diane227

If you have a lot of surveyors in your facility, some are probably in training.

CMS and the QIS process sets forth very structured numbers for review. Residents are pulled at random into the sample based on the MDS data and other things depending on our observations of the facility. It always disturbs me that surveyors are rude. I, fortunately, do not work with a team like that. We make a strict commitment to be nice and courteous to everyone. Because, like it or not, we are all here to make life the best that it can be for the residents who live in the facilities. There are a number of excellent systems out there and in every facility I have been in I learn excellent ways of doing things. It is a shame that the facilities don't talk to each other more and discuss what works and what doesn't. When I go into a facility I make the assumption that the facility is in compliance unless I see otherwise. And yes we do follow staff around because we are observing direct care given to the residents. Observation is the most important part of what we do. For the most part I have seen committed, friendly people who like helping the residents they care for. Most people do not come to work with the idea that they are going to do a bad job. When you have a negative experience with a surveyor, please call their field manager to discuss your concerns. These matters need to be brought to their attention. And remember, if you don't know the answer to a question it is ok to say that. It is not a test and you can't know everything. But you should be able to know where to find the information. And PLEASE use your care plan. Your care plans should be up to date, working documents that are used by all team members. This is not just needless paper work. The best facilities use their care plans, share the plan with all staff members and update them any time a change occurs. They are up to date and should be structured in a way that if you had a nurse who walked in off the street, he or she would be able to look at that care plan and know exactly what needs to be done for that resident. If you have a question, ask the surveyor. Most will be glad to explain the QIS process. You can also find out a lot of information on the CMS web site. We are not out to get you. We just want to make sure that residents are getting good, safe care. Remember, they live there, and those of us who come in, staff included, are visitors to their home. When you remember that this is their home, it has an effect on how you approach your daily work. Good luck to all of you in your next survey. Take a deep breath, answer questions the best that you can and ask questions if you need help.

I am a surveyor. The advice that I can give you is be honest in your answers and if you don't know, it is OK to say so. My role is not to pick on the staff and when you are asked a question it is not because you did anything wrong. Data gathering in the form of resident/ family interviews, staff interviews and record review are all part of the process. In addition, each facility does things differently and documents their data in a different way. We have to learn how you do it at your facility. You will not know all the rules and regulations and you are not supposed to. If you are observed on med pass, slow down and take your time. It is hard to do a med pass with someone watching you. Calm, composed. But know your medications so that you will know the correct way to deliver each medication.

You should use sterile technique. It is the best practice. You don't want to introduce bacteria into the trachea and thus the lungs. Who ever thinks this is a non-sterile procedure is mistaken.

It is going to depend greatly on what your conviction was for. I urge you to have legal representation and try to find an attorney who is a nurse or who has had legal dealings with the board previously. You need an attorney who understands the board rules for your state.

Moving to another state will not help you because your background check will still show up. It also depends greatly on what your convictions were for. If you have convictions that have to do with domestic violence, child abuse, sexual assault or misconduct, assault, theft and certain other crimes, hospitals and nursing homes will not hire you. Because you would be in a position to care for a population that is considered vulnerable and the laws are very strict on this standard. What ever you do, DO NOT LIE on any job application or application for nursing school. Be honest and up front.

First of all, do not lie on your job applications. Be up front about the conviction. Was it a felony conviction? If it is off your record, why do you think you were not hired because of it? Battery is an offense that can keep you from getting a job where you care for patients because patients are considered a vulnerable population.

First of all you have to know exactly what is going to be on your record and if it will be considered a felony or not. If it is not a felony (and usually it will not be with first offense if no one is harmed) then I personally would not disclose this to ANYONE at the school unless you have a mandatory alcohol course that you have to take that will interfere with your class time. Second of all, you need to speak with your attorney to see how this is viewed on your criminal record for the future. In some states, a DUI conviction stays on your record forever, even if the judge allowed you to plea to a lesser offense like reckless driving. In my state, Washington, there are two processes. The state process for your drivers license and the court process. Even in court if they plea you down to a lesser charge, the state has you down as having had a DUI. This has happened to a friend of mine. She cannot even visit in Canada now due to this conviction, which was not at a felony level.

First of all, it depends on the time frame of when you got the felony conviction and what is was for. There are certain felony convictions that will absolutely prevent you from getting any job in health care and those have to do with any history of client abuse, sexual assault and any crime against a person under your care. If you have a history of homicide, sexual crimes against a child etc, you won't get a job. It is IMPERATIVE that you be totally honest on your employment application about your felony. Give the dates and information about the conviction, and what it was for. For example, I had a nurse have a felony DUI 15 years before he applied for a job with me. And I was going to hire him. But he lied on his employment application and you can't do that. If he had been truthful I would have hired him in a minute. It was 15 years ago with absolutely no criminal history after that date. I had no reason not to hire him until he lied on his application.

I had a few classmates like that. Some were really book smart but could not do anything at the bedside. Some were just stupid. But they were weeded out on their board exams. One guy in my class got the lowest recorded score on a nursing exam in the State of Texas at that time (33 years ago). He was never able to pass the board exam. It is probably too late to do much about this. If the instructors have not caught these issues by now, they probably won't in 14 days... but I would tell them anyway. It is a matter of patient safety.

And speak to the patient again and ask if she would mind if you have the social worker come and speak with her. Social services often have resources for victims of abuse that we as nurses may not know about. In the future, try to take a bit more time to get a little more specific information about the situation so that you will be better informed when you make your call. And be sure to document all your actions in the chart and inform your charge nurse/ manager in case follow up is needed when you are off shift. It is never too late to go back and speak with her about the matter.

It totally depends on the area, your experience level and the requirements for that facility. I just started working for the state last November as a nursing home complaint investigator/ surveyor and my orientation period will be one year. And they no not expect me to really know my job until about two years. I have been a nurse for 33 years. It is a totally different line of work. So it is very variable.

If you don't like people, you won't like home health because you WILL be dealing with people. Social workers, case workers, doctors, family members. It can be intense. You might think about trying a job like being a nurse in a short stay area where you only have your patients for a short period of time. But I URGE you to work on your interpersonal skills... really. It will help you in the long run. My husband is also not a person who enjoys working with management so he works nights. He works in a 30 bed neuro ICU in a very huge county hospital but he still has to communicate with other departments, family members and lots of physicians. It is the nature of being a nurse. You gotta learn how to do it.

Spit does it for me... mouth care. I just hate it when people spit into a cup or into an emesis basin. I can take vomit, GI bleeds, gun shot wounds, open fractures, poop, people vomiting into my shoe (or into the handbag of the social worker), pus, maggots, etc but spit... Just hate it. One thing that kind of grossed me out once was placing a foley into a lady and getting nothing but pus back.

I must have missed something in nursing school back in the dark ages because nursing school was just not that hard for me and I am not super smart when it comes to "book learning". I am a hands on learner. I rarely picked up a textbook and never read any required articles (I find I do much more of this now than I ever did in school). We did not have the internet or an Ipod and we had to actually go to the library to look stuff up. What a pain that was. Boards were two days long divided into sections. But I passed on the first pass and that was it. 33 years later, still at it.

It is important to assess the patient. If the nurse was not willing to come in and take a look at the patient, you should go and get another nurse or the charge nurse. A breathing treatment may not have been exactly indicated for this patient and a pulse ox reading can be misleading depending on the overall status of the patient and his/ her diagnosis. It is important to remember that a breathing treatment is considered a medication and you are not licensed to administer medications. Plus, please spell check.

Listen to what people tell you. Try to just observe behavior and interactions. Be on time and prepared. Don't get to friendly with people until you get to know them. Sometimes the most friendly ones are the most dangerous. Eyes and ears open. Be friendly but DON'T disclose any of your personal life to anyone unless you want it go get around the entire unit.

3-11. I am not a morning person. But now I have a 9-5 job, Monday through Friday, what others consider a "normal life". Not for me. I HATE working these hours (but I like my job) because the only time I have time to get stuff done is on the weekend when everyone else has time to do stuff. I miss having my days off during the week. UGH!!

This has happened so many time. So many wonderful patients and families relying on your expertise and compassion to help them. That in itself is a reward and honor. Flowers, small gifts, cards, candy... it is so wonderful when someone thinks of you. But I guess to me, the gesture that always sticks with me was Mrs. Greer. Trust me, she would never mind having me give her name, the wonderful woman that she was. I was working in the ER of a very busy county hospital in Houston. This was back in the 80's. Mrs. Greer was a lady who had severe CHF and a husband at home with renal failure. They were both pretty ill but managed to get to their clinic appointment and to work their way though the maze of county hospital red tape. They had no transportation so they had to take the bus everywhere. And if you know Houston, you know that the transit system leaves much to be desired. Occasionally Mrs. Greer would have an exacerbation of her CHF and require a trip to the ED. Each time she came in, no matter how ill she was, she had a smile on her face. She never forgot any of our names and any time a staff member came in to see her, she would smile and greet them by name. Always thanking us for all our help. She had one vein in her right AC. And only myself and my friend Leslie could get an IV in her. She was always glad to see us. One day I was at triage, it was Thanksgiving. All of a sudden Mrs. Greer shows up at my desk with two homemade sweet potato pies. She took three buses to get these pies to us on a holiday. Instead of being with her family during the holiday, the thought of us and bought Leslie and I those pies. I will never forget her or her smile and endless kindness.

This is very sad. Being a surveyor, I am always sad to hear when a facility does something like this. But just get your resume up to date and go for it. I guarantee that with your expertise in this area you will be able to find a job.

Frankly I would start looking for other employment in another field. A felony conviction, especially related to diverting medications away from a patient (narcotic or not), will keep him from getting a job in nursing. I can almost guarantee it. With the background checks that are done today, there is no way to hide it. If a facility hires him with this type of felony on is record and other drugs go missing or a patient under his care fails to get their required medications, they WILL be held responsible for his actions and can face strong sanctions/ fines by regulatory bodies, not to mention law suites from family members and patients. Most facilities won't take the risk.

Instead of fixing the system problems, they terminate someone so they can say they did something about the "problem". The really good facilities don't practice this way. They have learned that the long term retention of staff is good for business.

It appears that you guys have been discussing this on another post and I did not see it. Thanks for the input.

I am a nurse of 33 years, ER being my past speciality and I have been having a debate with several people regarding this issue and I want to get the opinion of the school nurses on this forum. An article posted on Newsvine is in regard to a 6 year old child who has an extreme allergic reaction to peanuts. So much so that she has been deemed disabled because the risk for severe allergic reaction/ death is very high for her. The school has apparently had to go to great measures to accommodate the needs of this student. From what I am to understand, all students must wash their hands, rinse their mouths before going into a classroom with her. At some point the facility had a peanut sniffing dog there. The issue regarding this child has come to the surface because other parents in the school want her removed from the classroom because they feel that her medical needs are disruptive to the other students and causing much confusion and burden on others. I expressed my concern that perhaps given the severity of the allergy and the fact that no nurse is available at all times, perhaps she could be home schooled or schooled by video remote access. Not to make her feel unwanted but to keep her safe. As all of you know, when a child starts to lose their airway, there is not much you can do. And if she came into contact with peanuts in some form at the school and had a reaction she might certainly die before EMS arrived. You would never want to isolate a child from their peers but in my mind her safety is paramount. How can the school assure that another student will not bring peanuts or peanut butter into the school and expose this child? Would you feel safe with this child in your care? Do you think that the school would be prepared to assist her in an emergency until EMS arrived? If there is no school nurse available and the child gets into a crisis, who deals with this. I would love to get your opinions and feedback on this issue. You can find the posting on Newsvine. Thanks.

It is a sad fact of health care but managers usually don't make much more than staff. I can tell you from vast management experience, even when I was at the director level with 7 departments to manage and over 300 employees, the night shift nurses made more per hour than I did. But I did not take my management jobs for the money. I took them because I loved management and felt that I could make real contributions in that role. And although I no longer work in a management capacity, I have very fond memories of those years and the experience it allowed me to gain. Management is something that can be quite rewarding when it is done well. I always felt that if I could get the staff what they needed, treat them in a fair manner, make expectations clear, follow up on their concerns and be at their back, they would take good care of the patients. And it never failed to be true. I did not get paid much, but my ultimate reward was to continue to this day, when I get a note or a hello from a nurse or other staff member that I worked with in the past who still feel that working with/ for me was a good experience for them. I was able to help develop others into the roles they hold today such as directors of nursing, deans of nursing programs, managers at all levels. I hope that something that I did along the way made that possible for me. Nursing has been a comfortable living for me. I did not get rich but I was happy with my career choice.