treeBranch

This is a very loaded subject. :typing Think about all of the different cultures outside of those medical walls and ask yourself how they culturally mingle. I would say, overall they do not, they remain cloistered to an extent. Point being, a care plan will not do much in enhancing cultural bridges. The care plan is always underutilized. I agree with the one poster that said one more piece of paper is a bad idea. I think for what you are trying to study, I would apply to LTC --- there I believe it would be successful and the poster that said to study pharmacy/culture would be useful to the prescribing doctors moreso than the nurse, yet a good idea. Good luck with the paper, interesting topic,

I do agree with Poster #1 :yeah:and add the following: I sense in your thread that you also concerned that because the other nurses are allowing this mom-med behavior to continue that it will make it more difficult for you do the appropriate intervention. I suggest you sit down with your DON and request a team meeting on the case and everyone get on the same page immediately. If this is not possible, consider another case. If it is possible, whomever has the best rapport with the mom should be the band leader to educate her why there is a change -- but most importantly have the skills to not offend her as a parent. The dynamics of her doing this involve more than control --- she is the parent. Personally, I never had any trouble with parents, because I knew the balance of parent versus nurse. However, if all of the health care providers are not on the same page it will breed problems for both the parent and them. Why? Because triangulation and confusion will ensue.

Hello, I hope you read this often. Are you an independent contractor that gives these workshops - or a staff member? Thanks.

I cannot even begin to tell y'all how much I am laughing and smiling at this moment. Some things never change. For years, I worked agency for those LTC facilities and did many a med pass. The greatest fun was when folks that had no arm bands needed meds and having to trust staff to identify them would go against the grain of everything you were taught. Or when a facility was doing construction and moving folks all over the place and the permanent staff would not help locate the resident, resulting in your DON at the agency scolding you for missing the insulin. There was always a solution to these incidents ---DOCUMENTATION!!! The writer of this story deserves credit. Well written and realistic indeed. Now, how do we participate in controlling this insanity as health care providers. Many ways, I say. Many ways! ? 1. Assure that all patients that you identify during the med pass, if they do not have proper identification, have it implemented immediately. VERY IMPORTANT !!! 2. Be a patient advocate and med nurse advocate at all times while you are identifying the ways that help the patient receive the medication. DOCUMENT IT ON THE MAR! This allows the next nurse to not have to struggle through, loose time, and will increase resident compliance. 3. Here is a very important one... START USING YOUR PHARMACOLOGICAL/CLINICAL PARTNERSHIP KNOWLEDGE as a nurse in a very aggressive manner with the intent of outcome adjustment. Ask yourself from a clinical perspective in your assessment of that resident and their health status if all these RX are necessary and start weening them off the MAR via Pharmacist, MD conversations and orders. For the older folks reading this. Think about what time in life does an individual start increasing the medications in their daily routine. It usually begins for some, when they are in their 50s and continues. It is no different for the geriatric population. "Prescribing drugs to take care of side effects from another drug is common". The Mice are the drugs. The CATs to take care of that mouse is the Pharmacist and Doctor. The Mousetrap in the med cart is the NURSE. She/He has the power to eliminate all the bad mice.

I am a doctor and how dare you call me for clarification of patient orders. After all that is why I employ an ARNP in my office and to bother me about a dose of a medication that was omitted is just absurd, after all -- your first shift can handle it. Learn to email them :typing and let me rest... :bow:Yes Sir. Okay, I do not know all of the facts involving this scenario - other than the briefly written post asking what to do if a doctor yells at you. (NOT!!!!) Simple. Use your de-escalating skills. Receive the order to its completion. Document the call and ommission of completed order as to the reason for the doctor contact. And most importantly, and please keep this powerful tool in mind --- WRITE UP AN INCIDENT REPORT ---- it is a medication error --- but not the nurse's. Do not forget to add the abusive language as part of the report and to whom you shall report this in the morning. The reason an incident report is important is because it will need to be addressed by upper management and if this doctor continues to verbally abuse on the telephone - in reality - it may cause the nurse to be hindered from calling the doctor because he/she does not want the verbal abuse and ultimately undermine patient care. This gives the facility a tracking mechanism. To the nurse that wrote this thread. You did your job, within your scope of practice, standard operating procedures, and acted as a patient advocate. Good job - keep up the good practice.