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Matt8700

Matt8700

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  1. Hello! Question for everybody who works in rehab. I recently began working in a Post acute Care facility which is really a skilled nursing facility that focuses on Post acute Care only, no long-term care patients. when I am receiving a new patient from the hospital and going over the admissions paperwork with them I trying to explain to them how the facility works. At my facility the ratio is 1 nurse to 19 patients, so clearly nurses are not rounding on the patients every hour which is what the patients are used to in the hospital. I have been trying to find a way to explain to patients that the nurses are always on standby should you need them but that rounds are not completed like they were in the hospital, but sometimes I feel like I am letting them down or in some way telling them that they won't have as much accessibility to the nurse as they did in the hospital. How do you orient patients to the facility without making it seem as though the nurse will only see them for medications? I always tell them if they need me to turn on the call light and I will come and check on them but sometimes I feel like they expect me to be coming into the room every hour just like what was happening at the hospital. Any suggestions on how to make this more clear. Thanks so much!
  2. Matt8700

    Medically necessary care

    Let me just preface this all by saying I am new to corrections. My previous field was ER, so I am having to learn and adjust to the prison culture. I am the sick call nurse where I work, so I am lucky and get to see a lot of different things. One of the things I am having to get used to is the art of saying no, and learning not to let them back me into a corner. I am also having to learn that the only treatment provided in the prison system is medically necessary care. One of the biggest things that everyone wants a script for is dandruff shampoo. Apparently it was something that they used to prescribe for the inmates, but as of recently, they no longer do it. The only way that we give them dandruff shampoo is if the dandruff becomes so bad that it causes open sores on their heads. Otherwise, even if we see the flaking, we have to tell them that the dandruff shampoo is available in the canteen and that their condition does not warrant prescription shampoo. When I explained this to an inmate the other day, he said "so the D.O.C. is just gonna wait until I get open sores before they do anything to help me" and then he just got up and walked out of my office. Is this how it is at your prisons? Do you treat them for things that are not currently medically necessary? What do you say to them and how do you handle these situations?
  3. Matt8700

    Pain control

    We had people on naproxen and ibuprofen 600mg for 365 days a year. The problem is, they say, that there are risks associated with long term use of these meds, mainly kidney issues. They were not reassessed at 90 days and when they were reassessed, they still had the same chronic pain issues...... arthritis, chronic back pain etc. What do you do for these folks? How do you manage their pain? The other issue we are having right now is everyone, and I mean everyone insisting they need allergy meds and ppi, like protonix, both of which are also being extremely limited now. They say with the protonox that it was not meant to be a long term med and to use it as such is dangerous. But again, our previous doc was writing them 365 days worth of protonix. Now that they don't have it, they are putting in sick call after sick call to get it back. I just don't know what to say to them because even when you explain the risks, they still insist they need it!! It gets very frustrating sometimes.
  4. Matt8700

    Pain control

    So everyone at the prison I work was just recently taken off of their naproxen and Motrin because of all of the new literature that shows how dangerous they can be. Needless to say we have some very unhappy customers to say the least. We have been told to tell them to obtain non-aspirin and Motrin from the dorm officers for their pain (they can get 400mg of Motrin TID). However, they keep coming to the clinic and to sick call saying that these meds are not working and they are demanding something different. Has anyone else ever had this issue, and how did you handle it? For the most part these people arent in too bad of shape, mostly just age related things like DJD and OA. What pointers can you give me? The medical director isn't very keen on writing scripts for anything else either. How do you handle this with the patient? Do you have to have a stern talk with the patient and tell them it is what it is, or do you advocate to the MD?? Any ideas or input??
  5. Matt8700

    Job stability

    For those of you that might be able to add to this discussion..... I recently left hospital nursing and took a full time job at a local prison. I had never worked in this sort of environment before, so it is all new to me. I am not a job hopper, so I was hoping that I could make this a long term thing, provided that I enjoy the work. I decided to look up information on how the prison system works, and was surprised by what I found. By reading a lot of the articles online, it sounds like tons of states are going to try and implement prison reform policies, which would decrease the total number of inmates in the system. I am in Florida where there are approximately 50 major facilities, but my concern is that if they decrease the population by as much as they want to, will there start to be closings of prisons? Everything that I have read online talks about how terrible the system is and it seems that everyone is in support of cutting the amount of spending on the prison system. Does this mean that for those of us choosing to work in this area constantly have to be worried about budget cuts affecting whether or not the facility we work in will be closed? What do you think?
  6. Matt8700

    Pain management

    You make good points here as well. I do agree that the wait should not dictate the meds you are given. But when I see a 60 or 70 year old get wheeled back to my room in wheelchair for something that they perceive an emergency, my first thought is "how can I help this person," not "man they should have waited to see this family doctor" or "ill just give them Motrin and tell them to have a good day." This particular patient was ordered the Motrin and discharge at the same time, so who knows if this would have been enough pain relief for them? And yes, the provider is a very valuable member of the team. My question here though is how do you approach providers who don't treat the nurse as a member of the team.
  7. Matt8700

    Pain management

    KeeperMom, thank you for your response. I appreciate your input. I have my ever worked in one ER and I hear from our travel nurses that the nurse/provider relationship in the er I work in is very one sided. There is never any discussion of the patients plan of care with the nurse, no input, none at all. They see the patient, walk right by the nurse and go to their desk and enter orders. I can't tell youbjow many times we could have ever them from putting in orders were can't complete if they had only asked us first. These were just a few different examples, but my real question is how do do you go about negotiating with a provider when you feel that you need to advocate for a patient, particularly one that does not like to be asked about their orders?
  8. Matt8700

    Pain management

    KeeperMom, I understand your point. And again, I was not suggesting a narcoticnfor these patients. What I would suggest would be things such as toradol, ultram, etc. Non narcotic medications, buttoned that will offer some relief. I feel bad when you say that you don't have to justify your decisions to the nurse, after all, we are part of the tram too, and often the ones that spend the most time with the patient. I feel that patient care is a team approach and to work with a provider that does not feel as though my input is valued means that I cannot properly care for our patient.....And yes, I said our patient. Nursing is not meant to be a simple process of completing tasks (you order and I do). There is supposed to be more to it than that. I am not saying I should be able to tell you what to order, butbi am saying that if I have spent a sufficient amount of time with a patient, I feel that my opinion should count. Remember a big part of nursing is advocacy.
  9. Matt8700

    Pain management

    This particular provider is of the mindset that their orders stand and that they should not be questioned. I am not suggesting narcotics at all, but the other medications that you mention could be very helpful and satisfying to the patient. I guess my bigger question here is how do you approach a provider that is not interested in your concerns as the patients nurse. Many times the answer that we get is "they get what I ordered or they can leave." And of course sometimes, especially after an 8 hour wait, we have to provide a form of customer service as well. Even if it is just a lidocaine patch I think the patient would be happier than a Motrin. I think the issue is more with the provider not wanting the input of the nurse and being unwilling to help a patient in need. Doesn't have to be narcotics, but it should be something. And btw, these instances were patients in their 50s and 60s, not a 20 year old that had nothing better to do than generate an er visit. These were reputable people that sort of just got passed off and somewhat ignored.
  10. Matt8700

    Pain management

    How do you maybe a provider that is either unwilling to treat a patients pain or is under treating a patients pain. Example: patient waits 8 hours in the lobby to be seen. Provider orders Motrin for the patients chronic hip pain. I know the condition is chronic but the patient appears to be very uncomfortable. Provider is approached and is unwilling to listen to or collaborate with nurse. Patient leaves unhappy. Example: patient c/o headache. Given toradol and is ineffective. Discharge. Again provider unwilling to listen to nurse. Example: patient fell, negative xr of knee. Given Motrin after waiting 10 hours to be seen. Patient appears uncomfortable but provider not willing to discuss pain management plan. These instances are all involving the same provider. But how do you all speak to a provider when they don't want your input. This particular person hates when nurses approach and will not listen. At times the nurse is made to look bad because the provider is not willing to listen to our assessment of the patient. How do you all handle?
  11. Matt8700

    Beyond Bedside? Advanced Practice? Really?

    The RN and APRN are two very different roles. It does not mean that the RN is less educated than the APRN. You can have an MSN and not be a practitioner. APRNs, in my opinion, do not provide nursing services, they provide medical services, and we are lucky to have them to do so. The fact remains, however, that the core of nursing was never meant to include writing prescriptions and making medical decisions-that was left to the physician staff. When APRN practice began, they shifted from practicing nursing to practicing medicine. I agree that there is a difference between an RN and APRN, but disagree in the titles, and the statement that they have more education, because that may not always be the case. In fact, if you had a certified wound care RN discussing a patients plan of care with an ER APRN, the RN would be the more advanced clinician here. They would have more working knowledge of the situation than most ER APRNs, so the fact that the APRN has "more education" to me is an invalid point......their education is different. I think most APRNs would agree that they are practicing medicine, not nursing. Nursing is at the bedside for hours during the shift (the NPs are usually only at the bedside for a few minutes). Additionally, the RN staff is coordinating procedures, meds, etc, which the APRN is not doing......instead they are writing admission and discharge orders, consulting with cardiology, etc......which are all aspects of practicing medicine, not nursing.
  12. Matt8700

    Beyond Bedside? Advanced Practice? Really?

    So many mis-spellings. Sorry guys
  13. Matt8700

    Beyond Bedside? Advanced Practice? Really?

    I think that it is very confusing to patients when a nurse walks in the room and tells them they will be the nurse providing their care, then comes the NP and explains to the patient that they are the advanced nurse. It sore of does make the bedside RN look less competent. I think that NPs are really providing more medical services to patients, not nursin services and I think it takes away from both professions to refer to NPs as advanced nurses. It makes the RN look "less educated" in the eyes of the patient......after all, they don't have "advanced" in the title. It also lessens the importance of the NP role because patients equate them to being "just a nurse." In my setting (ER), patients being cared for by an NP often ask when they will see a doctor. When I explain that they have seen an APRN, they seem confused and will sometimes question why they have only seen a nurse? The provider status is not there in the title of "nurse practitioner." If you think about, any level nurse, be it LPN, RN, BSN, is a practitioner of nursing. I think APRNs need a title change, maybe something like Advanced Clinician or something of the sort. The nursing profession has become very confusing with the role titles. As I said, anyone that is a nurse is technically a practitioner of nursing. I think to preserve respect for both professions we need a title change. Also, I feel that APRNs do not really offer expanded nursing services, they offer medical services. Nursing was never about prescribing medications and ordering CT scans, so to equate that to expanded nursing practice is not very accurate.....those are medical services. I think the APRN is very important, just as the RN is as well, however I do agree that at times it does seem like that to refer to an APRN as the advanced nurse is a bit of put down to the RN staff.
  14. Matt8700

    Med administration

    Just a question for the OR nurses. I was speaking to a coworker the other day who is leaving the ER and going to the OR. She mentioned that she is going to miss being able to administer medications. I asked her what she meant and she told me that during the operation, the anesthesia team are the ones giving all of the medications. Having never worked in the OR, I was wondering if this really is how it works? Are any meds given by the OR RN or does the anesthesia provider handle all this? Just wondering.......
  15. Patient education question here. How do you all approach the ER patient that is admitted and awaiting a bed on the floor, it has no active interventions taking place when they tell you that they "might as well just go home since nothing is being done?" It's one of the most frustrating things that a patient will say to me, and even after I explain to them that they have already been given fluids and antibiotics and that even if they were upstairs they would still just be sitting, they think that they are just wasting their time? I have tried to explain that there will be periods of time when there are no meds infusing and no tests being done, but they don't seem to accept that. It's like they think that unless they are hooked to some infusion or being taken for some test, then there is no reason for them to be in the hospital. How do you all handle this? Especially when the family starts to get pushy too and feeds the fire? I have never been able to find an explanation that seems satisfactory to anyone. Ideas?
  16. Matt8700

    Pain management approach

    Looking for some input. In my ER, they stress pain control big time. We are supposed to do all we can to manage someone's pain adequately. My question, though, is how do you chart on a patient whose pain has not been controlled, but the MD won't give additional orders. Of course I am chatting that I have spoke to the provider and no new orders were given, but what do I chart for my hourly rounds where I'm supposed to reassess pain? Do I chart every hour that the patient is in pain and the MD is aware? Doesn't this look like I'm not doing enough, like maybe I should be going further? And what about those patients that tell you they are in pain, but look very comfortable? I know that a patients iOS is what they report it to be, but when it comes to charting, I never really know what to write! It's tricky, because I don't want to chart that they are in pain every hour, but let it look like I'm not doing anything......but when the doc says no to any mess, I'm stuck. What do you chart in a situation like this? any input would be great. Thanks!
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