tiggertoo

I'd say there isn't much of a shortage here in the Seattle area. Despite ads on TV. Last fall was running a nice TV ad for nurses, the had a hiring freeze. Also Swedish, this summer had a tv blitz, but they are also having a hiring freeze. What's up with that? I as an RN was out of work for 6 months last year. I finally landed a job in LTC (which I just quit) and now I have a Agency job, a part-time LTC job and another job. I learned this in LTC most of the nurses out here have 1,2 and sometimes 3 jobs. Some work 32-36 hours in a hospital and also do agency work. Some work in 1, 2 or more nursing home. I have seen a few just work 24 hr shifts (self scheduled that is). I just finished 2 shifts as an agency nurse here for a hospital that I have been applying for for a year. They are advertizing for nurses, I just never get any calls back from HR or anyone else. Yes, they do have my correct numbers. I guess they would rather pay my agency $$'s that regulary salaried $$'s Anyway I was one of 3 agency nurses working the unit. The only regular employess on the unit where the charge nurse and one cna. Go figure?

I would not pre pour meds for a NAC to admister later, however, I would and have handed an NAC who is feeding a resisident, the residents medication (crushed in applesauce for instance). To give to that resident while he/she is being fed. With explicit instructions on which resident and that they where to report back to me if the resident was not able to take all the medication. I am getting conflicting information from my DON now. Does anyone out there have the definitive, referancable, answer. Thanks According the my states practice act, I as an RN am able to delegate medication adminstration. http://apps.leg.wa.gov/RCW/default.aspx?cite=18.79.260 (3) A registered nurse may delegate tasks of nursing care to other individuals where the registered nurse determines that it is in the best interest of the patient. (a) The delegating nurse shall: (i) Determine the competency of the individual to perform the tasks; (ii) Evaluate the appropriateness of the delegation; (iii) Supervise the actions of the person performing the delegated task; and (iv) Delegate only those tasks that are within the registered nurse's scope of practice. (b) A registered nurse, working for a home health or hospice agency regulated under chapter 70.127 RCW, may delegate the application, instillation, or insertion of medications to a registered or certified nursing assistant under a plan of care. © Except as authorized in (b) or (e) of this subsection, a registered nurse may not delegate the administration of medications. Except as authorized in (e) of this subsection, a registered nurse may not delegate acts requiring substantial skill, and may not delegate piercing or severing of tissues. Acts that require nursing judgment shall not be delegated. (d) No person may coerce a nurse into compromising patient safety by requiring the nurse to delegate if the nurse determines that it is inappropriate to do so. Nurses shall not be subject to any employer reprisal or disciplinary action by the nursing care quality assurance commission for refusing to delegate tasks or refusing to provide the required training for delegation if the nurse determines delegation may compromise patient safety. (e) For delegation in community-based care settings or in-home care settings, a registered nurse may delegate nursing care tasks only to registered or certified nursing assistants. Simple care tasks such as blood pressure monitoring, personal care service, or other tasks as defined by the nursing care quality assurance commission are exempted from this requirement. (i) "Community-based care settings" includes: Community residential programs for the developmentally disabled, certified by the department of social and health services under chapter 71A.12 RCW; adult family homes licensed under chapter 70.128 RCW; and boarding homes licensed under chapter 18.20 RCW. Community-based care settings do not include acute care or skilled nursing facilities. (ii) "In-home care settings" include an individual's place of temporary or permanent residence, but does not include acute care or skilled nursing facilities, and does not include community-based care settings as defined in (e)(i) of this subsection. (iii) Delegation of nursing care tasks in community-based care settings and in-home care settings is only allowed for individuals who have a stable and predictable condition. "Stable and predictable condition" means a situation in which the individual's clinical and behavioral status is known and does not require the frequent presence and evaluation of a registered nurse. (iv) The determination of the appropriateness of delegation of a nursing task is at the discretion of the registered nurse. However, the administration of medications by injection, sterile procedures, and central line maintenance may never be delegated. (v) The registered nurse shall verify that the nursing assistant has completed the required core nurse delegation training required in chapter 18.88A RCW prior to authorizing delegation. (vi) The nurse is accountable for his or her own individual actions in the delegation process. Nurses acting within the protocols of their delegation authority are immune from liability for any action performed in the course of their delegation duties. (vii) Nursing task delegation protocols are not intended to regulate the settings in which delegation may occur, but are intended to ensure that nursing care services have a consistent standard of practice upon which the public and the profession may rely, and to safeguard the authority of the nurse to make independent professional decisions regarding the delegation of a task. (f) The nursing care quality assurance commission may adopt rules to implement this section.

Graduate schools nursing programs rankings are based on the number of research dollars the are able to attract, not the quality of their programs, teaching, instructors or anything else. Buyer beware.

I believe that the idea is that fanning may/will disturbe dust or other airborne particles in the area and increase the likelyhood of contaminating the area just cleaned.

I am new to nursing, but I just had a LPN convince a doc to leave a stage 2 decub ulcer open to air. It was covered with DuoDerm with Silverdine for the last 2 weeks. I never heard of this in nursing school, the doc said there was no scientific evidenct that covering the wound would help it heal! Can anyone point me to evidence based articles. Thanks.

Thanks for the suggestions, I was thinking along the gift card route, as about one half of the CNA's are male. Keep the suggestions comming however.

I just started at a LTC, after my first week I gave all the people that really helped me along a little gift (chocolates) in appreciation. What is a good give to give to your fellow workers just in appreciation of being helpful, supportive etc. Under $5.00 each would be good also. Thanks for your input in advance. :monkeydance:

43 when I started, 45 when I finished.

Do you follow this procedure for your chemsticks? If not, why not? I was taught this way in nursing school but I seem to see few people follow this on the west coast. Advise please? 1. Has the patient wash her hands with soap and warm water, if she is able. 2. If patient is in bed, assists to semi-Fowler's position if possible. 3. Turns on the glucose meter. Calibrates according to manufacturer's instructions. 4. Checks expiration date on the container or reagent strips. 5. Removes a reagent strip, then tightly seals container. 6. Checks that the reagent strip is the correct type for the monitor being used. 7. Dons procedure gloves. 8. Selects a puncture site on the lateral aspect of a finger (heel or great toe for an infant). 9. Positions the finger in a dependent position and massages toward the fingertip. 10. For infants, older adults, and people with poor circulation, places a warm cloth on the site for about 10 minutes before obtaining the blood sample. 11. Cleanses the site with an antiseptic pad, or according to facility policy, and dries it with a gauze pad. 12a. Engages the sterile lancet and removes the cover. 12b. Places the back of the hand on the table, or otherwise secures the finger so it does not move when pricked. 12c. Positions the sterile lancet firmly against the skin, perpendicular to the puncture site. Pushes the release switch, allowing the needle to pierce the skin. 13. If there is no injector, uses a darting motion to prick the site with the lancet. 14. Lightly squeezes the patient's finger above the puncture site until a droplet of blood has collected. 15. Wipes away the first drop and squeezes again to form another droplet. 16. Places reagent strip test patch close to the drop of blood. Allows contact between the drop of blood and the test patch until blood covers the entire patch. Does not "smear" the blood over the reagent strip. 17. Allows the blood sample to remain in contact with the reagent strip for the amount of time specified by the manufacturer. 18. Using a gauze pad, gently applies pressure to the Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing puncture site. 19. Places the reagent strip into the glucose meter. (Some manufacturer's instructions require you to first wipe the reagent strip with a cotton ball so that no blood remains on the test patch. Follows individual manufacturer instructions.) 20. After the meter signals, reads the blood glucose level indicated on the digital display. 21. Turns off the meter and disposes of the reagent strip, cotton ball, gauze pad, paper towel, alcohol pad, and lancet in the proper containers. 22. Removes the procedure gloves and disposes of them in the proper container.

This IS the scariest forum on this web site, on a number of levels. I've had complaints that I was too nice to patients.

I agree that potential employees need to present themselves in the best light to get the job and be polite. However, I have been in the business world for quite a long time. Nursing not so much. I have never seen such unprofessional recruiters as nursing recruiters and HR departments. I don't know, if I know of another job that has less accountability. Loosing resumes, not returning phone calls, I have had email rejections only to be followed up by job offers from the same place. A year ago I was dealing with several hospitals most of the HR departments closed for 2 weeks at Christmas. At one huge hospital the recruiter was out sick for about 2 months, I guess they just don’t hire people or need people when she is not there. I have had recruiters call me for a phone interview from their cell phones (bad connection) with kids’ crying/screaming in the background. I wonder if the nurse managers know what is going on in the HR/recruiting office, as I am sure there are a lot more qualified candidates out there than they know about as every job interview I have had I was competing with multiple other candidates. The HR dept acts as a huge filter, mostly gated by their office hours, vacations and accountability. Of course, they could all know about it and just keep the floors understaffed and tell the nurses there is a nursing shortage and no one is applying for their open and posted positions.

Thanks for the encouragement. I don't think that hospitals or employers in general would open themselves up to lawsuits by reporting anything to anyone. Even when you use them as references they only report the standard worked from mm/yy to mm/yy. I was told about two weeks out that they where “worried about me” but they could not give me any elucidation as to what I was doing wrong, just generic “how do you think you are doing” stuff. It’s a very passive aggressive place. I didn’t think it was that bad relative to the horror stories I was hearing from my fellow new grads at other hospitals so I probably took the “worried about me” comment too lightly and was not aggressive enough about getting and exact prescription for success. I think I was hosed at that point anyway. My experience tells me if you start getting bad vibes especially with no support or anyone on your side you are done, leave before it gets worse. Also, there is no such thing as an appeal during the probationary period, I doubt that appeals are heard of much in the nursing profession, especially after reading other posts on this site. Also, an at will employment hospital, so they really don't have to give cause and certainly won’t volunteer it. As far as agency nursing, no agency (I have come across anyway) will hire a new grad with less than 1 year experience. Even with 1 year of experiences, nurses I have talked to had trouble getting placements.

I just ordered it used from amazon for $3.89, book $0.40 Shipping & Handling: $3.49 total$3.89 Good tip use ADDALL.COM, search for the book by name or isbn number, it searches all the book sites and will give you a list of all the lowest prices. I buy used mostly.

:yeahthat: I had one preceptor that swore that it was a universal concept to give coumadin at 1700 and that of course everyone knows that. She even looked it up in the Drug Reference. She didn't find it.

Same thing happened to me. After 3 months I was told I wasn't a good fit. I had had at least 20 preceptors during my orientation. Most of them gave conflicting information and couldn't explain any of their rational, e.g. you have to shake the purple top tube vigourously you know! Or, I know there is an order that you take the vials for a blood C&S but I don't know what it is. I was told by one preceptor that I used the wrong pencil when updating a Kardex! It was a pencil, not a colored pencil or anything. She just didn't want me taking a pencil from the supply cabinet, I was supposed to walk around the whole unit until I found one that was in use already. There was a new grad class; this was a magnet hospital after all (whoopti), where the instructors were just going through the motions. For example, they would show up without their supplies to give demos! "You all know what a butterfly looks like right, well then you put this thingy into the vein push the button and voila". Complaints about the level of instruction where made on their evaluations and were responded to with "You don't have to be here you know". Real professionals! Oh the part I liked best is how they loved to tell you how much money they spent on orienting each new grad, each quote went up a couple of thousand so I can't give you an exact number, anywhere between $40,000 - 45,000, I think they pulled the number out to their hat. Well, they didn't hesitate to throw that money any. During my tenure there I can't tell you how many complaints I got from patients as I walked in the room at the beginning of my shift about the last nurse. Many of them were to be my preceptors. My last day I had comfort care patient, her iv had infiltrated about 2100 the night before (according to her husband). This was the one hand she could still use and more importantly write with. She had oral cancer and was not able to speak, but was still very much a0x4 and would communitcate with her family by writing, very clearly, now with a hand the size of a baseball mit she was unable to. The night shift had not done anything about her IV, her bed was soak with iv solution not to mention that she wasn't receiving the med for pain. Unfortunately, for me I turned down about 5 other jobs and took this (the wrong) one. By the time I realized how horrible it truly was, all the other jobs where taken and now I am waiting till the hospitals start hiring new grads again. Usually, only twice a year here and then new grad jobs are pretty few and far between, which I didn't know before I moved here. Live and learn.