Nancynurse1983

Thank you so much for your reply. I completely understand and agree with the safety measures we have in place, but our policy is ambiguous. It leaves it up to the charge nurse, and unfortunately we have some that do see things in black and white, and don't apply critical thinking skills. For example, I allow a patient with no history of self harm to have a small hair band, I know what it's like to have out of control hair and the need to keep it pulled back. I'm also culturally conscious and understand that skin and hair needs vary and will allow home products as needed with an appropriate assessment and supervision as needed. It's the black and white approach as you mentioned that frustrates me. The biggest concern is, if we make their hospital stay feel like prison, they will be much less likely to reach out to us again for help.

Nurses, I understand we work in psych, we have patients that will measure and assess all means In which to harm themselves. But unless you are in acute crisis what is the harm in allowIng a patient to floss under supervision , or to have a 1" elastic to gather there hair. They don't come to us to be imprisoned. They come to us for help battling the crippling anxiety and depression that have caused them to reach out for help. They are already on routine 15 minutes safety checks. We confiscate all policy banned items. What's stopping us from using our critical thinking skills to allow them to apply chapstick at the nurses station, or let them have a small cup of their own body wash to shower with? Why can't they apply hair products under supervision? I have a lot of patients coming to me that have been so depressed they haven't showered for weeks, and when they finally feel up to it they are denied the small comforts like their own hair gel, or deodorant to make them feel more like themselves. It's demoralizing to them, but staff seems to take some kind of authoritative stance that allows for no comforts at all. And relishes in it. Psych is not a task oriented profession. We are not so busy monitoring telemetry, hanging IV's or performing wound care. We are there to assess and help meet the mental needs of our patients. Why do so many deny them the small comforts that are easily obtained? And don't come to me with "well I had a patient that ate his deodorant and died" or "I had a patient that swallowed all his shower gel to OD on". This is few and far between and can be accomplished with hospital provided products. They can harm themselves on the beds they sleep upon by smothering themselves with blankets (yes, I've seen this happen). Where is the compassion in psych? Is it the litigiousness of society? Or the gleeful satisfaction some people get from taking an authoritarian stance?

Thank you. I've been doing all you have suggested. Tried discussing it, she assures me she's been in practice 7 years. I've given her time to adjust, this is not her first nursing job. Have had patient complaints, staff complaints, management complaints. Nurses look out for one another, and this one concerns me. I'm concerned that this is happening in the profession in general. Is it due to a lack of nurses willing to educate? How can we fix this? I've seen throughout my years of practice a continuing lack of respect for us from higher disciplines. Anyone have any links to legislative measures being taken? I'd like to get more involved.

Hello everyone, I'm having growing concerns about the number of fraudulent nurses we have practicing in the US. If you are not familiar with Operation Nightingale, here is a link to the report https://oig.hhs.gov/newsroom/media-materials/nightingale/ . I've been keeping abreast of the new reports coming out, and it seems 89 nurses have been terminated from VA hospitals for practicing with fraudulent licenses. I am employed within the VA system and have major concerns that this news was not communicated to us. I work with a nurse recently hired whom related to me that she had been in practice for seven years. I have growing concerns because she has absolutely no critical thinking skills. She takes little initiative when it comes to problem solving, and I observed her the other day sitting with a patient and staff for 30 minutes waiting on a pill, that could be and was ordered to be crushed, to dissolve in cold water. This seems like a public health crisis that should be getting more publicity. I am especially concerned about the care of our veteran population, and concerned that even this amount was allowed to practice after obtaining licensure fraudulently. Your thoughts are appreciated!

{BigHug}! Don't keep beating yourself up over this. Realize your mistakes and learn from them. You must not lay all of the blame on yourself. Why did the admitting nurse not put suction in her room, I wonder?. This makes me believe that all nurses in your unit need a thorough educational in-service on tracheostomy care and assessment. Perhaps you could offer that suggestion to administration. In the meantime, educate yourself. There was a basic, key, critical thinking skill that you neglected in this case. Your ABC's. You did the appropriate thing by raising her head and increasing her oxygen, which covers Breathing, but what about Airway? With mechanical airways you must always check for patency and suction as appropriate if O2 sats decrease. Did her lungs sound "wet"? Or diminished? How was she moving air? Could she have aspirated, was her cuff deflated when it was supposed to be inflated? What color, odor were her secretions. Any mental status changes or changes in VS besides Sats? From your posting, due to the nurse:patient ratio, it sounds like time management has been difficult for you. Remember your patients come FIRST. In this instance the time should have been given to this woman for further assessment and close monitoring. Remind management that your patients are first the next time they frown on you for being behind and ask for suggestions on how to provide quality care while staying on task. If they can't agree and help you with this, I would start putting in applications elsewhere. We all make mistakes, I have made many in my few years in providing care and have learned from every single one of them. That is the true character of a good nurse, accepting you were wrong and learning from it. This woman sounds like she had several comorbidities that also may have taken her life. Investing in malpractice insurance might ease your mind if you are concerned about legal liability. Good luck in your career and in trying to get into hospital care :)

Thank you so much for the replies. I was able to meet one of the instructors and tested with her to challenge two of my classes (we don't have a transition program, but I was able to test out of pharm and basic skills), she was extremely helpful and most of all didn't expect perfection out of my skills just because I'm an LVN, lol. This was my main concern. I"m a little rusty since my last job was at a clinic doing mainly patient assessments. I'm just very excited to be beginning this journey, and cannot wait for the opportunities ahead of me.

Hello ya'll. I've frequently browsed this website, but don't post often. Was wandering if any of the nurses that have gone from LVN to RN could offer any insight. I was accepted into my school's RN program and will start next month. I remember when I was in LVN school I was terrified at clinicals, LOL. I believe this stemmed from being an extremely bashful and socially awkward 20 year old. Fast forward to now and I am actually excited to start clinical and care for pts again after not working for my youngest sons first year. How different was it for you being in clinical after having actual nursing experience? My guess is it will be a little easier than the students starting from scratch. Are you treated differently by the instructors as far as what they believe your knowledge and skill should be?

In order for me to get my LA license(original state of licensure is TX) I had to send in an application with a fee and a notarized copy of a passport photo, have my transcripts sent to the state board from my nursing school, send a fingerprint card to the FBI (with a fee) for a background check, and pay to have my TX license verified to LA. I would check the other states website and see what must be done for licensure, the fees do add up and I would only apply if seriously considering employment in that state.

Hi there. I worked in home health for a year and loved it. I had previously worked in LTC. On nurse visits I generally had to spend at least 30 minutes with the patient. You do a lot of patient/family teaching, also prefilling med boxes, wound care, and lab draws. I saw 6-8 patients per day. It was great not being confined to a building, but you will put a lot of miles on your vehicle.