Nickle

Thank you so much, Micco! Best wishes to you and yours

How do I submit my signatures on VA applications for forms 10-2850a and 306? I do not want my application rejected on a technicality. Adobe Acrobat Reader has the option to submit a digital signature, but this function is disabled on the 10-2850a, and not even an option on the 306. Do I upload the documents unsigned and then submit a signed copy somewhere later on in the application process, or do I sign a hard copy and scan and upload that? Thanks all!

It's from her post above: 1. get specific 2. check regs 3. read policy 4. determine audience 5. set time and place 6. evaluate effectiveness Good luck!

My best guess about what you're asking is that if you want to develop an inservice, you aren't sure how to get it approved - is that right? As in, do you need to ask someone in advance, develop it, get approval? If that's what you mean, I don't have to go through that process. I work for a large national company that has an extensive library of presentations developed by the corporate office. However, we also have a lot of latitude at the facility level, and within my facility, I'm given a lot of autonomy with the whole process. So, I'm usually developing things according to the learning needs of the facility at that time. Classicdame's chronolgy is a great reference for the process, and my additional focus is specifying what can be practically applied. For example, when I do a falls prevention inservice, I do talk about etiology and risk factors, but my area of concentration is, "What are the things that you actually can do to reduce falls? What does falls prevention really mean in my job? What are steps I can take to improve this at work?" Hope this helps - Nickle

Hi, I'm not sure exactly what you're asking. Can you elaborate?

The large national company I work for also uses a paid employment verification system, but this is for verifying wages when applying for loans and housing. It varies from state to state as to what an employer can or will say in a reference check. This isn't an attempt by your current employer to keep you from taking a new job. They just have a contract with this third party agency. Could you give the new potential employer the name and phone number of a supervisor who can provide a direct reference for you?

Jessica, I feel the same way - now that I'm in hospice, I finally feel like I'm a real nurse. It's a good fit for my personality - it's where I am supposed to be. Isn't this a great feeling?

Thanks, doodlemom. I've been reading a lot of old posts over the past few months and that has ben really helpful. Any other advice?

Hi all, I'm starting orientation tomorrow on my new position as a case manager. Do you veterans have any advice for a newbie - things you wish you'd known, learned more about from the beginning, mistakes you wish you hadn't made, things you had to learn the hard way, etc? I've joined HPNA, and after payday I'll be ordering the HPNA generalist nursing text and study guide to use as a primer on the guts of hospice nursing. (No, I won't sit for the exam until I have the recommended 1-2 years experience.) I have also read Final Gifts. Any other suggestions for must-reads? Reference texts? Other educational materials, for families or myself? Suggestions for preventing burnout? I am so excited, but nervous too. Thanks in advance!

Jersey RN, are you using the 1990 book called Notes on Symptom Control in Hospice and Palliative Care, by Peter Kaye? Is this the newest edition? Thanks-

I accepted a job with hospice today! I'm going in for IDG and new hire paperwork tomorrow - yay! Congrats on your new job. I bought Final Gifts several weeks ago in preparation for the career change. (TCU/Float LPN in hospital for 2 yrs, brand new RN.) It was really helpful for me to learn what to anticipate so that I can better educate families about what a patient may need before they can die. As another poster said, it's not so much a reference as a great primer for beginners. And you can recommend it to families, too.

You have to have seen the movie (Office Space) to get the quote. Highly recommended, it's one of my faves. If you've ever worked an office job outside of nursing, you'll probably relate. We watch it over and over and over again . . .

Transforming Nurses' Stress and Anger: Steps Toward Healing 2nd ed By Sandra P Thomas 2004, Springer Publishing

At our facility, the infection control department uses both methods (tracking hand rub usage and having staffers watch for complicance.) But to clarify the "spy" reference - it's not as bad as it sounds. When you are asked to do hand hygiene surveys, you are given very specific instructions to watch your chosen staffer for a predetermined length of time, and to track the opportunities for hygiene versus the number of times the hygiene was actually used. That's where the percentage comes from. The thing that leads to inaccuracies is when the watcher sits out at the desk and therefore can't see me wash my hands in the patient's room, as I often do. It's not a perfect system.

OP, I am still confused about why the doc is threatening to sue the agency. On what grounds? Can you please clarify for me? Or was it the patient who threatened to sue? Not sure I'm getting an accurate picture of what went on here. Thanks-

OP, I think you did the right thing, for all the same reasons given by the other poster's who have validated your actions. This thread has given me a lot to think about in terms of liability; I will no longer be taking family member's BPs "out of curiosity." Instead, I'll politely redirect them to the outpatient pharmacy downstairs, which has one of those automatic BP self-check machines. I have one question for everyone: would it have been appropriate to call 911 anyways? I suspect the family would have been less likely to refuse transport if the EMTs/paramedics were right there. Then the issue of liability is out of the staff nurse's hands; if they refuse again, the ambulance team can document that.

i can't eat m&m's anymore since they changed the colors. i always used to save the greens for last because they reminded me of kermit the frog. the kitchen sink is only used for food-related washing. if you come in from outside and need to wash up, do it in the bathroom, not the kitchen sink. (wish we had a sink in the laundry room!) no food items touching each other on the plate, items eaten one at a time since it's not the other foods' turn yet! though i'm not so bad that i won't eat touching food, i just reseparate with my fork. somehow beet juice doesn't bother me! although maybe it should. . . i'm obsessed with eating every last grain of rice on my plate, including partial/broken grains. my husband pointed this out to me. it feels like a game to get 'em all! no rice grains or other debris allowed to remain in my soy sauce dipping container at the sushi bar. dishes must be washed in order of cleanest to dirtiest (can't wait till we have a dishwasher!) this just seems practical - why goop up glassware with chunks from the pots and pans? toilet lid must be closed after each use. please drop the lid before flushing to prevent germs from going airborne. :uhoh21: at work i do the same multiple handwashing routine regarding bathroom use - wash out at the desk before going in, wash in the bathroom, and wash again out at the desk. same for getting food from the cafeteria - wash before going, wash again upon return to the breakroom with my food (before eating.) and wash after eating in the breakroom, and again out at the desk. this is on a day when i actually get a break, and when the cafeteria is actually open! can't stand to share a drinking glass. though kissing and sharing chap stick is fine! can't drink from a water glass that's been standing out too long. like the little girl from the alien movie "signs." yes, i have also disinfected my face with alcohol wipes when contaminated by a patient! shudder! i clean the mouse and keyboard on school computers with alcohol wipes before using . . . check out this fascinating article on ocd and various other mental illnesses: http://www.cdc.gov/ncidod/eid/vol8no9/02-0204.htm it proposes an organic infectious basis for many psych disorders. wow!

Well, my LPN to RN program has definitely not rehashed everything from the LPN year. We have been presented with completely new material. I have learned so much that would have helped me in my practice earlier, and it's expanded my critical thinking abilities tremendously. I was always dissatisfied that I wasn't seeing the big picture as an LPN, and I wanted to be a better nurse. The one year LPN program just wasn't enough for me. I work with some LPNs who are every bit as sharp as the RNs from years of experience - but for me, I definitely wanted additional education on top of experience to get me there.

Please feel free to PM if you are uncomfortable discussing this openly.

Okay, what kind of comments are you anticipating? I think we can answer your questions better if you give us some more info. Did your instructor say something or have a strange expression when she couldn't get your BP? What happened when she couldn't get it? Your post made it sound like you do have an eating disorder and are in treatment. Is that right? (If I have misunderstood and that is not the case, I do apologize.) If you are in treatment, I would look to your treatment team for advice on how to handle these types of questions. Self-disclosure is tricky, between classmates, instructors, nursing staff, coworkers and patients. I can't really advise you as to the best way for you to respond, because there isn't one best answer for every situation. People may ask out of concern - they may be snoopy/nosy/gossipy - or they may be naive. Their interest may be benign, caring or otherwise. You may not want to disclose to certain people. Or you may find some degree of self-disclosure to be therapeutic. One student I went to college with (before nursing school) is now a medical student coming to see patients at the hospital where I work. She has an eating disorder, and looks unwell. I have never said anything to her, nor said anything to anyone else about her. I wish I knew how to handle the situation better. I guess what I'm wondering is, in a perfect world, how do you wish people would respond to you? Do you wish to start to have a dialogue with certain trusted people about your illness? Or do you wish to only discuss things with your treatment team and family/friends? As for your question about exacerbation/relapsing due to a stressful environment, nursing can be very stressful. Your success really depends on how you deal with stress. Nurses in recovery can definitely be successful with a good support system in place. The levels of stress vary by hospital unit, types of patients, facility size, and I think most importantly by your coworkers. At my facility, the medical unit is commonly felt to be the most challenging area - yet I love going there since the staff is so great and supportive of one another. Going to the surgical unit is another story - it's a very tense and non-helpful atmosphere. It just depends on what your triggers are. There are many other options in nursing besides hospital - there's hospice, home health, government, private duty, etc. One environment may be wrong for you, while another could be a good fit. I think it is smart for you to post here in order to prepare yourself for any possible questions. It's good for you to try to anticipate some of these situations. I wish you all the best in your treatment and recovery.:redbeathe Hopefully some nurses who have dealt with these problems can lend some insight?

Yep, no problem!

Getting good at BP's just takes a lot of practice. It's hard to sort out all the artifact noises (tubes bumping, etc.) from the actual Korotkoff sounds. One way that helps sometimes is to watch for the needle flutter - it usually flutters with the returning pulse before you can actually hear the sounds, so you can generally predict when the next actual Korotkoff sound might come . . . That said, DON'T go by the flutter! It's wrong! It just helps you gauge when the actual pressure is about to become audible (though I've also seen it take as many as 20 or 30 mmHg before the flutter converts to a true tone - it's just a guideline.) Also, I have weird upwards-slanting ear canals, so it helps me to use my non-dominant hand to hold some tension on the metal auricles (the metal arms of the stetho that end in the soft ear tips) although this can increase artifact noise, you have to be careful. Don't rely on the cheap clinic equipment - buy the best stetho you can afford. And change out the hard earpieces to the soft ones, they form a better seal in your ear canal.

Our Foley kits come packaged with Betadine; I've never heard of NS being used. How do the infection rates compare? Although the urethra is sterile, the external genitalia are not - that's why we disinfect. My "lucky charm" is to always have an assistant to hold the labia apart. The way they show you in school (to hold the labia apart with your non-dominant hand and place the cath with the other) often fails because those parts are slippery and you don't want to lose your grasp with your now unsterile hand, since you'll need to reswipe with Betadine again. And you'll have used all the Betadine swabs/cotton balls in your kit already, so you'll have to get a new kit and start over. If you have an assistant, this prevents some of those problems. It's much easier to see the meatus this way. And it's faster. The other trick with Foleys - if you screw up and need a new kit, just GO GET IT. (We're not allowed to bring a second into the room with us due to infection control reasons.) I have seen too many people use sloppy technique or just use the same cath when they place it in the lady parts, and the patient will end up with a UTI.

Right - the tricyclics pose a risk of causing arrhythmias, that's why pt's should have a baseline EKG before starting therapy. Does this happen? No . . . Add in an SSRI and you're in deep trouble.

It really bothers me when staff wear their name badges on the swivel lanyards - and it's always flipped around backwards, so I have NO idea who they are. Also patients/visitors are in the same boat of wondering just who these people are.