CynicallyVexed

I have, she gets majorly defensive and yells at the nurses station that she gives her meds. But the card packets of new admissions that have been there for days and the cards for dayshift haven't been touched state otherwise.

HI I'm fairly new at the SNF I'm currently working at.. (Less then two weeks to be exact) and in the past week the nurse I follow (she works days and I work evening shift) she was constantly leaving me in a hot mess and not wanting to count narcs until it was 30 to 40 minutes after the time I had clocked in for my shift. I started noticing medications that are due 4 times a day that I give twice at night and she gives twice during the day where on the same count that I had left it at the night before and she was signing she gave them (this would be blood pressure meds to be exact). On these same patients she was signing out routine narcotics and prn narcotics as soon as she could sign them out. I kept up with her pattern. She had picked out four people who get routine hydrocodone or oxycodone that also have PRN orders to go with it. I pointed this out to the preceptor I had during my orientation and she reported it to the DON immediately. Both her and I found shortly after that she is neighbors/best friends of the DON nothing was done about it and the situation has become worse. 20 PATIENTS are being affected. The facility I'm at has a corporate number to leave tips anonymously about whats going on there. Both the preceptor and I called the line and the state has been called. We have copied the med cards and are dated and stamped of when the cards came in. There is patients that have been there for a week to two weeks and most hadn't got their blood pressure meds but their narcotics are being signed out. A patient was recently put on antibiotics and out of the past 5 days that patient has only gotten one dose of the medication. I truly feel my job within the facility is at risk now cause this so called nurse stealing drugs is best friends with DON who is doing nothing about it. Is there anything I can do? Do I fall within the whistleblower act? I'm so lost and astonished of what I'm seeing, but I know I can't continue to work there knowing these patients lives are in jeopardy and possible hurting cause they are not getting their medicine!! Its so bad that the patients that are alert and aware of whats going on are complaining and have went to administration but nothing has been done. We called the ombudsmen for one that is alert enough to explain. Im just truly astonished and this week has been so stressful.

My patients never change unless if somebody dies and I get an admit, so I always had the same patients. Which means I remembered their meds. We have computer charting so checking out our mars and tars. During meds I only do meds cause to me those are the most important and we don't have cards we have cassettes with individual dosing like hospitals have. I'm sorry but it is possible to do 50 people's meds in three hours cause me and four other nurses have been doing to for a couple of months now. Chemsticks are done before medpass, skilled therapy and crazy patients that sit on the call light for their narcotics get their meds first, people who take their meds the slowest get theirs last and I stand out side of the room and chart... And again only treatments requiring my initials on their body get done cause time is limited. Btw our med is suppose to be only 8am_10am. So with 25 patients they want you done within that period of time. Sorry it takes you three hours to do 19...

i put my notice in today, going to a different facility and I'm going to be trained as a floor nurse while they are opening up their new rebab/skilled area, when that opens up they are going to make me a restorative nurse coordinator. On dayshift tho the DON told me on bad days at the most I will ever have will be 35 patients, the very least I will have will be 15 and it's a mix of ICF/Skilled. better benefits and pay too. I felt so much relief when she told me I had the job today that I immediately ran back over to my other job and put in my notice. And I probably won't work my notice cause at this point I don't trust them.

I'm actually an LPN in charge of doing medications/treatments/charting of 50 patients as well as charge nurse duties. Each floor is suppose to have two nurses and four months ago I had a second nurse and I no longer do and some of the other floors their nurses have quit as well or out on medical leave and they have yet to hire or replace any of them!!! Things get bypassed I will admit major treatments that require my initials are the only things I have time for. Med pass takes about two and half hours and that's only because I've been there so long I remember most of all of their meds. And I am looking I have applied at 7 other places as of now cause I'm over it and there is NO support, the only time I see management on my floor is cause they found something wrong and want answers. Sometimes I might get somebody that will help me for a total of an hour during a medpass to do a pass pull where I'll pull the meds and they give them, again another big no no I know. Which is another reason I'm leaving.

So obviously I work LTC/Skilled facility and the facility itself is nice all private rooms nice furnishings/finishings etc etc, even nursing has computer tars/mars/charts on the med carts.... All the floors have 50 patients. how is it acceptable to have ONE nurse to fifty patients? I'm job hunting now cause I'm over it. Maybe this is just a rant, but i'm not the only one in the building that is being staffed like this and several more nurses are leaving and Management only want to ***** about the stuff that doesn't get done...

As a LPN who has taken on primary nursing roles under supervision of an RN and allowed to do IV therapy/push as long as it wasn't IV insulin or cardiac drugs on telemetry acute and ICU, I would suggest both are at fault. One LPN not communicating the order. Two CHART CHECKS!!! I do not know your hospitals policies but chart checks are mandatory at all hospitals I have worked at and also where I have worked only RN's can sign off on a new orders of any kind. Plus a LPN shouldn't take an order like that from the MD in my opinion. In those type of settings I would think it would be the RN's responsibility to deal with the MD/NPs orders and progress. I would suggest you suggest your LPN's to get a list of IV meds/pushes at the beginning of his/her shift and hand them too you, if you do not trust your LPN's to do this then you can check the mars and make yourself a list. Sounds to me the LPN you had has poor communication/professional skills with poor training. Maybe an inservice on communication among co-workers on patient progress and care would be helpful at this point and those fail to comply face consequences.

anything clear no matter the temp is a clear liquid diet a full liquid diet is anything that is liquid including dairy like ice cream, creamer for your coffee, tomato soup, pudding, ect.

At the last hospital I worked at your RN's would laugh, are DON is insane, on acute care floors they have gave CNA's 10 patients a piece, 8-10 patients for the LPNs, and 5-8 patients for the RNs... RN's Duties : VS, TOTAL CARE (bathes, call lights, assist to the bathroom, turns, everything the CNA's do) plus all the regular RN duties of dealing with the docs, chart checks, getting paperwork ready for surgery or procedure, assessments, ect.. LPNs Duties: VS, medpass and assist RN CNA Duties: this is quoted.. "Q1hr rounds on patients check and see if they need anything, make sure falls precautions are in place, pass trays, and help RN's with total care if time allows!" So what do our CNA's do? Nothing anymore no joke... The DON says she wants the RN's in the rooms more often but she is also starting complain now that patients are not getting the bathes like they should, which I can see why they are not cause before this came in place the RN's were busy enough dealing with orders, doctors, and families!!!!! Which is why I left. I think if we have CNA's they should be entitled to do everything they can within their scope for patient care, that is what they are there for, just like LPN's and RN's and like a stair case, what the CNA can not do the LPN will do within their scope and what the LPN's can't do the RN will do within their scope. you know what I mean? When I was a CNA on the floors we had to give baths to all our patients, and when i was in the ICU, half of the unit got a bath and any that did a major poo or got messy during a beside procedure got a bath. I always had time to give my baths as CNA and my people looked good cause I took my time with them and lotioned them up, ect!

I have very little tolerance for drug seekers. In my town several pain clinics have been busted which means more patients in the hospital that are drug seeking... What does our hospital do? Gives anybody that walks through the door 0.5mg - 1mg of dilaudid automatically to anybody that complains of pain... no joke. They said in a meeting one time that they are starting to do this to improve their hospital scores!! I understand the pain control issues and all, but when these patients get admitted and they are getting dilaudid every 2 hours and they are calling out 30 to 40 minutes after their dose for another dose or phenegran and a ham sandwich yeah I start to wonder and I do put a halt on allot of it and do other interventions before pain meds. And if they complain of nausea with me the only food items they are getting from is going to water or sprite. I call the MD and get heat and ice treatments ordered the effective area, ect. Or try and get alternative Nausea meds like Zofran and Reglan yes I know it's not my place to judge, but I do believe any doctor prescribing these medications should be aware that the patient is drug seeking and it should be put in the H&P especially if my instincts are right and they are drug seeking. I give Pills before IV meds and remind my patients when they go home they will not be on IV pain meds and need to be adjusted to PO pain meds. If I have had a patient on a PCA for awhile I watch for S&S of withdrawals and trust me I see them about every 3-4 hours breaking out into sweats, chillin, nervous, anxiety attacks, c/o of extreme pain, and these are seen as hospital psychosis allot and not treated and they need to be treated with some type of withdrawal protocol! Try and prevent your sick patients from becoming addicts. and I never give PRN pain meds to anybody with a low BP/HR or is calling out and when I go in the room, they are fast asleep and don't wake up to the knock on the door. It absolutely annoys me to see a nurse who had a patient call out for pain meds and falls back asleep and when the nurse walks in the room she can knock the door, run the medcart by "accident" into the bed and call out the patients name and all you hear is a snore and they continue to wake the patient up and give them more meds.. I don't understand that.....

1. Upper management RN's that have lost all realistic aspects of nursing and have forgot what a nurse is and what it's about. 2. short staffing, unsafe patient care ratio and with upper management with their unrealistic expectations 3. FAMILIES that have no respect what so ever when you put 100% into pleasing them and making their stay at the hospital more pleasant.. 4. did i mention short staffing and unrealistic expectations from upper management.. 5. Hiring freezes? Seriously I have no respect for a hospital that is so short staffed on nurses and CNA's where there is 400 beds and only two cnas, one secretary and about 10 patients per an RN/LPN at night. I believe hospitals have forgotten our acute care patients are sicker than what they use to be. 6. ICU overflow on floors with short staffing? I hate having cardiac drips and insulin drips on my floor, this is VERY unsafe when a RN/LPN share this patient and have 9 other patients to care for, admissions, playing secretary and CNA at the same time. and I've seen it happen more times than I care for.

I was a new grad in 09, starting salary in a LTC/Skilled 16 on days, 18 on nights... Hospital pay on telemetry nightshift is 14.82 and i'm with a nursing agency now and depending which assignment I take it ranges from 18-20 doctors offices hospitals, 20-22 private duty, 23-29 group homes and nursing homes. This is in the Knoxville, TN area.

you did the right thing by adm O2 up to 2LNC with out MD order it's within our scope of practice. My next judgement would be asses the lungs, heart and vitals, especially if they are full code. If they were stable I would go ahead and call the DR see if there is any labs they want done for the morning or order in Nebs if they don't have any. If not stable I would have probably sent out. I hate to say it if they are DNR/DNI, I would have applied the O2 for comfort gave any Nebs if they have anything ordered and if they were stable called the family and then the MD in the morning. PE's and Pneumonia are some of the #1 causes for SOB and decreased sats in them little nursing home patients..

Unfortunately this is the life of a LTC/Assisted living LPN on nights... If you have medicare/skilled tho you can't have more than 25 in the state of TN, but there is more to come with that than 60 LTC/Assisted living patients... At least they give you phones to carry around instead of locking up your cart in the middle of the hall way and running to the desk... and I hate to say it, but you also end up remembering what 60 patients take every night and every morning... I haven't worked in a nursing home in 6 months and I can still tell you what they all get.. lmao

I'm rather excited that I have interview with them next week, but I'm curious if any of you L's out there work there or have and where at? What was your pay range? I've been in the nursing home enviroment and hospital environment and the current hospital I work with is on a hiring freeze, and for thirty patients at night we have 3 RN's, 3 LPN, NO secretary and NO CNA's!! did I mention hiring freeze? And this isn't just a normal Acute Care floor I work on, we get over flow ICU patients at times and us Lpn's are having q1hr and q2hr chemsticks IVPB's, cardiac drips going, lots of pneumonia and heart patients, and surgical patients. most of our patients can not get up and go the bathroom themselves, and it's very rare when we do have a patient that can do everything themseles... So yes... I'm ready for a change. I applied for nursefinders last night about 3 a.m. and they called me at 9:30 a.m. wanting an interview. So far 5 of the RN's an LPN's have left for nursefinders and have been happy. I'm just curious to hear other people experiences.

I've been in the nursing field for a long time, 5 years as a CNA in a hospital where primary care was the thing RN did meds, assessments, NO LPN's, and CNA's did everything the RN wouldn't do that the RN could delegate, VS, I&O's, BATHES, ect... you get my drift, and now I'm in a different hospital cause ofcourse the last hospital I was at didn't take LPN's in their hospitals and I had to quit. I mean I literally got hired on two months ago, and the first week, I went to my first staff meeting where all the LPNS are mad.... RN's Upset.... CNA's happy.... Here are their Rolls::: There is going to be more RN's and LPN's on the floor (but we don't have enough computers to cover them) and only 2 CNA's when they usually had 3-4. These rolls described from my nurse manager (which when I was hired on, I was told I would be a med nurse, I would have a CNA doing care of ADL's and an RN I would work with that did assessments and my IVP's and cardiac drips) CNA's to do walking rounds every 1 hour and do basically candy striper duties and maybe assist them to the bathroom, pass trays, feed if anybody needs help ect. 2 Cna's to 30 patients LPN's if you had a computer you could do your medication administration if your RN wanted you to. other than that you did wound care, vs, I&O's, bathes, turns, ect. there would be 3-4 LPNS to 30 patients RN's also to do bathes, vs, I&O's if your LPN couldn't get them, but to do assessments, IVP, cardiac drips. There was 5-6 RN's to 30 patients TWO Lpn's have quit their job since I started. CNA's think they are too good to take someone to the bathroom, RN's want to sit behind the desk and delegate everything and drink their coffee so who is left with all the work.. LPN..... When I was a CNA I had 15 patients sometimes 30 on a medsurg floor that was just as critical as this one that VS were done q4hr, q2hr turn and tolieting with skin care, I&O's, bathes, trays, ect..... I don't understand these changes, but the way I feel about them is that they are trying to **** off all the LPn's into leaving so they don't have to fire them all cause they are fixing to phase out LPN's, although I'm not sure if that's true that they are trying to phase out LPN's but that's how I feel.. I'm glad I'm going back to RN school, but I'm very afraid to work there as a RN now of these things... It's not that I'm not above and beyond to do ADL's and I&O's, but I went to school and there is things I went to school and was trained to do that I want to do and I feel those things are being taken away from me and I'm being told that my cna is better than me that after q1hr rounds she can't come and help me bath somebody or help record a simple PO I&O... what is nursing coming too.. Sorry this is just a rant... but I want to know if other places are doing this.. BTW this new piloting of their new role descriptions is not working out. Bathes are not being done, I&O's incomplete, more med errors, more patients crashing, more falls, and not to mention we are switching Emar programs and fixing to start computer charting...

UT is a great hospital to work for, East TN sucks on pay tho, new grads range from 18.50-19.50 for RNs shift diff ranges, benefits are Okay. DEPENDING ON STAFFING, which you will learn in nursing changes often, you will have between 5-8 patients a piece on the floors, ICU 3:1 depending on condition and needs of the ICU patient. Then you get the lovely plus of putting up with all the new resident docs in July. Over all it is a great working environment, There is things I hate about that place as well as I do about other places.. It's usually upper mgt issues and papers and charting before patients, those issues are anywhere you go tho.

they only check it depending on the strength of the antibotic and the strand of bacteria the resident is fighting.. Also as well if the doc writes Pharmacy to dose then pharmacy will check a recent BMP and creatine levels... And any drug that requires Peak & Troughs like vanco, gentamycin, tobra... ect., they will ask for a recent labs. The only bad thing about this in a LTC facility is that these labs are never up to date, you will be lucky find a recent BMP on a resident that's not older than 6 months. In a hospital setting they send for stat labs and pharmacy will look them up and write the dose amount without bothering you.

I put in a three day notice (yes I know two weeks is more acceptable.. but I work in a very hostile environment.) The director of nursing stood there and cussed me for a good minute and then I had a RN nurse manager that likes to degrade people that was up my ass all night and then wanted to sit me down for my yearly eval and I refused cause I don't think I could handle being in a room with her alone without cussing her out and losing my cool. But I played it cool tonight, and slipped my badge under the door stating I won't be back for the smirks, remarks and the RN supervisor treating me like a 3 year old. There was other RN supervisors there that are fully aware of my knowledge and skills and proud to see me move on and said i could use them for references them any day. I feel bad for the way I left, but then again... I feel like I can breath again.. I start my new job next week, which I'm excited about.

slim to none!! hahaha I was a CNA for four years in a level 1 trauma/neuro icu and had to go through extensive training that the hospital provided (which has helped me allot when I became a LPN) and with night shift differential I made 11.20... This was after 4 years of being a CNA and going for the extra training to do a cool job though, I started out at 8.75. My weekend diff was 1 buck. But still though it took me 4 years to reach 11 bucks..

It really is unreal the things I have witnessed licensed and certified professionals do in this building. I know over half of them have to be druggies. Which you know I was shocked when I found out that they only do drug test when they suspect, not when you are first hired on.. LUCKILY, the place I'm getting on now does do drug test on hire. THANK YOU! I think what I'm going to do is tell them I will work till Saturday night. And if they give me any slack or harassment about it anymore than I'm already getting then I will just work my shift tomorrow night till 11 p.m. like scheduled, hand over the keys, and hand over my badge with them. it's just a badge situation, these past three months I feel like I've had a ***? stamped upon my head.

I do believe you have to have an MD over you looking over the 'consult' cause you are giving medical advice and really MD/DO's, PA, and NP can diagnose and give medical advice, LPNs & RN's do more along the lines of patient education of those diagnosis and medical advices they give. For ANY practice or consult of any kind, there has to be a medical director involved that oversees the practice or consult... I am almost positive on that. I know the wound places around here have active MD's working in the facility and they do the consulting, and the LPN's and RN's initiate and educate treatments... ect.. You know maybe if you were a NP? you could do this on your own? But I really don't see you doing this on your own as a LPN... legally anyways.

Most state boards will remove your CNA and replace it with your current status as a LPN... At least they did in TN for me. and yes it's bad ju-ju... wouldn't even try to attempt it.

try to get in at a teaching hospital and put in that you are nursing student. :) GOODLUCK!!! Nursing homes can be rough on CNA's who are going back for nursing, so if there is a teaching hospital around please apply!

I have another job lined up and I start next week with it, but I'm literally too scared to quit my other job. I have been a LPN for less than a year, and before that I was a CNA. the environment I'm in is so freakin hostile though and I feel as if either I will get bodily harmed or my licenses will be at risk due to what the CNA's that work on my hall do to the residents! I've tried to do the right things. But I can no longer handle threats, cna's asking me if they can buy the narcs off of my cart, making up vitals on my patients and giving them to me, CNA's yelling at the residents, RN Supervisors getting on to me for requesting treatments on my patients who have severe UTI's with mental status changes or getting yelled out for wanting to send a full code patient who had a stroke on my shift out... and trust me this list gets longer and I have only been there for three months. I went to this facility cause I thought it would be different and it's a chain off of a large corporation with great mission statements, benefits, to even buying their employees uniforms. And I have went as far as the DON on several occasions and I can't get nothing done about the CNAs that are doing this or slacking on their job. And when I write them up, they just laugh it off. I can see it now if I tried to work out a 2 week notice how bad it will be. I need ideas, how do I approach this? especially with it being either an effective immediately 'I quit' or I'll work till Saturday then I quit... I have NO intentions of going back to this facility and I had used one of the RN supervisors as a reference for the new job I got (he's quitting too very soon over the same things..) I have VERY strong references from being a CNA in a level one trauma center and have some of the attending docs as my references and from LPN school I have all of my clinical instructors as well.. I'm just lost and astonished at the situation I have gotten myself into..