onthemark

Thank you, Sour Lemon. There's not much time to give this patient Tylenol ahead of time but I will certainly try. I appreciate your thoughtfulness and response.

I realize our aides are under pressure to complete their duties but it upsets me to see them hurrying so much with the very fragile patients. I have one very fragile patient who's made it to 100 years old, and it tears at my heart to hear her screaming "Stop it! You're hurting me" when they bathe and dress her. I don't know why they need to roll her to her side so fast or put her arms in her sleeves so quickly. When I intercede, I speak to her nicely and move her slowly, and she cooperates just fine.....but I know the aides aren't really happy when I do this. They say I don't really understand because I don't do this type of care all the time like they do. What do you think? Should I stay out of it and let the aides do their work as they want? Basically, they have never really hurt anyone so maybe I'm making too big a deal of this. I'd love to have your input.

Thank you both so much. You've answered my question. I've been using the sticks to cauterize the raised, bloody parts of a wound, and simple Bacitracin for the rest of the wound.

Can someone please tell me what the difference is between silver nitrate sticks and silvadene creme? How interchangeable are they?

Thanks so much, akulalawkRN and KatieMI! I really appreciate your both taking the time to explain.

Thanks so much, KatieMI! This all makes sense.

I work at a LTC facility. Last night a patient said she had a headache, felt a little nauseous, and thought if she took another Lasix, her bp would come down and she'd feel better. Her bp was 163/80. The nurse I was working with asked the patient if she had had a lot to drink during the day, and when the patient answered that she had only had coffee and tea at breakfast and lunch the nurse said that she definitely shouldn't have a Lasix because she was already low on fluids, and that what she needed was to drink fluids. During the next hour, the patient drank a ginger ale and glass of juice. After the hour, the patient reported feeling MUCH better and her blood pressure had come down to 145/67. What was going on here? I realize she was dehydrated but I thought that increased fluids would make her bp go higher. Would someone please explain?

Thank you, Ruby Vee. I'm glad you liked it.

No Stars in My Eyes, I really like your post. I think it's great that housekeeping is comfortable "sharing" information without "owning" it. I would guess that YOUR attitude towards the housekeeping staff has a lot to do with that open communication which benefits all. MsLindaW, I was very rattled by the PT for the rest of that day when she had been so offensive, and that's what led me to post about it on this site. I needed to deal with it and was hoping to get ideas and support from this community, and that's exactly what happened. It wasn't until I woke up the next morning that it hit me that I wanted to confront the PT personally because in many ways I really do like her and I wanted to straighten out our differences without reporting her or making things worse. I then jotted down a few points I wanted to make and how I was going to present them to her. After planning what I'd say, I was able to come to our meeting prepared and fairly calm because I was certain I was right (from all of the comments here) and because I was prepared with what I was going to say. If I'd tried to confront her on the day she offended me, I probably would have blown up at her It has always been hard for me to deal with conflict but I do believe things get worked out better in a direct confrontation rather than holding a grudge or complaining about it to others.

Thank you so much JustBeachyNurse! You just made my day :)

Thank you all for your comments. You bolstered my confidence in confronting her today. (I've never reported anyone and don't want to if I not necessary. My rule has been to confront the person directly the first time; if it happens again, I tell them that if it happens a third time, I'll realize my warnings aren't working and will report them. So far, no one has reached that 3rd time.) Anyway, after asking for a moment to talk, the PT and I found a private spot and I told her that I had always liked working with her but that I was surprised -- and actually offended -- by the way she kept trying to oversee everything my orientee and I were doing yesterday with that particular patient. She acted quite surprised and said she hadn't meant to offend me. She said the reason she kept questioning us was because the day before she had tried to alert the nurse caring for the patient then, but had felt that that nurse had not taken her seriously and had not extended appropriate care to the patient. I told her that I did not know about the previous day or the nurse on duty then, but that I still didn't think it was appropriate for her keep questioning us and even wanting to give the patient the tylenol. She kept apologizing and saying she realized it hadn't been necessary to doubt my care. I told her that not only was her behavior demeaning to my orientee and me, but that I felt she was encouraging the patient to lose confidence in us particularly when she'd said, "but I care about this patient so much." She said she only said it because she DOES care about the patient and she thought it would make the patient feel better but she understood now how it made my orientee and me look in comparison, and she was very sorry. She said she'd try very hard not to behave this way in the future. I accepted her apology and will hope that she really will think in the future about her behavior affects others. As I said above, if it happens a 2nd time, I'll tell her the next time I'll be reporting her, but I have a feeling it's not going to happen again. Again, thank you all for your input and support!

That's what I thought, klone. Kind of unbelievable!

I work in a LTC facility and today I was orienting a new nurse. The physical therapist was with one of our patients and called for us to come see the patient as she thought she was feverish. I took the temperature and the patient did have a fever of almost 101. We gave her tylenol, had the doctor see her, had her resting comfortably in bed, and planned to give her tylenol again in 4-6 hours. We thought we were handling the patient all right but the PT was continually asking about her and telling us she should have more tylenol. When we said we were getting the tylenol to give her, the PT took the bottle and said that SHE would give it to her! My orientee spoke up and said no, she (not the PT) would give it to her. Then the PT said that she wasn't doing it fast enough, to which I then spoke up and said "we're the nurses." The PT then said, "I know, but I care about this patient so much" ... as if we didn't! I appreciate other staff being concerned for the welfare of our patients, and I appreciate input from other staff when it is constructive, but I felt the PT was going too far today. Not only was she undermining my orientee and me, but I felt she was also getting the patient to lose confidence in us. Do any of you have any ideas about this? Has a non-nursing staff tried to tell you how to do your job, and how did you handle it?

I've just read these latest comments. I don't think I can use the 5 hours because I work 7-3 -- an 8 hour shift -- and wouldn't have anyone to cover for me if I left after only 3 hours.

morte, I agree with you but from reading these posts, it seems like it's pretty common for facilities to get away with this sort of practice. Because it's so prevalent, it must be legal and there's nothing I can do

no, dudette10, it doesn't work that way where I work. Vacation time does not carry over to the new year. I'm left with 5 hours vacation time that are lost because there's no way I can use just 5. HR suggested I use an hour here and an hour there such as coming in an hour late or leaving an hour early -- but how is a nurse supposed to not work her full shift? At least where I work, there's no one who's going to fill in for me if I were to take those individual hours. I need a full 8 hours and I don't see how I can get 3 more.

krisiepoo, I'm grateful that they paid me the 5 hours overtime but I wouldn't say I came out ahead or they were doing me a favor because those 5 hours vacation time are lost.

Again, thank you for your comments. Although we don't have a union, every January we sign a contract stating what our pay/benefits will be for the new year. However, in reading their policy manual, I think they get out of giving the full number of days off with this statement: "...any authorized paid leave taken in a week in which an employee is asked to work beyond the normal schedule is not counted toward the forty hours after which the overtime pay rate goes into effect." keIRN215, this must be what you're referring to. Dudette10, you are right.....I was paid the 40 + 5 OT in week one and then paid for 35 vacation hours in week 2. They told me this was to my advantage because I then had an extra 5 hours vacation time left over. But they didn't seem to understand that there's no way I can take 5 hours because once I'm on duty, I'm there 100% for the full 8 hour shift. Well, I'm happy I was paid the time and a half for the 5 hours but I still feel a little cheated. As many of you have suggested, live and learn -- I now will refuse any overtime in a pay period in which I plan to take vacation time. I still feel "there ought'a be a law" -- if any of you have any suggestions, let me know :)

Thank you all for your input. You're making me realize that my situation certainly isn't unique. I still feel these practices are unethical, though. KeIRN215 says "paid vacation time is not guaranteed in this country." However, when the contract we signed when we accepted our jobs stated the benefits, then I believe the facilities are under contractual obligation to fulfill them. We were guaranteed a set number of vacation, personal and sick days, and I believe we should be able to use them regardless of any overtime we work.

I have a question about how my facility determines our pay but don't know where to put it on this site. Hopefully, one of you will see this and have an answer or suggestion for me: During a 2-week pay period this summer, I used one week for vacation and in the other week, I worked a total of 5 hours overtime. When I got my check for this period, I saw that I was paid the 5 hours overtime but was not paid for 5 hours of my vacation. When I inquired, they said, "when a person works overtime and then takes time off, how do we know the person just didn't work overtime to make up for the time they were going to take off?" This response shocked me -- it doesn't make sense! -- but when I asked my co-workers about this, they said they'd been told the same thing and that they just accepted it! I thought I was doing them a favor by accepting the overtime when asked, and never dreamed it would mean I'd be penalized for vacation time! Furthermore, I got permission months in advance for my vacation and I just don't see how I can be denied 5 of the hours because I helped out by working 5 hours overtime the previous week! During a pay period in November, I see I'll have one vacation day but I was asked yesterday to work another day in that same pay period as overtime......so now I'm worried I'm not going to be paid for the vacation day! Do any of you have this same policy in your facility? If you agree that this practice is unethical, do you have any suggestions for me? Thanks for any thought you put in to this.

I tried the paper clip method today for the B Complex gel cap but it was difficult to puncture and then very difficult to squeeze it out from such a small hole. I ended up resorting to the scissors. I will pursue getting the liquid or the dry form suggested above by morte.

The best bet seems to be MrChicagoRN's suggestion of a paper clip that can be cleaned before each use and then discarded. I'm going to try that today! Meanwhile, I'm relieved to report that the head nurse on another shift took the initiative and ordered the liquid colace! The other gel cap, though, (B Complex, not B12) is still being negotiated. Thank you all for your input!

I don't think it seems right either, libran1984. Based on all your comments above, you seem to understand what I'm going through and I want you to know that I appreciate it. Thanks!

Some of my patients DO have the liquid colace. I asked my charge nurse if I could give the liquid to the patient in question but she said "no, we want her to have the gel cap." When I told her it was difficult to open, she got a pair of scissors and said, "Just cut it -- like this." The Vit. B gel cap also comes in liquid, and it was the same thing with that. I don't know why my facility is insistent on the gel cap over the liquid but anyway, I just wanted to know the proper way of opening up these gel caps. Thanks to all of you who responded.

I have patients who take gel capsules (both colace and b12) but because the patients can't swallow these, I'm asked to open them and squirt in with their crushed meds. (Why they don't get these in pure liquid form, I don't know.) Does anyone know the best way of opening these gel capsules? One nurse said she pricks it with a needle, and others have told me they cut the capsules open with scissors. I feel there must be an appropriate way of getting the gel out and I wonder what anyone here might suggest. Thank you to whoever takes the time to answer this :)