jodispamodi

Totally agree, what was the lockout dose on the PCA?

Thats not exactly true, I've done alot of training r/t and your patient should talk to an experienced elder law/estate planning lawyer. Also many people who go past the 100 days either self pay for additional services, or get services through the state. I'm not sure what your role in this is: nurse, aide, family member... BUT if your role is through a facility or agency then your facility/agency HAS to ensure a SAFE discharge plan happens whether she be in the facility or her own home-can't just walk away and say good luck. So if she's a facility patient you need to speak out and raise your concerns, and if she's in her own home you need to let your agency know she's not safe and needs to be evaluated for home safety, which may involve reporting her as an elder at risk to EPS. Once reported they can often bring in additional resources. There are many options, including AFC/SL. But the most important point of this is she cannot be dc'd without a SAFE discharge plan.

Good for you! Sometimes good things come from bad.

when I worked on geri-psych we took patients with dementia all the time, it seemed if someone with a medical dx had a comorbidity of dementia they ended up on our unit. But each geropysch unit has their own criteria about who is appropriate for that unit.

It would be interesting to know how many patients were referred to her by other doctors, and how many patients self-referred, I'm sure some who saw the videos probably considered her as a "down to earth" doctor who was "fun", but ignorance is bliss. Those with even a modicum of knowledge will see her videos and cringe with every fiber of their being.

Find another doctor... Has he had any exposure to ticks? may be worth testing for tick borne diseases

I trained and worked as a Surgical Tech, and very interesting that if the people who were gowned and gloved in the 10 seconds of video I saw were actually involved in the surgical procedure because they violated sterility up down and sideways. The only areas considered sterile when gowned and gloved are the hands up to the elbows, and the gown from the chest down to the (natural) waist, so hands on hips-not sterile, hands on butt-not sterile, hands above head-not sterile... I try to avoid watching this type of stuff as it inflames me.

And it also has to be factored in that patients ard much more acute than they were years ago. These days, and in the span of my career, unless you'rd a self paying plastics patient, you have to be pretty sick to get admitted to a floor

In my time on my current unit I can count on one hand the number of lunch breaks I've gotten.

I agree with Libby, checking her back and neck would have taken at most a couple of minutes, just lifting the shirt and hair, but that also would not have been a thorough check... The original tick was on her leg, why check just the back and neck those are two places ticks would be unlikely to be, as ticks tend to go into hair, behind ears, armpits, under breasts, skin folds, even near genitals, between toes, etc. Also weird the patient didn't remove the tick from her leg herself...but I digress. Perhaps in future a solution could be patients coming in with report of a tick bite have a thorough skin check from office nurse before provider sees them. jmpo

At my facility we wear gloves when giving meds, but one pair as the package is opened into the med cup. OP your hospitals policy is excessive and makes me think that either they have a pending lawsuit from an employee who was exposed to some med (oral chemotherapy???) and/or they were reported to OSHA- this goes beyond a CYA type of thing. (On a side note, it has always amazed me that oral chemotherapies are giving in a sort of cavalier way on med/surg units. When I have to give them I always call pharmacy and ask what precautions if any I should take). And I'm not saying an oral chemotherapy was the issue in your hospitals case, but it is one of the meds that has the potential to cause harm with unintended exposure.

Exactly... and my facilty has required staffing levels BUT I wouldn't call them SAFE staffing levels... BTW, the poster who wrote about nurses making gads of money. I've never broken over the mid-forties/yr as a nurse. I know some make who do make big bucks 80 or 90K/yr... But for what I make AND the amount of work I do, I could probably make just as much working a job that allows me time for lunch and breaks, and doesn't havd the "forced" liability nursing does- but I love being a nurse, and slowly, as I get farther, and farther into my career I realize certain things will never change because money is more important than quality care.

If I had the millions of dollars required to produce, make, and air a commercial? Sure.

I think the terminology I saw was "chronically understaffed hospital" and relates to the CoPs through medicare and medicaid. Just google medicare and chronic understaffing, it should bring links that mention it.

I'm not sure about links, I'll hunt around. What I have seen clearyly with my own two eyes were notices put up at several hospitals in the "legal info" area (where they put required labor notices from the state, etc) saying that if a hospital was "consistently understaffed, that medicare would be reducing payments", and I know as a direct result of this in the past 2.5 years I have gotten cold calls or emails from the HR of hospitals I had applied to years earlier asking me if I was still interested, my current job I got this way, because their medicare payments took a big hit. I seen it in writing and will see if I can find something to send you (I have no idea what the numbers look like as far as deciding short staffed)

This is one from my rescue days. We went mutual aid to another town and an older lady had ruptured varicose veins in her leg and had lost a huge amount of blood, because of our department then having multiple rescues we had to mutual aid a second paramedic from another town. The woman was shocky and frightened, and fighting care and having IV's placed for fluids. I thought to myself how can I be the most useful? So I sat at her head and told her she had to stop fighting, we knew she was scared, I told her we were going to fight for her so she didn't have too, I explained about the siren, and the pressure wraps on her legs, blah, blah. I honestly didn't think she really heard much of what I said. We got her to the hospital and she was rushed to surgery. We left and returned to our respective departments. I forgot about her as other calls and rescues happened. Several months later the captain got a letter from her, in it she thanked everyone for helping her, and she talked about the person who sat at her head and told her we'rd fighting for you, and explained things. She said she knew the other people were important in helping her but the one who sat at her head and talked to her was the one she felt, who saved her. I'll never forget that call, all that blood (her bathroom was covered in it) or that letter. I thought I was doing little.

My favorite compliment came from a coworker who was a total type A, perfectionist, anal, kick-♧♧♧ nurse. One day after a long hard in the trenches sort of shift he said to me "I could be sick around you". Now he had said about other people, if I ever get sick don't let him or her near me, or transfer me out. LOL I still think of it as the best compliment ever.

If the order does not have a range, such as give 1 to 2 tablets per patient request you cannot give it, that would put you in the realm of prescribing the med and unless you have prescriptive authority, even if the patient requests it. If you are not licensed to prescribe meds-Don't simple as that. The patient is a lay person, you are not. Protect yourself!

Its crazy... I'd love to see those nurses have to work a month on a busy floor with the current staffing levels, they'd last maybe a week and complain about their full bladder, yet its a reality that we often go without breaks, lunches, or even a two minute pee break.

But when I worked here in LTC/subacute we might have 40 or 60 patients per nurse.

I don't know. My speculation would be they don't want "official legislation" muddying the waters, such as a government body deciding what is a safe level. I'll research it.

The sad thing is medical/nursing errors ard NOT seen as preventable, but are accepted as status quo. I can say I felt I was a much better nurse with 4 patients (high acuity unit) than I was with 5, 6, or 7 patients.

I think that is what annoyed me, the commercial would lead the average person to believe that staffing levels are decided on the floors by the nurses doing the care. Yet medicare is reducing payments for unsafe staffing levels.

Just venting... I heard a commercial this morning that aggravated the heck out of me. My state will be voting to add safe staffing measures to the upcoming ballot. The commercial was to the effect of "Don't vote for safe staffing, it will cost healthcare billions, nurses should be allowed to decide safe staffing levels (meaning those that have gone to the dark side as staffing specialists). As someone who worked on a super busy unit with an avg load of 5 patients, occ. six, and on one memorable occasion seven patients., I can attest to the fact that there was a HUGE difference on the (very) few occasions I had 4 patients. When I had 4 patients I felt I could critically think, thoroughly assess, and provide my patients with a good level of care. Five patients meant running all day and feeling guilty over the lack of time I had for the less needy ones. Geez, if I had several million dollars I'd make my own commercial. Ok done venting.

one other thing to think about if you have a common name or an easily misspelled name (as is my case) that its possible they could have googled or something and came up with the wrong info... But the hiring manager being mute about it makes me wonder if perhaps there was no reason at all... just another candidate they liked better.