NurseStyles

Wow! I am soo jealous. I guess if you don't ask for things, you don't get them. Actually, our pipe in our house broke Sunday morning. Our entire house/carpeting/floors flooded. So on Christmas Eve and Christmas we have all our flooring taken out and about 30 loud, obnoxious dehumidifiers running in our house, so we spent monday, tuesday, wednesday, and tonight in hotels which needless to say, took up our christmas money. Therefore, we promised the kids a late christmas when the insurance reimburses us. My mom did send some gifts over so we did get to open a few gifts for christmas. I am grateful the kids are taking it so well. That is my only concern that the kids didn't have a good christmas....In a Hotel for goodness sake. Our nicely decorated tree spent christmas alone in our house. On the bright side, we get a partially remodeled house for free!!! There is always next year. Merry Christmas everyone!!

I agree that sometimes HIPAA is taken to far. I have been trying to find out more info on providing info over the telephone. People refuse to give out info over the telephone to family members who may be outside of the area or unable to come in to the hospital. I used to go by this and feel very guilty because family would be very upset, and after all we are to be treating the families needs as well as nurses. I usually will transfer the call into the patient's room and have him or her identify the caller and give me permission to give info to the caller and then I will do it. If the patient is unable to identify a caller due to altered mental status, I will not be able to give out information. If there is power of attorney, I think if we ask for 2 forms of identifying information, it is enough to provide info over the phone such as birthdate and street name or something like that. It is confusing to me. Also, I would ask radiology to call me, the RN, with the results of an xray test so I could relay to the MD if he/she called. One tech said she can't give me info. Then I informed the DON and she went down and straightened things out.

First of all, We are not to judge a patient's pain. A patient can most certainly be able to fall asleep and have horrib le pain. I had a cancer patient woman with cervical CA with mets who had a bladder distended up to her ribs but couldn't be cathed. She was within days of dying, visible tumors allover her body. Although the 75 mg/hr morphine drip with 2 mg ativan and 4 mg dilaudid per hour did occasionally allow her to sleep for a few moments, I know she was still in pain. Secondly, drug seekers are more than likely addicts. Addiction is a disease of the mind and body. As an addict myself who has been gratefully clean for three years, I do have quite a bit of intolerance for such judgmental nurses. I;m sure there are times an addict comes to the ER for a fix in desparation for a way out of the torment of being trapped in the cycle of addiction. I wish more people could look at it this way rather than condemn and look upon addicts with disgust. There is no easy answer. You can't very well ask them if they want help because that may be accusing a non-addict of lying about his or her pain. I also know that addicts are in their own kind of pain as well...Pain that is not as easy to relate to. Merry Christmas.

I could not imagine doing anything else besides nursing, but I am frequently told by patient's that it takes a special person to be a nurse. I do have several patients who tell me that some nurses are very rude, uncaring, etc. I have to assume the reason for this may have something to do with burnout. I love nursing. for so many reasons. My favorite thing is taking care of patients. I do get frustrated when I can't spend the time with a patient or family member that they need to be consoled, informed, educated, or whatever the case may be. However, the good news is that there are so many avenues in nursing that one can take. Home health, hospice, administration, hospital, long term care, supervisory, public health, office nursing, legal nursing, case management, etc, etc, etc. Job security is another excellent benefit of being a nurse. Pay is not bad either. There is no perfect job, but I love being able to make a difference for the better.

Our CNAs do vital signs, ADLs, enemas, urine specimins from foleys, collect stool, sputum specimins, some put on ointments and cremes (although I don't believe that is within their scope of practice). Not much else. They do not do fingersticks or anyother invasive procedures. Theyu do not d/c ivs or catheters.

we have several nurses on our floor in their mid 70s. They are vey efficient. That is a tricky situation. Did anyone ask the pt. who was to have received the dilaudid if in fact he remembers receiving it. When suspicions such as these are made, investigation should be performed immediatly in my opinion. If there are other incidences such as these, a manager should be informed who would be responsible for investigating the situations further.

We do not use cooling blankets on our floor. I have never used one.

I forget sometimes that I am talking to nurses all over the country/world here. In California, LVNs cannot administer any IV medications or tpn or do anything involving a central line. They do not do care plans. I agree that the LVNs that I work with are some of the best nurses we have, however, if a new RN has questions on pushing IV drugs or piggybacks, or what not, the LVN is not going to be able to teach him or her or to make sure she or he is doing it correctly because she or he has not had any education in iv administration....things like that. The reason they orient RNs with LVNs is so the new often inexperienced RN can do all the LVNs IV meds so that the charge nurse doesn't have to do it. To me that is unsafe practice. Definitely no offense whatsoever to LVNs. Sorry if my earlier post was misinterpreted, that was actually the very least of my frustration anyway. Thanks.

I really need to vent here. I have been a med surg nurse for 4 years. Up until about the last 6 months, I have pretty much enjoyed my job. I do have a couple of concerns that really piss me off, and I sometimes want to talk to the DON, but then sometimes I think I am just overreacting and need to just accept things as they are. 1) I do not think LVNs should orient new RNs. 2) One of the PM nurses spends the first 30-60 minutes of the shift in the NM office talking about other nurses, mistakes, problems, etc. they have almost a sickening relationship. Thisi PM nurse is now usually charge with few to no patients. The NM will not let any other PM nurse orient new staff except her. Even if she is orienting 3 or 4 nurses at a time. This PM nurse does not like to take patients, etc. She is also intimidating to new nurses. After only 1 or 2 days, she basically sets them on their own and doesn't follow or help much. Due to the new ratio laws, we need have a PM charge nurse position open...full time, 80 hours a p/p. This PM nurse asked the NM "Do I even have to apply for this position, or do I already have it?" The NM said, you will get it, but it is full time. "The PM nurse only works 60 hours a p/p and will not do more. This PM nurse thrives on other people's mistakes. If a patient has a tiny complaint, she goes in, makes it all better, feeds off of it, then tells the nurse how much the patient complained about him/her. As charge with no patients, she does not help. she complains about how bored she is...NO JOKE! She spends plenty of time reading magazines and going out to smoke. I cannot take it. 3)The nurse manager......She does not speak to us, does not say HI when passing us in the hall. The only words she has ever spoken to me are: You are getting an admit...or The lottery is up to 30 million, do you want in? or...I have some packets for you to fill out.....or I think she knows what she's doing, she doesn't need your help.....or then she goes behind my back to report things. She will say things within my ear shot such as "I will jsut leave this here for HER To clean up then". but never says a word to me. If I ask her to start an IV that I can't get, she tells me to call the doctor to put in a central line. Me and several other nurses feel we cannot approach her. She either looks at us with a blank, evil stare when we tell her things, or does not follow up when we have issues that need taken care of. The only person she talks to is that PM nurse...and about everything. I want to go to the DON, but i don't really see what could be done or how it could possible help things. Thanks for listening.

I need to clarify my concern. The CNA website q and a page says that it is not legal for an LVN to have 6 patients and the RN to have her 6 plus the LVN's 6 because that would give the RN 12 patients. It also says that the LVN should be assigned to a nurse not to patients as we discussed in the earlier post. Because of reading that, I was led to believe that LVNs are not counted in the ratios. After reviewing the DHS website, I saw several parts in the addenum (2nd to the last), that said that LVNs do count. How can this be? We are told that at all times a nurse can only have 6 patients. How can they get around this and give us 12? I really am confused and do not understand the CNA q and a page. It conflicts with the DHS page. Is the CNA q and a page just what the CNA hopes for, or is it reality? Do you understand my question? Say we have 18 patients on the floor. We have two RNs, one LVN, and one charge nurse. EAch RN had 6 patients each and the LVN also has 6 patients. Technically, the charge nurse has 6 (those of the LVN). So when it comes down to relieving for breaks and meals, could the charge nurse cover for us even though she is assuming responsibility for the LVNs patients although assigned to the LVN? Very Confusing to me. Also...The CNA q and A website also says that hospitals cannot cut out ancillary personnel, it must remain the same as it is currently. The DHS statement of reasons says that they cannot regulate the ancilarry staff ratios. They keep referring to the PCS, but obviously the PCS does not work or we wouldn't have this ratio law in the first place, right? Where I work, the CNAs are all worried that they will be responsible for 12-15 patients each now as opposed to the 6 or 7 they currently have. They claim they will not do but the minimum amount of care for the patients under those circumstances. Is there anything illegal about cutting CNAs out altogether? In teh CNA website Q and A, it says that if the ancillary personnel are cut, the hospital MUST hire additional RNs. I did not see that written in law. I am rambling because I am sooooo darn confused. Please answere any questions and clarify any of my concerns that are understandable. Thanks so much. Jen

Spacenurse: How do you interpret these articles? To me they seem a bit vague. I would appreciate your input. From the CNA Q and A webpage: The minimum, baseline ratio of 1 RN to 4 couplets represents the The notion of "covering" an LVNs patients is wholly incompatible with the Nursing Practice Act , Title 22 regulations and the Standard of Competent Performance which governs RN practice. Patients are not assigned to LVNs. Patients are assigned to RNs who are required to directly provide ongoing assessment of each assigned patient. The LVN practices under the supervision of the RN and performs delegated functions or nursing activities under the effective supervision of the RN. The following from the CNA Position statement: CNA Position 1. The acute care LVN can only function in an assistive role. LVNs may assist direct care RNs and may provide shared nursing care under the clinical direction of the assigned direct care RN. Example: General Med/Surg RN has five patients; LVN has no independent patient assignment but assists RN (could be more than one RN) with tasks/procedures requiring manual and technical skills. NOTE: This is to avoid the doubling factor syndrome i.e., RN with 5; LVN with 5; RN has 10. 2. An LVN assigned to an acute care facility unit shall not be included in the calculation of the nurse to patient ratio. In other words, the LVN should not be in the count for purposes of complying with the nurse-to-patient ratio.