Kerber

I am doing 8 th grade hearing screening today. I sent schoolwork email that I am doing this today and keep that in mind before sending students. I keep getting i Interrupted With stomach aches or my finger hurts!! How do you deal with that? I sent another email only send students if it’s an emergency and not for minor complaints and I think I upset some staff members by doing that.

I am struggling about 504 evaluation. Student with ADHD. No problems from teachers but has many office referrals. This is due to peer relationships this student is always getting into altercations with girl drama. Last year parent requested plan we denied saying she wasn’t substantially limited with no classroom problems. This year parent requested again. End of last year she got expelled for planning a fight. What would you do?

How do you guys do your vision and hearing for middle school? This is my first year I was going do 1 and 3 hour core classes and knock them out but I got a lot teachers upset and got a call that I needed to talk to 7 th grade lead teacher so she came to my office and said in past they did science classes problem was I only had spot screener for 2 days these sciences classes were 5,6.8,9 hours I had a lot of wasted time in between I would go back to my office to wait and get stuck with health room traffic it was horrible!! I have hearing to do and I would like practical advice!

I did my vision today with 7th graders I sent email last week twice and again this morning but it didn't work every time I went to my office to grab something or use bathroom kids were coming in! These kids were coming in with headaches stomachache nothing serious. I was trying to do hearing screening in my office because it's quiet and same thing was happening. Finally I said " are you bleeding do you have anything broken"? I sent them out! I feel bad but jeez why do they send down all these minor problems?? And when I am screening??

I am at middle school I noticed like today there was couple sub teachers in 1 and 2 hour lots of kids were coming in. This is my first year how do you stop all these stomachaces headaches when they don't look distressed or have any other sx ? I had one girl come by saying she has sore legs from running night before. What am I suppose to do with that?? Or kids say they don't eat breakfast and their stomach hurts. I am at a title 1 school where 90% are free lunch.

I am in Kansas I have to see if they have state wide data base

I am new! I came from inpatient psych nursing last 16 years. Now I am at middle school over 760 kids. I am in Wichita Kansas. The district has been very helpfully with title 1 support nurse helping me. These immunizations are awful!!

I don't mind being called nurse that's what I am í ½í±

I subbed for our distinct last year but I am so lost being full time nurse I am at middle school 6-8 grade. I have all week and 3 days next week in my health room. I got 2 Med orders and 100 release of information I don't know what start doing? I ran reports today on kids with health problems. What advice would you have ?

Kansas

I am started new at middle school I have bear office I want make bulletin board need ideas how to indtroduce my self on the board as their new nurse?

I have this young patient 56 yr been on methadone for years he states it's for pain got into accident years ago had chronic leg feet pain. According to his h&p from methadone clinic he's was iv Herion user and bipolar he denies this up and down!! He's very poor limited transportation to methadone clinic to pick up meds. He wants morphine for pain and states he quit methadone doctor however refuses this states he never be able to come off methadone. I suspect he is selling his methadone when I visit him he has all kinds traffic coming in and out. I used to be psych nurse and can pick out a meth head from mile away! His DX is COPD and he does have trouble breathing. He's using Ativan now for SOB but he's always calling for more when it's not time to reorder. I told him today the doctor won't rx morphine or methadone he asked for another hospice agency number. What more can I do ?

I have 70 yr old hospice patient 6'7 250lbs primary Dx CHF and end stage alzhemiers bi lat pitting edema feet. 02 sats drop often. Very strong man! His confusion is worse takes clothes off won't stay in chair or bed but unsteady. Lives at home with wife. We have been using 1-2 mg Ativan topical and liquid because he spits everything out alone with 5-10 mg morphine for pain and SOA. It hardly touches him. This family tries to sedate him durning day because they are exhausted. He won't keep 02 on either. He's at respite now for 5 days to give family break. He won't eat drink the other day he tried to take off out house and fell down the stairs. Any suggestions on how to deal with this?

I started out med surg and hated it!! Went into psych was doing that for last 15 yrs and got burnt out on it. Looking back I am glad I tried other things you either love it or hate it

I did both inpatient and intake at our ER. I thought intake was very busy some days we were 10-15 patients backed up in ER you see them at the tip of crisis so it can be very crazy with drunks and drug users. I don't think intake was easy at all! You always had to have your guard up so you wouldn't get hurt!!

I did psych for 15 yrs started on 3-11 shift I thought it was busier shift more admissions come in evening and patients seem to get more agitated in evening time. I loved 3-11 shift though there no management around and all the MD's were done rounding.

I have 2 scales myself maybe I throw one in my car and take it with me to visits. I have 3 certs to do all first 90 days. Never did one before. I was looking at paperwork and I saw mini mental do you use that? I was told to write narrative note that shows decline in past 90 days. My dementia lady haven't really decline she is the same still aggressive can't commumucate word salad when talks hits and spits durning shower. I thought I would weight her she's so skinny

How to do get a weight on a patient at home with no scale? And on dementia patient I need to do 90 day recert what do you guys document? What forms ?

Thanks!!!

6 week orientation wow I got 1 day and I couldn't keep any reading materials I try to take Manuel home to read and was told to bring it back!! Thanks for the link! I wish I had more information

The new DON is a OB RN oh boy I didn't realize this. I bet I have been doing this all wrong. I had little to no orientation on hospice 1 day was read this manual and 4 days following another nurse who is a home health nurse on visits. That was it! My other hospice nurse they hired has experience in inpatient hospice so I ask her too. We both got our butts chewed when we did continuos care over a weekend because we didn't fill papers out right but no one showed us! I think I have a lot to learn. Is there a good web site that covers hospice eligibility with Medicare?

Oh boy! The owner told me and these are her words pick Dx that will kill them the fastest. Then write a order and fax it to Doctor. She just hired a DON I think I will talk to her tomorrow about this. I had a feeling something wasn't right. No guidelines I was just told to look at symtoms and decide what would end life the fastest. Such as if a patient had COPD and CHF but the COPD was worse we would use that one.

THe way I was shown was the owner said to pick a DX that will end life the soonest and then write a order - open to hospice with terminal DX of CHF. Then that order gets faxed to the medical director to sign or if they have PCP it goes to them. Is this how others do it?

I talked with doctor at our IDT meeting we are changing it to Alzheimer's. Doc wanted cbc and cmp but I couldn't get it she was hitting and spitting. Honestly I don't think she has Alzheimer's. Now I just signed a patient Friday with late stage Alzheimer's and you can tell the difference. I didn't use Alzheimer's has primary though he also has CHF I used that instead although he didn't have a lot symtopms some edema in lower legs feet and he was on bunch heart meds. Was that a good decision?

I feel I just need to vent. For the most part I get along with owner she is very knowledgable but at times I feel she puts money before patients. I also feel she expects more from me. She has gave me great praise already that I am very calm person and I can calm anxious family members down probably due to my previous psych experience! I am also more faster at admissions then the other RN. So she gives me more patients. Right now I have 5 patients and other RN had 2. Your right I need to have a talk with her and I will do that. I am greatful to find hospice I really enjoy it!! The best part is sitting and visiting with my patients. I actually feel like I am making a difference. In psych it was different they were either court ordered to involuntary ordered to inpatient and they didn't want help. I can't tell you how any times I was cussed at called every name in book, charged at, spit on or had someone try to hit me!!