Huq

I am a nurse/midwife, all of my education in England. I entered the midwifery programme with a bachelor's in nursing. I did this a long time ago and things may have changed. The first thing we were told "You may be RN's with degrees, but from now on you are simply pupil midwives, starting from the very bottom" and we did! We grumbled about the long hours, the on call hours and the very heavy scolastic load, but we loved it and at least half of us became midwives. Please, please do not do this if it is for the added qualification only. (as so many do) Do it. Love it.

I work in a SNF and recently have seen a trend. Extensive remedial therapies ordered (PT,OT,ST.) for patients who have remained at the same physical level for many years, mostly patients in their eighties, nineties. We have an excellent Remedial nurse's aide program for ROM, ambulation with assisted device etc. but licenced therapists? I see braces, special shoes etc. ordered for people, some with severe footdrop, who have not walked for twenty years. Apart from the very high cost of this specialized equipment facilities are paid at a higher rate for patients receiving any kind of Medicare approved treatment. Isthis good care or a way to make more money? I would appreciate opinions on this.

Not the fault of the nurse? Giving medication when unable to read an order is the same as giving medication without an order.

Nurse Mates. Their Hunter 230504 has a very wide toe. The most comfortable nursing shoe I have found.

A patient's chart is a legal document. Don't mess with it!

I agree that surveys should be unannounced, but as I said in a previous post JCAHO charges a fee...pretty hefty fee.....I cannot imagine any corporation saying "Plesae come in unannounced and here is your big fat check" JCAHO surveys are not mandatory (yet) I think by 2006 the whole concept of unannouced will sail off into the sunset. This is a great shame, but the almighty dollar will win out.

I have also read that JCAHO will make surprise visits in the future. Unlike the State surveys there is a fee for JCAHO and this fee is paid by the facility. Cannot figure out why a facility would pay for an unannounced visit.

I do not recall any mention of LPN's being looked down upon by RN's. I do not have time for that nonsense. We are all nurses. This will be my last post on the subject because I also find 'I'm right, no I'm right' counterproductive. The only time frame for a State survey is, for example. They came last August so perhaps they will come in August again. Pretty large time frame! A State survey is always unannounced. There is a time frame for a med. pass.(Incidentally it is not one hour) To go grossly over this during survey would be questioned. Finally an RN would be, ultimately, held responsible. This is defined in Section 2725 of the Business and Professions Code of the Vocational Nursing Practice Act. This has also been discussed at length in other threads.

twinmom2k Read my post again, I said "maybe" resolve the problem. I am perfectly aware and do not minimze that these signs and symptons might cover any number of more serious conditions; however, one should also keep in mind the more simple problems. One of the many supervisory duties is to keep things running smoothly. Should a State surveyor walk in and find a med. pass way over the mandated time, things would certainly not be smooth. They would immediately want an explanation from the supervisor unless, of course, that supervisor was an LPN. In this case they would be after the luckless head of any RN that might be working in the area or, failing this, the on call RN. Of course one would interrupt a med. pass for an emergency (if there was knowone else to take care of it, but in this case there was) I believe it is called teamwork.

I'm playing the devil's advocate, but here goes. Could your problem be attitude? one sentence jumped out at me " i dont mind helping out my nurses," They are nurses on a shift you happen to supervise. I doubt, very much, that any would admit to belonging to you. Just imagine how much faster everything would have gone if you HAD initiated vitals etc; yourself. You might even have pushed fluids and, maybe, resolved the whole problem. "decreased po intake , increased temp, tachycardia, and increase lethargy." sounds like dehydration to me. An important part of supervision is ensuring that everything runs smoothly. Picking up the slack and allowing a nurse to finish a med. pass. (which has a time limit mandated by the State) is a good start. Just imagine! The nurse might even have had enough time finish treatments

Re: "a nurse that doesn't allow you to leave a thing to be done on the following shift" We take over from one another. This is why they are called SHIFTS.

I have worked with wonderful nurses and not so wonderful nurses. In my experience the Lack of knowledge, laziness of work ethic group are the ones who are so tight with administration that nothing would get them out.

Catsrule16 thinks the program went downhill after Lisa Ling left. I think the program went downhill when Lisa Ling started.

ventrogluteal site is relatively free of major nerves and blood vessels, the muscle is large and well defined, and the landmarks are easy to locate. It is an excellent IM injection site in infants. Simply place the palm of your hand over the greater trochanter, index finger over the anterior superior iliac tubercle, and middle finger along the posterior iliac crest. Inject perpendicular into the center of the V formed by the separated fingers.* It has been my experience that this site is less painful than the vastus lateralis.

Another confirmed 3-11. Would not have it any other way. Bed at six, up in time to get ready and off to work. Until six, eat,television, computer. The early bird gets the worm, but I have never really cared for worms!