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My MIL had been in an LTC facility for 9 years. She had Pick's dementia. When we placed her initially we decided then on 'no feeding tube' or other extraordinary actions. Recently she developed a UTI, and her fever wouldn't break. She simply stopped eating, and became dehydrated. She was hospitalized, put on IV fluids, etc. They called us about a feeding tube, and we elected to stay our course, so no tube was inserted. We agreed that she should return to the LTC, get hospice involved, and hope for the best. She died quietly in just a few days, probably from the pneumonia that developed from aspiration. But this decision was one that was not made during the crisis. It was still not easy to keep to the plan; my husband needed a lot of support. We were relieved that it was over so quickly. About waking up people for meds needed to be taken on an empty stomach - - ask what they do at home. I was recently in a rehab facility and was aroused for an early morning med - twice was enough. I then told them that since it was not an 'empty stomach' med they were not to wake me up again. And they didn't. But the patient needs to express their needs/wants. Some things should be about common sense.

Well-written article, many good points. Long before unit dose and automated systems, an instructor taught us that if you need to give less than 1/2 or more than twice of what is conventionally available then go back and read the entire order from it's original source. Where this holds true for adult dosage, it is less so for peds. But it is an excellent starting point for many people. Peds is 'a whole nother' story! I have made my own fair share of errors, but there was one I didn't make and couldn't stop the doctor from making. I was working in a neonatal ICU, and the baby needed Digoxin. It was night shift, I was the only RN, just off orientation. The order was off by a decimal point - - 10 times the amount my own math seemed to indicate. I even showed the doc the difference using an empty syringe. I called the house supervisor, who came to the unit, then proclaimed she couldn't do the math! I begged her to call the Neonatologist, but she wouldn't, and sided with the Fellow. I refused to give the med, and the supe got very annoyed with me. I let the doc give it. The baby died during the next shift, but it was preventable. The head nurse never reprimanded me for refusing the give the med, but also never stood up for me. About 2 weeks later, the Neonatologist squeezed my shoulder one day and told me that I was a good nurse, and knew what I was doing. He was looking straight into my eyes. We both knew what he was referring to. Nearly 40 years ago. I am still sad that I felt I couldn't do anything about it.

No, no, no. While I have silenced an IV alarm, I can't imagine how you managed to silence your monitor without getting out of bed. Not appropriate. I tried to be a 'good' patient but once asked 4 times for pain meds. Not right.

You say that your husband is retired but not eligible for Medicare, then I am assuming he is under 66ish. Could he possibly return to work? I am only asking.

I did a long stretch of nights after my divorce. Two reasons. One, they were offering a 20% diff if you signed on for at least 6 months. The diff applied to any sick time, vacation, overtime, etc. Major money in my pocket! The second reason is very unusual, I think. I noticed that I was making inappropriate decisions about my personal life, related to being lonely. I found it very hard to sleep alone at night. And that meant I didn't want to be alone at night. When I switched to working nights, I found that sleeping alone during the day didn't have that lonely feeling, as much. And my inappropriate, promiscuous behavior was greatly reduced. So there are many reasons why people choose to do nights, and they are rarely due to laziness.

Many many years ago, in Philly, we had a gypsy queen as a patient, and lost a massive amount of linens in 2-3 days. This was before most places had an entire security dept. In those days, the supply rooms didn't lock like they do now. When she died, the family wanted to put her body in a wheelchair and take it around to the other pt's rooms so everyone could pay their last respects! Didn't happen.

Best wishes in your new position! I have been through a bunch of surveys, and, truthfully, although a bit nervous, not really afraid. I was not easily frightened because I knew my stuff! MSDS book? On the shelf behind the nurses' station! How to do 'x' -look in the procedure manual. Types of isolation? Policy manual! But the best was - - I was being questioned about my patient who was on contact precautions with MRSA, and the surveyor had his chart on her lap. And she would lick her fingers and then turn the pages. Ewww! After a few times, I leaned in very close to her, and asked her to please stop doing this! The entourage behind us - the DON, my head nurse and supervisor, and others - collectively gasped. The surveyor looked at her hand, then looked at me and said that she just never thought about this habit. And that it was inappropriate! When she finished her perusal of the chart, and her questioning of me, she shook my hand and thanked me! My employers were not impressed with my 'forwardness', and let me know. The next day, I was in the cafeteria, and the DON approached me. She said that the surveyor couldn't stop talking about what I said and was glad that someone stopped her from doing that! BTW, our unit got a perfect score, and I was the only one she spoke to! I remained unafraid of surveyors, no matter when or where they appeared, because they are only humans with clipboards! Or computers, these days! Try to put the individual nurses at ease, most are intimidated by your very presence! Again, best wishes!

Excellent article with very pertinent information. Thank you!

I never received any extra pay for being a preceptor. Sometimes the assignment was a bit different, but not always. One placed I worked had a clinical scale for pay, and those of us who were willing to be preceptors were higher on the scale overall. So my base was a bit higher overall, al the time. But if the admin was willing to pay for this, and then took it away - wrong. And how can someone who has not proven their competence be appropriate to train the next one? See one, do one, teach one only works if you are actually competent in the procedure. Scary.

There certainly needs to be a Fall review committee on your unit, or in the facility. 20 falls this year?? Wow. Scary.

In over 30 years of direct patient care, I can count on one hand the number of times I have done a favor where money or off-duty time was involved. One was actually in nursing school! and not my patient, either. I came on my own time, in the evening, to shave a patient that had a broken arm, not yet set. He was my age, and the break was from a cancerous tumor. As I left, his dad gave me 10 bucks that I tried to return. When I was a home health nurse, I had a patient whose daughter did his grocery shopping. She rarely brought him any fresh fruit or veggies. He was a very angry man, very depressed, constantly complaining. One day, I passed by a fresh produce stand and bought a basket of peaches and took him a few. It was like bringing him gold nuggets. His entire demeanor changed toward me AND his HHA! He understood that this was an anomaly, and never expected anything else. But he felt like I listened to his complaints, and was so happy. We need to be very careful when 'crossing the lines' because we can inadvertently put ourselves in a compromising situation. A quick run to the gift shop or cafeteria may turn into an expected activity. Be very careful about your choices.

WHAT WE NURSES HAVE BEEN SAYING FOR YEARS BETTER STAFFING = BETTER CARE BUT WITHOUT THOSE RESEARCHERS CRUNCHING THE NUMBERS NO ONE EVER HEARS US. B E T T E R S T A F F I N G = B E T T E R C A R E There has never been a doubt.

My comment has consistently been - - who wants to spend 40-100,00 bucks on an education to work weekends, nights and holidays, ad infinitum? If you do, then so be it. But is there compensation for your education? Best wishes!

Sigh. In the early '70's we were told that a BSN would be mandatory by 1985. Or 1992. Or 1999..... Still hasn't happened. There are, however, as noted, some facilities that are attempting to go all BSN. This reminds me of a wave of 'primary nursing' facilities in the 80's where there was no ancillary personnel. Until they realized how much cheaper things were when aides did certain tasks.... Oh - and the doors would close on all the LPN schools, the diploma schools, the ADN programs..... It's all about the Benjamins! Personally, if I spent 50-60-80 thousand bucks on my education I would be loathe to work weekends and holidays forever for less than 35-40 bucks an hour. Let's see when that happens in a wide variety of geographic area! Oh - and that union idea? Not if I am a 'professional', dearie.

I could understand looking at the meds to see if they were something that the child had to have that night, ie, antibiotics, something for an ongoing problem, etc. and needed to be returned right away. I was a camp nurse for a few summers; although HIPAA doesn't apply, there are some basic respect issues. We didn't advertise which kids were on ADD meds (although everyone seemed to know, anyway) or those that were on meds to help with bedwetting. But the kids usually told their friends, anyway. Every camp needs a basic med policy, and a form for parents to sign, same as the schools do. I have seen plenty of schools where the secretaries dole out the meds! But checking out the doses probably wasn't necessary.