Lorrie34

Completely unsafe! Not just for you and your license but for the resident as well! I administer my own meds and when I'm doing my pass, if I'm dispensing a med I don't know or can't recall, my med book is in my cart and I look it up before I pop the pill into the cup and travel into the room to administer it...EVEN if the resident has end-stage demtia! I NEED to know WHAT I'm giving and HOW it will work, if there are parameters on the med or not too! Too many times I have seen in my MAR to give Midodrine with no parameters, or Procrit without the H&H parameters and I have seen other nurses make the unfortunate mistake of giving these meds then without checking those parameters! I recently had an inicident where LPNs with above 20 years of experience were giving Amiodorone to a resident with a heart rate in the 40s!!! OUCH! That is why it is soo important to know what you are giving and what it does. I would never, never give a med that somebody else poured even if I see the word "tylenol" written right on the pill itself.

It's a med error. If you didn't give what was scheduled and double-dosed on another med, that is a med error. If this was your own mistake, I think the moral action to take is to report it to the DON and let him/her make the call if an incident report should be filled out. Many times, if the medications given and missed were not meds that could result in serious consequences for the resident, the DON will simply give a warning or write up the nurse responsible, without doing an incident report. We are human and mistakes happen because we can't be perfect all the time. But I believe that nothing entitles us to ignore our imprefection. We learn from our mistakes. ALF are different because the residents are more like if they were in their own home and taking the meds themselves, and in that case, how many doses would a person miss on their own for different reasons? It isn't the misssed dose that is the issue, rather the double dose that is the concern.

I was an MA for 14 years before getting my LPN. In my opinion, having that experience absolutely helped me get through the LPN program. I had very strong skills in injections, vital signs, venipuncture, medical terminology, charting, and most importantly, pharm! I saw many of my classmates in LPN fail out or sturggle with pharm when I excelled right through it, already knowing most of the meds and the usual dosages, side effects, common uses, and dosages. The only draw-back I could see was those that had the CNA experience were far more skilled with the direct patient care (ie: transfers, bathing, body mechanics...). Being a Medical Assistant also helps you learn how to deal with doctors. As an MA you work in the office, right along with the doctor, assisting with exams and following their direct orders. Sometimes doctors are a challenge to work with : ) The bottom line is, any medical experience will help you further your medical career. Good luck to you in whatever path you follow :)

Nursing is all about tending to every patient's needs at all times. Unfortunately, there are many times when more than one resident has multiple needs at the same time. It DOES get hectic. You have to be able to prioritize and assess. You also need to be organized, and confident and you of course, above all, you need to be calm and caring. Where I work, sometimes I'm on a floor by myself with 60 residents to medicate. However, that is on the night shift so it usually is fairly quiet. But I always have my RN supervisor on the other floor that I can call if I'm in too deep, and I have wonderful aides that tend to the residents as much as they can. In a hospital, the ratio will be lower, but that doesn't mean the patients won't have multiple needs all at the same time. A nurse is always needed in several places at the same time. That is why it is so important to learn how to prioritize and organize and do a really good assessment of every patient under your care. There are so many shifts that I have left the building with tears in my eyes, or have gotten home and collapsed into a deep sleep on my couch with my coat still on, but at the end of the day, if none of your residents died or took a turn for the worse, and YOU survived, you did alright and you have one more day of experience under your belt so pat yourself on the back :) Many of us forget, in the heat of the moment, that we are HUMAN and we are doing our best at that moment. In nursing, or any medical profession, it is a CONTINUAL learning process. We will never be prefect. We will always have days where we feel like we are drowning because "people are messy". You can't predict when Ms. Jones is going to get a UTI, or when Mr. Smith is going to have a stroke. But most of the time, once you learn your residents and they form a connection with you, you settle into a norm. Nursing is hectic, but it is one of the most rewarding careers EVER and I am thankful every day to be a part of it! :) Good luck to you with whatever you do, and always believe in yourself!!

I'm wondering what school you went to, imanedrn, that you came out into your first job so fast and efficient, full of confidence too... I'm looking into schools and want to go to a top-notch school so that I don't read a post like that on here about myself

OMG, I don't know what to say about those nurse's notes! At the LTF where I work, we have regular inservices on documentation. Our nurse educator even gave us a written test on it for our employment records. She audits our charting regularly. "Nurse's notes should be a storybook of the care provided to that resident" is what she always tells us. When I enter my nurse's notes, I always remember that and I make sure I include all the interventions and if a resident has a specific complaint that sounds like a med. dx, I put it in quotes (like: resident states "I think I'm having a stronke") to cover my butt. Remembering to make it a "storybook of the care provided" helps me to remember to dot all the i's and cross all the t's in my notes. I describe colors and hues of bodily fluids too! I may have a longer note than some other nurses, but at least when they read mine, they feel like they were there and saw it themselves! LOL

I wish I only had one resident on my assignment--I actually have a handful like that. I spent half of my shift literally running after the one lastnight, pulling him out of everybody else's rooms and restarting the IV that he keeps pulling out of his arm. When we medicate him, he gets worse and manages to get out of his chair or bed and falls every time. I feel very bad for him, can you imagine how hard it must be to feel so confused all the time and nothing makes any sense? But it is very trying to have to pass meds and tend to 30 other residents while I keep running down the hall after him. It feels like babysitting a 2 yr. old sometimes. He's just everywhere and doesn't stop. I wish there was a class in nursing school on how to handle resident's that are that severely confused while you manage all the other tasks of being a nurse. I'm not a fan of chemical restraints to begin with, but the effect they have on him just re-enforces that for me because it doesn't make him sleep, it just makes him fall and get hurt.

Wow, I really feel you there. I just had my first resident die on my shift, my assignment too. She just took a sudden turn on the daylight shift, and was put to bed and started on IV antibiotics on the evening shift. I came in for night shift and got report that she was not doing so well, but being that it just started at noon, nobody expected her to expire so quickly. I went in to check on her as soon as I finished report, and I didn't like her respirs. I took my stethoscope to her chest to listen to lung sounds, and she suddenly opened her eyes and looked right at me. I assumed that I had woken her and startled her, so I put a hand on her shoulder and told her it was okay, and while she was looking into my eyes, she took her last breath! . I lost it. It was so unexpected. It was my first death. And it was just the two of us and she was looking right into my eyes, and I had my hand on her shoulder. I was a mess for the rest of the shift, and to be honest, I took the next day off to re-evaluate if I can handle losing patients all the time. After a few days, another little lady, about the same build as her, moved into her bed. I still get a chill when I am in the room if I'm in a hurry and just glance at her while working with her roommate. All I can say is, at least she didn't take her last breath alone with nobody comforting her. That is my biggest fear in life for myself, so I hope that I served some kind of purpose to her in that last moment.

I'd like to apologize. I did go on the defense when it was posted that I jeopordized my license. Not every fact was posted in the original thread. Nothing scares a new nurse worse than thinking they could be in trouble. The fact is that I did act directly under the superivision of that RN supervisor at the time. Every action I took regarding my findings as well as hers was under her supervision. She was the one that called it to my attention to fill out the investigative report for the ADON and she even signed off on it. In the end, she didn't totally fluff off my report on the resident, it was that she didn't see what I saw that upset me and prompted me to post this thread. Despite her not seeing the rash, she did stand behind my report to a degree, being that she told me to fill out the report and notify the family. I'm sorry for getting defensive.

Furthermore, the RN did have me call the next of kin to inform them of the rash etc. I was upset that she didn't have the same findings on her "official omnipotent RN ASSESSMENT". That was my only gripe when I posted this thread. Sorry I ever did now....

Thanks to everyone that replies with SUPPORT. Zak, to you, where do you get that I went "over the RN's head" and reported it? If the LPN finds an abnormality on their assessment, we are required, by my facility to fill out an investigative report for the ADON and to chart our findings stating "RN made aware" which is EXACTLY what I did. The RN saw me fill the paperwork out, she knew I had to! My license is NOT nor will it EVER be on the line for me reporting what I see on patients on my assignments. The only issue I have is with people that are on support forums and are so quick to point out "mistakes" and form judgements without understanding the whole story. Did you really read my thread? Just because I referred to it in my thread as charting my "assessment" does not mean that I charted it as "my assessment". Who is the one with the attitude and issues here, Zak? I did not waiver from my scope. I followed protocol. My RN is aware and has no problems with my charting or completing the required form. Wow. You are on some powertrip here with this.

Umm, I'm not sure how you say that I'm out of my scope of practice to chart on abnormal findings. Maybe you are in a different state? But I am obligated to document if there is a change of condition in a patient on my assignment AND report it to the RN for further action. I do have to do head-to-toe assessments, we were taught that in school. I have worked at another facility since getting my license and they too had us doing assessments and charting. When I say that I assessed the patient, I mean that I took vitals, listened to lung sounds. That is absolutely within my scope of practice as an LPN in my state. If it were not for the LPNs doing the inital "assessment" of the patient and getting the vitals to report to the RN, quite honestly, the RN would never have a clue if a patient is going downhill because they are glued to the desk with all the paperwork and they only manage to get to check a patient when the LPNs tell them something is up and they need checked. I thought this forum was for new nurses to support each other, but from your reply, all I get is yet another person trying to make me feel STUPID, and like I don't know my SCOPE OF PRACTICE and I'm jeapordizing my license...not what I really needed and you are wrong. I'm within my scope and I'm done with this forum thanks to conceited know-it-all jerks on powertrips like YOU.

It's common and legal. Most facilities (the ones I work at) do it for census reasons. Every LTC facility I have interviewed with admits without hesitation that they over-hire on purpose. They have to make sure if a nurse calls off, takes leave, etc that they are staffed--they don't want agency in their facility. But for as many times that I have been sent home, I get called in on days off or asked to double when the census is back up and admits come all at once. It's the way it goes and the cycles end up making it all flush out in the end. Sometimes, they will let the extra LPN stay and do primary care if she wants to, but if she chooses to go home, she can get paid for at least 4 hours with her paid time off (union policy). I work in PA also.

Can you imagine what those poor souls in pharmacology school have to go through? The pharmacist on duty is my BFF for 8 hours every shift LOL. I have a friend that is a pharmacist and any time I call him with a random drug question, he has the answer in seconds--I just don't know how 1 brain holds that much info. Bless them all!

I wish I knew where this rumor started. I've been hearing it for about 10 years now--I just got my LPN last month. I don't know why people say LPNs are being phased out, but it isn't true. It can be difficult for an LPN to secure a position in a hospital, but LTC facilities, school nurses, and yep, even doctor's offices still hire LPNs by the drove, every day, all over the country and in Canada. I don't see how they can ever "phase out" the LPN position as long as there is a demand for healthcare services--we are cheaper than RNs which means, if they don't need an RN for the position, they will hire an LPN to save the buck. Go to school and get your LPN. You will find a job without any problems.

Yess, we were drilled about our meds and the actions, therepeutic ranges, side-effects, contra-indications....yada, yada too and there were days that I said "wait, I am in nursing school, NOT pharmacology school, right?". There was one time that as I was pulling my meds to pass to a pt, the instructor asked me what it was for and it was a BRAND NEW med to me, I had no idea--I told her that, and she handed me my med dictonary and told me I could come back and pass the meds to that pt. when I knew what it was for and it's classification and side effects. I was peeved! Every day, on every med we passed, we had to write out a "med card" with everything to know about that med (including non-formulary name) and hand it in at the start of the next clinical day. I hated it! BUT, it was ABSOLUTELY necessary because when you graduate and get a job in a SNF, you are going to be passing medications ALL day, EVERY day. Like 20 pills at a time to some residents and you will have 20-40 residents to pass pills too--I'd hate to not know anything about the meds I'm shoving in their throats. It helps to know they need their pills crushed and the MD just ordered a pill that can't be crushed. I loved my insturctor, but I did call her the Medication Drill Sargent because she was hardcore about it :) I thank her every day that I go to work.

I just need to vent and see if I'm the only newly licensed nurse that has been made to feel like a complete Idiot by their superior nurses. I graduated LPN school in December as valedictorian of my class. I passed my boards with the minimum number of questions. Prior to becoming an LPN, I worked as a Medical Assistant for 14 years. I just came off of orientation at my new facility. I work midnights and there are a lot of challenging nights for us with the sun-downers etc. It usually seems happen that once one starts climbing out of bed, they ALL do and the 2 LPNs and 1 RN on duty quickly feel overwhelmed with chasing residents back to bed or doing one-to-ones and/or filling out incident reports on top of our "normal" duties for the night. I can understand that when a resident has already fallen out of bed and possibly injured themselves and needs sent out to the hospital, the last thing the RN wants to hear is the other LPN report to that she has another sour resident. HOWEVER, if this were to happen, for the RN to brush that LPN off and tell her she is mistaken in her assessment findings makes that newly licensed LPN feel so stupid and doubt herself! I had a non-verbal patient that is completely bed ridden and contracted in all 4 limbs. The previous shift reported that he was running a low-grade temp off and on but seemed okay. So I go in and check his temp which is normal, and decide that something might be brewing with him so I better look into it...I do a quick listen to the lungs and hear wheezes bilaterally. Then I notice a rash on him. It was not an obvious, blazing rash, but the rash was on the majority of his body. Thinking to start with the simple, I remove the extra blankets from his bed in hopes it is heat rash. Then I take my findings to the RN. When my RN follows up with her assessment on it about an hour later, she comes back and reports no wheezes, no rash. "humpf, well, maybe I'm stupid and don't know my lung sounds, and guess it was just heat rash...but it was on his face and head too...?" so I promptly go back to his room to see for myself, and....I STILL SEE THE RASH ALL OVER, AND I STILL HEAR THE WHEEZES! So I quietly sit down and decide to chart on it anyway to cover my butt, then I fill out an investigative report and put it in the ADON's mailbox for the morning. When I gave report to the oncomging shift, I informed them of MY findings and of the RN's findings. When I came back on for my next shift that night, that resident had been sent out on daylight and admitted to the hospital with PNEUMONIA. I asked the RN that sent him out what made her send him and she said "He had a funky red rash all over him and he had wheezes and a low-grade temp so I just figured I better send him". Well, whadya know? Somebody else saw my mysterious rash? This is not the first time this has happened to me and it isn't just with one RN supervisor! They all know I'm a "New Nurse" and I really feel like my assessment findings are not being counted on as accurate and it's making me MAD!! When I report something and get fluffed off, I want to tell them "Look, I know I'm a newly licensed nurse, but I AM A LICENSED NURSE. SBON felt I have enough knowledge to provide safe NURSING CARE so please don't dismiss my assessment findings just because I'm new. I may not have seen and done it all yet, and I realize that you have been doing this for however many years, but maybe possibly at some point, we might cross something that you haven't seen in awhile and it isn't fresh in your head, but I just learned about it in my schooling and it's still in my memory bank so maybe I might catch it, and you might not--THAT'S OKAY!! We are supposed to be working together to provide high quality nursing care to every one of our residents. If you ignore my assessments and reports, that can't happen. I need to know you trust me as the nurse that I am!". Being a Green Nurse stinks! But one thing is for sure, the next time I find something abnormal and my peers try to dismiss it "because I'm a new nurse" I'm not going to back down! I'm going to jump up and down and flap my arms and yell "Let's go assess the resident together because I'm sure I'm finding something that needs a second look!!!". How could I let somebody make me doubt myself? A rash is a rash. It is either there or it isn't. I've listened to enough lung sounds by now to know wheezes now too. It would be kind of hard for somebody to say they see a rash and have it turn out that there isn't a rash so why did I let her let it go? I just need to stand up for myself and earn their trust.

Demerol is best. But toxicity is an issue with elderly and Demerol.

I had to remove my plain analog watch too. And I had a terrible cold so I had some tissues in my pocket to my sweater and they made me throw them out and take some from their box right before I entered the test. I had to get fingerprinted 3 times and they took palm prints of both my hands AND took my photo. Talk about adding to anxiety going through all that and the little pat-down they give you! Geesh! I was so nerved up by the time I sat down to start the test, I almost forgot my own name. LOL.

We learned it as "MOAN". It is just to help you remember what the interventions are--not the order. I would go with O2 first. Oxygen/airway ALWAYS pirority. Never anything before airway. Remember that and you will be fine. If they aren't breathing, they aren't perfusing so pumping nitro and morphine into them won't help because it won't get to where it needs to go to work. :)

You absolutely have to be able to separate your personal feelings from your profession. When you walk through those doors and take report, what happens within those walls STAYS within those walls as well as whatever goes on on the other side of those walls can't follow inside. The goal within the healthcare setting is to help the sick heal. If you can't keep personal from affecting professional, you shouldn't be a nurse. I run into patients of mine from the ob/gyn office I worked at for many years and some of them I got very close to at the office, within that context, however, when I bump into them in public, I also try to avoid them noticing me, or will avoid eye contact unless they acknowledge me first, and then I make ABSOLUTELY no references EVER as to how I know them. I also don't intruduce my husband or kids to them. Sometimes my family feels I'm rude to do that, but I really care for my patients on a nurse-patient level and would NEVER jeopordize their trust as their nurse. It's just the right and respectful thing to do.

There is NO way to determine what kind of questions you will get on boards. You may get a lot of OB questions while the person next to you gets prioritization, and another may get an even mix of everything. The computer assess YOUR INDIVIDUAL level of knowledge. So only question 1 is pre-determined. After that, it all depends on how you answer each question. If you get the question right, the level of difficulty goes up, if you get it wrong, it goes easier. I would just focus on your test-taking strategy and how to guess when you have no idea what the correct answer is...attack the questions! If you try to study for categories, you will overwhelm yourself and have a heart attack with all the studying. Good luck.

I would also include the rate of the infusion.

Yup, the prototypes. DIGOXIN! LASIX! ASA, Dilantin, Haldol...those are the ones I'd focus on. And for the love of all things Holy, know your Dig levels and don't ever forget it. Toxicity sxs of it too. You will need it many, many more times.

Humpf! Is this just your school's own policy? My school did the ATI tests as well--never told us they wouldn't release info to boards if score on predictor wasn't high enough. I know there were people in my class that had to retake the ATI predictor because they didn't make the cutoff but they are happily licensed and working at this moment. I'd call the board. Let me know--I'm curious to know more about this. Good luck.