Peetz

As labor nurses, do you consider pain as part of your reasoning for increasing Pitocin?

Hahahah. yup. Basically study all meds, ya never now.

I worked in LTC/SNF for almost two years, as an RN I did it all, including push meds. The most common were colase ( everyone was on that, regardless) Norco, Insulin, blood pressure meds ( brush up on them all) omeprazole, many different chronic pain medications and all kinds of cardiac meds. Best to brush up on all of those. )

You could get in the door of the hospital you want then work your way to that unit. Get some med/surg nursing under you and get to know the staff, then make your move. May start with an On-call position while you work your regular unit then wait for a part time or full time slot to open.

Sure sounds like the mother is the one that needs medical help. Glad the boy is not suffering with Cancer.

First, you have to ask yourself, why is it stinky? Necrosis? Infection? Yeast? That needs to be treated first. Debridement, different antibiotics, anti-fungal cream. Dankins is good but you can only use it for a short period of time. If the odor continues the would should be cultured again to find out why. Charcoal dressings are great for odor absorption too. I also use Hydraphera blue to control odor in wounds. The other advice give, i.e change bandage frequently, remove all garbage after change, is also a must in controlling odor.

I have two different signatures, one for work and one for "other" stuff. My last name is long so I write it out during work for legibility purposes and of course that includes the RN and on formal letters to Docs and what not it is RN, BSN. On banks stuff its a non-readable ball of scribble, but it's mine. ) Having two keeps me from accidentally writing RN by accident.

Most is EMT work I would imagine. I am comfortable with the requirements but not sure if EMT work in in my scope? Any advice would be great. Also, they asked an LPN to do the same thing, I am really unsure of what is in the scope of an LPN. I was told by co-workers that they were not allowed to do an assessment, is that true?

I work in a SNF, going on a bit over a year now. I shake my head often at things that I would never do yet are being done by other RN's and LPN's. I understand that things are different in the world of long term care but some things just seem not okay. Maybe I am wrong but taking an antibiotic from one pt to give to another because you were to lazy to pull the dose from the pixis or look in the fridge for the patients meds seems wrong. A nurse "borrowed" two bottles of 1 gram antibiotic meant for IM from one pt to give to another who has an order for the same drug but IV at 2 grams. Now patient with IM AB is short two doses and IV pt has one extra we can 't use. Not sure how I will feel if everyone tells me this is okay practice. I really don't know anymore, I feel very lost as a new nurse when things like this happen. Any advice would be appreciated. Also, can someone tell me why IM Antibiotic is given BID X 10 days vs. IV ? This lady has no muscle mass, what would be some reasons for this being ordered this way? Also what is the reason to give a pt 1000 ml of 0.9% ns over 2 hrs, times two days for dehydration. Should that be given over a longer period of time? When things like this happen, I feel so darn stupid for not knowing. One part of me says " it was ordered by a doctor it has to be okay" another part of me says, " question it if it feels wrong, that's how we learn." Which is right? UGG, when does this get easier?

or to re-negotiate my wage? I work in a SNF and just found out they hired an LPN,( I am an RN half way done with my BSN) at the same wage I make. Not sure how to feel about that, but this LPN quit without notice after a few weeks, we are stuck without cover for shifts and vacations. I was thinking of approaching my DON after the first of they year with a wage increase request but have no idea how to go about it. I have been there for over a year with no raises at all, not even cost of living. I am grateful to have a job so not sure if it's worth the effort to bring it up. Anyone renegotiate their wage without to much hassle? Would like to hear your stories.

The short answers is NO. The control of when a person evacuates the bowels is driven by the colon muscles and sphincters inside the rectum, therefore there is no contraction control over muscle movement in the areas where the stoma is located. The first person to post a response had the correct answer, and the following responses were great too. There is a lot to be learned just in those posts.

A large part of me knows that but the new nurse in me is very naive regarding the outcomes of these things and have yet to come to terms with the fact that she simply is a lousy nurse and should not be taking care of people. I feel bad, but then I don't. I am really unsure of what will happen with this case but the more I see the more I question any of the things she does. I don't like working like this. I changed a bandage today that still had the one I put on on the 28th!! It was nasty and was never checked. I feel so lost as to what to do, I have never been in this situation and really want some advice on what to do next. I guess my question is, now that the DON is aware of the issue will she take it from there or is it my duty to report this nurse to the board? I will defend my license at all costs, if reporting her is what I am to to then I will, I just don't know how to go about it yet. Thanks for the advice, I appreciate it.

We had a med aide who charted they gave meds to a person after they died. I called her on it and she admitted to charting ahead.

There is a treatment for one patient that I know is not being done because I asked the patient. She is A&O x4 so I trust what she says. The treatment is not a life sustaining treatment but still being signed for and NOT being done, and this particular "treatment" is not one a person would forget happened daily either. lol

This is the same indecent that started the dating and initialing of bandages. I found a bandage that had a smiley face on it, one I did a few days prior yet it was marked in the treatment book it had been changed. If things like this are done one time with one patient , it makes me wonder how many others are being mistreated and not having wounds properly cared for. I was the wound care RN for a while when census was up and before medicare cuts almost killed up.

My charting is not in question in this matter. We date and time all briefs and all wound dressings are supposed to be dated and initialed.

This is about proper pt care. I am a strong advocate for education before discipline and feel a strong dose of re-education is what this rn needs most. I know there is documentation of treatments that have not been done. I feel she does this to make herself look good in the scene that she is getting everything done. She as been told repeatedly to fill out the proper paperwork where wounds and skin are concerned and responds with a a negative attitude about the form being " new " and not needed. She has been at the same facility for many years and has no respect for other nurses, they are all" new and temporary" as she said. " she will be gone soon so why should I change to suit her." a quote about our most recent DON. I do not want to make my small working environment more stressful than it is, so "reminding' her of how things are supposed to be done is useless, she responds with rude, ill-educated responses. The facility is barely making it, a law suit could bury this small facility. We are a good facility, I would hate to see that happen. I have no desire to retaliate, she has never done anything to me personally to warrant payback. Honestly I feel that payback is childish and a waste of energy. I did not get into nursing to stand by and watch lazy people do a half baked job of patient care.

I am the other day shift charge nurse. It was the family that was using the words like lawyer, suit and neglect repeatedly during their visit. I am only on shift a few days a week due to my schedule at school , I am half way through my BSN. I understand that staffing is small, the nurses are asked to do more than we have time for, but if something does not get done it can be picked up by the next shift. The DON is aware of this issues and it was going on for a while before I came on shift. My issue is when they asked to see the would care documentation, there wasn't any to find which really looked bad for the company. Each week I do would documentation on all current wounds that are not due to surgery. I get a list of who has wounds and measure ,describe and document them. This person was not on my list, I only had two, which seemed small so I asked the DON if that was truly all we had. ( which is a really good thing) She assured me it was. She gets her information from weekly skin audit sheets, no sheet turned in on this patient and the mark in the treatment book was negative for skin audit. ( meaning no issues) That was day shift on the 29th. That evening family came in ( angry over another issue) and observed her being put to bed, the wound that was observed at that time was a large excoriation wound on the buttock. There is no way that would have been missed with a skin audit that morning.

I am going to say, first stop ASKING her to do her job. Remind her of her duties when there are discharges and things happening outside of the normal routine. Insubordination is a fire-able offense in most areas of nursing, but if no one reports it or takes corrective action then it can't be fixed. Fix it for the sake of the patients and you will have a clear conscious, fix it for your sake and you are no better than her. Maybe she needs some new motivation to be proud of her work? Maybe she needs a career change and is afraid to take the first step? If you approach it with true concern for her work ethic and with the desire to help her be better and more efficient, she may not take offense. But then again some people are just mean and rude and should not be working in patient care, maybe she is one of those. Let the situation develop new management skills and dealing with insubordination, see this as a learning opportunity for you and not just the giant pain in your ars that it seems like.

Oh, and I have gotten in the habit of saying " here is your ... ( and saying the name of the medication)." And telling them about a new medication the first time I give it. It is said that teaching a person something helps you retain 90% of the information. Teach your residents about their meds and you will get a great education on top of it.

Welcome to long term care. I doesn't get any better. What will get better is your ability to deal with situations like that. Your abilities to prioritize , work with what little you have, multitask and you will get a rock solid, crash course in medications. Look at your time in LTC as RN boot camp, it's hard, fast and feels like it will kill you on a shift by shift basis, but you will come out a better nurse, if you let it teach you instead of break you down. I am still learning after more than a year in LTC and value each lesson it have been taught. I have some mad prioritizing skills, and you will too.

I work in LTC/RH and we are having to deal with family of a resident over a wound. There is talk of lawyers, suits and what not. I found out that the documentation for this "wound" was poor if at all. There was a signature that another nurse has preformed a skin audit the same day and it was negative, yet did not fill out the paperwork for skin audits ( she never does, even after repeated complaints to the DON.) There are several resident she charts that she does treatments on and I know they are not getting done. I feel this is another treatment that she signed off on and did not actually do. Has anyone had this happen and what was the outcome. This RN has been there many years and feels she is un-fire-able. I would really like to see this person reprimanded for her actions, simply so things change for the sake of the patients. I believe in education first and discipline second, but she has been told multiple times about skin audit forms and just refused to take part in any change.

Not true. I work in a SNF and our meds are given out by a CMA. If anything is to change in SNF's and LTC facilities it will be due to our voices changing regulations and finding new ways for patients to fund the stay. Until then, it is what it is. We have to step up and give the best care we can with what we have. One valuable lesson from working a SNF is organization and prioritization skills, you will learn them hard and fast and use them in every working environment you will have in the future. I say stay where you are until you obtain a job elsewhere. Might I say 35$ is REALLY good. I have been working a SNF for over a year and only make 24$ with no raise is sight due to recent medicare cuts.

This was a team mistake, the narcs should have been removed from the cart and destroyed long before two weeks. Not saying that a mistake is okay, I have made a few myself, but as a learning tool, all actions need to be looked at not just yours.

Administration could learn a valuable lesson from this mistake also. They should be asking themselves "What allowed this mistake to be made?, and how can we learn from it?" Do NOT throw in the towel, you caused no harm to the pt. You owned up to the mistake and learned from it. If we all gave up on our second or even 20th mistake there would be no nurses. There are two kinds of nurses: Those who make mistakes and own up to them, those who make mistakes and hide them. Good for you for being the own up nurse.