rmarz

I'm still tryin to get the DON to put out some disciplinary action forms... If the money and hours weren't awesome I'd run as fast as I could... team leaders think 0.125ml = 1/4ml. No TAR created for someone with a problematic SP on admit... ugh. As my dad says, "Collect 200 dollars and pass go." I guess so! Not like it would be any better if I left. Just watch my hours get cut now that I've spoken up =P

Thanks for the replies. I've had to deal with this time and time again... but I actually would like to keep this job. Being an actual nurse who doesn't turn a blind eye unfortunately puts you on the outs in most places. Its a little LTC, 27 residents, not many people work there~ These CNAs were 2-10. Aides work 8s, while nurses work 12s. Its pretty easy to see what the CNAs left on the previous shift cuz I'm still there when they are gone, helping the 10-6 with bedcheck.

... that CNAs should do what the nurse tells them? I remember when I was a CNA, if a nurse asked/told (to me there really isn't a difference) me to do something. I went and did it. Tonoc I had the lovebirds working, and a new girl they were supposed to be training. The lovebirds already ran off the one good CNA I had on evenings, now who is gonna do all the work? lol They like to take about 5 30 min smoke breaks in an 8 hour shift. They did no bed check before they left, didn't take out the trash, didn't pass snacks, and thats just what I noticed! Now what really hacked me off... we have a res with a belt in his WC that beeps when it is unhooked. When he starts unhooking it, it usually means that he is wet. The lovebirds know this, as they are the ones that told me about this correlation. So I tell the lovebirds he needs changed, while they are at the computer charting (which is a one person job, but they are joined at the hip so they both have to sit there). I go pass some meds and come back, they are still sitting there. I get the wet res's meds ready and tell them they can go change him after I give him his meds, I then push him out of the DR and up the station where they are sitting. They say they will do it after they are done with the person they are charting on. "Ok, that works." I think. I go pass some meds, do some BS, come back... still sitting there, res in same place as before. Now his brief is saturated and I can tell he's wet by the smell and the big wet area on his gray sweat pants. I then look at the computer to see what res they are on, maybe they are just realy slow... go pass some meds, give some insulins, come back... they are on a different res on the computer and have not moved. I think my head started to spin around at this point, but I tried to hold back the anger... I asked them what the problem was, what part of what I asked them to do they didn't understand, I know what res you were charting on last time I left the desk, "If you have a problem I can call the DON and she can come up here and let you know what your real problem is." I asked them if they were wanting to be written up for insubordination, neglect, or both. They went and changed him after that. The hall smelled of terribad urine after this. I think I might have made them mad cuz they didn't talk to me the rest of the nite. We are short staffed as 2 CNAs have just quit, one dt her being tired of doing their job, and this place pays CNAs horrible wages. I let them get away with murder already, but this obvious neglect of residents just doesn't fly under my radar. What to do

Sorry ya had such a bad day! I'm a sick sick person and live for those kind of days =P

From what the people I know have said about Neosho, it sounded about the same as Labette. Pretend ur a mute when the teachers are around =P Seems they have a fully online LPN to RN bridge program there.

A common trend I have noticed with nurses that I work with: They hate to make phone calls. I admit I was kinda scared of picking up the phone and talking to someone, such as a hospice nurse manager or a doctor when I first started. Its possible the charge nurse you talked to that had this resident falls into that category. All the nurse has to do is pick up the phone and the problems would be solved quickly. Unfortunately I see this a lot. New grads et experienced nurses alike sometimes seem allergic to making phone calls et expressing a situation in a way that gets the desired results. People do often make you feel stupid when you call them. I think thats one of the finer points of nursing... being able to call someone up and get exactly what you want even tho they have to be the shot caller on paper!

In SEK it varies greatly, from 6.50 to 10.00 an hour at LTC et hospitals. Agency pays 10-14 an hour. Seems the cycle with CNAs that they pay crap as long as they can. Then they don't have hardly any CNAs, and the ones they do have aren't so hot, so they start using agency.... CNAs that have been there a long time get mad cuz these agency people are making twice what they are making and then quit. So the facility decides they need to pay more per hour to save themselves money and improve continuity of care, lol - they are usually 1-2 years too slow to realize this tho~ My point is, sorry for the derail, you can start out at 10 an hour as a CNA. You may just need to look past the first ad in the paper to find a place that has a high demand and is willing to compensate for it.

Meds taken prior to being put on hospice are often continued... if the med falls under the dx for hospice care, then hospice will pay for it (so they should be buying that Effexor for this pt). Other meds can still be continued, but if the med doesn't fall under the dx that they are on hospice for, the facility/res/family/insurance will have to pay for it if it is to be continued. If I was this resident's nurse... I'd call the hospice during business hours et get ahold of his case manager. Tell them what I want, why, and see how everything fits together... then write the telephone order for it. Rarely do I ever talk to an actual doctor for hospice patients, I just talk to the hospice nurse, we make a plan, see if its covered, then send that order to the doctor to sx! But! Being as ur still in school, u don't want to rock the boat or attract any attention. So my advice would be to keep ur mouth shut about it and just call the Omsbudsman. While at clinical maybe ask the charge nurse why they are doing this and that, just be inquisitive, try to learn the reasoning behind what they are doing... The hospice plan of care should have a rather long list of standing orders you can use as well: Morphine Sulfate SL, Ativan, Atropine SL (for excessive secretions), these are the most common orders initiated. It sounds like these 'hospice nurses' that you are seeing may actually be CNAs? I'd call the case manager et inform them of the behavior, but once again, ur still in school so keep a low profile on matters such as this imo.

A cheap 10 dollar one from Wal Mart. Plastic with soft edges so I don't give anyone skin tears. At first it was because I figured that if I got it nasty filthy I could just toss it and get a new one... but they last YEARS and I've yet to shove my hand that far up someone's bum without a glove lol

What I do is this: Whatever gets me thro the shift! As you get to know the people, the meds, the txs, the BSs, the Br Txs, and individual routines... you can revise what you are currently doing to save more time. I usually start out a place going straight through the MAR/TAR, front to back (no skipping around), so I don't miss anything. I tend to stick to that routine, but cater to the residents as I get to be able to anticipate needs better. I have made up some sheets for all shifts that I take with me. I call them my "Hey Dummy, Do This" sheets. Helps on days I'm tired, or too busy to keep on track. They really help on agency shifts! As far as CNAs... I try to make sure I see a trend and habitual behavior before I start attempting to effect change in how they perform their jobs. I also try not to jump on them on a day when everyone has called in and half the building has the runs! I will let my head spin around and flames shoot outta my ass tho in the case of habitual neglect!!

New grads are making 26 an hour up in KC. Just about any LTC here in Southeast Kansas will pay an RN 26 or more dollars. Regardless of experience. The hospitals in this area just recently started paying more dt the LTCs paying so much more than they do. LPNs start out at 18 in LTC, hospital wages vary greatly. I've heard of nurses up near Witchita making 40+, there seems to be a severe shortage up there. Seems that all the LTCs around where I work are matching the agency wages now, dt being tired of the revolving door and turn over they have had over the past few years. Now the agencies don't really pay enough, so I hope to see those wages go up soon! I'm an LPN of close to 2 years. I make 20 at my full time LTC job and 20 at agency as well. Its very adventageous to job hop in this profession it seems. The nurses that I know that have been loyal to a place and stayed there for years, well they make considerably less than the new hires straight outta school. Sad but true. I have seen some nurses have success with finding a new job that pays more and then getting a raise where they work at, seems to be the only way to get a raise these days.

I only chart absence of vitals in Kansas

I got tired of laying in bed awake during the day, so I just sleep every other day now =P

I generally find that I get along with all doctors, even the ones the other nurses don't. Can't say whether this is dt being male or not. Although, I will say that female nurses seem to have problems with the Middle Eastern doctors, while male nurses become buddy buddy with them. Thats cultural though, really.

Mr Garrettson said it best: Being all hot and sexy sure is fun for awhile but it sure does get boring. It really does get old. The worst situation was this little CNA whispers in my ear, "I know how to keep you awake." At the beginning of a noc shift. DON had to hear about that one, it was a little far.