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.

When you borrow money you sign a contract stating you will pay it back in a prescribed manner, for example $200 on the 1st of each month. If you don't pay it back as agreed, you are basically stealing from the lender, causing them to lose money on your account. If you have any doubt that you can repay your debt, don't do it. If you have bad credit it means you haven't paid your debt as agreed. There are good reasons for having bad credit but this is rare. You can name all the exceptions you like (your brother-in-law who had a sudden devastating illness and lost everything and now his children have to beg on the street) that doesn't change the fact that most people with bad credit got that way through bad choices. I believe most people that have bad credit are in that position because they have made poor financial choices. And people who make poor choices in one area of their life, make poor choices in other areas. Like it or not, we are all in the situations we are in because of the choices we make. If for some reason you do have a run of bad luck and bad credit, fix it as soon as possible. A lot of people get into trouble because they panic and stick their head in the sand and ignore the situation - that makes it much worse. Having bad credit is not a reason, in itself, to deny credit anymore than good credit, in itself, is a reason to hire someone. But in general, you credit score speaks to your competence and character.

I don't understand why you would give a double dose of phenergan, aside from all the other comments and legal implications, since it isn't a pain med. Very poor judgement all around.

Hopefully you would have said "Dr regardless of my title I was asking you for your professional opinion as a favor to the attending. I will be more than happy to tell him you are unable to give it and will document this conversation in the patients medical record." "Irregardless" is not a proper word and it may give him more ammunition against you. Aside from the grammar, where do these physicians get off talking to anyone that way. This doctor has mental health issues (which are not your problem) and needs someone to look down on. He picks on nurses because he thinks they can't or won't fight back. I bet he would never speak to a fellow physician or the CEO like that. It just shows what a weak, stupid twit he is. One possible response is, "Excuse me? I am nurse, not "just a nurse" and I was carrying out a request from the attending physician. I will pass your message along to him. I also want to let you know, your comment was totally inappropriate and I don't tolerate people speaking to me like that. You will hear more about this." (Of course, you never think of these things at the time.) Then, submit a QCC to your manager and if you think he/she won't follow up, send a copy to HR, the CEO, and the medical director. Most hospitals don't tolerate that type of thing anymore, at least not in this area.

Hopefully you are not using answers on a bulletin board as a basis for your medication adminstration. Do you not have current drug books on your unit? If nurses are not drawing up insulin correctly it is a med error - fill out a QCC or incident report or whatever you call them at you facility. I assume 2 nurses are witnessing insulin since it is a high risk drug.

Dubin is the one you want.

As previously posted, if you buy something on credit and don't pay the bills, as agreed, you are stealing. It is a character issue (most of the time). If you will steal from the credit card company or the landlord, or the bank, why should I believe you wouldn't steal from me given the opportunity. Identity theft is another issue - it should be much easier to clear that up than it is. And sometimes things happen and people are unable to pay through no fault of their own. The vast majority of the time it is irresponsibility, and who wants an irresponsible nurse?

Whether or not an RN can pronounce death depends on the laws of your state and the policy of your facility. As practicing RN you should be familiar with both.

I agree with everyone not to place a PEG or give IV fluids but I am with you Mermaid on the NPO order - it should be "Diet as Tolerated". I believe it is unethical to deny someone in that condition food or fluids. She will probably not eat or drink much anyway - just a couple of sips. It is cruel to deny someone who says they are hungry or thirsty. And if she aspirates at this point, so what?

I am working on my MSN in a program that uses teleconferencing and online courses. I prefer the online classes because I can work on my own schedule. The classes I have taken, both online and teleconference, use the Blackboard program that has different areas where you can communicate via discussion groups on a bulletin board or sometimes in a chat room - so there is contact with fellow classmates and the instructor. It also depends on the course, some are more amenable to online learning and some (like research and statistics) are better with live interaction. If you do online classes you need to set up regular time to work without the external motivation of actually attending a class. But if you are working on a doctorate, I'm sure you know that and have the discipline and motivation to follow through on your own.