. Does every am and pm mean I can give that antibiotic at 1100 and 1230? How about Norco BID, 1200 and 1400? Protoni every AM, is that 1130, 0600, 0300? Yea right. There are recommended times to give any med and your facility is following them just like the rest of us are.

If you are not giving a patient their meds within that two hour window then you are not giving them "safely". There is a reason for that time frame and a reason an MD orders a med at a certain time (usually). That window is not just to make you hurry up and get the job done. If you dont give a med ontime then you are commiting a med error and that is the way the state will see it if they catch you. How is not giving a med ontime "safe"?

Wow. Thats alot to do in two hours. Did you have GTubes also?

Great video. Where I work "they" would love to catch a staff member bringing a camera into the building.

sometimes i am mistaken for a doctor and am ok with it. i have mistaken a few doctors for nurses and they were ok with it. i dont understand the big deal about being mistaken for a doctor when you are not.

I am willing to do alot to get a good grade whether or not I like doing it. Maybe one way to look at working with a student like that is just to view him/her as an unpleasant class assignment. Do your best to get the best grade possible on the assignment and hope the next assignment is more fun/interesting.

If the family said don't tell someone they are dying, I would not put my wants and needs ahead of the families and tell. How can a nurse conclude his/her opinion in this situation is more important/informed than the families. The family has known that person their whole life. I would happily step aside and let someone more informed than me (at the facility) make that call. The patients I have dealt with in this situation had no family that even wanted to be with them while they died. Kind of sad. Another thought; If a patient spends their life involving their family in all aspectd of their life, sharing everything with them, it almost seems like the death isn't just the patients. it is just as much the families? It will have a profound affect on the people not dying. Not saying that is the way it is, just wondering.