1RNLadybug

My thought is, some days only LPN's are doing patient care, with 1 rn as charge nurse...Some of these LPN's have been doing nursing longer than I've been alive! Yet, they have to have their assessment cosigned by an RN...That will be the next thing, asking the RN to cosign the LPN's note. When you have a team of your own patients, unless you are going in and assessing everyone (which would be a real accomplishment with 42 patients in an 8 hour shift)...I mean it could be done, but with all the other stuff you have to do, who has time? I know the LPN's I work with are as qualified, if not more qualified with years more experience, to do an initial assessment on a patient, as well as patient care... No, it doesn't make sense, but alot of hospital policies don't make sense. One hospital I work for, up until 2 years ago, wouldn't hire an LPN to work as a nurse:confused: They would only hire an LPN as a PCT/nursing assistant:( I mean, come on, LPN's trained at a local technical school in middle georgia get tons more hands on clinical experience than the local community college RN program! Yet, you have to have an RN in charge (now, granted I am an RN and I feel this way). Personally, I'd much have the 30+ experienced LPN next to me in a code, than the new grad RN...but I don't make the rules, just try to work with the rules. Linda

It reminds me of an episode of ER...Nurse is fussing about patient with chronic copd, on ventimask at 50%, and trying to go out to smoke... Nurse says "do you know how hard it is to care for Mrs. Smith?!!!" Dr carter responds "do you know how hard it is to BE Mrs. Smith?" Patients have free will and we can't change their behavior, but all we can do is help them and listen to them. But it is hard when you see them going out to smoke, then ask for a breathing treatment... linda:)

I recently transferred to another hospital, out of a hospital that sounds alot like the environment you described. Queen bee is the manager, second bee is her best friend (who has been written up so many times for what comes out of her mouth she actually gave notice started at another hospital, then came back so she would have a clean record), and the third bee is a secretary that has been in the position for 20+ years and is known to run off new RN's and other employees. It is like high school. Consider your termination a blessing in disguise. When you fill out an application when they asked why you left your last job just put "ethical conflict." You know if they were dogging other nurses and other shifts, they are dogging the patients. Good luck to you, there is a better position for you at another facility. linda

...Your patients are saying "you don't look well...why don't you sit a while. Hard to balance home/work. I used to feel guilty for taking a few days off because staffing coordinator will call and plead to pick up a shift. You have to take care of you first, before you can adequately care for your patients linda:zzzzz

Patient must be assessed by an RN upon admission, then assessed by RN/LPN every shift...also we make rounds every 2 hours to check on patient, and of course when they use the call light. linda:roll

I work at a small hospital/rehab facility. We still use Kardex's! Orders are few, yet STILL at times don't make it to mar and takes days to realize it. It goes back to the nurse that received the patient & missed the order. We had a patient come in with "obstipation" and was to get reglan IV q6h, I found it 2 days later. We sometimes get too busy to start at the beginning of the chart & verify with kardex & MAR. In fact, I found out that at this small facility, if a med isn't charted on mar and signed off correctly, the facility wont get paid for the med...same thing with procedures. For instance, I was so excited to get to leave because they had too many nurses, I forgot to sign off a whole page of MAR's, even though I came back in & signed them, it was still an error. Also, someone had billed a $7,000 procedure incorrectly and now the facility has to eat the cost because they can't bill for it once the 3 day limit has passed. I've been a nurse for 8 years and usually if someone forgets to sign off the med, the oncoming nurse will call, verify it was given, and let them sign it the next day, without concern. I learned something yesterday...take your time and make sure you document completely. We all make mistakes, the thing is to learn from them. Happy nursing! linda