MollNick

For 30 pts we would have 3 techs. When the other charge nurse said anything, the charge nurse was ignored and didn't want to push it further. The other charge nurse asked to go to 32 hrs/week and was told the position was not available and had no choice but to go PRN.

I work in an acute care psych unit of 30 beds. The ratio averages 10-15:1. Being the charge nurse, I have always split the pts with the other nurse so that more time can be spent with our pts and the charting can be more thorough. When working with an LVN or an RN, the patients are split. The interim DON just told everybody last week that LVN's are no longer allowed to chart on patients, that all they can do is give meds. The rumor is that the DON got permission from Medicare (CMS) who was just there and the CEO to implement this new rule. We do not understand why and are not happy about this. We think our licenses could be compromised since it can be difficult enough to be charting/giving meds for 15 pts especially when there are pts disrupting the unit but charting on 30 is ridiculous and unsafe. A nurse giving meds to 30 pts is too much as well. We don't know what we can do about it if anything can be done at all. Or, maybe we are just overreacting. The other charge nurse and myself are afraid that if we challenge, we will be fired since the DON and CEO just fired 2 nurses last week. I've been looking for another job but haven't found anything I like well enough to quit. Any suggestions would be appreciated.

In our psych unit, the ratio is around 10-12:1 but can go as high as 15:1

I should probably know the clearance time frame for all these drugs but I don't. What is the clearance time for BZO, OPI, and BAR? We are testing with urine drug screens using the i-cup. I know the clearance for THC is about 2 weeks if a patient smokes frequently and has numbers in the thousands on a lab result. But, what about the pt. that doesn't smoke that frequently, is it still about 2 weeks. Is there some sort of statistical chart or something of that nature used? We want to try to retest to hopefully get a neg result without waiting the full 2 weeks. This is easier when sending urine to lab for quantitative results to determine if a pt. quit smoking pot when they say they did and see the numbers drop. But, it's more difficult with the i-Cup giving a yes/no result. We are trying to avoid sending every positive result to lab. We will be putting the i-Cup results in the patient's charta. The plan is to somehow let the pt. know the i-Cup testing is on us but if results come back pos the 2nd time, they will have their insurance billed for the lab testing. This is an out-patient CD clinic. We were sending all urines to lab and absorbing the cost but are trying to cut costs by doing our own testing. I am being asked to write a policy for this i-Cup testing and a information sheet to go in the patient's info packets about it. The majority of staff doing these i-Cup tests are not nurses. If anyone may some advice on developing a policy can PM me. I would would really appreciate any input on this matter. Thank you in advance.

I should probably know the clearance time frame for all these drugs but I don't. What is the clearance time for BZO, OPI, and BAR? We are testing with urine drug screens using the i-cup. I know the clearance for THC is about 2 weeks if a patient smokes frequently and has numbers in the thousands on a lab result. But, what about the pt. that doesn't smoke that frequently, is it still about 2 weeks. Is there some sort of statistical chart or something of that nature used? We want to try to retest to hopefully get a neg result without waiting the full 2 weeks. This is easier when sending urine to lab for quantitative results to determine if a pt. quit smoking pot when they say they did and see the numbers drop. But, it's more difficult with the i-Cup giving a yes/no result. We are trying to avoid sending every positive result to lab. We will be putting the i-Cup results in the patient's charta. The plan is to somehow let the pt. know the i-Cup testing is on us but if results come back pos the 2nd time, they will have their insurance billed for the lab testing. This is an out-patient CD clinic. We were sending all urines to lab and absorbing the cost but are trying to cut costs by doing our own testing. I am being asked to write a policy for this i-Cup testing and a information sheet to go in the patient's info packets about it. The majority of staff doing these i-Cup tests are not nurses. If anyone may some advice on developing a policy can PM me. I would would really appreciate any input on this matter. Thank you in advance.

Unit is a locked down acute adult unit. The sup. is a psych nurse for psych hospital. We take E.D's, detox, pt's too sick to be in reg. adult unit. I spoke with mgr. about the sup. once. Sup. still doing the same things. After thinking about it and after calming down, I decided that I will professionally and politely tell this sup. they will not undermine my role as charge and "no, we will not.... because ....". If sup. threatens to call mgr., I will suggest they use unit phone so I can speak to mgr. also. So, basically, I am not going to take any of their stuff anymore.

I recently had a situation I am not sure how to handle "the next time". Scenario: 14 adult patients, me (RN) and 1 MHT. Patient A is diabetic, manipulative, intrusive, frequently asking for extra breakfast, snacks, extra juice, milk. For AM med pass, pt. A wants Xanax which is scheduled for 2100. Pt. A told they will see Dr. today and to ask for it. Pt. A did not appear to be anxious. Pt. A slept through AM smoke break. When pt. A found out they threw a fit at nsg. station demanding to go smoke. They were told the next break will be before next group therapy as scheduled. Approx. 30 min. later, house sup. is in room with pt. A for about 1/2 hour. Then, sup. comes to station and inquires about situation. Sup. updated and informed of the scheduled smoke breaks. Sup. tells us that pt. is very upset about not getting to go for smoke break and instructs the MHT to give pt. a smoke break at 1st opportunity. After the sup. left I instructed MHT to wait until scheduled break for taking pt's out. . A little while later, another pt. is at station throwing a fit about going to smoke (who did go out for break in am). About 20 minutes before the scheduled smoke break, pt. A wants to go smoke and again gets very upset when told it will be in about 20 min. Shortly before lunch, pt. A wants a snack and told lunch will be soon. Pt. A becomes upset about it then said "she told me I could have one" referring to the sup. I also learned that the sup. promised the pt. a unscheduled smoke break. The sup. didn't even bother coming to talk to the MHT and I about the situation before going to talk with the patient and making promises to the patient for a special smoke break and a snack. She did not know the pt. was diabetic. I often see sup. in hallway cajoling with the patients. We have had patients get upset because they can't have something they want then they want to speak to the sup. I think this sup. is disrupting our unit and undermining my role as a charge nurse. I am very upset about it. There have been many other times this sup. does something to disrupt the unit. A while back, a pt. was frequently asking the only MHT (the same one as above) on the floor to go get a soda for them. When the sup. arrived in the unit, the pt. hit them up about it. The sup. tells the MHT to go get a soda for this patient. After the sup. left, the other patients were asking for a vending machine run which would leave me on the unit alone. I am thinking about finding another job before I get written up for telling this sup. off and to stop undermining my charge role and getting the patients upset (what I am thinking about doing the next time).

Currently working in adult acute care 22 bed unit. We take care of ED's, OPC's, detox, too unstable for other unit patients. I have taken (total) care of 15 patients with 1 MHT. And, I have taken care of 22 patients with 1 RN (myself) also charging, 1 LVN (meds), and 1 MHT. What is the staffing in your units?

The unit I work on is an acute adult (PICU). Max is 22. Staffing matrix used includes MHT's. For 15 or less= 1 RN and 1 MHT days. For 16 or more= 3 staff persons which would be 1 RN and 2 MHT's. I have cared for 21 pt.s with 1 RN (me), 1 LVN (meds) and 1 MHT. Unit consists of ED's, OPC's, detox., potentially agressive patients. This is my first psych job so I don't know what staffing is in other hospitals or if this staffing is adequate or not.

I have been on unit dayshift, 1RN (me), 1 LVN (meds), and 1 tech for 21 patients in adult intensive care unit.

I had this pt. who became extremely psychotic. The Dr. phone ordered a med for the pt. There was another nurse (LVN) and myself (charge RN) working. The LVN told me the med. could not be overrided in the PYXIS. As the pharmacy person was leaving the unit, I asked them if they could overrided the med for the pt. The person nodded their head no and had the door open to leave. I said outloud "I'll call ***** (the supervisor) to come and override the med. (one of the job requirements of the sup.) When the pharm person heard me say this, they closed the door and came back into the unit and started talking to the LVN as I started to talk to the sup. The pharm person then starts scolding me loudly about calling the sup. I put my hand over the phone and loudly pointed out that they said no and also the urgency of the med for this pt. This pharm person tells me they were not talking to me, they were talking to ****(LCN. So, I talk the sup. and told them what happened and during my conversation, I see the pharm tech entering the med. room (to ovveride for the med.). While the pharm was in medroom, I am tellling the sup. about the urgency of the med, pharm saying no, raising their voice when they heard me calling the sup. I then let the sup. go b/c the pharm person came out with the med. Later in the shift, I spoke tot the LVN about it. The LVN just basically told me it was a very tense situation and basically blow it off. I spoke to the sup. later and told them the conversation b/t the LVN and myself and I agreed with the LVN about blowing it off and chalking it up as just a tense situation. Should I report this to my manager?

I just recently did my BLS/ACLS renewal with an instructor I found in my area through the AHA website. It was hands on and the class was very quick since there was only one other student and myself. I paid $175 for both. Many hospitals in my area do not accept on-line renewals. Also, I think on-line would be more expensive and time consuming than doing hands on with an instructor from the AHA website.

This 50 something year old man came to ER with CP. He started having VT, first stable then unstable. Shocked a total of 17 times with a couple of thumps in there. We finally got him stable enough to move to CCU. After his CABG and recovery, he came back to see us to say hi.

Somebody from HR called me and clarified that I am eligible for rehire.

I have an e-mail from this manager replying they would be a reference for me.