Passion8RN

I would have given you a failing grade as well. This scenario has very little to do with ethics. Good luck the next time around.

I personally have several years PCU experience. Our PCU is considered a critical care area requiring ACLS and (in my hospital) to be a part of the code team when you are Charge RN. PCU will definitely cover you for the Med/Surg requirement and might even cover you for the critical care requirement.

I've been a nurse for a total of 13.5 years between LPN and RN. I have come to accept (after a long time) that there are going to be patients that just don't want to change, no matter how much education you provide, or how much you care. I accepted my powerlessness over this. Now, I try to focus on the tiniest of tiniest changes (taking meds at least 5 days a week as scheduled, maintaining dr appts, drinking water more than soda or booze :), using their nebulizers as scheduled, turning off oxygen while smoking, etc.) Appreciate the small changes and continue to provide incredible nursing care. I can tell you do actually care for your patients and are not there just for the paycheck, like many home care nurses I have worked with in the past are, so keep doing it and feel rewarded by the minute changes!

Nurse Maru, BSN, RNI will say being a good nurse is a learning process. Healthcare is forever changing a being a nurse affords us the opportunity to continue learning everyday. So, as nurses, yes we are getting paid to provide competent compassionate safe nursing care, but we are still learning in the process. I've been at it for 14 years, in a variety of positions, including leadership and lead preceptor, and I still learn something new daily at work.

CanadianAbroad I get kinda where you're coming from, but I wouldn't consider being a nursing student working for free. You don't have the same responsibility and repercussions if you make a mistake as you would as a licensed nurse, and the purpose of being a student is to learn and get prepared to become a nurse. Nursing students should appreciate this and use it as a time to absorb as much information and attain as many skills as possible. Anyone who thinks of being a nursing student as working for free may need to choose another career avenue. IJS

You were young and immature. What have you learned from this incident? Would you ever do it again? I would not share that I was caught having sex and was fired for it to a future employee. I just left a leadership position, and I would have accepted that answer of having a relationship with a co-worker and it caused a conflict of interest. When you say intimate, that can mean a lot of different thing, i.e. kissing, touching, intercourse, fondling, etc. I would choose a different term to describe it. I don't know, maybe romantic?? How long did you work there? If not long, do you really need to list them? You were terminated. You paid your dues for this mistake when you were let go. You shouldn't have to pay for something that did not cause harm to anyone for the rest of your career. I hope it all works out, but I will say again, I would NOT divulge this mistake in an interview or on an application, because people DO judge and will use that incident against you to define your character.

At the end of the day, we are all human. We have issues just like our patients. As long as your seizures are controlled, I would encourage you to pursue your career goals. I work in a neuro infusion suite and take care of several nurses that have neurological disorders including seizures, and it does not hold them back. You only live once, so I encourage you to live your life to the fullest which includes pursuing your career goals. You are an individual that has a seizure disorder. Your disorder is just something you have not chosen, but have to live with. Don't let the disorder define you or hold you back!! I am praying and rooting for you pavlovnurse!

Run!!

Hello :) This is the reason I am leaving my current agency and going to an outpatient infusion suite (Unable to get another RN position approved and having such a HORRIBLE branch manager that does not support nursing, she is a pharmacist) and having to do field visits myself. It is very hard to cover new referral cases and fullfill all of your responsibilites of the Nurse Supervisor. We actually have 2 full-time nurses as we have grown by leaps and bounds since I took this position a while ago. To justify the need for a FT position, use the data to support the agency's growth. We need another part-time RN since we have grown so much. It can work. If my FT RN's are low on visits, I have them come in and help out in the office. They are garaunteed 30 hours per week, but it is rare that they are unable to get their hours with our current census. Do you have any specific questions that I can answer for you?

It sounds like you had a very rough way to go from the beginning, but I do agree that you should be taking more responsibility on letting a Levophed drip run dry. You have to be able to prioritize, and if your preceptor was unavailable to guide you in getting a critical care drip refill, you as a new or seasoned nurse, should have stepped up and asked another nurse on the floor for assistance.I will say that, your preceptor should have left someone else on the floor in charge of your supervision while you were still considered in training, no matter how much she/ he trusted you. It sounds like you have the potential to be an awesome nurse, and I hope at this point you have had the opportunity to find your niche. I also hope you learned that you have to be comfortable in reaching out to other nurses if your preceptor is not available, because at the end of the day, the responsibility of providing the best patient care lies on the whole team, not just you and your preceptor. Overall, it sounds like in this whole scenario, you were set up for failure, but the positive side is, I bet you will never forget your experiences on this unit and it will benefit you in the long run. Good luck to you. You are a very articulate great communicator based on reading your post, and this is definitely a skill that is vital in critical care nursing.

Thank you all for your responses. We will be discharging this patient and referring to another hha because this case has too much liability risk and poor caregiver/ family adherence to POC.

My thoughts exactly. I didn't quite understand how a chha can do this when changing the drsg calls for an "assessment" and there is more risk involved with wound vac therapy. Also, I didn't mention that the clinic placed black foam directly over an exposed tendon. I called KCI and the clarified this should never happen and that there needs to be a nonadherent mesh barrier drsg in between this. This makes me question the competency of the podiatry clinic that applied it.

I did find this link that somewhat clarified my question http://www.kci1.com/cs/Satellite?blobcol=urldata&blobheadername1=Content-type&blobheadername2=Content-disposition&blobheadername3=MDT-Type&blobheadervalue1=application%2Fpdf&blobheadervalue2=inline%3B+filename%3D396%252F678%252FV.A.C.%2BTherapy%2B101%2BAwareness%2BBrochure.pdf.pdf&blobheadervalue3=abinary%3B+chorificet%3DUTF-8&blobkey=id&blobtable=MungoBlobs&blobwhere=1226639760702&ssbinary=true

I have a patient that has private paid home health aides. He has multiple wounds and we have trained them to provide the wound care. They were doing a great job, but now his podiatrist applied a wound vac to the most complex wound. My concern is, they instructed the home health aide on the wound vac and expected her to change it 3 x weekly. The home health aide is through a private duty agency, but called me and said she was not comfortable doing this type of dressing change, but we did not have orders to perform wound vac drsg change. So the question is, Is this even within their scope? I've never even heard of people doing their own wound vac dressings changes at home, let alone a paid unlicensed caregiver. In my experience, this type of drsg change has been done by skilled personnel. This idea is new for me. Is it ok to teach the home health aide this skill?

It is standard for hha's to change oasis data collection if it is inconsistent. Especially with the functional aspect because this is where it confirms their homebound status and brings in reimbursement. My documentation has only been altered in this area with my current agency because of inconsistencies. They reinforce "is the patient able to complete the tasks safely" and usually they are right. And if I feel that it doesn't make sense, then I do not agree with it. I back up my assessment, and so far no problems. But, I would be concerned if they are changing pain ratings. That does not make sense. If a pt rates pain an 8 for me. I usually review the pain scale and what it means. If they still say and 8 then its an 8. That's something that should not be altered. That is subjective information. The patients pain is their own.