midnitelpn

i know.....i just dont know what to do...i am afraid of the "i was never taught that, shown that etc.." no sign off sheets with this orientation...i pride myself on providing the best orientations i possibly can & dont want any of this to reflect poorly on me---i after all, am providing the training. i've even offered copies of my old orientation book that has everything you ever wanted to know & then some--declined! i've just never come across someone like this in 15yrs & am just so taken aback...

i am a "pocket nurse" myself.."your so little i could put you in my pocket", and the like has been uttered more times than i care to hear...for some reason that dosent bug me....but comments that did bug me, where when my twins were very young, and random strangers would approach me & make comments! it happend every time we went out! i often threatend to print up fliers to hand out saying, "yes i do have my hands full, yes they are identical, no twins dont run in my family, i only dress them alike when nothing else is clean! etc. etc. etc. some folks are just like that, they have to comment when something appears out of the "norm". i'm a unconsicious gawker myself....or so i've been told! lol...humans r weird!

thank you so very much for your replies...i think that part of the problem, is that the re-structuring of the unit is not very clear cut. they are filling positions w/o positions descriptions being approved first. i think this person may have one idea of what they are to be doing & myself being the orientor, i am viewing them as orienting them to do what i do as an lpn charge, as that is what i am... the facility is asking me to orient them to my position. i am going to ask this person, what their understanding is of the position they are taking, actually is...maybe this will answer my question as to why all the resistance......(i doubt it though, i get the feel that this individual may be a tad on the passive/aggressive side, i hope i'm wrong!)

dont know if there is money in it....would teach people to read (do it now as a volunteer!) or recreation therapist....

i have been asked to train rn's for the lpn's that are being phased out on my unit (i am an lpn charge)..i have done this many times before, without any difficulty at all (i will still have a job somewhere in the hospital). i wish i could say the same thing is true this time! i was asked to work o.t. to help the rn orientee's out, as they did not feel comfortable being "alone" yet. while explaining WELL established protocol on the unit, the rn i was orienting, felt it necessary to tell me all of their credentials & that they have "established a rapport with the provider" and if they felt it necessary d/t their assessment of the pt, they would by-pass the protocol. this was in no ways an emergent situation. the provider in this case has sent many a nasty gram regarding this exact issue and what her expectations are of the pt.s and staff. we have an rn assigned to our unit, who has been w/us for over a year, and she does NOT bypass this protocol. this really upset me! in all the years i have worked, i have never had anyone, throw their credentials in my face, especially when i am trying to teach them something! i have to say i lost my cool! said "i'm going home, you obviously dont need me here to teach you anything, because you are an rn & you can divert from protocol when you want....what the sense in trying to teach you protocol, when your going to do what you want anyway!" i was inappropriate in reacting that way, i know. was dragged in the n.m.'s office to "kiss & make up". the rest of the day was spent trying my darnedest to show this person unit policy & procedure, only to have them circumvent everything i tried telling them! attempted to show them how to assign a bed in the computer, they picked up the phone & called the secretary to have the pt admitted! they were already admitted! we needed to assign them a bed-secretary called me, asking me what to do! many other incidences similar to. this person feels that the jobs we as lpn's have to do, are "busy work", that some else should be doing, not the nurse...i dont know about that, but i have been asked to train them in what i have been charged to do as an lpn. how can i train someone who dosent want to be trained, or feels that they are "above" the established protocols on this unit? i feel like i've lessend my own credibility when i flew off the handle & had to have a meeting w/the n.m., and that if i take this issue to her in private, i will be looked at as though i'm tattling, because i dont like this person. i have a wk of night orientation w/this person & i can see the handwriting on the wall! the other orientee has been away from floor nursing in this facillity for 12 yrs & is eager, yet overwhelmed, with all that they have to learn/the one i am having difficulty w/has been in ltc. the unit we are on is a admission unit w/80 beds, very fast paced & you hit the floor running every day, doing 20 things at once, not at all for the faint of heart...i dont know how to deal with this person. help me please!

we have had >87 inches of snow this year. i work nights (usually plows are off the roads > 3hrs before i leave) & am a hour away in good weather! I leave alot earlier. some times i am alittle late, but, those i am coming into relieve dont really care, cause they dont have to stay! I have slept over in an empty bed, more times than i care to admit, because someone who lives 10mins from the hospital "cant get out of their driveway/the roads are too bad" etc...and i drive little 5 speed grocery getter! i wont drive during an ice storm, however! i refuse!

i just spoke with doctor.....after reviewing your chart, he wants me to prep you for a "stat crainal-analetomy", its the only thing that will cure your condition! i am trying to see things from your point of view, but i cant seem to get my head that far up my own azz! you stink! you need to wash your rusty butt!

I work 12mn-8am & haunt my house on my pass days...I'm up & down all night!

I'm in a federal facility! I am told in report, when I recommend that some has their 2nd or 3rd +ive uds, they should be d/c'd, the response is "they are homeless & the refuse to go to the mission, they have no funds etc". I swear I couldnt make this stuff up! We had one pt. (admitted straight from prison) who was followed by parole, his casemgr reported his 2nd +ive & the p.o. wanted him to stay in tx. He was +ive 2 more times and given a voucher for housing!! And he was the most argumentative, verbally nasty, non-compliant pt (very well documented, even by physicians). I guess we would be paying for his housing reguardless if he went back to prison or given a voucher, but we did nothing to attempt to rehabilitate this pt! They miss mandatory groups and are given wknd passes to go home! We also have the largest pyxis in our facility. Have had pts sucking fentanyl patches that I give them. On any given morning I give dilaudid, morphine, percocet, lortab, xanax, ativan, fentanyl, klonopin and the list goes on & on. I am wondering if the truth be known, if mgmt is afraid to upset these people, because of the fear of retaliation! My colleagues and I are planning on reporting these incidents to the proper authorities this wk. Thanks for all the posts. I thought all rehabs were run kind of like ours, as I dont have any other experience to go by and it seems to be normal to mgmt. I used to love to come home when i worked straight psych and tell my kids how a pt was getting stabilized & coming out of their shell or just feeling mentally better, going to their first apartment etc. Now I dont have much good to say....or much good to feel about:(

Anyone work a mica unit or substance abuse rehab? i've been an lpn for 11yrs, working in some type of psych setting all 11yrs; at the same facility. I have been on mica/substance abuse for the past 3yrs. I am the night charge nurse, with 2 aides and a avg. census of 70-80 between both floors. Since I have been here we have had 3 new nurse mgrs & 2 interim nurse mgrs. How are your units structured? Are they locked units or locked during the night only? Are you out pt.? Are your pt.s allowed to stay up all night, play cards, watch tv etc. Are they allowed to work off campus? Have their own vehicles & come & go? Are they allowed to self medicate (sans narcs & insulin) in their rms? Are they allowed to keep unlimited amts of personal belongings in their rms? I have these kinds of questions, because I, along with the majority of other staff on our unit feel, that our unit has become a complete free-for-all. We had some incidents last week, ex., live 22 gauge pistol rounds found in a common bath rm, 40 cartons of non-tax stampped cigarettes in a pts locker (pt selling cigarettes), empty vodka btls, and narcs found in the ceiling tiles......long story short, gun never found, pt. not discharged/disciplined for selling & distribution which violates a ton of policy, rm searches not done properly cause of too much personal junk & pts. going to the director stating that its a violation of their rights having their rms searched!. If we have someone come in intox or use while already in tx., we are asked to "sober them up", not "detox", cause if you were detoxing you would have to have some sort of protocol/policy to follow, which we dont. I have worked detox in this hospital on another unit that was closed, so I have alot of experience & know the proper way to do this. We dont even have beds on this unit that you can raise the head!!! Oh, your pt has a breathalizer of .280, just put him in bed & monitor his v/s & breathalizers till clear!!! 3 staff w/70 other pts. and one intox...now there is a exercise in frustration!!! I'm just wondering how other "residential rehabs are run". Our pts are not made to comply with any of our protocol/policy & its getting dangerous! I expect to find contriband, I expect to have intox pts, but I also expect management to have clear cut policy & procedure on dealing with all of this & adhering to these policies! The old, "everyones an individual" dosent fly with me when you are allowed to stay in the facillity after numerous uses in tx & conducting illegal behavior etc. We allow these folks to continue the same street behavior and lack of personal responsibility that they are supposed to be working on in tx!! Counter productive if you ask me!! How do your residential rehabs run?

my 12 yo has been having heavy periods & horrible mood swings since starting last year. they are regular, but heavy & lasting 7-10 days. her dr. wants her seen by gyn. she mentioned that they may not do an internal, but may rx. something like birth control to help regulate her periods. of course she said it would be up to the gyn md, as to what course of tx. etc., that they would take.....I am wondering what types of advice that you all could give to me. How i can prepare her for an internal, if thats what is needed. I also have some concerns about not having a internal & meds being rx.d w/o one (i'm fearful of masking something wrong & tx.ing just the sx.) what types of meds do you see rx.d most frequently, and what type of effects do they have on someone so young? what age would you recommend for tampon use? she is very active in sports & has a big problem w/using pads (she has to use very thick ones d/t flow etc), being embarrassed & having to change so frequently. is she too young? she is asking & talks w/me alot (for now, we'll see in a couple more yrs! lol) how graphic should i get w/ my explanations? she is a "young" 12 yo by todays standards.

maybe the addiction potential could have to do w/the onset, peak & duration? i really dont know...isnt valium a longer acting benzo....i cant remember. (wheres my drug book?!) i know its not a benzo, but we used to use alot of chloral hydrate, and now i hardly ever see that...

clonazepam seems to be the routine narc med of choice where i work. lorazepam is used more for prns, here. i will have 3-4 pts on routine diazepam at any given time (out of 70 pts), however. depends alot on the doc. the im drug we use is ativan. i see diazepam used im alot more for medical emergencies. i'm not sure either about one being more addictive than the other....i've seen difficulties weaning pts off/tolerance, w/all 3 when used for extended periods.

I work for the VA (federal) and the NA's are nursing assistants who are not certified. They get their training through the VA. They get training that exceeds most certification criteria in the civilian sector, but when they leave the VA to work civilian, they still have to get their certification (at least in NY). They also get specialized training dependant on the unit they are on, psych, geriatrics, med surg etc. We also have health techs, but they are usually only seen in medical and can do alot of what an lpn can do, minus meds. Thats a certificate type program. I think mental health techs are used in the civilian setting & I dont know what type of training or education you need to obtain that type of position. The NA's in psych where I work help w/adl's when necessary. V/S, tx.s, escorting pts who dont have off ward privleges, have recreational groups on the unit:movies, cards, bingo, holidays, fresh air groups outside etc. They do special observation, 1:1, w/pts who have been placed under observation d/t say suicidal ideation, and they get no more than arms distance from that pt., same w/someone who is in locked restraints. They do health & welfare cks, cking for contriband in the pts. rms, drugs/etoh, weapons, items they could injury themselves with etc. They are on the floor w/pts their entire shift. They really get to know the pts. and are usually the first ones who can alert the nurse that maybe someone isnt quite themselves that day, is more quiet, more agitated, dosent feel well medically etc. or that they seem to be doing better, are able to stay focused on task, not hallucinating, isolating as much, taking better care of their adl's w/o prompting etc. They are trained to respond to emergencies, psych or medical. They do alot w/the pts.! My NA's are great & I rely on their input!

Passing meds is an important part of psych nsg.! Passing meds involves interaction w/the pt. Trust is a big issue w/alot of psych pts., especially when it involves medications! And that type of rapport takes time spent w/your pts. A good question to ask your therapist (albeit, alittle confrontational) is, "how many full, 8-10 hr shifts s/he has spent on a psych unit, on the floor, interacting w/their pts?" The NA's are the ones who spend the majority staff time w/pts, and are a priceless part of the team. And the nursing team as a whole, spends the most time w/a pt, when hospitalized, aside from other pts that is....period. I am kept very busy with an absolute ton of electronic/non electronic paper work, but thats all nsg. I think. You have to learn to juggle your time & attempt to make your interactions count, no matter what specialty you decide on. Psych nsg is not for everyone & you will meet all types of pts. Look up about 10 different types of psych diagnoses & you might have all 10 different ones on a unit at the same time! Start reading, and you may find you might want to specialize in only one form of psych nsg....there are many! In 10yrs I have done acute psych, gero-psych and now MICA (mentally ill, chemically addicted). Good Luck w/your studies!!!:)