patmostoi

can't see the forest for the trees. ok first in michigan as far as i know. if in individual pkgs the meds may be set up. the pkg must stay sealed until time of use. the liquids ,stock meds, and narcs may not be preset(or to some prepoured) it is not illegal to pull the meds and stuff them(still in their pkgs) in a dixie cup and keep it in the pts med drawer until time of use. this prevents med errors.however the problem people have is presigning. the triple check insists we triple check med pkgs just prior to administering. i cut time by sticking my sealed meds in a dixie cup at the beggining of the shift. right before i give it i triple check them like any other time sign them out, add the stock meds, narcs, liquids that may not be prepored. it is a time saver and it is legal and safe for the pts. prepouring may be easy and save time and"everyone does it"(not me saying this) but how time consuming is it for you if you have to code a pt because he received something he was allergic to , then you have the supeonas and being unable to practice nursing for at least 6 mo during an inquiry. stay with what you were taught in school or learned at recent inservices. it will save you your life and license

i have worked in alot of different areas. if the pt has a cath and no loose stools.only use a draw sheet. apply a&d. if loose or alot of inconts use a&d or epc cream. and a underpad.if a person is incont of urine when up use wicking briefs that gel and nuetralize urine. also a layer of a smith and nephew product called clove protective ung is excellent we affectionately call it blue goo. it nuetralizes urine to protect the skin and releases a clove smell. this is one of the most effective preventative measures i've seen. but remember it is a chemical barriar vs a physical barriar like a & d ung.less is more. as a general guideline only wicking briefs when up and a cloth pad when down(one and only one for several reasons. staff change 1 pad quicker to prevent the whole bed from being changed 2- the less between the pts and the air mattress the better. the more layers the less effective the mattress. 3 less layers,less wrinkles therby decreasing the changes to circulation and decreasing chance of skin breakdown. several rules to briefs.never use the bottom tabs on a nonambulatory pt. it leads to blisters since we all know when we lay down things fir better-and when we sit up they are tight(don't believe me put on tight jeans) on ambulatory pt it is preferable not to use briefs, but liners if possible. also the key to preventing skin breakdown and providing for comfort no matter what item you choose is to change the item frequently AND clean the pt. a changed brief or pad does no good if the chemical from urine or feces remains-even if unseen on the skin.

i have been a lpn for almost 6 years-so i am a young un. i have worked with people with different titles..some are skilled others you are afraid to work with this goes for cenas, lpns, rns,cma,pas,mds,dos, and cnp. it depends on the person entirely. i understand the anger with the statement "real nurse" i can take it one step furtur. i went to a university to sign up for rn classes. the counselor asked me where i worked i told him i worked in a ltc facility. he replied "so youre not a real nurse , you don't practice with your license?" i left. each area of nursing is not only defined by its type of care but by the nurses and staff who do the work. we are the ones who supply the definition to our jobs by doing them competently and with care. we are one of the few professions-the profession of caring for other human beings-who use are physical, mental, and emotional skills to define our trade. let no one tell you are are not a real nurse. despite the nurse practice act.. we all go beyond it and have since florence nighhtingale and clara barton. outside of clinical skills we supply a shoulder to cry on, a heart to listen, and a hand to hold in any circumstance..no matter what area of nursing we are in.i respect all other areas of nursing..we all are seperate and the same..we are seperate in clinical settings, the same in human circumstance. we have alot to be proud of no matter who puts us or our profession down. they still come back to us we are needed and they will never do our jobs..you can train a monkey- you can not train a human heart. ------------------

you have got to be kidding.i know where u are coming from. i do know that census' are fudged they list resident assistant who only pass water, linen, ect and do not do pt care as staff members. so despite having 37 pts the record looks like we have 5 staff members on the hall the truth is we have me the lpn, 2 regular cenas, one cena on light duty, and one ra. that actually leaves 2 staff members to do pt care on 3-11. so it is not that jhaco does not monitor-it is that there are loopholes that facilities may use for staffing..this also applies to mandated nurse who have to work as cenas.scary huh! i love my work-but somedays i wonder why i got into this profession.between the politics, staffing, lawsuits, and managed care-ugh!

hey any body around who can give me advice? i work in a nursing home. the new don came in last 6 months -she acts really nice most of the time, but i have seen her show bipolar sociopath with pathological liar tendencies. she set the administrator up so he would be given the choice of quit or be fired. i feel she is the cause of dissention in the nursing home. our quality of care has dropped and our risk of legal liability has drastically increased. i chose to stay for the pts and my staff. but i feel like i am walking on eggshells. there is no one in the facility or corporate to talk to becauseof misleading statements she has told them. most of us are at risk any one outspoken is more so. any bosy have any ideas on how i should proceed? i am a good clinical nurse who wants to stick by my pts, staff and facility but do not know if i can.. should i get out or watch her and go with the flow? any body ever been in this situation where the boss is a danger, but few people see it?and those who do see it will not turn it in due to the risk..stupidly i turned her in so i am at risk.need advice...

has anyone considered that for census-legally they are not supposed to list rns as cenas. in michigan last time i knew if an rn in the building-despite working as a cena they must be listed for state numbers as rns, or lpns depending on licensure. this i believe changes with type of facility. is it medicare approved, not for profit, ect. each facility type has different regs. as a long term care nurse. i routinely assist my cenas on the floor- yes i get my hands dirty, but that is my choice not the companys. i became a nurse after 5 yrs as a cena. i hurt my back as a cena. i am very careful of it now.cenas are underpaid , underrecognized, and underappreciated by other staff, often by nurses who "supervise" them. a kind word or a helping hand goes a long way to improve working environment. i do not believe in general mandates when it comes to cenas, but we work in a 24hr facility that if the weather is bad-everyone is mandated. not all administrators are bad my last one did help on the floor, it is the don who did not help.(nurses or cenas) the cenas work hard as do the nurses, but at least we get paid semidecent for the crap we take and we are more able to afford insurence for are health, often because of low wages, cenas can not. it will only change with specific legislation regarding changing from census to acuity level to base staffing on. and it should also make specific provisions for cena wages and legalities.cenas do not know their rights that if someone gives them a directive to say lift a 2 person transfer by themself they have the right to refuse..for their and pt safety. the system will only change if enough people stand up and demand changes i appreciate and respect my staff. they are my eyes and ears and i would not trade them for anything.. ------------------