Dixiedi1

I agree here, why would any facility have 2 open day shift positions at the same time. Other shifts very often happen with the quick turn over rate, but day shift is generally a premium nurses wait sometimes years to get. The whole thing would cause me to wonder.

The rule, I think, would be if it cut off that soon, you did an excellent job. Or, it could be that you knew so little and got so few corect that it was not possible to get enough correct to pass. 85 is like 1/2 the possible questions, right? (They didn't do it that way when I took boards way back when.) My reaction is that cutting off at 85 was darn good. But, I've been wrong before. Hope not!

He's doing it because he can. The array of "problems" falls into only one category, Psych. And the diagnoses is .... You guessed it. "Hatred of authority" with a good dose of "I can make them come to me."

Nurses used to have to behave in such a manner also. It is very sad that it is not that way now. The language here is pretty raw and may offend some but it''s the truth of it...

This is wild, a friend of mine sent me an email this morning telling me about the same thing where she is. As I told her, I think, not sure mind you, I think there are federal regulations the prevent employers from making you use your sick time or vacation time for anything other than that. There is very likely a huge loophole and your employer has found it. Hope it works out for you but it is very common knowledge that health insurance rates are rising and the employer must do anything they can to recoup some of it. I feel for all of us on this subject.

you are it nit-picking. it is assumed the nurse did her job. we all try our best to do our job so there was no reason for any of us to assume she did not know what she was doing. the point of the whole thread seems to have escaped you. we are not talking about the need to change the diet but rather the dons apparent need to "take it out" on someone. please, you have much to share here, don't ruin it by reading too much into posts. it just sounds so much like you need to point out how much more you know now than you did when you were an lpn. we are happy for you and we know lpns do not know nearly as much as a doc should know but that does not mean the lpn is not capable of performing job duties and thinking beyond basics. (changing the diet as she did is not beyond the scope of practice.) with this i will leave this thread because it is far too heated for what it is. hope to see you around here in the future.

I have to agree with chimama this time. Reporting rarely corrects a situation. However, the risk you take in doing so may be worth it if pts really are in danger. Which state regs? Sometimes facilities bend state regs just a tad too far and that will never change and reporting it will likely get you in deep do do. How would they know it is you? Have you ever, I mean ever, said anything to another employee about it? If you have, they will know. They may not be able to prove it, but they don't have to in order to retaliate. None of us are perfect and getting fired over the same mistake everybody makes (like meds not being passed within the window) is not unheard of.

Now I am beginning to wonder about how much time lapsed between the diet change and the reprimand from the DON. I had the impression it was a matter of between breakfast and lunch. In the LTC world this is not very much time. A whole day in a LTC facility would compare to mere minutes in an acute care facility (hospital). Since the original post did not mention any other symptoms it would be safe to assume (yes, assuming is not a good thing but this is a discussion board, not a book) that there were none. Just because a pt was on a "regular" diet in the hospital does not mean he successfully ate a full meal. He may have merely eaten the mashed potatos, ice cream and jello. Yep, he ate about 1/2 - 1/3 of the meal. Sounds pretty good for an elderly pt in the hospital. Let's just leave his diet right where it is, he seems to be doing just fine. Been there, seen it, it very surely happens. Now, he's in a LTC facility, the admition orders have "house diet" on it and he can't eat it. So, the staff nurse decides an easier to chew and swallow diet is in order until he can be evaluated. If he can't tolerate that, well, I am sure (been there, done that) his Doc would have been contacted within those mere minutes so common in the hospital. Docs don't want to know just "he can't eat the house diet" they want to know what he CAN eat, what other symptoms there are, etc BEFORE he is called. Yes, at breakfast he tolerated the pureed she brought in for him but I would have tried it a second time just to be sure, the big question here is will he be able to maintain adequate nutrition on the pureed. After all, there are so many possibilities and the Doc will want as much info as possible before he gives an order. But, that's MHO after only 30 years.

before your first shift, sit down and think about what it is you have to do. try to put some order into it. when i was working agency ltc staffing i printed out some cheat spreadsheets to help me stay organized. i put the name and room number along the side of the sheet. then filled in meds, tx, tf, etc in more columns. as i went through the kardex i put a slash in each need for each pt. then as i completed that need i made it into an x. it took some time to get ready to go but everything went so much more smoothly for me. if you create the cheat spreadsheet for a floor you will be working on full time you can use a clear overlay to make your marks (will wipe off at end of shift) and within a week you won't need it anymore. this worked for me when i was doing one shift here then there then another place. in several months i never went back to the same facility a second time but it was never because hey asked that i "not come back" scheduling was just so crazy that it never happened.

Excellent response!

I was not making an RN vs LPN comment. However, RNs can and do, make changes to pts diet. LPNs, if their facility has enough respect for them can also, however, it was fairly evident to me that in this instance, the DON did not want the LPN to make a nursing judgement. This DON wanted it to be at least an RN (a degree), maybe even the MD (also a degree), to make that change.I agree a speech therepy evaluation would be great but that can take several weeks to arange in a long term care facility. It was resonable and prudent for the LPN to change this pts diet at that time to ensure adequate nutrition is maintained while waiting for the MD order and/or evaluation. Utilizing her knowledge is what she is there for and it wsa not practicing outside her scope in any state. Maybe the DON should reread the practice acts for her state. Edit note.... I did not mean education is a waste of money. Underutilizing LPNs is a waste of money. I have degrees and certifications of all kinds. Nursing is my 1st choice of all the things I do and now that my kids are grown I will return to get an ADN (I'm 50 now and see no reason at this point in time to go any further. I want to retire at some opint and their are other things I still want to study outside of nursing.)

Since triage requires the pt to have an isitial assessment, it would have to be done by an RN since "they" do not feel LPNs can correctly assess a pt. However, it is possible for hospitals to employ LPNs they are comfoartable with, I couldn't find anything in several states scopes of practice to say they couldn't; but... what would JCAH think about it?

I've run into the same type of thing. A new RN fresh out of school is supposedly better at assessing pts than we are with 30 plus years. Go figure! Not a thing we can do about it except return to shcool. It's the paper they want (degree) not the knowledge. Sad and such a huge waste of money.