ms40

Sorry that I took so long in getting back to you. I hadn't run out of time, I had only been answering questions for about 15 minutes. Because it it was such a short time, I figured that I had done so badly that the program kicked me out but, thank God, I passed. As for the time it took to get the stuff in the mail, it was about two weeks. That may have been because it was late November, rather than right after spring graduation, and so the BON was not so busy . . . So, how did it go?

I work at a state run facility for the developmentally disabled. 100% of our residents have guardians/conservators. The patient may refuse any med or Tx, but if as Explorer noted, the situation is serious enough, the meds can be given IM against the wishes of the pt. I am guessing that much depends on where you work, state and facility-wise. In TN, all the state ICF-MR (intermediate care facility-mental retardation) operate under a federal injunction (bad abuse and neglect in the past) and the rules are strict. To give IM meds we have to consult the behavior analyst or psych examiner who will assess the situation. The BA/PE then gives the okay to the MD/PCP to write the order to administer IM meds. At our facility, this intervention is almost always considered an emergency and we have a case conference with the interdisciplinary team the next business day to discuss the situation. I think that this proceedure is particular to TN and so it may not be the case in your state. I would suggest that you look up the laws in your state and also have a very good look at the facility policies before you sign up to be the only RN for 100 residents. The LPN's should have your back (I am an LPN) I always have my RN's back and he has mine, but we usually work one at a time . . . I would be concerned by the staffing ratios for the care providers. We have one tech to four residents at a minimum during the day. At night the ratio is one to seven (state law). Some questions to consider-What is the average level of adaptive and cognitive functioning? I have found that my pts that have higher IQ's, mild retardation as opposed to severe and profound, tend to have a greater propensity toward bipolar d/o 1 and antisocial personality d/o. This can be seriously problematic and potentially very dangerous. How many people require total care? Are you caring for people with g-tubes, j-tubes, trachs, etc? How many have self-injurious behavior? How many have a history of aggression/violence? What are the proceedures regarding restraints? How does the administration support medical and other staff? The list could go on and on . . . There are many wonderful and rewarding aspects to my work. My coworkers are, with a few rare exceptions, terrifically competent and passionate about serving this population. There are risks involved in any psychiatric setting though, so be careful. Let me know how it goes. Best of luck to you!:chuckle

Hi there- I live in Nashville. I took my boards a year and a half ago. When the computer shut down after approx. 15 minutes (didn't notice the question numbers . . .) I freaked out. About two weeks later, I got notice that I had passed. Don't stress. I'm sure you passed with flying colors! Best of luck to you in your career.:rotfl:

to report all medication errors to state board of nursing. A bit of background: I work in a State intermediate care facility for people with developmental disabilities. We are currently operating under a settlement agreement that is overseen by the US DOJ. As such there are numerous inspections, reviews, surveys, etc., to measure progress made toward fulfilling the requirements of the settlement agreement. One of the most recent problems (approximately a month ago) noted by a particular surveyor was that a number of nurses had failed to sign the MAR after giving meds, treatments, etc. When this was revealed the DON and Chief Officer sent out a memo that outlined a new policy of progressive disciplinary action for making medication errors (not signing is considered an error), which to me, did not seem unreasonable. The memo left off by stating that this particular surveyor would return in a few weeks time to spend more time visiting with staff and residents which I am presuming was a bit of a "heads-up". The surveyor made the return visit and found unsigned MAR's still an issue in some units. Some had been presigned (yikes!). There is no doubt in my mind that there are some big problems. Here's how the administration has chosed to deal with this issue. Yesterday, we received a memo from the DON and the Chief Officer regarding another new policy on disciplinary action for failing to sign the MAR or any other medication error. It is now facility policy to immediately fire a nurse that makes an error regardless of the circumstances. A strict "no-rehire" flag for negligence will be placed in the offender's personnel file and, I assume also passed on to any future employer. The facility will also report any medication error, and the offending nurse, to the State Board of Nursing for investigation. I suppose the facility can make any policy that they like, but this seems wrong on so many levels. What recourse would I have for example, if I get fired and reported to the BON for forgetting to inital the MAR on the 1100 administration of Boost Pudding for patient "X"? I would appreciate any feedback, words of wisdom, etc., that any of you have to offer on this situation.