gigi918

I can say that the CNAs will respect that you were a former CNA so use that to your advantage by indicating that you know how hard they work to make a good shift happen and you can relate to thier job.

I am in the same boat so I cannot really give advice but I can offer support! My personality isn't one of assertiveness and I am so new to this that my confidence is on the low side and I know they can sense that. I don't want them to run me over! I intend to approach my situation with a teamwork attitude. I hope to be available to them for assistance just as much as I will depend on them for their help. Establishing a trust between us hopefully will help. I realize that is a fine line between being friends and supervisor.

Thanks for the comments. I guess what I am trying to distinguish is, what level is "bottoming out". And how accurate the term even is. Is bottoming out considered anything below the low norm of like 70? It appears that since these patients regularly run high, the nurses think a level of around 140 is low. On the sliding scale, that warrants insulin, but the nurses are holding or adjusting that. I am confused. I know that because I am inexperienced, I am looking at this in a literal view. If the order reads " x,y,z" then that is what I should give but these seasoned nurses have the experience of knowing how the patient responds based on their experience with that particular patient and use their instinct to determine altering the dose. I ask, ask ask and usually the response I get is something like"I know how fast they bottom out" or "I can drop in a heartbeat" or some other personal or patient experience story.

I am on a 2 week orientation at a 26 bed LTC facility. I have been assigned 4 different nurses to follow during this time. Each seems to have a different opinion about holding or adjusting insulin dosages per sliding scale as well as long acting insulin administration. The concensis seems to be a preference to keep the patients at high levels to keep them "from bottoming out". These nurses know the residents well and a couple are diabetics themselves so I feel they know more and I am underconfidient in my judgement. When a patient has a sliding scale to follow, shouldn't we follow it? If a patient has an order for long acting insulin at HS, shouldn't we give that dosage? Is it a judgement call or do I follow the orders as written?