yasmina

my title is quality assurance coordinator. i am it (with a very young assistant) for a 120 bed facility. i do the care conferences (the only rn there). i do all the mds's. i am also administrative (like an adon without the title). the people who work in my facility really don't understand what i do. the don is very non-paper oriented, and really does not get involved. i do think that getting into this field can be very lucrative. i am planning on staying put for a year, then will expand my horizons. it is very stressful. i am glad to know that lvn's are acknowledged in this work. good for you.

I re read the beginning of this ensuing nurse practice dilemma. The person who spoke of the study taking a few weeks (perhaps) is correct. The nurse who downgraded the diet, in my opinion, was prudent. If the DON was concerned, it would have been prudent to quietly discuss the situation. Sounds like the nurse involved is a GEM! And, could get a job just about anywhere. Yes, we all want to cover our behinds. However, in the real world, I don't think what she did was at all negative. May have taken her many hours to notify the doctor. She may have ended up on the phone with a doctor who didn't even know the resident. Nurses make a lot of judgement calls. That is why there are verbal orders that are signed 48 hours later. Perhaps she should have been quietly told to get an order for the diet change....and if in this instance there was significant concern over dysphagia, contact the doctor. But, writing up the nurse who used her judgement? No. Good nurses who care are hard to find. The nurse who comes to work impaired, steals, can't document at all, cannot calculate rates/doses...these are the kinds of nurses to get written up!

I work in a nursing facilty as a MDS/Quality Coordinator and have been a RN since 1978. We can 'what if' about the cause of a resident's dysphagia until we are blue in the face. The bottom line, in my opinion, is that nurses can tell when a resident is having an acute problem. LPN's and CNA's are intimately involved with these individuals. In the real world, doctors are not notified every time a resident has a complaint. Today I had a resident mention to me that he 'just didn't feel right.' He was sweating a bit. I questioned him, and determined he needed to have his vitals taken, blood sugar...and get somebody to him that really knew him. That was the LPN on duty. She assessed him, I assessed him...we decided to observe. Yes, he could have been having an onset of many, many, many problems. Realistically: in long term care, the nurse makes a lot of independent decisions. If the nurse is constantly contacting the doctor, the doctor gets upset. I don't see the nurses calling doctors for everything. In long term care, the LPN is in a position of great responsibility (well deserved). I came in the middle of this forum. How long had the resident c/o dysphagia? What is his history? If I notified doctors of residents complaints, I would do very little else but be on the phone to the doctors. The other thing...in long term care, things are much slower paced. Yes, a resident could have a problem ensuing. The nurse might observe for a while. In long term care, I don't see health care practitioners jumping every time there is a complaint. I kind of need to go look at the original message conveyed. I just think that this thread has gotten really mean! Really, doesn't matter that much who the clinician is: doctor, nurse, APN....It is clinical judgement. Just because someone has a higher degree doesn't make them better than another clinician. In long term care, again, the primary nurse (typically an LPN), along with the CNA are so important and intricate to care. A APN or MD who visits every month is usually really detached from the picture. I will go back to the original thread. There is too much argueing here! All health care professionals are important.

When people we work with are difficult,accusatory and hard to please (if not impossible),the people pointing their little fingers and gossiping need to evaluate why they decided to go into Nursing in the first place. Yes, there are plenty of places to move on to. However, I wouldn't leave if the ONLY thing you would leave for is the DON> Perhaps she will move on herself. I was an auditor myself. I wasn't very good, as I gave 'everything away.' So, if the DON is good with the State, perhaps she would be a good state surveyor rather than a team player. My DON would not get wrapped up in such stuff. He totally respects his nurses. If they are caring about the residents, and trying to do the right thing, that is what matters. Blatant incompetence of course wouldn't be tolerated. Doesn't sound like that is your situation. Only jump ship if you really want to. How long has she been there?

I feel if ADN and Diploma RN's were grandfathered and a BSN was mandated for all new RN's by say, 2010, we would help our profession...by uniting US. Many disagree with this but I'm ready to see SOME solidarity in this crazy profession myself...LOL!! But...I digress and this has been discussed to death here....

I appreciate help with the RAPS. I also am curious about what is called a waiver...I have been told that after skilled service is done, there is a 2 day period when family is notified of non-coverage...and those two days...can they be billed under skilled? I find this illogical. I don't know what to do with that 48 hour window.

i have tried several times to finish my bsn but have run into multiple obstacles through the years. mainly with bsn programs discounting my college courses, and essentially requiring repeating most of the nursing courses as well, not recognizing my experience and college credits because they were 'thru a diploma program'. so...i tired of this money grab and gave it up. i was doing excelsior but they kept adding more coursework so i tired of playing that game too. you and i are on the same page. i went to a very difficult diploma program. then, ran into the credit thing you did. yup. it is all about the money. i strongly feel that the educators should grandfather diploma grads in. we should not be expected to repeat courses or pay money to do challenge exams! i took pharmacology (for example) at the same school where the same teachers teach pharmacology to the bsn's. yes, the nursing shortage involves this to a very great extent. i am 47, and know that many nurses like myself have just gotten fed up and quit nursing all together. shift work is difficult. seems most good jobs where i live that have day hours are taken (with no chance of anyone leaving them...they know they have good jobs). i can't seem to get it through anyone's head (that is in education or that has an advanced degree), that the nursing shortage is partly due to this education issue. most nurses are older (exactly my age). i have written to the nursing spectrum (i think), it might have been advance for nurses. they don't post my writings in the magazine. so, i don't get how the nurses that make the decisions regarding nursing education get away with demanding diploma grads take over course work and pay for challenge exams. especially with the nursing shortage now.... i know that i got a wonderful education in the field. i just think we need acknowledgement for working like zombies for three years. it was like a work/study through school for me. and, to top it off, i tried to go back to the floors. i have been working in case management, insurance, etc. that is also a fiasco. there are very few refresher programs. i took one which was 8 days long with no clinical hands on. it was all that i could find. i then worked for a couple of months at a teaching hospital. i was overwhelmed, and didn't feel supported by my mentor. so, i went back to insurance (which is what i didn't want). now, i would love to go into psych drug and alchohol/ or hospice. it is hard to enter these fields without experience. everyone wants clinical experience. i think that a lot of good nurses are being underutilized (like me). i think that nurses are grossly underpaid. why our country pays twice as much to a computer programmer is mind boggling to me. when i look at the help wanted ads, i see people with those type of degrees starting at very high salaries. so, what have i done to furthur my education? i mostly study holistic stuff (yoga, meditation). at 47, i feel i am in a career rut. i make really great money where i work....but am not advancing.... sorry to go on a soapbox like this. it was just very good to hear from a nurse who has had similar experiences (instead of being told to just do it already and be quiet). yasmina.:rotfl:

I know......it happened to me. And the best thing I ever did was to shake the dust of the place off my feet and head back to the hospital, where I'm just a little fish in a big bowl and I can do my 8-hour shift and go HOME--- without middle-of-the-night phone calls, take-home paperwork (RAPs are pretty labor-intensive) or being called in to work the floor when the night-shift nurse doesn't show up. Why were raps so intensive? I know that it is another process to go through, but is it really that complex? Please enlighten me as I am new (if you read this).

Help? Na. Not anybody who will jump in and cover while I am away. Upper Management has the knowledge, but has other responsibilites (which I totally understand). I am learning how to be VERY efficient VERY quickly. I am having trouble with OMRA's. The time lines boggle my brain. Check this, monitor that, count this, audit that, document this, respond to that......... I guesss you know what I mean. Anyhow, I think my main problems involve OMRA's, and getting everything caught up. Any information sources, or information would be greatly appreciated. I research as much as I possible can. Yasmina

sounds like you had a great diploma program, unlike me ( as far as credit transfer)

soberland. I am a CD nurse (although dont have much use for it where I work) Walter, what is a CD nurse? In my area, the hospitals only seem to need night psych nurses if any. (at least entry level). Have you had many physical altercations? I was told by one psych nurse she got bit, hit, etc on many occasions. What do you think about the state hospitals? Yasmina:)

i am working in insurance nursing. i would really prefer to be in a counseling role...working with detox of drug/alchohol with teens. i feel there is a need. however, the jobs all seem to want experienced rn's. how to get the experience? i know i could work at a state hospital. however, i have heard that they are just horrible. ..that people who work in state hospitals have lower 'standards,' and that if they take a dislike to you, they may do really mean things. so, how does a diploma nurse with very little psych experience break in to this field?