freddiebear

WOW. It sounds like they did you a favor. The management team sounds like they are inexperienced, intolerant, unreasonable, etc. The part about hiring someone younger sounds like age discrimination to me. I dont understand why they had you passing meds without a preceptor. I just dont know what to say except I hope you get hired by someone who can appreciate your experience and is experienced enough themself to offer the training that one would need in order to be successful on a job.

First for the sake of your sanity and confidence make 100% sure that you are mentally fit to work again. And do not return until you are. If you feel that you can not trust yourself to be mentally competent than maybe now is not the time to return to work. But, once you do and you and your doctor feel that you have resolved this problem then put it behind you. No need to discuss your past. All you need to focus on is what your new responsiblities are and your skills to take care of residents. If for some reason you have a relapse then deal with it. Call in sick and take care of yourself. Remember you cant live your life in the rear view mirror because the past is dead and gone and the future never comes. All we have is today it is a gift that is why we call it the present. No, you do not need to offer information about your mental illness to your employer, employees or anyone else. Cause either you are mentally fit to work or you are not it is not a gray area. If you are not then why bother working. If you are then talk about all of the positive things you have to offer. By the way good luck. You are taking a brave step and just put one foot in front of the other and start walking into your new future.

With HIPPA I dont see how anyone can access someones medical file without either you signing permission for them to do so or a court order. You need to talk to your psychiatrist and ask him/her if they think that your illness could interfere with your ability to perform your job safely. If someone is disabled as long as they have their disability under control and are stabilized on meds or havent had a relapse in years it may no longer be an issue. If you were to be accused of harming a resident in some way or incompetent, etc. and the board does an investigation and discovers you did not disclose this problem you might have your license revoked but if you were in trouble for harming a resident you might have it revoked anyways.

your question could be best answered by your BRN. Is there a position in nursing that you could hold that did not require direct patient care?

As far as meds are concerned in LTC a med can be given one hour before until one hour after the time ordered unless it is insulin, or a med that must be given before meals, after meals or with meals. What someone can do is change the time of meds to more convienant times if possible. If you are new somewhere it takes some time to get familiar with the routines, meds and priorities. After a while you should be able to arrange your dutities so you can get your work done in a timely manner.

cotjockey- Most facilities I have worked for had set schedules. Anything from 4 on 2 off to m-f with every week end off and a seperate weekend staff to every other week end off. 12 hour, 8 hour shifts. Yes I did work for a hospital that had a put the staffing book out and let people write their names in. That place had a lot of registry filling in gaps. In my opinion someone needs to meet with the entire staff to get their input. Then implement the schedule that the majority of employees vote for. Then thats it. You have no control over who will quit. But when new employees get hired they should know what their schedule will be before they start work to end all of the confusion.

Barefoot lady- I hear ya. But, the nursing act states that every nurse must perform the acceptable standard of care less one be accused of unprofessional conduct. Charting is basic. For example if one of your residents were found deceased, with a broken bone, aspirated, on the floor etc. by the next nurse that came on and you did not chart their condition you could be accused of gross negligence. The fact you had to much to do and didnt feel like charting at the end of the shift is not an acceptable excuse or justification for not charting your skilled observations of the residents. My opinion of flow sheets is that they take a lot of time to read every box, you have to read stuff that doesnt apply and it is not possible for them to include everything cause every resident is an individual and charting needs to be individualized. Many people do copy cat flow charting and the stuff they check off doesnt apply to the resident. But, the forms are up to the facility and their policy. The nursing practice act doesnt care if you document on a flow sheet, a formal form, or a blank piece of paper as long as your documentation is legible, accurate, dated and signed by the author and place in the residents medical record. Of course if a nurse doesnt follow a facilities policy and some harm to a resident results the nurse could be guilty of negligence. What you are doing makes about as much sense as walking out into traffic with a blind fold on thinking maybe I will get hit by a car maybe I wont. If you are working too many hours, and getting too tired, maybe it is time to change shifts, cut your hours back or find a less stressful setting to work in.

First you need to review her job description, what duties she is expected to perform. Then you need to review the employee manual. This is not a personal issue. So no need to make it one. Just write down the facts in regards to the times she takes her breaks, what time she leaves what time she comes back. She could be violating the policy as in not clocking in and out and leaving her assigned area without reporting off. Then review her job duties. Record the ones that she is omitting make a few copies keep one for yourself and give one to the DON. If you are her supervisor you have all the right in the world to hand her a written verbal warning. Be sure and have a witness when you do this. Might want to have a talk with her, armed with the evidence in writting in front of your DON. Then ask the DON if this is OK. Maybe this nurse wont like you but she will learn how to respect you. After all this is the best thing for the residents. To have nurses that are available to do what they can to meet their needs.

You need to call your nursing board ask them the question. They can give you the best response you do not need to tell them who you are or where you work. Sounds like your facility had grounds for termination. I think that clocking in and taking report and doing a narcotic count might be 2 seperate issues. It is a fine line as to what constitutes accepting an assignment. In the future do not clock in until you find out the assignment and decide to take it. If you dont clock in the facility can terminate your employment but the nursing boards cant take your license. I think you might be OK as far as your nursing license is concerned cause you didnt accept the assignment. I think that it is better if a nurse does not accept an assignment they know they cant handle as opposed to accepting an assignment they cant handle. Better to get fired then to loose your nursing license.

When it comes to abuse I think the law is very clear. Even though someone is working in a prison cant an inmate complain to the RN board in regards to allegations of abuse? Sounds like there needs to be a definate medical evaluation done as to the mental fitness of this man. As in if he is refusing to take care of himself ( his right to refuse or perform self care) or is he legally incompetent, unable to make his own decisions and needs someone else to? Also, in a prison setting isnt the safety of the staff a concern, considering the type of people you are dealing with? One clue to this inmates behavior would be what was his mental status before he got locked up. If it was in normal range then there is a good chance he has morphed his personality into whatever will bring him the most profit. As in controlling the nursing staff with his unacceptable behavior. Nothing that an MRI of the brain wont solve.

What specialty a nurse chooses is a personal choice.

I was wondering what is your facilities policy regarding this issue and how do they ID residents?

The bottom line is outcome. The resident was observed and brought back to safety. If you want to defend yourself please look at the facility policy. If the facility policy states you were supposed to do something and failed to do it then it is appropriate to have a mini inservice that you sign and they place in your file so if it happens again they can prove that you were informed. If it is not in the facility policy or told to you during orientation then you can file a written grievance in regards to the facility making policy, not documenting it in a policy book and not providing inservice to new employees about how to handle a resident who attempts to wander outside of the facility. Good nursing judgement might come in handy. If a resident tries to leave a facility it may mean that the facility is not an appropriate place for this resident to be due to the fact if the residents leaves they are at a great risk for harm. If a nurse is aware of this, they do need to review the care plan and make sure all the interventions are being implemented. If not they need to revise the care plan. Sometimes their are prn meds that are ordered. You might also want to call the MD and see what they suggest as well as the family. In any case if you are taking care of someone that you cannot keep inside the facility you might want to consider having them transfered to the ER for an eval and an appropriate placement. Sometimes family members are willing to come in and stay with the resident.

First of all you might want to consultant some references. The first one is your state regulations the second one your federal regulations (OBRA). In regard to what you must inservice staff on and when. Then you can make a calendar for the year with the inservices and they usually have to be offered to all 3 shifts. After you give an inservice such as one in regard to wearing name badges and providing privacy there must be follow up. As in giving feed back or the inservice might be ineffective. So, after the inservice recognize those who have the name tag on and give a verbal warning to those that dont the same thing with the privacy issue, etc. Of course you're role is to teach. You are working with an entire team around the clock that needs to be responsible for the staff that they are directly supervising. The nursing supervisors and charge nurses need to make sure that they do rounds and make sure their staff is complying with the regulations. Dont get stressed remember your responsibility is to give the classes. It is up to the supervisors to enforce the regulations.

Hmm. This is an excellent question. The best place to get an answer is through the labor board. If your were working as nurse, finding your own clients, setting your own fees and getting paid directly by the clients then you would clearly be an independent contractor. But if you are working though an agency that finds the clients, sets the fees and Does have a schedule for you and you are putting in full time hours for them. Think about it most agencies have shift work available meaning you have to work 12 hour shifts or 8 hour shifts or hours that the Client decides they want a nurse to be there. Doesnt sound like a nurse controlling their own hours to me. And the pay is set. You get paid whatever the agency tells you you will get paid, you have no control over it. And if you dont work the hours and days they need you to work the agency usually wont offer you any work and give the job to someone else. I know some agencies give nurses their entire salary and expect them to pay their own taxes out of it. Even so doesnt mean you are not their employee. A lot of agencies wind up getting into trouble with the state workers comp, unemployment insurance benefits, over stuff like this.