Youda

Before there can be a change, nurses (all of them!) have to first figure out there's a problem. We talk about these things at allnurses, but the percentages of nurses willing to work for these kinds of wages and benefits, and tolerate a 2.6 million salary to management far exceed the few who find this obscene.

25-33% of every healthcare dollar spent in the U.S. goes to upper management salaries, according to the World Health Organization. This is nothing new. It has been going on for years. Odd that people are just now figuring it out.

Maybe I'm being pessimistic, and would like to continue this discussion. No offense intended. But, I don't think saying "No" or "negotiating" solves the problems for individual nurses. This seems overly simplistic to me in view that very few employees have an input into decision-making within their work environment, conditions of employment, expectations for workload, benefits available, stress level, staffing ratios, adequate equipment and supplies, insurance plans, retirement benefits . . . The assertive approach is one that I can certainly appreciate; and it works well in certain circumstances. But when an entire industry is ailing, being assertive falls short of fixing the problems. For example: if I go into work and say, "Hey, NM! I will no longer take more than 4 patients, and I will need another $5.00/hr. to bring my salary up to the median wage for nurses of my educational level. Also, since my birthday, I've started to worry about my retirement; so please arrange to have a retirement plan for me. Oh, by the way, the deductible is a little high on my health insurance. Please take care of this as soon as possible, OK?" Now, assuming I could muster up a tactful and assertive and positive way to say this, and also assuming I had input into decision-making, I can guarantee you that I would find myself unemployed by the end of the week. Perhaps it is different for a traveler, because they need the nurse bad enough to pay agency wages in the first place. But, for a long-term, until the day you retire? You wouldn't get those options, and if you did, they'd get rid of you at the first possible moment. The problems of nursing can't be solved by just saying, 'no.'

I hear the negotiation, stand-up-for-yourself, etc. What do you suggest when that has already been tried? I run up against budgets, cut-backs, etc., etc., etc. The answer is NO. If you leave, they hire someone else; and you go somewhere else and encounter the same mandatory OT, staffing ratios, poor bennies, etc. You can only negotiate if someone views you as valuable; nurses aren't seen as valuable, in my experience.

I was the happiest I've ever been in nursing at my last job. The difference was one of the best human beings, and nurses, that I've ever had the pleasure of working for. She encouraged everyone, was always positive, fought corporation tooth and nail, defended her staff, and demanded to run nursing the way it should be run. They fired her. It only took a couple weeks of the new DON's corporate attitude to ruin an excellent place to work, and a mere 4 weeks before the state Division of Aging showed up and gave the place 3 J tags, two G tags. (Immediate jeapordy and actual harm). Every nurse quit or walked out except four of us. We were all eventually driven out, too. Well, I wanted to say that because it isn't WHERE you work, it's WHO you work WITH! And most managers that are good nurses never survive the management BS.

You just go up to your local printer, look in the yellow pages, and you can find plenty of places who will make custom bumper stickers. So what should it say? (I like the idea above). Make a dozen and hand them out to nursing friends? I have no idea how much it would cost, but wouldn't cost a fortune. The schools around here do it and give them to parents of students on the honor roll "My child is a honor roll student at So-So Junior High." So, if a school district can make a few, we surely could do it for ourselves.

Everyone agrees there is a huge problem. Most nurses are willing to help. Not to bash the ANA, but even with state and national organizations, change isn't happening. I agree the need for changes must go to the general public, because fighting politically through Congress isn't getting it done. Changes needed to be made last decade, and we're still fighting about unsafe mandatory OT! (And -jt, before you say anything, please remember that most nurses don't have a union!) Yes, a grass roots effort seems to be necessary and about the only real chance to make changes.

I'm on sabbatical because my job "sucked the life out of me" (a good description of how I've felt, quoting Mattsmon from another thread). It wasn't nursing that did me in, it was the corporation and the realization that I could not be a good nurse and a good employee at the same time. My ethics and morals were in direct opposition to my need to get a paycheck. I know, like Anne, that this experience is not unique. In fact, I suspect it's quite common! I'm one of those 500,000 nurses who refuse to do bedside nursing anymore until some of the problems are fixed.

As a diabetic, I will tell you that if anyone tried to give me an insulin dose in a standard syringe, I'd have to smack them alongside their heads just to hear their shrunken brains rattle around. Insulin syringes are designed to give, accurately, very small doses. This isn't just due to the markings on the barrel, but the shape of the barrel, the shape of the plunger (flat instead of curved), and the amount of med that is still in the syringe. A possible alternative would be a TB syringe because it is also made to deliver small doses. The only exception would be in an emergency situation when the BG's were dangerously high, you were going to give it IV, and it would be more important to get the BG down quickly. Even in that situation, 8 units isn't going to do much for bringing down a critically high BG! If the doc wanted to use a standard syringe, why did he want a goofy amount like 8 units? Why didn't he say he wanted .25 cc's or whatever? What was the patient's BG, just out of curiosity?

It depends on the setting. In nursing homes and long term care, leather or four-point restraints are forbidden by law. In an emergency room or psych unit, I think they are still used (someone help me here?) as a temporary measure to control violent patients until medication takes effect or they can be transferred to another setting. I've seen EMTs use leather 4-points to keep a violent patient on the guerny while being transferred to the ER . . .

:roll :roll

The kind of stripe and style of cap is chosen by the nursing school. Wide black velvet stripe might indicate you graduated from St. Mary's College of Nursing, two narrow black satin stripes if you graduated from University of Texas, whatever. Usually black was for RNs, blue for LPNs, but that wasn't always exact. Some RNs schools used red stripes, or other colors. I have no idea if schools still have a designated cap for new grads? Here's a link about the history of the nursing cap, it's symbolisms, etc.: http://www.civilization.ca/hist/infirm/inevo01e.html

You are so right, Kevin. It hasn't been so long ago that I reported to work at a LTC. To make a long story short, I didn't clock in, did not get report, and refused the assignment. I was told that if I didn't take the assignment, I would be fired. I thought that was a real good idea, so I told them 'thank you' and left the building. Mind you, I'm in uniform and ready to work. I drove two blocks to another LTC, walked in the door. They hired me on the spot because they were desperately short. I went to the floor to help pass breakfast trays; and I only lost about 30-minutes pay. (BTW: the new facility hired me at more than I was making at the other one!)

Just to answer this question... The LPN programs in Missouri now include IV certification as part of the program. The older graduates (before IVs were included into the curriculum) have to take a 40-hour certification course. Also reciprocity LPNs whose original out-of-state school did not include enough IV hours to be certified in Missouri have to take the additional class. But, even with the certification, an LPN has limitations on doing IVs as I mentioned above.

Good for you to decide to go back to school! The differences in what an RN can do vs. what a LPN can do in Missouri are: LPNs don't hang blood LPNs don't do IV pushes LPNs cannot start IVs except peripheral with the cath LPNs cannot administer certain IV meds such as chemo Hummmmm, I think that's about it. A good rule of thumb is that if you haven't been trained, and/or don't have experience doing something, don't do it. The choice between going to LPN or RN is really your decision. All the things you talked about (family, expenses, etc.) are part of it. I would just recommend that any LPN program that you attend be a "step" program where your hours can be applied to the RN program should you decide to continue. If you take an LPN program where the hours don't automatically apply to the requirements for the RN program, then you basically have to retake the same information again. Also be aware that even in some of the "step" programs, if you don't go on for your RN within 5 years, you start all over, also. Leave the options open to continue for your RN, if you go LPN first. And find out BEFORE you enroll in the LPN program what will apply to the RN program you plan to enter. Good luck to you!

Oh, yes! This happens often enough with dementia/alzheimer patients, and I have seen this often. Bathing and personal hygiene is the most personal and private activity. Many people, prior to their illness, never undressed in front of others. To do so now, is a very uncomfortable experience that causes the personal to be completely vulnerable. It is a strong statement that the person is no longer able to do for herself. The loss of independence can be terribly difficult. It is important to recognize that these feelings may be contributing to the resistence. The dementia may also cause a person to BELIEVE they are being raped when you attempt to give care. Also consider that changes in the hypothalmus region of the brain can cause mixed signals causing changed sense of perception of hot and cold. The sensations of bathing may also become much different than you or I would experience for the same reason. A warm, soft washcloth can feel like a searing hot bristle brush. Other factors that can cause this behavior include: fear of falling fear of water or being hurt by it disruption in daily routine or schedule unfamiliar caregivers mechanics of taking a bath too overwhelming purpose of bath forgotten humiliation of being reminded to take a bath agitated from another unrelated cause feelings of being rushed by caregiver Feeling embarrassed and vulnerable about being naked in front of others fatigue fear of hair washing, a task which is no longer understood kept waiting too long while caregiver prepares bath fear of soap, washcloth, sound of running water depression causing loss of interest in hygiene physical illness changes in gross motor skills changes in fine motor skills memory loss (can't remember why they're getting undressed) side effects oof medication causing dizziness too many distractions such as noise, people, clutter in room lack of privacy room temperature task too complicated caregiver not giving simple or clear instructions attention span too short for task no longer able to recognize bodyparts Etc. This is a really tough problem as you know! I'd suggest first trying to figure out what is causing it from some of the possible causes. Since you know the patient better, you might be able to zero in on even another cause of it. But, if you can't find the cause of the behavior and a good intervention, AS A LAST RESORT, you should get an order for a haldol or ativan to be given about 30-minutes before attempting hygiene. The risk of injury is too great without calming the patient first. As much as we all hate to medicate, it's kinder and gentler than allowing the patient to suffer this trauma every time hygiene is needed. Good luck to you. You're a caring, wonderful nurse!

This is just a type of harrassment. Someday, maybe we'll get these mandatory OT laws enacted! In the meantime, I would make it perfectly clear that the reason is not holidays, but that it is an issue of patient safety, since you know you are not physically able to work those kinds of hours. And don't back down, even if it means that you need to put in your notice. Staffing isn't your problem, and your management needs to understand that they aren't going to make their staff problem into a safety issue for you. "Not eligible for rehire" is a relative thing. It's a lovely threat to force you to do what you can't do, but if they're really needing staff, you'll get rehired anyway. I keep staying this, but I'll say it again. Management can always find staff if they want to bad enough. I come from a medical family. We PLAN to celebrate the holidays on a day other than the traditional day; because we all make ourselves available for those big bribes we get to come into work on a holiday. It usually runs about double-time-and-a-half with and additional $100 to $250 bonus for showing up. Staff if available, even for a holiday. Losing a job isn't fun. But, it's better than the alternative.

The last time I called in on a weekend, I had a nasty NM say (you know the haughty parent voice), "Well, if you call in on the weekend, you'll have to work next weekend to make it up." I said, "Well, since I ONLY work weekends, was hired for weekends, I'd rather planned on working next weekend anyway, so go ahead and schedule me." Here's the simple facts, as has already been said: people will call in on weekends. Some are legitimate, some are not. So, what are you going to do about it? Punitively taking away a "benefit" hasn't worked, has it? So think of another way. One place I worked, towards the end of the month, the NM put a big calendar in the breakroom. You signed up for "on-call" days. People got to choose when they would be "on call" and you got to choose by order of seniority. The hospital paid for two cellphones. When you were on-call, you carried it with you, so you didn't have to be stuck by the phone. YOU GOT PAID HALF-TIME WAGE FOR BEING ON-CALL EVEN IF YOU DIDN'T GET CALLED IN!!!! If you were called in, you got time-and-a-half. It worked. Everyone was happy. No one was punished. Most of the time you got paid for carrying a cellphone to the movies, or to the mall. And we didn't work short. Find other solutions. Have you ever held a nurses meeting and explained your problem to them and asked THEM for solutions? Have you ever thought to make the people who cause the problems part of the solution by asking for their input? Maybe they call in because morale is low and they're fed up and close to quitting. Maybe your scheduling is screwed-up. I've worked in places where the nurses all got together per unit and made out our own schedules. We traded days when we needed a day off at the last minute. But, we also never scheduled ourselves for the day of a doctor's appointment or a daughter's dance recital. Call-ins dropped considerably when we got to make our own schedules. It's amazing to me that NMs are so quick to punish. I realize the starter of this thread is looking for input. You are a rare exception. Usually, these rules are just cramped down our throats, and they doesn't even solve the problem that the "rules" were made to correct. Try talking to your nurses. Try asking for their input. Allow them to use some of that "critical thinking" we're suppose to have. Give them the problem and see what they do with it. When THEY find the solution, they'll abide by it and feel that they have some control and power in the workplace. Your morale will go up, call ins will slow down . . . . because you treated them like the intelligent, adults that they are.

Can I be the hat? :) What really blew my mind several years ago is when I naively volunteered to be part of an infection control team. We were having a high rate of UTIs and other infections, usually of the same Genus. So, we went around doing environmental cultures. E.coil in the ice machine. Pseudomonas on water fountains. C.diff on silverware. And you don't even want the list of bacteria on door knobs, the telephone, in the clean utility room, on hand rails in the halls, at the nurses station . . . Wearing gloves to protect ME is essential !!

Mario, it's great that you do ask questions! Washing hands after gloves are removed for two major reasons: 1. The gloves may have imperfections or have been damaged during use so that your hands have been exposed to allow microorganism entry. 2. Your hands may become contaminated as you remove the gloves. Washing your hands before putting on gloves is for similar reasons. If the gloves have imperfections or are damaged during use, washing your hands before putting them on helps prevent microorganisms from transferring. Also, you can contaminate the gloves when you put them on. As Anne said, the boxes of "clean gloves" must be considered contaminated as soon as the box is opened. Just a tiny speck of dust is enough to contaminate a box of gloves with pathogens. Many bacteria actually thrive and enjoy these environments. When a pathogen like pseudomonas can metabolize soaps, you need the friction of handwashing to remove these kinds of pathogens. So why care? Because gloves protect YOU. Everytime a nurse doesn't do this, they take those pathogens to clean utility rooms, into surgical suites, to the nurses' station, to the phone! Ever wondered why everyone gets the flu or a cold at work about the same time? Because someone isn't wearing gloves and washing their hands.

This is right out of my "Fundamental of Nursing" book, Mario: "Gloves are Personal Protective Equipment. Gloves are worn for three reasons: first they protect the hands when the nurse is likely to handle any body substance . . . Second, gloves reduce the likelihood of nurses transmitting their own endogenous microorganisms to individuals receiving care. Third, gloves reduce the chance that the nurses' hands will transmit microorganism from one client or a fomite to another client." Clean gloves (like sold in bulk in boxes) do NOT protect the patient. They can help reduce, but not protect the patient from pathogens. To protect the patient, you have to consider the 6 steps of the Chain of Infection: 1. the microorganism (pathogenicity, characteristics of the bacteria, etc.) 2. source of the microorganism 3. portal of exit (urinary tract, nose, skin, etc.) 4. method of transmission (airborne, contact, etc.) 5. portal of entry to the susceptible host 6. host. Mario, any of the above steps in the Chain of Infection are can expose the patient (or the nurse) to nosocominal pathogens. Gloves just don't do it. They are there to protect the nurse and help reduce the chances that the nurse becomes a fomite. To believe that gloves alone protect the patient is really oversimplifying how infections are spread and the varieties and transmission of these nosocominal pathogens. And yes, MRSA can colonize in your nose or anywhere else for that matter. But remember that colonization protects the colony. There will always be individual cells that will break away from the colony and can reinfect the host or be spread to another host.

A friend of mine always smiled and was happy at work no matter what she felt inside. The admin took her aside and did a random drug screen on her (of course, it was negative). The point is (besides stupid admins) is that no one is happy all the time. If I'm feeling like crap, down, upset, whatever . . . I just try to focus on WHO I'm talking to. I try to see them as a person, and for that few minutes that I'm with them, I try to give them what THEY need, and not worry about what I need or feel. I can deal with my own self later. Often what I do or say for my patients makes a difference in their entire day. So, just see that patient as a human being. Beyond that, allow yourself to be human and don't try to do the impossible, or else someone will wonder what you've been smoking.

There's a combination drug that I've seen prescribed from hospice, but unfortunately I can't remember the name of it. Maybe a pharmacist? Anyway, it was suppose to hit every possible cause of N&V. It came in either a paste that you could apply direction to the skin or in suppository (no po pills, because it is used for N&V!) Anyway, it contained haldol, thorazine, phenergan, . . . heck! Wish I could remember it better. I do remember that some pharmacies didn't carry it, but mixed it up for us. Good stuff, very effective. Can anyone help me out, jog my memory about it?

Mark, these silly nurses are afraid they'll "kill" the patient 30 minutes early. Although I've known a couple of wouldn't give it because they didn't want the death on their shift. That's when I really hope in the concept of karma.

When a nurse questions a doctor's order, the nurse must notify the doctor and explain the rationale for questioning it. I've seen many nurses question the order, refuse to do it, and that's it. But, you are REQUIRED to call the doctor and discuss it. The doctor will either change the order or not. If not, the nurse is then obligated to follow the order. If the nurse still cannot follow the doctor's order, for ethical or moral reasons, or whatever, then the care of the patient should be turned over to another nurse who can meet the patient's needs. Nurse manager should also be notified of the question involved, and the need to transfer care to another nurse and why. A nurse is not forced to do something that is against her ethical or moral beliefs (as in participating in abortions, or etc.) However, the nurse *is* required to insure the care of the patient by turning over the care to another. Document that the doctor was called to verify the order, doctor's response.