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Katillac RN

That's not a pic of me. That's Nurse Ratched from One Flew Over The Cuckoos Nest for you young pups.

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Katillac has 18 years experience as a RN.

Comedienne Brett Butler says of her devotion to her second husband, "You let one dog get away, you're gonna build a taller fence and put better food out."  Translated to nursing, that means employers need to provide attractive opportunities including some combination of compensation, benefits, scheduling, training, and workplace environment and culture. Then, equally importantly, they need to prioritize retaining the staff they hire by actively showing they respect and value the commitment, knowledge, caring and experience of their staff, both seasoned and newer.

It's kind of that simple. There is no nursing shortage, there's a shortage of attractive opportunities for nurses.

Katillac's Latest Activity

  1. Katillac

    PRN nurse forced to take a call shift **NEED ADVICE**

    My advice is to adjust your expectations. You seem to expect that schedulers, including this team leader, will be considerate, reasonable, fair and/or interested in your priorities. Some may be, but others will simply look at you as a resource, a possible plug-in for a hole that's hard to fill. That's why and how this person did what she did. I agree with others; as a PRN, the most useful response is, "Yes, I'm available," or, "Unfortunately, I am unavailable." Not sorry - you have nothing to apologize for. And when someone says you must come in, see above. No explanation or justification after the first time, if you even elect to give a reason then, which I don't recommend. If you elect to meet with the director, I'd suggest you clarify with her if there is another response from you under the circumstances that would be more effective. In all likelihood she understands that schedulers sometimes exert more pressure than staff would like to get shifts filled. They get to ask. You get to say yes or no; those are the roles of the scheduler and the PRN.
  2. Yep, for sure there's more we don't know than we do. All I've been able to glean from other stories is the student was 14 years old and the school has denied responsibility. It could have gone down so many different ways. It could be that the nurse (and you're right, it isn't stated whether RN, LPN or other) exercised perfect clinical judgment but the parents were approached by a lawyer who smelled money to be made. Or it could be anything else, we don't know. In no way am I suggesting blame. I guess I should have said my point in posting this was I have mad respect for school nurses who need to navigate these waters, which can become life and death matters or be a routine assessment and back to class, every day. I was thinking it's such huge responsibility to manage the well-being of hundreds of kids, especially because you're pretty much a single practitioner.
  3. I feel horrible for everyone involved in this situation. LAKEVILLE, Minn. (FOX 9) - A family says their daughter suffered a traumatic brain injury and is now in a vegetative state after her school nurse in Lakeville, Minnesota didn't treat her asthma. In a lawsuit filed on Thursday, the family's attorneys say the nurse at McGuire Middle School failed to properly evaluate her and sent her to gym class where she lost consciousness and had to be taken to the hospital. Now, they say she will require caretaking services for the rest of her life. Leading up to the date of her medical emergency, the family says their daughter Aaliyah had a long history of asthma with severe exacerbations that required medical intervention. The school district and nurse were aware of the severity of her condition, according to the lawsuit. http://www.fox5ny.com/news/family-minnesota-girl-in-vegetative-state-after-school-nurse-failed-to-treat-her-asthma
  4. Katillac

    Aide Documentation - Rationale?

    I'm not technically tasked with the role, but to protect myself and the organization I feel I need to, as this aide's supervisor at times, direct the aide away from inappropriate charting. I say protect myself because the aide often charts details that are very different from what the nurses are charting about the same interventions. Unfortunately, due to the EHR we use, the aides often don't have appropriate check boxes and data fields to use. The PTB tell them "Just check off what you do and fill in the blanks", but depending on how the case manager has set up the care plan, the aide may or may not have anything to check. So maybe the answer is to just tell the aide not to chart on what the nurses do and when the PTB get around to auditing and giving feedback they will correct what they want to, but I won't be at risk in the meantime. Thanks for helping me work it through!!
  5. If you don't have a prescription for what they found, it's a failed test. It doesn't matter why. Some employers report to the BON, it doesn't appear to be consistent even by state. If you got notified you failed, they already confirmed it positive. If they report to the BON, they may or may not take action, it depends on the state and other factors. I wouldn't reapply for this position, it's poking the bear as far as I'm concerned. I would surely talk to a lawyer. It may be that steps you take now will affect your future. You don't say what state you're in; following is a link about Florida. Also check out the allnurses board Nurses/Recovery https://www.joneshealthlaw.com/failed-pre-employment-drug-test-for-nursing-position/
  6. Katillac

    Aide Documentation - Rationale?

    Couldn't agree more, but it's not my call.
  7. Katillac

    Aide Documentation - Rationale?

    Can some of you wise ones help me with the rationale for aides restricting their narrative notes mostly to documenting care plan tasks they've performed? I've come up with some dont's, but I'm stuck on rationales. For example: We never document care someone else gives. (The nurse put him on the pan.) Assessments, other than objective data requested, are outside your scope. (He was breathing really hard. Her leg looked infected) Findings when appropriate need to be as specific as possible. (He didn't get very far on his walk. There wasn't much in the urinal.) Opinions and explanations are not a part of the medical record. (He smelled like a margarita when he came back. He didn't like what PT told him. He was pissed because he wanted his special mug but dietary took it. I didn't see her light because I was showering someone.) And my favorite: Writing pee and poop is unprofessional, the words are urinate and defecate. This last one, I don't even know what to call it. (I took him to the sun deck so he could get some fresh air. Her family came in with their own snacks and soda and talked loud. He was watching Fox news until his wife made him change it. He took communion.) Soooo. . . what do I use for rationales when I counsel that we don't chart the above statements in parentheses?
  8. Katillac

    Two Job Offers

    If you think the vitamin people are shady and unethical, it's a pretty good bet potential employers will wonder the same thing when they see it on your resume. With the competition for nursing jobs, you can't afford to carry the water for snake oil salesmen. And I get that you are desperate, but this is out of the frying pan into the inferno. Doing work you believe is fundamentally wrong may sound OK in comparison to what you're doing now, but it won't feel anything like OK in the long run. As for your partner, anyone who encouraged me to do something I feel is wrong because it will look good on my resume wouldn't have much credibility with me. Just saying.
  9. Katillac

    RN Visits

    Your state board isn't likely to weigh in on the standard of care for a hospice patient. It's Medicare that writes the standard, or the conditions of participation. Your agency does NOT meet the standard at all to simply ask about satisfaction. Here's the specific wording (COPs link at the bottom): Hospices are required to update the comprehensive assessment as frequently as the condition of the patient requires, which may be more frequently than every 15 days. The hospice must ensure that each update is completed no later than 15 days from the previous one. Hospices are not required to complete, in full, those documents that they identified as comprising their comprehensive assessment every 15 days, although hospices are free to do so if they so choose. They are required to identify and document if there were no changes in the patient/family condition or needs. As you can see, the reg says the comprehensive assessment must be updated no less frequently than every 15 days, though not necessarily completely redone. Additionally, the IDT must meet no less frequently than every two weeks and determine if the patients needs are being met as outlined by the services specified in the plan of care: Standard: Review of the plan of care. The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) must review, revise and document the individualized plan as frequently as the patient's condition requires, but no less frequently than every 15 calendar days. A revised plan of care must include information from the patient's updated comprehensive assessment and must note the patient's progress toward outcomes and goals specified in the plan of care. If the nurse doesn't assess the patient, how can it be determined whether the needs are being met? How can progress toward goals be determined? Let's say the patient has wounds. If there's no assessment done, how can it be determined if it's healing, staying the same or getting worse? When they have a Medicare survey these will represent significant deficiencies, but that will be against the agency, not you. With that said, your agency could well throw you under the bus, but it still would have fallen to them to supervise you appropriately;ty. However, anyone can report a nurse to the state board, and anyone can sue if things go Dixie. But prevailing against a nurse is a whole 'nother matter. But bottom line, you know in your heart this isn't right, that it's not good care. If you can't get the powers that be to see that, you may want to move on. https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol3/xml/CFR-2017-title42-vol3-part418.xml#seqnum418.62
  10. Katillac

    Brand New Case Manager Here!!

    No idea how useful this will be, but maybe check out this allnurses thread? https://allnurses.com/interqual-milliman-training-individuals-t524195/
  11. Katillac

    Advice from experienced nurses please

    It might help to think of it from the perspective that not all enter the field for the same reasons, and not all have the same perspective. Some CNAs see the work as a valuable team effort, others see their day as a series of tasks they must perform and prefer the list be short. Some are experiencing compassion fatigue or burnout. Like nurses, some see it as a paycheck, some see it as a calling and most are somewhere in between. As supervisors, nurses need to balance supporting other team members to the extent possible while ensuring the work gets done regardless of their take on it.
  12. Katillac


    If you read the OP, you'll remember that the in service she talked about was given to nursing staff. They, as well as the group of RNs shown the hand drawing of a bronchial tree, already have a basic understanding of patient care and patient safety, which you believe most mandatory meetings are about. And even when shown to a group of employees across the levels of all disciplines, cutesey language and pictures are demeaning to people you want to behave like adult professionals, but are being treated like children. And honestly, the pizza and gratitude thing. . . let me save you some money. If you want me to believe my time is valued, help vet the in services and see to it that we don't get treated like children by the presenters. Stand up before the presentation and say sincerely that you appreciate that people have come in on their day off, or come in early or stayed late. Explain to us what value you hope we'll find in the material being presented. Ask the attendees for their feedback, and then communicate to the attendees what you learned from the comments and how it will help shape future education. But a slice of pizza because it's cheap - and as you explain, easy - makes me feel NOT valued like an adult professional but rather like the toddler given a cookie to keep him placated and quiet during church.
  13. Katillac


    That's . . . disgustingly and appallingly insensitive. Faking a trach demeans every person who has one. To do it as a joke, well, I hope this presenter got burned to a crisp in the feedback.
  14. Katillac

    Would you be insulted?

    I think you have a pretty good understanding of why you haven't been asked; the nurse educator has a different opinion of you than your co-workers do. To confirm that, you'd need to in some way confront her which may not have a good outcome for you. Why push for an answer that may carry consequences when you already have a good idea of what the answer is? Precepting takes time and energy. With the high turnover in nursing, many experienced nurses are getting pretty burned out pushing that revolving door. On the other hand, I wouldn't thank my lucky stars, either. Teaching has, for me, been a great way to bring together my own knowledge of something and point out places where I need more depth of understanding. But I'd leave it alone and continue doing your good job. The nurse educator will come to see - or she won't - that you've grown in your practice.
  15. Katillac

    Advice from experienced nurses please

    I think you're doing great at 5/6 months in. Here's why: You know what you don't know and you're fixing it. You have developed an intuitive grasp of the big picture, and you're getting a good sense of priorities. You take responsibility for your mistakes, and learn from them. You feel like you're "barely making it" each shift, but you ARE making it. I hope you don't mind if I give you some suggestions. You need to start caring less about what the CNAs think. In your career you are going to deal with a lot of people who have all kinds of motivations. Some will want to do as little as possible and still get paid. Some will spend a good part of their shift comparing the amount they have to do with you and others. They aren't all going to have your professional values, leading them to agonize over every missed task and mistake. Some will conveniently "forget", others will actually forget; it doesn't matter, it's your job to pleasantly remind them. They may or may not get how busy you are and want to help you. They may be resentful and think you are making work for them. That needs to be OK with you because you can't control how they think, but you can direct their actions. On the other hand, some will be a pleasure to work with. Maybe just on some days, but still. . . Validate the hell out of them when they do perform well. Tell them you really enjoyed working with them. Tell them you appreciated the good care they gave. Tell them it's nice to work with someone who tries to give such good care to OUR patients. Celebrate with a high five or a "toast" over a glass of juice or water something that went well. Congratulate yourself and others when things go well. Some things to reconsider: If you already have a high turnover of aides, why not give names to the director of the ones who are not pulling their share? (After, of course you have talked with them and see no change) If a bad actor stays, you have no chance of getting a helpful assistant. If the bad actor leaves, the next one might be a bright and shining star or not, but there's a chance he or she will be. Also, reconsider how much help you are asking for and how much you delegate. If you are hustling and someone else is not, you must delegate or your time management will suffer. If you think you need help, ask yourself if you can do it and ask for just the help you need, no more and no less. If you're in a supportive environment the other nurses won't mind your questions and requests for help because you are being thoughtful about it. Even if you're in an unsupportive unit a nurse's failure to ask for help when needed can cause bad outcomes for patients. Which is worse, asking for help or seeing someone with a bad outcome because you didn't? Lastly, please consider sticking with that unit for at least a year. If you transfer, you just have the standard learning curve of a new unit PLUS the new grad learning curve. That's the frying pan into the fire. This is too long. Sorry.
  16. Katillac

    Case Study: HIPAA violation or not?

    It looks like photos of wounds aren't PHI because the wounds themselves aren't permanent, so they aren't considered identifiers. So no HIPAA violation, but if taken without consent and disclosure how the photo will be used is against my personal and professional ethics. From https://www.novarad.net/hipaa-and-your-patient-photography/ "What makes a photo PHI? Not all patient photos contain PHI but are identified as health information. A patient photo is considered to contain PHI if it has any of the following patient identifiers: Any portion of the face Tattoos Name or Initials Birth Date Social Security Address Date of service Medical Record Number For patient photos containing PHI, HIPAA does not require a patient release if used in your health care operations (training, teaching, etc.). But photographs used in external settings (conferences, seminars, etc.) Cannot be used without patient consent. Patient photos that do not contain any identifiers, do not require approval."