Thomas RN

Your employment in a correctional facility will depend on a couple of things. Number one: The violation your licenses was disciplined for Drug related? Scope of practice? Were you charged with a crime - Domestic battery? The law enforcement agency responsible for the correctional facility will do a background check on everyone civilian or sworn - what shows up in the background check will have a great deal to do with your being allowed access to the faicility. The agency will look at your background with the principle: will this possibly jeopordize the safety or security of the facility - if they think yes; your chances of employement are slim. The State Board of Nursing that took the action against your license might require a "work site approval" meaning they must give their ok to the place where you work - if they thing a correctional facility is not conducive to the terms of your probation they may turn down the work site. Also it is a case by case basis sometimes. If the agency does not have a diefinite "not allowed for,...." the person responsible for hiring you and upervising you might have the authority to hire you with certain restrictions - like random urine drug screens- it is always best to tell the exact truth what happened and why- was this a frist time and only time thing. I think if you have a drug related violation and your license is on probation for that you may have a tougher time and have to wait until your probation is completed. I have worked in large urban jail settings for years and we have had nurses n probation fro time to time - with supervision, random drug screens and frequent meetings with peers and supervisors and usually day shift assignments they all did very well. Good luck to you Thomas Posten RN BSN CCHP

RN CCHP (Certified Correctional Health Professional) twenty years working in 2 large urban jail settings. Never have worked in prison setting. Most challenging is the integration of Nursing Excellence into a site operated by Law Enforcement (quasi military) and maintaining compassion for all patients incarcerated; maintaining professional decorum where verbal abuse and threats by patients are common. To keep totally objective in all patient encounters and working alongside some custody staff that are "bullies" and attempt to antagonize inmates; be comfortable and high functioning in a setting that has potential for violence; attacks on staff by inmates. To be an advocate for all persons in the facility regardless of crimes they have been convicted for committing or pending charges. Crisis oriented and highest stress possible for nurses. It's great!

i agree with one nurse that says that the "intimidated nurse" needs to have established control over the situation and gone from there. the first thing i would have done in that situation would have been to call the nursing or "house supervisor" that person should be experienced in dealing with most situations. first of all get the attention of someone that appears to be giving the most direction. which of you signed the admission forms for your mother or who assisted your mother in helping her during the admitting paperwork. which of the family members will most directly involved in her care while she is here? who will be speaking for your family as a whole? by now there is always one person that seems to be doing all of the talking. ask that person to step outside the room. be calm but firm; "the number of people in your mother's room is keeping us from doing what we must do for her. this is an unsafe situation. we need to move around the room quickly and do some very critical things that are necessary to save her life. i am sure that you understand how a distraction could result in something being omitted. until the room is cleared out we can do nothing more . get the nursing 'supervisor involved immediately.

The company I work for has very strict policies and guidelines for frequent call in's and take a hard line when a nurse doesn't call or show up for work. If a nurse calls in sick at the last minute (sometimes an emergency takes place and it cannot be avoided) the nurse is given a verbal warning and an anecdotal note is placed into the nurses on site file. The second time during a one year period the nurse is given a formal written counseling notice, the third time a minimum of a thee day suspension and is terminated if there is another incident Every nurse is well aware of the company's policy that at lea a four hour notice must be given to their direct supervisor or his or her designee. That person is always available and must be called at home in the middle of the night if necessary. A nurse cannot leave a message or have someone call for them If a nurse doesn't show up for work, that nurse is given a formal, written counseling notice and an automatic three day suspension (no paid time off can be authorized) if during the following one year this happens again the nurse is terminated. The administrator has the authority to not terminate a nurse if it was some catastrophic event that resulted in him/her not showing up for work. (Perhaps the nurse had an accident on the way to work) We have several per-diem - on call nurses. Sometimes we are able to find coverage at the last minute and sometimes we cannot. If coverage cannot be arranged, the administrator (an RN), or the Director of Nursing must go in and cover the shift. In the setting where I am employed, it is unsafe for one RN to work alone in any area. The company makes certain that every nurse knows the policy and signs their name to a document stating they are aware of the policy and the consequences for violation of that policy

When i am interviewing nurses for a staff position on an addiction treatment unit and that nurse has volunteered that he/she is a recovering alcoholic or addict I always ask them to explain to me if there own recovery will "color" the recovery of the patients. If they tell me that their own recovery won't influence their care and teaching of our patients that have addictive disorders,I ask them to explain to me exactly how they would prevent this from happening. At one time this unit did not hire any counselors or nurses that were themselves recovering. Now it is on a case by case basis. I also ask them if they will volunteer their history with patients. Our patients go to AA/NA/GA/OE meetings everyday, sometimes two or three daily. If the candidate for employment is a member of a 12 step group and there are clients there, how would they react if at all. Our program is based on clients having an "addictive disorder" not being "alcoholic" or "addicts"A few recovering nurses have tried to establish "core" groups based on their own history. The resist the application of "addictive disorder" to themselves. We believe very much from day one that teaching that cross addiction is the rule and never the exception is essential to complete abstinence from drugs and alcohol and all mood altering substances.

I am curious as to the treatment the patient was receiving the first time you had the responsibility of caring for him. Was he receiving an aggressive alcohol withdrawal protocol? Possibly valium or librium.

i work in a free standing detoxification unit that specializes in a 3 to 5 day detoxification of clients that are withdrawing from opiates and/or alcohol. we have had patients react to suboxone only if the first dose is given too soon and the patient is not experiencing moderate withdrawal( from heroin or other opiates). we prevent this by using the clinical opiate withdrawal scale (cows) and the client must score a 13 on the scale before the first dose is given. i think that sometimes the client is anticipating the withdrawal and will try to exaggerate the signs and symptoms but if the nurse uses the scale carefully this won't happen. other than this type of reaction our clients have no adverse or untoward effects and generally fell better right away. hope this helps .

i am concerned that the nurses at my workplace are being given the incorrect information about placing a ppd tuberculin skin test on patient that says the he/she has a positive ppd history. my place of employment is very small and only has only four full-time rn's and three per-diem rn's. i am one of the three per-diem rn's/ we do not have a director of nursing and there is no written policy or procedure in place for how to correctly care for a patient that arrives at the facility telling the nurse that they have had a positive ppd test for tuberculosis and a chest x-ray wast taken and the results showed that this patient was negative for any respiratory disease. we were not able to fax a release of information and a request for medical records. i arranged for that patient to have a chest x-ray because of a positive ppd history. i was told that i had done the wrong thing. i was told that i should have repeated the ppd skin test regardless of what the patient had said about his or her ppd skin test history. taught that once an individual has had a positive ppd skin test, the skin test should never be repeated because of the possibility of a severe reaction including, blistering of the skin, infection of the skin, necrosis etc. is it not the usual practice to order a chest x-ray or ask the licensed physician or apn or pa to order one. isn't this a liability issue as well. could not the facility be sued if a severe reaction occurred? a co-worker and i have decided that if told to repeat a ppd skin test on a patient that states that he/she has had a positive reaction in the past, we simply must refuse because this could cause harm to a patient and be a violation of the nurse practice act? thank you thomas rn.

i personally believe that alcoholism is and is not a choice. individuals choose to drink alcohol at some point in time. they choose how much and how often they drink alcoholic beverages. individuals choose to use alcohol to often produce pleasurable feelings and to diminish inhibitions in social situations. they experience euphoria and return to a normal state after drinking. they choose occasional drinking, perhaps a few times monthly; weekends. individuals can also choose to increase their use to several times a week and may choose to drink during the day. they might choose to drink alone rather than with friends. they may choose to drink alcohol in quantities and at a frequency that is not consistent with maintaining good health. at some pint a "switch" is turned on and what were choices are no more. when this "switch"" is turned on it is at this time alcoholism is not a choice any longer. the individual begins to drink compulsively and his or her control over drinking is impaired and now there is a preoccupation with obtaining and using alcohol and continues to drink despite adverse consequences such as health problems, legal problems, job loss etc. the experts talk about individuals that possess certain vulnerabilities and are biologically susceptible to becoming addicted to alcohol and through molecular adaptions in the brain that are important for the alcohol reward and cravings have now taken away the choice of drinking or not drinking. this is at the point the "switch" has been turned on. regardless of how much the individual wants to choose not to drink alcohol they cannot stop drinking. also i personally believe that certain individuals that are given the tools and skills through rehabilitation and treatment often choose not to use the tools or do the necessary things to be completely abstinent (this being their first priority) and going on to become sober in life long recovery. in a round about way this is choosing alcoholism. i understand that if individuals do not have the skills or tools and information they need to stay completely abstinent and then sober the return to drinking is gong to happen sooner or later. if the tools, skills and information have been given to them and they choose not to use them or do as they have been taught; that results in choosing to remain in the state of being "alcoholic" addiction is a disease that is chronic and life-long, but remission is totally possible. individuals can choose to be in remission or choose to be in the active disease state.

For a general pupose all around excellent stethoscope I like the the Littman Masters Classic II. It is about $100 tops and lasts forever and I have used mine both in critical care and outpatient settings. If you are a cardiac nurse that does only cardiac stuff and need to be diagnosing heart tones etc the Littman Masters Cardiology is the one for about $175 but take a look at the Prestige Clinical cardiology (#7424) forr about $70 excellent piece of equipment.

i am so sorry that you have had such a difficult and dis-heartening experience as a nurse with five years experience. my heart goes out to you. i apologize for all of those nurses that could have and should have helped you and seen that you were struggling and given support, even in the smallest way, a smile that is sincere, pat on the shoulder, a comment about your hard-word; something we all need to do for our colleagues and work mates. it sounds that you have had some wrok situations that were toxic to begin with and co-workers that were not at all team players or professionals. i must tell you it does not have to be this way. do not give up. keep looking and look to alternate job sites for nurses. it sounds as if you have done mostly long term care. that is one of the most difficult areas of all to work in my opinion. i have had nurse colleagues that have worked in long term care for years and love it but they have found facilities where everyone is there for everyone else. the work in ltc is inherently difficult. the numbers of patients assigned to one nurse and one cna is overwhelming and the patients are so in need of nursing care that is not rushed or restricted by large assignments or short staffing. unfortunately that is often the way that specialized area. ltc is supposed to be the most tightly regulated of all industries and i personally think tha often the employers or owner-operators are so focused on the regulations that they loose sight of the needs of the nurses having to follow them so closely. if at all possible look to enrolling in an lpn to rn program and yes the economy is not conducive to taking on more expenses but look tuition reimbursement and the community college programs that have more reasonable tuition. there are scholarships and grants out there too; it takes some time to research and locate them but they are there. going back to school would renew your interest and enthusiasm in nursing as a profession and with an rn license there are so many more. venues for you to pursue. in the meantime, look to areas that are not the usual nursing job settings; correctional nursing (the large companies that provide contract services for correctional employee lpns and give them a more autonomous role in most states. look to blood banks and free standing dialysis units that sometimes employ lpns or train lpn as dialysis techs; medical offices that provide special services. perhaps look to working as a phlebotomist as something to do while gong to school and medical records often need nurses to review charts and communicate with various providers. look on-line for companies that provide immunization clinics in alternate sites like pharmacies and schools and colleges. if you husband can provide your health insurance through his work look for something part-time or per-diem.this way you are not enslaved to a full-time job that you don't like and and work more than one job per-diem. do not give the training and experience you have too little credit. those things can be built on and expanded. as a young rn, it was often the lpn's that guided me and showed me the art of true bedside nursing. a friend of mine who has been an lvn for many years got a job teaching medical assistants at a private vocational college. don't give up. even though nurses are not highly paid workers, there are few jobs that with the same level of education that provide the salary and rate per hour that nursing does. yo are still a young person and have many years left for you to work if you want to - it is never to late to get more education and use that education and your experience and current training to work for you and work at a job you will like and look forward to going to. there are many, many nurses that are really discouraged with being a nurse; and rightly so but don't give into the situations that we can't change. i have been a registered nurse for 38 years and if i had to do it all over again; wuld i? ina heart beat. i have very negative feelings abut what has happened in the nursing world today; so many changes have had such a negative impact on every nur practicing today. in my humble beginnings health care was a service oriented business; not a business organization that cares more about profits than patients, but i am so glad to have chosen nursing as my life-long career. i still feel very proud to have the privilege , honor and distinction of writing the letters "r.n." after my name. best of luck to you and god bless you nurse. thomas posten rn, bsn, sparks, nevada