wyogypsy

I have been a nurse for 20 years and have had a lot of great experiences. However, I have only briefly worked with trach patients and never vent patients, and would not consider doing so unless I had a LOT of training first. And I mean a LOT of training. I realize you need a job but working alone with a patient on a vent is not the job. Trust those of us that say that, we are looking out for the patient, family, and you and your license. We do not have any hidden agendas.

Good for you for giving the Roxanol. Yes you should describe what you see. I describe the dressing and wound, I just don't use what Stage it is as I am not a wound care nurse so rarely use the Stages, I would rather just document what I observe. The only thing different we did in hospice is that the wound care was more to maintain the wound than to heal it, as the pt was already on hospice care and healing the wound was not the priority, but giving good wound care was important to prevent infection and hopefully not let the wound get worse.

What I hate is that when I find a med error (or usually errors) because some nurses don't use their MARs, I am the one spending my time filling out the med error form because I 'found' the error. Then the nurse that 'made' the error gets a talking to, if that. I would much rather be able to write down the date and time of the med error, even the nurse making the error, and give it to you. Then the nurse that 'made' the error could complete the med error form. Maybe if they have to spend time completing enough of these they will learn to use their MARs? Honestly I can't begin to write all of the med error sheets that I should write and just let the minor ones go. No, I don't feel good about that - but after turning in the same nurses over and over and over again for errors related to not using their MARs I have lost my faith in that system.

In my years of nursing, many of them in LTC, I have found that most med errors are due to nurses not using their MARs. They pop the meds out of the blister packs, pop them out of the pre-filled packages for each med time, etc. The reason they give for not using their MARs is that they don't have time, or that they give those meds so often they know them by heart. Amazing how many med errors can be found then by the relief nurse that does use the MARs. When I follow a nurse that uses her MARs, I rarely find an error. I believe you can pass meds on any med cart in a LTC facility and by the end of the med pass you can tell which nurses do, and which nurses don't, use their MARs. Kudos to those that still know comparing your meds to the MAR is an important safety measure that doesn't go out of style.

3 days is not enough orientation for a new nurse. Talk to your DON, Staff Development Nurse, or Human Resources. Hopefully each day they are having you do more of the actual work and having the staff nurse supervise; but I know how easy it is for them to expect the staff nurse to just leave your side and do 'this' and 'that' which takes them away from you. They need to be by your side the entire shift. If you are working 12 hr shifts, and are a new nurse, I don't think that 6 shifts is too much to ask.

I much prefer 8 hr shifts with regular days off, I hate every other weekend to where the days off are split. In some areas 12 hr shifts might be OK, but I know in Hospice and LTC they are the pits. Falls and deaths and admissions happen at shift change and you are there much longer than 12 hrs. Yes, some of the work can be passed off to the oncoming shift but if you have a fall at the end of your shift there isn't much you can pass off as they didn't see it, didn't assess the pt, and wouldn't be able to answer any questions the family or doctor had. I like my 8 hr shifts.

This is a liability issue for the facility, not to mention the employees are getting paid to take care of residents, ot their own children. Does your facility management know of this? Even if yes, I bet the corporate offices would not tolerate this.

First of all, you generalize and say 'you all' call them offenders. If you would read the posts again, most of us call them inmates. Those that call them offenders call them that because that is what their state has told them to call them, it is not a personal choice. I do not think you should apply for a job at a prison even though the pay is good. Based on your posts, it is doubtful that you will like it or that you would be successful at it. There must be a specialty in nursing that you like, why not work in that area? Many nursing jobs, especially in CA, have a high rate of pay. Correctional nursing is a speciaty in itself. Like any other area of nursing, there is the good and the bad. The majority of nurses that work in corrections do it because that is the specialty area that we like. We are professionals, and are proud of the job that we do in spite of people like you who put us down because we provide medical and mental health care to inmates. Where do nursing agencies get your infomaton? Regardless of which area of nursing they are recruiting for, I would bet they got it from your State Board of Nursing. There are no nursing registries or agencies that contract only to prisons. Visit their website and you will see all of the areas of nursing that they are recruiting for.

I quit that facility. My license was on the line more often than not, and the workload was out of my control. The company is well known for having as low of staff as possible. Part of the problem could have been fixed by dividing the Medicare patients between different halls, but the Area Manager, who was not a nurse, wanted them all in one hall. I don't mind working hard, and I love LTC, but that assignment definitely got the best of me.

One of the facilities that I worked at had a male CNA apply. Some of the people there had concerns re: his multiple tattoos and piercings. The administrator asked some of us what we thought. The clinicals for his CNA class were at our facility so I had gotten a chance to know him. He interacted exceedingly well with our nursing home residents, and was very kind to them. I wasn't sure how they would take to his appearance so I sat back and watched. Some just stared at him, others would ask questions, but there were no negative comments. Our administration hired him because he had been such an excellent student in the CNA class, and was an exceptional employee. It would have been sad for our residents to have missed out on such good care because someone didn't like his appearance.

Our residents deserve better than that. So the staff.

Yes, we 'can' take care of more issues in-house, that doesn't mean we always should. There are many factors to look at before deciding to treat in house. What is the staffing like? What is the acuity like? Is it realistic that the nurse and CNA on that hall can actually give that resident the care and treatment that they need? Are your staff stretched to the limit already on what they can get done in a shift? If I have 31 residents, one CNA who is not only taking care of those 31 but an additional 12 because a CNA called in, or there aren't enough CNAs at the facility to cover all of the slots, then maybe it is not a good idea. 31 residents you say is manageable? Oh most definitely depending on the residents. But let's add in 5 of them to dialysis, 14 of them QID blood sugar checks, 8 of them scheduled insulin with each meal plus prn, 3 of them with involved would care each taking a minimum of 45 minutes each - then don't forget the easier wound care, 3 on q 8 hr IV antibiotics and 2 on q 12 hr IV antibiotics and 1 on q 24 hour antibiotics. Now let's draw the labs that are not drawn on the two scheduled lab draw days; call the pharmacy and receive calls from them re: med issues; take the calls from dialysis about the one or two residents they have concerns about or that the doctor wants to change orders on; remind a family that we only have one more day of meds left from the mail order meds that they bring in and that we have been reminding them for two weeks about; receive calls from the Infectious Disease group about the resident they just saw who will need to be on IV meds another 3 weeks and don't forget to continue to do the Vanc troughs; oh yes the resident in room 114 needs turned and happens to be soiled as well; and is one of the 45 minute dressing changes and oh goodie she is on isolation as well; and don't you know that the lady in room 120 just pulled her dressing off of her leg and picked at it and blood is going everywhere and remember she has MRSA in that wound; the couple in room 117 are wondering where their meds are and do not understand why they can't always get them at 9:00 like they take them at home, don't you know those eye drops have to be given at 9 as they have done that for years? Why are so many call lights on in your hall, we are doing an audit and the call light response time in your hall is not acceptable. Hey, your admit is here for room 101, do you have the oxygen, the air overlay, and the BSC set up? What do you mean nobody told you about the admit, admisssions and the DON knew about it yesterday! Hey, we are taking the resident from room 102B to therapy and he is refusing to go unless he gets his inhalers and his pain med before we go, I know you are dressed to go in the isolation room but can't you just please give them to him before you go in? It will only take a minute. Where was I? Oh yes, please keep the frail little old lady with the temp of 101, respirations 24, breathing heavy and sats still in the high 80s on 2L here for me, I would love to come right on down, draw labs including blood cultures, and start an IV on her and get her the stat respiratory treatments. I will be there in about............

The best revenge is to smile, be pleasant, and not let them know they are getting to you. Though they may not show it, that totally deflates their balloon. They only do this because they get something out of it.

If you think any area of nursing is not filled with the problems you face in corrections then you are fooling yourself. You have had issues from at least 3 jobs according to your post. You need to look in the mirror. I am not saying the places you worked didn't have their problems, but don't they still have people employed that worked there a lot longer than you? That is because they learned how to get along in the environment in which they work; whether it be corrections, SNF, acute hospital, whatever. You are going to need to learn to do this as well. It is not always 'somebody else's' fault.

That workload, especially if you work 40 hours per week, is less than that of any wound care nurse that I have ever known. I would make a spreadsheet of the treatments, list each patient's room then name down the left side, then put the treatment that needs done, and a column for how long the treatment took. When I can visualize it on one sheet it makes it not so overwhelming for me. After a few days you learn which treatments take just a couple of minutes (g-tube dressings), and which take longer, as well as the best time for each patient. You should be doing 'wound care', not routine care such as changing the dressing on a healed g-tube site, or changing catheters. You do not need to monitor bruising or healing cuts/lacerations requiring no further treatment. Your time needs to be spent measuring wounds, describing them, making sure you are doing the appropriate treatment, and that your documentation is complete. Make sure that treatments aren't being done more often than needed. There are times you will be swamped with treatments, wound vacs, packing huge gaping wounds, etc. There are other times you won't hardly have any wound care. During the times that your acuity is low, you could offer to change g-tube dressings and catheters during those times if that is acceptable to your supervisor. They may want you to do them all of the time though. During the times you are learning, or slammed, be careful of what extra that you do, or how long you take with those patients that want to visit. Until you can get your job done in the time allotted, don't volunteer to do extra things - though at times that is very difficult.

The patient had the right to refuse her regular insulin, the nurse just needed to chart that. A blood sugar dropping from NPH is nothing new - and 19 units with a blood sugar of 121 is outrageously high in my opnion. I have worked under physicians that would not change the insulin dose, would not give more of a sliding scale, were adamant the patient receive the dose they ordered - well, we just flat out couldn't give that much because the patient would have died. Even holding the insulin or decreasing the amount given often resulted in critically low levels. I have diabetes and take Lantus - and patients are not supposed to 'bottom out' from Lantus. My blood sugars have gone down to the 40's a few times after taking Lantus when they were 120-130 prior to taking it. The explanation given to me was that my pancreas kicked in at the same time which caused the quick decrease. I am not sure if this is accurate but it is what I was told. Even though you don't have to eat after taking Lantus, I had eaten before or during the time I took the Lantus on each time that I dropped. The Board of Nursing may investigate but as long as she followed policy and protocols she will be fine. If she didn't, then some remedial action may be taken but she will not lose her license as she was not negligent. In a right to work state they can fire you for any reason, and for no reason. Unless it violates your Civil Rights there is nothing you can do about it. As for future applications, if she doesn't put it then they can fire her later for having lied or omitted on her application. If she didn't work there for very long she can just leave that job off of her application and/or resume.

When I was younger I liked 12 hr shifts, but now I hate them. What would be perfect would be a combination of 12's and 8's, two of each and that would give 3 days off. I currently work 8 hour night shifts with regular days off and I love it. I can't work nights with 12 hour shifts. I have time to eat, sleep, shop, go to the beach every day, do crafts, do things with friends, just basically have a life. When I worked 12's I was so damn tired and in so much pain that at least 2 of my days off were spent recuperationg. I think the facilities that offer different schedules are wonderful, what a great thing to do for the nurses - I am sure it helps with retention! The only think I won't do is work five 8 hr shifts with split days off. Give me Tues and Wed off every week before splitting my days off.

I don't know if we should have to work as a CNA without a CNA being scheduled, wouldn't want to do that to the poor patients! I used to be able to do it but am not so young anymore. But I definitely think a nurse should be scheduled to work a full shift with a CNA, how else do they have a clue what the CNA does and how busy they are, especially if they haven't worked as a CNA before?

Always do a full set of VS with each visit, and rate their pain. Other than that you can just address the issue that they signed up to be seen for. If they come in for athlete's foot, then want to discuss their back pain, and their broken tooth, put a stop to it. They are seen for what they signed up for, if they want seen for something else they need to complete another sick call. I would see them for more than one thing if they put more than that on a sick call but limited it to two requests per sick call slip. I would suggest you look at getting a book from the National Commission on Correctional Health Care. This is a wonderful group that was started to ensure (insure?) better healthcare in correctional facilities. Every facility I have worked in, with the exception of the current one, has been accredited. They have a book specifically for jails - Correctional Health Care Standards | National Commission on Correctional Health Care I had the great privilege of being audited by the founders of NCCHC. They were amazing. Look at the above website and I think you will find publications that will help you, as well as conferences that you could attend if you so wished. Good luck!

Oh you shouldn't go there. I am an overweight nurse and I can tell you that I outwork most of the nurses that I work with. I can make it up and down those halls as many times as needed, do CPR, help turn patients and reposition them, help them to the bathroom, do whatever is needed without difficulty. I can probably get down on the floor and back up faster than you can. I am a human being just like everyone else. I show my patients compassion, empathy, sympathy, tough love, educate them, and am one hell of a patient advocate. I started as a CNA and have done everything in between that and Health Administrator in multiple settings. If you are stupid enough to think being overweight is all about the food choices you make, or lack of exercise, then you need to go back to school. I also suggest that you find out what is lacking in your own life that you feel it is right to criticize others that you do not even know, based on such superficial criteria.

Try Supplemental Healthcare Staffing. I have worked for them a few times - the office in Buffalo, NY is the one you would be going through and they are excellent! They have benefits, are quick to get things done, keep in touch with you, always pay on time and correctly, I have no complaints about that office at all. They are always my first choice! You can look online to see what openings they have: Health Care Staffing | Supplemental Health Care

I just have to say that no nurse wants to work for a manager that hasn't been there done that. If you can't do what I do, then who are you to be my supervisor? How am I supposed to respect you? I am not bashing you for not being a bedside nurse, not everyone is cut out for that. Just don't expect to be a manager over staff nurses when you haven't done their job. They will eat you for lunch. Yes there is insurance, there is also utilization review, some home health agencies hire case managers that do not have a lot of experience (just check to see if you are strictly doing paperwork or if you ever have to do direct care), there are nurses that work for Kaiser that have jobs such as checking physician credentials and continuing education that do not do patient care and the salary is good. So there is something out there for you, but a lot of it depends on where you live. Another option is to become an MDS nurse in LTC - talk to those that are already working in it to see what it involves. I will tell you though, that if anyone tells you that an MDS nurse is a 40 hour per week job don't believe a word of it - I loved being an MDS nurse but the hours were brutal.

I went to the doctor as I feel I need my meds tweaked, am on Effexor XR 150 mg qd. She wanted to lower me gradually down to 75 mg qd and start me on lamotrigine, a small dose and work up to help stabilize my moods. I don't get manic, I think I go from severely depressed to 'normal'. I haven't made this change yet, she is leaving the area and I didn't want to change meds when I am going to have a new provider that may have different ideas. Though I feel I need a med adjustment is is so scary. Have any of you been on lamotrigine (Lamictal)? Did it help? What can you tell me about it, good and/or bad? I do realize it affects everyone differently but really don't know anyone that has taken it.

If there is any way that you can get on with the Calif Dept of Corrections (CDCR) as a registry nurse, and you like it once you are working, you can apply to go fulltime - they can make special provisions to keep you after the usual six month maximum registry period if you have an application in with the state, so you don't have to be out of work and they don't have to lose a good applicant!

I am not sure what area of nursing that you work in, but there are a lot of LVN travelers in correctional healthcare.