sunshineyday

Here's a link to the MO BON Abandonment Criteria http://pr.mo.gov/boards/nursing/positionstatements/Patient%20Abandonment.pdf I'm an agency nurse, showed up for my shift read my assignments on their sheet, and quickly ran through the H&P's... assignment was DANGEROUS and I wasn't about to lose my license for some extra money (felt unsafe practicing). I tried to find the charge... she didn't show up in 10 min... start time was approaching... nurse was pressuring me to start report... so I left. Called my agency, they couldn't get a hold of the charge either. They asked if I would take a reduced load. I said did the charge say I could? She said no, she wants you to come talk to her. I said no, they are going to try to force me to take report I want her to confirm via telephone first that they will reduce my load. She said they wouldn't do that. So I said I was leaving. I let my agency know I didn't feel safe working there and that I hadn't accepted report. So what constitutes "establishing the nurse/pt relationship" is it accepting my shift... taking report....or what? I hate the word "reasonable" .... did I give "reasonable notice" given the situation? I think I'm ok but I just want some reassurance.

I am a graduate student and am currently learning how to use SPSS. I have to work on a project which requires using outcomes data but the problem is that I'm working agency and can't get data anywhere. I guess I can "make up" data but I don't see how I'm going to be able to learn much from that. So, if anyone can share some data with me via a .sav or .xls file I would be much obliged. I really don't care what the topic is. Thanks.

I like Candlewood suites cheap so more money in my pocket. I'd just do the math and see how much money you make.

I'm confused... if you are going to wear your Danskos as part of a clinical you will have to look at your school's policy. Typically, any type of shoe with holes in them aren't allowed when you are functioning in a clinical capacity. On my unit there are different Danskos of every color and pattern so I think it's just a matter personal preference. But you don't want to stand out too much from your peers either.

It's sad but this seems to be the status quo. I really can't get my head around why women who are smart, have a lot on their plate and claim to be "caring" people are so hateful and disrespectful towards each other. Nursing is a second career for me and I thought there would be less politics in health care. Wow, I was really wrong. It's a lot worse. Interestingly, this is a management problem IMO. Too often, the best nurses are selected to be in management and they are not necessarily the best managers. I've been on both ends of the spectrum. It's a really sad reality of nursing. And unfortunately it's everywhere. That's why I enjoy traveling or agency. You fly under the radar.

I was just trying to be a patient advocate. I really bonded with this patient and really felt scared they were not going to get the proper treatment. I didn't show up "just to" "check their chart" and barge in - I am well versed in HIPPA law. I had to go in anyway to have my time sheet signed and I wanted to follow up about filing an incident report. While I was there having a conversation with the charge nurse about my shift the previous day - she said, "I wonder what the K came back as last night" and she personally pulled up the labs NOT ME (because it was the same charge nurse from the day I worked). They seemed happy to have me involved with the plan of care, didn't seem put out at all that the "agency girl" was "back" and in fact my agency called me saying I had "glowing reviews" from the client. When I'm old, I would want a nurse to care that much about me. What alterior motive would I have going back there? It creeps me out that you would even think of anything besides me just being a concerned patient advocate. If the charge nurse didn't bring it up, I would have put a little bug in her ear to try and ensure someone followed up. There is no federal law that says I can't do that. There isn't even a policy at my agency that says I can't go back to client sites as a conerned private off duty citizen. I didn't go through their chart again or anything, I didn't even go into the pts room. As we were leaving the unit we walked by the pts room and the charge nurse asked the pt how they were feeling from the doorway and I observed them saying "i feel great" from the hallway. BTW, the patient asked if I could come visit again (because like I said we really bonded and they don't have any family and since it was Christmas I spent a lot of time with them since they seemed depressed). So the patient gave expressed permission for me to be there anytime I wanted to be there. So the details about the patient are most certainly my business since the pt has given me permission. I was just chatting with the charge nurse about the previous day and the charge nurse followed up with ensuring the K was under control in my presence. So no, I did not violate federal law and I did not have an unsolicited conversation. Jeez. Oh and at no point did I inquire if the patient was alive I'm more professional than that... lol "Hi... is this patient dead yet?" LOL ya right! Why is that the crux of your response? Scary. I know you are probably quite defensive of LTC since you are part of the system and by your post there seems to be serous issues with staffing and education. The only thing I will say is you should be more welcoming of agency staff because they have the knowledge base to provide some education that by your post you are obviously lacking. I am also concerned with the "this is just the way it is" attitude. I know tubing changes sound petty to you but infection control and BSI's on top of the diagnoses these people already have will def cause increased LOS and mortality. I'm also confused that you said you don't regularly practice the five rights of medication administration. I don't care if I recognize the patient - I always perform the 5 rights. I hope you are able to perform the care those people deserve and that no adverse or sentinel events ever happen at your institution. I also hope that your license stays safe. Good luck to you.

Can I do that anonymously?

Unfortunately (and actually fortunately lol) I am just an agency person and not actually on their staff. I just talked to my agency and let them know I don't feel my license is safe working at this facility. Moving on!

I recently decided to start picking up shifts in a long term acute care hospital with an agency. I worked Christmas day. AMAZING MONEY BUT... OMG!!! All of my tubing was expired AT LEAST by 24 hours, there was one PICC dressing that was dated 12/14 (so it was 4 days overdue for a change), nothing was labeled, they don't double check potassium or insulin or any other high risk drug, they just check narcs. Oh and 3/5 of my patients were sitting in their own feces for IDK how long. Oh and another nurse didnt have the TPN hooked up to filter tubing AHHHHHHHHH There was also a patient on cellcept but they didn't have the correct PPE and they didn't know that pregnant workers should not be around this med, and the nurse from the previous shift was pregnant! Also no black box disposals...??? what the heck? The MARS were horribly messed up even though night shift does the "chart check" what a crock! One of my patients had TWO profiles in pyxis with different birthdays so when I did the double check at the bedside - his MRN, DOB, and Account# were off. Now, here's where my question comes in. I advised the house supervisor of these problems and it looks like the previous shifts were using the incorrect medication profile. Interestingly, the medication profile under the pts room number was the incorrect med profile. I called the doctor and got everything squared away. Oh btw their "pharmacy" was closed for xmas. But he was given a few incorrect medications. By incorrect, I mean someone else's (not by me by other nurses). I asked about incident reports and the house sup just said, "we are too busy to deal with that right now...welcome to (insert name of hospital here)" and I felt that incident reporting was frowned upon? But I got a really weird vibe from him. And another patient ended up having an EXTREMELY high K level. The person in the bed next to him was on an ace inhibitor and potassium replacement and my patient with high K was on spiranolactone. I know when these things are combined it can cause really high K. The pt never had high K before, had no renal issues, was not on any maint. fluids with K so I have a suspicion that a previous nurse gave the wrong meds to the wrong patient (it was a double bed room)? How can you even prove that? I am just venting it was a frustrating day and I need to make some sense of it all. Is this how long term acute care rolls? I didn't get all of my 9 am meds passed until around noon!!!! That has NEVER happened to me before. I have some general questions because I am scared to work there again for fear of being called into court someday. 1. If a pt has an adverse med reaction and expires - do they do the toxicology to see what drugs are in his system and if there is something askew do they look at what other patients were taking to see if a wrong patient med error occurred? Surely, the toxicology doesn't screen for every chemical under the sun? If so, can they pinpoint what nurse it was? I don't want to be held accountable for some other nurses med error. I mean everyone excretes medications at a different rate. Same with PICC lines, incorrect TPN. Do they call every nurse in who signed the MAR or chart to a court case? I really need extra money but idk about working here again. Does anyone know how I can protect myself if I do continue to pick up shifts here? I have asked about filing incident reports again but they said they would have a supervisor call me and of course nobody called me. Ugh. The people here are really understaffed, I'm not trying to say they are idiots but OMG I have never been somewhere so messed up!

thanks i really appreciate it!

Quick question - I will be graduating with my MSN in a few months but would like to go back to school for another year in order to get the FNP certificate. I could also go for the PNP certificate since I've been in PICU a while. Anywho - was just wondering if most people only want MSN NP people or if certificates are okey dokey? Future outlook, being able to find a job post certificate etc. Does the FNP leave more options available to me at the end of the day? Thanks for your time.

Hi, I really need advice. I am about to graduate with my MSN in Health Care Systems Management. I have two years of bedside experience. Which, is really not enough bs exp to transition into a manager role. I have suffered so much in my first two years of nursing - being left to sink or swim, horizontal violence, older staff nurses who ate their young, mean doctors, no respect, crappy pay... I'm burnt out. I feel like I can't make a difference with my patients and I can't spend any time with them if I want to leave on time. All my time is spent ensuring we meet core measures, clinical pathways, putting out fires of other people (I charge) making the quality people happy and making sure we get maximum reimbursements from CMS all while fighting off the sharks and charting to cover my rear end. I have worked in ER, CVICU and tele step down. I think I could be happy in cath lab or OR but getting into those specialties has been impossible. At any rate, I could continue but I'm not here to vent. This profession is just not for me. Thus, I want to leave to the (bedside) nursing profession completely. What a way to waste over 100K in student loans huh? I think I could utilize my MSN in the business world as management is as management does. However, I wanted to pick up a second masters degree to help me transition out of nursing and make me marketable in this economy. I was thinking accounting... but was wondering if anyone had any fabulous ideas for a career change.

Hi, I graduated with my BSN in 2008 and immediately started work on my MSN with emphasis in health care systems management. I almost have two years ED/CVICU/Post Interventional Cardiac unit experience and recently made a big move across a few states for a job. I have a lot of bills and want to work as much as possible and with the move and life I'm finding it hard to balance everything and I am really REALLY burnt out on school. What bums me out even more is that when I signed up for the MSN program I was under the impression I could sit for the Certified Nurse Executive after graduation. However, I found out that you need an MSN PLUS executive experience. So, I can't sit for that after all. I am planning on getting my CCRN here in the next few months. Salary wise what is going to get me the most money? My hospital pays a bonus for CCRN, but I don't think I get paid more per hour for having a MSN. And I won't be eligible for a mangement position for a few years? I know this sounds horrible but I have $140K in student loans. I have two semesters left (four classes) before I can graduate with my MSN. So does anyone know: MSN, CCRN or MSN, BSN salary differences? Thoughts? Thank you so much for your time!

During a snowstorm in January, I was walking my dog... slipped on some ice and my siberian husky ran away, leash attached. He was later found by animal control and I picked him up at a shelter. At the shelter, I was told since he was found with his leash still attached that there would be no fine as I made a good faith effort to confine the animal. Great. Signed some paperwork stating I was the owner of the dog and me and the pooch went home. Fast forward three months to 4/28/09. This morning I awoke to loud banging on my door. Two police officers, their two police cars with lights on in my parking lot. My first thought was that someone had died and I was being notified. I was quickly told that I had a warrant out for my arrest for, "failure to confine an animal and failure to appear in court". I begged to disagree. I had not received any fines related to my husky being captured by animal control. I had not received any mail related to a court date, etc. I was not allowed to change out of my pajamas. I was not even allowed to close my front door (the officer made sure to put his boot in the door jam - so I wouldn't, "lock" the door and refuse to come with them). The officers pushed hard for me to "bring a credit card" and I was swiftly handcuffed in front of all of my neighbors (I live in a prestigious area of town) and put into the back of a police car. Again, I stated that I had no knowledge of this offense. At the police station, I was made to wait 45 minutes in handcuffs and I was placed in a locked small cell with a fabulous metal toilet. They didn't take a mug shot or take a set of prints. After a while, the officer came in with my "file" and said that he had my signature on a "ticket". I thought, I did fall that day, maybe I just didn't realize what I was signing? A few minutes later I was in front of the judge pleading guilty, when suddenly I saw the "ticket" with my own eyes. My signature was not on it! Someone else had signed for me, followed by a badge number #359. Yay! I wasn't crazy. I quickly changed my plea to "not guilty," posted bond ($300.00) and a court date was set for June 8th. Now, doesn't this whole ordeal sound a bit ridiculous? I think I was unfairly racially profiled (I'm Hispanic) and treated horribly given the circumstances. I have been applying for jobs and as a RN, we all know they conduct a rigorous background check and I'm sure this outstanding "warrant" prevented me from obtaining employment! I'm freaking out... after two months of looking for a job I finally was offered two in Texas. The officer said that this wouldn't "go on my record," but I'm not sure if I need to check "yes" when I apply for endorsement into Texas? Does my pending court date constitute any "pending charges"? Has anyone had a prior "arrest" (omg I can't believe I just typed that) and applied for endorsement into TX? What is the process like? Can I at least receive a temporary permit? Or should I call the judge and try to get it expunged? All this, because my dog ran away!!!!!!!

I think we all know how tough the new grad market is. I completed a 320 hour senior practicum within a level II trauma center. then dove right into graduate work. passed the NCLEX. I finally have an interview Monday for a NICU position!!!!!!!! I'm faxing over my transcripts, letters of recommendation etc. prior to interviewing (it's a phone interview). Can you guys please help me prep? i.e. what characteristics would you want in a new grad within your NICU? What are some good answers to the typical questions... i.e. why are you a good fit for us etc.? Thanks so much!!!!!!! If I don't get this job, I'm going to be living out of a cardboard box...