Crystal2dish

Ryansofie - I will add that I see the opportunities and possibilities opening up for nurses like ourselves. We need to redefine ourselves as nurses apart from what the MacDonaldization of nursing has become, i.e. a corporate crank out of entry level highly skilled human mechanics or disconnected PhD's. I have been discouraged from working as a nurse because of the growing conflicts and dehumanization of "healthcare". I know that I need to redefine myself for others not as an employee but as a consultant or "gun-for-hire". I see the niche opportunities and know that I have to polish up my outside persona with college credits, possibly a graduate degree or maybe two. For example, how long do you think that the fleecing of hospice patients (among other things, of course, but money is corporate speak) in an assisted living situation would continue if you added legal advocate to your resume? Bulldog nurse with legal teeth! I will leave the PhD in nursing for others. I refuse to stay quiet or quietly disappear because I don't "fit" into the current picture of the time. I am tired of being spoken to as though I were a simpleton because of the work I chose to do and I am tired of being paid a fraction of what I know I am worth. I am also increasingly aware of increased discrimination from "energetic" employers who are blinded by my gray hairs and apparent career stagnation from logging so many years in one field. It makes me wonder how far this division between young and old will go - to the point where we are prodded much like cattle into the proper channels for aging and dying "humanely"? Who will advocate for us then? A recent annual visit to my physician has further steeled my determination to be a force for change. At first it was the exam room that brought me to attention: I was brought into the room before it was ready for me as the paper on the exam table was obviously used and there were not one but TWO tubes of KY jelly left uncapped on the countertop by the sink. As I stood in the room frozen in surprise, the trainee CMA proceeded to pull down a fresh sheet of exam table paper and tell me to "hop on up". She told me to hold my arm up as she took a BP without supporting the arm. This was one visit I remained fully dressed and washed my hands immediately afterwards. I realize I could have said something instead of letting my jaw catch the breeze and swing, but I realized the fledgling CMA was doing what she had been taught and for me to do anything or say anything would have sent her from the room in tears. Who is teaching these CMA's? Scary stuff. I am learning to see these problems as opportunities for change. I don't rely on the existing system any longer to take care of my health and have become an active DIYer. Life is short. Too short. However long I have left to live this life, I want it to be sweet. Hope this rant helped... :typing

If dementia is involved, there is a different process to deal with the resident's behavior than if the resident is lucid. Examples of dealing with the dementia may include positioning the resident so he may not see out the door (but still have a view out the window) or approaching him with a partner. The resident may have some very real fears that will not dissipate with a confrontational discussion. If the resident is lucid, then the SW and NM may discuss the appropriateness of his targeting male caregivers and disturbing other residents by yelling out. Whatever route is chosen to deal with the resident, it will need to be a team effort with proper protocols followed and documented. Residents are considered to be vulnerable adults and as such have specific rights. Then I must comment on your statement " I need this resident to know who is in charge..." as a possible reveal as to why he may be targeting you. You are an employee. You may be in charge of some things, but perhaps you have not yet grasped the limitations of your dominance. The resident cannot up and leave. He has to live there. Perhaps it is not the resident who needs an attitude adjustment? Rudeness is a somewhat subjective description of behavior. Perhaps the resident knows more than he is given credit for and is expressing his fear (?) of you the only way he can. So definitely involve others, to include the nurse manager and social worker, in working to improve this situation for everyone.

My advice is to find a place for your grandfather to live. Preferably somewhere close enough for your grandmother and you to be able to visit often, if not daily. Think of your decision not as "putting them away", but placing them in an environment where they will have the caring and the support to maximize their lives as they change. It is a transition for this stage in their lives and yours. All of you will have the opportunity to just enjoy each other. It has been my experience as a nurse that people with dementia become comfortable with routine and familiar things. I worked in a unit that had been designed specifically for the wanderings and behaviors of dementia to allow maximum freedom and safety within the structure of the unit. Staff was handpicked, trained, and educated on the natures of dementia. Activities are planned for the residents daily and personalized for them while participating within a group setting. Not all nursing home/memory care units are the stuff of nightmares. The best ones encourage and support continuing family relationships and participation, including meals together. Caring for a loved one with dementia is a noble task at best. The reality often results in caregiver burnout, among other things. What is your support system like? Another point that may come up is the legal one. The familial responsibility for caregiving may be clear among the family members, but if it hasn't legally been clarified, there could likely be issues down the road when you will least be able to deal with them. Especially if money or real property is present. I understand your position as I, too, have been in a similar position. On a personal level I learned the hard way that one person cannot do it all for another person. Sometimes stepping back and letting go while letting others step in to share in the caring can be a more loving act for both yourself and those who love the person with dementia. Sometimes as caregivers, we forget we need TLC, too. So good luck with your decision! :icon_hug:

My two cents; Books to read - (food for thought) Gary Zukav - The Tao of Physics Barbra Ann Brennan - Hands of Light and Light Emerging Beck Walters - The Sacred Lawrence Blair - Rhythms of Vision Ina Mae Gaskin - Spiritual Midwifery Fritjoe Capra - The Web of Life These books are alternate reading to explain commonalities in a different light, so to speak. Best way is to find material that clicks and build from there. Life is short. Follow your bliss.

my guess would be so they can grow her they way they want her. or maybe because she was cute and smiled and giggled... plus maybe because gn's work for less until they become rn's. anyone? :typing

I have lived with both dogs and cats, often at the same time. I have come to the conclusion that cats take things seriously because they often live twice as long as dogs. :typing

Always safety first. Proper body mechanics. Protect yourself by refusing to participate in unsafe situations. If you or the resident become injured, it is not helpful or positive to say the least. The resident's behavior is inappropriate and the expectation that he be assisted to the commode anytime he asks is unrealistic at best. Unless, of course, he is the only resident in the LTC facility. The standard for toileting is every 2 hours, which would allow for a max of four times/shift. Behavioral issues aside, does the resident have regular bowel movements? What does his stool look like? Does he use the urinal? Does he produce regular urine in adequate amounts? Is there pain or discomfort with elimination? If all physical systems are clear and functional, maybe caregivers could be restricted to males only. You do not have to regularly tolerate sexually inappropriate behaviors from anyone, including residents. The ideal scenario would be a team effort and nursing care plan to realistically revise the residents care plan. If your immediate supervisor is helpless to make changes, continue up the ladder of responsibility until you start to be heard. State the facts: Record dates, times, pertinent comments, actions, staff involved, etc. Do not include OMG statements or speculations. Don't fluff the pillow as the facts alone are enough meat on this bone to evoke change. Coordinate same efforts with your coworkers (writing/documenting just the base facts) and put forth a concerned, respectful but coordinated front to your superiors. Don't be alarmist, but work pro actively. If change doesn't happen and you all continue to be ignored, perhaps you may consider changing employers. Good luck!

number one reason to change is because you know you love peds. everything else is either a bonus or an incidental. period. office versus hospital: regular, predictable hours with weekends and holidays off. regular breaks. a desk. patients usually are not as ill as ones in the hospital. your own computer. vacations. your own phone line. more time and energy for home & husband. able to make more plans and carry them through. you start to realize you can have a real life... bored? you will always be as busy and interested as you need to be. maybe you will be the one nurse who has the energy, vision, enthusiasm (because you love peds), and interests to pro actively bring changes or new ways of organizing or doing to the office setting. for a start. you can be a role model. a mentor. a safe pair of arms. the nurse patients ask for when they need an injection because it doesn't hurt as much. the list is long. and if you try the office setting and it really, truly does not work out for you, the worst case scenario would be a new set of experiences in peds and new personal/professional references to add to your resume. how could you possibly go wrong? you love peds! :dncgbby:

i think that your staffing ratio is on par with the average ltc night shift - in my humbling experience. that means it is consistently busy enough to keep everyone awake and if a change in resident status occurs, the roof won't collapse. so to speak. i have also learned that numbers of bodies can mean so many different things. as in how responsible and reliable and professional (to name a few)are the people you work with? how well do you all work together as a team? is your work about following up on some more than others or tracking one or more members of your team to make sure everyone is in the same game? quality vs quantity makes all the difference in the world. so does youth and vitality. and really great coffee... :zzzzz

Here's my two bits: you will almost always get less than you ask for, so the rule of thumb in negotiations is to ask for more than you will settle for. It will help to check with the state employment agency or other local authority to determine the pay range for your area. More experience usually will get more pay, but not always. Another tried and truism is that it is the nature of people to lower their asking price to make the sale, but the quirk in the nature is that people also place more value on the same object if listed at a higher price. You are your best asset, so don't sell yourself short! Good luck! :)

Like the posting but must let you know your links are not direct.

NYG -You are fortunate in so many ways that you don't really grasp at this point. But I must ask the burning question to you of how is it that you can experience such intense and moving emotions in an environment that made you very miserable, then believe keeping your emotions to yourself will be possible in your next patient care position? Surely if psych is seems to be "it" for you, you have the ability and insight to at least recognize that the emotions and body are inseparable in healthy people. Now that you have said your goodbyes to the horrors of Med Surg, you feel relieved and elated and can eat again. Have you clarified for yourself what it was about the work in Med Surg that made your body respond as it did? Was it the sights, the sounds, the smells, the contacts? People are people and in Psych, still waters may hide some very deep drop offs. They may also vomit, defecate, swear a blue streak, and other foul and other unpleasantries. The scary ones may feel no emotion at all. Like the sociopathic personality. And if you spend some time there, you will eventually meet the person who will challenge your core emotional fear and shake the inner ground you stand upon. Hide your emotions? Bury them deep? Only at work? In psych? Listen. What would you say to the suicidal teen who is on your unit and her history includes regular sexual activity with family members since birth, the inability to physically conceive a child, and isolation from normal socialization processes outside of the home environment? Keep a stiff upper lip? Life is what you make it? Go forth and start anew? The privileges unique to nursing include the opportunity to appropriately and respectfully connect with others on an emotional level. To tell you that I have physically felt the room fill with the light of joy and happiness at the moment a patient dies, despite the visual of the family crumpled and weeping at their loss is to share with you that I am connected emotionally to myself and able to empathize with everyone else in that room. When the family members hug me and cry on my shoulder, I know that it is okay to let my tears, my emotion, my sadness, show. I don't feel ashamed nor do I ball up in the corner and wail like a toddler. I have found my emotional balance while retaining the professional integrity of a nurse. I have experienced situations where my gut connection, my emotions, were not in sync with what appeared to be happening. If I ignored my feelings and went along with what I was told to do or what everyone else was doing, eventually I would reach an "Aha" moment and recognize what my feelings, my emotions had picked up on long before my head was in agreement. Like feeling the dagger vision of a bitter old nurse raising up the fine hairs on the backside of my neck... Professional nursing can be compared to a lifelong apprenticeship as there's always something new to be learned. You are a well educated nurse at the beginning of her chosen career. Emotions are part of this game. They are part of the hands on of health care. Emotions can keep us connected to ourselves and others. As you evolve in your nursing career, you will no doubt encounter other nurses that will try to manipulate you through your emotions. You will have situations where you absolutely must be alone in a private room with the door locked behind you before you can express a strong emotion safely. The odds of turning into an embittered old nurse will be less if you learn to accept, understand, and trust your emotions. Keep them private if needed, but don't deny them healthy expression. They are a part of being human. They help you understand yourself. Think about it. :icon_hug:

An addendum for the thread... every LTC I have worked has the narcs in the same blister card as the regular med drawer. Many times the cards are so tightly packed into the drawers that pills will break through the foil backing and either be found rolling around on the bottom of the drawer, stuck somewhere among the cards, or magically disappear. It is another reason why I check the back of the card when counting narcs. If I can see that the backing has been cut/slit or otherwise corrupted, I will call a supervisor to co-initial and either confirm that the tablet in the blister is correct or someone's substitute tablet. It may be a pain for the nurse I am counting with, but I have learned narc count is not something to flash through just so everyone can go home. So more advice for nurses working in LTC's that use med card blister packs in drawers, it pays to be careful when pulling them and returning them to their assigned order. Your careful efforts will be less lost or missing pills. This is critical with narcs and things like coumadin, antibiotics, and qod meds. Plus your cart will be neater for the next nurse who follows you.

Just a thought, but having had the experience of single parenthood and having friends with same lifestyle, I will recommend that you search for job that best fits your needs for regular, possibly flex hours, great wages, and is close to family friendly amenities. If you take a job because it is close to family but is a job that you disdain, you are shorting yourself and your child-ren of a happy parent. The best case scenarios for professional single parents that I knew were always made possible by relocating for a promising position. The job interview can include questions from you regarding family issues, childcare, schools, etc.. You will bring your job home with you whether you intend to or not, something to think about when deciding to accept a position that is not what you really want. Single parenting is hard enough, why not accept a job that gives something back, enriches your life, and makes you smile?

My two cents; I have worked in LTC and in clinics as LPN for years. Many, many years.... My experiences with the missing narcotics were always in the LTC facilities. The agency nurses were never responsible for the missing narcs; it was always an employee of the facility. One offender removed liquid MS from 10 ml bottles and replaced the quantity with tap water - as he shot up in the bathrooms. It takes a long time to nail narcotic thieves in the LTC system, so in this case pts were dying and nurses were unknowingly administering tap water for pain. Another instance of narcotic theft was in a very large LTC (several stories in a large metro area) and the shift supervisor (of the entire building) possessed the keys to all the narc drawers for all the med carts. She regularly took one to two tabs from the blister cards as she had opportunity, and would occasionally take the whole card (30 to 60 tabs per card). Yes, two nurses counted at the end of each shift and the nurse ending their shift immediately became suspect. The sheer volume of med carts in the building, however, created many suspects. Eventually the thieves were "caught". The MS nurse was brought to the office of the DON and confronted by the eyewitness that saw him taking the bottle of MS into the bathroom and found his used syringe in the wastebasket. The supervisor who was helping herself to narcotics was observed under suspicious circumstances by myself and only by by writing up a detailed report of what I had witnessed and giving to the DON, was this supervisor finally confronted and questioned. Under no circumstances were police involved. Both employees were terminated on the spot and escorted out of the building by in house security. No reports were ever filed with the Board of Nursing. And so these nurses were free to continue working as addicted nurses elsewhere. And I must add that the agency nurses I have worked with have always been some of the best nurses I have ever worked with. And that's my two cents.