alt_one

There is a lot of good advice here about stepping back and not bringing your job home with you. Also it is correctly pointed out there are dozens of different career paths available to you. I have worked second shift for 13 years in the same LTC facility. I have gone thru 8 DONs and 4 Medical Directors. Some were good at their job and some were not. It can be very frustrating trying to provide good care for your patients and then turning around and have to fight with management for support. So don't give up. Take a deep breath, step back and consider your options. Also consider professional counseling. I have found it helpful. It allowed me to blow off a little steam and offered insights into coping with pressure at work and home. One last comment. I don't correct MD or NP orders. It is not my job to write orders. If I don't understand or have a problem with an order I put a yellow sticker on the order asking for clarification and put it into the MD or NP inbox at the front desk. If it is an emergency or critical I will call them even if that is at 11 o'clock at night. I have been yelled at by MD and NP and have given them the same answer. "What did you write on the order". I was even called into the Medical Director's office and told "You know what I meant" concerning an order. I replied that I "Had a good idea what you meant but that is not what is written on the order". I work second shift so I only see management and doctors for the first hour of my shift.

Yes, lets count how many died last year from Ebola. The point is that Ebola is a deadly virus with a high mortality rate. The flu is not. If vaccines were 100% safe we would not be talking. It is impossible for a manufacturer to conduct the wide scale testing needed to account for every possible risk with vaccines.The Supreme Court stated that vaccines are "inherently unsafe". That is why physicians and drug manufacturers were made exempt from lawsuits and the vaccine injury compensation board was created. Yes people die every year from the flu. Does that justify a mandatory vaccine? Where does your moral certainty come from? I can make moral arguments as well. How many people die each year from gun violence? How many die from mistakes in hospitals? How many innocent civilians die in wars each year? How do these compare to deaths from the flu? Do the numbers make my argument superior? I've written previously about informed consent, educating the public, and more research to create safer vaccines. Respect for different opinions is crucial if progress is to be made. I accept the consequences of my decisions. I also respect your right to make your own decision.

I think the word mandatory is the one that rubs me the wrong way the most. The science clearly shows that vaccines are an effective tool in fighting certain diseases but it also shows clearly there is a risk of serious injury or death. If you find the risk acceptable or don't care about the risk you get the shot. That is your decision. If you don't find them acceptable you can be fired or publicly shamed? This is the flu we are talking about not the Ebola virus. Sacrificing an individuals right to choose because the majority say it is a public health issue that needs to be addressed right now, by this vaccine seems like a slippery slope to be standing on.

Vaxxers anti-vaxxers A lot of passion around this subject. I like to see the arguments that avoid the name calling. Boston FNP had asked me in an earlier post if I had any specific concern about formaldehyde and mercury in vaccines or if my concern was more of a general concern about the amount of toxins and chemicals we are exposed to. Mercury and aluminum are neurotoxins that have no metabolic function within the human body. I don't think I need to cite any study about that. My overarching concern is the amount of toxins we are exposed to. A child born today has man made chemicals in their bloodstream. They are then exposed to other man made chemicals through diet and vaccines. The human body is very adaptable and resilient but I believe our ability to absorb these chemicals is finite. So I would ask what is the limit we can absorb and not cause harm? What impact do they have on fetal development and childhood diseases? Do adjuvants impact the elderly? Allergies, autism, and Alzheimer's have exploded in the past 30 years. Why? We approved GMO crops in 1982 and have done nothing but increase the amount of herbicides and pesticides we use. Interesting research is being done about the impact of these chemicals on our bodies but so far only hints about possible impacts. No definitive papers out there yet. I will bring this all back to vaccines in a moment. I bought a filtration system for the water in my house to eliminate fluoride, chlorine and other pharmacological products from my water even though the water department says my water meets all EPA standards. I grow 80% of the vegetables I eat for the year. I buy meat and eggs from a couple of farms within 15 miles from where I live. My workplace is 3 miles from where I live and I bicycle to work over half the year. I consider my overall health as good and I need no prescription medication. I am responsible for my health and I think I am doing things that are healthy for me. Now along comes the question of a mandatory flu vaccine. My facility recommends but does not require the vaccine. I do have to attend a class on immunization when I refuse. If it was mandatory I would no longer be employed there. While the flu has the potential to be life threatening to some I do not feel the threat warrants me injecting neurotoxins into my body. This is an old philosophical issue that has gone on for centuries. Aristotle, Martin Luther, Bertrand Russell and many others have debated the issue of individual responsibility and doing what is best for the majority. I've made my decision on how I want to live my life and I respect the decision you have made.

To Spidey's mom re:your comments about NVIC.org Amanda Z. Naprawa is a lawyer who writes a blog she calls "The Vaccine Advocate" Her comments that NVIC is anti-science, anti-vaccine and anti-informed consent are beyond comment. She lists some websites she likes. Some are financed by the CDC and pharmacy trade groups. There are legitimate concerns about vaccines that need to be addressed with more independent research. To dismiss people who question the safety and efficacy of vaccines as anti-science is not helpful. I believe vaccines can be made safer. I also believe that the current child vaccine schedule is too aggressive. You need to be healthy to receive a vaccine. We are exposed to more man made chemicals than ever before. The past 30 years has seen an explosion in allergies, autism, and Alzheimer's and we don't know why. Pollution free air, food, and water would be a good place to start to get our health back. I was born in the fifties and had the mumps, measles , and chicken pox. I also received all the recommended vaccines in place at that time. I have also traveled extensively in my adult life and was required to be vaccinated. I got them because I wanted to travel. My decision and I accepted the risks. I think anyone would be foolish not to consider getting most of the recommended vaccines provided you are healthy. Having said that I personally do not get the flu shot. I do not wish to have formaldehyde or mercury injected into my body. I will get a shingles vaccine soon. It is a shot for a specific disease that does not contain any preservatives. I will be exposed to a bovine protein but I consider the risk acceptable. Informed consent. Know what you are getting,know the risks, and possible reactions. If someone does not want to accept the risks I accept their decision.

To BostonFNP: You should revisit the NVIC.org website. It is true you will not find original research on this website but you will find numerous links to universities and other researchers doing legitimate research on vaccines. NVIC advocates for the principle of informed consent. Informed consent for medications and or medical procedures should be an ethical principle of medicine and vaccines should not be an exception. Vaccines are an intervention on a healthy human being that has the potential to cause serious injury or death. Everyone needs to be educated because ultimately you are the one responsible for your own health.

Consequences? Are we going to have mandatory treatment for disease now. What if we find you have a STD or Hep C, can we force you to be treated? If not can we isolate you from society so you will not pass it on to someone else? Maybe we should build something like a leper colony for those who won't vaccinate. Who decides these issues? I am not against vaccines. I believe in informed consent. Know what pharmacological product you are taking, why you are taking it, and the risks associated with that product. And having the right to decline the risks. I have traveled all over the world. To travel I have to have proof of vaccines. I got the shots. I made the decision and accepted the risks. I had the mumps and measles as a child. I did not need the MMR vaccine but took the shots. My choice. Education is the key to a proper vaccine program. The government needs to make safer vaccines. There is no metabolic need for mercury or aluminum in your body. The average person will have over 100 man made chemicals in their body and our government has no idea of the consequences when they interact together. Glyphosate is an endocrine disruptor and research indicates it may impact fetal development. There are limits to your exposure set by the government but our government doesn't even test for it in the food supply. Over a billion tons are sprayed on food crops annually. One more point then I will get down off my soapbox. We are exposed to 100's of chemicals that were not around one hundred years ago. We have seen an explosion in autism and Alzheimer's and we don't know why. It is prudent to consider what chemicals are going into your body. I personally believe most vaccines are safe and that they should be seriously considered as part of your health plan. However I also think that the adjuvants could be the trigger to disease for people who have been exposed to toxins. Babies, children, and the elderly with immature/compromised immune systems could be most susceptible. Can we develop vaccines without adjuvants? Do we really need all the vaccines the CDC says we need? We should double or triple the money spent on Planned Parenthood for prenatal care and focus on providing proper nutrition to children. And let's listen to others concerns about vaccines with some respect. It is a very emotional subject for many. Informed consent is a great way to start

1)__ Do you take the flu vaccine yearly? If you do not, what is the reason you do not participate (if you don't mind answering this question)?No I do not. Unnecessary pharmaceutical product that may contain neurotoxins, heavy metals, altered DNA from unlabeled sources. This article has an over inflated percentage of the effectiveness of the flu vaccine. Other sources I have read indicate last year's vaccine effectiveness was under 20%. The principle of informed consent. Know what you are putting into your body and the risks associated with it. We should have the right to decline the risks. Our government has no idea what all the man made chemicals do when they interact within our body. I would never tell anyone not to get a vaccine. I would tell them to get all the facts and decide what is right for you. 2)__ Does your employer have a mandatory influenza vaccination policy as a condition of employment? If yes, where do you work? No it is not mandatory. 3)__ What concerns do you have about the flu vaccine? Go to NVIC.org and get a different perspective. 4)__ Do you know if anyone who has been released from their job because they did not get the flu vaccine? No

A lot of good advice here. Focus on the med pass and always read back the order to the physician. One thing I tell myself as I make my med pass is one resident at a time. I have staff and residents calling my name or asking for help as I walk down the hall. Unless it is an emergency I don't stop what I am doing. I made mistakes when I tried to help everyone immediately. Meds and treatments left in other residents rooms or missing scheduled BG checks and insulin. I just tell residents that I'll have someone assist you shortly. As other nurses stated "It will get better over time". You'll learn everyone's routine and when is the best time to get treatments done. Good luck

Our state has multiple survey teams. Could you ask the health department manager for a different team? Several years ago we had an ex-employee get hired by the state. When she came to our facility for an inspection she was not professional. Got in everyone's face and was incredibly rude. We failed our inspection. Management called the state and asked that she not be allowed to inspect the facility again. They agreed and came back the next week and we passed the inspection.

Staying calm and having clear expectations is great advice. We go through a lot of CNAs at my facility. I usually only have one CNA who has been there more than a year. I review what I am looking for at the start of the shift and when appropriate will revisit issues at the end of shift. My experience is that CNAs work hard but they don't always work efficiently due to lack of familiarity with the facility, the residents, or perhaps being new CNAs. When things go well at the end of the shift I complement them. I also will suggest different approaches to residents if there have been difficulties. I also like to ask "What do you think could make a difference?"

I agree with the other responders. Take a vacation. Your mental health is the most important thing. I work second shift and have had 4 DONs in the past 2 years. I get a lot of useless suggestions from people I never see on the floor. Staffing is so bad I started keeping track of the actual number of days I had a full staff. Last year we were fully staffed 43% of the time. Takes it toll on you after a while. I scheduled vacation time of one week off a month for 3 straight months. It helped. Good luck

It takes a little time as you learn about the residents you are caring for. A good orientation with a nurse who works the floor regularly would help. I've worked for 10 years on a 21 bed nursing home unit. We use electronic charting. I usually review the meds and the treatment records for any changes since my last shift and then chart the meds as I give them out. The treatments I chart at the end of shift. We chart by exception on this unit so I usually only have 3 or 4 residents that require detailed charting for new admits, behavior issues or change in status. The only other thing I would say is that this is the resident's home. I'm the visitor coming to work there. I try to learn their routine and adapt to their needs as much as practical. This can be difficult considering the level of dementia at times.

Sorry about using the wrong forum. I was searching the website trying to find similar situations and came back and entered the wrong forum. Thank you for your thoughts on my question. I did contact my state BON yesterday but have not had a definitive answer yet. Supposed to get back to me this week.

I work second shift and rarely see the staff doctor. I would write the order as written by the physician and ask first shift nursing to get a clarification since this is not a medication order. If it was medication I would be on the phone with the doctor getting a clarification. As a general rule I want to see discontinue orders for treatments or medications.

Arguing with a resident is inappropriate. I will tell a resident that their behavior is inappropriate if they try to punch, kick, injure someone, or are verbally abusive. If they respond appropriately I will sit beside them and talk about it. If they don't respond appropriately(which is most of my dementia patients) I try to redirect by talking about something else. The secret is to know your residents. I have some that I would never bend over and try to do something without making sure they know I am there. Even then you must always be aware that their demeanor can change quickly. I tell my staff "No means no" and "Leave me alone means leave me alone". Their responsibility is to make sure the resident is in a safe position and to update me. Most of the time you can leave them alone for a little while and revisit them. I probably would not have sent you home. I might have swapped out the assignments so you did not have that resident for the rest of the day.

I work as a 2nd shift nurse in a LTC facility. 24 residents with 3 scheduled CNAs but half the time actually having only 2 CNAs. We use electronic charting and recently management added that a skin assessment be done for every resident every shift. I objected because an assessment is a nurse specific task and would take 3 hours or more every shift. Management responded by changing it to skin check every shift and said I could delegate it to CNAs. It is listed on my treatment record as a skin check. There is no space or button I can click that would show this as a designated task. I have the choice of putting my initials on the form as completed, hold( I must explain why it was held), or refuse(again I have to explain the refusal). I asked management to move this to the CNA documentation sheet and they refused. They said I must sign or be subjected to disciplinary action and termination of employment. There are items on my treatment record that are delegated to CNAs that I already sign for, such as bed in low position, foley leg bag changed to overnight bag and draining properly, and TED stockings removed at bedtime. I thought that since I can verify those tasks were performed that it was okay to sign for them My objection to signing for skin checks is that I can't verify that they were done. Has anyone else had similar problems? How did you resolve this? I understand my electronic signing of the MAR and TAR as legal documents. I am not comfortable saying a skin check was done when I can not verify it.