donnapalmer

Actually, my issue isn't with my fellow full-time workers on other shifts; my issue is with the per-diem/float staff who don't take care with our "stuff"...the three of us who share the cart on a regular basis have a nice compromise system going on...the fill-in staff should work with things as they are, not move them all around to suit themselves for their one eight hour shift out of 2 months...

Hello! My first post as a licensed nurse; I passed boards on October 31 (whew!) I have been working at a LTC/rehab center on the short-term stay unit since graduation, and rapidly developed a mania for my cart arrangement. The scripts are generally kept in good shape (if they are re-ordered, or if there is only one blister-pack open for each med, I'm generally happy with that). I have moments when my stock meds are empty or moved from the bin that I'm used to getting them from; please please please date when new bottles are opened...the real goat-getter, though, is the freakin' mylanta all over two drawers and the entire right-side exterior of my cart, down the trash can and all over the wheels, dried as hard as cement (replace mylanta with your choice of liquid med). After a weekend off, it took me 30 minutes first thing in the shift to get the cart even close to presentable enough to be seen on the unit; additional time was spent restocking my laxatives and supplements. I also had to carve Resource off all the crevices of my Silent Knight pill-crusher, thank you very much. I'm not a neat freak, not a psycho nurse, I love what I do, and am often considered to be one of the happiest gals on the 7-3...these things just :angryfire me up. ps--great to be part of the nursing "thang"...

We were in our summer clinical in July, 2004, on a med-surg unit at a large, regional medical center...my patient had a large, draining post-D&I wound of the hip (s/p ORIF, post-op infection). It had cultured for large amounts of MRSA, and she was on isolation (contact precautions). Here are three LPN students, "half-done" (we graduate this year), with isolation gear on, two to pack her stuff...she was being discharged AMA) and one to assist this patient to the bathroom, per doctor's orders. In comes the med nurse, to dispense her meds (long-time med-surg RN--23 years at this facility alone). Now, the patient has made it to the bathroom, and the students are collecting her personal items in bags...the med nurse parks her bottom not only in the patient's bed (bad enough!), but on the canvas-backed absorbent pad that has been contaminated with the patient's MRSA-rich wound drainage, and not yet removed. As the three of us watch in horror, she dispenses meds, and goes out to the nurse's station and sits out there. Lucky for all of us and our families, we aren't allowed to sit during clinical (until we do our nurse's notes), and aren't at risk in that specific situation. Perfect example of "learning by negative example"!

Part time BOCES program; 2 years. First year, 2 days theory, 1 day lab and 2 days clinical, from 8 a.m. til 11 a.m. for all three. This follows the usual New York school year from early September until June 18th, then 2 weeks off, and on to 7:30 a.m. til 2:30 p.m. for the month of July. First week July, all theory, last three weeks, all clinical. Off for August, and back to school with all the New York school districts in September. 2nd year--2, 3-hour days of theory; 1, 3-hour of day lab (both from 12 noon to 3 p.m.) and 1, 7:30 - 2:30 day of clinical, with a day off (tentative). Sounds complicated, but our instructor had a goal of our getting full day clinicals in so we can do pre- and post-op, among other things. The afternoon hours will allow me to get my kids on and off the bus, and relieve my husband of the morning routine (which often doesn't go well!). It will also give my youngest the full, undivided attention of her caregiver, my aunt, instead of having to share her with my older children! Hey, I'll climb any mountain to get this goal met at this late date, you won't hear any complaining from me about scheduling or summer school...as of July 5th, 2004, I'm officially Level II and "half-a-nurse"!

I had forgotten how frustrating this was, because I have had the immense good fortune to be able to leave my LTC job to attend nursing school...reading a few posts brought it all back, and just as fresh as if it happened this morning. I have worked all three shifts, in under- and over-staffed situations, and have found out that it all boils down to the "who" not the "when" or "what". 4 CNA's on a 30 bed unit can be even less productive than 2-CNA-staffing on the same unit, if they are all of a particular work ethic. A pig is a pig no matter what shift s/he works, and a lazy slob is, also. A person who is a joy and a pleasure to follow can be found on any of the three shifts. Everyone is subject to unfair stereotypes, and everyone is all to happy to judge and label. Surprise, guys, some people work nights because they can't afford day care, or don't like the options that are available for day care, the providers are inept or not kind enough...some work nights because they have elder parents to care for, and split the duties with a spouse or siblings...some work nights because they're trying to complete school while keeping a roof over their children's heads, and food on the table. Some gals/guys MAY work nights because the pay is higher and the work "easier", although there are certainly trade-offs that offset whatever advantages that may have. On days, I followed a wonderful night shift that would inform me of what was undone (if anything), and why, and that was fine with me...and I've followed a horrible night shift CNA who left a dying resident (with family at bedside, no less) on a bedpan and didn't mention it in report, so that the woman actually died with the bed pan under her, 45 minutes into my shift. When I worked 11 p.m. to 7 a.m. (for day care purposes, for 6 years, the 6 hardest years of my working life!) I followed a 3-11 shift that was 3/4 excellent and 1/4 foul, and the 1 filthy worker poisoned the entire floor with her nasty attitude and lousy work. And, when I worked the 2 p.m. to 10 p.m. shift, I came in during the last hour of the day shift, and they were all too happy (some of them, again) to give up all the work of their last hour to me, or to tell me, "Hey, I've put in my full shift, I'm not helping you do toileting and early-to-bed transfers, you can wait until 3-11 comes in." It ain't the shift, it's the people working the shift. Once we get past the "shift" mentality, the "shift" loyalty will fall by the wayside, and the individuals responsible for the nonsense will either knock it off, or go away. The "shift" mentality is so damaging to the 24 hour team effort, and disregards the most important person in the caregiver-patient relationship, which (of course) is the patient. I believe that each worker has to be accountable for what they do (and don't do), have the sense to prioritize that which must be done over which can be left undone (and replacing necessary supplies is not optional), and have the pride in their team to be supportive if someone occasionally falls short. Management needs to stop the "my shift" nonsense and get down to the brass tacks of who is pulling their weight (or more) and who has the fastest excuses this side of a 10 year old, and an equivalent work output. The whole working world should be composed of grown-ups, why can't we act like it more often??

Orange/Ulster BOCES, Goshen, NY...grad date 6/2005 (God willin' and the creek don't rise!)

Quickly, (one of three kids howling with hunger!) I'm taking my LPN at a BOCES--community college nearby (OCCC being the closest) don't offer an LPN, just the RN.

I am currently in the first year of a two year, part time LPN program in New York...I am student living in Pennsylvania (by about 6 blocks) and formerly working in New York. I am a CNA, for 14 years, but left my job with the County to go to school. The program is tough, but I was out of school for exactly 20 years when I started last September...it is an excellent program, but I'm hearing that your instructor makes all the difference. Our class is fortunate enough to have a terrific nurse for our instructor, tough though she is. I have wonderful confidence in my critical thinking and my clinical skills when we're out in the hospital, and it has a lot to do with her teaching style and methods. The entrance test was not easy, bone up on your math, and our instructor says that we should expect to invest equal time in study as we do in class and in clinical, in order to be successful. It seems to be true, as some of the class has found out...you get out of it what you put into it. Our instructor doesn't give much homework, per se, but we know to do our study guides and handouts, and she has been known to send an assignment out via our website when we have had clinical snow days...we've also done a bit of extra credit via that route. No one has mentioned dissections in this course, although our teacher has told us that we will be handling animal hearts for our module on the heart... Good luck to you, and whatever you decide to do...

Hello, Rapheal...a couple of thoughts on your post.. Besides this, there were three people who independently of each other, had the same suspicion. We are also all students, and are transitioning from CNA to LPN, and learning about leadership roles, and how to conduct ourselves on a different level than we have been used to. As a CNA, I would have pulled the basin (as a matter of fact, I have--and been told, "I used the paper towel to dry the basin"), or perhaps waited until the following day to ask the night shift if they had dressed Mr. B. or not. No one would be dismissed or had their careers ruined based upon only my say-so, or even the one incident that has occurred. The fact that the students were already the subject of some interest among the clinical instructors should demonstrate that events had been going on that I wasn't even aware of. It was only because I was team leader on that day that I even took this to be so much my concern. Couple that fact with the breakdown in the residents' skin status, that was not reported the previous day, and I have a sense of having done the right thing. Thanks for making me think, though--never a harmful thing!

Actually, Jenny, the facility I just left (CNA 14 yrs) was County-run, which has the same reputation, but actually has a lovely campus, (largely) caring staff, and a broad mix of social and economic levels as residents. I don't know where you are located, but I have seen 3 NYS County facilities, and they aren't nearly the nightmare they are reputed to be. Look at this way; they need you even more, if it is what you fear it to be! You'll be fine.

I appreciate your concerns, RN2be--it so happens that the two students in question were already under scrutiny for unrelated incidents, that nobody outside the faculty was aware of. We did make sure when relating the incident to our instructor that we emphasized we were certain of nothing, but all she had to hear was that the man was fully dressed at 8:45 a.m. (and, I neglected to post yesterday, he has had a progression in a previously-identified area with potential for breakdown...now from a Stage I to a Stage II on his sacrum). Our instructor knows what should take how long, and the fact that they were under suspicion already makes me feel as though I chose the proper course. Nobody would be released on my say-so, anyhow...there are steps to be taken, and a warning would always come first. She also has other options for confirming our information, like the regular staff on the unit (did the night shift dress the man, or not? The staff will know that...) I like that you express your reservations--it helps to keep things balanced... And, proud2basn... Thanks a bunch, will try to continue to live up to it...

I was a CNA for a number of years before beginning nursing school. The first time I even knew that adults used incontinent briefs I was 22 years old, and shocked by the revelation. In quick succession I was shocked by catheters, tube feedings, death and the anatomy of the elderly, period. The clinical assignments are carefully planned in our institution, and people with dementia are not among those assigned to nursing students. The choices seem to be those who are aware and consent to have the students care for them, and those who are not cognizant enough to make any kind of contribution to care. Our class has two students who have never done direct care before, and they haven't had any trouble beyond perhaps taking a little longer than we old hats. Keeping a few things in mind may help you overcome your anxiety... First of all, the residents in the LTC facility are well-used to being cared for by people that they don't know or recognize, and (for the most part, if they are able) they will try to make the experience less awkward for you. Second, these folks love having the students on the unit, because they get much more personal attention than they are used to (I know this from the years as a CNA, when the nursing students used to come on clinical, and the feedback from the residents then). Thirdly, you will have the time that perhaps the regular staff do not have to do the things that make a bath so darned pleasant for a resident, such as meticulous oral care and a lovely back rub! You can spend time talking to your resident, something that many of them miss terribly, as they have become someone's task, not someone's sole focus. So, in the future, when we get into an area that makes me extremely anxious and uncomfortable, someone will be here to give me lovely warm fuzzies--I'm sure!

Thanks, everyone, for your help--my classmates and I approached our instructor this morning and got the whole situation out in the open. (I actually navigated to the subject of this thread on the classroom computer, and told her that this was a concern that a few of us had). We were commended for our nursing integrity and advocacy for our patient, and I believe I speak for all of us that we feel immensely better for speaking out. I hope you are all around for the next (inevitable) issue that arises that I need guidance in! Thanks, again :kiss

delete--"Dooped" post

just a test to find out why my image won't upload...didn't want to "play" in someone else's thread! (these are my three kids' names, by the way)