yooperPN

Your test results are back showing you're positive with MRSA in your sputum

Them finger painting with their BM.

I was in a similar situation, a co-worker who worked midnights with me was sent home and later terminated for similar reasons. She has blood sugar issues and it was unsure if her sugar was acting haywire that night or if she was intoxicated. Of course, the rumor mill states they requested her to be screened and she refused, but I'm not personally sure of the situation. I was torn in the beginning if the company I worked for did the right thing. She was very nice and I never heard any complaints about her from anyone (residents or the staff). But, I put myself in her shoes and if I was sent into the office at 11pm with the DON and ADON, I would immediately request to be tested to prove my case. I would think anyone who is being accused of not being capable of performing their job duties would do whatever they could to prove they could. I eventually accepted that they did what was best and although she was very nice to work with, she probably was in the wrong. After the fact, she attempted to contact me through facebook. I didn't respond. I feel bad about it, but I really enjoy my job and have heard from the union that she is filing a lawsuit against my company. I figured at this point it's best to focus on staying employed instead of outside work activity. More likely our conversations would be surrounded by the issues that took place instead of developing a healthy outside work friendship. It sucks when you're in that situation. But, I think it's best to have faith that your company did what was best for their patients.

I don't know why your supervisor or DON would even ask for the keys. I guess if mine asked me for them, I'd give them since they are above me in the chain of command. But, if they were asking for the keys to administer a med, I would make sure they were the ones who signed the med out.

The only dressings at my LTC facility that isn't "PRN" would be the ones wound care specialists come in and do, and that's rare. I'm willing to bet the CNA gave you the wrong information, and maybe in the future you should direct your questions directly to your nurse or your instructor.

Disturbed Body Image, Impaired Mobility.... possible activity intolerance. All r/t Amputation.

Had my first death last night. I'm a midnight nurse in LTC and after a year and half, I finally experienced it. My resident died with his wife at bedside (she had been a nurse for 30+ years and actually worked at my facility for 18 yrs), she held his hand and continued to feel for a pulse. He went pretty suddenly, bounding pulse then nothing. He would've been 99 yrs. old tomorrow. I wasn't sure how I'd take my first death. I've seen many actively dying, but they didn't go until after I left work. To be honest, I have a new feeling about death. I wasn't emotional, I was at peace with the whole process. It might be because I see these people suffer before they get into the actively dying stages, so when it's finally over I feel like their suffering is over.

So, the Resident passed the evening of the last shift I worked, which was not surprising as he was mottling. I guess a nurse just happened to be in his room when he took his last breathe, got the same charge nurse that I spoke with that morning. She assessed that he had no pulse, told a nurse to get the charge cart and called the MD to have him pronounced. No paging Code Blue, no dramatics with CPR, no nothing. He left us peacefully :redbeathe I'm still at a loss as far as getting answers to the legality question, but if I ever find an answer to this I will definitely post here!

Dixie, If you were in my shoes, would you consider paging the code blue and then picking up the phone to call the MD to have him pronounced as initiating the code? Or, would you attempt initiate CPR (fighting with the family in this situation), have your CENA's page the code, then have one of the responding nurses call the MD?

I attempted to look up this law to find out what it is with no luck. I'm going to have to get clarification from someone at my facility to find out what exactly was his situation, instead of hearing the different things from different nurses. But, from what I understand, there were several residents in our facility that changed from a DNR status to full code because of some technicality. It just so happens that this particular resident began actively dying. He has a legal guardian, but she was not appointed as his DPOA. I didn't realize a MD could order the DNR, or he could order Hospice in this situation (kinda irritated that didn't happen). I work tonight, so I'm going to find out more information with specifics because this is probably a situation I will be facing again in the future. UGH!! Oh, and I live in Michigan. Thanks for your input so far!

Zen123, his declining status is a whole other issue.. I picked up on something going on with him a few months back. He's diagnosed with hematuria and neurogenic bladder. He's had a permanent catheter since he's been with us, changing it out once a month. He's had blood (and I mean red) urine for as long as I can remember, but the MD wasn't keeping up on doing CBC's with him. A few months ago, he had 3 falls in a 2 week period, one of them involving him being behind a closed door on the floor sleeping with chair alarm sounding off. That night I called the MD because it was obvious something was changing with him, and changing drastically. MD came in the next morning, didn't think anything was wrong, noted the blood and clots in the cath bag, but that was it. 10 days later he finally ordered a CBC, and his hemoglobin was 9.3 or something like that. His orders were for us to monitor for changes.... WHAT?! (I secretly wanted to yell "What do you think I called you for in the first place?!") That was infuriating, but then I thought maybe it was family wishes. So, since nothing was really done about the low blood count, he's just gotten weaker and weaker. But, because he didn't have a terminal diagnosis, he wouldn't qualify for hospice (which the family wanted also). So, comfort care wasn't really something, as far as I know, that we could legally do.

Is that actually the case? Or, is it that you need court documents deeming him unable to make his own decisions? His wife passed away years ago, but he has living children that were all at his bedside the night I thought he was going to go. Each and every one of them did not want CPR performed because they knew that not only was it more traumatic for him/his body, it wasn't going to bring him back.

Haven't read that article, going to look it up! Thanks! The resident has no POA, DPOA, or however you want to word it. He has a guardian and a person in charge of finances. Apparently, from what I understand, there was a law passed recently (not sure if it's state or federal) that in order for you to have a no code status you or your DPOA has to make those decisions. Prior to this law, guardians could also make those changes. Since he's been in rough shape for the past couple of months, he or his family has been in no shape to get to the courthouse to get those papers signed. So, instead, our facility had to update his code status and had him/his guardian sign the new status. I guess I am thankful that he didn't code on me. But then again I'm having mixed feelings because I don't know how the family reacted if he did code on someone else.

What I would've done was just calmly responded to his requests. He's probably lonely and just wants someone to care about him too! Not saying that no one there cares about him, but he clearly felt like he wasn't being cared for. Then, after that, I would've charted his behaviors and left a note in the social worker's book about his behaviors. They're better trained in those situations.

Hi! The last couple days at work have been extremely stressful. I work midnights for LTC and we've had an actively dying 80+ yr old who's code status changed a couple months ago from no code to full code. I've heard there was a recent law that passed changing a lot of resident's code statuses, and another nurse explained to me it was because the resident had a guardian, not a DPOA. This resident has been deteriorating over the past couple of months, refusing meals and medications. He is probably a little over 80 lbs. The other night at work, he went into unresponsive status and began the actively dying process. His physician and family knew and were in agreement, do not preform CPR. His physician left his cell phone number behind in the event he passes, so we can get him pronounced immediately. This same physician who doesn't like on-call doctors treating his patients explained for us to not only have a nurse calling his cell number, but to have us page the on-call at the same time so SOMEONE would pronounce him immediately. So, I arrive to work the other night with all of this going on and I'm stressing out. I go in his room to check his status and his family is at bedside. They leave the room so the CENA's can do their cares, and one of the family members lets me know that she will throw herself across his body if I attempt to preform CPR on him. I tell her that it wont get to that point, I have the Dr.'s cell number at hand and will be calling the on-call Dr. if need be to avoid all of this. I, out of courtesy, let all the other nurses in our facility know the situation so they can be prepared if I called a code. Luckily, I didn't have to the first night. The next morning I explain the situation going on to the charge nurse (his status changed after she left work that day so she wasn't aware he was actively dying). I tell her about the CPR situation with the family, and my agreement I had with them knowing that technically I couldn't do that. She didn't come out and say I was in the wrong, but did say that if he goes that day when she's there they have to initiate CPR while others are trying to get him pronounced. I warn her about the family and their statements and hope it doesn't have to go to that point. That night I'm scheduled to work and find out he's still with us, but in worse conditions then he was the first night. Of course, it's time change night so my usual 8 hr shift is 9 hrs and I'm figuring he's probably going to go on my shift. Same family members are at bedside and this time they seem relieved I'm there because I said the night before I wouldn't perform CPR. So, I again make my courtesy calls to the other nurses in the facility. Later in the night, one of the other nurses comes down to my floor and chit chats with me on the situation. She asks me what my charge nurse said about the CPR thing, and I explained she didn't necessarily tell me I had to do CPR, but told me she would do it if he passes while she's there. This nurse then asks me if it's against the law to not initiate CPR on a full code Resident. Immediately I think, uh oh... here we go. I tell her my plan is that if he passes, I have the CENA's calling the code while I'm calling the Dr. because I do not see the point in battling in the room with the family about doing CPR. She then states, "I don't know if I'd risk my license doing that." So, the rest of my night was spent in his room every 30 minutes checking vitals to see if he's beginning to go downhill more so then he already was. He didn't pass on my shift and I've been off the last couple of nights, so I don't know if he passed yet and how they handled the situation. My question is, I know technically what we're suppose to do with full codes, etc. But, what would you really do if you were in my shoes? Would you really go through the dramatics and the trauma to the family to begin CPR on a resident that you know isn't going to come back from it, and you're only injuring the body more. Was I in the wrong by saying I wouldn't initiate CPR and would call the Dr. first? Ethical dilemmas are not fun!