Maremma

Wow that is sad. I wonder if this lady has something like that going on. I actually feel bad for her. I can't begin to imagine what it is like to be the way she is making one enemy after the other burning one bridge after the other. She had NO idea the harm she is causing to herself by being so ugly to everyone. That may have worked for her at her old job but where I am at you need all the friends you can get. It is the only way to actually survive that environment for very long. She was not there today but I had to spend a considerable amount of time backtracking and undoing the damage she did when she was there and I wasn't. Again causing harm to a patient with a mistake she made. Although her getting so ugly and arrogant against another nurse that tried to nicely tell her she made an error and what she did to "fix it. Sadly she did not actually "fix" the biggest problem but the attack on her from my "partner" right in front of me yesterday made me able to hone in rapidly on what happened to my patient that made her "crash and burn" at PT that day and get it corrected before it killed her. Now I have to mull this mess over and am fully expecting to be called into the DON's office to "clarify" what I did. I will be the next one on this RN's "chopping block" if that happens I am sure. There is no way to get around this one.It is all in black and white print in the computer. I was forced to tell her Dr what had happened and what I figured out and corrected because it did cause mayhem to this poor patient, the Physical Therapist was in a panic, I was scrambling to help this patient when they brought her back. THIS disaster makes me REALLY hate that they have computerized everything. This could not have happened at all if we were still using paper. I wish I COULD refuse to work with her to try to "save myself". That is not an option. They will not let me transfer off my unit. My only option is to leave the facility or hope she is just like all the rest and gives up in three to six months and just leaves....

I am a rehab nurse. In our facility we are suppose to have 2 nurses on my unit for both first and second shift due to the high acuity of these patients. Unfortunately more frequently I do not have a partner. I have been on my unit several years and have have seen many partners come and go. Even with 2 on it is still extremely difficult. It seems most simply cannot handle it very long and give up and leave or transfer ect. As anyone can imagine the longer I go without a partner the more exhausted I become. I used to be happy to hear "You have a new partner starting Monday" They will orient with you x amount of weeks first" I am to the point I now think "Oh great. Another couple of weeks of getting slaughtered every day AND having to try train someone new:(" They always wait until we are so short staffed that there is no hope of a second nurse coming to help me at least until I get the new person trained.They "try" to get me an RN for a partner. (I am an LPN) They have this delusion that RN's are going to actually STAY working the same position as us LPN's indefinitely. This alone discourages me to no end. They say RN I feel hopeless. I'm going to kill myself training this person and they are going to bail on me within 3-6 months anyway. They can go anywhere else make a lot more money for a lot less work and stress. Why WOULDN'T they bail on me? Anyway I always give every new person 110% to try to help them learn and "carry" them until they are able to stand on their own. Even knowing what I know. I have a new RN partner now again and I am beyond my ability to make this one work. I can work with a LOT of different personalities. I can teach a lot of different type of people too. This one though is maxing out my "training skills"! Part of what I do with new people is "shield them" from the sharks in our facility and work with them to help them blend in smoothy to work as a team on the entire unit not just my hall. Well I am almost sure this one IS a shark! Hmm. She is systematically making one enemy after the other! Unfortunately she has the attitude that she can do no wrong. She knows everything and gets very ugly to anyone that even tries to help her or explain anything to her or explain what she did wrong and how to fix it.She attacks other people verbally. Other staff and even family members that question what she is doing or has done. All the other staff come and tell me what she has said or done to them and tell me they are sorry but they are not going to work with her "on purpose" So pretty much don't ask them to work any days for me if I would need off. It isn't because of me they will say no, it is so they don't have to work with her. There are NO nurse's left now that will work for me if I need to trade a day or something! She has only been here a few weeks and this is where it stands already:( I also more unfortunately have caught her lying about other nurse's to blame them when she does something wrong. Worst of all she is not a very good "floor nurse" either. She is making very serious errors in judgment and not following protocol then looking for someone else to blame when the disaster strikes that is sure to happen. For example giving someone with a chem stick of 151 insulin at 3:30 pm when they don't get supper trays until 6-6:30 pm. IN SPITE of being directly told when the trays come, reminded that we check chem sticks and only give insulin 15 minutes before food. I even warned her WHO we do not give insulin until we make sure they will ACTUALLY eat food before giving it due to them having dementia and or behaviors. I have a boatload of patience for new people and especially brand new nurse's out of school. I have no patience for someone that refuses to put patient safety above their arrogance and pride. She has been a nurse for many years but she was a dialysis nurse. She never worked in a fast paced environment much less the type I am in. I am overwhelmed already without my "partner" creating one disaster after the other for me to have to "clean up". I am at my wits end how to turn this one around and get her on track. It is as if she is not able to learn from her mistakes and has no regard for who she hurts with her arrogance. She is 60 so I have to wonder if there even is a way to get her change at this stage in her life or am I wasting my precious little energy on a lost cause? Upper management is of the mind set "A warm body is in that slot.We are already down way to many staff and can't get them in here as it is. It has an RN attached to it making us look good on paper. Do what you as the LPN has to do to make it work" "stop trying to eat your young".

I get "pulled" to work as an aid too. Where I work though it is hardly "fair" and certainly not very smart how they decide "who" is getting pulled. (It is ALWAYS me if I am there that day. If I am ALREADY pulled and they need ANOTHER nurse to work as an aid THEN they pull only certain ones) It is not a matter of seniority (because at this point I now have seniority)or who is permanent full time (because I am the permanent full time 3-11 on my unit) vs part time or float or PRN. I worked as an aid before I got my LPN. Most of the other nurse's did not so they use that as justification for their insanity. They will throw me on the floor as an aid and put a float or a PRN in my position that doesn't have the first clue what they are doing or what is going on and doesn't stand a snowballs chance in hell of keeping up. They will then expect me to not only work as the aid but ALSO do everything the fill in nurse can't manage to keep up with,all the treatments for my hall, stop what I am doing and go show her how to do whatever it is she can't figure out how to do or can't do because she is still passing meds and has the entire hall in the red. THAT is the problem I have with them putting ME as the aid on the floor. My hall is extremely difficult as the second shift nurse all on its own but to then throw someone there that cannot stay afloat even is insane.It is even more difficult because the day shift nurse's they have in my hall at this time are on break more than they are working and leave all THEIR work for the second shift too. They simply say "its a 24 hour facility" as they smile and laugh going out the door. Hmm really? Cause third shift doesn't know how and refuses to learn how to do the brunt of the work. All the admissions come on second shift too. And the supposed second nurse for my hall for second shift is always the one that is pulled to fill in for call offs, other peoples days off, vacations and to do the 1 on 1 with behavioral residents.I actually have my partner maybe once eveyr other week if I am lucky(um she has had enough and is applying for other jobs. She will be gone right shortly too. She can afford to take a pay cut or fall back on her teaching degree) They don't even bother to attempt to cover any of that and simply use my partner as their convenient scheduling tool. Leaving just me to do the work of 2 nurses plus day shifts work and any and all admissions that role in. Yeah so throw a float in there and watch what happens to my hall:( I do not mind in the sense that I am doing "aid work" I easily slide right into that role. I also do not have any issues with any of the aids being disrespectful to me trying to "be my boss". We are a team no matter what job I am doing that day. If you have that mentality all the time you are working as the nurse you will not have issues when you are working as an aid. Not to mention, tomorrow I am the boss again and I have a long memory. I get paid LPN wage to work as an aid but I do not get paid double to do the work of two nurse's every day or the aid and nurse wage to do both those jobs at once. I do not get preceptor pay to have to constantly be training all the new people or fill ins. I am told that "it is just the way it is, get used to it". Hahaha NO. And they wonder why they can't manage to keep second shift staff?

I most certainly do document everything he is saying and doing. Sending him out is useless. They give him a shot of IM haldol and send him right back. They "can't" admit him. No other facility will take him (or has room for him or whatever). He is very manipulative and has learned to threaten to kill himself to get things he wants. He WAS admitted to a psych unit for 10 days when he said he was going to use his call bell to hang himself.(which of course everything was promptly removed from his room) He says "I have to kill myself, I don't have any money" "I can't even buy pepsi or a candy bar when I want it".THAT gets him a psych unit visit. The solution they sent him back with? Hand him soda and that will "solve his behavioral problems" Umm NO. He GUZZLES it down woofs down one candy bar after the other and simply demands another one as soon as he is done. He is a diabetic sooo I find this ludicrous that that is what they think is the solution. Not that it works anyway. So if he wants to kill himself suddenly he can be placed in a psych unit. (where he gets all kinds of one on one attention all day) But when he tried to kill other people there is no need for psych unit? What is MOST ludicrous to me is that I have discovered that it is ALREADY documented in his chart that historically he has this reaction to ativan and rather than take him off it and KEEP him off it they had increased it instead. U/a? Negative as always.What responsibility does the psychiatrist have in this situation? Of course they also were aware he was behavioral before ever accepting him to our facility but took him anyway. Its not like they aren't fully aware that we do not have a psych unit or even a dementia unit. He is not the first patient they were fully aware was behavioral and accepted anyway. "well they need care too" is what we are told! Wow really? We are not equipped to handle them THAT is the problem. It seems that we need LAWS to force these places to do the right thing and not accept patients you are not equipped to properly handle and are unable to protect other patients and visitors from. I can say that I am not going to be the one paying my medical bills when I have to do to a Dr to get meds to be able to keep working in such an abusive environment. That much I am sure of.

What is the responsibility of a Nursing home/ rehab facility to protect staff from sexual harassment by a patient if the patient is also bipolar with dementia involved? I can no longer take the abuse and asked that this patient either be moved to another hall with a male nurse or to move me to the other hall and ask the male nurse to take over my hall for a while. I was told "it is a complicated problem" and I have not been moved nor has he. Indeed it is a "complicated problem" as HE is an over all problem and should not even BE in our facility at all. We do not have a psych unit. We do not have a dementia unit. He has to be in a private room due to his violent behaviors and so is on my "rehab unit" so he can be in a private room. I cannot afford to quit work to end the abuse.I can't find another full time job. I have been trying for quite some time. I also cannot take anymore of it. I am exhausted. I go home crying and can't sleep. I can't eat right. I am shaking and dread going anywhere near work. I have even considered finding a Dr (I don't have one right now as mine retired) and asking for ativan or something to help me be able to keep going there. I do not have an anxiety disorder. I am not a depressed personality or anything that would actually justify ativan though. It is JUST this job. This patient becomes verbally and physically abusive to not only me but everyone around us every time I have to tell him I am not his girlfriend I am his nurse and that is all I am. He needs to stop being inappropriate. He makes threats to kill me and others or himself whenever he has to be told not to do something or he can't have what he is demanding. He started in on me as soon as I got on the floor yesterday. Another staff heard him and told him "Don't even start that" Well that was all it took to throw him into a rage. He was cursing, calling names and suddenly decided that a female resident had taken his money and tried to go after her in her room. I was able to intervene before he go to her but I took a physical beating KEEPING him away from her. He was punching and kicking and made contact before I could get behind him to avoid any further beating while trying to redirect him back to his own room and show him his money is exactly where he left it. THIS is my daily routine with this man. It is a constant battle to protect the other resident and staff from his constant barrage of abuses. They changed his meds in an attempt to help with his violence but all that did was make him worse and hyper sexual against me instead. I am having to deal with this from the time I get there until I leave. All the while also trying to do my job effectively and take are of everyone else and their family members as this is supposedly a physical rehab unit so there is always a LOT of extra paper work and family to content with on top of everything else. why is it that it is the "norm" for employers to expect staff nurses to be able to take this kind of abuse day in and day out and still manage to get everything done and act like everything is wonderful? Is there no legal responsibility of the employer to protect us from these things?

I am so sorry this happened to you. I am glad to hear you are doing better. I have just very recently been pondering this type situation and the effects it has on not only the individual staff in an incident but the staff surrounding that person.Things are so bad in our facility this is a daily issue I think about. I find it surreal the way employees have been conditioned to "accept" this violence against us as "no big deal" perfectly normal to be abused and just keep right on going "like nothing happened". Except it did. It most certainly did and it has caused a ripple effect. I have personally been physically attacked so many times I truly cannot even count them all anymore. The verbal abuse is daily. And no I do not work in a psych unit nor a prison. I SUPPOSEDLY work in a physical rehab unit! It is weighing very heavy on me. I am sure I do not get paid near enough to be a punching bag. I sure didn't sign up to be a boxer a wrestler or any job that you are PAID to get beat on. The jobs for LPN's are pretty limited here and I actually feel trapped. Because of all the school loans to get my LPN I cannot afford to go back to the old job I used to do. I guess that is where they get us.

Is it possible that the part time job will eventually go full time? Rather than pick up any extra hours where you are at maybe you could work both jobs to get your foot in the door and as soon as its available switch to full time at the better position? Or maybe you could pick up a second part time job to supplement the income of the better job until a full time spot comes open? I understand how frustrated you are. I walked a mile in your shoes as a new nurse in LTC. There certainly is no mercy in the LTC setting and it is about to get a whole lot worse with all the problems coming from Obamacare. It is already very hard for a new nurse and to be put in such a tough position right off the bat it is no wonder so many fail and leave the profession. I can tell you that even in a horrible work environment the longer you stick it out the easier it gets because you find your own routine and system for getting thing done. Speed comes with experience. I cried every night after leaving work for the first 3-4 months as a new LPN in LTC. It is a nightmare where I am too. We have RN's come in and go right back out because they are shocked and unable to do what is expected of us. It seems to be a matter of do or die for an LPN right now though. We have a lot less options on where to go to escape the abuse heaped on us. Good luck and just remember that speed comes with time. Perseverance is required to be able to maintain most options open for an LPN.

Are you sure the license number wasn't also available when you checked with the quick view thing? Mine was immediately assigned. Check your nurse registry website and see if you aren't on there to get the number.

You know when I was in my LPN program every single one of my instructors had said that when the time comes that they or a loved one would need an RN they want one that worked as an LPN first. They said hands down they make better rounded nurses. You get more variety of experience than someone that would just come straight out of RN school. I also will say that it is my experience that the LPN's that worked as a CNA first also make better LPN's! You will be awesome no matter what level of education you are at because you will be giving yourself the time in between to gain those unique skills required by working each job as you go that you would otherwise be deprived of going straight through for your RN. LTC is changing rapidly. With the increasing cuts to medicare you can bet more and more facilities are going to be adding in rehab units like where I am at right now. I do everything the RN's do except No TPN, No starting IV's, no changing IV dressings, no blood draws through a PICC or Port. Everything else I not only am "allowed" to do I am darn good at and am expected to do. When I first got started on this ladder there were a lot of people that made me feel as if I wouldn't be a "real nurse" unless I got my RN and if I were an LPN all I would be is a "glorified pill pusher". I no longer can be made to feel as if I am "less than" any other nurse. RN or not. If my own personal health were not part of my personal equation I wouldn't even be considering the bridge program and would just be staying right here on the front lines doing all the hands on REAL nursing rather than the paper pushers that the RN's in the LTC setting really are forced to be. They have no time left after all the computer and paperwork to really do much if any hands on nursing. It is actually a joke in our facility when an RN is forced to "work the floor" because an LPN called off and no one else can stay late or come in, get pulled or whatever. No lie, it takes TWO if them just to get med pass done and they "can't possibly manage" to get treatments or charting done too! God FORBID if something is "wrong" and we then need an SBAR, incident reports etc. That is all left for whatever LPN they can get to come in and finish the shift for them! But WE are to do it all, do it perfectly, and do it in the time they give us. Hmm No, I will never be made to feel as if an RN is a better or more important nurse than I am ever again.

Wow, your situation is similar to one of our RN supervisors at our facility, except we only have one RN super on the second shift at a time. She was an ER RN for years and now works the 12 hour shifts on the weekends and fills in the one day off during the week for our full time RN super. Ironically our full time super is VERY young. She is 22 or 23ish (sorry can't remember exactly) Both have still "made it work" for the most part in spite of their backgrounds. Age of a supervisor quickly become irrelevant when their actions speak louder than their numeric age. Given you already worked as an ER RN probably already puts you in an easier position than she started off in. It will be a challenge for you to transition from ER nurse to LTC nurse so you will need to be patient with yourself and not burn any bridges you absolutely do not have to. Sometimes us LPN's have to help this particular RN super remember what environment we are in because the "rules" are different. You are likely "hardwired" from your previous job to just automatically do certain things that will now get you in a lot of trouble if you do them "on the fly" in a nursing home. Like making sure you know what the persons code status is BEFORE you start CPR. Getting a Dr order BEFORE you start an IV line etc. Indeed I must agree that it is wise to treat others the way you want to be treated. Show them respect and be willing to hear them out before you make decisions and it will serve you well. ANY nurse that thinks they can "fly solo" and has not need to confer with other nurses or try to work as a team with the other nurse's in a nursing home/rehab setting is just asking for trouble. Including the RN supers. It makes no difference what letters are behind your name when crap is hitting the fan in this type environment. If you cannot work as a team everyone is going to suffer. If you cannot learn to respect each other and pool your experiences and knowledge, again everyone is going to suffer. It is highly likely that the facility you are in is no different than any other LTC/ rehab unit. Good chance the patient ratios are to high. LPN's are already scrambling to just try to keep up with all the issues on their own floor, get all their meds out on time, get all the treatments done for the day do all the charting on all of these issues keep all their dementia patients safe, deal with their own aids etc. Be willing to jump in and help crank out the mountain of paperwork when an issue comes up and someone has to be sent out or an admission comes in or incidents happen etc.Be willing to jump in and start taking off orders when the fax machine goes nuts. Do not take the stance "that is their job". Don't make them feel like you cannot be called on for help. You will certainly not be earning any respect that way and ultimately you are the one in trouble when your LPN's fail. You are going to be sitting in the DON's office right along with them if they are not getting done on time and costing the company money in overtime or if they miss a piece of paperwork because they were overwhelmed etc. Team work always teamwork in this environment.

Wow, we aren't allowed to have ANY side rails. Beds cannot be against the walls. We are no longer even aloud to have bed or chair alarms! EVERYTHING is a restraint in our facility. They have cut us off at the knees really so most of our fall risks just never get put in bed at all! Fall risks that refuse to or due to dementia cannot remember to use the call bells wind up being kept in their wheelchairs being moved down the hall with the nurse they try to do med pass and keep the behavioral fall risks off the floor at the same time. It is sad state of affairs. They SAY they want to go to bed but as soon as you try to let them go to bed they try to get up. They wind up sitting in different types of wheelchairs that can sort of lean back somewhat and prop the feet up at the nurses desk when not being dragged with for med passes. That is sadly how they sleep at night to keep them off the floors. HOW we get away with that is beyond me. Our facility "doesn't have the staff for one on one" for these patients either so we are left with no other choice but to have "slumber parties" for all our fall risks out in the halls and at the nurses desk! State should come for an overnight visit. I wonder what they would think of that.

Well Holy Smokes! Wow I can't even imagine the nerve it took for them to pull that! I sure hope I never wind up as a patient on their floor! I am so sorry that happened to you and I sure hope they get what they deserve for pulling that!

I understand your frustration and desperation but trust me when I tell you that you are better off NOT working that job and still having your license to get another job with than to have gotten that job then lost your license because of it. The first piece of advise I would give to any new nurse is to ALWAYS protect your license over ANY specific job. I have had to make that very clear to the place I am currently working at. They expect far to much in far to limited a time frame and continually "blamed" me. "Time management" issues my orifice! Do not think for one second ANY of these places are going to protect you when they are being sued. You are not a person to them, you are just a "dime a dozen" piece of property easily replaced if it serves them to let you take the fall for them. When I finally had enough and told the DON flat out that enough is enough the problem is not my time management issues it is broken system issue. I am NOT going to do what other nurses do to make it LOOK like they are doing everything expected in the measly 8 hours they expect it in.I flat out told her, I would rather loose a job protecting my license than loose my license trying to protect a job. I fully expected to be fired that day and didn't care. I would have left with my very hard earned license intact.

Well congratulations becoming a new nurse! I am not a very old nurse myself. I know how you are feeling. I promise you will pick up speed. The most important thing to focus on is accuracy. Speed comes with time. Indeed please do ask for more time if you are not comfortable yet. Then the first thing you should do is make a face sheet to put in front of every single MAR that tells you how each patient takes their meds. That way it will be right there in front of you for every other shift you work. Just a real basic piece of paper that says whole___, crushed___, in applesauce____ (or pudding or whatever your facility uses), Water___, juice____, thickened liquid_____. Make photo copies of the face sheet. Then you can just put an x next to whatever each patient uses as you go. This not only helps you it helps keep your patients safe if a strange nurse works the hall. You don't want a thickened liquids to get plain water for example. You can also make a sheet that lists all your chemsticks in your halls and keep it in the front of your 24 hour book or something. Then you can use that to highlight those patients on your census/report sheet at the beginning of your shift. I personally put a small "box of highlight under each patient I need a chemstick on for my ACD and second one next to it for my HS sticks. (I work second shift)That way I can just write their chemstick numbers right on the highlighted box and the amount of units coverage in a circles next to that in the highlighted box. Then I not only know I didn't miss anyone I also have it right on my census/report sheet for charting later. If you have parameter meds on some patients you can also make a sheet for vitals on and what times you need those specific vitals. You can type that up for yourself and make photo copies of that too. Then you can just hand it to your aids if you have them doing your vitals for you or in the least you have it and can grab them before you start pouring the meds for them or grab them a few minutes before you start that specific med pass. (If my good aids on she can handle getting them for me and back to me in time if not I grab them before starting second med pass.) My first med pass I hook up one patient to the dynamap go out and do meds on their room mate, the dynamap is done by the time I am done with the first patient and I have what I need to go out and just get all that patients meds without interruptions. If you have alert charting vitals you can hand write them on this same sheet so your aids can get them for you and have them all right there when you are ready for charting later or you can use a different color highlighter on your report sheet and put it next t their name to write over top of as you go if you prefer. You will pick up tricks that work for you as you go. It does get easier as you go.Give yourself the patience and time to let it all soak in. I think ALL new nurses feel overwhelmed at first. One day you will wake up and realize that you are more and more comfortable and you are no longer the "new nurse" but rather the nurse that is encouraging the next new nurse to come along!

Honesty is ALWAYS the best policy! 49 patients? Really? How heavy are the med passes? How many chem sticks? How many g-tubes? How many crushed med patients Etc? Could you REALLY safely and accurately get them all out in the two hour windows (three if they split the halls for admin times) What ELSE are you ALSO responsible for in an 8 hour shift? Unless you know what you are REALLY dealing with there is NO way to honestly say you could handle something or not. On an overnight shift sure 49 may be doable but day or second? I would question ANY nurse that would say "Oh sure piece of cake" and not even know what all is involved and expected of them. I work with some of those type. Umm they also sign for meds that aren't even opened yet or even in the building. The patients "mysteriously" always have super high chem sticks only after THEY worked the shift before me. The patients supplements they signed for are still in the fridge when I go to get mine for my shift. The patients are literally lined up waiting for me to come in to tell me something is wrong because "They tell other nurse's but they don't DO anything about it and so they have given up on them" What about the patients that CAN'T come and tell you something is wrong? Is THAT the kind of nursing YOU want to be providing? Probably not and that is exactly why you questioned whether you can REALLY do what they are expecting you to do. Consider how you would feel and what would happen to you when you are scrambling to get all those meds out safely and someone is deteriorating but you are so frantic getting meds out you missed it? You absolutely did the right thing by questioning this and being honest. Now if ALL nurse's would just have that good conscience and not pretend they can do more than we really can humanely do maybe things would change for the better for both nurse's and patients.