SierraN

Can anyone tell me or give me a reliable source to find out what happens to a residents social security benefits once a person becomes long term care resident of a nursing home? We have a patient who was admitted to our hospital from long term care nursing home who has been on the vent for 3 months and we cannot find suitable placement. The patient will never be able to wean off of the vent and has a terminal illness. She spends day after day in her room, on the vent, without visitors. Her family wants "everything done" but won't even come to visit. One of the doctors mentioned that the family is most likely getting the social security check and that is the reason they have made the decision to leave her in our facility. I would greatly appreciate any information on where to find information on how this system works and if in fact this is the case. State of Alabama if that makes a difference. Thanks to anyone that can give me some info! Also if ANYONE knows of resources to place long term vent patients (with or without terminal illness) I would be extremely grateful.

Just wondering why some of my friends are traveling all over the country to fill positions in states like California. Is it cheaper for the hospitals to pay the travel nurses? We do not use travel nurses at my hospital so I have no idea how this type of employment works.

I want to thank all those you replied to my question. I am sure that your input will spark some interesting discussions in class!

Your replies are very interesting and I thank you for your input. I was surprised to read that some nurses believe there is no nursing shortage. Here is a reputable website that tells a different story: http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm I wonder if the shortage of nurses is only in the harder to fill positions - For example, I work as a labor and delivery nurse in Alabama - getting a day shift job immediately would be impossible - eventually a night shift position or evening position opens. (I work all shifts as prn, 3-4 days a week while I am in school). If I wanted to work at my hospital on a medical surgical floor, at night, I wouldn't have a lot of trouble finding a job.

Hi! I've been a nurse for almost 10 years and I am currently pursuing a BSN. For a project I have to teach a class on the nursing shortage. I have looked through this site, but want your opinion on the nursing shortage and how it effects you. Please share what state you are from also. I would like to read your opinions to my class. Thank-you in advance for your time!

Well, it goes to show that most of us feel pretty much the same way - we do a good job and most days we love what we do. I mean it's not a popularity contest! Another nurse I worked with made the comment that she suspects _________ of saying something to the patients that prompts them to thank her with cards/gifts because it's not a "once in a while" kind of thing...I mean it happens ALL of the time. If a couple of weeks go by that there isn't some kind of card/flower/gift basket/gift card at the nurse's station for this particular nurse it only means she was out a lot the week before! I'm not doing this job for the "pat on the back." But, it does tend to make me question what's going on? My idea of patient care is doing all the things that make for a healthy mom and healthy baby - that usually doesn't give me time to make coffee for the patient's family. If I have spare time, I help other nurses, restock our unit, make sure our OR is ready, and restock our rooms. I don't hang around chatting it up with the patients, their families, or the doctors. Oh...and completly off the subject, my absolute pet peeve is when nurses simply ignore the phone ringing, call bell buzzing, fetal heart tones dropping because they're laughing and chatting with a doctor about what they did the weekend before!

wow - ok that's exactly what happened yesterday...it was running through my mind when I posted my origingal post! I agree 100% that we arent doing this for praise and I know that there is a lot of self-satisfaction from knowing you did the best job you could do, but we are only human and it sure feels good to be acknowledged for all the hard work we do.

LOL - How funny!

You're the bomb. I love your posts. I'd give you a high-five right this minute because you hit the nail on the head, told me what i needed to hear. (see how i'd give you a high five, well "nurse I'm complaining about" would give you a hug) How did you get so smart?

Well, I think you may be right. She's worked there longer than anyone and she is always saying things like.."I helped her with her 1st baby and blah-de-blah." Also, I'm not from the South...I'm former military (started out as a dependent (army brat), then went active duty, than got out and married active duty, then divorced and finally a civilian for the first time). It's hard when you don't go to their church...know so-and-so who went to high school with such and such and like to fry everything but the toothpaste your brush your teeth with. (Not that there's ANYTHING wrong with fried pickles, Twinkies, Snickers..hehheh)

I don't know what you mean.

yeah, she's been there a long time...I think she helped pour the cement when they were building the hospital. She is always calling everyone "baby" and she's always telling all her patient how she's had 5 children and how she knows what they're going through..and that her children are in their 20's and 30's..then everyone exclaims how young she looks..(which she does). She talks with this sing-songy type voice and she's usually upbeat. On the Flip-side - she's one of the most disliked nurses on our unit because she's 1. always calling out sick so we end up working her shifts 2. Finds ways to "disapear" in a patient's room when it's slamming on the unit 3. Constantly talking/bragging about herself 4. usually charges and when making assignments, gives the crap assignments to others

I also think you need to speak to your manager. The day you described sounds like some sort of a nightmare. We all have days where we don't get to eat (as a matter, I might get a meal break once a week if i'm lucky...but unless I'm in a room pushing with a patient or in the OR, I just yell out to someone..HEY __________ watch my patients and then I run to the bathroom when I have to go because i'm crazy like that)... but your day sounds a little over-the-top. What were all the other nurses doing while you were running around like a chicken with your head cut off? It could have seemed overwhelming because you're new...or your preceptor has her head up her___. I don't know. Only advice I can give is take good care of yourself and your health, try to have a good attitude, take one day at a time..or sometimes one hour at a time and if it keeps up...find another job...it's not like there's not 1000's of other places you can work as an RN.

I feel a little silly writing this, but I want to hear from other nurses and maybe you can shed some light on this. Ok..I feel a little stupid but here goes...I work in a small hospital as a labor and delivery nurse. Although, as everyone knows the 3-11 shift can be crazy busy, I do my best to give great care and anticipate needs before the patient even asks. I'm not going to go on a brag fest but I think I'm a good nurse with a good attitude...well...I'm starting to question if there is something that I'm doing wrong. Another nurse that I work with (we work the same shift and have similar schedules) is CONSTANTLY getting gifts of gratitude from her patients...At least once a week a former patient of hers comes back to the unit with a "goodie basket" or flowers or a card thanking her for her for the care she gave. Of course she shows me the card and I tell her, hey..."her name" that's great! I'm not jealous, but I'm starting to wonder if there is something that I'm doing wrong that I'm not having this kind of connection with my patients. At first I just blew it off. But now it's starting to mess with my head a little. Hey...sometimes after I've given all I can give, I don't even get a thank-you..much less a card. I used to think that just knowing I gave the best care I could give and knowing for myself that I did a good job was enough....and most of the time it is.

SueBee - it sounds like they run your unit the right way. It sounds like it's safe. I think my patients deserve the safest environment possible and a good experience. After all, your labor and delivery is a memory that will last forever.

Molly: I'd rather have lunch also - they don't pay us extra for missing it though! It's exactly the same with having someone watch our patient - you end up having to "catch up" so, it's not really a break. It's just wearing me down to run my butt off for 8 to 12 hours straight almost every day - go from one delivery, right to the next (with no tech help, no secretary...) and no breaks. I love my job. I love my patients. But I'm getting so burned out.

I saw a similar thread addressing this a few days ago - I'm just curious how other hospitals staff their labor and delivery unit. I work 3-11 shift and there are usually two RN's staffed, sometimes three. We have a "call" person from the 7-3 shift that may have to stay until 7 and, depending on how busy we are, the night shift "call" person may have to come in to meet the day shift person. We base our staffing on the census - you can come in and have two patient's in labor, both on pitocin. You may come in and have a laboring patient and a PIH observation patient. You may come in have a c-section to circulate and while you're recovering that patient, you can get a patient in labor. We usually don't have a secretary to put charts together, or answer the constant phone calls. We dont have techs to help us clean up after a delivery. We circulate our c-sections. Most days, I don't get a meal break because we are just too busy. Some days (very, very few) we actually sit down and eat in the break room...while we're answering the phone. I've actually had times where I sit down to eat my dinner (that I just heated up) and a doctor or sometimes even a patient! will come into our break room to get me to assist them with something! Is this about how it is everywhere?

Hi - where can I find the info about what's in our scope of practice. I'm an Alabama nurse and am having a hard time finding where it says in our Nurse Practice Act that we can't turn down the epidural pump setting. At our hospital we are often instructed by the MD to turn the epidural down because the patient is to numb to push. Sometimes we have to turn the pump off completely they're still numb after two hours! (But that's an entire other story...) Edit - nevermind - i just found our (Alabama's) nurse practice act on line - we are allowed to adjust the pumps settings and change out the bags - just not give a bolus.

Can anyone recommend any books? I'm going to be taking the exam for RNC in Inpatient Obstetric Nursing and would like to review. I really would appreciate any responses!

I find that very interesting. I will look for that research when I have time. If our patients are 3-4 cm and contracting every 2-3 minutes, they're going to get an epidural. If our patient's are 2 cm and the doctor orders it, they're going to get an epidural. Each doctor is differant and there are very few hard and fast rules. There are numerous factors that we take into consideration. My biggest complaint with the epidurals is that there are just too dense and I hate that these patients are so numb they can't even move their legs! Sometimes it's just perfect - the patient isn't really hurting but they can feel contractions and move their legs...but for the most part they end up not feeling a thing and then when it comes time to push, especially if they are a gravida 1, it's a pain in the butt. Laboring down helps to an extent, but if it's a big baby, you're gonna have to PUUUUUSSSSHHHH! :) Most patients here would rather gamble with an increased risk for c-section then hurt...and I don't judge that decision. I did have my one and only child without an epidural...notice how I never did it again after that!!!:) As far as ironing goes, I have not done that either...I hate ironing of any kind. Some people say it works...some people say it does not...that's one thing I'm trying to learn more about. I don't want to be responsible for causing damage, but if there's more I can do to help, I want to learn about it. Yesterday, my patient's doctor was pushing with the patient (this is very rare - she is a female doctor that is partnered with another female and they actually push with their patients..the more experienced nurses HATE it, but I'm always hoping I can watch and learn instead of trying to figure what works and what doesnt by trying this or that. Anyway the doctor basically had her fingers inside of the lady parts, rotating completely around the baby's head with lots of gel and ironing (as Dayray described) every time the patient pushed...I really don't know if it made a differance in speeding up delivery...I do know the patient was extremely swollen afterwards. I suppose it made a differance...it looked like it would...why else would she do it?

SmilingblueEyes: Thank you so much for your response! Thanks for telling me to hang in there. It really does make me feel better! Dayray: Thanks for your response. I too intially trained in a hospital that did not have as many epidurals, nor where they as dense, so it's a whole new ballgame. I appreciate the time you took to answer my question. I've heard of the "stripping membranes" and never had a clue as to what they were talking about because everyone always assumes you know what that means. I'm still a little confused - Ive heard other nurses say, "Oh, he must have stripped her membranes in the office today.." I just nod knowingly but if I was a cartoon I'd have a blank air bubble above my head when they tell me that!:) So thanks for explaining it. RNNL&D _ thank you for your advice also! With this patient, she did complain of pressure for approx. 30-40 minutes and told me that she was feeling a lot of pressure - when I checked her before putting her up to push I asked her to push and could have sworn I felt the head come down. Next time I will take my time and really be sure about this. There was a lot going on - The MD kept asking if I was putting her up to push yet, the 100 or so family members were pressuring me every time I walked into the room...it was just one of those messed up situations...The patient go her epidural at 2 cm... One option I bounced around in my head was the one you mentioned about just giving it a rest after the first hour...but the MD didn't want me to do that and wanted the epidural turned down or off because he said, "She's not pushing worth a damn." Ok...I'm going to let it go...I just want to keep improving. I think that with so many experience levels here there is so much to learn from each other.

Hi, I've been working as a labor and delivery nurse for about 8 months at a private hospital. Before that I worked labor and delivery, off and on, for 5 years at various facilities. I work with a nurse who has 17 years of labor and delivery experience and prides herself in getting woman delivered vs. going to the OR for c-sections. One of her methods is "stretching the cervix." She tells me that she often goes and "stretches" the cervix and throughout labor checks her patients often and proceeds to "stretch" them. For example, her patient yesterday had been on pitocin all day on the 7-3 shift and at 3 pm was 1 cm. During report, we were told that this patient would most likely be going to the OR and my co-worker told the day-shift that she would show them how it's done. The MD did an AROM, placed an IUPC and my coworker went into the room quite a bit, "stretching" the cervix at intervals. The patient delivered lady partslly 6-7 hours later. A 6 ½ pound baby. Ok - Here's my question..Is this stretching causing damage? I thought that this may cause trauma to the cervix so have not done it. I thought that nature should take it's course...but how can nature take it's course when 99.9% of our patients here get epidurals so dense you could drop an anvil on their legs and they wouldn't feel it? One thing I have noticed here and it's quite frustrating is that the epidurals that are given are so dense that oftentimes patient's can't even move their legs after they're given the epidural for hours and hours. Sometimes they can't walk for a couple of hours AFTER the delivery. Yesterday I got a 38 +3, gravida 1 patient at 3 pm and in report was told the was 9.5 cm and 1+ station. She had arrived last night ruptured. (1230 in am.) Pitocin at 5 mu/min and contracting q 2-3 min. I was delighted! Easy. In a little while she should start complaining of pressure and we could proceed. I assessed her and everything WNL except urine coming out of foley was cranberry colored and that she couldn't move her legs due to her epidural. Everything looks good so tell her to let me know when she's feeling pressure so I can check her and we can start pushing. Well, 30 minutes later she' starts complaining about pressure. She states she feels her contractions although they don't hurt. (She accurately tells me each time she's contracting.) I check her and she's complete and I put her numb legs into stir-ups to start pushing. We push for 3 hours...baby barely moves down 1 cm. Ends up a c-section at 7:30 pm and I feel like a complete failure. The entire time we pushed I only felt occasional pressure from her when she pushed. Methods I tried: sitting her up more...lying her back down...I tried the towel pull and she wouldn't pull. At one point, near the end, my experienced co-worker came in and proceeded to "iron" the perineum and told me that she got the baby to move down. This made me feel quite relieved...until I checked the patient after my co-worker finished whatever she was doing down there to cause quite a bit of bleeding...and didn't notice any difference in station at all. In the beginning I had the epidural turned down...finally, after the 1st hour I clipped it off for a while. Pt started complaining of pain and pushing didn't improve. NOTHING I did work. The MD came in after 3 hours, pt at this point states she wants a c-section, checked the patient, stated he did not feel comfortable with vacuum and due to to infant starting to get tachy (170-180), pt spiking fever (ruptured for 17 hours at this point) we proceeded to c-section. Outcome - 9/10 Apgars, ph 7.3, 7 pound 14 oz girl.....I still feel like a failure as a labor and delivery nurse today. I need advice on what to do to help my patients.

I was surprised to hear this myself. The next time I see him, I will ask about the literature/studies and get back to you. This is a great place to learn...like from now on, it's cold water, not a roast beef sandwich..just kiddin' about the sandwich :) I just feel like a fish out of water sometimes at this new hospital.

I agree with you completely...I posted to see if perhaps i was wrong in thinking the CST was not indicated... In my former place of employment, we didn't do CSTs....so I'm a little confused why they think it's a good idea here. I asked another doc about the CST and he told me that it was a better indicator of fetal well-being then a BPP...what do you know about this?

Thanks for the advice - so from now on - Cold water.