TrixieKat

When I was in nursing school, one of the teachers would never answer questions, she would say "Look it up", and if you still had questions and asked her to explain it, she wouldn't. I just took it to mean that she didn't know the answer. Even now, there are nurses who are in 'teaching' positions, such as risk managers, nurse educators, etc., and when asked they are asked a question and say, "You're a nurse, you should already know that," I take it that they don't know the answer. My position is Care Plan Coordinator and I also have to educate CNAs on documentation. I always take time to explain, even when they don't ask, CNAs and nurses, both. Thank goodness there's the internet, where you can find almost anything. Helped me out in nursing school and is still helping me out today. Nursing education never stops, you are always learning, even those who have been nurses for 20, 30, 40 years.

I starting nursing school when I was 35 years old. My daughter was 9 years old. I worked 10pm to 7am in a grocery store. When I told my mom, who left me, my brother and dad when I was 16, that I was going to nursing school, she told me I was wasting my time and wouldn't make it. She had tried to get into nursing school when she was about 35 and didn't make it. Not only did I graduate, but I received honors. I have been a nurse for 10 years now. Don't listen to anyone else. Do what you feel you should do. My dad has a very large family and 75% of the women are nurses. All my life I was told by them, you should be a nurse. My reply, "I'm never going to be a nurse, that doesn't interest me." But look what happened!! I'm a nurse and I love it. Good luck

I was told today (by the DON) that every time I leave my office I have to lock the door because I have personal resident information on my computer. My response: So does all the other computers in the facility - duh! Asked why I just couldn't lock the computer. Her response: Just do what I say. So I did. It was lunch time, I go out of my office to get a chart, and I lock the door. As in my previous reply my office is where administration eats lunch. When I get back to my office there's the DON trying to "break into" my office using her name badge (instead of a credit cared), so she can eat lunch. :chuckle

I have my own office. It would be spacious if not for the table and 6 chairs around it for the care plan meetings. And we (Administrator, DON, 2 Unit Managers, and me (MDS/CP Coord), and sometimes the QA director when she is in or building, sit at that table for lunch every day. The Activity Director's office is adjacent to mine, with a door that leads into one of the dining rooms, and when I first got this job (4 years ago) the CNAs wore out the carpet on the floor going through these 2 offices to get into the dining room. It was very distracting. There is a large hallway through the lobby that they should have been taking. (They were used to travelling through and chatting with the previous Activity Director.) I sent word around that every CNA that walked through these offices would be written up--And they stopped. My office is also across from the therapy room, so there is a lot of yelling back and forth about residents, minutes, etc (our way of communicating--too lazy to get up and go to each other, or pick up the phone:bugeyes:. And the beauty shop is next door (and only on Tuesdays, thank goodness). The smell of perms, hair dryers going, and demented residents yelling out. I hate my door being closed, but Tuesdays it is closed. I got to decorate the office the way I wanted it (from facility funds), and I've added my own personal items to personalize it (a variety: gargoyles, fairies, buddha, monkeys, maracas, sombreros, cowboy hats, large potted plants, chinese decor: something for everyone. Everyone wants my office (except the Administrator - she has a beautiful office) because it's quiet (most of the time) and comfy; they just don't want the job that goes with it .

Join AANAC. Then join the discussion board there. Very informative. My company pays for my membership. It's well worth it. I've learned over half of what I know from reading the questions and answers from the discussion group. I have asked many questions there also, and always get answers. Attend some Medicare bootcamps, seminars, inservices: not only do they discuss Medicare MDS, but how to do a regular MDS and care plans. I've been the MDS/CP Coordinator for 4 years now and I'm always learning. The hardest part (to me) is learning how to code the ADLs (and then teaching the CNAs how to code the ADLs). It took me about a year to learn the coding for ADLs without having to refer to the RAI Manual. I love this job and I don't see myself doing anything else. Good luck!

Our risk manager was in our building today. She's only there 1 day a week. I asked her if she had gotten an email about the "clarification orders." She said no and didn't know what I was talking about. So I filled her in. She thinks that there is no email from whatever organization, but if she does get one, she's going to forward it to me. Nothing has been said about writing clarification orders since the nurse manager spoke to me about the email. I won't be auditing the charts until Thursday (and it may have to wait until next week--Easter vacation, going out of town). And then I'll know if there are any more "clarification orders." Our wound care nurse is kind of a new nurse. She was a med nurse for about a year and then became our wound care nurse. (No one else wanted it.) This nurse manager has taught her to write her orders as clarification orders. When Adm & DON talked to her, she said that was what she was told to do it. Now she knows the correct way. I also told them that clarification orders can't be counted on the MDS for reimbursement and we could lose a lot of money if it were during a resident's assessment period. That really opened the Adm ears. We like money -- we like raises . In my facility I'm called the computer wiz. Our IT from corporate calls me for help at times. I can do almost anything on a computer. I fix them (if it's something simple like getting a printer to network), I make charts, graphs, etc., I can find out almost any information about anything that someone wants to know - I love the net, but I couldn't find any site or organization on the net with any information, guidelines, or regulations about clarification orders, except when to call the MD about clarifying his order because you can't read it. This nurse manager calls me to restart her computer for her, so how could she find this info on the net when I couldn't?

I audit every chart once a week and see every order written, so there are no previous orders for these clarification orders. One clarification order was written and the nurse's note that went along with the order stated, "New order written." Asked her to explain that one, but didn't get an explanation. I just put what I find on a report and turn it into the Administrator and DON and let them handle it from there.

Hi Again, I'm new to this, and was wondering why my post is not showing up in the New Posts area. I thought that if I posted a Reply, it would show up.

Hi All, Sorry this is kind of long:yawn:. Need some clarification. Here is the situation. I work in a Long Term Care facility. There is a nurse manager who writes a lot of "clarification orders" as the first order written (no previous order to clarify). Example: 3/23/09 Clarification Order: Cleanse skin tear to left wrist with wound cleanser, apply TAO and Band-Aid QD & PRN until healed. (Then she signs it). There is no previous order regarding a skin tear on the left wrist. When I asked her why she wrote it as a clarification order, she stated that there was documentation about the skin tear on 3/22/09 (the incident report was done on 3/22, no other documentation). She stated, "I was taught in nursing school that if there was documentation but no order written at that time to write an order as a clarification order to cover your a$$." I have never heard of this. Our Administrator and Risk Manager have never heard of this. Our Administrator and Risk Manager are also Legal Nurse Consultants and have told her not to write "clarification orders" unless she is actually clarifying an actual written order. The nurse manager did not come to work the next day. The day after that she informed me that she had spent the previous day on the phone with "a nursing organization", which she would not clarify who, and that they told her that the way she is writing clarification orders is correct. She also said she had an email from them proving this and she was going to email it to our Risk Manager. I asked her to email it to me, but she wouldn't. She said she had to do some tweeking to it. Sounds fishy to me. I also see clarification orders for treatment changes. Example. An order for corn cushion to corn on left middle toe written in January. In March: "Clarification Order: Corn cushion to corn on left middle toe and right pinky toe." I told them that this is NOT a clarification order. This is two separate areas and there should be a new order. I was told I was wrong (by the same nurse manager). By the way: I'm the Care Plan Coordinator - and things like this are going into the care plans. And who do you think will get cited by surveyors - me! So I try to keep things "clarified.":chuckle My question is: When do you write clarification orders? I thought it was to clarify if the first order was written wrong, such as wrong dose (was written 25mg and should have been 0.25mg, etc.), wrong route (should be PEG instead PO), etc.