merlee

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.

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.

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.

I have actually called 2 codes on pts that were AAO! One was about to go into anaphylactic shock - and would need to be intubated, the other was severely fluid overloaded and drowning. Both survived. In the first case, a doctor told me to just call the anesthesia office, to get someone to come up, but they wouldn't answer. The doc was pi$$ed when I called the code, but the code team was impressed that we didn't wait. The second person had rec'd 2 units of RBCs and plenty of saline, needed a diuretic and then more extreme measures. Too often, we do too little until it becomes a true emergency. I like the idea of a 'fast response' team, makes it easier to call prior to an arrest.

In some facilities eating something off of a patient's tray, regardless of the circumstances, can be cause for dismissal. Frankly, I would only eat something that was store-bought and individually wrapped. 'Thank you for the offer, but not today. Maybe the next time.' Many places now have 'no food' policies. The LTC facility where my MIL is one of those, but my offer of a pizza party for the entire staff on their yearly inservice day was much appreciated. It wasn't very expensive, and everyone who came in could partake.

Since I found out that the exam could be as short as 75 questions I have been amazed. That covers 4+ years of schooling? Wow! I don't believe that 2 days of testing is necessary, but one hour cannot be very inclusive. Also, if you failed a specific segment, like pediatrics, 3 times, then you needed to take that course again. Very different now. A good friend of mine moved to another state a few months ago and had to be licensed to be an aesthetician - - someone who does facials. They have a written AND a practical exam!!! She passed the written portion easily, but failed the practical. They didn't tell her what portion she failed, and now they have changed the practical portion from working with live models to working on mannequins. Imagine if we moved to a different state and had to show our proficiency in starting IVs, doing a med pass, and inserting a foley cath into a patient with dementia. Hahahaha! I am not sure that it should be '3 strikes and you're out' but there should be a way to know what area was lacking, and that area is what needs to be retested. Further, if most of your testing in school followed the NCLEX format, then you should have a good idea of what to expect. If you struggled through school you should have received help then, so that when you get to a testing site you should be relatively confident in your knowledge and test-taking skills. Best wishes to all!

Someone at your agency should be able to give you the expected guidelines. 3,3,2,2,1,1-,1 is not uncommon, but could be fewer, like 3,2,1,1,-,1-,1. Depends on the individual case. Hopefully, the last visit is discharge, and pick up the monitor. Always double-bag the monitor before putting it in your trunk. Best wishes!