kwagner_51

I came on here looking for advice. I didn't ask to be judged and left wanting in other nurses eyes. 1.) I have met the OWNER and he is very comfortable with me taking the position as DON 2.) He is willing to TEACH me and so is the Administrator. I have met the nurses in the field and they are very well versed on OASIS. 3.) I wanted information on what to study so that I would have a leg up when I take over. 4.) The requirements for the DON position are: At least 2 yrs experience as an RN, one of which must be in HH. Willingness to LEARN and take some of the pressure off the Adm. I have been an RN for almost 3 yrs and have worked in HH for over a yr. 5.) I will also keep my other job and will be working 7 days a week caring for pts and working as DON. 6.) I asked for help, so I can provide the best care I am able to. Instead I have been told that I have no business taking this position. I didn't ask if I was qualified for the job, I already KNOW i am. I wanted to share in my good news about the position. Instead, I have been told that the employees will hate me and that I should quit before I even start. :argue:

Hi nurseby07, I have been in HH for over a yr. I also did home visits with children r/t Head Start for a year. so I have over 2 yrs collective experience. I don't have experience with OASIS but as far as being in compliance with Fed rules I had to get an entire program within Federal requirements within 6 weeks. It was so far behind and had papers missing when I took over. The program passed with no problems or errors.

I took a p/t DON job in HH. Does anyone have any suggestions about what I will be doing? I will start on Oct 13,2008 Some of the things I was told at my interview were: OASIS Hiring P & P Supervised Visits State regs Really need some input from Nurses who have been there and done that. Thanks!!

I have one pt that is stable. I go in give his meds, give his eye gtts and take his BP. I am there about 15 min. I wouldn't be there that long but I have to wait 10 min between eye gtts. Hope this is helpful!

I had to give this to my 19 y/o pt yesterday in his nebulizer. I checked the box and the orders. Orderes were 2ml per neb. The box is labeled for injection!! This guy can't talk and has no way to tell us if he has ringing in the ears, etc. I need to know if this is common? Can the injectable solution be given in a neb treatment? I looked it up in my davis guide but am still confused. FYI he does NOT have CF he does have pneumonia LLL. Thanks!!

:redbeathe I told my dh and kids that HH et private duty are the BEST kept secrets in nursing!! I have been doing private duty for almost a year now. I LOVE it and am not looking for anythin else!!

He can't talk and may have the reasoning ability of a 3 y/o. I found this site and copied the picture and info for her, but I can't make her order it. I wish I had the $$$ to buy it. http://www.acidrefluxpillow.com/PTPDesign/toddler.html He stands about 3'9" and his legs are crossed most of the time. He weights about 70 lbs. He can't walk but can scoot on his butt.

I am working HH and desperately need some advice. I care for a 19 y/o male pt. He has a G-Tube and a Trache. He is not on a vent and is mobile. I care for 2 other pts with g-tubes. Neither of them has the problems the 1st pt has. He is constantly getting pneumonia. Here is the problem: I was caring for one pt and was thinking about the 19 y/o. Comparing the similarities, ie G-Tube, resp fail, etc. It hit me like a ton of bricks. I almost puked when I realized why he was getting pneumonia constantly. Since Dec. he has had pneumonia no less than 6x. He spent a week at Riley Hospital. He came off the atb last week and this week Monday he had a fever. Tuesday he was dx with pneumonia again!!! When I took over the case in Dec. the nurse before me had him lay down to give his bolus feedings. I was concerned about that given that he has a G-tube. I had him sit up to feed him. He has 1000 ml of feeding running at noc while he is sleeping. I have put him to bed and hooked the feeding up to the pump and his g-tube and let it run. Here is the problem: HE IS NOT ELEVATED!! He sleeps on his side and has an almost flat pilow under his head. I immediately called his Mom and explained that he needed to be elevated at least 30 degrees while he was eating. She took my concerns to his dr. and the dr pretty much laughed and said good luck trying to keep him elevated!!! :angryfire I took my concerns to my boss and asked if I needed to write an incident report. She looked at me like I was crazy and said the family had been doing this for years. Therefore, I wasn't responsible for the pneumonia. :angryfire I don't feel like I am being a good advocate. Do I need to talk to the dr? I honestly believe that if we could get him elevated he wouldn't get pneumonia as often. Please give me advice. Am I rght to be concerned? Am I wrong for not writing up a report? Thanks!!

I have been in private duty nursing for almost a year now. I ABSOLUTELY love it!! I am losing one pt due to family [ hers] issues. The POA is bi-polar and refuses to medicate self. She watches us with a camera in the room and tells us how to do our job. [Literally, instructed me on how to give a fleet's enema. You know, left lateral position etc :angryfire :angryfire ] I care for two young males. One is 19 and has trisomy 9 the other is 14 and has trisomy 8. I have very little spare time for reading etc. The 19 y/o will sleep and he likes basketball. When I work nocs I put him to bed. The 14 y/o likes pro wrestling. His fave is "Undertaker". I am supposed to do all the moves that his rivals do. Of course I don't do anything dangerous. We have so much fun. Last Sunday we walked outside and I introduced him to trees. Unknown to me, he is afraid of trees. we will work to overcome that fear. I actually got him to touch the trees and to stand under them so he could see how tall they are. As far as losing skills, I think that I have gained skills. The 19 y/o has a new HHN that has two machines. One is the regular HHN machine. The other one hooks into the first machine and delivers 10 lbs of pressure to force the medication into his lungs. It attaches straight to his trache. He also has something called a percussion vest that he wears while he is getting the neb tx. It precusses his lungs to help prevent pneumonia. I don't think I will be leaving any time soon!! :heartbeat :heartbeat :redbeathe

My first nursing job was at our local hospital. I was hired in July. Learned alot but was in a managers meeting in Sept with a laundry list of 'crimes' against me. Stupid things like, Doesn't know how to assess for a subdural bleed. [i had just graduated] Uniforms are not ironed, isn't able to take pts on her own yet.[i hadn't passed boards yet and hadn't been through their nurse training either]. Said that "When I am a nurse I won't have to answer call lights". [seeing as how I had never worked anywhere in the medical field before, answering call lights relieved the boredom.] And my all time favorite reason: DRUMROLL: I BRAGGED About passing NCLEX!!! I was telling everyone that I had passed and that I was now a nurse. I was happy! I was fired after 89 days and 6 days after passing NCLEX!I was never trained at the hospital to be a nurse. It has been over 2 yrs and I still can't get hired back. I finally decided that I DON"T want to work for them. I walked out after my last shift a year ago. I was the only RN in the building,. I had 2 LPN's, 2 QMA's and 3 CNA's working. I had to cover the QMA's and had a death on my unit that night. Even though I quit w/o notice, they still called and asked me to come in.

Trisomy 9 is an extemely rare chromosone disorder. He is not verbal but can "talk" For example, his bottom is raw from severe diarrhea. I put Riley's Butt Cream on it today and he squirmed all over the floor. I know that it hurt him. As far as being in pain, I don't think he is. Can you list some of the the off label uses fopr clonidide? Thanks!!

That's ok. I just remembered something. This is a new order but he is also taking predinsone [N. O.] and he started to scratch nurses and Mom and pull their hair. They were giving him 4 tsp QD Mom told them no more because he was shaking so bad and was extremely aggetated. They cut it back to 2 tsp QD and we are slowly weaning him off of the prednisone. Here are his discharge diagnosies: tracheitis Influenza B Severe Actelectis yeast infection Does this info help any? Thanks!

Hi, Y'all, I need some serious advice. My pt is 19 y/o and weights about 70#. He has Trisomy 9 very rare. Anyway he came home today from the hospital and has an order for clonidine 0.1 mg 3 x a day as needed. I didn't know what that med was and didn't have my med book with me. I don't have his baseline B/P so I don't know if he is hypertensive. I read that even 0.1mg is considered toxic in children under 12 y/o. I know that he is 19 but I don't know what they base the age on. Is it weight or organ growth? I need to know ASAP> If it is dangerous for him to take it, I will call his mom and tell her so. Thanks and eagerly waiting for wise answers.

Hi y'all, I have a question and would like your help sorting it out. Here is the situation: I work in home health, doing shift work. Pt 1 is constantly getting sick with pneumonia and strep throat. He is very hand fixated and has scratched/clawed my hands, to the point that I have bled. [it is not done on purpose.] Pt 2 has severely diminished lung capacity and has requested that if I am sick to please not come to her house. I was with pt 1 two weeks ago when he got sick again. Monday and Tuesday of this week I was sick. I was running a fever and felt like I had a URI. I no longer have a fever but do have a deep cough. I was asked if I wanted to work with pt 2 this Friday for 8 hrs and then work pt 1 for 4 hrs. I was going to do it. I need the $$$ due to the fact that I didn't work my 12 hr on Tuesday. While I was at pt 1's house last noc, I realized that I couldn't work at pt 2's house d/t the possiblity that 1. I have a cough and think it might be r/t the fever and 2. I might carry something from pt 1 to pt 2 or vice versa. I called my boss and tried to explain it to her, but she said I couldn't let that stop me. After all, nurses care for sick people in hospitals going from one to another. I do NOT think it is the same thing. For one, pt 2 is in her home environment and has asked me not to come in sick. PERIOD!! My boss pointed out that she has 24 hr care and that any one of the care givers could make her sick. I understand that point. However, if a pt requests that we not come in sick, shouldn't we listen?? What are the chances of me carrying pt 1's illness's to pt 2? Please give me some advice!! Am I being stupid? Thanks!!

When I took NCLEX, I didn't take a review course. I used Saunders book et CD and Mosby's online tests for the NCLEX. I passed the first time. A friend of mine took the review class and failed NCLEX the first time she took it. Another friend failed 2 xs. He got ALL 265 questions every time. He passed on the 3rd attempt. Good luck!!

HI evilnightwitch, I have LOTS of experience in LTC and that is where I work with the agency. I am NOT about to work in a hospital w/o experience/training!! That is why I told the scheduler that I didn't have any hospital experience. I was hired as GN at the local hospital. They kept me as an NA. Did NOT train me in any nursing classes. I passed boards 4 days before the FIRED me [at the 89th day]. My NM told me I wasn't being recommended for any other floor in the hospital. That I NEEDED to work LTC for 2 yrs. The experience I don't have is IV starts, blood draws, etc. I shouldn't have been surprised that my local hospital won't let me take the course, hell, they won't even hire me and when they did, they didn't train me. I love home health. I do NOT want to work in a hospital. I can get the training I need and not work in a hospital. I want to improve myself and I want to LEARN!! I want to stay away from the constant backbiting, gossip,etc.

Hi, I have been an RN now for 2 yrs. I have worked several jobs, none of which have provided any real training. I work agency and HH. I had an oportunity to work in a hospital with the agency. I told the scheduler I would LOVE to work in a hospital but I don't have any experience [as an RN]. She called the hospital to see what their requirements were for an agency nurse. They wanted a nurse who was certified in ACLS. I am not certified. I took basic EMT in 2001 but didn't get certified. I decided to look on the AHA website to find out where I could take the course. I found out that I can take it at my local hospital. COOL!! I called the educator and asked about the class. She said I needed the basic rhythms class first @ a cost of $50 + $31 for the book. This class meets in Feb. The ACLS class meets in March. Price for that class $175.00 + book. Fine, I don't care how much it costs, I just want to get more education so I can expand my horizons and help my pts. I asked her to but me on the list for the classes and she asked me who I worked for. I told her, then she said that she doubted that I would ever need those classes and that I would be wasting my time. I told her that I didn't care, I really wanted to take these classes. Then she said that I couldn't be on the list for the class because they have to give it to the in hospital staff first. :angryfire :angryfire :angryfire I understand the need to train in house, but why can't they make room for me? I have decided to take the CD class offered by AHA so that I will know something if and when I get to take the class. I really just need someone to watch me do a 'megacode'. Thanks for letting me vent. Any advice would be appreciated.

My day is a lot different because I do 1 on 1 nursing with just one pt at a time. Come in, receive report from family, make first tea, Ck pt for wetness do complete bed bath shampoo hair start feeding [g-tube] do PROM et ROM get her up in the w/c via hoyer lift comb hair and put in ponytail document in nurses notes give meds every hr except 1000, 1900, et 2000 change briefs, restock chucks, and briefs take out trash give report to family and leave 12 hrs. Another pt, on shift, receive report fix breakfast feed pt take puppy out to potty play with puppy talk to pt repositon pt in w/c fix lunch feed pt change brief give report leave 8 hrs This is shift work in Home Health.

I gave her 3 Tbs Lactulose at 1PM. Today, she will get 6 Tbs 3 @ 9AM and 3 @ 1PM. She eats 4 oz baby food a day. She can't talk, the stroke left her paralysed on the R side. With everything she gets, should she have a BM every day? Thanks!!

The sister is a perfectionist. She has also taken care of her sister for 4 yrs. She does care but I am concerned about her giving another enema after I gave one with no results. She did decide not to give it [while I was there anyway] because she said she would poop too late. The pt's voids have been off since Thursday. She had 3 XL voids today and they were very strong. She has a hard time keeping Home Health agencies because she has her sister on supplements. She decides what the pt gets, the amount, time etc. When we submit the orders to the dr. they sign them. However, she has gone through 3 MD's since I started working for her in May. They all say that it is ok for the supplements but when we submit them, the dr says they didn't order them and refuses to sign the orders. I know that she has a new MD and so far he has no problems with the supplements. We will see if she can keep him. She has had bad experiences with nurses. I am not trying to excuse her actions, I'm just explaining. As far as social services, I doubt if it will happen. I have NEVER been accused of not following an order!! Could someone please explain how long it takes for ammonia to build up in a person with liver failure? What are the s/s? Thanks!!

Here is the story: I work HH in the pt's sister's home for 12 hrs every week. Last noc at 8 PM the pt had a major BM. It was all liquid. Today, sister insisted that the pt have a BM. She said that the pt could NOT go without one r/t ammonia buildup. I did my weekly assessment, including BS. They were hypoactive. I had to listen for 2 full minutes to hear them. Anyway, the pt had a upper scope run Thursday. She had a small ulcer that "could" have been old. The MD ordered prevacid for 3 wks and then prn. Sis decided that pt didn't need the med so didn't get the script filled. No varicies were visible and for being in liver failure, she looked great. Anyway, sis told me to give pt a fleet enema at 5 PM. I started the enema and she started crying. I thought that I had put it in her lady parts so I checked her manually. There was no poop! I gave the rest of the enama, and waited 30 minutes. I checked her and all the water had come out with no results except for a tiny smear. I appologized to the pt for putting her through the pain and discomfort of the enama. I felt really bad. At 8 PM sis came into the room and asked if she had pooped. I told her no. She told me she was going to take out the trash because the cans were full. She went into the kitchen and searched the trash for the damned fleet bottle!! :angryfire :angryfire :angryfire She came back into the room and asked me for the container. I had no idea what she was talking about. She finally said she wanted the fleet bottle. I walked over to the small trashcan, pulled it out and gave it to her. She said she was going to give her a "water enema". I repeated that I had given the pt the enema as ordered and that I had NEVER given one with no results. She stated that I should have told her sooner that the enema didn't work!!! She was pi**** that it didn't work. She kept saying, "she has to poop." I can't make the lady poop! I tried. Have you ever given an enama and not gotten anything? Is this normal? Here is what she gets in a 24 hr period: TNP 1000 cc. 90 cc's every hr x 11 hrs. 1000 cc's H2O + 4 oz baby food. Hx: CVA, hepatic failure, resp. failure, ICH. One other thing, I talked to one of the other nurses on the case today because I couldn't find the MAR. [The nurse that lives close took it home with her. Another story.] Anyway, the RN I talked to said that the sister is in her manic state. I need to know if I should ignore the fact that she accused me of not doing my job, or if I should tell my boss. Thanks!!!

Hi all I need to talk and am also looking for some career advice PLEASE!! I was hired as a grad nurse in July 2005 and fired from said job 89 days later. 6 days after passing NCLEX. Got a job in LTC 8 days later and was fired 6 weeks later. Worked 18 shifts. Reasons? Lack of experience and I informed her that I couldn't work swing shifts. [i wasn't informed when I got the job that I had to work swing shifts. I would work 7p-7a be off the rest of that day and the have to come in 7a-7p the day after.] Completely unemployed until March 2006. I went on several interviews but no job. I was hired at another LTC facility 30 miles away from home. I also applied for Head Start Nurse at the same time. I got the HS Nurse job and quit the LTC. In May 2006, I started working for the LTC again and continued to work for them and HS until January of this year. I went in to work my Saturday night 12 hr shift and found out I was the only RN in the building. I decided right then and there that I wasn't working there ever again!! I completed my shift, doing my work and the QMAs work, had to call a death, inform the dr., the family and the facility. I didn't get out of there until 0930. I didn't get a lunch break and was there for 14.5 hrs. When I went in to pick up my paycheck, I checked the schedule and my name wasn't on it so I never went back. I found out from one of the CNA's that State had come in in the middle of the night Sunday after I had worked my shift from H***. I continued to work for HS and got a job in May 2007 working in HH. I went back to QOSunday in HH to work at Head Start again. At HS, things went to H*** real quick. I was responsible for ensuring that each chid had a physical before school started. We had switched to new computer program in Feb. None of the enrollments had been done. I didn't get the info needed to inform the bus driver about who could ride the bus. My site superviser ordered me to ride the bus, work as a teaching assistant in the classroom, and to work in the kitchen, because she didn't have enough staff. :angryfire :angryfire Please don't read that wrong. I don't mind helping in all those areas, but I didn't have my work done. I was trying to get my center ready for health screenings, when I was ordered to do dishes by a teaching assistant. :angryfire :angryfire I told her that as of Oct 12, they would need to find someone else to be their whipping girl, because I was quitting!! I filled out my resignation form and turned it in to the site supervisor. I continued to work HH and instead of working every other Sunday, I now work every other weekend. I am also employed with an agency and have worked one shift with them in LTC. I have gone in to HS several times since I quit to help with paperwork and yesterday we finally finished the health screenings that I tried to do in October. I just didn't feel right leaving the new nurse with all the undone crap. So I helped her out at least once a week. Yesterday, we did capillary lead screenings on 20+ kids. I can now say that I don't have to go back and help the nurse anymore, because the job I was hired to do there is now done. The nurse is more comfortable with the job and the major screenings are done. I called the hospital today that I was fired from 2 years ago, to see if I was on their do not rehire list. The lady in HR was nice and asked if it had been 2 years. She then said she ould let them know that I was interested. I filled out apps for them in Oct and November. Now for the questions: How do I explain 6 jobs in 2 yrs? Do I mention that since May 2006 I have worked 2 jobs? How do I explain resigning from a job but still going in to help the other nurse? How do I present myself to a hospital? I really want to work in a hospital, so I can get much needed training. How do I overcome the fact that I feel like a failure d/t the fact that I have had willy/nilly experience? Thanks!!

Yes. Thanksgiving Night 2 years ago. The nurse before me used a needle and cap to cover the lure-lock on the end of the tubing. I was running vanco and gentamycin for paricarditis. There was blood in the tubing and I had to pull the needle out of my finger!!

I have a degree in Automotive Technology [a mechanic] I worked on our cars, replaced brakes, and rebuilt an engine. I was also a Stay at home mom from 1986 to 2001 when my youngest turned 6. He started kindergarten and I started nursing school. My 15 y/o son wants me to help him replace the brake lines on 'his' truck. So, I guess I'm still a mechanic as well as a nurse!! :lol2:

As a brand new agancy nurse, let me state that I agree. I finished my application on Wednesday and had my first assignment that night. I have 2 yrs experience in LTC and Head Start. I was terrified that they were going to place me in a hospital. They didn't. I was placed in a LTC. I went in at 10 pm to get oriented. [i got about 1 hr orientation.] I replaced another agency nurse from the same company. I started setting up my 6 am meds at 3AM. I wasn't done until 7AM. I didn't get my accu checks finished. I wasn't able to find half of the patients. I finally told the Nurse replacing me, that she may as well relax cause I wasn't even close to being done. She pitched in and helped me and I was able to leave at 8AM I felt like a complete failure!! I know how to do LTC, but I have to tell you it was one of the hardest jobs I've ever done!! Alot of the meds hadn't been ordered. Or if they had been, they weren't in the cart. The lab tech came in [On Thanksgiving Day] wanting to know where the pts were. I was like, I have no clue!! I helped him because there were labs that had to be drawn. Daily PT/INR P & T etc. I figured I had just lost that job, but they called for me to go back in. Unfortunately, I had a prior job scheduled for this weekend, so I couldn't take the agency job. The reason I didn't do a good job was I wasn't familar with the facility, I didn't know the pts, et I underestimated the 6AM med pass. On a positive note, I did do a wound dressing on a man who had so many decubes, I wanted to puke. His wife stayed with him all night. I think the reason agency is in the LTC is d/t failing survey and several incompentcies. The wound I changed was supposedly a skin tear. Whoever dressed it the first time should be taken out and shot. This man had several 2x2s, a 4x4 and an ace bandage around his ankle/foot. I unwrapped the ace bandage and before I was half done I was seeing blood. It had soaked through all the dressings to the ace. I had to use saline to get it off. It wasn't a skin tear, it was a 2 cm decube. This man had them everywhere! On his ankles, feet, bottom of his feet, heels, toes, knees, back etc. I knew I didn't have the experience to work in a hospital and I would have told them no if they had suggested it.