JoytoWorld

Check placement on Gtube (G-gastric) by pull back by syringe for residual, note amt, then refeed to preserve electrolytes. Chart residuals to track. Orders should indicate what residual amt to hold feeding (usually about 25 mL for ped and 50 mL for adult) wait half hour then recheck. If still up after 2 checks seek new instructions. Residuals often increase when client digestion decreases due to oncoming infection or other compromise. Vent Gtube before feed to release gas. Insert barrel of syringe and hold upward - gas rises. Needs only about 30 seconds to vent. Do not check residuals on Jenunostomy tube (J tube) creates too much pressure.

Unfortunately there is no standard for performing an INTERNAL INVESTIGATION in response to a complaint. Internal meaning that it is performed within the facility. For less than enlightened organizations they can be witch hunts. If your company has a risk manager that is a good sign, that someone will attempt to do a decent job. Law Courts advise but do not require, a PROCESS like this: Complaint received. Investigator interviews the person complaining first, then witnesses, then lastly the person complained about. The investigator then summarizes findings and writes recommendations to decision maker. Brief FEEDBACK is given to the complainer - 'we investigated and action is being taken' or 'we investigated and case was dismissed'. They are NOT supposed to inform the complainer WHAT personnel action was taken against you. Who the DECISION-MAKER is depends on how serious the complaint was. Mild issue decisions usually go to the supervisor of the person accused. The more serious, the higher up the totem pole the decision is made - supervisor - dept chief - risk manager - company attorney - CEO/Administrator. 'Believing you' is nice but does not mean anything if the person making the decision is not the person who made the statement. Also the decision outcome usually depends on how serious the issue is. Judge by DEGREE OF HARM/ INJURY the patient experienced and how important the patient is to the facility (celebrity, doctor's mother, patient's son is a lawyer, etc.). In this case how important the complainer is also computes. The fact that the PA complained and not the MD is in your favor. Degree of harm: A) Did patient experience harm that resolved within 24 hours (ex: BP up and HR down but normal in 24 hours). B) Harm occurred but resolved in 2 weeks (ex: arm painful and numb but normal in 2 weeks). C) Harm occurred and has not resolved. (ex: paralysis, death, kidney failure, etc.). If Harm is C get a lawyer. Remember some lawyers will give you 15 to 60 minutes free to assess your case. Some may ask for $75 to $100 as an initial review - that may be all you need. Get clear on money before you start. Listen to everything they tell you in general and in relationship to your concern. Practice telling your story in short, brief sentences so most of the time is spent with you asking questions or listening to their advice, rather than in you listening to yourself talk. If the harm was "A" they may do investigation, write a report but take no action in relationship to you. If harm was "B" you may see some disciplinary action against you. If so, get a lawyer. If "A" or "B" ask the manager who "believes" you who the decisionmaker is for the concern, if a decision has been made, ask was there any decision made in relationship to you?, if a decision has not been made yet - look at the TIMEFRAME. The longer they take to make a decision the less likely it will be in your favor. "A's" can get wrapped up in a week. "B's" in 2 to 4 weeks. If they ask you to sign anything, pleasantly let them know you would like to consider it overnite first. Then get help. Talk to a family member/friend who was a manager or in HR or who is a lawyer. Check the laws in your State, you may have a right to see your personnel file. If so, ask to see it now and ask again when issue is resolved. Usually you review it with your manager or someone from HR present, this proves you did not alter it or take anything away. If the law allows you to have a copy ask for a copy of your file. If they make a decision against you, the worse their investigation format is (meaning no real written procedure) the better it is for you IF you get a lawyer. Remember, stand firm. Don't let fear overtake you. Trust in Truth, but take every step to educate yourself and to protect yourself.

I was feeding breakfast spoon by spoonful to a tiny, frail, elderly lady who had a smidgin' of dementia. She lightly pushed the tray table away indicating she had enough to eat; then in her sweet birdlike voice, she said: "Thank you Dearie, now turn the tray around and I'll feed you".

Quitting is never a good idea if you intend to continue working and it seems you do. Though I applaud your husband's support. You will always be better positioned for new employ while currently employed, especially if in a sticky situation. MDs can behave badly everywhere unfortunately, so a new company will not guarantee that you do not experience this again.

If no written complaint was filed by the MD about you and it is just talk at this point, you may be able to do what alot of nurses should start doing to nip this behavior in the bud. If the MD has filed a WRITTEN complaint against you it is too late. Then it would be seen as you retaliating against the MD. You can FILE a COMPLAINT with the STATE MEDICAL BOARD about UNPROFESSIONAL CONDUCT. I just researched my State laws, you can do the same in your State. Most of the Laws are now on the internet. Something like http://www.leg.state. (your state initials).us There are Laws (statues) and rules/regulations. Both are enforceable. The difference is that rules are usually written by a State agency and laws by congress. Research under "Complaints against healthcare professionals". Definition: "Unprofessional conduct" means conduct detrimental to the best interests of the public or conduct that endangers the health, safety or welfare of a patient. I would certainly categorize lying about an order as endangering a patient. You may be able to file anonymously. You can in my State. My State also REQUIRES any licensed person to report. In my State the report you file is CONFIDENTIAL, meaning they cannot reveal who filed. Though the MD will probably figure it out. Keep a copy of the complaint report in your own records signed and dated by you. Scan in the copy to your computer records as well. THEN if any action is taken against you by your employer due to the event you mentioned you can CLAIM Retaliation with the medical board/ nursing board or attorney general to protect your job. RETALIATION means that after you exercised a State or Federally granted right or a responsibility, someone with power has done something negative to you, such as had you disciplined, demoted or fired. Good luck. Stand firm.

"I wrote a note and the order to CYA but in reality what this comes down to is my word against Dr. X's." A very real and far too common problem. I've certainly witnessed this type of behavior multiple times in my career. If the patient outcome is other than what was expected or if the patient experienced unfavorable outcome from the MD's orders: a) MD denies order was given b) or states a different order was given, c) or states they were never notified of the patient need. You wrote your note, however if the patient outcome is severe enough I've also seen: d) your note disappears from the record. As you gain experience you start to see the conflict coming. Your nursing judgment speaks to you and sounds an inner warning. For those events I also would send myself an email in my personal email account describing the situation to myself, use initials to describe the persons involved and what my observations were. Stay factual and unemotional in the note. And do it timely. S/he who documents first has the strongest credibility. And that email is under your control and does not "disappear". Also if you know someone you trust in management, give a brief report then or at the end of the shift of your concerns. Add to your email who (in initials) you reported to. As a manager I often advised my employees to add in their notes that they spoke with me, giving my title in the notes. "Discussed matter with DON/supervisor". If you are unionized it would be a good idea to log a report with your representative. Proactively you might have a meeting with your risk/quality manager and submit a WRITTEN request for the institution of policies that utilize some of the ideas you learned here. State that you believe it is in the interest of "patient safety". Once it becomes policy you have the support you need in the future: 1) nurse #1 writes order, nurse #2 reads it back. 2) all doctors must write their own verbal orders if present on the unit. License protection is a very good idea. I've been with NSO for 20 years. It pays up to $25K in attorney fees per event. If an event such as this comes up, submit a report and get attorney counsel (and support) and the insurance pays the attorney. Sometimes all it takes is a friendly letter from your attorney to the MD for the accusation to change to a "it was just a little misunderstanding". But what can you do now? Will do some research.

Regarding MILITARY and the military saying 'freedom is not free' and the 'sacrifice of privacy for safety'... Remember that when you enter the MILITARY your US Constitutional rights are suspended. You have NONE. No freedom of speech ('sorry Sarg, I don't like that order'??). No right to privacy ('waddayamean you won't take the vaccine shot'??). The rights/freedoms are suspended because a Commander needs to have his/her orders obeyed in times of combat and war. It is why the military are tried in their own courts - different rules. So you cannot compare the rights of a US Citizen or of a Citizen of a State Republic, to someone in the Military. Also Conspiracy means 'more one than one person planning to do a crime' and Theory is an untested concept. The term 'conspiracy theory' is often used to discount and to dismiss real arguments based on facts, on personal experience and on history that another does not want examined. It tends to frighten away from discussion, those who do not want to be judged as being less than sane. Freedom implies choice. If all employers require fingerprinting, where is the choice?

Think it through! A criminal SCREEN can be done WITHOUT invading privacy. For what reason would your employer need your FINGERPRINTS? You've already agreed to a CRIMINAL BACKGROUND CHECK by your employer. Most crime convictions in US have been computer logged for the last 20 years. If the individual is still on parole or has been registered as a sex offender that will show in the record. So the potential employer has the SCREEN to find criminal history. [And unfortunately also NON-criminal history in NON-convicted INNOCENT but appearing guilty, ARREST records.] Convictions are PUBLIC record (if convicted you lose the privacy). The investigation was done, the trial occurred, evidence reviewed, the court/jury decided. That is a lot of due process before conviction, even still evidence can be manufactured. Innocent people can still be convicted for having opinions or being in the wrong place, even in this country. So your employer can find the criminals WITHOUT your fingerprints. Screen done. For what reason would your employer need your FINGERPRINTS? NO good reason. They are not law enforcement. Fingerprinting today is a PRE-CRIME CATALOGUE SYSTEM. Back in the day when I first became a nurse it was ILLEGAL to obtain someone's fingerprints UNLESS they were CHARGED with a crime [because it violated the 4th amendment right to be "secure in your person" if there was no evidence against you]. Fingerprints are attached to your body, thus one aspect of "person"; they belong to you, not your employer. An arrest does not equal a charge. [Charge means 'we THINK we have evidence you did this crime.'] ANYONE can be arrested. Arrest simply means 'Halt, law enforcement wants to check this out'. Then they either let the person go or if after the halt, if evidence is found, a charge occurs, then the fingerprinting, trial etc. With Pre-crime Fingerprinting of everyone, you go past innocence, past arrest and go directly to charged. The State considers nursing a privilege, not a right (you have access to others privacy among the privileges). Thus if they decide fingerprinting is necessary to grant that privilege as a way of monitoring access to the profession then the State has that right according to the US Constitution (rights not reserved to federal government belong to the State). However, no one should give that right to your employer. The Court rules that a right not exercised or protected by you is considered relinquished, including right to privacy. However if every employer of nurses requires Fingerprinting, how will a nurse exercise that other right, "right to pursue life" as stated in the Declaration of Independence? Law considers pursuit of your livelihood, right to pursue life, since most have to do something to obtain the means to life - food, shelter, etc. As long as the majority 'have nothing to hides' see invasion of privacy of nurses as OK, it will remain a challenge for those nurses who want to exercise and maintain their right to bodily, personal privacy [that includes PRECRIME URINE TESTS] and eventually it is made easier for all employers to require everyone to relinquish their 4th amendment rights in order to pursue life. And that will be the END of the 4th amendment.

Should any one who sees bodyscans and fingerprinting as an invasion of privacy be shipped out? Where else is there for them to go? Is this not the country for those free to dissent? The Bill of Rights itself was included because George Mason dissented. What if he had not? The US Constitution is a very short document to read and worthy of every citizen's, at least, single read. Better still to examine the discourse of the founding fathers and how they came to the conclusion to include the Bill of Rights. Constitution of the United States - Official It was a hallmark document then and now. Freedom of speech, freedom from unreasonable search, freedom of religion. The right to due process (government and police powers cannot remove your rights/freedom without following lawful procedure). Amendment IV is about privacy. The right to petition the government with grievances [means complaint] (including complaints about loss of amendment rights and freedoms without being shipped to another country or to an isolated island).

The term HOSTILE WORKING ENVIRONMENT is a specific legal term when used to represent discriminatory treatment received in relationship to your public policy rights (gender, race/color/nationality, age, disability, etc.) and to your actions to either support those rights or to oppose abuse of them. It does NOT refer to bosses who yell, co-workers who complain and gossip or any of the other work elements that can make a job less than pleasant. A pleasant work environment is not a right. A safe one is -- OSHA. If you complain to HR rather than your supervisor then your supervisor more than likely will be very unhappy. HR usually just tells your supervisor. You have not complained about anything illegal so only your supervisor can correct it, if you lack the skill or power to make an effective change interpersonally with your co-workers. If you don't feel talking to your supervisor will be helpful or will backfire then you have little recourse then to grin and bear it or to move on. If you forgot to empty the trash and it is part of the job then say thank you, I will do better next time then take out the trash. Sometimes the complaints of others has some value. If that's not this case... Obtain a copy of each of your performance evaluations. Send an email to yourself on non-company email about your concerns. Don't complain to anyone at work; commiserate with your friends, family or all-nurses. Stay professional and non-reactive to those in your work environment you feel make you feel uncomfortable and start looking for another job while still employed. You can do it. It is the way of maturity. It is always easier to find a new job while employed then when unemployed, then you don't have to worry about poor references, you've got the new job. Then submit your resignation, make it very short and simple: "Thank you for the opportunity to work here however I found new employ." Never wise to complain on your way out the door, because it will follow you like a bad memory and won't make a difference to those you left behind except to see you as a grumbling quitter.

"I don't have anything to hide": It is probable true that the majority of the populace is law abiding. However history is filled with stories of those people falsely imprisoned or denied basic human dignity and who "didn't have anything to hide". It is the view of the uninformed and naive individual who lacks understanding of the depth of the issue. The issue is not "do you have anything to hide" the issue is "do you want the right of privacy"? It will not be until your rights are violated or those of someone you love that you will realize how much you aided the violation by thinking the issue is "nothing to hide". If we are guaranteed the right to be innocent until proven guilty then why does society permit behavior that treats everyone as guilty until proven innocent by fingerprinting and other such actions? A fingerprint ID can be stolen. Just change the name on the plates. Even top secret federal information can be stolen. Just ask wikileaks. How much easier your fingerprint data? Once obtained it can be used for or against you. When the majority of the law abiding populace who doesn't have anything to hide thinks it's therefore allowable to invade just one more level of privacy then just one more level will be invaded and then another. It is the law abiding populace with nothing to hide that permits invasion of privacy because it makes them feel safer. Those who do not law abide, always figure out a way to evade the next level of detection. The purpose of privacy is to protect personal freedom. Freedom is something you won't know you had, until it is going, going, gone, all gone.

The asking is not the illegal part. They can ask, though it is not wise. Think of the EEO questions most employers ask about your gender and race, yet they cannot by law, deny you a job based on your answer. Yet how can you prove you did not get the job because you are female or hispanic or asian after you answer the questions? They can ask. They cannot discriminate by denying you an opportunity for a job based on a decision after reviewing your medical history if the decision was based on any of your public policy rights: right to employment opportunity regardless of age, race/color/nationality, gender, disability if qualified etc. much of which info is in your medical records. But how do you prove you did not get the job for a decision based on any of these reasons? You do have a right to refuse to release your medical records: HIPPA. Not all employers are wise, but it does not prevent you from being so. Their main objective is probably to know you can do the job physically. A letter from your MD based on the job description could do that. You protect your medical history and they know you can do the job physically.

Highly suspicious request. HIPPA only requires the individual's PERMISSION to release the records. Once you sign a release they have all access. SO THEY CAN ASK PERMISSION, BUT WHY ARE THEY ASKING? Not all States require physical fitness exams for healthcare work. Most require TB screening. Immunizations are not required by some States although many hospitals/facilities require them for certain positions, such as rubella for work in labor/delivery but may not be required for work on med surg. For nearly all job related functions the company does not need a copy of your medical records and if they are smart they will not ask. The exception is WORKER'S COMPENSATION injury/illness and even then they only get medical data related to the injury /illness you claim, NOT your entire medical history. Check to see if your State requires physical FITNESS EXAMS for healthcare work. If if it does, the MD only has to indicate if you are able to perform the job. It's a YES /NO response. No medical information. Your medical info is between you and your doctor. The doctor will need a copy of the JOB DESCRIPTION for the job you seek, to determine if you can do the job, then will issue a YES you can do it letter or NO you cannot, or can do it with these specific limitations. Please note, if the MD states that you can PART of the job, but not all of the job, then you do not qualify as the job is written. The same process is true if you are returning from work after injury/illness. If you can do the job but need reasonable MEDICAL ACCOMMODATION then you still qualify. Example: you apply for a secretary position, you can type but have carpal tunnel so need a special keyboard (accommodation). A special keyboard request is reasonable. If the job requires you to lift 50 pounds and you cannot lift 50 pounds you do not qualify. The company can still hire you, it is their decision. If you want to work for them, ask for a copy of the job description. Go to your doctor and request a letter that indicates your ability to perform the job duties. If the MD says YES, then you qualify medically. No need for a release of your medical records.

Experience is experience. The experience that you gain in work that was not paid remains experience. Sometimes the volunteer experience is of greater career value than some of the paid jobs we have held. If it is significant experience for the employ you are seeking, it is worth noting on a resume. That you volunteered usher at the community theater may have little bearing for a nursing job. May be of value if the job you seek is to gain a position on the theater board. If you volunteered for American Red Cross to do triage during a recent flood that may be of interest for a position in an ER. Be clear about the amount of experience though. 2 hours per 2 weeks over 2 years is NOT 2 years experience.

The only real rules are State or Federal rules as to what you must have degree wise to get a job. Companies can have rules for entry into a position but they can be changed with one decision from someone who has the authority to make the decision. So a position may indicate they want BSN or MSN but what they really want is someone with good work ethics who can do a good job. Unless there are State rules (usually not federal rules for employ) requiring a specific degree or certification for a job you really don't need the degree for the job. Company HR depts make up the lists of degrees they want for a position in the ads or in the job description but those "rules" change or are disregarded if the candidate with the right EXPERIENCE comes along. Experience is the trump card. The degrees for a position are the HR dept's "wish list" and make it easy to eliminate candidates for the interviews since the manager only wants to interview the few best candidates. Interviews take a lot more time then reading resumes. The hiring manager is more likely to know what they are looking for, more than the HR person. But you usually have to get past the HR person to get the invite to the interview. 'Onaclearday' pointed out the sorrow of the new hiring manager who hired by an impressive degree on a resume and not by experience. Sometimes a company will belong to an accreditation company that requires that a candidate for a particular position have certain qualifications, but those are usually again, are listed as years experience in a field rather than in type of degrees. So if you look up the State rules/laws/regs for the states you want to practice you'll know what you will need. Search under healthcare and licensing and nursing boards.