ehooper80

yeah, you really have to watch your belongings in the hospital. there are so many people in and out all day long, it's a very easy environment for people to steal in. there is so much hustle and bustle, no one really pays attention to what anyone else is doing. get your wife a pad lock for her locker or do what i do... carry my cash in my pocket and lock my purse in my trunk. i also made the mistake of leaving my stethescope laying out while i went off the floor to eat lunch. i've never seen it again.

As a nurse who previously worked in long term care, I chose to leave the field because I felt that the nurse-resident ratio was too high to provide quality care. I'm sure not all facilities are like the ones I am familiar with, but I was given 24-28 residents every day. The population was a mix of general LTC and sub-acute rehab (patients needing therapy to recover from an illness or surgery lasting several weeks to months), and many I felt needed more nursing care than I had time to provide. Not long before I left, the corporate office began to push a new initiative to treat residents in house for pneumonia, UTIs, and other common infections with IV antibiotics, rather than send them to the hospital. This meant many more IV starts for the 1 RN in the building per shift (the rest were LPNs who could not start IVs or hang the first dose of IV antibiotics). Nurses can debate the problems of LTC all day... I want to know if nurses feel that the current situation of LTC, particularly nurse-resident ratios, reflects how our society values the elderly?

This sounds familiar too... I heard the same "not that bad" stuff from some nurses. IMO, these were probably the people that documented things that had never been done, etc. It always seemed funny to me too that when the state surveyors were there, it was mandatory for almost all the staff to be working, so that things could actually get done the way they were supposed to be. But the rest of the year they have half the staff struggling to do the same jobs. And let me say that there are many dedicated, caring, professional nurses out there that work in LTC... I'm not trying to put down the whole profession. My mother has been a LTC nurse her entire nursing career. I'm just saying that the LTC industry as a whole needs to be revamped. LTC can put it on paper all day long how concerned they are about resident care and safety, but until they actually live up to those standards, what does it matter? How can anyone think 1 nurse to 28+ residents (most with cognitive dysfunction and physical mobility issues) could ever be safe? If a nurse had 28 patients in any other setting, it would not be tolerated.

I'm sorry to hear that you lost your position. When you're employer said "possible felony charges", did they mention any specifics, like they were pressing charges, etc? I would guess the more information you had, the better. I would suggest seeing a nursing attorney as soon as possible. With charges, that's about all you can do. I personally don't have any experience with felonies, but if you search the topic on allnurses.com, there are lots of threads about it. I wish you the best of luck with your recovery, and remember that your sobriety comes above all else!!!

You are right. Psychiatric nursing is very different from medical nursing. Instead of dealing primarily with a patient's medical/physical issues, you are assessing and treating problems with their emotions, behaviors, cognition, personality, coping skills, etc. Psychiatric disorders are much more subjective than medical disorders... medical nursing is much more black and white. I've done both and I currently work as an RN is an acute psychiatric hospital. I love psych and I couldn't imagine doing anything else now. Our patients generally are admitted for acute psychiatric/behavioral crises and stay for an average of 7-14 days. We have units for ages 3 to the elderly, and I almost always work with the adult population. I became a nurse because I wanted to help people, and everyday I work I feel I accomplish that goal. Some patients have an acute bout of depression/anxiety related to a certain event, become stabilized, and we never see them again. Others have chronic, disabling mental illness and are admitted over and over. The goal in psych nursing is the same as in all nursing... to assist the patient to reach and maintain an optimal level of functioning. It's just very different different approach... instead of using a stethescope, looking for physical signs/symptomology, you are assessing the patients mood, affect, coping skills, thought processes, adaptability, etc. You also have to be able to interact with patients objectively and be empathetic without "feeling sorry". I know a lot of nurses don't like psych... and I can understand why. Nurses who thrive on the technical aspect of nursing (monitoring blood pressures, titrating drips, algorhythms for blood glucose, etc) probably won't like psych. Anyway, as new nurse, you will just have to get a feel for what you enjoy doing. There will be areas you love and areas you hate. That's the good thing about nursing... there are so many different fields to go into.

What you describe is exactly why I RAN AWAY from long term care. Although I'm sure there are some good LTC facilities out there, unfortunately some of them aren't. I worked for a 110-bed nursing home/sub-acute rehab facility owned by a major national healthcare corporation. Every day was exactly what you describe... I was responsible for 24-28 residents on a mixed LTC/sub acute rehab hall; the only other staff were 2 CNAs. I had to pass all the meds, do all the treatments/dressing. There were usually around 6 PEG tubes, 3 trachs w/prn suctioning, 4 hospice residents w/prns as frequent as q 30 mins, disoriented high falls residents, etc. Plus I was the only RN on the shift for the entire building, so I had to start IVs/hang IV meds for the entire building... and I got the title of "charge nurse" which meant I had to deal with resident family issues, staff call ins & finding replacements, talking of the phone to pharmacy, etc. And I had to chart, which I usually didn't even start until an hour after my shift ended. We operated on 8 hour shifts and they were all busy. Things got signed off in MARs/TARs that never got done... not out of neglect, but just because of lack of time. It was INSANE what they expected a nurse to do with so many residents. Anyway, I found another job as I could, put in my notice and left after working there only 4 months. My mom worked as a floor nurse for years in LTC and she said that's just how it goes. After 7 years, she got a position in management... otherwise she said she would have left LTC to work as a cashier if she had to. LTC FACILITIES ARE OPERATED FOR PROFIT, and as long as they can get away with operating with bare-bones staffing, they will. Get out while you still can.

Wow, it sounds like you really have a lot of complex emotions going on. It sounds like you have a history of depression and maybe your new job is bringing all that out again. Nursing is a stressful job... no bones about that. I would suggest seeing your doctor about your medication if it's not helping. If you are seeing a regular family doctor, then ask for a referral to a psychiatrist. Hope things get better!

A 20:1 ratio for a psychiatric hospital sounds about right. I currently work at a psych hospital 7P-7A. The 7A-7P nurse usually has an LPN to pass the medications, but night shift does not. I actually prefer to pass my own medications because it gives me a chance to assess the patient and do some education on the meds if they are unfamiliar with it. And yes, you are ultimately responsible for what happens on your unit. You supervise the duties of the LPNs and MHWs. BUT remember that psych is totally different from medical nursing. Your patients may have some medical issues, but almost always they are stable, chronic conditions, such as diabetes, stable angina, hypertension, etc. We admit ONLY MEDICALLY STABLE patients from age 3 to the elderly. We have a geriatric unit where staffing ratios are higher just because the patients tend to have more cognitive impairments and are greater falls risks. All patients are constantly assessed for suicide risk/suicide ideation... If a patient is actively suicidal or high risk to be suicidal, they are monitored more frequently. The general patient population is on "Q 15 min checks", meaning they must be seen every 15 minutes by a staff member. We have two higher levels of monitoring: LOS (line of sight) and 1:1. Actively suicidal patients are always kept on 1:1, meaning they must have a staff member within arm's reach at all times. It's usually a MHW assigned just to that patient for the entire shift. Patients with suicidal ideations or at high risk for suicide or that are self-harmers are kept on LOS, meaning they must be in the direct line of sight of a staff member, usually a MHW, that is assigned to watch patients for the entire shift. Because of better assessments and monitoring techniques, suicide rates in psychiatric hospitals have declined greatly. Great precautions are taken in psychiatric hospitals to assess patients for potential self-harm and to monitor patients to prevent this from happening, but unfortunately it still sometimes happens. You would not "lose your license" because a patient harmed themselves during your shift unless you were negligent in enforcing staff monitoring or patient safety.

I agree with everyone else... salary for a floor nurse sounds very suspicious. I've worked in several different settings as a nurse and in all of them, there is a big likelihood you will not get off on time.

Hi Michelle!... and welcome. I'm sorry to hear about all the problems you are having struggling with your alcohol addiction, but now is time and present. Have you returned to your groups and meetings? Have you gone to see a therapist/counselor? If so, make sure you have documentation backing all that up. If not, maybe now would be a good time to go back. And I'm with Jack on this one, you really should get a good nursing attorney to represent you in front of the board. Particularly because you've had more than one relapse. I know from personal experience when you're not working as a nurse, you have NO money and lawyers are not cheap. I'd suggest begging and borrowing from anyone and everyone, because attorneys can make a world of difference on the outcome of your license. I wish you the best!

Your state could be totally different, but I hope that gives you a general idea of how it works. Some other words of advice that I can give is: :redbeathe Keep a positive attitude about the whole experience. Yes, you will have to do things you don't want to do. Yes, meeting compliance on your recovery agreement with consume a lot of your time. Just remember that we are here because of our own actions, and the staff at the nurse recovery programs are ridiculously understaffed. (ISNAP has 900 nurses active in program and three case managers). If you can't go back to nursing right away for whatever reason or can't find a job, DON'T DESPAIR. This is part of your recovery and one day it will be over. I firmly believe that being forced to live on 1/4 of my regular income for 6 months was a good lesson in humility and that we should not take what we have for granted, as I so often did. Be honest with all your health care providers, and more importantly yourself. For example, lying about drugs/amounts used is pointless. You can't change your behavior until you are honest with yourself and with others about what you were doing. Don't stress out about what other people are thinking about you. This is time for you to help yourself and make yourself better. I thought I never knew any nurses who'd been in recovery until I got fired from a job for med diversion. Two nurses that I worked with every day were both recovering addicts and had gone through the same situation I was. I'm not a fan of AA/NA, but if you can attend a nursing support group, I highly encourage it. They are also called Caduceus Meetings or Healthcare Professional Meetings. These meetings are targeted to nurses & other HCPs recovering from alcoholism/addiction. I felt so stupid and alone before I went to that meeting for the first time. It has been very comforting to know that I'm not the only RN that ever made a poor decision. Anyway, Good luck with your dealings with the BON, and please keep us updated! :)

Well, I was going to write out my whole experience, but I live in Indiana (ISNAP) and mine is basically the same as RN4HUGS was :). I self-reported in December, had an intake assessment by an addiction therapist in January and signed my RMA (contract) at the end of February. I was diagnosed with opiate dependence and given a 3 year contract. My mandatory narcotic restriction time was just recently over and I just began working as an RN again. For six months, I could not find RN job with the narc restriction, so I waiting tables and working as a phlebotomist. Ihave to call an 800 number everyday and enter an ID code and it will tell me if I need to report for UDS testing or not. The minimum amount of tests per year is 12, usually for nurses that aren't working as nurses; For nurses working as nurses, the max UDS/yr is 42. Mine is currently at 32/yr. You are limited to working no more than 12 hrs/day and 40 hrs/wk. You need ISNAP approval to work nights, overtime, or in home health/agency/hospice. Different BONs have different processes and requirements they tack.. I live on the border of Kentucky, and most nurses in the area are licensed in both states., IN's max program is 3 years and KY's program (KARE) has a max program of 5 years. I haven't dealt with kARE, but other persons in my meetings have and say that it is more rigid. For example, they require incoming nurses to go to an inpatient detox/drug treatment center. However, all nurse recovery programs provide some kind of contract that you must sign and return, detailing all the steps you will need to do be in compliance. ISNAP requires to see an addictionist every three months; a counselor (frequency determined individually); attend AA/NA/Nurse Suport Group meetings,. I have to attend three meetings a week, and the NSG has to be one of them. You also must find an AA sponsor within 60 days We have to submit our self assessment and meeting log every month.; the addictiionist, counselor, sponsor, and your work-site monitor have to fill out an assessment form and mail them in to ISNAP quaerly. Your state could be totally different, but I hope that gives you a general idea of how it works. Some other words of advice that I can give is:

I live in Indiana and Jack is correct that they also enforce the same restrictions: shifts 12 hrs max/week 40 hrs max, no night shift, no home health/agency, narcotic restriction for a minimum of at least 6 months. BUT... ISNAP does personalize rules based on individual circumstances. You can request reinstatement of restricted privileges, provided you have support from your addictionist, therapist, sponsor, and/or work site monitor, AND you are in total compliance with all the requirements of your monitoring agreement. After reading some of the nurses stories on here about different state's monitoring programs, I'm very thankful I live in Indiana. :)

Although I no longer live in Michigan and never practiced nursing there, I can tell you that most employers have some nurse employees in recovery. Most employers have no problem with a nurse being in recovery/monitoring program, HOWEVER many WILL NOT hire nurses with narcotic restrictions simply because of cost. A nurse that cannot pass narcotics requires another RN/LPN/Medication Aide to be staffed, which many employers will not/cannot provide. If you do have a narc restriction, look for places that don't administer narcotics (dialysis clinics, e.g.) and positions that don't require narcotic access (many office jobs), but some employers will still hire nurses w/narc restrictions for direct pt care positions. When I worked at a major metro hospital, I remember working w/three nurses who could not pass narcotics (unit charge nurse passed them). Good luck in your pursuits for employment, and DON'T GIVE UP!!!

Yes, nurses in recovery can and do get jobs. I am an RN in recovery and I work full-time at an acute psychiatric hospital. This was the first RN position I applied for after having the narcotic restriction lifted by my nurses' monitoring program, so I was a bit nervous because I really wanted the job. I lived in a small town (35,000? pop) so empooyment opportunities are limited here, even for nurses. I applied and interviewed for 3 RN positions while I had the narcotic restriction, and was not hired all 3 times because the employers could/would not pay an RN salary that needed an LPN/Medication Aid for med pass. I was advised by my nurses' monitoring program to seek employment at dialysis clinics (because they don't administer narcotics), but those positions are extremely limited in my area. Then there are other RN positions that don't require passing medications at all, such as chart auditing, utilization review, etc. In my exp, you usually need several years of experience to get these jobs. When I entered the monitoring program, I was given a narcotic restriction and my employer let me go (LTC facility). However, I've never asked any others nurses, so I don't know if this is a common practice. I actually worked as a phlebotomist for 6 months while I was trying to find an RN position. It's not easy, but nothing worth your time ever is. The most important thing is to realize how important your sobriety is. Also, you would be amazed to find out how many nurses are in recovery. Of course it's confidential, so its not common staff discussion, but of the 4 employers I've had (2 hospitals, 2 LTC), there have been at least two nurses at each in recovery. Have you attended any nurses/health care professionals support group yet? If not, you should contact your monitoring program to get information on when/where they are held. The attendees of my NSG have been an invaluable resource, professionally in how to navigate the nursing world in a recovery plan and personally, to help rebuild my self esteem and confidence as a nurse. I wish you all the best of luck and DON'T GIVE UP! Recovery is a process and you have to take it one day at a time.

Yes, the Indiana program says basically the same thing... that if you require long-term narcotics use you will be discharges as non-compliant from the program, because taking narcotics is not compatible with safe nursing practice.

CONGRATULATIONS(!!!!!) on 5 years of sobriety!!!! That is an awesome accomplishment, and for that alone you should be proud! And as for the boards, I'm sure you remember the jitters we all had the first time around. Don't jump the gun and assume you failed... and if you did, you can always study harder, take a Kaplan class, or do some NCLEX reviews. Just remember that the boards are there for a reason, so that we can safely practice as nurses. They aren't they just to punish us or deny us our entitlement. You did it once before and you can do it again!!! Keep your head up and best wishes!

I would HIGHLY suggest bringing it up early in the interview. I wouldn't mention it the very first thing, but I have always mentioned it early enough in the interview so that I did not waste their time or my time if they were not interested. I don't say I'm in recovery first thing because I don't want that to be the main factor they think of about me... but I do want to be honest and let them know early enough that it doesn't appear like I'm hiding it. Good luck in your quest!

Of course I am no expert on the issue, but it sounds like what happened to you with the first and second state will also happen with Florida. I do know it is the policy of boards of nursing (who have to approve a license endorsement to another state) notify all other states of complaints received, so more than likely they would notify Florida. I have also read in other people's postings that most states will NOT let you endorse a license in another state while you are in monitoring. I live on a state border and had licenses in both states prior to my incident. I participate in the recovery program in the state I live in, which sends reports to the other state. I hope that helps a little bit :)... Stay strong!

I know all charges that have EVER been against you show up on background checks, even those that have been dismissed. I just have some major traffic violations from when I was 18 (driving w/o insurance, expired tags, and another one along those lines)... I plead guilty to no insurance and the rest were dismissed. I will be 30 this year, and just got a new job. Those same stupid charges still show up, even the dismissed ones. Not sure how that is legal, but evidently it is.

I'm assuming because the RN thought the pt was possibly having Sundowner's that this was an elderly patient w/ a prior Hx of dementia? If this is the case, the RN and yourself were not wrong to assume his behavior was dementia related... even the MD thought this or they would not have ordered restraints, Haldol and Ativan. You can only learn from experience. Just FYI, the elderly (esp. those w/dementia) are commonly misdiagnosed/delay diagnosed because it is hard to differentiate the dementia (long term) from delirium (short term, r/t infection, shock, etc). Those coming from nursing homes often don't have a report to specify their baseline behavior or mental status... and nurses that have worked in LTC know that A&Ox1, A&Ox2, etc is not very helpful as the pt's cognitive status can change depending on time of day, mood, etc. But for future reference, mental status changes are often the first sign of many conditions in the elderly... infection, stroke, pneumonia, even UTIs. The best rule of thumb I can offer is to NEVER assume a patient's/resident's behavior outbursts are due to dementia unless you ABSOLUTELY know that for a fact. Combativeness/hitting/crying/etc is often a sign that something is wrong. Have all basic needs been met (hunger, bathroom, hot/cold)? What are the vitals like (high/low BP/HR/RR, temp, O2)? The only thing you can do for a person that can't tell you what's wrong is a thorough assessment to try to find anything abnormal. Then report whatever you find, as well as the behavior, to the MD. The other RN and you did your jobs... you've learned from the experience and next time you will know how to react. Don't worry about becoming aggressive... that's not always a good trait to have in nursing, and like my grandma always said, you catch more flies with honey than you do with vinegar. You can explain to the MD that you are concerned because your pt is acting very different than they were a few hours ago, is now combative, etc... but I would never tell an MD they needed to get there now unless someone was coding. Unless the pt was going into septic shock or V/S were very unstable, it's not really an emergency. But again, that is something you will learn with time. Just a question... where was the charge nurse during this episode?

I had to switch preceptors with my first job out of school too. The first was a nice enough person, but she gave me tasks to do all day instead of letting me figure out what needed to be done. She didn't let me call doctors or do the charting or learn to manage my time... she just focused on me learned clinical skills... which I had done plenty of in nursing school. My nurse manager switched me to another nurse for the last couple weeks of orientation, who was much more laid back and just let me figure things out on my own while still giving guidance when I needed it. It may have hurt my first preceptor's feelings a little bit, but this is YOUR career we're talking about here, and you need to feel comfortable doing your job. Fast forward a year... I was a preceptor on the same unit. Basically you need a preceptor that matches your personality. I'm pretty laid back, so I do best training the new nurses that want to learn their own system of organization and jump right in and do things. I don't use them to do my job, I just let them take the reigns and it builds their confidence and ability to be a nurse... which they are. Some people like a more structured preceptor that watches everything they do and constantly suggests the way they should be doing things... and that's fine if that's what they want. I've always been one to organize things my own way and I don't do well giving anyone step by step instructions for their entire day... but my first preceptor was, and some new nurses love how she precepts. Anyway, change preceptors to someone that fits your personality a little better. Soon you will be in charge of your own team of patients, and what you did or didn't learn from a preceptor will help or hurt you.

Also, in the situation of your rude lady, our charge nurse or nurse manager would go talk to her. If that did not resolve the problem, security would be called to escort her out. Thankfully, the hospital does not give in to ridiculous demands of crazy people.

On intermediate/med-surg floor, visitors cannot stay the night in a double room... period. There are hotels/motels within walking distance that give discounts for patient families, and there are couches in the waiting room. It's disturbing and disrespectful to the roommate... and it's a hospital, not a hotel. Thankfully most of our rooms are private, but we do have several doubles. Private rooms are randomly assigned and they cost extra... if a patient/family requests one, guest services comes up to explain that insurance usually does not pay for private rooms and they will be responsible for the cost. That being said... if a patient truly warrants a private room (i.e. very sick/dying patient, needs a sitter r/t dementia, etc) they will be moved to a private room as soon as possible. In a private room, guests can stay overnight as long as they are not disruptive.

Hi Debnky, I'm currently in the ISNAP (Indiana) program, and my healthcare support group has a few people enrolled in the KARE program. You will be ordered so many per year... not sure about KY, but Indiana has a minimum of 12 and max of 42 a year. How many you get should be in your contract and is determined by your individual case. It also depends on if you are working as a nurse or not (less testing if you're not, more testing if you are). It is expensive, but hang in there, it's worth it to get your license in order. If you are getting more tests than you think you should according to your agreement with KARE, call them and verify. The labs have been known to make mistakes.