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  1. cookienay

    911-ing a resident out, requires an order?

    Do you seriously need an order in LTC to call 911? Any reasonable layperson should have been able to recognize that the resident was suffering an acute medical emergency. So a trained, licensed nurse does not have the authority to do the same? What if the family was with the resident when the episode occurred? Do they need an order? If it were my family member I would most definitely activate the EMS. I call hogwash.
  2. cookienay

    MSU Mt. Sterling Fall 2011

    Don't know anything about the Mt. Sterling program specifically. The Morehead grads in general come out of school at a higher level of competence than some other schools regionally. I think it is a great school. We have two students doing their practicum in our dept and they are on the ball! Good luck in your endeavor!
  3. cookienay

    PTO/Sick Leave for Nurses

    Accrual of PTO is based upon hours worked and years of service. More time with the hospital means you accrue at a higher rate. I find it to be very generous. We are allowed 4 occurences of absence in a rolling 12 month period, on a no fault basis (meaning dont give us a reason just say you can't be there). Absences due to jury duty, FMLA, OJI, states of emergency, or those qualifying for bereavement do not count as an absence. 5 occurences- informal write up, 6- 2nd write up, 7- suspension 8-termination I have only at one time in my almost 20 years with this facility have ever received an informal write up due to absenteeism (my kids were sick alot that year). Pretty fair and enforced consistently which I know is not the case with many of you.
  4. cookienay

    work excuse and privacy issues

    Refer to Occupational Medicine if available (family MD if not). They can determine if someone is fit for their particular job duties.That is not ED issue.
  5. cookienay

    Bedside Report dillema

    THis is slightly off topic, but your management's reasons for starting this practice are puzzling. Bedside reporting is actually a component of Joint Commission's NPSG to increase effective communication between caregivers. (As was the read back and verify component you are probably familiar with by now). The whole "increase staff accountability" and prevent "dumping" issue makes it sound like there is a problem with each of these and they don't know what to do about it. Good luck with this issue and the above posters have all given good ways to handle this issue. Just my $0.02
  6. cookienay

    ppd question

    That happened to me once and I was scared to death. Turns out it was a local reaction and was gone by the time the 48 hour read time came up. Try not to worry until you have to!! If your employer won't foot the bill for the cxry if one is needed, call the local health dept. Good Luck!
  7. I am all for a certain level of customer service. For starters, people most likely will not sue someone that they like. Secondly, it makes my job easier. To go above my patient's expectations is something that actually alters their perception of the actual care they receive. Unfair as this may be, most people equate "nice nurse" means "good nurse". They don't care that you are 30 minutes late with their meds, fail to advocate for them, or choose to play on facebook while they sit on the bedpan for an extra 10 minutes. They just want you to be sweet. For the most part, I love that my facility is known in my region as the place where you are treated the best. Yes, we also give great medical and nursing care. Now are all of our nurses Susie Sunshine?? Absolutely not. But there are standards of conduct and we are all held to those standards. And yes, the entitled, demanding patients are a pain in the keester. However, they will always be that way whether you have a "customer service" component to your care or not. For myself, I could have the most hateful nurse and doctor and not care one whit. As long as they know what they are doing and follow the standards of care, that is all I really want. Just my perspective. Sorry to hijack this thread, carry on. :)
  8. cookienay

    new to the ER with a question for you experts :)

    Esme- good info. Would it still be considered EMTALA if they were under the care of the admitting inpatient physician and not the ED physician? They were just geographically in the ED area? This is where I was coming from in my initial response of it not being EMTALA. Such an informative thread!
  9. cookienay

    new to the ER with a question for you experts :)

    This is not an EMTALA violation per se that I am aware of. Ideally, these patients should be moved to a different facility that has the staff and space to properly care for them. There is increasing evidence to support what we have always known: outcomes suffer when inpatients are boarded in the ER. While it may not be an EMTALA violation necessarily, it is most definitely a patient safety issue. My advice: do search for articles/studies relating to ED boarding relating to patient safety. If your facility is big on customer service, there should be info available on that as well. Share these with your director and your QA/Safety director. Approach in the manner of wanting help find a solution, not just whine about the problem. However, this will not change unless top leadership is on board. ED boarding was a huge issue before our VP got on board. It was a pain in the butt during the change (micromanaged to the nth degree!!), but well worth it as we almost never have any boarded patients anymore. If it looks like the situation will not be changing, look for solutions that prevent things being missed or overlooked. We developed a checklist to keep things from getting missed (our processes were so different). YOu may want to develop that for your department. This is a bad situation and one with no easy solution. Good luck!
  10. cookienay

    Have you ever been told

    I have no idea what you all are talking about. I sit around all day painting my nails and eating bon-bons. Being a nurse is waaaaaay easy. *insert sarcasm and eye rolling here*
  11. cookienay

    Todays Most annoying pt award goes to....

    This thread made me laugh out loud. I know I have taken care of each one of these fruitcakes at least once in my career.
  12. cookienay

    Need Advice

    I find it ridiculous that a fellow nurse would say it was "your fault" because a pt became septic. Complications happen. While there are things we can do to prevent sepsis I find nothing in your post to indicate that you caused the sepsis. Sounds like you acted within the standard of care as any reasonably prudent nurse would. Best wishes and you will be fine (hopefully your patient will too!).
  13. cookienay

    Access to Nurse via Telephone

    "Now, I know you can't tell me anything because of confidentiality and all that, but what was was wrong with him?" That is my favorite. You can bet the clerks hear about it when I get that phone call. I tell them "The patient has a phone in their room. You have a transfer button on your phone. Use it." Ok- maybe not exactly in those words but you get the idea.
  14. cookienay

    "Good Housekeeping" Got the ED Nurse's Message

    Love the call ahead advice! Umm, this is not Chili's. We do not do call ahead seating.
  15. cookienay

    Different Licensure for School Nurse?

    Thank you all for the information! Supernrse, so it is a licensure and not a certification, correct? who licenses you as a school nurse? Is it the state BON? Or is it a professional organization? I guess I better get started on this coursework! Thanks!