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.

I attempted to call the oncologist but he was already out of his office. (I work the second shift). Her attending from our facility had referred the issue to the oncologist. (as he does with EVERYTHING concerning her because of her condition) Whatever was explained by them to the daytime nurse was not told to me and I could not find anything in her chart about it which is why I am confused and looking for answers. I am questioning what it was she actually told him once they actually spoke to him. I was EXPECTING her to be sent out to see him but that is not what happened. I did get permission from my DON when something like this happens again I am allowed to come in a little early and get on the phone for myself so I CAN speak to the right Dr about a problem I am seeing. I am sure it was not her port itself as you can feel that off to the side of where the lump WAS (It is completely gone now so DON doesn't know what I am talking about) It is scary to think chemo drugs had infiltrated but now I am really afraid that is what had happened! She had told me that the morning before they had to draw blood out of her arm because the RN was not able to draw it from her port. I knew who was on the night before and sadly had to question this in my thinking. (She goes out of her way to get out of doing much of anything on the floor)

I am a relatively new nurse. I am working a "rehab" hall (but not always rehab patients) Anyway I have a very sweet lady that had breast cancer metastasize to her bones. She has a port in her chest. She had gone out for her first tx. She has developed a "lump" on her breastbone right about where the catheter to that port would end. It does not hurt her it is not warm or inflamed appearing. She had asked me why this suddenly appeared and what it is. She said she did tell the daytime RN but she did not explain anything to her. She just felt it, looked at it didn't ask any questions and left the room. She told me nothing in report so I was totally unawares when I walked in for first med pass after being off the weekend. It does seem to be dissipating from when I first went on shift and when I rechecked her at the end of the shift. Can anyone explain to me exactly what is happening to her when she is getting the chemo tx through this port? She is unable to tell me. She said they gave her benadryl and "some other medicine" before the treatment and it made her so sleepy she slept through the whole day there. I couldn't even find any paperwork from them to explain what happened to her while she was out. This lump looks and feels just like a bolus of sub-q fluids that I would give to a guinea pig or cat on the scruff of their necks just on her chest instead? Is it possible that chemo would create a bolus? Sadly we do know that she does have a spot of cancer that had developed on her sternum as well as several other areas. I am scrambling to learn as much as I can about her diagnoses and tx so I am better prepared to talk her through them. I am not getting any support in this area at work either. They are not very sympathetic to her suffering and say stupid things like "well she's terminal, what's to explain?" or something else cruel like that.

We are having a disaster at my facility with the flu and norovirus right on its heals. We were all confused and upset because quaratine was not implemented fast enough, when it was it was half hearted and then we kept getting admissions who then of course also became more ill with these things. I heard a rumor last night that the reason for all this "strange" behavior from our DON was because she would not allow the infection control nurse to report this to the state. She got in trouble by corporate the year before for profits dropping because we had reported to the state and they would not allow admissions until the facility cleared. Well now I am really confused. What exactly is going to happen to us when they find out that we never reported the flu and norovirus to the state? Can we loose our licences for this? How insane is this anyway!

Well this topic is certainly a hot one. Quite ironically my facility is still one that does not require the flu shot to maintain employment but for anyone that does not accept the shot must wear a face mask whenever they will be within 5 ft of a patient. The past two years I had accepted the shots and both times had increasing problems right after. (I have an autoimmune issue and have problems with many many things I put in my body) I also still contracted the flu even with the shot last year. So this year I gave up and said no to the shot and yes to the mask.I also decided I am wearing it at ALL times, not just around patients but also around other staff. It only came off on my way out the door at the end of my shift.Using paper towels to open doors as I went. The flu came into our facility via a new admission. Of course it spread before they decided to even think about quarantine. Of course it began getting staff as well as patients.The ones who took the shots were dropping like flies. Those of us with full time masks on were not. The "big problem" with those of us that chose the mask over the apparently useless shot was that we were the ones carrying the load for all the other staff out sick because they refused to wear masks. Working short and overtime for weeks. Exhausted and burned out increased mistakes of course followed. Let me tell you the amount of masks we are going through would certainly far exceed the cost of those shots if ALL staff were required to wear them the entire flu season, at all times and change them every time they leave a room with known sick patients in them. Not even just when leaving a room. It seems to me if the medical facilities REALLY cared about patient safety they would require all staff to be wearing masks rather than taking shots the entire flu season. It has certainly proven to be far more effective than the vaccines at my facility. They would immediately quarantine any suspect patient rather than wait for it to spread wile waiting for the tests to come back confirming it as a flu strain. They would not allow admissions to the quarantine floors. They would not allow sick employees to be at work at all. They would not continue to send clearly ill patients to physical therapy to spread it even further all the while PRETENDING to be on quarantine lock down. They would not have housekeeping sanitize the door knobs and handrails one single time and then continue to allow patients to come and go putting the germs right back on them. They would not refuse to report to state immediately when known flu and norovirus cases are in the building. (thus making it impossible to accept new admissions until facility clears) It is and has always been about money and just barely sqeaking by with any laws or regs imposed on them as cheaply as possible. Accepting those shots is not protecting your patients. It is protecting THEIR pocketbook. Don't be fooled. Masks are the safest way to go for both patient and staff.

Well geeze! In our facility they have removed all bed and chair alarms. We are not allowed to have them! How do you like that? They said there are complaints (not sure from who, state maybe?) that they are being used as "babysitters" to negate our responsibility to keep them from falling! Yes then on top of that they decided to cut our staffing even further so we cannot have a staff member watching all our fall risks in an activity room while we scramble to do even more work from the staff cuts they said we no longer needed. It has definitely been a nightmare for us. These people are demanding to be put in bed but we can't put them there because they then try to get up by themselves and wind up on the floor. Our halls are lined up with all the "fall risk patients" 24-7. We are flirting with disaster. Pressure sores on all these people are going to be piling up around us. Pretty hard to change their positions at least every two hours when they are stuck in chairs all the time. Of course any legitimate concern that could in any way cost this multi billion dollar corp money is just ignored and brushed under the carpet. My facility made us believe the removal of the alarms was a universal thing that some government entity was forcing on us. EVERYONE had to remove them. I should have known better! It must REALLY be the cost of the alarms and replacement of batteries etc why we can't have them anymore.

I don't mean a provision to build more LTC facilities. I mean some other kind of provision that would provide incentive for facilities to continue to take medicare patients in or increased funding for families to keep their family members at home with them since there are going to be less and less LTC facilities willing to take medicare patients. WHO is going to take care of all these people is my biggest question? HOW and WHERE next? MY facility is CALLED a LTC facility with a Rehab unit. That is not REALLY the type of patients they are bringing in to us! They are coming to me 3-5 days post op for example. The REALITY is these patients are med surg patients not rehab and definitely not LTC! The "rehab" unit has 30 beds in it and my hall "rehab overflow" soon to be all rehab also has 25 beds. I have a mix of patients and I am the only nurse down this hall on 3-11.I currently have an "isolation" room that is used for C-diff, VRE, shingles etc patients. If we need more than one they shift patients so they can put a second isolation patient in my hall. (Like now) I have a shingles in one and VRE in another. They can be hospice, LTC or rehab patients any given week. I have 3 hospice patients right now. I have 6 LTC and the rest are "rehab" Part of the problem is some of my "rehab" patients are still not going to be be able to go home after we "rehab" their current injury/ illness. some of them will still need to be transferred to LTC after they are done with me due to dementia or other underlying problems that are not rehab-able. yes one nurse for all 25 of these patients and I can tell you it is a nightmare. More often than not the actual rehab unit also only has one nurse on the 3-11 shift and none of those patients are LTC.

I was sent to a training seminar this week. "assessment training". Some of this training was the trainer talking about obamacare and what it means to "us". I am wondering how many other facilities are already taking steps to "deal" with the new issues and exactly what steps are they taking? She told us as of Oct 1st the hospitals will have to give free care to anyone we have to send back to them for five specific diagnoses if that diagnosis is what they were there for in the first place and it is within 30 days of their discharge. We are required to be able to maintain these patients or improve them. If we have to send people back the hospitals are not going to keep sending us any patients because we will be costing them money. We are not really LTC anymore even if the people coming to us are not "rehab and send back home" patients.We are more like med surg units now. Yeah med surg with LTC nurse to patient ratios. It is already a nightmare, I can hardly wait for it to get even "better" with NO LTC patients and ALL med surg filling my 25 beds. She also said that we are going to be pushing hard and fast to get out of LTC altogether and be strictly rehab because there is a 28% cut to medicare and it will no longer be profitable to take these patients and most likely we will not even be able to break even on them. (Well this explains why we have been cut to the bone on staffing, having people called off, nurses working as aids, not allowed to have any overtime, told to clock out and go finish our work after we clock out crap) We are also going to be losing Dr's willing to treat them because they will not make any money either. Without Dr's willing to treat we obviously cannot take those patients in. Well where ARE they going to go? She had nothing to say about what will happen to all these medicare patients nor the medical assistance patients that are taking an even bigger cut. She said 50% cut for them! Is there some kind of provision in Obama's plan to deal with millions of medicare patients and no facilities or Dr's willing to treat them?

I am in PA. I have also wanted to be able to do home health care at some point. I used to do that as an aid. I have not seriously thought about that yet because I had to get my magic "one year experience" that is required by all of them around here. I still doubt I can go that route even though I would love to be able to do one on one nursing. So far everyone I have talked to that already does this tells me it is unstable work. Health insurance is a big road block to doing that too, I must be able to carry health insurance. Of course No insurance AND no job at all is much worse.

Thank you so much for the advise. I really appreciate it. I am feeling so incompetent as it is with not being able to get done on time so often and being yelled at almost daily by someone. Yes we have had C-diff in the facility in the past. Currently none down my hall though. If someone does wind up with it then they are put in quarantine. That indeed would create a HUGE problem with this patient. As it is now the patient is never allowed in their room alone. We would need 24/7 one on one staff to properly quarantine this one. Can't see how we could even consider such a thing. Can you tell me which antibiotics are worse than others? The bacteria keeps coming back susceptible to bactrim and cipro and so the Dr had used them. Bactrim then cipro then bactrim. The long term antibiotic patient is on macrobid. Is that one of the better or worse ones? Should I be worried for that patient too?

Can any more experienced nurses help me with an issue with one of my patients? I have a 95 year old patient. Diabetic, dementia, going into kindey failure. I have noticed a pattern with this patient. This patient has perods of SEVERE behavoral issues. Spitting, punching, kicking, biting, constantly trying to get up but unable to stand on their own so of course also a serious fall risk. So the UA comes back positive. Antibiotcs started. Within 24 hours this patient turns into another human being. Pleasant, cooperative, patient and kind. End antibiotics within 24 hours the behaviors begin. Ativan is most often useless. Behaviors continue to escalate. Another UA, again pos. start antibiotics rapid change back to pleasant. cycle continues 3 times. So after 8 hours straight of violent wild behaviors, untouched by ativan and the routine clonazapam I put the fax out to the Dr to ask when we can do a follow up UA and tell him what all had happened. Dr responds yes we can do a follow up UA now. I had a pile of other issues that also came up on my shift that had to take priority over getting this UA so I was not done with EVERYTHING by the end of my shift. I was forced to leave the last order to be taken off by the next shift. It is ALL I had to leave for her. I have actual blisters on my feet today from literal running my entire shift trying to get done with everything on time. They are freaking out about OT and we are not "allowed" to stay to finish everything or I would have also stayed to do this too. So I explain to the oncoming nurse what was going on and that it was me that actually asked for this particular UA and WHY. I told her I am going to try to get the Dr to put this patient on the low dose long term antibiotics like we have another patient on with chronic UTI problems. She was very angry at me. Now mind you she HATES having to get UA's on anyone. She has repeatedly complained that whoever keeps asking for them need to be the one that gets them. I understood that she was going to be mad at me for not being able to get this done before I ran out of time. SO now I ma wondering if what she said is actually legitimate or just said because she doesn't want to have to get any UA's on this patient. It is not like she doesn't also have to deal with this particular patient being combative, violent and requiring one on one supervision (which in itself creates SERIOUS problems as they keep cutting our staffing more and more) She got ugly to me and said "Oh yeah sure so said patient can get C-diff and then we have to deal with that instead". I personally suspect this patients kidneys failing is related to these chronic UTI issues. I KNOW their violent behaviors are linked to them.. "strike three" for me this time.. There is no longer any doubt in my mind about that. I personally feel we would be protecting what kidney function they has left by using the long term antibiotics. I also worry about the damage being done by the instability of the patients diabetes. Patient is either refusing to eat or overeating (staff trying to placate the patient to avoid increased behaviors) due to behavioral issues. Now I understand that the Dr ultimately will decide whether patient should or shouldn't be put on the long term antibiotics. But in the same breathe the Dr's tend to respond to our persistence about something. I really feel awful for this patient. Sadly all their chronic behavioral issues has made even the kindest staff upset. We have had staff quit because of them, we had someone fired for losing patience with them. This last behavioral marathon even affected me and I have nerves of steel. Of course my inner shaking was directly related to not being able to get done with all my work on time because of having to try to do all my work and deal with this out of control violent patient for 8 hours straight. This patient does not just go after staff with their ugly behaviors. They has attempted to get hold of visitors to hurt them and hurt other patients. I must admit there is a part of me that is trying to avoid a lawsuit by getting them on antibiotics. I am just waiting for the day this patient bites open a visitor or knocks another patient out of their wheel chair and of course it will be MY fault because I am this persons nurse. Am I pushing for something that is only going to make the situation worse for the patient?