justus501

I am writing from illinois. I am assuming you are talking scope/severity being a F. In that case, as resurvey would depend on if it was substandard quality of care (ie the deficiency written under on of the care tags like 225, 323, etc). We, as a general rule, only do revisits on level three deficiencies (G or above). The only time a level two deficiency (D, E, F) requires a revisit is if it is at a F at SQOC. However...you know what they are going to be looking at when the come in, so just make sure it is corrected!! In our state, as long as a complaint is not done with the revisit, all they are looking at is the tag that was originally written. Hope that helps

I assume you are talking about federal tags, not state tags, as state tags vary from state to state. -They are looking at all incident reports...reporting and investigations events..with citations at F225 -Falls are always a big one...with citations at F323 -Pain is always big...with citations at F309 -Pressure ulcers..with citations at F314 -Care planning on residents...with citations at F279 -Sanitation in kitchen..with citations at F371 -Infection control, especially with glucometers and cleansing between residents with appropriate wipes (ones that actually kill things such as C-diff).... with citations at F441. Those are the big ones I am seeing. Also seeing some nutrition issues. Food temp with last tray pass, and pureed food stuff.

I may have missed this in anothers suggestion, but can you put a fall mat in place to minimize the injury when he falls? Also...think about why he is getting up... Does he need to use the toilet? Put him on a toileting program-like every two hours or less. Does he want to go out for programing/groups? Make sure aids are taking him out? Can you plan times up, such as every...2 hours, get him up. Try a schedule. Try to contract with him, with his input, what his day will be like...every 2 hours toilet, up at certain times for activities, up for meals. Have this contract printed at his bedside to remind him. I know this type of individualized approach takes time and staff. I don't think alarms really work...they just alert you as to when the do fall. If it isn't working then get rid of them, documenting why you did so. I think the schedule could add structure to his day. Just thoughts from a surveyor stand point.

I have just graduated from a MSN Nurse Educator program. I now wish I would have picked a different program. I love education, don't get me wrong, it just limits you. I now cannot afford to quit my current job to teach because of a $15,000 or more a year pay cut. If I would have done the Nurse Practitioner program, I could have still taught, but also practice as an NP. A Masters degree is required to teach, but many instructors have degrees in areas other than education. Just thoughts....

Start making a journal of daily events as they happen. Then a year or two down the road you will have pleanty to work with. I love this idea!! I wish I would have written down my first year experiences in psychiatric nursing-whew- what a hoot!! I had been a nurse for 10 years, but had encountered many "firsts". Perhaps as you go, you could submit your stories from time to time in nursing magazines in the comic relief section. The key is to write down every detail daily....time causes you to lose much information. Good luck on your journey!!

Do they have a grievance procedure at the place where you were employed? Reason I ask...I was fired for refusing to accept a patient assignment that I felt was unsafe (9 patients total; on a cardiac stepdown unit with fresh MI's, Cath's and 4 open heart patients day one with Chest tubes, cardizem, etc...) Anyway, I went through the grievance process, and it was removed from my record, I was offered my job back, but resigned. Perhaps you could get this off your record...in the mean time, since you were fired, can you draw unemployment until you get another job??

Definately, hands down, take the ICU job. You will learn and see so much!! Especially since it is a "poor hospital". I worked with a nurse who had worked at cook county and she had taken care of such a broad range of things...alot of trauma and gun shot wounds. OR experience is not going to give you what you need to be a nurse practioner. From an educational standpoint, I would not admit someone to the program if they had just worked in the OR. You will have a distinct advantage working in the ICU. Don't think of it as working in a bad hosptial, think of it as a GREAT opportunity. They are willing to hire you and train you, take advantage of that!!

Hmmm...interesting question. I have worked ICU and we used to give them simultaneously, as we had multiple IV's or a Triple Lumen Catheter. If you didn't have multiple access, It would depend on the situation. My initial thought is that the blood should be given first, as it has oxygen carrying capacity, and platelets do not. Do not be afraid to ask the physician which he would like given first.

I think that any fall that resulted in more than minimal harm (ie a fracture) is at least a G at F323. If the facility has a history of multiple falls...it could be considered an Immediate Jeopardy. Just make sure you have documented well. The inservices are great, but what did you do to PREVENT the occurance from happening? Fall risk assessment? Care planning? Increased supervision?? All issues that will be considered. Good luck with the survey. Hopefully it will just be state surveyors and not the Feds with them. :-)

Hi there! Bravo to you for coming forward with your issue. It takes courage to do so. I think that you need to seek help. Privately!! It is not anyones business what your issue is, unless you make it theirs. Unfortunately, the medical field does have a stigma associated with mental illness, so I have always kept it private. No one at school needs to know. You are not a danger to yourself (not suicidal) or others (not homicidal)....so it is not something that will effect your licensure. Mental issues, unfortunately, bring tremendous amounts of shame upon us....perhaps it is society's negative view of mental illness. There is a reason you are doing what you are doing. You mentioned control. Did you feel powerless and unable to control things as a child? (perhaps during the divorice you mentioned?) Seeking help, perhaps counceling and medication, will help you to identify the trigger. There is a method to our madness.....a reason we are the way we are. If we can figure it out, we can try to find different ways to deal with it. Church is a wonderful idea. I go to a nondenominational christian church. Very non judging. Something I finds that helps me is the serenity prayer: God grant me the serenity to accept the things I cannot change; Courage to change the things I can; And the Wisdom to know the difference. You cannot change the past. It has happened, it is done. What you can change is today. Pray for courage to get through the day. Pray for courage to do the the right thing. Our body is our temple. Try to think of it like that...Jesus wants us to take care of it. You are on the right path...you have done one of the hardest things.....admitting there is a problem. I pray God gives you the courage and stength to take the next step.

You have done the hardest part.....admitting there is a problem. Everyone of us battles with our own mental issues, whether it is depression, anxiety, adhd, bipolar disorder...what ever. It is nobody's business what your diagnosis is, or what meds you are on. I have never told my employer or school of my mental history. It is personal and private. The doctor is not going to laugh you out of the office. Do go to a psychiatrist though, as they are more trained to diagnose your particular issue. Our profession has a negative image of mental health. That has to change. Don't go through it anymore....go to the doctor. They will help u.

What about a legal nurse consultant? Something you could do at home, on your own hours as your body allows. You sound like you have had some very good clinical years, and that could definately help. I know there are online courses or seminars you can attend for this.

First...welcome to nursing!! Second....take a deep breathe...you are ok....you are not alone!! The first year of nursing is VERY stressful. Nursing School just does not prepare you for the real world of nursing. It takes time....give yourself that time....time to learn time management, prioritization, and dealing with coworkers. Nurses have a tendancy to "eat our young". Instead of nurture them, mentor them and encourage them, we leave them feeling inadequate and unprepared. If you are becoming more depressed and stressed, it is difficult to do your job. Consider the Lamictal again. Your mental health is so important. How can you care for others, if you don't care for yourself. I have been on antidepressants for years. Depression lurkes in at times. I just started on Lamictal and will see how it goes. I know...I cannot do my job effectively if I am not well. Take it easy on yourself. Be patient with yourself. Be kind to yourself. Nursing is an art. It takes time to perfect that art. You will get it...it just takes time. Don't give up on hospital nursing until you have done it for at least a year. You need that year to gain skills and organization. If you need anything or just want to talk, email me at [email protected] Best of luck to you!! You CAN do it, don't give up.

What you are describing has been described in detail in the literature!! It is called horizontal violence...also known as bullying. Literature describes this phenomenon as a prevalent behavior among nurses. It is very unfortunate. One study I read found that 50% of new grads consider leaving the profession within their first year due to the way they are treated by colleagues. We, as educators, have to educate ourselves about this issue. We can educate students as to what horizontal violence is, how to identify it, how to react to it, and most of all....that it is NOT ACCEPTABLE! It has to begin in the education process if we are going to make a change to future work environments. Take a look at the literature on this topic...it is abundant.

Hi... Although unfortunate, it is just life. No matter what the profession, there are always those who are slackers. Nursing Education has changed since I was in school. I just completed my education... Master's Degree in Nursing Education. I too was surprised at the students we are passing. All I can say is....it will catch up with them. I think you should do this....keep your mouth SHUT!! My experience has been that those who try to do the right thing, and inform faculty as to what is REALLY going on, end up with problems. You seem to be a bright, motivated, and dedicated student. Don't mess up your education, please trust me. All you can do is be responsible for your own behavior. Trying to control others behaviors, or make them accountable for their behaviors will only frustrate you, and unfortunately, get you in trouble.