anndoodle

? In several places of your post, you state "the nurse will take this patient and the lpn can do this/that". Do you not consider lpn's to be actual nurses? Or is it just a typing error? In our hospital, we do team nursing: rn, lpn and cna together. Each team of 3 is assigned so many patients to care for. rn's do the assessments and open charts while the lpn's do med passes (including iv meds) and med audits while the cna's start vital signs, bed baths and routine patient care. It is common for the rn's to do the dressing changes so they can assess the wounds. All cna's on the floor assist each other with turning and bathing patients. At our 6am v/s, the rn does the I&O's and the lpn does the v/s while the cna's complete their rounds for turns, bed checks and daily weights. Any time we are available to help turn or help do anything, we do it...regardless of our titles. Of course, not all shift rotations work the way we do, either! There are some wonderful nurses in our town.

When I worked at the nursing home, I knew most of the aids I was to work with before I was employed...whether through high school or just around town. I found that working "with" them, being friendly and approachable yet strict on patient care worked best. Sometimes another nurse would find her day filled with the aids constantly coming to her with little problems all day, such as "so and so needs tylenol, so and so was found sitting on the floor, so and so doesn't want to take her bath, etc. Just anything to pull the nurse to the room and away from her charting. If an aid didn't like you in particular, they could make all kinds of problems for you. I made sure to take time and talk with the aids throughout the day, asking their input on the patients care, keeping them involved in the plan of care as well. After all, they are the ones who work more hands on with the residents day after day and are so valuable in their healthcare. I say be nice, and keep yourself approachable. You don't have to be their best friend, but you sure don't want them as an enemy. :)

Thank you. In Arkansas, LPN's can push IV meds, hang IV meds. I have been a nurse for 17 years, so I'm not new to nursing - just new to how they actually run things on a med/surg floor. The other lpn I was talking about that works as an aide is much older than I am and is due to retire this fall; I believe that's why she works as an aid. I have had very good orientation on the unit I was hired to (ob) actually had over a month of day shift orientation. I feel very comfortable working there. I have had one night of actually going with another nurse on the night shift for the full 12 hours, then one night up until midnight when I was pulled to ob. In my honest opinion, it's a very mixed up situation. Nursing secretary and DON had stated to give me orientation but when I show up for work, invariably someone has called in or they're short handed and they (house charge) use me to fill in for whoever didn't show. Hence, the lack of orientation. I spoke with the nursing secretary today and set up a meeting with my dept. manager and the DON. My manager apparently was unaware that they have been doing me this way. THe other nurses in ob instead of calling me and putting me on call, like everyone else, have just been telling me to come on in to work and would not tell me where I was going to work nor did they give me the option to be on call. From now on, if I'm not needed in ob I will work on the floor as an aid, not as a med nurse per my request. That or I will stay home and not work. Period.

I think maybe I've given the wrong impression. I have been trained in IV therapy, but it's a different world on the floor than in OB. I am up on all my competency exams and certifications at the hospital; I'm not a complete idiot and I do know my scope of practice. The problem was that I was uncomfortable being put in the position of working in a new area and took every opportunity to learn more about what I was to do, even though I knew how to do it....I don't give IV meds every day, and in our geri psych unit if the patients were sick enough to require iv meds, they were transferred to the floor, so we didn't give them back there but we did start the iv's before they were transferred. I just want some orientation on a floor that I'm not used to working, which I was told I would get. I am only trying to do things the RIGHT way and the SAFE way....and especially the legal way. And, yes I do have a certificate for IV therapy in my continuing education folder. I'd just like a little more information and orientation before they just toss me into the madness all by myself. I came to this board looking for support; not more reasons to doubt myself. Thanks for your positive replies.

My main complaint is that I get no orientation, ie. going with another nurse through the night's routine to learn how everything is done, where everything is, etc. When they started making me pass meds by myself, and I came to an IV med that was written to be pushed, I made another nurse go with me, and I watched as she gave the med and showed me how it was properly done. Gues this would be called "on the job training?" I would shadow her then. Next time it was due, she went with me and observed me giving the med. It's like they all believe that since I've been a nurse for so long, I should just automatically KNOW how all this is done. So they just schedule me on the floor and assign me patients....all when I should be back in OB getting my orientation in the Nursery, where I'm supposed to be. But they're short of nurses on the floor so guess who gets pulled. I am going to the hospital on Monday to speak with our DON and nurse secretary again about this situation. Cross your fingers for me! And thanks for your support.

I have filed for a transfer to a physicians clinic that will be opening this spring. The doc I previously worked for will be one of the two docs working there, and he says he's pushing HARD for me to get the position...since they basically took my job away with him before.

i am so furious. been a while since i've been here, so here's some catch up. had a job in geri psych, they closed the unit so i took a job in a doc's office. i'm an lpn since 1990, have experience in doc's office, ltc, and geri psych. after 6 months in the new docs office, they "closed" my job position since the doc wasn't doing much business and they stated they couldn't pay both a nurse and a receptionist. i either could quit or take a leave of absence/summer leave...that's what i did, in the hopes that at the end of my leave business would have picked up and i could go back to the doc's office. had to use all my vacation time, too. when it was time to come back, he still wasn't busy, but the hospital said that they would find a place for me. i had never worked med/surg, so i took a part time job in post partum in ob. i really liked it, too. but now, the ob census is low and med surg is high and they've been pulling me to work on the floor as an aid. here's the clincher: i'm one of two lpn's that works ob, all the rest are rn's. they (the rn's) don't have "floor experience", either, and when it's their "turn" they have the option to take call or stay home/off work, and don't have to work on the floor. the other lpn is older and they only make her work on the floor as an aid. they never give me an option....they just tell me i "need to come in". then when i come in and go to ob, they tell me "you've been pulled to the floor". several times they've made me pass meds, but a few times i've been able to work with the aids. i had a long talk with our don about this over a month ago, and told her i'm not comfortable, either, and that i wanted some orientation. (never worked the floor, remember....) she said that i would have at least 2 weeks of orientation and that they would start putting me with another nurse. after 4 weeks now, i've had one night of actual orientation. they have made me work by myself with at least 9-10 patients to do meds on by myself. the rn's do the assessments and the lpns do everything else. i have asked repeatedly for orientation to no avail. funny tho, i'm supposed to be orienting in the nursery for ob, but they would rather make me work the floor. why not let me have a night of orientation in the nursery??? this is why i'm furious now. this last wednesday, i was off work. i called our nursing secretary to offer to work that night to help out, as i knew the census was up. told her i would still like to get some orientation, go with another nurse, etc. she said the hospital was so full they were admitting pts to our outpatient area, and that she would put me there with an rn and 4 patients for the night - said it would be ok. i got to work, went to that area, and was told by house charge that i was moved to work out on the floor. they had me with twelve patients all by myself, plus an admit!!! i was in tears 4 times that night. and i swore i'd never be put in that position again. we recently had a meeting with the don and allthe nurses, and the don said she could't pressure the ob nurses to work the floor if they felt "uncomfortable". then why the hell are they making me do it??? i have been physically sick with uri's for the last 3 weeks from working on the floor and being exposed, had a 102 temp all day, sore throat, n/v so i called in sick for tonight. my nurse mrg called asking if i was really, really sick...or did i just not want to work the floor. ???? i told her i was actually sick, and filled her in on exactly what happened the other night, and told her specifically: "due to the position i was put in on wed. night, after volunteering to come in on my night off to get some orientation, i discovered just how uncomfortable i am working on the floor. if the other nurses don't have to work out there, then neither should i. i am scheduled to work tomorrow night in ob, but if they don't need me then you need to put me on call....since we're supposed to be taking turns taking "call"...i haven't been on call since our last schedule. i can either be on call for ob or i will stay home. i am no longer available to work on the floor." am i wrong for feeling this way, or should i just let them continue to use and abuse me? i don't see how they can make you work like that without having orientation, iv therapy classes, etc. i mean, last week i just learned that you're supposed to use an option 21 to hang a piggy back on an ivac!:angryfire:angryfire:angryfire

I agree. Lodge a formal complaint in writing, and present it to the physician in charge of the clinic. If it is a hospital based clinic, do the same with the CEO or administrator. I know one lady who wrote the state board of nursing when something very similar happened to her daughter. A nurse gave her 13 year old all THREE hepatitis B vaccines the same day. Said she thought that's "how it was supposed to be done"....needless to say, she took it to court. Clinic is now closed. I'm curious....did the clinic charge you for BOTH the vaccinations? I know they can be pricey. If it were me, I would do every thing I could think of to make sure this situation was taken care of.

Wait a minute....just how does a "lady from administration" come in and pass meds? What state are you in? Or is this person a medication administration aid, which is allowed in some states? At one point at the nursing home (where I USED to work) I was the only nurse for 86 (yes, that's EIGHTY-SIX) residents. Administrator told me to my face that he only had to have 1 LPN for up to 120 residents, and I should be thankful that he "allowed" two nurses to usually work 11-7 shift. Heard he was recently fired from that facility....perhaps they finally came to their senses. Funny, I came to my senses 2 years ago!!!!!!!

Ahhhhhhh......but if they're alert/oriented x 3, they CAN be held liable for their own actions. I know a CNA who pressed charges against a resident because the resident stabbed her with a nail file (yes, the resident did her own nail care, a/ox3) and the CNA retalliated with a lawsuit. And the nursing home let her off for sick leave. Got damages; pain and suffering, and lost wages. It all depends on just how alert and oriented they are.

This question always tickles me. The LTC where I used to work was total chaos when state entered the building...several nurses would run like chickens with their heads cut off. Basically, all you have to do is do your job. And do it right. If you do your job correctly every day, then state should be no problem for you. The ones that get hysterical and are nervous wrecks are the ones who probably don't do things they way they're supposed to. If you do your job right, then there's nothing to worry about. Just do what you would normally do! And do it with a smile!

Speak with your DON concerning this issue. If it bothers you to the extent that you feel you cannot give quality care, ask to be reassigned to another area. Or you can speak with the patient's nurse and ask whether a psych assessment is warranted. They may need some med adjustments or even an inpatient stay. It's amazing how much a little Klonopin, Depakote, or Seroquel can make a difference!

I have worked both LTC and Geri/Psych, am still currently Geri/Psych. In the LTC setting, nurses are encouraged to chart accurately, which means if a resident pinched you, cursed you, etc. then you chart exactly what happened and what was said. To do otherwise would be falsifying medical records. We had several residents that we had to do "behavior charting" on every shift. The DON was to be infomed of all behaviors so that we could track those residents with a violent temper, etc. We have a geriatric psychiatric inpatient unit in our town, which comes in very handy (where I currently work) and we get patients from all over the surrounding counties. Agreed, sometimes we have a patient come in and the nursing home refuses to take them back due to their extreme behaviors. However, unless it is a physical event (direct harm to another resident, causing a police report and LTC report) the nursing home must take them back, according to state law....unless the facility has sent the resident's family a written 30 day notice of expulsion. I mean, you can't just boot these people out with no notice and no where else to go live!!! That's one of our biggest problems. Sometimes LTC sends them to us and then refuses to take them back, and it takes forever to find these poor people new homes. Also, many times, we resolve the behavioral problem with new meds, and send the patient back to the nursing home, only to have the MD "continue regular nursing home meds & orders" and the nurses DC the meds they were on in the psych unit and resume their old regular meds. These are the ones we get back within the week, because they're acting out again. (duh...) Many times we have to send notice with their discharge papers to make sure they do NOT stop the psych meds....many of them must be on the psych meds daily to prevent their behaviors. And then pharmacy does their LTC reviews and recommend that the dosage is lowered, so they lower it and the problems begin again. It's just a vicious cycle that never ends. And the patients, and our tax dollars, are the ones who suffer for it.

This is EXACTLY why I quit working LTC. I was working the night shift, which should have 2 LPN's for each night. It never failed...one nurse would call in, and the 3-11 nurse would have to stay over until 1 or 2 am, then I would have to count out HER cart and be the only nurse in the facility (for 86 patients at that time...) until the next nurses came in at 6 am. I contacted the OLTC and they told me that in Arkansas, they can have 1 LPN for up to 80 residents. Yes...EIGHTY residents for one nurse to take care of all night long. But if there's 81 residents, they MUST have TWO nurses. I informed our administrator about this, and he stated to my face that "We only have to have 1 nurse for 120 residents....whoever told you that doesn't know what they're talking about". So, I quit. Now I'm happily working in geri/psych where I'm the med nurse for a maximum of 7 patients each day. *sigh of relief* It's amazing what really goes on in the nursing homes that the state isn't aware of, such as the staffing "fixes" mentioned above. Every nurse in the LTC facility where I used to work signed every one of the staffing sheets, but they NEVER worked on the floor.....just in their offices. 3 days out of 7, the treatment nurse wasn't there, and we were responsible for all the dressing changes, too. It was too much, and to this day, the turnover is still bad at that facility. They've even been bought by someone else recently and hopefully they are making some good changes. It's just amazing what gets under the state's "radar" sometimes. State enters the building, and those nurses ran like chickens with their heads cut off. If they did every day what they were supposed to do, then they shouldn't be concerned about state inspections. I wasn't....I did my job! But I wouldn't risk my license to be the only nurse, at night, for 86 residents anymore. PERIOD.

The psych unit where I work has oxygen supplies, but they are kept in our locked procedure room. Does your unit not do medical screenings before admission? New admits for our unit are usually sent through the ER for a medical clearance before admission. But we have to have an RN and a LPN on the night shift. What state do you work in? Sounds like to me you did the right thing. Why call a code on a conscious patient with stable vitals? I agree with most of the posters above.