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TCU, Dementia care, nurse manager

Gained experience with excellent nursing assts, nurses, and docs, including a hugely experienced, caring DON. Second career.

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bbyRN is a BSN, RN and specializes in TCU, Dementia care, nurse manager.

bbyRN's Latest Activity

  1. bbyRN

    The Stigma of Men in Nursing

    As a 2nd career, I worked as an RN for 3.5 years, 1.5 as a nurse manager on a dementia floor and TCU, and 3 years as a CNA in dementia and TCU. (Got sidelined with a blood cancer and hope to get back to work soon.) I did not experience hostility or obstacles because I was a man. My masculinity did not take a beating and, in fact, I felt like hot @#$@ because I was a nurse/healthcare/dealing with stuff that others don't want to deal with. Some patients were a little taken aback at first, but they were usually pretty happy after a couple days. As a nurse manager, it took the staff - a lot of women of various ages and experience - a little time to warm up to me, and then we became quite a team - I miss them and they have said that they miss me. Often female nurses said that they liked having male colleagues.
  2. Hi. I'm looking to support healthcare in a decent job using my RN but as an RN with a new disability. I am about a year post bone marrow transplant (BMT) and in the process of living a new life with graft-vs-host-disease (GVH, GVHD), after effects of myeloablative induction, etc. I struggle with physical and cognitive fatigue, though it's getting better; work-out but it takes days to recuperate; have to stay away from highly infectious environments; have difficulty with appetite and weight; and so on. But I can walk, talk, chew gum, use a computer and EMR and other software. Continue with continual education. Advocate for healthcare, healthcare professionals, and patients. It would be very cool to work for a good organization - wouldn't we all. If anyone has any ideas and websites to look into, please let me know. It will not only help me, it will help a lot of us.
  3. Yes, the patients and families see a problem with staffing, but they do not comprehend the role administrators and other managers in hospitals play or won't play. Further, the patients and families have no idea of the complicated regulations nurses operate under: BON, State, Facility. Neither do they know how poor the electronic medical record (EMR) software is, for nurses and docs and the consequences of this poor quality. Most of the time the patients, families, and media blame the direct-patient care providers instead of facility management, state and fed legislators, shareholders, etc.
  4. More or less like many other nurses have commented, but in my own words: Is anybody listening (ie active listening like we are supposed to do) and do they have the commitment and power to make the necessary changes? How do we find these people and impress upon them the emergent needs for nurses? Myself? I write my State reps and senators, sometimes feds, with research showing all the things that the nurses write on allnurses. I also talk with my colleagues in a non-provocative way about writing the politicians.
  5. bbyRN

    Humble Nurses Do This

    Two things: 1. Humility includes acknowledging that one is unable to help someone and admit that. The example of what would you do if a new nurse (or an old nurse) asked for help inserting a catheter at the end of the shift. If your 4 year old is waiting for you to pick him up or your mom is depending on you at a certain time, maybe you can't help. Maybe, you need to look selfish. That takes a lot of humility to perform one's duty and look "bad." Of course, an explanation might help, but a lot of people are very judgmental and talk behind people's backs. Being a martyr is not the same as having humility. Of course, when you make a commitment to your co-workers, they would be able to trust that you stick to your word and have the competence to manage your time. So, respect could come out of such an instance. 2. I forgot what the second point was.
  6. bbyRN

    Ask Me If I'm Safe At Home

    Thanks for sharing your story. It make me, and others, better nurses and better people.
  7. bbyRN

    What do you do when admin doesn't have your back?

    I agree with this. What are your (OP) considerations? To be tough and tough it out? See the advice above. To have a decent (maybe great, maybe OK - it doesn't all depend on you - that's an ego-minded philosophy that has nothing to do with reality) nursing career? Then keep working to have a decent career - don't stop. Innovate, move on, find good people. There are more good than bad and sometimes the circumstances turn good people into monsters (everyone in the US is stressed.) You still don't have to put up with it. There is never enough time or perfection in nursing, or anything else for that matter. Anyone who says differently is naive, unaware, or dishonest and has an agenda that has nothing to do with you.
  8. Maybe on break while eating? Ask her just how long she spent scouting the nurses. BTW, there's no time to play cards in LTC. My nurses are some of the the most dedicated people I have met..
  9. bbyRN

    Hospital being sued

    For $100-$200/yr, I see no reason why a nurse would go without malpractice insurance. The legal system is so convoluted and there are so many business reasons for employees to NOT be protected that spending at most 0.2% of one's yearly income should be considered a cost of doing business as a nurse. Like buying scrubs or shoes or a gym membership. Furthermore, when the legal system makes a mistake, the "little person" pays way more of their income than a hospital or clinic or etc. Ideally, one never has the "trigger" hit on their coverage. Of course, G-d willing, the insurance one buys isn't run by a fraud, as well. Thankfully, there are good people like RiskManager, but one cannot always count on that.
  10. bbyRN

    911 Debrief

    This understanding of the context/scope in which we practice in is really important. MrNurse knew he had a minute or two before escalating care and he knew he could really escalate care effectively - not just make a phone call or something similar. He had the experience and knowledge, was in a particular environment, and probably other contextual things, to attempt care before escalating. All these things had to be present. It is unfair, by management or others, and unsafe, (and incompetent) to demand action in circumstances/context/experience that does not positively support either or both the action and the possible outcomes.
  11. bbyRN

    911 Debrief

    I agree with all the posters who said that you thought through the situation correctly and did the right things. My colleagues and I in TCU/LTC have similar questions on the situations that we are faced with. At least we can call over to another unit to get the experience of another nurse, but it sounds like in a school you don't have that luxury to have another nurse, much less a physician on hand. A second set of experienced eyes. I am constantly learning and looking things up in order to determine what is emergent, what is urgent, what is less urgent, and how to triage. Just because we can call an on-call physician does not mean we do not have to triage because the on-call is dependent on our observations and ability to clearly communicate situations in which our people have serious co-morbidities. [Added edit:] Also, the on-call has little or no history with the pt/resident even if she has the chart open in front of her - the on-call is at a severe disadvantage and the good ones err on the side of carefulness, like you did [end edit.] This maybe is not true at the school-age level, though it may be becoming more complex. Moreover, if things go south from some intervention, you/we do not have resources to address, get labs and assess, the new situation in a timely way when there is already an airway/respiratory situation occurring - like earlier posters said. As for pulse oximeters, I think we all need to learn more about exactly what the readout means. Just because a pulse ox reads >90% does not mean everything is OK. Also, anyone having dyspnea, tachypnea, SOB, etc is going to have anxiety and that anxiety is just going to feed back on the dyspnea. So, which is it? You heard adventitious/abnormal lung sounds - that's what you have to go on. You cannot doubt your assessment. Later, you can learn and practice more. That's another thing, it is great to work with other nurses and physicians in order to have our own experiences/understanding/thinking validated or improved in a way that works for us.
  12. bbyRN

    is this ethical? ?

    When society, the legal profession, and POA's make it possible for every patient or resident to have a one-on-one caregiver 24/7 or at least really robust, well funded activities teams, then maybe there can be an "ethical" question. "Hypothetical" question as the OP wrote? This is not hypothetical; it happens, though most family/POA's have some understanding of their 90yo's and the limits of caregivers and healthcare systems such that they make a request but do not to make a big deal out of napping and other behavior (not "behaviors" but behavior in the common meaning of the word.) Sarcasm: let's amp up the 90yo so that this pt/resident becomes a fall risk and then have to answer to the POA, the facility, the State, etc for falls. No, it's not one or the other, but too many families and professionals/administrators create these either/or situations with debilitating effects on good aides, nurses, and physicians.
  13. bbyRN

    Terminated after giving resignation notice

    I hope that any nurses who had to work shifts to cover the open shifts that the nurse manager needlessly created did OK, didn't make any errors due to fatigue or unfamiliarity with the unit, didn't hurt themselves due to fatigue or unfamiliarity with the unit, didn't mess up plans with their families, and so on. This nurse manager is probably one of those nurses that screams, "Unsafe, unsafe," when someone makes the same errors that they made and covered up.
  14. bbyRN

    RADAR delirium screening tool

    Thanks. This, as well as the whole topic of delirium and its significance, is really helpful.
  15. bbyRN

    What to do in critical patient situations?

    I work on a TCU - that might be the same or similar to a post-acute job like yours. First, you posted months ago. I expect you are fairly seasoned now, though still have many questions. Maybe you have a decent working relationship with your on-calls now. I hope so. Maybe your supervisor is being more helpful. I hope so. My two cents: Call another nurse who has experience at your facility with your question if it is late at night, or even if you have started working AMs. I have learned a lot from my fellow nurses. Pay attention to your ABCs (and D and E for that matter - environment? Sometimes the O2 has run out; sometimes an O2 line is not hooked up to the O2 even if it is hooked up to the Pt. Etc.) Take care of your ABCs quickly and then ask your questions. Get vital signs and have the chart open before you before calling the on-call. We have nurse triage lines for some docs - so you get to talk to a more experienced nurse first - late at night. You can learn a lot that way. Ask questions early in your shift. Look up stuff on line in reputable web sources to keep learning - plus this will keep you fresh and interested. Look up stuff here on allnurses. Cover your a$$ with documentation or without documentation. Keep learning what is an emergency and what is not. What is urgent and what is not. And, you have to do this after your shift because we are too busy on the shift. I hope that you are still questioning everything - that is asking questions and learning, as well as questioning. Good luck.
  16. bbyRN

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    I would love to have real-time, on the job, learning with real-time, on the job nurses - that is, in my LTC and TCU shifts, I would love to be able to work with an experienced nurse - experienced in both skills, time-, and BS- management. From what I hear, nurses at hospitals get this kind of training - whether it is done well or badly, but at least they can learn in a live environment like Benner talks about in her Novice to Expert book: experience, experience, experience. You just cannot get the necessary training in a school environment or in a single nurse unit, like so many LTC and TCU's are. And, even if you are paired (working the same unit, not shadowing) with another nurse, you and she are so overworked that there is little time to discuss patients and cares. All there are are "corrections" and "that was a big mistake" or "error" or write-up. That's the kind of "learning" that management seems capable of "leading" with. I like my BSN completion program because it gives me some introduction to public health, though that could be done in a less expensive way for me, but this world is all about maximizing profits. Profit=OK, crazy maximizing, MBA style=stupid, except for the person who gets the initial credit and hands off the sequelae to those who come after. All industries are failing to train their hands-on workers, not just nursing (though my friends in their preceptor programs seem lucky to me). We see what is happening in the work-place and to the country.