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tyvin BSN, RN

Hospice / Psych / RNAC
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tyvin is a BSN, RN and specializes in Hospice / Psych / RNAC.

Graduated Cum Laude OHSU 1995'

tyvin's Latest Activity

  1. Judgemental...those doses aren't anywhere near what I've seen. I've worked with nurses like you and I come on shift to find some select patients who are suppose to be on routine pain meds writhing due to the attitude that you know better. You would mean to have me believe that in over two years as a med-durg nurse, this is the first time you ran into this situation? Me thinks not. You labled her the minute you saw her meds or heard from report that she was an addict. Was it fun playing God? Did you and the other staff laugh with the power of gossip over this human being at how mighty you were and what an addict she was? Were you patting yourself on the back every hour you didn't comply with her request? When she was screaming and begging; how did the power of control over someone you would regard as an addict feel? Did you chart her screaming or did you infer you own interpretation or just check off without leaving a note? Some of the rugged responses against your proud post of action were rough, but I agree with them and they are in no way connected to my response. Your post has allowed me to come to a decision that I've been pondering for a couple of years as this sites population slowly changes to people like you. You didn't come on here for advice; you did this so others could praise you. Thank you for opening my eyes...I could have been more vitriolic in my response, but I believe one day you may grow up. ...
  2. tyvin

    Long Term Care Stigma

    There is stigma but as far as being bored at a LTC job; that was my first biggest laugh of the day. Maybe on nights like any other place and it will definately depend on how many residents you're assigned. Don't think you'll get lots of training either. It's the impossible load of people you have to deal meds to (if that's what they have you do). Being charge is no different...I can remember I never took a break for lunch or went to the bathroom until the shift was over. So, it depends on your state and the place you work. I remember this one time when no one could cath this poor 86 year old man (monthly cath change). I was charge and no one came and told me about it until they drew blood maybe an hour or more later attempting to put the foley in. The floor nurse finally comes and gets me, I go in the room and see this man who is profusely sweating has an abd extended like he is going to burst and looks into my eyes with pure desperation! I know this man; he's a slim guy with no belley and he can't even talk at that moment. I called 911 and had him transported to the ER stat (I got in trouble for it too, but I would do it again). Later my friend from the ER was telling me how the ER RNs were putting us down and laughing as they admitted him; how we couldn't even cath an old man until they couldn't do it either. It turns out the ER RNs had to get the doc and of course the doc figures out why no one can cath this guy. His prostate had grown so large that when the foley was introduced it would stop at the prostrate and just coil and coil around (I hadn't tried to cath him; it was far too out by hand by than). They have special foleys for these types: it's called a coude catheter designed for enlarged prostates. The catheter is stiff with a special point to get past the tight spot. My friend said the doctor got 1800ml's out of the guy! After that I ordered coudes and had teaching done. We all can learn but that was over 20 years ago. Don't think you will be sitting around and don't be shocked when they give you 32 patients to care for at once (that includes giving meds, doing the wound care and charting). I never bothered with the CNAs taking vitals, I just did my own when the need arised when I had to go on the floor (they already have way too much to do). It's best IMO, to have your own equipment. LTC places pay better or even with the hospitals to retain good staff but the turnover is great due to the hard work, low moral (sometimes) and overload in my state. Location is important as well. Know the code status of your people and how they take their meds. Ask the CNAs; they know and it will save you a lot of running around looking for red velvet pudding (some resident's can be very picky and have a ton of meds to take). If you're a charge; it gets real complicated for awhile. Hopefully you got a good place where camaraderie flows. It is imperative you establish a good relationship with the CNAs. That doesn't mean to let them walk all over you but have limits. Know your states regulations rules per your license for delegating tasks. Hopefully you'll be a patient advocate as some of those LTC places aren't concerned with the population and cut corners that can be less than desireable for the resident (they call them residents, not patients, because the people live in the home). Look up some of the posts on this site about LTC; it will be an eyeful. Hopefullly you drew a good card...let us know how it works out. Good luck :)
  3. tyvin

    Memory on the job

    Unless you have some deficit already, this all takes time. It's like any other job. Think of being a waitress...are you going to memorize the menu and all the stuff they have to do and if the chef will substitute and all that in 1 day (I've done it and there's tons of info you have to remember)? No way! Same thing with nursing; once you get comfortable and know what's happening, it will come. When I use to bartend prior to nursing people would come in and I would remember them by their drink. I don't think it has to do with good memory vs bad memory. I believe it has to do more with familiarity of the subject and your surroundings. You're new so you want to impress. Write things down and eventually a system will come to you and in 2 years you can look back at this quesiton and help others. Once the confidence kicks in, things will also definitely get better. It also depends on where you work and in what specialty. Know your scope of practice per the state you're working in. I remember people by their meds and diagnosis. Right now it must seem like everything is buzzing right by you but it will all be good once you get familiar with the job...you'll be fine. :) The biggist critic of your work is yourself.
  4. tyvin

    Can you refuse to give care to a resident in LTC?

    It would appear that none of this behavior is being put on the MDS or else the behavior would have triggered a care plan/action for it. What is the MDS coordinator doing about this? If the behavior is not being put in the MDS that is a big no no...big. There are codes for all this type of behavior and it sounds like the MDS coordinator doesn't know any of them (refer them to the RAI manual). That should be seen as a joke but these days I don't know. It also depends on how your facility does the MDS as well. If the nurses are filling out the MDS they should be filling it in correctly (this is why I dont' like the system where staff fills out the MDS instead of the MDS coordinator). It isn't the job of staff to fill in the MDS document. Places do that so they only have to hire one MDS coordinator that does all the residents which is impossible as seen at your place for instance...why isn't this behavior on the MDS? You have rights and he is not entitled to emotionally abuse anyone he want to at his convenience. Write out a detailed incident report everytime this guy emotionally or psychologically abuses you. This is why I work for union places only. You'ld have a union rep and a union lawyer to assist in your dilemma.
  5. tyvin

    Percussion question

    We were taught percussion in my nursing program and expected to employ it. It's part of the total examination of the client/patient and lots of info can be gleaned from percussion; create a baseline as well. I liken it to a skill of listening to the heart. Like everything else; if you don't know what it's used for or weren't taught, than you probably don't understand it's significance. Percussion was expected to be employed during our final physical before graduating as well (the one you do in front of your instructor for a grade). Auscultation, palpation, percussion, the history, objective and subjective analysis.; etc... It's all part of a physical and at other times apporpriate most definately. Isn't the point of a physical or assessment to detect possible conerns that further testing can determine. Percusussion and palpation aren't used enough in my opinion. :)
  6. tyvin

    Can you refuse to give care to a resident in LTC?

    This needs to be care planned. Always two staff when givng assitance and your boss has the right to fire you. So what...you just throw the other nurses to the monster. Your facility took him knowing full well the behavior and now it's their responsibility to take care of him. Sounds like he doesn't like being there.
  7. tyvin

    They were in bed together.

    SNFs are considered patient homes now...I though that was LTC, AFCHs, and AL. When I first started out I was a charge in a SNF (Blank on earth) and it wasn't their home. The patients that transferred to the SNF I worked in (exclusively SNF) were not ready to go home and still needing 24 hour nursing intervention but had overstayed their welcome at the hosptial ortho floor, whatever floor in the hospital so Voila; SNFs were born as opposed to having some beds in LTC deemed skilled beds (which they still do). Hips, hearts, psych patients they were trying to figure out where to put because med-surg wouldn't take them and the psych ward was filled, the whole gamut of post operative patients, wounds, anyone with anything where more teaching was in order, PT, OT, etc...; the whole ball of wax. Could you enlighten me about a SNF now becoming a patient's home. Is this like "While you are here; consider this your home...(give me a bag). I have found people in all kinds of compromised positions (no pun intended). One of the places it's an absolute no, no is the inpatient psych wards. The law for a person to not have capacity is very high level of proof per state. I've seen full blown cat ladies with dementia change their wills at the end right before they pass and though challenged in court; it is still legal unless you can prove the person did not have capacity (very high benchmark). As long as that man understood where he was, what he was doing, who he was doing it with, along with the consequenes of his actions...like the final outcome (come is not a pun) than he's legal; unless your facility has a policy in place that addresses this issue and basically says patients can't have sex in their rooms. If that is the case, patients need to be informed. Now there's another bunch of paper work and careplanning. Or: you could just slip it in (I can't help myself) the patient's rights and responsiblities. There's also undue influence and insane delusion; did he appear in distress, or the women for that matter? Later
  8. tyvin

    Registered Nurse Salary Purchasing Power Across States

    I think we all know that state taxes, federal taxes, health insurance payment, social security taxes, medicaid taxes, etc are going to be deducted from our checks. The more you make the the more they take. In my state; state taxes are high, but we don't pay for many things like the small number of states that have no state tax. When I visited my mother in Wa state I was shocked that she paid for her own garbage pick-up, the fishing license I got my son for salt "and" fresh water fishing was the most outrageous thing I"ve heard of. That's beside the point. The point is this is an article where they took a sample from each state of new grad and older nurse salaries and averaged them. So the new grad shouldn't expect to go to one of these states and get the projected salary shown per state. Maybe in 5 to 10 years depending on how this article did their sample size per state and the state itself and of course there's location, location, location. You could live in the same state and in the big cities get $68 per hour and than not 50 miles away in a little town be offered $22 per hour. There are many outliers to this study that the average RN should be able to calculate. Of course you don't get your whole check...I was lucky they only took 33% of mine after I quit doing overtime. It is what it is. Now maybe some of you will understand when I get angry how our government spends our money...because it is our money they are spending. Now if we had a system like Sweden where the people acutally trust their tax athourity that would be OK. But we all know WA DC is crooked and the IRS is bull. It's astonishing what we have let this country become.
  9. tyvin

    Running into former patients

    Oh please, since I worked in an inpatient psych ward I ran into my former and frequent patients all the time in the grocery store on the little island I lived on. They would wave wildly and I would give a little wave back and leave stat. One time this one guy actually approached me and I said since he was a prior patient I couldn't talk to him due to hospital policy but next time just wave and I can wave back...he understood. I know of many famous and not famous people who met while hosptialized or working together at a medical facility. How about the LPN in the psych ward I worked at marrying the psychiatrist. That's after the psychiatrist had an affair with the LPN than got a divorce from his wife of 28 years.
  10. tyvin


    MDS coordinator...it depends on what system the facility you're going to work at uses. I worked at a place that let us have "not" over 24 patients each and we did it all save for sending. You are the team leader. You are responsible for going to the team meeting q morning. It's usually a Monday to Friday days. The place I worked let us make our own schedule. You set up the family meetings, make the care plans, do the 90 days assessments and the annuals, family meetings, etc.... You need to research it. Places want their MDS coordinator certified (most do). They pay for it or they should. There is constant training and updates to the actual MDS form. Than you have the faclities that make the staff RNs do the actual fill out the acutal MDS forms thinking this saves time. It doesn't; than you have one MDS coordnator for over 80 to whatever amount of residents and that is insane! When someone else fills out the MDS form it's been my experience that the many of the busy staff RNs copy from the previous MDS. Hey, how does a night staff RN do an interview with the patient and check their skin head to toe and everything else that's required? Since nights isn't that busy this place I worked gave most of the MDS forms to staff RNs and LPNs to fill out in the nocs and eve shifts...ridiculous IMO. I was asked to be the MDS coordinator (more pay) at this one place that had the staff nurses fill out the actual MDS form and I refused unless they hired 2 others MDS coordinators since there were 84 residents in the facility. CMS has made the MDS process so complicated. It may be overwhelming at first but take it step by step; it will all come together. There are constant changes. I think because we have computers that CMS just looks for things to change so that can redo that darn thing over and over and over...(LOL) As team leader you sign your name to the MDS (minnimum data sheet) and you are responsible for it all. You need to check the all sections to make sure the people responsible for sections filled it out their's correctly: psych, activitity, diet, medication review, mental status, etc... get my meaning here. I had 2 years experience in LTC/SNF when I started as a MDS coordnator but like I said, I worked at a very good place with a doable resident load. The other job that wanted me to do the job where the staff nurses filled out the form I flat out refused. There's a lot to it but you get your own office (or you should). You're independent. You are the team leader and never forget that. I read things on here that makes me wonder if the MDS coordinator knows the scope of their practice in relation to a job of this sort. If you worked 6 months in a LTC or SNF facility than it would be doable as long as you had someone who would train you. Now days with the EHR it's a breeze as the computer kicks out the care plans now days instead of you having to make them. Many will have to be tweaked and there's lots of vocabulary you will learn but if you get your feet wet now and pay attention it's a great job that is days and should pay more. Look up RAI MDS RUGS. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=0ahUKEwiW-9ux7v_UAhVMwWMKHeqKBAAQFghHMAY&url=http%3A%2F%2Fwww.aanac.org%2Fdocs%2Fmds-3.0-rai-users-manual%2F11115_mds_3-0_chapter_3_intro_v1-10.pdf%3Fsfvrsn%3D6&usg=AFQjCNGe-qgxnHySXazm2J_NyB_Dosq0Vg Some info...good luck :)
  11. tyvin

    "I Narcanned Your Honor Student"

    https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0ahUKEwjTyYqg5fvUAhVQ72MKHY6EB0kQFghHMAQ&url=http%3A%2F%2Fwww.who.int%2Fmediacentre%2Ffactsheets%2Ffs310%2Fen%2F&usg=AFQjCNGjdVb6Z5NNC8FaHkoqY6wjXW-9jw More current and globally.
  12. tyvin

    "I Narcanned Your Honor Student"

    I just found out that my step-brother is on disability. Why...he can't quit putting food into his mouth. He's 400 lbs and brags he gets to sit home and eat. There are many more examples of people that have a disease that they cause so please think about it. Even cancer...the majority of hospice cases I had one year were nearly all lung cancer. Can you tell me what the number one killer in the United States is? Heart disease or CAD. Yet we shovel that meat and meat by products down our throats heart related disease occurs. I like to tell the story of when I was in clinical and a young women was in for pancreatitis. She was warned if she drank one more time she would die. I wanted to get a counselor, social services or the priest to have a talk with her. She told me no one cared anyway. I was stunned when the nurses laughed at me saying she was a frequent flyer and will die soon anyway so why bother. Yea, many examples of that kind of treatment towards people who are addicts. I watched my mother ignore her blood pressure and eat whatever and drink whenever. There's just too many examples of habitual over eaters, smokers, drinkers, non-compliant with whatever, so their health is failing but that's ok...the doc will prescribe something while the body takes a beating and we all get to pay for that too. The cost of heart disease is huge. So diseases that a person inflicts on themselves are a plenty. :) Frustrating to watch because I know what's going to happen to them. My friend had COPD and A-fib...yep; a beautiful barrel chest and many medications and probably won't see the age of 70. Accidents happen and many times those people are impaired due to age, drug and alcohol use, distracton, etc... I was just involved in an accident where a women just T-boned me out of the blue. She took full responsibility but as I observed her there was something off about her. She was stopped at a stop sign and as I was making my turn (I had the right of way) she was waiting her turn to come out into the intersection but suddenly she just shot out and hit me full force on the side. I couldn't smell any alcohol on her but she was about 350 lbs and had clubbed fingernails, probably in her 50s. There were cars behind me...it was a mess. Everywhere I look I see overweight stressed people. Addicts deserve the same treatment as the ones who know they're killing themselves via bad habits like large portions of food, alcohol, couch potato syndrome and just not caring enough or too lazy to care. Somehow, I think that's worse. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjTyYqg5fvUAhVQ72MKHY6EB0kQFgg1MAE&url=https%3A%2F%2Fwww.cdc.gov%2Fnchs%2Ffastats%2Fleading-causes-of-death.htm&usg=AFQjCNEPXeNGfjHFUG91YZmdHo2ik7lGig
  13. Dear OP, I agree with you but apparently you stepped on a few nerves. Perhaps nerves wrought from overworking in med-surg. I am an RN who worked as a CNA when I was an RN (long story). Don't take the haters to heart. Keep up the good work. Med-surg has always been a challenge for some, especially due to the high patient to nurse ratio. As a nursings student myself, I did clinical at several hopitals and some the nurses worked great together and others not so well. That's the reality. It's really about where you work mostly. For me, I don't think your attitude is holier than thou. Nursing has a wide variety of positions and opportunities but you really do need that first year in med-surg or similar to get the jist of it than go...you must go after it is that you want. Research; there's a lot more to nursing than med-surg but there's also nothing wrong working in med-surg if you like it. Good luck :)
  14. tyvin

    "I Narcanned Your Honor Student"

    Excuse but to add to the comments about fiscal responsibility... The money...do we include the elderly who falls 3 times a week at home and is helped by EMS, do we include the alcoholics that continually go to the ER and get hydrated weekly and go back out and do it again: there are so many examples. I say that the addicts are chosen because people don't understand the disease/addiction and therefore think addicts are disposable. If we can send billions of dollars of aid money to countries and support sanctuary cities and have hundreds of thousands of people cheat the SSDI system or welfare fraud that is blatantly rampid here in America but than point a finger at addicts, what does that say about us. Three strikes and you're out didn't work in the prison system and two srikes and you're out; allowing a person to die won't either. There are so many posts on this forum by nurses complaining they waste their talents on junkies that it's discouraging. Congressman Picard doesn't believe the current theory of addiction as being a disease or why not apply this rule to all scenarios where we waste resources in healthcare? Why pick on the addict? Congressman Picard of Ohio wants to send a message to the world that you don't come to Middleton, Ohio to overdose. That's right Congressman Picard; the addicted people overdosing are doing it on purpose (some maybe but I believe the majority aren't). As a congrssman he has the power to introduce bills to have the drug companies selling narcan to reduce the price...instead let the people die from a disease/addiction? Chief Paul Loli of the Fire Department of Middleton says that 85% of the overdoeses in Middleton, Ohio are first time ODs, and that 15% are the repeat ODs. Tennessee has passed a bill that will be the first state to allow any and all adults to free education at the community colleg level. Wow; many states will follow suite. How much is that costing the taxpayer who (in all llikely hood) already paid for their education and in all probability may have student loans. I say this to compare to the 2 strikes and we won't come because if this anti-treatment of addcits bill is allowed; other states will follow suite. If it's all about the money than use your power in Congress to change the pricing of narcan. Oh, would the drug lobbyist object? How far in their pocket is this congressman? The smart thing to do would be to pass a bill to lower the cost of narcan sold to the EMS community. Where does all the heroin and cocaine come from? Mexico, South America, Afghanistan...how does this all come into the United States? Primarily through Mexico via the Rio Grande River, by coast via boat, submarines, air planes, bribed officials at the border of the Mexico-America crossing, cossing over the multiple areas of the states that border Mexico, persons strapping it to themselves and basic smuggling in general. Some have a theory that the CIA and or the military of the U.S. are smuggleing heroin from Afghanistan. The Taliban banned opium years ago yet our troops protect the farmers who grow it. They say the military is trying to convert the Afghan farmers to grow other crops...ok https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwik_aPJwuvUAhVSxmMKHRY1CyAQFggrMAA&url=http%3A%2F%2Fwww.washingtoncitypaper.com%2Fcolumns%2Fstraight-dope%2Farticle%2F20836192%2Fwhy-dont-we-bomb-afghanistans-poppy-fields&usg=AFQjCNF_qXhz_h8HT60xdSR3wo07ZRdjEg These addicts brains are changed by the drug; the drug tells them that at all costs, to get the drug. Now we're going to legalize premeditated murder against sick persons? They said it when Obama introduced ACA (Obamacare). Death panels...here we go. I've already got many more ideas for t-shirts slogans with this added to the mix.
  15. tyvin

    Flagged FBI Report

    I know a couple people who were stopped, had a bench warrant out for non-payemnt of traffic tickets and were arrested. It's not that unusual in states that still pursue to do this stupid practice. It's just a waste of resources to book the person. My one girlfriend told me she was stopped on a Friday and there was a holiday on Monday so she served 4 days. If that's all it is, than you're fine. Who makes you do your own background check...my goodness have things changed. I see all kinds of things wrong with letting the person do their own background check. If you're good enough you can make your own background check.
  16. tyvin

    Need advice on challenging for a CNA test

    When I got my RN license I was in a state where the island I was on only had 2 hospitals and 2 LTC facilities. Someone had to die before a position was availible. I had to make a decision if I was going to buck it up to get my foot in the door somewhere and I did. I took a CNA job. I had to perform at my license level nonetheless. In my state anyone can challenge the CNA testing. I was in the office and the manager said "OK; let's have you take the CNA testing for certification as a CNA." Uh...OK? The main thing with the testing was; it was a breeze except for the transferring stuff. I had no idea how to do many of the transferring trechniques I was asked to perform but the manager was very helpful and taught me. It was embarrassing that an RN could not transfer the way a CNA is expected to know. The whole experience was humbling and made me appreciate our CNAs even more. This was over 2 decades ago. I worked as a CNA for a year and than was hired as an RN. Now when I see an RN say that's it not their job to do something the CNA usually does, and goes and tracks down the CNA taking longer for a 4 minute task...I shake my head. There are always exceptions to this but usually it's the RN thinking the task was beneath their position. You do what you need to do in this world to make it work. Good luck to you and congratulations of pursuing your goals. Research CNA challenge testing in your state.