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  1. NurseQT

    End of shift narc count

    I know this has been asked before but I've never really seen a clear answer on this... Are nurse techs and med techs allowed to count narcs at shift change? I was always told that the shift to shift count had to be done and signed by two licensed nurses. This has always been the protocol at every facility I have ever worked at. My DON decided this last week that the techs could count with either a nurse or with another tech! Some of our nurses see no problem with this. I do. Ultimately I am responsible for those medications and I am most comfortable doing the count with another nurse. It's nothing against our techs, they are all pretty darn awesome, but at the end of the day I'm the one with the license not them...
  2. NurseQT

    "You can't call off!"

    I'm with the OP on this... years ago I was hit head on by a semi on the highway during a snowstorm. I wasn't speeding or driving carelessly, was actually driving 30 mph below the speed limit. My vehicle, which was a 4x4 did a 180 and I was hit. The officer who responded said had I been t-boned I and my two youngest daughters would probably have been killed. From that day on if the driving conditions are bad I won't risk it... I have four kids who depend on me and they come first.
  3. NurseQT

    Admission Skin Assessments

    Besides the 10-12 step process on the shift of admission there are additional assessments and tasks that are done over a 6 day period. For example, a 3 day toileting assessment is started on the morning after admission and then a bowel and bladder assessment and toileting plan are completed on day 6. Every facility that I've worked at the admission skin assessment was always done at hs. Every so often there would be talk of changing the skin assessment to be done within 2 hours of admission but it wouldn't ever go through. The other thing I'm finding is that when almost a full admission is being done on the shift that they arrive on and then there are no further tasks until the following day shift the nurses are barely looking at these people!! I had an admission come in this past Friday, on Sat I asked her if I could take a peek at her hip incision/bandage, her response? "I was wondering about that, you're the only person whose even asked to look at my hip!" What??!!! The woman was admitted with a 2 day old incision on her hip and the previous two nurses didn't think to look at it?! That's a problem.
  4. NurseQT

    "Nurse" arrested for using stolen license

    She never went to nursing school. She claimed she graduated from the Madison tech college with an associates and then completed her bachelors at UW-Madison. Neither school has any record of her attending EXCEPT for the med. term. class at the tech college. And she wasn't found out by the person whose credentials she stole, that nurse didn't even know until she was contacted. It was the hospital who figured it out. She has multiple felony charges filed against her, haven't heard anything new on this and her husband (whose a friend of my brother's and mine) had been silent since the news story first came out..
  5. NurseQT

    Admission Skin Assessments

    Wondering when other facilities do an admission skin assessment. At my facility the majority of our admissions are short term rehab patients and are admitted to our rehab wing. Most of our admissions usually arrive on the day shift. Our current admission process really sucks to be completely honest. On the day of the admission there is a 10-12 step process which we are expected to complete in one shift, this includes an admission skin assessment! Trying to do a thorough skin assessment on a fully clothed person while fighting off therapy, who will wisk that New admit away to do their own assessments the moment the nurse turns her/his back, is next to impossible. Not to mention the fact that most of these admissions are A&Ox3 and have absolutely no interest in taking their clothes off at 1:00pm! All too often we day shift nurses have asked the PM nurse to please do the skin assessment at bedtime, well one of the PM nurses complained and the day shift nurses scolded. Every facility I have ever worked in the initial skin assessment was done at hs. Not to mention the fact that so have never worked anywhere that required almost an entire admission to be done in one shift. Then nothing until the following day shift when there are more assessments and various tasks, most of them being assigned to days, only a couple on PMs, and none on nocs. Days also has the heaviest med pass, all the care conferences, all the discharges, and doctor rounds, and inter-disciplinary meetings. No one in management would dream of helping and our charge nurse is also a floor nurse. The process is just ridiculous I think..
  6. NurseQT

    "Nurse" arrested for using stolen license

    No, she wasn't a LPN, never even took the CNA course. The extent of her schooling was one medical term. class.
  7. NurseQT

    "Nurse" arrested for using stolen license

    I guess she worked as a unit clerk at various hospitals, all the while telling her family and friends that she was working as a nurse. She was still on orientation when she was found out. The other nurses working with her began to get suspicious when she was unable to perform basic nursing skills. The place she was hired at first was a LTC facility, I've heard from people who worked with her and they all said the same thing, that she was very unprofessional and never seemed to complete any of her tasks. Sadly, she is continuing to claim that she is a RN as is her husband!
  8. Nurse at Reedsburg medical center used fake RN credentials, officials say | Channel3
  9. NurseQT

    Typical Staffing for a SNF/Rehab Wing

    Sassafrass- you describe pretty much how I feel as well. I have been a nurse for 14 years and have never seen it as bad as it has been these past few months.. It's so disheartening..
  10. I work for a SNF that has three wings, two are LTC and the third is Medicare/Short stay/rehab. The short stay wing has 32 beds. We typically have 3-4 CNAs and either 2 nurses or a nurse and a med tech for the AM and PM shifts and 1 CNA and 1 nurse for the noc shift. Is this typically how staffing looks at other facilities? Right now we are so busy it's not even funny. Multiple admissions a day along with discharges on top of passing meds (unless it's a nurse and a med tech), wound care/tx, there's usually at least one PICC in house, and then there's Doctor rounds, care conferences, and then there's the never ending charting, ect ect ect... We are running like crazy to a point that it's not safe and leaving there hours after the shift has ended. We're getting burned out... Is this how it is other places?!
  11. NurseQT

    Prescribing Narcotics for Pt with Drug Abuse Hx

    Patient has now gone back and forth between doctors demanding more pain medication... The physician following them at our facility has now said he will not sign any further orders for more narcotics, his colleague saw patient at his request and this physician asked patient if they were ok with her contacting the "primary" MD that patient is also seeing at the other hospital so all providers could be on the same page and patient said "no." Patient was also seen for chemical dependency assessment today and will be seeing them on an ongoing basis as well. THIS is what I was concerned about happening. Pretty sure I DO have an understanding of working with someone with an addiction, seeing two of our providers are sharing many of the same concerns that I had when patient was admitted 3 weeks ago.
  12. NurseQT

    My AL facility admin have lost their minds.

    So the noc nurse is on her own? That can't be legal, what about residents who are assist of 2 for transfers and bed mobility?! Care plans have to be followed, a facility can be cited for failure to follow a care plan. I doubt these changes are coming from corporate, I'm gonna bet it's a combo of the DON and NHA who are responsible for these changes. If I were you I'd address my concerns first with the DON, if she won't listen then go to the NHA, if they won't listen then it's time to go above them. If you have a union bring it to your rep's attention as well.
  13. NurseQT

    Catheter Policy

    Our orders to change indwelling caths always come from the ordering MD. We have some that are every month and some that are every other month, and some that go out to urology for their routine changes. We have it in our standing orders to change PRN though. We also include PVR bladder scans qshift x 72 hours after removal
  14. NurseQT

    Prescribing Narcotics for Pt with Drug Abuse Hx

    Concerns were brought up to the discharging facility as well as the PA who ordered the narcotics in the hospital and works with the MD who signed the discharge orders... The patient will be seen by the provider following them at our facility on Friday and I know he'll f/u, especially since it will be on him to sign the scripts for refills. I feel that the intent of my original post was misconstrued... Nobody in our facility has "judged" them or treated them any differently then our other patients. I'm not looking down on them at all. Addictions are not a choice, they are an illness and should be treated as such. From day 1 in the hospital nobody took steps to help prevent a relapse, when treating one issue you can't just ignore other issues or illnesses that may be directly affected by that treatment. THAT'S where my concern lies. As to my question about whether they can considered "clean". Granted the patient remains clean from crack and heroin, they are on multiple narcotics and displaying drug seeking behaviors. When our admissions coordinator reviewed the patient's discharge summary that "has been clean for many years" was very misleading to her and unfortunately, we can't do anything about their dx list from that hospital. In reality they're not clean, the hospital loaded them up with multiple narcotics and sent them on their way with no plan of care in place to prevent relapse. I was raised by two recovering alcoholics, my husband's mom died of a heroin overdose when he was 10, and my sister-in-law is fighting an addiction to narcotics right now so for me to see so little care or thought put in to a patient's recovery by their medical team is heartbreaking and maddening at the same time.
  15. NurseQT

    Prescribing Narcotics for Pt with Drug Abuse Hx

    I'm not saying they should suffer in pain at all, but there are other non-narcotic options out there. When a physician orders Morphine, Oxycodone, and Lortab but not Tramadol, ES Tylenol or even a cryo-cuff I think the physician has done this person a great injustice by ordering multiple narcotics when they have a history of narcotic dependency. Ordering narcotics for a limited time is completely understandable but these orders have no stop date. If a patient is taking MsContin 15mg q12hr, Oxycodone 10mg q4hr, and two Lortab 10/325 q6hrs on day 9 post-op I think that may be a cause for some concern. We are now on post-op day 11. It would be concerning with any patient not just someone with a history of narcotic and opiode dependency. As far as this patient goes when they calmly rate their pain a "12" but their body language doesn't jive with having worse then the worst pain ever, is asking for PRNs at the exact time they can have it again around the clock, tries to get nurses to give it sooner then ordered, and yells at the nurses when she has to wait it is concerning. Even more so when the patient is refusing to participate in therapy but then leaves to "go out" with family. When a physician orders opiodes for a patient they are to take proper steps to help prevent that patient from developing a dependency or in this case a relapse, ar least in my state anyways, I cannot see where this was down for this patient...