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txredheadnurse BSN, RN

Correctional, QA, Geriatrics
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txredheadnurse has 39 years experience as a BSN, RN and specializes in Correctional, QA, Geriatrics.

obviously I'm from Texas and a redhead

txredheadnurse's Latest Activity

  1. txredheadnurse

    How would you transcribe this order?

    Treatment, nutritional supplement or medication any change in dosage or frequency should always discontinue the old order. This gets rid of the confusion because, technically, if the old order has not been discontinued then it also needs to be followed. This was one of the biggest causes of med errors I noticed when I was doing LTC consulting.
  2. txredheadnurse

    What does "On Call" mean to you?

    I was a manager in a LTC for about two years. I and the other nurse manager alternated call every other week. We usually worked our normal 50+ hour week and two sometimes 3 additional shifts a week. It was brutal and I fell asleep in the car on my way home one day after working 30 hours straight. Fortunately I was stopped at a red light when I fell asleep and no one was hurt but it could have easily turn out much differently. My co manager and I inherited a culture of no overtime allowed by corporate and a nursing staff that resisted strongly pitching in and helping out when call ins occurred so I can totally understand the on call managers reluctance to work shifts in addition to their already full work weeks. IMO the best solution is a reliable PRN staff who can respond to same day call ins or no shows, a willingness on corporate's part to pay overtime after a manager has pulled one shift on the floor that week and floor nurses being willing to work over or come in early a few hours in exchange for a shortened shift later in the week. I personally think it is unreasonable to expect managers to work more than 16 hours in a day or work more than 1 shift on the floor in a 7 day on call time frame.
  3. txredheadnurse

    Dying with Dignity? Can't Everyone Die with Dignity?

    I, too, believe that the definition of a death with dignity is determined by the patient. The person that inspired this article wasn't afraid of unbearable pain or being alone. She was experiencing uncontrollable seizures, had lost most of her ability to do the things she loved because of the complications from her cancer and, for her, the quality of life required that she maintain that one last shred of control: dying when she was ready and she was still able to make the decision instead of waiting for her higher functions to be totally gone. Hospice is a wonderful thing but each death, like each life is unique. Not all of us wish to remain alive at all costs or unaware of our surroundings when our time to die comes.
  4. txredheadnurse

    I've been a nurse since.....(fill in the blank)

    This November marks my 40th year in nursing. Two thirds of my life. I remember being so thrilled when we were allowed to no longer wear uniform dresses but pantsuits.....yes double knit pantsuits with a flared pointed collar. And when the pantsuits were allowed we could also wear "nurses clogs"' scrubs were worn only in OR and L & D and were either 10 sizes too big or so damn tight one couldn't sit without fear of splitting the seam of your pants. It wasn't until years later that I realized some of the nursing aides on night shift went through the laundry delivery and hid away all the popular sizes and pants. I wore those hideous potato sack scrub dresses during my 5 months in L & D because my sizes were hidden in someones' locker. {shrug} I remember getting down on my knees to measure the drainage in the chest tube bottle (yes glass bottle) because we didn't dare raise it too high lest the contents flow back into the chest cavity; we had those killer heavy metal frames on the ortho beds and having to push those Stonehenge-sized things up and down the old ramp style hospital during nursing school. I remember in the Recovery Room (as PACU was called back in the dimness of time) cleaning the patient stretchers on night shift, mopping the floors and ensuring all the metal bed pans, emesis basins, wash basins etc. went through the sterilizer hopper and were lovingly placed into a paper cover and racked up in the clean utility room ready for use.
  5. txredheadnurse

    "Right" way to pulls meds from cards?

    The problem with your method is in the popping pills from the blister packs while the packs remain in the drawers. Having audited literally hundreds of med carts for years as part of my job I found more loose pills in the carts where staff popped from the card while it remains inside the cart. I have literally removed in excess of 100 loose pills from a single cart. Upon questioning the staff as their methods of pouring meds and/or observing them I saw that the majority of the staff was not removing the card from the drawer. The bending and twisting of the card to remove the pills further down the pack results in pills bouncing off the cup or missing the cup entirely. I understand and applaud your desire to have all the meds in a particular order but you can achieve the same result by only removing a few cards at a time, popping out the meds over the top surface of the cart where the cup is securely against the surface of the blister pack and returning the cards, in order, back into the cart. YMMV
  6. txredheadnurse

    It's Already Gone On Long Enough

    Whenever I read a posting like this one I am eternally grateful that I was an only child and didn't have to contend with siblings who wanted to not follow my parents wishes or were convinced that there would be some kind of miracle recovery. My parents were very frank from my childhood on about their wishes and opinions regarding dealing with a terminal illness....comfort, maintain as much dignity as possible, die at home. I was able to ensure that exactly those things happened without futile care or making their final days a misery. I am so sorry that you Ruby and your DH are having to deal with this final insult to your mother in law. Please know you have the support of your colleagues here on AN and our wishes for a peaceful ending for Mamita.
  7. txredheadnurse

    Heat and LTC facilities

    I am a "fluffy" person so I already feel the heat plus I must wear pressure hose year round, I am in Texas and I take Synthroid so my heat tolerance is already impaired. So when I was doing audits in SNFs I would be literally soaking wet after an hour. At the end of the day I looked like someone had dumped a bucket of water over my head. I started carrying a small old fashioned paper fan with me so I could at least move the air around my face and evaporate the sweat before it flooded my eyes and blinded me. I was dehydrated and exhausted at the end of day. I also noted that sometimes the excessive heat would cause the gelatin caps to stick to the blister packs or sort of melt together in the bottle. I am sure the high temps also damaged all the meds to some degree. I lost count of how many times I went into a med room to discover it either didn't have any vents in it at all or they were closed off. Most meds need to be stored in conditions less than 82 degrees. I swear some of those hallways and med rooms were well over 90 degrees at times.
  8. txredheadnurse

    Open up....Spoonfed report

    If I was the manager I would be inclined to say that both the off going and the oncoming shifts would receive write ups for going beyond the allowed report time frame. Maybe a few write ups for miss slow poke will change her style.
  9. txredheadnurse

    Legend / Non-legend Drugs

    I meant to include this also. After a master ordering list is obtained then someone will need to amend the non legend drugs for each resident to reduce quantity etc. I suggest doing this whenever the orders are reconciled on a monthly basis. Start with the extended care/intermediate care residents and do so many per week/month. The new skilled admits can be handled the way I have seen a few facilities do in the past. They had a facility "formulary" and would substitute some drugs for others upon admission. An example it seems like every single admit from a hospital comes to the facility on Protonix for instance. The facility would have on their "formulary" replace with prilosec otc. A way to assist your facilities with maintaining adherence to the preferred use list is devise a tool or process that incorporates a review of all non legend drugs during each consolidated orders review. Again I hope that helps. My beloved doggie has been bringing me toys to play with while I am typing this so any typos or muddy thoughts are her fault lol.
  10. txredheadnurse

    Legend / Non-legend Drugs

    To expand on what a PP stated reduce the overall variety of non legend drugs stocked in each facility. By that I mean is it really necessary to have so many different strengths and types of calcium (with and without vitamin D), or multivitamins or GI tract drugs, of single vitamins such as Vit D, E, C or GI tract meds. In addition be careful of purchasing very large bottles (like 500 or 1000 count) of OTC analgesics (unless it something like EC aspririn 81 mg) because those expire before all the pills are used. Side note in many states all non legend drugs stored on a med cart must be dated when opened and expire within one year of opening or sooner if the manufacturer expiration dates precedes the opening date ending time. Those gigantic bottles end up being tossed long before all the pills are used. I would suggest obtaining the last two non legend drug orders from each of your facilities and look over them to see what is being ordered. Identify the commonalities in the orders then further break it down it down as to different types and strenghts being ordered etc. It is usually pretty simple to decide from there that it is best to order only 250 mg Vit C for instance instead of 250 mg and 500 mg and 1000 mg and so on from there. In other words only stock the lowest common strength and the least complicated formulation. Prepare a company formulary list from that and ask your DONs to have their medical directors to sign off on that. Then make a new ordering form that only lists the "formulary" strengths on it and have your DONs distribute those to the appropriate staff and in service accordingly. I would suggest that if a doctor insists on some non legend drug not on the formulary then the DON or their delegate has to approve it. I would also suggest that the DONs keep a running list of those providers who always seem to order large amounts of meds not on the suggested use list or large amounts of non legend drugs in general. Some of the EMR systems have the ability to generate data bases per physician of most expensive meds, largest number of meds prescribed etc. Many prescribers are cost conscious nowadays but not all are or they have the misperception that Medicare pays for all meds for the entire time of admission to a SNF which of course it not the case. And even when a resident is in that payment category all those meds come out of that lump sum payment so excessive amounts of non legend drugs can be damaging to maintaining a profit. It is not evil to make a profit because if a facility doesn't ultimately no one gets paid or can afford to stay open. I mention the list because I have had facilities in the past that when they say the concrete evidence of prescribing patterns of some docs had their medical directors have a very focused discussion with those prescribers. There is consideration of reducing the amount of storage space used for non legend drugs in the med rooms, on the med carts, reducing the number of errors because someone in a hurry picked up the calcium carbonate 500mg with Vit D 200IU instead of the calcium carbonate 600 mg with Vit D 400IU, wrong type of multivitamin with minerals and so forth. Plus more room on med carts is a good thing. I have opened more than one med cart in my day and simply been staggered at the sheer volume of non legend drugs stuffed in there....like 60 or more bottles. Even if no one makes any med errors from using the wrong non legend drug simply having to constantly hunt through that sea of bottles is a time waster. I hoped this helped.
  11. This happens when nurses refuse to look past their shift, their list of tasks and take a few minutes to think ahead. When I was doing consulting one of the things I preached and preached was making a good guestimate as to the number of daily doses used and reorder or ask for a new order when approximately five days worth of pain meds were left. This leaves plenty of time for the prescriber to send a new order to the pharmacy or give the paper script to the facility and the facility sends it off to the pharmacy. The second part of this is making sure when the order or refill has been sent that it is received at the facility. In the better facilities I did consulting in this info was included in the shift to shift verbal report and was on the 24 hour report until it was resolved. That way there is no excuse for not having the medication available; ie I didn't know a refill had been sent and hadn't come in yet, or I didn't know a new order was needed etc. Saves time in the long run, stops having to try to track down providers after hours or on the weekends and saves having to pay stat delivery fees to pharmacy for last second refill. Most importantly it is for the welfare of the residents who don't have to literally suffer through an interruption in their pain management.
  12. txredheadnurse

    I Hope No One Hires You

    I want to preface this posting by saying thatI respect CCM & I understand her frustration with the abrupt leaving of her nurse without notice or a face to face. However I myself have twice in my nearly 40 year career left without notice. Both situations were beyond awful and it was imperative that I remove myself from them immediately. I am not saying that was the case for CCMs' nurse but to make a blanket statement as some posters have that it is never acceptable or understandable to leave without notice is unrealistic. There can be situations in which staying past your shift is not the best choice to protect oneself from a big stinking mess. Also sometimes an employee is struggling with a situation outside work that can drive them to make drastic decisions. I remember one time I had a nurse no call no show and I was furious. I couldn't contact her or her emergency contacts. I even called her landlord because I was worried something might have happened to her. Well something had. My nurse was a victim of domestic abuse and she had fled from her abuser. Which is why she no called no showed. My point is most of the time quitting a job without notice is unacceptable, sometimes the departing employee is simply acting out anger or disrespect but sometimes there can be personal issues driving that employee to feel desparate or unable to see another way to handle something overwhelming to them.
  13. txredheadnurse

    PA-RN looking to relocate to Austin

    There are other threads on here in the Texas forum giving basically the same info as previous posters have stated above. Hopefully you will be able to stay with your family while job hunting because apartments close to the hospitals tend to be on the pricey side. This is said tongue in cheek so no offense HouTx. Austin is too still Texas lol. I know we are the weirdos here but I still love my town best of all the Texas locales I have lived in through the years. However I really think we are the victims of our marketing efforts directed towards the tech community. If one moves to Austin with a housing budget of greater than $450K and a tech background making high 5 figure to 6 figure incomes then Austin seems surprisingly easy to transition into. Not so much for other professions like nursing.
  14. txredheadnurse

    how to deal with an evil boss...

    I once saw a nurse manager pick up a PDR and throw it at a fellow nurse who was "sitting in my chair". She literally knocked the nurse off the chair, calmly walked over and sat down. I was standing there with my mouth hanging open shocked. The nurse manager looked and me and said "What is your problem? She was sitting in my chair". I found another job two days later and left.
  15. txredheadnurse

    What is the job market like in the Austin area?

    I echo the previous poster. Native Austinite here. We have both a community college and a BSN program here so there are 3 graduating classes every year hitting the hot streets looking for a job. It really behooves anyone with less than 4-5 years of experience contemplating moving to Texas to consider the out lying smaller communities surrounding the major cities. Many of those communities are less than an hours drive away from Austin, San Antonio, Houston, DFW area etc. so you can enjoy the attractions of the bigger cities on your days off. Or consider the Rio Grande Valley, Lubbock/San Angelo or Tyler (which has a very large hospital system btw). If you are determined to come to Austin anyway be prepared to have a lot of competition and be prepared to have to consider working only part time or for much lower wages than you would like since the experienced nurses will get the cherry jobs and better pay. Despite what the media might say Texas as a whole is not just full of unfilled nursing jobs for new grads or those with less than 4-5 years experience.
  16. txredheadnurse

    A&O x 3?

    I always used awake and reactive to their environment. IMO for the non verbal or lower functional clients this is a more accurate reflection of how they do interact and how the direct care staff tends to judge the clients functionality and mood on any given day or shift.