karenesn

Thanks for the input; much appreciated!

Yes, Lifepath Hospice.org in Florida does. Yes I agree, treating the bladder cramps, and probable urinary retention related to a UTI, and treating the pain, SOB, and anxiety associated with dyspnea related to pneumonia, are considered compassionate comfort measures. Infection is a complication of immobility. I strongly suggest writing to your state legislature. Is your company for profit? Lifepath is not.

After working in a nursing home for over two years, I continue to struggle with the realization, that nurses today can no longer offer consistent quality care to our institutionalized older adults, at no fault of their own. These are the patient's who often cannot speak for themselves, many have no advocate to keep tabs on their welfare, and are left at the mercy of a low patient to staff ratio, and the corporate owners of these homes. This I believe, is part of the root cause for patient neglect, whether intentional or not. Neglect comes in many forms, but often it is caused from a too low patient to staff ratio and administrative interference with resident quality of life. I first heard the term "nursing home flipping", from the son of a resident, who visited his frail mother, (at least twice daily). He stated that the DON told him that the facility would be getting a new owner again, and then hopefully "things would get better; to hang in there". When I mentioned I hadn't heard that the current owner; a healthcare management company (not the name of the nursing home), was selling, he stated "oh no, that's not who owns this place". This family member had decided to go to "public records" and ask, "who owns this building"? He stated he suspected something wasn't right when his inquiries about his mothers care were unsatisfactorily answered. In public records, it stated that Formation Capital was the buildings owner. Let's face it, nursing home and rehabilitation centers are just another business. They should be profitable in spite of laws and guidelines. I didn't realize until recently, that most of our nursing homes and centers, are owned by large investment corporations like, "Formation Capital", who is based in Alpharetta, GA. This company, from what I understand is one of the many like it, that buys up financially strapped facilities, in many states, and then makes that facility profitable again by contracting a health care management company to run it, (like "La Vie" or "Seacrest"). Once profitable, Formation Capital has the option to "flip" or sell the facility for higher profit. In the mean time, while a facility is being slowly pulled out of debt, the full-time nurses complained that they have not gotten a raise in three years and staff turnover was high due to burn-out. This particular facility proudly displayed "A 4-Star Facility!" banner at its entrance which gave the public the impression that, this must be a wonderful place for recovery or end of life care. In reality, it meant that the the facility had followed the Medicare minimum guidelines for staffing, and their other logistics numbers are in sync, nothing more. It was quite commonplace for beds to be filled quickly by clients who were mentally unstable or decompensated. Some often presented an immediate danger to themselves, other residents, and the staff. Thus, it was common to chemically sedate them, until they became compliant, instead of sending them out. Transferring a patient out meant a bed on hold and profits lost. Is profit more important than risking a patient or staff member from getting injured in this situation? All fall-risk adults must sit by the nurses station to be monitored during evening shift, to ensure their safety whether they want to or not. Other older adults who are still alert, oriented and mobile, end up staying in their room by choice, because frankly it is depressing to observe or hear their sun-downing, mentally unstable or just plain angry neighbors crying out, use profanity, or sitting alone looking sad for 3-5 hours. Can you imagine their thought, "this is my home now". As a hospice nurse, this surely is not living with dignity; I continue to see it everywhere in centers to this day. I am in awe of our elders who have learned to become humble and complacent to survive; not everyone has that ability. Nurses did and continue to do their best to re-direct, distract, and entertain residents in addition to their many other duties. Nurses should not be verbally reprimanded for not clocking out on time, because then the management company has to pay them over-time. Nurses shouldn't have to minimize time spent to care for their residents in a safe manner to save a company money. One year, administration in the facility I had worked for, had the nurses, both RN and LPN, take a two-day ACLS course. Only one floor nurse had been ACLS certified before. Upon completion of a 2 day course, the nurses were tested to become ACLS certified. I was told the test was easy. I attended half of the first day of class and did not attend the second day. I was told by a nurse that we really would not be getting telemetry type patients anyway, and that administration was only doing this for marketing. A few weeks later, I was given my ACLS card as if I had attended and passed the course! I refused to sign it. I had a conversation with a colleague in California, who is familiar with Medicare rules. She told me that the reason my facility had haphazardly certified our nurses in ACLS, was to get more money from the state or Medicare. In other words, If the facility is trained and shows proof that they are skilled to accept acute care patients, they can get more money. This is fraudulent. I wonder how many nursing homes do this. Does "Formation Capital, LLC " turn a blind eye to the practices of their healthcare facility management companies, as long as their profits are met? If an investment company has a goal that interferes with the physical, emotional, and spiritual needs of the aging population, and who's management interferes with staff to work in a ethically and morally responsible manner, then they must be held responsible for any discrepancies or law suits. If change is to be made, addressing all the reasons for low staff to patient ratio, and nurse burn-out is a must. The public must be made aware of the true nature of the nursing home business. An investment company's profit is not more important than safety, comfort and compassion.

I worked at a nursing home/rehab center in Florida two years ago. I had read the article, "Overview: Health Care and the Aging Population: What are Today's Challenges?" (author: Ella Kick, DNSc, RN) on OJIN. An issue was not addressed. Yes, work still needs to be done to provide quality nursing care, but let's not forget the institutionalized older adult. They're the ones that cannot speak for themselves, and they have no advocate to keep tabs on their welfare; they are left at the mercy of a low patient to staff ratio. This I believe, is related to the root cause for patient neglect, whether intentional or not. Neglect comes in many forms, but often it is caused from a too low patient to staff ratio and administrative interference with resident quality of life. The facility proudly displayed "A 4-Star Facility!" banner at its entrance which gives the public the impression that, this must be a wonderful place for recovery or end of life care. In reality, it means that the the facility has followed the Medicare minimum guidelines for staffing, and their other logistics numbers are in sync, nothing more. It is quite commonplace for beds to be filled quickly by clients who are mentally unstable and/ or decompensated. Some often presented an immediate danger to themselves, other residents, and the staff shortly after admission. Thus, it was common to chemically sedate them, until they become compliant, and a select few may become productive in the coming weeks. The patient to CNA ratio was reduced to 5:68 in this particular facility. Unfortunately on evening shift, the nurse often had to place challenging residents on one-on-one supervision, because there were not enough staff during evening hours. The CNA's were ordered to take hourly turns "watching" the new resident, and this may go on for several days. This takes precious time away from staff who are already juggling a full workload and reduces the time spent with the other residents. Because of the rise in ambulatory residents with psychiatric issues, the "starlight program" was eliminated. A trained CNA in starlight, use to entertain and keep sun-downing residents busy with activities, and other meaningful distractions during the evening shift. Now, these confused older adults have to sit by the nurses station to be watched during evening shift to ensure their safety. Which by the way, is common in all nursing homes today. Other older adults who are still alert, oriented and mobile, end up staying in their room or seek out a private space by choice, (like the patio), because frankly it was depressing to observe or hear their sun-downing, mentally unstable or just plain angry neighbors crying out, use profanity, or sit alone looking sad for 3-5 hours. Can you imagine their thought, "this is my home now". This is not living with dignity. Nurses do there best to re-direct, distract, and entertain residents in addition to their other duties. A priority was to get out of work on time to avoid the wrath of being verbally reprimanded for over-time. Let's face it, nursing home/ rehab centers are just another business. They should be profitable in spite of laws and guidelines. I didn't realize until recently, that most of these facilities are owned by large corporations like, "Formation Capitol", based in Alpharetta, GA. for example. This company, from what I understand is one of the many like it, that buys up financially strapped facilities, in many states, and then makes that facility profitable again by contracting a health care management company to run it, (like "La Vie" or "Seacrest"). Once profitable, Formation Capitol "flips" or sells it for higher profit. In the mean time, while a facility is being slowly pulled out of debt, the full-time nurses complained that they have not gotten a raise in three years and staff turnover was high due to burn-out. I believe there is a connection. One year, administration had the nurses, both RN and LPN, take a two-day ACLS course. Only one floor nurse had been ACLS certified before. Upon completion of a 2 day course, the nurses were tested to become ACLS certified. I was told the test was easy. I only attended half of the first day of class and did not attend the second day. I refused to attend the second day. I was told by a nurse that we really would not be getting telemetry type patients anyway, and that administration was only doing this for marketing. A few weeks later, I was given my ACLS card as if I had attended and passed the course! I refused to sign it. Just recently I had a conversation with a colleague in California, who is familiar with Medicare rules. She told me that the reason my facility had haphazardly certified our nurses in ACLS, was to get more money from the state or Medicare. In other words, If the facility is trained and shows proof that they are skilled to accept acute care patients, they can get more money. This is fraudulent. I wonder how many nursing homes do this. Does "Formation Capitol" turn a blind eye to their health facility management companies, as long as their goal is met? I first heard the term "nursing home flipping", from the son of a resident, who visited his frail mother, (at least twice daily). He stated that the DON told him that the facility would be getting a new owner again, and then hopefully "things would get better; to hang in there". When I mentioned I hadn't heard that the current owner "LaVie" (not the name of the nursing home), was selling, he stated "oh no, that's not who owns this place". He had to go to "public records" to find out who is the owner of the building. He stated he suspected something wasn't right when his inquiries about his mothers care were unsatisfactorily answered. In public records, it stated that Formation Capitol was the buildings owner. If a capitalist's company has a goal that interferes with the healthcare needs of the aging population and who's management interferes with staff who should be able to work in a ethically and morally responsible manner, then they must be held responsible for any discrepancies or law suits. If change is to be made, finding the root cause for nurse burn-out and low staff to patient ratio in this field must be addressed. The public must be made aware of the true nature of the nursing home business.

I work in a nursing home rehab center in Florida. Administration has a policy, that nurses are to call the DON before we call the doctor or 911, if we feel a patient needs to be sent to the ER for any reason. The DON instructs the nurse on how to treat the patient if possible, (like giving them Lasix IV if they're severely congested w/CHF or a COPDer), and the nurse has to write the order. It's a cost/revenue saving measure. The facility loses money for every day that person is in the hospital. A few days ago, close to change of shift, I overheard that the Nurse manager had given a resident IV push Lasix, because she had suddenly developed CHF; was extremely congested. She was fine the day before and her admit dx. was s/p suicide attempt, she also had COPD and HTN. She was at our facility for wound recovery and rehab. This elderly resident had voided > 2000 ml urine. Afterwards, according to the nurses notes, the resident was stable, alert and oriented.... A few hours later on the evening shift, she became unresponsive and with total lt. sided weakness. The evening nurse, called the DON first, and was then instructed to let the MD know and call 911. She had suffered a stroke. Is this the new trend among LTC facilities; for nurses to treat and take a chance?

I started using Vyvanse, which was great!! Then I switched med. insurance companies after divorcing, and Vyvanse wasn't covered; too expensive for me. My doctor has me on Focalin XR 15mg. which is working out well. At first the only adverse effect was a headache for a week or so (normal), then it went away, and now I'm fine. Both Vyvanse and Focalin XR lasts almost 12 hrs.

Hi, If you read all the threads, then I'm sure you've read mine. I graduated 12/08 from a 2 yr. RN program. What helped was going to the school's disability counselor who, every semester, typed letters for me to give to each of my teachers/instructors. It informed them that I had a disability (not saying what it was), and what consessions must be provided to me, by law (persons w/ disabilities act). For example, I should need to sit at the front of the class, I will be allowed extra time to complete all exams, tests,... if I chose to enlist a close friend/classmate to be a note taker, (the school would even pay them, I think it was like $4 bucks an hour),though note takers didn't help me. I could choose to take a test in a private room to avoid distractions... Of course my friends helped me in study groups. You will need to officially be diagnosed with ADD/ADHD, providing a doctor's note to the disabilities counselor. Then came the time when I started taking medication (third semester). For the first time, I could read an entire page without having to re-read it 10 times. ( I was always 'labeled' a slow learner in grade school). Being diagnosed late in life was a revelation for me. Finally, never, ever tell your D.O.N, or fellow employee's that you have ADHD, because like it or not, there is a stigma attached to us, causing you to be 'watched' more closely, and sometimes unfairly. Good luck in school, and good luck in finding your niche in the nursing field. ADHDer's make great nurses.

Hello out there, I graduated from RN Nursing school Dec. 2007. I had been an LPN for over 20 yrs. I was diagnosed with ADHD about 2 yrs ago, and CAPD 3 yrs before that. Well, I'm 50 yrs old now. I can identify with all of your stories and concerns. I don't want to get into my life journey's, 'cause I'll just go on and on. First, the best thing I ever did, after it being highly recommended, was read the book, "Driven to Distraction" (authors: Hallowell,and Ratey). The author's are two Physicians with ADHD; it took them over two years to complete the book ...ha. It is the best of all the books I've come across, that answers so many questions, and is an incredible self-esteem booster. I was able to rent it at the library; I eventually bought my own. It's a smooth, powerful read! Next, when out in the workforce, NEVER disclose to anyone on the unit, that you have ADHD,especially not the charge nurse, because there are just too many people that will hold a stigma againsnt it, and they can make your life miserable if they start to over-analyze you. Besides, it's nobody's business. To the writer who is concerned because her daughter wants to work with children with ADHD. She can do it. Have her start in a 2 year program; she may then want to start her internship in Psych., because with that, she can eventually get into children's psych. program/job. Her Nursing Psych instructor can help her get her foot in the door after graduation. So many people with undiagnosed ADHD, are also diagnosed with bipolar disorder, depression, oppositional defiance disorder. Yeah, it's all connected. Did you know that there are 6 types of ADHD?? ADHD has now, finally been recognized as a medical disorder only 7-8 yrs. ago, Not mental or Psych as before!! I'm on Focalin now, and doing pretty well. My brain was like a race car with no brakes, before I started ADHD meds. Though I do like myself when not on Focalin (I have character; I like being different) ; I take it for work. I also have been taking Celexa for depression for many years. People with ADHD are intelligent and creative; we make excellent nurses because we are able to multi-task. But starting out, take it slow, find your niche. I too believe that they should remove the word "Disorder" from the diagnosis of ADHD, and replace it with "Trait" instead. We can learn and we learn well, just differently.

I decided to become an RN five years ago, at the age of 45. At that time, I was blind-sided by divorce after 25 yrs., I had recently been diagnosed with CAPD (Central Auditory Processing Disorder), and I was also strongly suspected of having ADHD. I was working as a Health Assistant in a school clinic at the time, and the RN that supervised me asked if I had hearing problems. She would also get agitated with me because I was easily distracted, always interrupted people, and my thoughts frequently wandered. I had this problem all my life. I was always labeled a slow learner, and I had difficulty keeping friends. Well one thing led to another. After a battery of special hearing tests, I was officially diagnosed w/ CAPD. The Disabilities Counselor at the community college, was encouraging and because CAPD is a learning disability, just like ADHD is, I was allowed extra time on tests, quizes, was allowed to use the test lab if I wanted to, if I needed more quiet during an exam, also the school paid for a notetaker if I needed one. There were many more helpful accomodations, that are all available by law. We are protected by the Americans with Disabilities Act. My instructors otherwise didn't treat me differently, and my disability was always kept confidential. I was able to finish school with flying colors, (which blew me away)! People with learning disabilities are not slow learners, we just learn differently. After graduation, I was scared to death, because I had to be extra vigilant; no more extra accomodations on a Telemetry unit. The Straterra I was taking wasn't helpful. Fortunately, my Physician started me on a new drug called Vyvanse. It is related to Adderall but with no crashing, lasts 12 hours,and it's safer. For the first time in my life, I feel very much in control of my actions, and organizing my thoughts is no longer a major problem. People with learning disabilities can, and should be encouraged to follow their dreams, and never give up. I'm proud to be a nurse.

My Nursing Process IV Instructor, who was also a former Telemetry Charge Nurse, informed our class that you must inform your supervisor of your lack of experiance and request to be given orientation to the unit first, or be cross-trained. Find out what your hospitals Floating Policy is, before accepting the job. If you are still sent, write a memorandum in detail, as a written protest. Keep a copy in your own personal file, then send a copy to the Nurse Administrator. This will show that the nurse was attempting to act reasonably. It shifts some responsibility to the institution in case something goes wrong.

I have ADD; I did much better in nursing school after my doctor prescribed Straterra. (I never tried any other drug). Finally, I could read an entire chapter without my mind wandering every ten minutes. WOW, what an accomplishment then. Close friends noticed a change too; I quit interrupting people inappropriately, I can finish a project without being distracted, I don't get frustrated as easily. At work I keep a cheat sheet in my pocket for important numbers, and I use a daily check-off list for routine things that must be done for each patient; I look at it frequently to keep tabs, so I don't fall behind. I'm thankful that this particular drug has worked for me, and is non-narcotic.