Irish_Libra

I entered nsg school wanted L&D. My mind was set & thats what I was doing period. The only other thing I was certain about was that NO WAY was I doing geriatrics. Jump ahead now 11+yrs.... I am a geriatric hospice nurse! I found my niche & LOVE IT. so don't listen to this nurse. It sounds like she's not happy with the area she decided to work in. You know the old saying, "Misery loves company"

Just to clarify I do not work for this facility. I am a hospice pt caregiver. I do pt care which also includes skin assessments, pain assessments, assess side effects of medications, & assess if there are any other needs the pt has (adaptive devices etc). I have been coming to this facility for 6+yrs. This DON has been there roughly 1yr. As for the non-nursing staff, it was the central supply person! This facility gives residents showers 1x week & does skin assessments 1x week. I do skin assessments 3x week (each day I visit a patient). I do the stna shower sheet for them on one day unless there is a change one of the other days. The problem was this DON wanted us to do further staff paperwork (signing off their books). My last supervisor had this discussion with him & told him we do our own paperwork, & verbally report to the staff nurses at the facility & we were not doing their paperwork just because their staff nurses weren't doing it. (facility got sited in last survey for nrsg not documenting). My new supervisor hadn't addressed the issue since it wasn't revisited prior to his outburst. As far as reportable I'm concerned with his inability to control his response in front of residents. What if next time someone doesn't respond so calmly to him & he takes the next step from verbal to physical. I can see the potential in him. Is that a safe environment for the residents if staff is verbally/physically assaulting one another? Even verbal altercations lead to unsafe nursing. I for one know if I had been working as a charge nurse that day, there was NO WAY I could of continued working without risking the safety of the residents because I was too upset & at the very least my mind would of been elsewhere. Thats one way med errors occur among other safety issues. As for the person that said something about me being fired, no I wasn't. I am still working with the same company, just had my annual review & was noted by my supervisor for being able to act/respond professionally when confronted with very difficult situations. And to those that seemed to have an attitude that: this happened, so what? move on..... I don't know about you but I have had nightmare situations & was able to walk in to my pts with a smile & walk out with a smile. I have worked as a pt care staff, a charge nurse, & even as a supervisor in a LTC setting. NEVER is it ok to yell/curse at a staff member let alone someone else unless you see them endangering your residents. Also this facility gets paid by my company for the residents residing there. So it wasn't about cutting costs.

just to add that educating patients families sometimes entails reminding them that men in the older generations were taught not to show pain & that to do so is a sign of weakness. And that since he is now unable to make decisions for himself regarding his comfort, it is their responsibilty to do so. Remind them how well he cared for them when they needed him to, & ask that they return the favor to him. (do all this with caring, compassion, & understanding... not so bluntly as I put it) Moaning, facial grimacing, flexing/contracting muscles, clenching fists can all be signs of non-verbal pain indicators.

It seems you've had a bad experience of some form of terminal aggitation. I'm sorry you had to go through that so early in your hospice experience. I've been in hospice for 6+yrs now, & I agree it does take some getting "used" to since the ideology behind it is different then other types of nursing. But remember that most cases pts are able to obtain a level of comfort & alertness that is right for them. Each pt (or pts family) will determine what that is. Sadly you will encounter cases where no matter what you do, which drugs you use, which relaxation techniques etc you use, the pt will still have pain/aggitaion issues. The ones that bother me the most have always been the pts whose religious beliefs tell them that the amt of suffering they have in life will determine their heavenly rewards. I can respect their wishes/beliefs but to watch them suffer needlessly still bothers me after all these yrs. Oh BTW my company uses Roxinol frequently & phentyl patches but other than your basic NSAIDS (for minor pain) I haven't heard of us using anything else.

The hospice company I work for doesn't 'require' it, but over the last 3yrs or so, has been sending the RN's & LPN's for it. This fall it will be my turn (finally). Our employer gives us the materials to review, sends us to the one-day seminar, & pays for the test. I never considered a monetary "reward" for obtaining it. I just want it for my own personal/professional gain/knowledge. Also, my employer is a wonderful person to work for & I like the idea of contributing to the marketability of the company if all it's nurses get certified. And yes, I did think it would make me more marketable in the future if I ever needed to change jobs.

Okay I'm going to give a situation and ask your opinion on what you think: just rude or is it reportable (to state board of nursing). I'd also like to know if you feel it is reportable what steps should be taken next. Here's the situation. I have been a LPN for over 10yrs, and for the last 6+yrs I've been at the same company. The company I work for has a contract with a long-term facility. I have been going to this facility to care for patients for my entire employment. Recently they've had a restructuring of their nursing administration. One morning as I prepared to see my first patient, a staff member (non-nursing) approached me about filling out skin assessment sheets everyday I visit. I explained to her that we typically do this 1 day a week & prn. I also informed her we verbally reported to the staff nurses any conditions/concerns regarding the patient. She told me I was going to get their facility in trouble with state, & I calmly stated I disagreed. Moments later I was informed thru the floor nurse on that unit that the DON wanted me to gather my things, go home, & call my supervisor. His reason: he said I refused to do the paperwork. I felt this was just a misunderstanding & that I didn't refuse at all, I was just doing it as had been done for the last 6yrs & we've never had a problem before with findings/follow-ups in skin conditions/concerns. After knocking, I attempted to explain that I felt their was a misunderstanding & I just wanted to clarify it, but he cut me off yelling at me, cursing, and demanding I leave NOW! Stunned, I just stated "OK" and left the building angry, frustrated, confused, & crying. The same staff member that initially approached me was in his office, as well as other staff nurses present not 5 feet from his door at the nursing station. There were also residents in the hallway 7-10 feet from his doorway that all heard this exchange. Due to "changes" in the facility, the nurses/staff that overheard are afraid to come forward at fear of losing their jobs. Even then, the owner of this particular facility has fired a staff member with similar tactics so I feel to report to him will not yield any results. And this DON has yelled/fired staff since then in the presence of staff, residents, & residents families. I know what he did was unprofessional, but my question is this: IS THIS REPORTABLE TO THE STATE BOARD OF NURSING? & WHAT WOULD YOU DO IF IT WERE YOU IN THIS SITUATION? BTW: My company supports me in saying this facility as been viewed negatively lately & is undergoing alot of stress. I feel that regardless, a certain level of professionalism is required. Afterwards, the DON will not permit me back into the building (not that I'd want to work with him, although I miss my residents terribly) & he was overheard saying he didn't like me & just wanted to get rid of me. Oh, I don't know his last name...