Cat_RN

The BON is suspending you for two years for some missed documentation from 2 years ago? From an LTC at which you were only filling in for 4 hours as an agency nurse that had documented issues with their computer at the time you were there? Something isn’t adding up, why is this so heavy-handed?

Will do!

They told me the answer was 6.75 hours.. So confused!!

On a pre-employment medication test I got one question wrong. I'm wracking my brain trying to figure out what I'm missing! Here's the question. You have 500ml to infuse at 60ml an hour. How many hours does it take to infuse? I answered 8 hours and twenty minutes using the formula of volume/flow rate. What am I not getting? If I used the wrong formula please let me know and explain why.. Thanks!!

Hello, I'm an LPN with a currently active Florida license. I am currently living in NH (right on the border of the two states) but plan to live in MA once I get a job. Has anyone done this before? I went to the Mass.gov website but saw nothing indicating what process I take to transfer my license to MA. Does anyone know how I can go about this? TIA!

Long story (kind of) short, I have worked in this rehab facilty for over 3 years, I am one of their most loyal employees and I am required to orient all of the new nurses on my shift. I have never been disciplined for anything, never an issue, no complaints. (There is a point to my saying this; I am not just tooting my own horn;). Regardless of who is on, I usually get calls about if something happened with someone/something and a LOT of pressure is put on me, which is fine because I like nursing. My facility has an extraordinarily high turn-over rate. Most new nurses last on the floor less than 2 weeks and it has the reputation to be the most difficult of places to work in the area. The DON runs it like an absolute tyranny. On the rehab floor we have 60 patients and 3 CNA's, one nurse for 38 patients and the other nurse takes the rest and floats upstairs to take some of the dementia patients. For a 120 bed facility thats 3 nurses and 6 CNAs. These patients are extremely demanding and the facility expects us to provide the utmost 'customer service' for them, of course. Anyways, this morning, me and about 10 other people are at the nurse's station giving/getting report. A call bell is going off. (Call bells are always going off; that's what happens when you staff 3 CNA's for 60 medicare patients!). The manager in question approaches me and only me, to ask 'where my CNA's are". I tell her I don't know, but given the time they're probably in rooms finishing rounds. The other nurse for the majority of floor does not get questioned. She keeps ranting about the call light and I tell her I'll find someone to get it- all the while knowing since I'm in report, why can't she get it? She ignores the CNA's standing at the desk, who could have very well answered the damn light. Anyways, later on, she pulls me into the office to tell me 'I'm ignorant' and that I should always know exactly where my CNA's are and that 'my pt could have been on the floor' etc etc etc. This pt wasn't even assigned to me!!! She conts on verbally belittling me in FRONT of another nurse. I keep my cool and remain polite and leave. I end up bawling my eyes out in anger all the way home. I'm going to be putting my 2 weeks in. This incident is the icing on the cake to the chaotic hell that is my workplace. I am contemplating calling corporate. This manager I used to have a great rapport with, and today she suddenly has turned on me. Am I overreacting or is calling your employee 'ignorant' for such a small thing TOTALLY uncalled for? I would never dream of calling a CNA that. tl:dr: Manager acts as if I am the only one who can do anything and should be responsible for everything and then calls me ignorant when I fail to rise to her unreasonable expectations. Life is more than treating someone poorly over a call bell in a nursing home.

1. Your emotions can make things a lot more stressful/chaotic; know that and keep them in check. Panicking is never going to make any situation better. 2. Don't let patients or family members control or monopolize you. Many will try but realize you have many others who deserve your attention as well. If they get antsy at your for not coming in every 5 minutes to 'fluff the pillow', suggest they may like to pay for a private nurse 3. Often times, the less you say, the better off you are.

I think management should have handled this better but I really think 'calling the state' is a bit drastic. Who made the assignment and why didn't the aide who couldn't take care of her SAY anything to her charge nurses? I feel she is very much responsible for this mishap as well. She needs to be dealt with regarding this situation.

Ha. We were all super-nurses once weren't we? Then we actually had to work the floor after graduation and got a reality check.

Perhaps someone with a social disorder affecting interpersonal relations? Maybe something on the autism spectrum or Asperger's. Doesn't seem like she can connect and work cooperatively with other people. She's too 'in her own head'.

Hydrating oneself at the nurse's station? That negatively affects patient care 'how', again? Please. If these managers have so much time to write up for such menial things, that tells me there are too many chiefs and not enough Indians. Typical top-heavy nursing unit! No wonder morale is so low.

"If you are not going to help yourself, do not blame us, or threaten to sue us, your doctor, the surgeon, or anyone else you can think to blame when you do not get better". I see this VERY often in the rehab. I suppose this is why many of them end up there in the first place; non-compliance with care, medication, dietary restrictions, etc..When you are 50 years old a have 5 stents placed, had a triple bypass and continue to consume 10,000 calories a day despite being a diabetic, drink all the fluid you care to despite your 1.2L restriction, refuse your showers and dressing changes.. don't blame us when your wounds don't heal, your kidneys fail, and your health doesn't get any better. The fact that you have to take 55 UNITS of aspart before meals should be your sign! Don't blame us!

The flagrant self righteousness must make them feel better I guess..

Yes, this thread is pretty much over before it even got started..

Uhh.. I think a critical lab value could probably be categorized as 'consequential' and would not **** her off in the middle of the night..

So, you think it's OK to call MD's in the night for 'inconsequential issues'? :icon_roll

Good point. Is anyone going to really 'buy' this guy's story anyway? I'd think this would be a very hard thing to prove. What a mess.

You REALLY need to get over 'the doctor is going to hate you'. You called for legitimate reasons. If he's mad, he needs a new career. It's not our job to worry about the doctor's sleep. I'm not saying calling the MD for Ted Hose in the middle of the night is OK, but really now, call when the patient needs help.

Yes, and please don't 'wait for day shift' to call for pertinent things happening NOW that require an intervention and orders. This drives.me.crazy.

No, it was not ok that you documented giving o2 without an order, especially saying that the on-coming shift would 'get the order' for you. That is like shooting yourself in the foot! If you did not feel the pt's condition warranted a call to the MD, you at least should have written the order for PRN o2- and 'may titrate to 3L as needed to maintain sats'. Yes, the oxygen was the correct intervention initially, but none of that matters in the legal world if you don't have an order. I would have written one. I probably also would have called the doctor too for CXR orders, labs, or whatever else they wanted, because obviously there is something going on with the pt. I don't care that it's late, nursing is 24/7. 75% is low for someone who usually sats normally. Pt condition changed on your shift, and as a dayshifter I would have been furious that the night shift gave to me a potentially unstable pt that had nothing done for him thus far. That would not fly in my facility. Why wait for patients to get worse, just so we don't have to 'wake up' doctors?

LOL. I see 'Bralava 10mg one daily-#30". That's all I can make out. I have no idea what it means- I cannot find any med called 'Bralava'.

The first foley I ever did returned 2500mL of urine. It was a LOL who was admitted for AMS who was hardly rousable to painful stimuli. Not 30 mins later the woman is alert, talking and asking for water!

1. I would have called the MD and informed of the 591 and the time other nurse gave the insulin. Also- I'd let him know the pt was non-compliant with her diet. 2. Document the non-compliance and that MD was made aware. 3. You can ALWAYS call MD at any hour. It's a 24 hour nursing facility. Cover yourself and protect your patient! If you think something's broken- it can't wait until morning. I've never been yelled at for calling at night for a real reason like this. (Plus, who cares if they yell- they don't really KNOW you and they get into this business knowing it involves late night phone calls 4. Is the DON aware of the business going on at the nurse's station at night? That would NEVER fly in my LTC and you shouldn't have to work amongst such slackers. Horrible! We are wayyy too busy even at night to be hiding in rooms or thinking of doing out hair at the NS! 5. Even though the other nurse failed to initiate neuro checks, you're responsible for the pt now. You should have initated them. Two wrongs don't make a right. You are responsible for evaulating your patients and to keep an eye on the ones with potential for a change in condition. Post fall assessments are integral and neuro's are included to monitor for a change in condition. Of course, let your unit manager know in the morning that they were initiated late so she can follow up with the prior nurse and understand what happened. CYA, CYA, CYA! I worked nights for 3 years in a rehab/LTC. I've followed more than one nurse who were slack on documentation and who have had falls and did not notify MD. When the pt begins to c/o pain on my shift, I have to call the MD in the middle of the night to request an Xray. There have been two instances where fractures have actually been the result of these falls and I'm SO glad I called. Don't let it wait until morning when it shouldn't. We night shifters are nurse's too! Not everything needs to be passed on to day shift :) Trust me, as a day shifter now, we appreciate it!

I hate when people lick their fingers to turn a page- especially at work I also REALLY hate when people call off right at 9pm on a Saturday night. Just because you have to call off by 9 o'clock (or two hours before your shift), doesn't mean you HAVE to call off right at 9! We will never get anyone now as it is way too late on weekend night and we will be working short. If you're going to blow off work, at least give us some time to find someone..

I like Echo Heron's book, 'Intensive Care: The Story of a Nurse". She has another book too but I haven't read it yet.