waves

If this is true, then what do you interpret as the team nursing "legal scenario"? If an RN and LVN team have 9 patients in Surgical Acute, is the hospital out of compliance? Or is it allowable because of the term licensed (and subsequent definition that includes LVNs) in the original draft of the law regarding patient ratios in CA? (In regards to spacenurse post #14)

You sound like a thorough nurse. Please do not blame LVNs only for doing poor assessments. I have worked with RNs who chart assessments on the wrong patient chart (and never notice), and who also chart WNL when they are obviously not. I won't go into the RNs who thought D5W and D5NS were the same thing, that a UA specimen could be taken from a long hanging foley bag, or that Lovenox could be given in the arm. One of our instructors used to chuckle that WNL meant We Never Looked.

I went to these website links and found nothing r/t LVN assignmnets. There was in the FAQ section of one a Q/A Heading regarding same, but the actual Q/A seems to have been removed. It is a very confusing business as the hospital I am at uses an RN-LVN team to cover up to 9 mixed surgical acute patients. The administration is hoping to have the RNs share the paperwork load with the LVNs as well as the direct patient care. They stress that the LVNs are trained in assessments, care planning, etc. It seems some of the long-time LVNs have no interest in adding paperwork to their burden. Some of the new LVNs have a different outlook and want the added responsibility. I do think that LVNs could be assessing POD #2 or #3 and beyond, provided the patient is recovering as expected, and no change of condition has been noted. The problem seems to be in the way pts are assigned. If the patients are assigned to an RN-LVN team, isn't the RN always responsible for delegating and follow-up? If, as in rural hospitals, the LVNs receive a patient assignment with an RN to cover a scattered IV ABX, who is overseeing the LVN? It still seems very interpretation and pint of view driven.

yes, finding out i had passed was quick. the way my school did the application process was flawed so approval to test was slow. the issuance of the license after receiving the pass letter is also variable by admission of the BVNPT office. due to budget cuts they are often under staffed and sometimes have seasonal help when a large influx of candidate information is expected.

bambou- hey there. i'm not sure if you are from california. i am and i will speak to my experience in earning a nursing license here. choosing nursing was one of the best decisions i have ever made. the nursing program that will be best for depends to some degree on how much education you already have, how much support you have financially and for child care etc. if you are already a parent. the non-degree program i attended for an lvn was through a local adult education program. there are not very many of these in california. more programs are offered thru junior/community colleges in cali. some have RN and some have LVN and some have both. the RN programs usually are awarded along with an associates degree. there are of course many RN/BSN nursing programs at colleges and universities across the state which are mostly geared toward high school graduates who plan to attend college full time directly out of high school with the intent of earning a nursing degree. some schools promise the classes will be done in 4 years. this promise is made, because it often takes students at larger institutions 5 years to complete the degree. the community colleges will advertise a two year RN program with an associates degree. the two years are once you have entered the official nursing program. to gain entry into this program you need to take pre-requisite classes in things such as anatomy, physiology, biology, chemistry, etc. this is where i ran into trouble. i had a hard time registering for the pre-requisite classes due to the large number of students who had priority over me in the registration process. i can't even guess how many years it would have taken me to complete the pre-reqs if i had continued at that jc. if you do not already have a large number of college credits, you shouldn't have the same problem. i strongly advise you talk to someone from the counseling and nursing departments to help you organize your scedule. many schools offer certain classes only in the spring or fall, etc. the lvn is not the same as the rn. i earned an lvn first because i needed to get myself into the workforce. in my area lvn's can make about $20/hour at a skilled nursing facility (SNF), $11-19/hr at hospitals, and $11-16/hr at doctor's offices. i personally am on the longest possible road to becoming an RN, because i went to the adult education program. none of my classes from the program were college accredited, so i am retaking anatomy, etc. to get into an LVN to RN bridge program or an LVN to BSN/RN program. but, i needed to start earning money and it was the quickest option to get me trained and into the work force. i must add, i work full time in a hospital right now. the experience i am earning as an lvn is the best training i could ever receive. i happen to be in an area with limited opportunity to take the classes i need, so it will be 3-4 years from receiving my lvn to being able to apply for an RN program. in mind it is worth it. one reason i chose the lvn over the rn initially, was that i didn't want to spend 5 years in school to find out it wasn't for me. i was in my late 30's when i began my transition into healthcare. nursing is a wonderful profession in that it can take you in many directions... there is direct patient care, specialized positions, home health, doctor's offices, clinics, management (with advanced training and/or experience). you will be able to change your career as you grow as a person. the nclex is the nationally recognized test. the nclex for the LVN(LPN) is different than the nclex for the RN. if i have any other questions, please feel free to ask. good luck. one last suggestion is to train as a CNA to get some experience in health care. the training programs are less than 9 months ususally. they are offered by skilled nursing facilities and other community agencies as well as some community colleges. CNAs in my area make $9 to $15/hr. And a word to the wise...if the job description of a cna doesn't appeal to you, well...everyone in nursing does those tasks along with the more advanced ones.

Thanks so much for your very complete answer. What do you mean by window pane the wound?

As for waiting for results... for my class, those that heard within two weeks from the state via a letter, were those that passed. Those that waited 4-6 weeks for initial results did not pass. Getting the letter from the state.... you are asked to send a check for $100 back to the state for license processing. Depending on the back log of incoming mail, it can be another 4 weeks to get the actual license. I wish someone had told me that! You do have the option of walking into the BVNPT office in Sacramento with your letter and check. You will be handed a temporary license. You'll get your license (not paper, but something like a credit card) a couple weeks later. You can work on your temporary license for 45 or 60 days. It will not have the same issue number as your actual license. You can verify your own licensing on-line sometime between when the receive that $100 check and when you get the plastic card. I was told it varies depending on work load at the office and number of staff. Good luck!

the first drug program i downloaded was epocrates. the free part is a very basic drug book. when you first download it, they provide you with advanced features that will magically disappear in 30-60 days or so. then to get the extra features, you pay as a nursing student, i found the pt teaching, nursing considerations, IV considerations, etc. very helpful in the NDH drug program. but, the hard copy drug book i am most likely to grab is the NDH too. being able to access by brand names and chemical names is quick!

I have Tungsten E from palm. I have a 128MB expansion card too. On the expansion card I have a drug "book", a book about diagnostic tests, and a book of nursing interventions and plans. I purchased all of the books from skyscape. I chose the option to do a trial download before purchasing each. I liked the features. I liked the drug book (I'll list it below) because it is geared toward nurses and has subsections for each drug on patient teaching, nursing considerations, and effects on lab results...as well as all the other things you'd expect in a drug book. I like my test/diagnostic program becasue it explains what is required before, during and after every procedure, as well as why it might be ordered and what results may indicate. I have referred to it many times in answering questions for patients about what to expect during a procedure. The nursing interventions is the hardest to use, but I don't like the nursing intervention that much. I have used it though to help decide what subjective and objective things might apply to my particular patient...and what I might expect to see. The programs are listed as follows: NDH05 by LWW (drug book) RnDxTests by FAD (test/diagnostics book) RnDx_Int by FAD (nursing interventions) the three programs link between each other, though I probably haven't used that feature to my full advantage. I love my extra tungsten brain though! good luck

in cali- iv cert means blood and saline but no K. the rationale is that the K requires the RN training to recognize issues...due to cardiac, ie. possible death, effects.

i know what you mean about 5 years to get the 2 year degree. i started taking my pre-reqs at SRJC. it became clear very quickly that i would not be able to get into classes i needed. i met people in the summer biology class that had taken some classes 3-4 times...at least they started them. there was a strategy to sign up for several classes and drop the ones you are not doing well in. and they didn't lose any priority status. i heard rumors the school was going to do some additional filtering of students who were doing this, like they lose their priority for that class registration on their third try. i ended up checking out other schools further north, mendo and college of the redwoods. there is less problems getting classes at these schools. mendo is just developing its ADN, but CoR is well established in eureka. keep in mind that pre-reqs are pretty much the same, but not exactly...you may have a suprise in store for you if you don't stay in contact with any school you want to take the ADN at.

it is definitely tougher to find the stuff in print about keeping LVNs aboard...if you have an lvn under you, how many patients would you be willing to take on? or do you prefer not to even delegate bedbaths, dressing changes, etc.? in your opinion is the whole ratio thing of 1:5 based on the notion that an LVN and CNA would help provide the total care...or that the RN would do it all? just very curious as i've never seen an RN do a bedbath outside of ICU.

Having my head deep in the textbooks for the last year as an lvn student, I was believing what the dir. of nursing at the hospital and our instructor was telling us about not being able to hire lvns due to the state law. now that i try to find more info, i see that it is the rn union that is pushing hard to eliminate the lvn from the picture. the hospital where i do my clinicals had lots of traveler RNs in Jan. some of them seemed questionable in their ability to provide care. now the hospital has more lvns on night shifts in med/surg. i don't know if the hospital filed for a waiver due to the rural location though. one of the other students works at another hospital as a CNA. she confirmed the hospital is reducing its CNA staff...punishment for RNs who demand ratios to be able to provide "total patient care". i guess folks need to be careful what they wish for!

depends on where you are in cali. if you are in the bigger cities/urban areas there are urgent cares clinics, large hospitals, rehab centers, and the usual nursing home/doctor's office stuff. a lot of california is rural. folks don't think so from watching tv, but it is true. there are plenty of rural areas in northern california that need LVNs (what LPNs are called in texas and california). most of the work will be snf/nursing home. the state is currently trying to work out the rnurse-patient ratios in hospitals. they way it stands now, most aren't hiring many new LVNs. depends on how many sub-acute beds, etc. there was a law passed and ruled on by a court that only RNs could be used in figuring the ratio in acute care. so hospitals are desperate for RNs. i'm a bettin' man. there is no way health care will be affordable with 5:1 ratios that only count RNs, else there will be no health care. things will shift soon...either law will be revoked/changed...or more sub-acute/rehab type centers will be used. depends on whether you want to work on school to be n RN...work in geriatrics, etc. good luck

Hey there. I have a BA, not a BS, so I have a lot of science to take before I can get into a BSN program. One thing I discovered was that MSN is not the equivalent of a BSN. Meaning...that if you want to be a traveler and do nursing in other statea...a MSN may not qualify you by that state's rules. From all my research, it seems a lot of east coast schools have programs that are geared toward students like you...but you get a BSN and then an MSN in 2.5-3 years. I haven't found a school in California that is set up that way. Sort of depends on what you want to do, I guess.

A 2 year RN program is two years after meeting all pre-entrance requirements. At the comm college in Santa Rosa, if you already have a degree you are very low priority for signing up for classes. There are always wait lists for classes. So the pre-reqs that should take a year and a half or two to get....take two to three years. Then the RN program accepts 1/4 of the folks who apply. It was based on points but may shift to lottery....so plan 1 to 3 years to be accepted. THEN the two year program starts. So a two year program can take longer to complete than a four year.

Hey there. Both Kaiser and Sutter in Sonoma and Lake Counties (and possibly elsewhere?) are helping LVNs including lining up preceptors and paying the bridgers for one day of study time each week. The new legislation, which court rulings confirmed, says the new licensed nurse to patient ratios do NOT include LVNs only RNs. This means that the LVNs that are already employed will be helped; but it will be almost impossible for a new LVN to get a hospital job...unless the hospitals will have "extra" nurses which would be LVNs. The RNs union pushed very hard to maintain that the RNs are the only ones qualified as licensed nurses. Since I don't graduate until early 2005, I guess I'll be headed to home health, a SNF, or an office. Crazy! Not really what I want...but I just have to head right for the JC to start in on all the pre-req classes to enter an RN program.

I see this too. When I've been preceeded in a dept rotation by other students who are "eager beavers" but do what we were specifically instructed not to do. So I am always cautious...I do want to learn, "get dirty", etc. But I won't cross a boundary that puts me in jeopardy... I have always been a bit paranoid that even doing something just one time is the one time things will go very wrong. Giving medications is so often treated as no big deal by some...but those students scare me. They can't possibly be thinking the pt might have a severe allergic reaction or respiratory arrest or cardiac arrest. And if they have...they probably haven't thought about what they should do first. Answering "airway" on the test is not the same as maintaining one in an unfamiliar setting, especially when you are just patting yourself on the back for such advanced care!

I would thrill to have an instructor who was confident in her instructor shoes. In my pre-nursing-student life I had to work with many young folk (I am nearly 40) who had a hard time following the work rules, uniform guidlines, etc. I am still amazed when other students who are in that 19-24 yo age group spend time arguing their rights to express themselves through their personal appearance, instead of studying. The uniform is supposed to free you from having to make those time-consuming fashion decisions. Our instructors talk-the-talk but can't always walk-the-walk. Sometimes they appear to be crippled by the system or political correctness or a need to be liked or something beyond my understanding. Students are allowed to turn in papers late, come to class late, etc. Rules are layed down and then randomly enforced. In fact lately, the instructors are picking on the top of the class and not the folks who don't score passing (75%) grades. There have been times when the average test score was so low, that the lead instructor went back and dropped questions off to bring most scores up enough to raise the average test grade. It seems a good nurse re-assessment would be to look at the teaching-testing method to determin why teaching objectives were not met. Guess it's easier the other way. There are actually students in our program who COMPLAIN that they shouldn't be expected to READ the textbook assignment...because they are very busy people. They expect to pass without opening their books! Okay- it's a practical nursing program in a rural area...and the nursing shortage is huge...but PLEASE! I can see why nurses see a difference in students today. It's not PC to be a tough-old-battle-axe instructor. And those type of instructors are replaced with the new breed. Conscientious students know they are suffering through a mediocre experience. There are a few of us who are very frustrated by the lack of responsibilty anyone assumes in our education. We are told time and again it is up to us...as if the instructor is already seperating herself from any responsibilty for the quality of the nurse she helps produce. I'm sure the old instructors were proud of everyone that they passed; and were confident to have their name associated with that student. I don't think our current lead instructor feels that way. But please floor nurses...try to discriminate between students who care and students who don't. We are finally far enough into our clinicals, that the nurses recognize the students they see becoming good nurses; but they still have to suffer through those that don't too. Thanks to those floor nurses have allowed me to assist in special procedures, or gone out of your way to time a procedure when I wasn't cleaning up another patient's backside. Students need good, strong nurses for examples...because we may not be getting that in class.

bukko- i'm with you. i decided to try nursing in my late 30's. i wanted to know what i was getting myself into before i buried my head in books for 5 years, only to find out it wasn't for me. is it true starting lvn's only make $10-15 an hour in southern cali? that's what a CNA makes up here in rural northern california. the local hospitals are all trying to help the lvn's they have move to RN licensure, and only can hire limited numbers of LVNs. but the more north and more rural you go, the less an LVN is poo-poo'd. folks are hard up for nurses...they do what they can to meet the laws and make money! no nurses = no patients = no money! by the way, i'm still in my LVN program. i'm already looking into the RN options because the length of time it'll take for me to finish all my pre-req's and file applications. and i do expect to be able to pay the bills as an LVN...money ain't that bad!

curious kid here... do bad working conditions include the problems between nurses in a shift? or does bad working conditions automatically imply bad managament and low pay? in my student rotations thru the hospital i have definitely seen areas where nurses cooperate and work together...and areas where this is a good days behavior but not the average days behavior. they ran a nurse short the last two weeks on med/surg...the charge nurse had a load...but if everyone isn't pulling their full weight...it can make for a rougher day for the others. so what constitutes poor/bad working conditions? do other nurses play into this or is it just the folks doing the schedules?

Always an interesting subject for me as I am in nursing school now...and have at least 5 more years of part time and fulltime schooling to become an RN. The point that nurses are not working as nurses is brought up. I have a degree in finance management...but when i graduated in the sluggish economy of the late 1980's there were no jobs for a college graduate in my field paying over $21K. And those were hard to come by. I ended up in tourism because I loved living in beautiful places, and having busy times and slow times. My last job in tourism I worked from May 23 to Sept 23 with only 3 full days off and 2 half days off...at a remote lodge where you couldn't get on-line or buy a latte. I loved it! Did I go back the next year? No. Am I bitter? No. It was just time to make a change. I have changed career paths 3 times. I am on my 4th path. With people living into their 90's and one's working life extending into your late 60's or 70's (my dad is still part time at 75, he was a teacher....there's another underpaid, under-appreciated role that requires dedication beyond compensation to be satisfied)...so the point is I will be in the work force for 50-60 years by the time I am done. Welcome to our century and the benefits of living a long, healthy life. You get to work an extra 10-15 years too! Will nursing be my last choice? I don't know. I did choose nursing because of experiences in emergency medical training. It has been and will be, a long row to hoe to get into the programs. In one article I read about this program it says I'll need straight A's. That's quite a challenge in itself. I am hoping with nursing that if I get burned out in one area or place that I can take another class and make a change. I think one reason people don't make changes easily is because they have structured their lives, more specifically their lifestyle around making a certain amount of money. If you always have money in the bank and aren't spending every dime on stuff...it makes it easier to change. In a way I think of it as a "therapy fund". When things get too crazy...it's time to change. I'm dedicated, hardworking, and easily taken advantage of....but not to the point of insanity! These are the words of someone who is not yet a nurse. But bad management is not limited to the healthcare field.

Truer words were ne'er spoken. I appreciate the replies. I know there is always more to learn. I am doing okay in the program. Too much empathy for the underdogs! They have thanked me most profusely for voicing what they find hard to say. I am presented with many opportunities to learn savvy. This may be the biggest hurdle for me. Knowing I need the school's approval will certainly keep my toes on the right side of the line. Thanks for the wisdom and good words.

I am a student at an 18 month vocational nursing program. The program had a great reputation because it was run by two great nurse/instructors for 30+ years. I didn't know this when I applied, tested, interviewed, etc. to be accepted. These two have since retired. The new director is trying to put her mark on the program. She ordered all different textbooks; but didn't bother to read them. She makes up new tests; and sometimes the answers don't match what the textbook says...because she doesn't believe it to be true. (Textbooks can be wrong, but the problems are not pointed out before we are tested because she hasn't read the chapters she assigns.) Not to mention that over half the teaching staff quit in the first two months of the program. Some stayed long enough to train replacements, some didn't. The program has been more stressful than waiting for the acceptance letter. The worst part is that, though we don't cover all the material scheduled for a day, we are let go early 80% of the time. The whole point of minimum requirements for classroom and theory seems to be a bit of a joke to the director. I understand her workload has picked up due to lack of staff, but it is really affecting us, the students. Many of my classmates and myself are annoyed, frustrated, and feeling cheated of a complete educational experience. But what do we do? If we bring it to the attention of those in charge...we could end up without a program. It's sort of a rural area...so it's impossible to find an equivalent locally. I've made use of the opportunity to voice student opinions once a month at the meetings that are held for student feedback. My dad says I should take it to the director's boss. Let her know the director isn't fulfilling her obligation. That just seems like I'll end up paying a hefty price. At present I'm learning as much as I can on my own and taking advantage of the nurses in the clinical setting that are willing to teach something. We were warned we would need to be holding ourselves accountable for our own learning; but it just seems ridiculous. Am I thinking too much inside the box?