TBlase

Six medical employees were fired for unauthorized access to medical records at Mt. Sinai. Amazing even today that people don't realize their every keystroke at work (and becoming more so in your private home) can be traced. Not only did they all get canned, that hopsital and the others involved will be sued for millions, for sure- then more people will probably be laid off. http://www.dailymail.co.uk/tvshowbiz/article-2362696/Kim-Kardashian-indicated-potential-target-hospital-security-lapse-Cedars-Sinai-fires-workers-inappropriately-accessed-medical-records.html

I've worked in quite a few 5 star places that I wouldn't allow a dog to be admitted into. I've worked in even more places that were 2 stars, that were in reality much better than a lot of five star places. I think the average person takes the 'star' system with a grain of salt. By and away, I've seen location as being the main issue in picking a place for Gramps. As far as acuity, if your state has a restrictive IV policy for LPNs, and you admit a lot of IVs, you'd naturally need more RNs. But in that case, you're probably going to take a lot of financial hits with the IV expenses, and the added payroll costs for the RNs? In almost every place I've ever worked (LTC), the mere mention of an IV makes management shudder.

Even if you are (yes, I know she died, I'm speaking hypothetically) Mother Theresa and leave with a 5 year notice, and wash the feet of your boss using your hair? You can still be made a 'never rehire'. This is all nonsense. What will happen will happen. And they will reference you when you leave anyway they see fit, truthful or not. The ethics about treating employees as humans, something to be valued, is long gone. Welcome to America. That said, there's another interesting point to be made about the consolidation of medical centers, doctor offices, labs, and the like: As more people cannot afford health care, they are not able to pay their bills. In the past, this would mean a trip to the collection agency, and bad credit scores. Increasingly, it now means that since you are in default of your medical bills, you are facing fewer choices to obtain health care if you need it since the provider you have not paid may have merged into a group of other providers- therefore none of them will treat you (aside from emergency room care).

The hostility towards CNAs in this post would be shocking, if it weren't so typical in real life. There are two types of nurses in LTC. The first, the holier than thou, I'm the nurse and you're my minion, has never worked a day as an aide, never answers lights, would never dream of helping an aide transfer a patient or god forbid toilet a patient, never includes the 'minions' in reports or decision making or even asks for their opinions (if you think you know the patient better than the CNA, as an example, you fall into this category), or even looks at them in the eye on a daily basis. The second, the supportive, 'glad I don't have THEIR job job because I couldn't HANDLE it for a day', thankful, appreciative, and helpful types that actively asks the direct care giving staff for opinions, advice, includes them in the day to day conversation, assists them because you want to make BOTH of their jobs easier, and realizes that without them? YOU would not have a job. That said, even the OP didn't post a nasty, broad rant against nursing assistans in general. The OP was flustered by an employee that appeared to have been sent from another planet, one that she could not get a point across to. Other than that, in fact, the OP is always level headed, and sounds like a bang=up DON. Is it easier to replace a nurse in LTC, or is it easier to replace a 'top notch' CNA? We old timers know the answer to that. If not for CNAs, nursing homes would not exist. There's your answer.

Constantly cutting staff pay, raising benefit costs, monitoring every staff hour on the clock and constant meeting to discuss those hours with the staff at every opportunity, constantly trying to scale back food costs, always trying to dream up ways to lure private pay patients, marketing gimmics (candy, flowers) to the preferred hospital discharge planners for the best (lowest cost) patients, constant meetings to determine ways to save on pharmacy overhead-such as meetings with the staff to hunt down missing meds or meds that haven't been charged out, asking family to escort patients to appointments, always trying to prevent being burned by accepting patients that end up becoming a nightmare by screening and then rescreening them before admitting them, the list goes on. Sadly, it's common to cut housekeeping in a lot of places when the census drops- the people that are paid the very least amount of money, but which keep some otherwise very nasty places in check. After all- if the census drops there are still miles of dirty floors, and still 50 or 100 toilets, for example? Also, it's not only medications- lots of treatment supplies are also not billable to the patient. Some of those things are outrageously priced, which leads to another attempt to control costs= constantly trying to get doctors to change orders (sometimes ussing subtle tactics, sometimes finding new doctors that are on the same page) to lower cost meds, treatments, and the like.

Here's the definition: Hate | Define Hate at Dictionary.com In my opinion, 'dirty' and 'ugly' fall right inline with it.

"Iko Iko", by Cyndi Lauper, is a great interpretation of the hypocrisy in America, that is also reflected in this forum. I can smoke dope because I have cancer, but you smoke dope because you're a drug addict, but I'm slim because it's OK to take diet pills, but you're fat because you're lazy, and I pray daily so I'm a saint but you're going to hell because you drink beer, but it's OK to drink wine so you're doomed, and etc. It's called intolerance, people. Aside from that, we all know that nurses are our own worst enemies.

Wow. Finally someone not ragging the ''lazy aides". A Buddhist, or are you just clear headed and thoughtful? I get ill when I see all this aide bashing. My experience lends itself more to lazy nurses, more than lazy aides, by 'far'. Thanks for the change of pace, jadelpn.

Operative words are: attempteD, leaD, and workeD. Since you led nobody anywhere, how did achieve your goals of 'MAKING people do the right things'? This post is confusing. You are no longer there, so we have to consider the relevance of your wisdom. You may think you can lead a horse to water- but you failed to make the horse drink. Do you ponder that? "Old habits die hard, the poster said", but you yourself are gone from the job? What is the point of this opinion? Please clarify this for me, thanks.

Based on the scale and directives ordered along with the Coumadin dose, to prevent constant phone calls to and fro: "For INR from 1.00-2.00 give ___ MG of Coumadin","For INR 2.01-3.5give ___ MG of Coumadin", and so forth. Or, "Hold Coumadin for INR over:___". Or, "Call for INR over: ___". Like the typical blood sugar/insulin chaos. Some places even have standing orders for insulin and Coumadin, to include lab draws, and those really cut a lot of headaches from a med pass!

Because your BON doesn't like you, maybe.

Tell just one of your 20, or 30 LTC patients on chronic pain meds that you can't give them their drug based on your VS assessments. Just one. Then get back with me, after you are discharged from the hospital with groin injuries.

Better to be safe than sorry. I'm sure you don't want supoenaed as the nurse (with 5000 posts!) that decided a patient was dead, yet then he started moving at the morgue? I'm just saying- if there's ever a time to follow protocol to the strictest letter, it must be when you think a person has died. It also amazes me the number of nurses that believe a DNR means 'don't call the doctor is the patient is short of breath', or whatever? Wow. Small wonder the lawyers are getting fat.

An LVN cannot 'pronounce' death. In most states an RN cannot 'pronounce' death, and in those that they can, most require verification by another qualified, licensed person- it's a big deal, really, regardless of how many people die on you routinely. An LVN can (in states where it is allowed) write a telephone order indicating that 'death was pronounced by the physician', a very different situation. Whatever type of place you work for surely has a specific, legal procedure to follow. Might want to peruse your state's nurse practice act. A lot rides on that 'pesky' final statement of death.

The starting pay for retail pharmacists is well over 100K. The length of time to complete the degree, and the debt values, match the starting salaries. But I have l have always wondered how anyone can stand such a dull job, big bucks, or not. My father was a pharmacist, but back then it was wildy different. Now, today, they stand in the back and monitor the techs, might consult with the patients, but really? What does the job involve? In a hospital, it may be more exciting- if there is any compounding to be done, for example, but surely the pay is far lower. If you are bored out of your head, I understand. But there are 'zero' nursing jobs anywhere, keep that in mind!

There is opinion, and there is hate. This is hate. While you're on your hate trail, kf15- please also advise the few remaining female Holocaust survivors of how 'dirty' they are to have 'allowed' themselves to be branded by tatoos. It is unbelievable that this post was permitted on this site.

The health effects of obesity are clear. The cost to the health industry are becoming clear. The pushback against overweight is happening all over the place- like charging them more for flights. Overweight is the new tobacco issue. From a visual point of view, however- compare the opinions on overweight nurses, to the comments about nurses with tattoos or piercings, and job performance. Many think tattoos and piercings are 'unprofessional'. I'm sure a lot of very overweight nurses are among that group. Do tattoos affect job performance, or does being overweight? Does a patient that sees an overweight nurse come in the door think: Hmm. Another do as I say, not as I do, type? Depends on whether the patient is also overweight. The odds are the patient IS overweight. Suffice it to say that the issue of overweight is too touchy still to be PC. Might want to avoid it, even if you think it, because there are so many overweight and even obese nurses. It's an evolving situation, made ever worse as our food becomes ever less nutritious. The situation will get much worse before anyone can get a handle on it. And I'm not talking about love handles. Me? I find staying slim takes ever more time and energy and planning- time and energy and planning (not to mention motivation) that more and more people just can't muster up.

I'm scared to run tomorrow, or ever again- this has me paranoid:

And if my disbelief that a nurse COULD get a license with pending criminal charges, there I found it- on the WA BON site, iteslf. It asks if you are facing prosecution for any crimes, and if yes? Do you want us to give you a license now, or wait until you've been convicted or cleared? I'm stunned. Of course, there may be a catch- when you are convicted they might pull your license. Still, the nonchalance of the application to receive a nursing license in the state of WA has me wondering if I am hallucinating?

Even though my writings in here may be casual and ofttimes spelt wrong (I hate reading glasses), your point is valid. I read through some of the resumes posted in this site, and they rather shock me with grammatical errors, and the like. Any online editing program would easily prevent most of the errors I am seeing in those reseumes. I don't get it. But then again, watching the TM trial today, a lawyer on TV used the word (very clearly enunciated, no mistake) 'supposably'. Another of them said 'libary'. Perhaps most people don't recognize this stuff anymore, so it doesn't even matter?

Are you saying that the WA BON granted you a clear and unrestricted nursing license, knowing that you have unresolved, pending criminal charges against you in CA?

The call was not appropriate, even if in you felt you were advocating for the patient, rather than complaining about the agency. You bypassed the velvet rope, the protocol. What does the plan of care state regarding transferring that patient? Who assessed that patient, since you feel it's unsafe without a lift? Your supervisor doesn't seem plan on getting the lift, so you may have set yourself up. If you otherwise like the job, and want to clear the air, you might think about eating some crow and apologizing to her, tell her you were just frustrated and acted in haste, you were not intending to badmouth the agency, then tell her why you think a lift is needed. Hash it out. Otherwise, things have a habit of stewing, then boiling over. But giving information to the patient's doctor of record is not a violation of privacy on your part- she told you that to put the fear into you, about 'bypassing the velvet rope'.

I keep it at the desk by the phone. That deflects people from coming at the cart in the first place- nips it in the bud. They can jot a note based on pt., doctor, and what the issue is. Also keep labs, admit orders, clarifications, incident reports, etc. in the notebook so you can only call each doctor one time, preferably at the same time every day (to train them also on how to save hours of wasted time chasing calls back and forth) and be done with it. A few staff will hover by the cart anyway, but ignore them until they get the point that the notebook is near the phone and that any issue they have will be taken care of like clockwork, but on your time, not theirs. It works real gud.

Anybody out there, wyo? My bags are packed, I'm waiting for you to tell me where to go!

Ah, the plot thickens. You don't have a staffing issue at all. You have a nurse you don't want or like or trust on day shift, but you need a night nurse, and are wondering if you can push here there, and keep her morale intact, and prevent her from quitting? You have to have a face to face with her, and be honest:"I am not sure you can handle the day shift. But I would like to keep you, because you're a good nurse. Unfortunately, the only other opening I have is on night shift- will you consider taking that?" She may, or she may quit. But since you've already made your mind up, you have to face that. But if the reality is that you want to get rid of her, and are trying to scheme ways to make her quit without you having to fire her, I say you owe it to her, on a professional level, to fire her straight off.