AMN74

As a nurse of almost 30 years with Bipolar, I've never disclosed to the BON, or to my employer. In my state the BON asks something to the effect of do you have any mental or physical impairments that would prevent you from doing your job? I have Bipolar Disease, but I have a Psychiatrist that keeps close tabs on me, I'm med compliant and I'm able to work. When I get really sick my psychiatrist pulls me out of work, puts me on FMLA and makes sure that I'm stable before I can return to work. It's been a life long battle, but my illness is not my employer's business, and until my psychiatrist says I'm not stable to work I can continue to tell the BON nothing.

Do what you feel you're called to do. I would check on rate of pay in clinics vs working in the hospital. You may find that clinic pay is somewhat less than what you make in the hospital, and therefore you'd be working more hours to just make the amount of money you are currently making. But if you could pick up a PRN job somewhere, that may be best.

I see several problems with pain and pain management when it comes to the "system" and for "drug seekers". First let me say that not all people that need frequent pain medication are "drug seekers" and they often get labeled that way, which is unfair. But the whole system is doing an injustice to the patients. First, it started back in the 80s when JACHO came out with the notion that pain was the fifth vital sign and had to be addressed. That's when the pain scales came into play. I worked in pediatrics at that time, so I can't even count the time I'd pull out the smiley face scale for the patient/family to decide pain on the patient. Once pain was identified JACHO said we needed to document interventions for pain management and effectiveness. This was scrutinized by management, in fear they would be sited by JACHO. Second, I grew up in WV where coal mines are a way of life. Pain medication started to be given out to coal miners liberally because they worked in cold, damp, cramped spaces all day long and their joints hurt constantly. I can identify with that pain. However, once the pain medication starts, it's difficult to come off the medication. Then not only did the coal miners become "addicted" but their families were also now experimenting with these drugs, and it became a whole family issue that everyone needed to seek drugs just to not get sick. I read several articles about how several pharmacies were shut down a couple years ago because they had lines of cars backed up at their drive through window. What they were doing was handing out pain medication to these folks, and then shipping the order to a physician across the street that would write the order for the pain medication to cover what the pharmacy had already dispensed. It became a lucrative business for the pharmacy and the doctor. And, of course, you can imagine that everyone an their uncle was very happy to be able to pop up at the drug store and buy pain medication The sad part of this story is that when these pharmacies and doctors got busted for their crooked work, it left all these people that were addicted to the pain medication very sick and in need of a fix. This brought about the rise of cooking crystal meth, and heroin. As a matter of fact, Over Memorial Day this year 12 people died in my home county from heroin overdose from a "bad batch" of heroin. I no longer live in WV but I have family that do live there. I am so afraid for their safety now. Growing up WV was the safest place a girl could imagine. We never locked the doors of our home. Heck, we didn't even have house keys to lock the doors. Now, everything is locked, secured by alarms and cameras. Lastly, came the payment to hospitals and facilities based on customer satisfaction. This is probably one of the most ridiculous ideas that I could even imagine. If someone presents to the ER and complains of pain that is 12 on a scale of 1-10, then to satisfy the patient they get pain medication. There does not seem to be much room for nursing or physician judgement about the actual pain. If the patient presents bent over in pain, guarding their painful area, grimacing, clinching fists then I really do believe they are having pain. If the patient presents laughing, watching tv, talking on the phone and then when the nurse comes in they have excruciating pain it becomes more difficult to really believe that they are in pain. But because it is now our mission as health care providers to make the patient happy so we get great ratings and get paid more money. This has become a sad state of affairs for healthcare. I feel like it's allowing the patients call the shots and it keeps doctors and nurses from being able to practice as we should. I've been a nurse for nearly 30 years and I've worked PICU, Adult Med Surg, Peds ER, LTC, Home Care, Gerontology, wound care, and just about everything except L&D. I enjoy all facets of nursing. I have been working hospice for the last 5 years. I've seen pain. Hospice nurses are charged with the task of pain and symptom management. When a patient tells me they hurt, I truly believe they hurt. But most of the time I also assess and document the physical things I see the patient display when they have pain. If a patient is non verbal we look for non verbal signs of pain like restlessness, grimacing, moaning, clinching fists, facial frowning, clinching face, unable to be consoled, guarding a particular place that may be painful. I feel these people have the right to be as pain free as they would like. Some do not want to be "sedated", some want to be comfortable. It is all in a patient journey. One of the difficult things I've dealt with is Hospice is drug diversion by family members. Yes, this exists. Who in their right mind would want to take granny's pain medication when she is dying? We do everything we can to keep the medications controlled. We use lock boxes, pill counting, limited supply at a time. Yet, about every 3-4 months we find a family that won't/can't comply and we end up having to discharge after breaking contracts and referring to APS, and most of the time they also ask us to report the incident to the sheriff's office. So, YES, in a nutshell the whole country now has a huge drug problem. I think its epidemic. I know many people truly do have pain, and need pain control. But it's always those bad apples that seem to put a bad taste in my mouth and spoil the whole bunch.

As a home health nurse, if I see that a patient needs a hoyer lift..if there is space to use/store a hoyer lift, if there are people that are teachable in the home, then I will order a hoyer lift. But I always order a PT consult to have them teach the patient and family the proper way to use the hoyer and hazards if hoyer is not used properly.

Every time I read about new nurses taking the boards and passing the NCLEX with 75-100 questions... I remember the NCLEX in 1988 when I graduated from nursing school. Two days of #2 led pencils circling dots on a sheet of paper. Four segments of nursing, med-surg, peds, psych, and ortho? Maybe, I can't remember. But each segment of the testing was 4 hours long. Each segment had 500 questions (maybe 250-again I can't remember) and the only way to find out if you passed was to wait for the mail man to bring your results in the mail 6-8 weeks after the test. If you got a thick envelope, you failed and it would give you instructions on how to re-apply to take the NCLEX in 6 months. The NCLEX was only offered twice a year. If you got a thin envelope you passed. Those days are long forgotten in the generation of computers! Congratulations on passing! Welcome to the world of nursing!

At my job when you come aboard, you are required to provide addresses for the last 7 years. If you have lived out of state you are required to get finger printed. The employee can work. However, if something comes back on your background check that you have not disclosed upon hiring, you will probably be terminated. The job application asks questions and gives you a chance to disclose prior to hiring. If you try to hide it and they catch you..that's probably when they will terminate.

I think it depends on the state in which you are licensed. My state BON does not require me to disclose my illness. When I renew my license it asks a couple questions like: Have you been convicted of a crime other than minor traffic violations? ; Do you have an illness or injury that would prevent you from performing job duties in your scope of practice and there are a few more. As long as my psychiatrist thinks that I'm able to perform my job duties as an RN, the I can say NO to that question. My psychiatrist has pulled me out of work several times to adjust medications or when she has felt that I am not stable, and I take FMLA. If I feel that I'm not stable, or if I'm sick with my bipolar then I take the responsibility to contact my psychiatrist and we work on mediation adjustment. She has taken me out of work a couple times when I thought I was capable of working, however I have to trust her judgement. I feel like if I'm working when she thinks I should not be working and I make an error or something happens then I will have big issues. I've been a nurse for more than 28 years and was diagnosed before I became a nurse. In all those years I've never disclosed my illness to the BON.

What is the difference in swallowing a med cup of pills at once or putting the pills in the tube all at once? Be aware of the meds that are DO NOT CRUSH, of course. They are all going to the same place (if it's a g tube) at the same time. I'm an OLD nurse and was honestly NEVER taught not to mix the meds.

I don't know what state you live in. I take several meds for bipolar, and have for more than 15 years. I've been a nurse for more than 25 years. I have NEVER disclosed my meds to my employer or the BON. In my state, when you renew your nursing license it asks a question like, do you have mental incapacitates that would prevent you from performing your job as a nurse? NO I DO NOT. I see my psychiatrist regularly, I follow my medication regimen. I try to recognize any changes and/or crisis early and contact my doctor. There have been times in the past years that I have been hospitalized in mental institutions, I have been sick for many months at a time. I fill out my FMLA paperwork and submit it to HR and do the best that I can.

The consent gives the nurse/agency permission to treat the patient. Without permission, you are touching and examining the patient. This is a NO-NO. Patient or Responsible party must always give written consent before you ever lay your hands on a patient or start teaching or anything. You could technically be charged with battery or some silly thing if you are treating a patient without a consent.

This often happens with PAD and it's generally a precursor to wounds in the lower extremities. Could your patient stand some compression to her lower extremities? Maybe start off with TED stockings or mild compression. Of course, you will want MD orders, and possibly a vascular consult.

Depending on if these patients you are admitting are for a medicare certified home health agency then you will need to be proficient in performing the OASIS assessment, this involves training to get it right!

I have been a nurse for 26 years. I don't think I was ever formally diagnosed with dyslexia. However, since I was a small child, I have had difficulty with transposing numbers. It was a challenge for me as a nursing student and new nurse back in the day when we had to total IVF and I&O at the end of the shift and sometimes the numbers I would write down after a long 12 hour shift were off the hook. I was tired, that is the worst for me, if I'm tired or extremely pre-occupied with something. I would end up going back into patient rooms and checking numbers again and again to get mine totalled correctly. In my current job I have trouble with phone numbers. I will always transpose a number or two. I just have to check, double check and then call a wrong number to find out I'm still wrong and go back and look at each number again one at a time, slowly to make sure that I get it right.

Welcome back. It's good that you finally realize something has to "STOP" in your head because enough is enough. It has taken me quite a long time to realize this within myself. When I get anxious all the time, unable to sleep, racing and irrational thoughts I know it's time to reach out to my psychiatrist and say, "Help". Because if I don't it gets worse. I do get impulsive. I will spend money I don't have, I will say things I shouldn't say, or I will just OD on meds to make it go away, and end up in the hospital. I got divorced about 10 years ago, so this battle has become my own. I make sure I fill my pill box weekly and then I make sure I take my meds every day. It is my safety net. My therapist gave me a self-assessment guide to follow for many years. It was a paper tool that I had to go down a list and check mark things about my day and my mood and my behavior for the day. I now do that mental check list daily in my head. I don't have to keep it in writing at my bedside to evaluate. These are just a couple ways that I have had to learn to cope with my iffy mood swings to make sure I can keep them in check and keep them in control. My biggest paranoia is being locked up in a hospital. I would rather be dead than be locked up like that. I have had very bad experiences being locked up in mental institutions. I will do whatever it takes to stay out. I do have a tendency to have seasonal mood swings. I try to incorporate that into my daily self assessment and make sure that I am "even" enough to funtion in daily society. I am so sensitive to so many of the medications that I have to be careful how much I take, and any new med prescribed is very scary for me due to some of the bad side effects I have had in the past. I am glad you are back! Take care of yourself....

Since the "blister" was on the hand...was it a pressure ulcer at all? Pressure ulcers, even "blisters" have to start with being a pressure point, or a source where the pressure started. Did something rub or put pressure on the hand to cause the blister in the first place? If I spilled boiling water on my hand and got a blister from a burn, then it is not and never was a pressure ulcer of any sort. If I had an IV canula taped down on my hand for days and it caused pressure and I develop a blister then it is a pressure area. The fluid filled blister is considered a stage II pressure ulcer. When the blister pops and the fluid is gone, then if the first layer of my skin is gone it is still a stage II pressure area. if the area develops in such that it becomes deeper, and muscle is exposed then it could be a stage III or a stage IV if you could see bone tendon in that area. Since there is not much flesh on the hand it could easily develop into a deeper sore. But calling it a pressure ulcer at all has to start with the root cause of the reason the blister is on the area. It is not a pressure sore if the blister was not caused by pressure. It would be a traumatic blister.