ljds

Thanks, everyone for the responses and the information. I'll have to check into some associations and investigate more directly what they exactly have to offer. I was skeptical of their worth (I didn't feel like any of my student associations had any direct or real worth once school was over--or really, even during school for that matter); but it sounds like the specialty associations are more practical and useful. Good to know!

I'm not saying I have all the answers; and people in the middle are ALWAYS going to fall through the cracks. I wish I could solve that, but I'm not sure I can. But I think that if insurance and medical cards paid for formula, we would see *greater* access of the working poor to quality breastmilk substitutes, not less. Of course, it would all depend upon how much the drug companies want to gouge for formula....

Okay, I'll rephrase my question. I've never really joined any nursing associations. My interests/areas of work are medical and office OB/L&D/MB. In general, do any of you belong to nursing associations? Why? What benefits do you see? Conferences, newsletters, information, education, etc? Do you think it helps you in your career, especially in advancing your degree or your position? Thanks! Lori

So what do those people do for food? I guess I just don't see the difference between paying for your baby's formula and paying for food. It's not like formula is cheap now. It's made by pharmaceutical companies anyhow. How would the price increase? Because of improvements? So we should keep it simple and marginally adequate, so that it is affordable. I disagree. I really don't see how the price would go up so much, because it's not a new med.

I just envision you getting your script for the year when you go in for your well baby checks. I don't see how it would be any different or make it more difficult. Uh, no kidding some people don't have insurance. I've sure been there. Still have to buy my kids' meds whether I have insurance or not. That is what planning, WIC, and assistance programs are for. Shrug. It's just a thought. I think the current system isn't working so well; just throwing out my two cents on how to improve the quality of food our babies get and the support their mothers and caregivers receive.

I work with alot of low income mamas, and alot of them DO make their own formula, especially when the formula from WIC runs out. Formula is expensive. If these babies' medical cards covered their formula, then perhaps I wouldn't see so many mamas feeding their babies overmixed formula (as in, twice as much water as called for), milk mixed with syrup or molasses, even supplementations with gatorade. What do you do when you spill your meds, or run out in the middle of the noc? You call an all night pharmacy. You plan ahead. It's no different than any other med for a serious condition. If someone wants to bottle feed, we dont' fire them from our practice. We try to figure out why they want to bottle feed--in many instances it is due to poor education or support. We do what we can with that. In some instances it is a very informed decision. Fine. We don't fire smokers from our practice, either. We encourage them to quit, explore options if they are interested, if they say they aren't interested in quitting, fine, we leave it at that. We've made it clear we encourage what we feel is healthiest for the baby and the mama( breastfeeding, decreasing/quitting smoking, increasing activity for sedentary moms, etc) and let them make their own decisions. We just want them to be informed of the consequences of their lifestyle and their decisions. It's part of being responsible healthcare providers, and it is part of being a parent, too. We take care of HUMANs, and humans aren't perfect. It's okay. I'm not perfect, either! Uhh, pretty far from it, actually! When I was a smoker, when I went to the doc for my annual, every year I got the quitting smoking spiel. As I should have. It would have been negligent, in my opinion, if my doc had not made it clear that I could improve my health by quitting, and by making sure I understood the risks involved. But I wasn't make to feel like the scum on the bottom of a shoe, either. Information was given, and then I was given the responsiblity of making my own decisions. That's what I try to do with mamas that choose to bottlefeed.

Thank you. I think that every forum has a "personality" as it were, and I'm just looking for a better fit. No disrespect intended for allnurses.com; it's fine. But I'm just looking to expand a bit and perhaps find something that, for lack of better term, jives with me a little better. Thanks! Lori

We have six mandatory holidays. These are also the paid holidays. On our floor we are divided into three groups, with a two holiday rotation. So for example, this year my group's assigned holidays are Labor day and Thanksgiving. I won't have these holidays again for another three years. I wouldn't be working a MANDATORY "holiday" that included no holiday pay, but for which office staff received the day off. Forget that!!! Hospitals and organizations like this, with such terrible staff-management relations (come on, what good administrator would think this is a good idea?!?!) are the reasons unions are needed. Our hospital doesn't have a union; but I honestly don't think we need one, either. I feel like our management and administration is pretty reasonable and I feel the nursing staff are treated with respect. Good luck; I agree with you that this doesn't seem right!

Perhaps not so heavily moderated? I don't know; I just feel very confined sometimes here. So, I guess you could scratch the word "progressive" and just help me with the question "What other nursing oriented forums are available?" Thanks!!! Lori

Does anyone else frequent other, maybe more progressive online nursing forums?

I skimmed all the posts (whew1) and didn't see much of anything on this, so here goes: I would like to see formula be by prescription only. If a mother chose to formula feed, she would have to meet with a pediatrician and a lactation consultant to ensure she was making an informed consent (in my time as a breastfeeding educator, I can't tell you how many times I heard reasons for bottlefeeding that were complete myths). This, of course, should occur before the baby is even born. For example, the PPD--there are meds that can be taken while breastfeeding. Maybe not the med that works for that particular mother--fine. But lets make sure she has the complete info before she has her baby. Then, if mom is still going to formula feed, give her a script for it. It makes me sick that there are decent formulas out there -- easy to digest, with little or no pesticides or additives -- but unless your baby has a medical condition, you only get to choose from the bottom of the barrel. HELLO!! Why can't all formula fed babies benefit from high quality formulas? I would also like to see insurance pay for it. This is an artifical means of sustinance--similar to TPN and lipids. The creation of it should be strenuously regulated, there should be contant research to improve it, and the product itself should be paid for by insurance. Healthy breastmilk is absolutely what is best for the baby. But the baby is part of a dyad. If a mom has sexual abuse issues, for example, breastfeeding may not be what is ultimately best for her OR her baby. Some women find breastfeeding a health means of recovery from abuse; others find it a horrible reminder of abuse. Let's help her discover her options prior to birth, get her any help that she needs, and go from there. Let's make sure that we are trying to do the best for moms and babies, not just give the lip service (yes, breast is best, but how do you do this if you work full time with no pump breaks, and if you can't afford a $300 pump? Let's figure these things out prior to birth.). So, anyway, to sum up: better prenatal education and screening. Continual improvement of breastfeeding information and education programs. Better quality formula available. By prescription only. Insurance coverage of formula. Healthier babies. When I'm queen of the world, you all will know it!

I can swear quite a bit, sometimes, especially if the g-word is off limits. And I am well educated, thank you! I have a fairly extensive vocabulary in a couple of languages; but sometimes the f-bomb is the word that best defines what I want to express. I tone it down at work, but sometimes something slips out, or something I never though in a million years would offend someone ends up being offensive. My swear word of choice are shite, frack, and mensch. But sometimes their american equivalents slip out. If I ever said "S*&T" and someone said to me, "I think you mean 'sugar'" I would probably respond, "Uh, no, I said 's*&t' and I meant it!". If you don't like it, be direct. If someone said to me, "Such language bothers me." or "Could you please tone it down for me?" I would in a heartbeat. But passive agressive crap doesn't do it for me. If I suspect something is offensive to someone, like if someone has a bunch of religious paraphenalia on their locker, I am not going to use the g-word around them. I'm more reserved around patients and do not swear, or verbalize ANYTHING controversial (religion, politics, sports, etc) with them or their families. At the nurses station in the middle of the noc, it may be a different matter. I grew up in a house where words like darn, jeez, dang, golly, crap, and shoot were considered foul and off limits. As foul as the f-bomb or the g-word, since, for example, the word "jeez" derives from the word Jesus and is therefore taking the name of Jesus in vain. So whenever someone says that swearing is offensive and is not to be tolerated, I wonder which words they mean? Just the f-bomb? Or the christian sensitivity of the g-word? Or my mother's definitions? Any "softer" words like fudge, sugar, etc, since their INTENT is to swear, to someone with my mother's sensibilities, it's the same as if you just went ahead and uttered f(*& or s*&t.

I appreciate your thoughtfulness, Timothy. That's cool. You're a good example for us all.

Our protocol is that if they are on tele, they must have IV access. So yes, we put a saline lock in everyone on tele who comes in.

Has anyone actually ever stood up to him? My experience with people like this is that if you DO stand up to them, calmly, maturely, and forcefully, rarely is there ever an issue again. I'd stand up to the guy and tell him in no uncertain terms that I WILL NOT be treated in any manner other that a professional one; if legal action is warrented (if he threw a chart at me, for example) I would take it. I would document, document, document; then I'd contact the Board of Healing Arts. If that didn't get any response, I'd probably give copies of all my notes to my local newspaper. But I can be a b**** like that.

Okay, I can gripe about our computer program at work all I want, but one thing it does well is that during an admission history, for EVERY admit, you MUST fill out the DPOA information. If they have some sort of DPOA paperwork, you must either click that it is available on the chart, or unavailable, and then why (copy at home, etc). If you click unavailable, then you must fill in what the stated intent is, and who stated this intent (the pt, or the family). Each person who has a DPOA, whether it is available or not, receives a visit from the floor social worker, who checks out the paperwork if they can, and confirms that everything is in order with the pt. Each person who has a DPOA is asked if they want to make changes. Each person who DOESN"T have some sort of living will or DPOA is asked if they want more info--if they say yse, the floor social worker will visit them that day and initiate it. All this info is carried over to their subsequent visits. Why oh why do we not push for this at doctor's offices? I work prn at one, and I dont' understand why we don't ask EVERY patient to fill out DPOA paper work and bring it in; similar to their insurance card and their updated health history and contact info. I think we are really dropping the ball here; every annual exam should include the stated intent and any updated copy; every annual exam we should encourage patients who don't have one to get one in to us ASAP and we should emphasize the importance of living wills and DPOAs. As to just having "understandings", as many have pointed out, that just doesn't work. Stress, fear, saddness, and guilt can bring out the best, and the worst, in people, and you never know how someone is going to react in the awful situation of potentially losing a loved one.

Hmm, this begs the question, what is considered a complete, routine shift assessment in your facility? In mine you listen to heart, lungs and bowel sounds, palpate pedal pulses and homan's, assess for any edema, and assess cap refil. Pain, cough, nausea, vomitting, constipation, or diarrhea. Urine and BM quality and quantity, mobility, gait, and anything out of the ordinary -- skin breakdown, wounds, equipment and drains; of course anything that pretains to the care plan. I'm sure I'm missing something off the top of my head, but that's it in a nutshell. It takes about two minutes (or longer, depending upon how talkative and complex the pt is, and whether you've had them the shift before or not). Things I *don't* do on every single routine assessment: neuro check palpate for neck, breast, abdominal or genital masses or for bladder distention complete ROM of all major joints palpate for CVA tenderness check bums (or any other body part) for skin breakdown or lesions check ears, eyes, nose, and throat check reflexes check cranial nerves What about you all?

It seems to me then that, by having unrealistic expectations and protocols, your facility is setting itself up for more legal issues. How (and why) in the world do they expect you to perform complete head to toe skin assessments on every person, every shift? That is simply rediculous. By the admitting physician, I mean the pt's physician who is in charge of their care during the hospitalization, not the ER physician. They should do a complete assessment of every patient, and document it on their H&P. If I were a nurse at your facility, I wouldn't do complete skin checks on every patient, unless all of them were at risk. That is just stupid. I can't believe your nurse manager thinks this is a good idea, or believes that any of her nurses are following this. Instead they are just probably documenting it as "wnl" or "pt refuses" or whatever; and so the next time someone sues over it, they are going to get in even bigger trouble when it is shown that the hospital's documentation is unreliable. Then NONE of it will be believed in a court of law. What is your risk management thinking?!?! And grow some thicker skin. I wasn't saying you were a perv. I was saying that I would be disturbed by a nurse who wanted to do a complete skin assessment on me, including my butt, if it wasn't warrented. I was trying to give you the pt's perspective. I've been hospitalized numerous times, and NEVER did anyone do a skin assessment of my butt, and I sure wouldn't have let them, either. There's little enough dignity and privacy in the hospital; I don't feel I should have to strip naked every shift change. I wonder how many pt's complain about it? Though, if none of the other nurses are doing it, then they probably aren't getting a good idea of how the pts feel about it.

Not in my experience. I get a shift differential that is more than the aides but less than the RNs. Some places calculate the shift differential based on a percentage of the base pay for that position.

I find it frustrating that LPNs and RNs cannot be hired in our district (only BSNs, for the reasons given in support of that practice), but that since the district doesn't have enough money to staff all the schools, they hire unlicensed "health aides." Great. If an LPN has to be supervised, as I well understand they do, then why not have a BSN in charge of the entire program and available for BSN type duties, with full time LPN on site at the schools? At least we'd have someone with some experience and education in there! Four times this year I have had issues with the school "health aide". Once she got the medications mixed up and tried to give my daughter the wrong inhaler. My daughter kept insisting that it wasn't the right one (it was ANOTHER CHILD'S) and was refusing. The aide didn't give up until my dd started crying, and the secretary came in and then called me to clarify. Another time I just happened to be in the office when one of my oldest dd's friends came in for her inhaler. She was in a full-blown asthma attack, but apparently, since she had come in just an hour before to use her albuterol, the school health aide just told her to go back to class, and come in in an hour (it was ordered q2hour prn). She had audible wheezes, and her lips and nails were dusky. I was like, "Whoa, this girl is not moving much air, honey!" and had her sit in the office while I gave her her inhaler and called her mom to her come and get her. The girl went directly to the peds office, who had her then admitted directly to the hospital. Her O2 sat was in the mid 80s. The health aide was totally clueless! She would have sent her back to class in that condition! Two other times she has inappropriately assessed my children. Once, when my daughter fell from the top of the slide and hit something, she applied HEAT to her back. Lovely. Good think nothing was ruptured. How about some ICE? And even though she hit her head, no neuro assessment was done. And she didn't call me; I heard about it from my daugher after school. Another time my youngest had a fever, but the health aide gave her some water to drink (she, the health aide, told me this herself when I questioned her about it) while she went to find the thermometer--of course her temp was normal when she took it two minutes later, despite it in reality being over 103. Each time something like this has happened, I have complained to the school nurse and the principal. Apparently to no avail. I'm thinking of applying for the health aide position next year. I wonder if they would let me? At least my kids would be safe!!!

So you check every patient's bum with physical assessments? I don't know, I guess I just think that is what my critical thinking skills are for--if there is ANY reason, then yes of course I will check. But we could spend all day discussing the what ifs. I don't do digital rectal exams on all my patients, even though they COULD be constipated, or have a hemrrhoid or enlarged prostate. I COULD do a breast exam on every patient who doesn't have a PCP, to ensure that they get one good breast exam in. I COULD do a complete ENT exam. I'm sure everyone once in a while I would catch something that might be initially missed. But I don't do these things routinely; rather, I use my critical thinking and my assessment skills to determine which patient would benefit from a more extensive, in depth assessment. We COULD just do routine chest xrays and full body scans on everyone who walks in; we'd probably catch some things that might have been missed. But we don't, because it is a waste of time and money. You see what I mean? I feel like checking *everyone's* bum is violating and simply unnecessary, and is more likely to cause problems (harassment lawsuit, patient's emotional discomfort and distrust of nursing staff) than be helpful. Do YOU want your bum checked every 12 hours? Even if you are completely mobile, have no other health issues, have no perineal pain and are in for, say, pnuemonia?

You know, whenever I have a grumpy patient, or one who has been in the hospital a while (our pt turn over time is something like 1.6 days), I always offer a back rub. Nothing melts away dissatisfaction with the nursing staff, schedules, hospital, or their general situation like a 3 minute back rub. The little old ladies just about die of happiness, the grumpy old men suddenly become charming and polite, and the patient threatening a lawsuit begins to rave about what a great nurse you are. Also, so much of our touch is with gloves; I think people don't get enough warm, direct physical contact. Unless there is some sort of contraindication of direct touch, I always perform the backrub without gloves. AND I warm up the lotion. You'd think I was performing a miracle when I do this. Just my little tip of the day....

LPNs are very much in demand in my area, and they are hired in the hospital here, though not in the numbers that Rns and aides are. It helps everyone if you are IV certified (if that is allowable in your state). I have never been disrespected as a nurse, not that I know of. I feel like my co-workers respect my skills and experience. I have several years of experience, and in a wide range of areas, so maybe that helps. I am very confident in my skills, but also very aware of my professional and skill boundaries, and am not afraid to consult my covering RN or to approach him/her with something that I need help with. I'm sure that helps in terms of my relationship with my fellow nurses, particularly with my covering RNs. We have white boards in all the rooms where we write the names of the patient's caregivers for that shift, to help them keep us all straight. I always write: "Nurses: Lori, LPN; Soandso, RN." when I am introducing myself. I always note to them that I am their primary nurse, but that Soandso and I are working on a team, so they may see him/her occasionally. If they ask for further details, I give them; but most people don't ask. I've never had a patient refuse me as their nurse because of my LPN status. Actually, I think patients prefer me, because I always have a TPC; I never work with an aide. So where as the RN typically has 6-8 patients, with an aide doing most of the hands-on care, I usually have 3-4, and do EVERYTHING for my patients. They get to see their nurse more. It's just the way our hospital has things set up; but I like it like that! That is one reason why I am currently still an LPN--the pay is fine, and the position I am in is unique and to my liking, in terms of how my patient care is set up.

Same here. However, most of our orders for our frequently performed procedures are now standardized; there is a place where the physician has to specify either "NPO including meds", "NPO except for meds", or "other". I tell you what, I am loving these standardized order sheets. It really makes the lazy/slacker physicians sit up and take care of their freaking patients. It has greatly reduced our phone calls for clarification.

I work on an acute medical floor. I NEVER check the skin on someone's bum unless they are at risk for skin breakdown--incontinent, immobile, dependent edema, loss of sensation, or history of previous decub all comes to mind. I would NEVER check the skin of someone who is a 30 year old walkie talkie with no risk factors. I think you *are* being a bit overzealous, and are also opening yourself up to a lawsuit. I mean, using your reasoning you could also insist upon performing a perineal and lady partsl exam, but it would be inappropriate. If I, as a healthy 34 year old, were in the hospital with some acute illness, I would be very suspicious of a nurse who insisted upon visualizing and touching my buttocks and perineum (unless I were in with a related issue). I would definately refuse, and probably complain to the hospital about it. Perhaps you should ask for some clarification on what exactly is considered the standard of care of your hospital in regards to a complete assessment. By performing more than a standard assessment, you are actually putting yourself at risk. Plus, the admitting physician should perform a complete exam, and you can access that in the H&P. If there are no risk factors, and the H&P indicates that the skin is intact (or exam was deferred), then there is no reason for you to perform one. Hope that helps. I'm glad you are so dedicated to your patients; but I agree with your coworkers that you need to tone it down a bit.