Roman1

I see this one documented all the time "floor matt down and next to bed". It's floor mat. I always want to say, so you put Matt on the floor!

Based upon your previous posts, you are in a monitoring program and most likely have stipulations on your license. So I do not believe it is discrimination. I hope everything is still going well for, with your recovery.

Unfortunately I have experienced this also with some families. The family/ responsible party want the resident up for all activities. How I have dealt with it is by telling the responsible party that the resident has rights. If the resident refuses to go to an activity and wants to nap that is their right. Now if the resident just wants to sleep all day, that is different story. The person can not be allowed to sleep all day. Can you or your DON speak with the responsible party and reach some kind understanding, that is in the best interest of the resident? I see too many families that do not consider what is best for their loved one. A lot of the time it is because, they are in denial of the change in mental or health status. This is were education by nursing is needed. Get the social worker involved as well. I have a situation right now with a skilled resident who had mitral and aortic valve replacement. The family does not want her to have any thing for pain but Tylenol, and that is not giving her the relief she needs. What I really want to say to the family is how about you have your sternum cut open and see how you feel! But I would never do that. So the MD and DON are going to speak to the family member. Hope the situation gets better for you.

Thank you for your input. I'll clarify some things that your responses asked. I was part of the RCA which is how I got involved in this, and I have previous RCA experience. Basically everything was broken down ( how often worked, staffing, environment of the hall the nurse worked, interruptions, etc) pharmacy was involved due to narcotics. Long story short. Unfortunately it could not point to a system failure. Hence why I was perplexed. This nurse though only PRN status, picks up 1-2x's a week. Works the same hall/ same resident's. It's a LTC hall with only 12 resident's. It's basically a straight med pass hall, no trachs, tube feeds, IVs. Treatments very light. Had 1 1/2 CNAs. The errors were on 3 different resident's I do not work with this nurse. I am on the skilled part. I am by no means starting a "lynch mob" mentality against her. I do not speak of it with other nurses. Yes I am a newer nurse, but I would not act unprofessional towards her. I'm sorry if my original post came off the wrong way. I was trying to be discreet but give details so people could get a picture of it. Yes stating she could have been impaired or truly unsafe was a poor choice of words. I did learn a lot from this experience. And I'm glad my DON asked me to be apart of the RCA. I did find out this nurse was let go the other day, and that there were Previous issues prior to this incident. I wish her no ill will and that whatever is going on in her life she gets the help she needs.

I know medication errors happen. We are human. As a newer nurse I am not naive enough to believe it will never happen to me. With that said I am concerned and upset about a PRN nurse that made 3 med errors in one shift. Let me know if I am being wrong in thinking like this. Without giving to many specifics, this nurse gave a anti hypertensive with specific parameters ordered. The nurse did not check BP/Apical pulse, nor did she have an aid do it prior to giving the med. The resident is known, and it is very well documented that this person often falls below the parameters ordered for this drug. So it is often held. The other 2 were with giving a wrong narcotic, and then a wrong dose of a narcotic. These errors can not even be blamed on a system error. All the orders in the MAR are written correctly, and clearly, and the name of the resident with the correct script are written correctly on the drug card. These were not new orders either. The narcotics in the lock box are even separated by resident's name and time. All of these were written up by the charge nurse as incident reports. (They were all caught at change of shift report/ narc count). There was no adverse effects to the residents from these errors To me this is a red flag that this nurse was either impaired, or just truly unsafe. The DON still has her scheduled for PRN shifts. I don't know, I'm just perplexed by the situation.

Red Kryptonite, (sorry can't quote from my phone) I agree with you. I wish the facility I worked for could have a designated hospice area, staffed with a hospice nurse and CNA. We at times can have quite a few resident's on hospice care. When I did my clinicals I was able to go to a couple hospice facilities. They were peaceful, comforting atmospheres. Families had the privacy they needed with their loved one, and were able stay overnight with them. It's so hard to try and provide that atmosphere on a busy LTC floor.

When a resident enters into hospice care at the facility I work for, all charting/ I&O's/ notes etc are paper charted in a seperate hospice chart. Basically do not chart in the emr any more. Not sure why it's done this way, but that's what this facility does. In report the nurse I was referring to was also given the information that the resident had received a suppository and it was effective. I'm not bashing this other nurse, she is very nice but as one resident said to me one time "she's not the brightest crayon in the box". She knows where hospice resident's charting is at, and not to go by the emr. (She is not new to the facility either). This particular resident was very dear to everyone. The hospice nurse believed she was dealing with a lot of internal struggles and this was a big reason for her agitation. So there was no need for a suppository to be given. I have learned and am still learning a lot about hospice nursing. I admire hospice nurses it is a tuff area of nursing.

It is a little over $18/ hour during orientation. Then $24/hr. Night shift differential is $25/hr. Hope this helps!

Heron I understand what you are saying, yes constipation can cause pain and agitation. I should of added that the hospice nurse had been out that morning and had given a suppository and it was very effective. Myself and the other nurse were told this in report. When I called the hospice nurse that afternoon the first thing she said was well the agitation is not from constipation, so that's why the meds were increased. Hospice doesn't chart in the emr, so that is why the resident came up on no BM alerts. That was why, I was like really, and told her to just leave the resident alone.

I can not like your post enough! I still work PRN at a skilled/LTC facility and deal with hospice resident's quite a bit. Recently had a resident actively dying with a lot of agitation, even on good doses of Morphine and Ativan. So I called hospice and they increased the meds. Finally was able to get the agitation down and make the resident comfortable. Along comes this other nurse and she tells me I have to give the resident a suppository, she is on the alert list for no BM. I am like really! I don't care if she is on a no BM alert, she is dying leave her alone. It's like use some common sense. Very frustrating lol!

I work PRN at a LTC and I know for new admits the discharge med list including prescriptions for any narcs are faxed or called into the pharmacy prior to the patient arriving. That way we are able to pull starters from the narc box along with any other med that has to be given prior to their meds arriving. Ask your DON or who ever deals with this if they can get the meds list and any narc scripts faxed prior to arrival. LTC can be very frustrating at times. It's hard not having the resources 24/7 that I have at my full time job at the hospital. Best of luck!

I agree with all the previous posters. That is a ridiculous question. Your instructor needs to give you a more detailed scenario. I have a 4 yr old and a 15 month old. Yesterday morning my 15 month old who is a new walker did a header onto the hardwood floor and now has a bruise on his forehead (my poor little guy). As the previous posters have stated kids bruise easily from playing and that question as stated is dangerous.

http://fox8.com/2014/10/15/ohio-board-of-health-ebola-patient-had-been-visiting-family-in-akron-area/ Scary

Duskyjewel is absolutely correct with her post. Make sure everyone in your group does an evaluation. The nurses on your floor have noticed as well. The last thing your school wants besides a bad reputation at the hospital, is to lose a clinical site. Clinical sites are hard to come by.

What is bothering me about your clinical situation, is that it takes your instructor 30-45 min to get you patient's. To me that is unacceptable. Your instructor should be there before you all arrive. The instructor should already have you assigned to a patient. The instructor should have gotten the ok from the patient already, for a student to care for them. This should all be worked out with the charge nurse beforehand. As other posters have said, practice your assessment skills, look over charts and also go over and look up the patient's medications. Start understanding the why, what and how of drugs being prescribed in the clinical setting. The medications you encounter now will be seen throughout your clinicals, so get to know your meds! I really hope clinical does improve for you and wish you the best.