SappyRN

We use LVNs. We have about 200 patients on servic. We have 2 full time LVNs and 2 part time. They go into the field and make routine visits when someone is on vacation. They also help when the caseloads are high. Yhe LVNs cannot " pronounce" but inbtexas they are allowed to report the signs and symptoms of death and write a telephone order for death pronouncement by the MD. Our LVNs are awesome and work very hard. They are much appreciated.

I have a friend that needs to choose a rehab center for her father. She has been given the option of Round Rock or Bryan. Does anybody have info on either of these hospitals? He is post stroke, also recent bka

I have seen "red mans" in children with a slow infusion. It is something you will never forget. Find out what your clinic policy is and discuss the situation with your immediate supervisor so next time you have some back up. When it happens again, and it likely will, simply explain that performing this is against policy and you cannot do it...if the doctor chooses to do it himself, document everything in a diplomatic non-accusatory manner. You can then control your your situation better and continue to provide optimal patient care so the patient gets monitored for adverse reactions. Notify your supervisor if the breech of clinic policy by the physician or file an incident report for patient safety. You cant go wrong following policy, being professional, and providing good patient care.

Love this... i want to create a board for my office like this... its awesome!!!!

That is excellent advise. Our Hospice utilizes part time and PRN staff to cover vacations or high case loads. We will only use experienced staff and it is usually someone that has already worked full time with us so we know their skill level.

I do know a couple of nurses that lost their liscenses for drug related issues. One did a goluntary surrender, sought help / rehab, cleaned up, then petitioned to get it reinstated, and was able to. Another, just gave up and never looked back. The majority of people investigated are able come out ok depending on the reason and their own determination to do what they need to do to keep it. Some people merely need more education.

You will need to express some of these concerns in the interview and ask them what training they will be providing that is specific to the job. Always promote what you are bringing to the table... the vast knowledge and experience that you do have. Most companies willbexpect a certain amount of training will be needed for a new manager and every company will have different expectationsfor the job. Good Luck.

Our hospice monitors prouctivity also, most do. Sometimes it is warrented because for all of us who work our rears off, there are some who slack, provide less than standard care, who want to be paid to shop for groceries in the middle of their work day, who state on their timesheets that they are "at the office" fot 2 hours every morning, yet you have to beg and threaten every week to get a single note from them, and very late on top of that. Those employees make it really hard on everybody that is honestly trying to do a good job.

unfortunately sometimes people are not ready to actually hear that their loved one ie dying. Something that helps is to be able to fully explain hospice. Every hospice has their own policies, but the family needs to shop for the one that will meet theit goals and needs. You do not have to be a DNR to be on hospice, but we will try to acheive that status. You always have the right to fire a hospice that is not meeting your needs. You should be alowed to continue previous medications as long as they are indicated, not harming you, and in some way helping even if sometimes the help they are giving you is merely the belief that they help. (I say again, reiterating as long as they are not harming you) palliative care is emotional, spiritual, and physical. Our company doesnt require a patient to stop feedings as long as the patient can tolerate it. We teach the family what that means... is the patient aspirating? What are his residuals. How much edema. Lung congestion. It is a process. Can we merely adjust the rate down to a more tolerable lefel. Then teaching further about the outcomes of the intervention. Poss wt loss, decreased nutrition, protein malnouishment, etc. Patients often live longer with hospice that initially expected because the constant availability of staff to intervein and the interdiciplinary process. The POC/interventions are patient and family driven. What do they wajt at this time. We do not have an expectation really of how long the patient will live other than at the moment of admission the patient has an "expected" limited life expectancy of 6 months or less if the disease process continues on its normal path, which is very vague because human will is not a factor. We do not tell a patient that they are "not allowed to go to the hospital," but we will explain that if there is not a contract at that hospital, it will be necessary for them to revoke their benefit sovthe howpital can bill medicare, not the patient. We will explain doing this several times will eventually lead to our decision not to readmit. We have alternate levels of care where we can provide nursing care in the home for block times from several hours daily to 24 hrs daily for symptom, crisis interventions. Pateints/families need the reassurance that hospice in not just giving up and taking someone home to die. Its about providing the best care possible for someone that is likely dying. If you have a particularly difficult family, tell them honestly that every hospice differs somewhat and ask them to interview several that service youtlr area to determine if one will meet their needs. Have more than one person present at the education visit, write important questions down ahead of time so they dont forget them. They need to find the company that makes them feel good about the decision, one that makes them feel supported. When somebody dies, the people left behind have to be able to go on with their lives without constant regret that they didnt do enough. Shopping for the right hospice will help them have control and starts them in the mindset that they are still looking out for their lovedone's best interest.

Something that also might help is to read up on how to deal with different personality types. There are many good books out on this subject. If you can identify a persons type of personality it helps you understand what they need from you to feel supported and valued which in turn makes them likely to be more productive. It also will help you learn how to steer them without the "because I said so" attitude, and can teach you how to set clear boundaries and expectations in a way they will understand.

I think she should peruse a refresher course and explain that her last job was not a good fit because she recognized her own need to refresh her skills in order to perform at a higher level. She should contact HR and find out her status. Since she wad PRN there was no obligation in her employers behalf to give her hours. But also since she had been working, she may have been eligible for "under employment benefits". So they would likely have termed her employment later stating that she had not given her availability. If that is the case, then she could put no down on her app when applying and simply use the same reason for leaving or whatever she wanted. I suggest that you never lie on an application because you set yourself up to be fired later if you do. Most apps actually have a clause stating that lying will be terms for immediate termination and some companies will do that. I have been fired before and have never lied about it. You just need to be honest and do a great interview. The reason you were fired means a lot more than the fact that you were.

OMG. That's all I can say

We usually cancel routine visits when the roads are iced over. If we know the weather is likely to turn that bad we have the patients tucked in really good with extra portable O2 and meds. We also will have families call sheriffs dept for pronouncements if we are unable to get there.

We use HPS and the pharmacists are great with advice. We also make sure all of the staff has copies of the formulary.

I dont smoke anymore but when I did, my favorite response to negative criticism about being a nurse that smoked was... " you know, before I became a nurse, I was a mere human just like you"

It depends on where you live. In Texas, it is DADs. Most of the time you can contact APS to initiate a referral and will actually need to in order to get an intake number that you use as part of the reporting procedure. If you are still unsure call another local LTCF and ask them or talk to the Ombudsman. He/ she will have the correct information.

I work for a "for profit" hospice and my medical directors would never stop lasix on a CHF patient unless they were imminent and no longer able to swallow. It is good symptom management to treat pulmonary congestion in a CHF patient. Nobody should be left to drown in their own fluids. Now having said that, was it a patient ir family choice to do this and if so were they educated of the consequences.

You have to set boundaries out you will burn out. You will be a better nurse to all of your patients for a much longer time if you can find the balance to turn it off and have your down time. I work with a Chaplin that has taught me that "God will put the right person in the right place at the right time... And it may not be you." Good luck.

I had an ACDF several years ago. I recovered without complication and returned to work (8 weeks is what my dr gave me).

If your actual coding is used for the Medicare billing and it is wrong you cN be personlly fined for fraud. You may want to ask them for an inservice.

I have actually just ran into a nurse that I worked with 13 years ago in another city. It happens.

It truely saddens me to hear about the bad experiences with OHC and VC. I went to work for VC 6 years ago. I worked throughout all the changes in ownership. We have a wonderful staff at our site. The patients get what they need. I know what mind of nurse I am and what kind I work with and each of them is a blessing. No matter what our name is, we are the same people doing the same work. We don't usually have a lot of staff turn over. There are many that have been at our location more than 10 years. I love where I work and what I do.

My employer will automatically terminate you if caught falsifying an application no matter how long you have been there when it is found out.

You have to seek a balance that builds the trust of your team along with the trust of your superiors. It can be a challenge, but think back to what you have liked and not liked about your past managers and incorporate some of those skills into your own. You have been in the field long enough to understand their duties and recognize weaknesses. You also know what things would have made you job a little easier some days. I worked in the field for 5 years when I accepted the PCM position over the team that I had always worked with. It has been difficult at times but also knowing everyone had advantages. Good luck.