rn 2b lnc

LOL Yes, I've been on admissions review for a nursing home, and nothing flags brighter red than "sitter" in the hospital nursing notes! My favorite orders come from doctors "on-call" who are not familiar with the restrictions nursing homes labor under. Usually given at 2am. "I'm sorry, doctor, we can't give Haldol IM... there are no restraints of any kind in the building ..." It's going to be the shift from Hades because even if I can convince him to let me send the person out for extreme behaviors, the ED staff is going to call me and (worst case) question my skills as a nurse and worth as a human being for sending the person in ("what do you want us to do?") or (best case?) say the person is coming back with a dose of IM antipsychotics having been given. I send the person in with a doctor's order to route through the ED to geropsych. But of course, no behaviors are shown in the ED. New environment and bright lights tend to take the fight out. And I'm not trying to put down ED nurses, please don't think that! I know the last thing you want to see come in at 3am is a combative frail nursing home resident. We don't have the options a hospital has, they're not even physically available to us, and taking care of up to 60 residents with 1-2 aides makes 1:1 impossible. The on-call doctor has already stressed out the nurse with his attitude when regs are explained, so you will hear frustration in the NH nurse's voice when you call and ask why we followed the doctor's orders...

I don't think the hairdresser was the offending party... wasn't it another customer?

Meanwhile, as the hospital and stressed-out staff are skewered in the press and community, the jerk who started it all is home, safe in HIPAA anonymity, probably laughing himself into a hernia... We can hope. No, scratch that, who'd want to deal with him as a patient?? He's not going to change, he's not going to be reprimanded, counseled, or punished. And he's gained bragging rights in his "circle." The sad part is he isn't the first, and he certainly won't be the last, no matter what policies are set. Can you imagine the flak if the supervisors had told him and his wife to hit the road? That's all, everything else has been covered...

Thanks! You've been an incredible help.

Thank you for the rapid response! The positions I'm looking at are in Long term care. They answer to "many bosses," such as the administrator, regional nurse consultant, and regional director. Sometimes those people are at odds . Thanks for the advice on budget... I hadn't even thought of that, duh! I seem to recall some of my DONs fretting over that, borrowing from Peter to pay Paul. My personal favorite is rationing disposable briefs. I'll have a lot to learn in that area. I don't even know the corporation name, so I can't do a search on them. I can guess which facilities and look at them on the watch-lists (maybe), but I may still walk into a mess. And my hair is still smoking from the last leap (see posts under Walked Out). I just have to do a lot of soul-searching before I make a decision; I know I have a lot to offer and would be dedicated to the facility, but am I really ready? As far as salary, what he's hinting at is far more than I've made even as interim DON; I know the places that I've worked at in the past are cheap cheap cheap so I don't really have any info on what's "usual." I do know what I need to make. The problem is, if I give a number, will they say Yes then laugh their butts off over getting me so cheap? A lot to ponder.... Thanks again, ainz! Are you a night-owl, too?

I'm considering "moving up" to DON; I've been ADON quite a while in different facilities. In searching for a new job, I was just looking at MDS Coordinator, but a recruiter has connected me to several possibilities for which I am qualified. I've hired, supervised, trained, retrained, evaled, suspended and fired staff and done many inservices; I've dealt with State and other regulatory as well as corporate; I've done the quarterly PPD report on staffing for the state; I've done the monthly DON report and participated in QA, TQM and its variation of the month, and attended corporate meetings out of state; I can do MDS in my sleep; I've developed POCs and the like for state and internal use. Infection control is something I've had minimal exposure to (sorry, couldn't resist). What else is going to smack me in the back of the head if I do this? In my experience going up the ladder, I've had very little support/training from a corporate level until this recent ADON job -- and I'd been ADON there before! First time, no "corporate training session," this time, a week at HQ. Go figure... It's mostly been experience by "bad decision," as someone on this board quotes A. Robbins. An additional consideration is the whole relocation aspect. Does anyone have any words of wisdom? It's Oregon that's on the table right now. Thanks in advance!

I don't know, I think that if/when he is a patient, or has someone in a health care setting, he would likely be one of those patients/family members from . Nothing would ever be good enough. IMO

I've just started agency nursing after being both staff and management in LTC. My first assignment was a double: the first shift was on an extra-easy LTC floor, the second on a specialty unit. The staff coming and going on both were really nice. My second assignment there, on the specialty unit... the oncoming nurse was incredibly cold and rude. This I had to deal with after a shift being short a nurse, having someone go sour on the other assignment and giving that nurse a hand with her load, and having a nurse aide that started the shift in a rotten mood. I'm half-afraid/half-hoping they don't want me back! But I'm just not ready to go on-staff for a specific facility...