KMSRN

I think most places have paid time off (PTO) rather than dividing sick time from vacation time. The issue is not sick time vs vacation time but calling out at the last minute. Calling it PTO does not change the fact that it is inappropriate because it puts patients and other staff at risk. The reason they say they are sick is because this is one of the only acceptable excuses to call out at the last minute. It has nothing to do with being "progressive"; it is rude, inconsiderate, and dishonest.

If you notice, pharmacists and physical therapists now require a doctorate for entry level. OTs, dietitians, social workers require at bare minimum a bachelor's degree and most have a masters. Nursing has refused to raise the bar on education and is consequently being left in the dust. It is my opinion that a minimum of BSN is required for the job because there is just too much to learn in 2 years. It is also my opinion that the BSN programs as they stand need to be revamped. Who needs nursing theory, management and research at this level? We need assessment, pharmacology, lab values, disease processes, wound care and hands on experience in more than bed baths, bed making and toileting. The last semester needs to be a practicum to put it all together while caring for patients. Is this going to happen? Highly unlikely. I'm sure there will be angry responses but this is my opinion and I'm sticking to it.

If I may respond. I work in Staff Developement and I develop and administer the medication test at my facility. I strongly advise that nurses use a calculator because, although most can do the calculations manually, it leaves much more room for error. Calculators are one more method for removing human error from the medication administration equation. Having said that, for students, I understand why you wouldn't want them to use fancy PDAs or other memory laden machines. Why not keep cheap basic calculators for them to use? Then they learn to do the calculations themselves but have the added safety of the calculator when figuring out doses. Plus they learn how to use the calculator correctly - you'd be amazed at how many nurses don't know how.

I just did some research for a report on cultural aspects of pain management and what I found was very disturbing. In study after study it was found that minorities received considerably less pain medication than non-minority (whites). These are a couple of them. Study of 127 black and 90 white patients with a diagnosis of long-bone fracture 57% of black patients receive analgesia compared with 74% of whites Risk of receiving no analgesia is 66% greater for blacks than whites Patient and physician pain scores were identical for the 2 groups Implies that any ethnic disparity in analgesic prescribing could not be attributed to differences in pain assessment In a study of 250 consecutive patients after open reduction and internal fixation of limb fracture. After controlling for other variables: Whites received 22 mg of morphine/day Hispanics received 13 mg of morphine/day Blacks received 6 mg of morphine/day In a study to evaluate the severity of cancer-related pain and adequacy of prescribed analgesics in minority outpatients with cancer: 65% of minority patients did not receive guideline recommended analgesia compared with 50% of non-minority patients Hispanic patients in particular reported less pain relief and less adequate analgesia It has also been found that if the cultural/ethnic background of the patient is different from the caregiver, there is inadequate assessment and treatment. It gives us a lot to think about - our conscious and unconscious attitude, prejudices, and stereotypes.

According to the way range orders are interpreted at our facility, you did the right thing. If the lowest dose is not sufficient, the remainder of the full dose can be given but then the 4 hours starts at the time the remainder was administered.

To get past prejudice everyone need to "understand the issues and dissect them". Contrary to the stereotype, faith and thought are not mutually exclusive.

In the first place it is HIPAA - Health Information Portability and Accountability Act - not HIPPA. In the second place, what the heck is a HIPAA code?

Morphine can be given orally, intravenously, intrathecally, subcutaneously, and rectally. It can also be given IM but I sincerely hope no one is giving pain meds IM anymore. Morphine can also be given subcutaneously as a PCA or continuous infusion - the volume that can be given is limited. This information is readily available in any drug reference.

I disagree with telling the charge nurse. The RN is in charge of their patients - why add another level to the process? It is one more opportunity for misunderstandings and mistakes. The patient's nurse needs to deal directly with the physicians etc. We should be moving toward more professionalism and autonomy, not less.

thanks for your response - it is very thorough and a good description of orientation. it is so much information thrown out in a short time that by the time nurses get through orientation they are in information overload.

I agree with operating as an independent licensed professional.

I am orienting a group of brand new graduate nurses. One of my questions for them is going to be, "What is your primary function as a nurse?" I have my own opinions and ideas but I would be interested in input from others. As nurses, what do you think our primary function is?

My granddaughter's name is Boston. I'm not sure if that goes under this thread or under unusual names. At first no one liked it but it grows on you. And the name suits her - she looks like a pretty little Boston.

Forget filing a variance or a complaint - go for criminal charges. It is totally inappropriate not to mention illegal for this bozo to lay hands on you. Where is adminisration in this? I'm glad to see your coworkers backed you up. It makes me mad just reading about it.

Get a GOOD junk yard dog lawyer now! I went through a similar situation while I was in nursing school and my kick a** lawyer saved the day. There is no such thing as an amicable divorce especially when money and kids are involved. Having said that, it is all up to the judge which can be a crap shoot. Hang in there, you'll make it one way or the other - and you'll probably be better off.