kermitlady

I have to add my two cents here b/c this is an extremely frustrating issue, especially after last weekend. I had a main who had metastatic throat CA with an old, open trach stoma. He'd been with me for about a week and had never had any discharge from the stoma. I arrived on Saturday to hear him coughing and see a bit of mucous. Go back to check on him an hour or so later and he has thick mucous all down his front. Do what I need to do, suctioning, O2 and whatnot. SpO2 is 61...get another oximeter, bump the O2 up...SpO2 only goes up to 65. Call report to the ER I'm sending him to and the nurse really had the gall to ask me, "Did you suction him?" WTH? I really had to fight the urge to say, "No, sorry, I missed school that day!"....But, I'm an LPN who works in LTC so most of the time the hospital nurses assume I have no clue what I'm doing. It just frustrates and irritates me to no end! I love my job and love my residents. I couldn't imagine having only 4 patients - even if they had central lines and g-tubes and all that stuff because I do that everyday. My case load is 24 right now and some days I still marvel at that b/c my previous job the case load was 36:1! So, thank you for listening to my rant and thank you to all you wonderful geriatric nurses. Not everyone can do it and without us, some of our patients would be lost.

I honestly don't see how pre-pulling your meds saves any time whatsoever. In all actuality, it actually INCREASES the amount of time you spend w/your med pass. You have to go through the MAR, pull the meds for that person, label that cup with a name, and hide it in the drawer of the med cart. AND THEN, you have to actually go down the hall, open said drawer and spend time FINDING the right cup of meds. And, hopefully, your hand doesn't bump any of the other cups sitting there b/c what would you do if you knocked over more than one cup of pills? Would you guess who gets which "little white pill?"....Sorry, but in my honest opinion, not only is pre-pulling your meds a huge waste of time but it is completely unsafe.

I'd say C b/c the underlying problem is that the patient perceives normal boday weight/shape as fat.

I was going to post something along the same lines. No offense to RN's in general but please educate yourself about the speciality differences if you're transitioning from a hospital to LTC. I've had two ICU trained RN's train at my facility in the past month. Both were in culture shock from the moment they hit the floor. One just kept saying "23 patients? How do you care for 23 pts?" Ummm....that's a really good number for LTC! You could go across town to the LTC that is 36:1. Like I said, no offense in general. Really just needed to vent.

My question is, how do you expect the experienced nurses to respect you in a management position when you essentially have no experience in LTC? (SDC is considered management where I work.)

I agree with everything the above poster said except for setting up your dressing changes. Changing dressings is outside the CNA scope of practice.

I agree that the OP is being quite offensive in her opinion of LPN's. I wonder what she would think of the RN-BSN I know who tried to give a suppository PO and couldn't figure out the dynamap. But, hey, she MUST know what and why she was doing everything because she had the illustrous "RN" after her name. *please excuse the heavy dose of sarcasm, just came off a really bad shift and the above mentioned nurse really does exist unfortunately

To answer the original question. I think it greatly depends on the setting where the RN is training. If it's in ALF or LTC then I don't see a problem with it but if it were in an ER or ICU or something along those lines, I'd say absolutely not.

A bit off-topic, but I have a question for some of you. Why does it seem like quite a few of you believe that LPN's are not taught the rationale behind nursing actions? I would really like to know where you received this information because where I live, LPN's better know exactly WHY they are doing anything. "This is the way we've always done it" is just not good enough.

[color=#b40338]how is the college network affiliated with the colleges and universities that make up the partners in education? we are separate entities. the college network offers comprehensive learning modules to help adult learners complete their general education and elective courses (up to 91 credit hours) using end-of-course college equivalency exams such as clep®, dsst®, and excelsior college® examination, or the regis university exam. they can then transfer those college equivalency exam scores into one of our partnership universities to gain college credit. excelsior college®* clinicals test your nursing skills; they do not teach you nursing skills. toward the end of your academic studies, you will enroll into excelsior college* and receive your clinical information. this information will tell you exactly what to expect in the clinicals and help you prepare. remember, we’re your educational partner, and we can provide additional support information anytime you need it. click here: http://www.college-net.com/faq.asp?faq=prepare for the above quote and click on the highlited excelsior college w/the * beside it and you get the following words: *the college network, inc. has no affiliation, formally or informally, with excelsior college. all of the above is straight off the tcn's faq page. here's a direct link to excelsior: https://www.excelsior.edu/ from what i understand, you can do everything tcn offers through excelsior and cut out the middle man so to speak. i strongly suggest you go to the distance learning forum and do a search for posts r/t excelsior college. *i am in now way affiliated w/excelsior college. i'm just trying to help others avoid the trap i've fallen into w/tcn.

Check out the distance learning forum under the "student" tab. You'll find tons of info there. And just so you know, TCN is NOT Excelsior! If you're going this path, my advice would be to skip TCN and go straight through Excelsior. HTH

Thanks again for the replies. It is good to know that this was probably more of a vent thread rather than a universal opinion.

Thanks for the reply! I know it was probably more a vent than anything but I figured I'd ask if it was common thinking. Good to know it's not universal!

I, too, carry my own manual BP cuff to work w/me. Especially after all sizes except the peds cuffs came up missing. The peds cuffs only work on like the 80lb old men!

Holding hands, I wouldn't think is a big deal. However, anything more than that, but resident's have to be competent to make their own decisions. So, yes, you need to report this to the higher-ups and see what your facility's policy is on the issue. HTH

do you really think badly of nh nurses? i just wondered b/c i was lurking on the student doctor network and found a thread in the emt forum w/an several posts berating nh nurses. here's a couple of the posts from the thread: to the nursing home "nurses" re: several things 1) a person who is very hot to the touch, does not have a normal temperature 2) patients in wheelchairs that disappear eventually turn up at the bottom of the stairs 3) a person who is in cardiac arrest does not require your changing their diapers at that time 4) 4 little nurses, each weighing 100lbs, cannot safely place a 300lb man on the floor from the bed during a cardiac arrest 5) when you see that your patient stopped breathing at 3am, it is not necessary to call the doctor, who will tell you to place them on a 2lpm nrb. then call ems at 6am because they are still not breathing (unless it is my shift) 6) a person with a blood sugar level of 400 is not normal 7) a quick peice of advice, if you do not need a stethascope to determine pulmonary edema, sit the person up. it really helps 8) getting off the boat from the carribean and putting on scrubs does not make you qualified to be a nurse, or a treee surgeon for that matter and the final peice of advice: the only use you have to me is to give me the paperwork and tell me how you found them. other than that you are as useless as the mask you put on them. now go an wipe some orifices. doctor+pulse oximeter+nursing home friday afternoon shift= abuse of the 911 system. attn nh staff: if pt. has rigor mortis or lividity, please do not attempt cpr. and don't get mad at us when we pronounce the pt. dead. shift change at nursing homes always occurs about 5 minutes before i arrive. as a result, none of the staff knows anything about the patient. exception: apparently sometime before 9pm, all of the nursing staff leaves except 1 nurse. said nurse not only knows anything about the patient, but instead of admitting it, claims that it is all in the paperwork and doesn't have time to give the paramedics report because she "has to take care of the rest of the patients, and thus can not spend time helping out this one patient." i know there are some bad nh nurse out there but we're not all like this. and as far as the cpr thing goes, in indiana we have to start cpr when we find them until ems arrives. and, believe me, sending someone out to the er requires quite a bit on my part so i'm certainly not going to do it for fun!

Nope, never seen that! There should definitely be some kind of internal document about a bruise the size you are describing. I think here in Indiana, anything over 7 cm has to be reported to the BOH (don't hold me to that, though!). And a clonidine patch SIX days over due? I would be contacting the MD on that one; you don't play around w/someone's B/P - especially when they already have a hx of CVA!

Thanks caliotter! I was thinking it was a Fundamentals of Nursing book but didn't want to assume anything.

What is the fundamentals book?

Thanks for the input from both of you! Scallywags ~ I'm about a third of the way through the abnormal psychology module. Figured I'd start back up with a subject I'm interested in and fairly good at.

I would like to know exactly what this is and what it entails. I'm assuming it's some kind of performance exam but am unsure from there. TIA

Well, I signed up with The College Network awhile back (like over a year ago), nut fully understanding what it was. Of course, I realized it wasn't what I thought after the cancellation period had ended. But I still have to pay for the stuff and I have several of their modules sitting around collecting dust ...so, I've decided that I may as well get some use of the materials. I've decided that I'll test out of everything that I can and then go from there. Anyways, I was wondering who else had useful study materials (online links, email-able files, etc.). I found a link to a flash card site somewhere on allnurses but cannot re-find that thread. Anything would be greatly appreciated. Here's a link to the flashcard site: http://www.flashcardexchange.com/ (Thanks again to whoever originally submitted this!)

Thought all of you would find this thread interesting: http://forums.studentdoctor.net/showthread.php?t=542853&highlight=nurses It's from a student doctor message board and it's all about THIS thread! I got a great laugh out of it! I also found it amusing that they were trolling the nursing boards. (BTW, sorry if someone else has already posted a link to this.)

morte - thanks for the info on the "too short" route. My thinking is going something like this: they've admitted her to ICU, since they're wanting aggressive treatment they'll want consults, MD's will come to consult and look at the poor woman and say "nope, not going there", maybe THEN the family will realize that she's ready to go.

Thanks to all of you who responded and understood that this was me venting more than anything else. As for an update, my lady is still hanging on. MD direct admitted her to the ICU today b/c the POA called and decided we "weren't being aggressive enough" w/the current treatment regimen. Hopefully, the family will let her go soon.