kasi

a nurse i work with asked me about the following order: vicodin 5/500mg 1 to 2 tabs every 4hrs prn her question was, if she gave the patient one vicodin tab at 9:00am and the patient was complaining of pain at 11:00, then could she give the other vicodin tab at 11:00. (no md order to give the extra tab before 4 hrs). she says this is common practice at the hospital with prn meds. then they will medicate the patient with 2 vicodin at 1300, because the first vicodin was given at 9:00am another example is ativan: 0.5mg 1 to 2 tabs every 4 hrs prn. again, i have seen nurses initially give the one 0.5mg, but then an hour or two later, they give another 0.5mg of ativan. their rationale is that they only gave one tab and the md ordered up to 2 tabs. i tried to explain that you can only give as ordered ( every 4 hours), and if the patient requires more in less than 4 hrs, then they need to get an md order to give the additional dose.

Wow, sorry you had such a bad experience at the hospital. Last year I had surgery for the first time in my life and had the best hospital care ever imaginable. The nurses were excellent, they helped me survive such a scary time in my life, kept me medicated so I never felt pain, they were always there at my bedside before I needed them, and the CNAs were so professional. Oh, and the food was hot and delicious.

Thank you for your support. It is so difficult to face these co-workers night after night knowing they did this to me. Especially since they all keep neglecting certain areas of patient care and act like their doing nothing wrong. There is one particular CNA who is constantly a bully type. The DON thinks she is a great worker, but only for the last few months. Prior to that, the DON constantly told me she could not stand her, that this CNA drove her crazy. I found out 2 days ago, this bully CNA is secretly recording her co-workers. She plays it back and thinks it is so funny. Yes, I am looking for a job. I want to desperately work with people who act professional on the job. I know once I turn in my notice, they will want to know why I am quiting and they will want to throw me a going away party during the night. I do not want to participate in any going away party. I am still angry, frustrated and hurt by what they did to me.

2 CNAs and 1 LPN wrote false allegations against me and turned it into the DON. Just a week prior, I had finished and gave evaluations to 8 co-workers, CNAs and LPNs. All of them got overall great evals, with exceptional and outstanding marks. I made great comments on their strengths. I wrote for one CNA the need to improve on attitude during shift change (not to yell and argue at previous shift ). 2nd CNA, made comment that she needs to improve on teamwork. I made a comment to an LPN that she needs to get her regular duties done before the shift is over (she tends to do her homework half the night and BS with her co-workers). All three still got over all great reviews. The false allegation by all 3 is that I do not answer alarms, but instead go get them to answer the alarms. That is not true. I have never refused to answer an alarm. In fact, I am the one who usually gets there first. The DON wrote me up. I told her they lied. She said no they did not because several of them turned in the same statements. I was told by upper managment that this would probably ruin my career. For over 10 years, I have had great reviews and no write ups as a manager of my shift. I keep witnessing the staff I manage to not give good care, ie. sit around, start their rounds late, not answer alarms or lights in a timely manner, not finish their rounds(ever though they say they do). I am in fear of writing them up because I know they will write false statements against me again. These same co-workers tell me that I am the best charge nurse they have ever had. To me this is a crazy situation I am in. I am looking for a new job.

Hello, thanks everyone for your replies. Our DNS has been there 4 years. He has been there long enough to have solved some of these problems. I don't think the DNS has it made. He has a tough job, but needs to work on priorities such as so many of the nurses not complying with the guidelines. As for inservices and training, I would love to educate the staff! But, they won't allow it because of the budget! They just expect nurses to learn during their shift. As for the residents, so far no one has suffered from protocols not followed. Thank goodness!

I am a RN in LTC. It has been well over a year now that nurses are not following important protocols. The new nurses in the last year are not taught to follow protocol or to document correctly, then they orientate new nurses without teaching them protocols, then no one knows what they are doing. Recently I have reviewed approx 30 charts for the MDS, and found many problems with documentation. Here is just a couple of protocols they do not follow: 1. Skin Protocol & Protocol for Pressure Ulcers - many nurses document like this: open area on buttocks, duoderm applied, check daily for placement or open area 1cm x 1cm, duoderm applied, check daily. Thats all thats done. My main gripe is Protocol for pressure ulcers, no prog note, skin sheet not started, order for labs, orders for zinc and vit.C not obtained by MD, referral to dietician not made, care plans not updated, no skin assessments to follow, pressure relieving devices not initiated. This is a constant problem, no inservices to correct this problem. 2. Fall Incident Reports - the nurses do not fill out the incident reports correctly, and the prog notes are extremely vague. Reading the prog notes, I have no idea when the fall occured, how they fell, no vitals, no intervention to prevent fall and care plan not initiated or updated. I am not in the position to make corrections with the nurses. The DNS is and is not doing so. Any thoughts on this?

I am an RN in LTC. Residents with tube feeding have the HOB up 45 degrees. The NAC needs to take care of this person every 2 hours to do peri care and change their brief. In order for them to this, the tube feeding needs to be turned off to allow the resident's bed to be put down to turn them. I delegate the task for the NAC to turn off the T.F. machine, but that I will be coming in a few minutes to make sure all is well and that the machine is turned back on properly. Sometimes I am with them to turn it off myself depending if I am right in that area of the facility. I have had no problems with delegating this task. But, another NAC claims that I am wrong for delegating this task and would like to turn me in. She states it is illegal for me to do this. Am I wrong for delegating this task?

Hi....no, he does not verbally abuse resident to their face. At the nurses station, he will sometimes will make comments that they are jerks and stupid. When he loses his temper in front of residents... it is what he says to us and the way he acts in front of them. The threats and verbal abuse is at the LN's. Majority of the time he is great with residents. The 2 other LN's and I wrote extensive statements and turned it in to our DON.

A few nurses and I work with another nurse who should be fired for many reasons. He is threatening the way he approaches us, gets very angry and gets in our face if we try to tell him how to do things the right way. He will give us a very cold stare and give us the silent treatment if confront him with an issue or delegate a task to him, he hangs out with the NAC's to act like he is there buddy instead of supervising them, he takes up to 3 hour breaks in an 8 hour shift, does not do all his duties (he denies there are duties to do), makes fun of the elderly and calls them jerks, loses his temper in front of residents and I can go on and on. And he thinks he does nothing wrong. We finally turned him in, but were scared to do so. If they only talk to him and then displine him only, then how is it possible for us to work with him again. We are afraid of what he will do when he finds out we turned him in. Has anyone ever dealt with a co-worker like this? Oh.....some of the work he does is very good and he brags up about what an intelligent nurse he is and the rest of us nurses are idiots.