shouldhavebeenanunRN

wow! very deep stuff... got my attention now! I'll have to read rather than skim next time. Thanks

Worked as charge in a LTC one night. A travel RN & Permanent RN counted and all was good @ end of shift. Travel RN comes on next day and says narcs missing since her last shift. Permanent RN said never counted particular narcs w/ travel nurse; and count was good until Travel RNs shift next day. Enter new DON .. who destroys wrong narcs w/ permanent nurse during shift (had access lets say and possibly destroyed narcs? but not case). I was on another unit that day thank god! No access.. DON gone for day too; and a full 80mg blister of oxycontins GONE! NARC sheet gone! SO, perm. RN did not recall any such narc on cart as she was forced to administer a prn 5mg prior to end of shift for same pt., claiming no knowledge of higher dose in narc box/count. MY role in the procedure as charge RN was to report to Administrator, ADON, DON and police if so directed by adminstrator. As I assumed/concluded permanent nurse was innocent/clueless of missing narcs as they were not incl. in count & fact she did sign out a 5mg prn before end of shift for same pt. Traveling nurse who reported narcs missing was my #1 suspect as she had direct knowledge of narc dosage & count and behaved suspiciously after I suggested a UA for everyone on the spot to administrator. Her eyes bulged for sure.. LOL! Anyway, could have been the new DON too.. but left before finding out how it all ended. I do know perm. RN was allowed to come back to work and DON still there, so I assume it was the travel nurse who was suspect in the end. I also know it is a federally reportable/investigatable offense and heads will roll. Glad I wasn't on shift with any of them... and I can only recommend if you have blisters... count every single pill/don't rush and compare to narc sheet #. If it is off, stop & report immediately. CYA!!

i have skimmed the key points of the book of the dead. it is very similar to the reverse of birth, except if i recall.. one of the first after death experiences which determine re-incarnation or purgatory begins with temptation vs. innocence and life experiences; and if successful through the phases/stages of death you choose you get to choose your parents/next life and are re-birthed; if unsuccessful, you remain in purgatory until you figure it out or are lost in purgatory forever?? Amazing!! I believe, the prophet monk who wrote it, also hid it for some 600 years and even named who and the exact date his book of the dead would be found--fearing it was too controversial for the time written; and it is still being used by Siberian monks today I understand. I agree with Selke on this one.. it is instinctive to nuture and guide a newborn as they are helpless and innocent, but it is equally important to give our dying support and permission to die; so they can move into the next stage of life....death! Great insight Selke! Thanks for post!

okay.. i'm a rookie... what is a swan?

My only hospital setting experiences occurred during clinicals. I am in LTC now, worked in home health as a CNA for 12 yrs and although told case managers were generally MA prepared, I have found that you can work with a BSN in community/public health setting as a case manager, or as a new grad with min. hospital experience. Besides, expectations and training varies from setting to setting. You may even be eligible to work in a office/outpatient/ambulatory setting without being as wordly as a 2 yr experienced med-surg nurse... fyi.. one month in a nursing home or ER and you may surpass an experienced med-surg nurse in many cases... good luck!

I totally connected with this thread as i skimmed sentences, such as: I sang to them, I talked to them, etc.. I work in LTC as a new grad; and its no picnic. I also lost my mother the day I graduated with my BSN; and skipped ceremonies to hold my mother in my arms as she died; and I am eternally grateful for the opportunity to look into her deep green eyes one last time; knowing she knew the person who loved her the most on this earth was there with her as she took her last breath and that she wouldn't die alone (her worst fear). FYI, statistically, 97% of us die alone.. according to some research I've read. Needless to say, the experience has impacted my nursing practice forever.. I could go on an on about my mom, but in reality, I have lost patients as a student and new grad too. I like to believe it prepared me for the loss of my mother to some degree, but to this day, I still work in a LTC facility, and it pains me to see the lack of compassion within my profession for the most vulnerable.. the dying. However, unlike my peers, I like to believe that I am a pioneer for the reform of LTC nursing practice and palliative care; and I lead by example. I am by no means a "super" nurse, trust me, but I am deeply passionate about what I do. I always go above and beyond, as if serving the needs of Jesus himself; and I hope that in the lives of people whom I touch everyday they can go to God knowing I gave them my best as both a nurse and compassionate human being . I too have also found myself singing to them, stroking them gently, telling them stories, making small talk, fluffing a pillow, washing the dry crust off their lips, soaking their moldy dentures, or in those last moments, simply giving them eye contact and letting them know a kind soul is there for comfort or last words if that is what they need. I have lost several patients my first few months as a RN who have looked to me in their last moments for comfort/closure in their last moments, including my mother.. However, that may be my personal experience.. but I can't be honored more in this lifetime than to be someone's link to this life and a trusted guide into the next :prdnrs: With that thought in mind, I thank you --those who take their purpose/profession seriously and may I be so lucky as to hold your hand and look into your angel eyes with my last breath as I seek God's redemption or the next life !!

gen chemistry goes into the whole electron, structure of chemicals, elements, etc. If I recall, biochem elaborates on it with a focus directed more towards lipid molecules, permeability, nutrient absorption, how dna strings together, how molecular composition can be manipulated to create new molecules/drugs. all i can say is when you get to isomers, and if you get stuck there -- remember use my spoon trick noted in another reply earlier. Good luck

no reimbursement, but I hear they want me back. I'd have to pursue through legal means to get back pay. No legal fees as I have malpractice insurance but didn't need it; as the BON threw it out during screening process seeing it was bogus!! If I ever get the opportunity to visit Israel I'll have to contact you for a tour of your facility and see how its done in your country. Blessings all!!

Now that is info I am so glad you mentioned - THANK YOU! Its true too, even for me. I had to ask and clarify the difference between Novolin and Novolog myself. A nurse working there for 40 years didn't know the difference. We called a pharmacist to clarify it. But I don't know what you know, I'll remember your words the rest of my career. If you read on, complaint was unsubstantiated and closed. I am so relieved. Regards

Great news all...complaint filed with BON was found to be unsubstantiated and that I was not in violation of any standards or statutes...also, started another job (not my dream job), but I am beginning to believe that nursing home orientation and training is sub-standard period. However, I am looking for a RN position in the mean time where I can be appropriately precepted/trained and can learn the right way to do things. I am told I could fight for my position back, but why would I want to go back after that? I'll have to start a new thread on my experiences thus far as new nurse in LTC-its mind boggling. THANKS FOR ALL THE SUPPORT EVERYONE - I WAS BESIDE MYSELF!!

documentation is a weak point for me as I learned on an electronic system, so when it came to hand documentation, I struggle. I am actually going to take a seminar soon on nursing documentation strategies as it has been a thorn in my side as a new RN. I obviously need it:smackingf

I feel the exact same way.. I too am procrastinating... now I know how a ex-con or disabled person feels when they desperately want to work and will be judged on pass offenses/disabilities which may or may not impede work expectations.

To my knowledge as a recent RN Grad & RN. Some states allow specifically trained CNAs/LPNs, etc to insert IVs; but in the administration of IV therapies and maintenance and assessment of IV site/cares are sole responsibility of RN. Do I agree? Not for me to say. I am a RN and only ever inserted 1 IV, but I'd rather a specifically trained person insert them than someone like myself who only inserted 1 once. I am perfectly capable of managing IV meds/fluids, maintenance and care after the fact... so Yes, I'd say if QUALIFIED and ACCOUNTABLE LEGALLY.. THEN YES!

and that my friends is the difference between IDEAL nursing and REAL nursing; as I was taught that CNAs cannot even take vitals for RNs. However, as a RN if I am counting someones apical pulse with a stethescope I count a full 60 seconds, esp., if giving a cardiac medication such as Digoxin. However, when taking q8h vitals as first member stated I do radial 15s x4 as do I take resp. rate. Note: If someone is struggling for breath and has 40-60 bpms YOU WILL NOTICE.. AS will you notice someone who has apnea (i.e. holds breath for extended period of time say 30s and then dramatically inhales, snores or otherwise struggles for intake), it isn't rocket science but I like the hand on chest after taking pulse to count respirations but another method is to put hand on upper back or watch for rise of stomach as you count if it helps... good topic for all beginning practitioners... nurses & aides!!

I will reply when outcome is clear but right now, I am compelled to hand over my license as my reputation and my family mean more to me than a nursing license. I would nurse for free for the rest of my days and is all I ever wanted to do except that liability is an issue. I use to offer my services to agencies, hospitals and people but was told I had to be paid for my services because of the liability. If I had my way (and were single) I'd be nursing abroad which has always been a deep rooted dream for me.. but it seems I may be well doomed before I even learn the legal/ethical ropes... Wish me luck!!

i have started seeking new employment with much understanding and forgiveness & potentially a new job offer in works I hope... and I was utterly honest about situation which when interviewed first time since incident occured and person seemed sensitive to my plight.... However, since that interview I have not heard back from facility as hinted I would, and I have since received a notice from state that my actions are being pursued as caregiver misconduct and that I will be screened for disciplinary action by my board of nursing. BEYOND DEVASTATED NOW!! CRUSHED!!! I don't know how to pursue this without an attorney and I feel utterly SICK that my character is in question. I've only been a RN for 3 months, I don't feel I was GROSSLY wrong for being human and I certainly didn't harm anyone. More to follow.. Wish me luck!!

Perhaps it is naive thinking on my part.. but I was never taught to document calibration of BGM or other foulable equipment on worksite or during nursing school. I am very literal person when performing actions as taught; and I was only taught to calibrate and teach others how to use a BGM during BSN training; and when all else failed I was told to READ!! Kind of hard w/ no hard copy or access to pc on duty; and your supposed hierarchy turns off their ****** pagers and leaves you to sink or swim!! PERIOD! Granted, I learn best under pressure, but a little supportive coaching or direction is appreciated and gives me a clue if I am RIGHT OR WRONG!! DUH!!

You are 100% correct! It is apparent to me as well that I need a supportive environment to learn in & get the opportunity to learn to do things the right way and not the wrong way. I will choose "for me" next time. Had to make a few bucks to get caught up on bills past few months, so that job was taken simply because it was close to home and it was first thing that came along! However, I am in a much better position to pick & choose according to my learning needs & desires this round & will not take it for granted again! So will pursue as a career this time not as a job per se. Thanks for feedback!

Thanks much for the feedback. I really appreciate idea for the my version for my personnel file. Now, I gotta figure out how to approach my termination with a potential new employer. I would not go back to other job anyway. They fired 3 DONs, 2 DCDs quit, 5 RNs, 2 LPNs, the administrator and the human resources director were all fired in the past month too r/t to State being in house. Funny thing is... they never fire the aides.. LOL! Talk about throwing away their investment in a quality workforce. I'll move on as you also suggested. Thanks again.

Understanding cell physiology is extremely important esp. when you get to pathophysiology. There is a level of microbiology that feeds into the whole cell physiology.. i.e. cell permeability, cell mutation/disease, dna, protein sythesis. However, it also involves nutrients, esp. calcium (i.e. bone formation, vit. D sythesis, vitamin deficiencies & related disorders), then there is K+, notorious for heart dysrhythmmias, leg cramps, electrolyte disorders (ie dehydration), just remember, K+ loves to be in the cell, Na+&H20 follow each other out of the cell or into the cell (ie. cell destruction/hemolysis/diarrhea), and Ca+ must be escorted by protein albumin from bone. Blood from epo/kidneys signals bone marrow to make it! Just remember RAA system & hypothalamus the regulator!! Understanding biochem is important too because it addresses cellular/molecular importance, how the body metabolizes and how the liver/muscles metabolize, store and utilizes it. Just remember when you get to (mirror-images-enanomers or isomers I believe), you can survive it by comparing two spoons at every angle possible, and although they may appear to be same molecular structure, when you flip one spoon and compare, they are not the same molecularly. Thats how I learned!! Good luck, Chem kicked my butt and wound up my favorite prenursing class!!

i had problems with bgm during my shift. i recalibrated a couple of times to verify accuracy & changed batteries (which resulted in loss of recorded bgls). one particular pt. who bottoms out & has extremes of hyper/hypoglycemia consistently had a fall after a change from a private room to a semiprivate room without injury & occuring several hours after my shift. however, during falls assessment of vs, his bgl was 55; an ir was done, md notified, etc. however, on call was on duty and questioned why i gave 20u novolog/rather than 10u to the resident @hs. my handwriting was misinterpreted by oncoming lpn as 400 but i wrote 408 on mar (but i was accused of lying as a result-and bgm #s did not match 400 or 408 either due to bgm calibration issues; and i was subsequently fired for a med documentation error because state was in house and my 408 could not be verified against bgm. i have been a sterling rn til now & would take a lie detector test to affect that i gave appropriate insulin per bgl result. i'm devastated!! threats of being reported to state to boot! how do i salvage my new career & stellar reputation? i gained monumentous experience in last 3 months, how can i claim now without looking incompetent. am i doomed before i ever get started?