coffeebreakrn

Have you tried Hospice? I have found that the nurses are very supportive and friendly. I love working there, they don't seem to eat their young. Another thing you can do is finish your RN, then go on to your BSN. You can then educate LVN's. May not be your solution... but it is an idea.

Unsure. But... If you are in a hospital setting or nursing home, you are only able to work if the other nurse is an RN Charge with at least 2 years experience. This is a "standard" order from the board that your speaking of.... It is a "Warning" with stipulations. You will have to apply to the position you are looking at, then during the interview disclose that you have an order from the board. It is only restricted in the sense that you have to have an RN to which you can call upon in time of need and that will honestly report on your performance back to the BON. Hope this helped.

I know this is a big jump...but have you thought about being a Pharmacist? They do make lots of money, they help people and the stress is not as intense as other areas of the medical field. They can/do work just about as long or longer as/then most nursing fields allow. You don't have direct patient contact, you are not subjected to multiple diseases on a daily basis, no "nasty" stuff, and you are highly respected. Unlike nurses or CNA's. There will always be sick people, your job will be a secure one, and for the most part...they seem to be pretty happy. I don't think they deal with the caddyness, that the rest of us do, in the medical field. If I had to rethink my career path...It's the one I would choose...Hands down.

Thank you. This helps a lot. I really am trying to understand. I will in the future refer to the P&P guidelines. I was not aware that you could not place an order on hold pending clarification of that order in an LTC. That is good information to know. Thank you! I did however do this: Dr is not alway readlily available at LTC, whereas they are usually at fingertips in ICU. Thank you again for your invaluable information!!!

Thank you for responding to my post. :) I put an order on hold because after assessment of a wound, I found there was no necrotic tissue...but a pink granulated wound bed. I documented that I put an order on hold and need for order clarification d/t Santyl medication (used to debride a wound from necrotic tissue...not to be used on healthy tissue) being inappropriate for wound at this time. I wrote an order for an order clarification for the physician. This order for Santyl was a new order that had just been ordered and to be started by me - the regular nurse did not implement this order; but took the order and wrote the order on the treatment MAR. The DON called me and told me that Santyl was ordered and could be used on the wound bed. She stated that I could not document or put an order on hold for clarification d/t change in condition of wound bed. I also ask another physician for an order change using a collagen dressing over a stage II pressure ulcer and to cover the area with duoderm dressing. She told me that a collagen 2x2 could not be used under a duoderm dressing. She did not explain why...but this has been done by physicians on numerous occassions and wound care for Stage II pressure ulcers in several nursing books/literature indicates a need in some cases. These are just a few things. In ICU, you need to document everything. If an order is inappropriate, you need to question it and notify the physician prior to giving the medication or doing the treatment. If he tells you to go ahead and do it, you document that you notified him and he told you to proceed. If you feel like he has made a grave error...you need to notify your charge, NM, or DON to protect yourself if indeed this is a grave mistake that will cause harm to the patient. So why not here? Also I know that incident reports are to NEVER EVER say that they were unwitnessed incidents, even if they were infact unwitnessed. I know the reason why... because "State" will make a call on the facility. And that is something that Every LTC facility that I've ever seen is afraid of. When State is in the house, everything is done letter perfect...Why not, when State is not in the house? Any advice...? I know I am probably rambling a bit.... Thanks in advance.

Hello! I am an ICU RN working as a weekend wound care nurse PRN in an LTC. In ICU, I understand what is to be documented...If it is not documented, it was not done... That being said... In LTC I have been told by the DON on several occasions...you can't document that! My question is; is there documentation guidelines for LTC that are online or printed material? I have looked online with no luck. I have combed the facility also, looking for some type of reference to guide me in this new world...No luck there either. I have also found, while working in LTC, that pt advocacy is frowned upon. So, if the full time treatment LVN wrote an order...The weekend RN is not suppose to question it (according to the DON). I am having a hard time swallowing that... Don't get me wrong...I am not devaluing LVN's...They are a VALUABLE ASSET! This particular LVN however, has no official wound care training and is a friend of the DON's. So, I need some help. Anyone have suggestions? Links? Experience relating to this dilema? Thanks in advance.