JohnBearPA

about the order for KCL not being d/c'd, and kaexalate given at the same time,,,,, doesn't anyone do chart checks in this facility? There's more than one nurse at fault here. it's still terrible that it wasn't caught sooner.

I really think you need to go and speak with your instructor. Also do some reading on HIV and AIDS. I am doubtful that the "AIDS pt." has full blown AIDS and is sharing a room with someone who is much more a risk to him than he is to this old man that isn't imuno-compromised. And for an instructor to say that this is an "AIDS pt" if he is in fact only infected with HIV is outrageous. Do a google search on AIDS and HIV, I'm sure you'll see what exactly I mean.

I wear my seatbelt in my truck or in someone elses car all of the time, but I'll ride a motorcycle w/o a helmet as long as I'm driving the bike. If i'm a passenger, i wear a helmet. I do enjoy the feeling of the wind on my face and thru what's left of my hair. I condone this to myself because i really can't see me having any quality of life after a bad m/c accident, so I doubt i'd want to live thru it. a motor vehicle accident on the other hand, i could live thru w a seatbelt and continue to be productive.

Hmmmm, tonight I'm already at work since 7p, until 7a. we had an LPN call off, so I'm in an unfamiliar hall until 11p. Just got done my meds, and charting is already done. Now at 11p, I go to my hall, and do my 30 pts, and the other hall's 30 pts because the other nurse scheduled has a family emergency and called off. that makes 60 pts. We do have 3 CNA's scheduled, but all noc meds and tx's will be on me, besides the chart checks, ordering meds, g/t's, charting, and appt's for morning. Not to mention I do my own v/s, because I'd rather have my CNA's answering call lights and t&p'ing people. Oh, I also answer call lights when my girls are busy. This is LTC, get used to it. I think I'd give my private parts for your job tonight darlin', but hey, only my opinion. Do what feels right to you, and good luck at whatever that may be.

I'm not sure anymore, and I've lost touch with one of them. I believe she was started in L&D but moved to postpartum later. I know LPN's at that particular hosp aren't able to work in the nursery, but they're employed in NICU, so some of this may be that particular hosp's policy. The other LPN works postpartum. I'm certainly not challenging anyone, just trying to share the info I remember. Again, I'm also assuming this varies not only from state to state, but facility to facility.

I think this depends on the state and the hospital. I know several nurses that I went to school with that work OB/Gyn as LPN's. Obviosuly RN's are preferred, but at least in PA, I know several LPN OB/Gyn nurses. Probably not the same everywhere tho.

I agree, because most of the CNA's here understand the reasoning behind telling their superior, the Nurse or Charge Nurse, that you're taking a break. If you're playing fast and loose with your staff, I'm just happy you're not at my facility. Believe me, you wouldn't even make it as a CNA. I'm sure sooner or later you'll ends up either understanding, or you'll lose your license for neglect or abandonment. Have a great day!

The pee break is getting blown out of proportion here. The OP said "stepping off the floor" which can be for anything from a pee break to lunch. From your responses, you seem to be just getting a laugh from serious responses explaining why nurses expect to know where their CNA's are, and I'm not going to keep on trying to justify my responses. When you're a nurse long enough, maybe you'll understand. Until then, have a great day.

Most units that I've worked on have staff b/r's on the floor, so no one is leaving the floor to go pee. As for the "MY LICENSE" thing, when you lose yours because of something a subordinate has done or failed to do, you'll understand why most of us feel as we do regarding our licensure.

No, it's NOT kindergarten, it's WORK, and as a supervisor of the CNA's at work, I too expect to be notified of when they leave the floor. I also have the courtesy to let my CNA's and the other nurse know when I leave the floor for break, or whatever else I may have to do in another section. I've been a CNA for years before I was a nurse, and I'm very aware of what their jobs are. That being said, I'M the one directly responsible for everything they do while at work, and I'M the one signing off on the fact that they did, in fact, do everything for their pt's that was expected of them. It's MY license on the line, and I let my CNA's know that, and that they can ask for help with whatever task they require help with, no matter how messy, or gross. I'm just asking the same respect from them that I give them, as I think the OP is also. As for the CNA in question, sounds like insubordination to me, write her or him up, and stick to your guns. CNA's like that don't need to litter the floor, as there are plenty of hard working CNA's that actually like doing their jobs to take their places!

The facility tried to get her to retract her statement to police the next day, but it was too late. The resident had been exhibiting this behavior for several MONTHS, and admin was VERY aware. In fact there were several other assaults, such as resident throwing feces, menstrual blood, and urine, as well as resident literally running over a staff nurse with her motorized w/c. Thankfully resident figured out that charges might be pressed against her, and checked out AMA with family the next day. Now she's someone elses problem, unfortunately. As for advocating, I'm a pt advocate AND a staff advocate. How can I expect my staff to give proper care when they're afraid to enter a room to answer a call light?

I was charge in my LTC when 3 CNA's came to me reporting an assault by a known combative, A&Ox3 resident. I called my DON and administrator, which were both unavailable, then police upon CNA request. Police responded, resident was made aware of consequences if CNA wanted to press charges, and resident checked out AMA the next day. Admin was furious, but I firmly held my stance that CNA was within her rights, and the powers that be were unavailable, after several calls and voicemails left. They eventually got over it. We have the right to press charges at work just as if we were at home, or on the street. Don't EVER take an assault from a resident and let it go, because Admin will NOT help staff, they're all about pt satisfaction!

I think you'll learn what's expected and your texts will become clearer when they're covered in class. We learned alot of this stuff in school, and had no idea how it would effect our nursing care until we got out and actually worked as nurses. As nurses, we care for the "whole" person, psych, physical, and spiritual needs. You'll realize the relevance when you get out on the floor. I was one of the few Catholics working at a Jewish run facility, and believe me, I learned alot about the Jewish faith. It certainly helped me better address my pt's needs, and I'm certain that it helped me grow as a nurse. No one asked me to convert, but I learned ALOT and it broadened my personal horizons. Just don't get upset yet, until you cover it in class and see how your instructors explain how it will relate to your career. Also, I agree, your spirituality has nothing to do with how good a nurse you are, and don't let anyone tell you otherwise. Best of luck, you'll make a fine nurse soon!

lol, while in the room administering meds, two CNA's gave the woman in the next bed a boost, and apparently came very close to banging her head on the headboard. They both apologized profusely, and the elderly pt told them "Don't worry honey, my husband used to bang my head off the headboard every Friday night for years, it wasn't the first time." I about died laughing!

you know, I'm reflecting on my past employer, and wondering why the heck I didn't quit before this. The shortages of both supplies and staffing was there, and they seemed to promote sloppy nursing. I always try to do my best, and there's one other nurse there that is a fantastic nurse too. The rest of them I wouldn't care to have look after my enemies, yet alone my family or friends. I know I'll miss my residents, but that kinda' goes with the territory, I guess. Also found out that the staffing error that caused all my grief was the DON's error, because he gave another nurse emergency leave to go to PR AFTER he already approved mine, and needed to cover his ass. Unbelievable! I'm really thinking I made a good choice, and I highly doubt I'll regret it. I'll be driving a little further, but what the heck, I'll be a happy camper! The new job was one I loved before, and just left to have a shorter commute. Also, the new job is all about promoting education and experience, so I'll get to be the best nurse I can be! As for Dad, no change in condition, still fairly stable and free of pain. Thanks again to you all, you're all angels!

Dad is stable, but poor. It looks as if this was the last time I'll be seeing him, but he knew who I was, and that's what matters. He's free of pain right now and apparently at peace, and so am I after being able to see him.

Good news everyone! I went in to speak to the DON that told me yesterday if I didn't come in I was fired with my ticket stubs and a faxed statement from the ICU staff where my father is, and the jerk refused to see me. I just walked my butt back out the door with my head held high and drove home and started making phone calls. I got a new job at a facility I quit from under good terms. Means I'll continue making what I am now, and get a sign on bonus to boot! The ADON at the new facility was formerly my unit manager, and gave me a glowing recomendation! As for the old facility, the state is there, and it apparently doesn't look good. they're out of alot of supplies, including syringes, graduated med cups, and tube feedings. Several nurses are using TB needles for insulins! When I told my old sup where I was leaving from, she told me some things that scared the heck out of me, such as they've changed pharmacies three times in the last year d/t non-payment, and they've had some CNA's complain that their paychecks bounced. I'm just hoping I get paid for the time I was there when payday comes. God truly did open a window, because I wasn't even unemployed for 24 hours. Thank you all again for all of the positive thoughts you all sent my way. I'm proud to be affiliated with such wonderful men and women as yourselves!

thank you all so much. I can feel your positive thoughts, and it's making me feel much better. I'm going to sleep now, and calling them in the morning and seeing what happens. Thanks again everyone, I so appreciate you all!

thanks guys, I needed at least one positive reply, and as usual, you guys came thru. I'm a big tough guy, but right now i'm balling like a baby. I can't afford the job loss, as I spent money for bills and rent to get up there. I just can't believe I'm being fired, after telling them that I have witnesses as to me calling and knowing I was off schedule until Monday. I really am in No shape to try to work right now, and my DON knows it. This just sucks so bad.

I need a bit of advice from anyone that can help lead me in the right direction. This may be a bit long, so please bear with me. I work at a fairly small LTC. My father in PA is actively dying, in ICU, and probably won't make this week. I requested time off, granted, on short notice, early last week, i believe it was Tuesday. I was off until Fri, which would be a double shift for me, Saturday which was a single, and Sunday which was another double. I was granted off until this coming Monday at three pm and planned on returning for that 3-11 shift. Thursday past, i called work to again make sure that I was off the schedule for this weekend. At that time I was told that I was on the schedule for this coming Monday at three. I said great, I would return to FL Sunday sometime, not yet having booked my return flight. Today I got a phone call at home, after having just gotten in the door and was told that I was seen in FL by a co-worker while I was supposed to be in PA, and I was needed at work this afternoon for a double shift, 3-11 and 11-7. I expalined to my supervisor that I had JUST walked in the door, and was not in FL this week, but my s/o was using my vehicle, which may have been seen by someone, and that NO I couldn't come in to work until Monday, as I haven't slept since Friday on the plane to PA, and a half hour nap on Saturday. This has been a bad week for me, as the s/o and myself drove to PA last tuesday after I heard that I had off until next Monday, and I only returned to bring the s/o home to go to work, and double check that I was indeed off the schedule for this weekend, before flying back and sitting at my father's bedside while he was in the dying process. Long story short, I don't feel as if I'm in any any shape to work after not sleeping, and that I can't pass meds and give insulins while in this condition. Also, i WAS given off until Monday, but due to THEIR mistake, was put on shcedule for a double shift today. I was told that if I didn't show, I was fired. I told them fine, I'm fired, I can't be in. Any one have any words of encouragement or advice at this point? Thanks in advance everyone.

We'll just have to agree to disagree. Again, my sincere wishes for you to have a great day, and be happy in what you do, whatever that may be.

You have a point. but if it wasn't for the facility being open and getting paid for it's residents by your tax dollars, they wouldn't have the money to pay you, creating those tax dollars that you're paying to take care of those residents, now would they? As for culture change, which is what I originally wanted to post on, our place is going thru this now, and it seems a success, except for the fact that overhead paging is no longer allowed. MD's have to wait longer on the phone, but that seems the only drawback so far. Then again, we're VERY early in the change, so it'll be interesting to see where it goes.

If a facility is engaged in illegal activity, it surely needs to be reported to state, but most facilities are NOT engaging in illegal or unethical activity, other than the short-staffing that is prevalent in our profession. The facilities that are engaged in anything illegal are caught by regulatory agencies and closed down, as they should be. I'd be willing to bet that if you polled most nurses on this forum, most would say that their facility works above board. To make a blanket statement is a disservice to the profession, as it makes it seem as the nurses are part of the problem, because they have no choice but to go running to the state surveyors because there are no facilities that are good out there, and we're forced to work in lousy facilities that are working illegally and unethically. That makes us as nurses part of the problem. You did state that there were some management people with scruples, but in the same sentence, you stated that they're soon run off out of the business. I also didn't state that the employee was incorrect to report, just that there are other avenues that carry less of a punch financially to the facility that signs our paychecks. I've been around the block a few times myself, having been in this field one way or another since I was 16 working as an orderly for the summers in a state hospital. I'm well aware there are instances where management turns a blind eye to anything but profits, but believe me, in my experience that's not the norm you are trying to portray. I'm truly sorry for your bad experiences. My loyalties are also to my pt's, as are my DON's, and my administrators. Staff that doesn't feel this way doesn't last long at my place. My loyalty lies in the fact that my facility lets me do my job, advocate for my pts, and pays me well to boot. Have a great day, and may you someday find a facility as pleasant as mine to work at.

Actually, I think you DO owe something to the nursing home, they're the people that give you money for your services, and allow you to live with a roof over your head and eat, pay bills, put your kids thru school, and not be on the street. I agree that some management is just looking out for the bottom line, and may not be AS concerned with pt advocacy as they should be, but I don't by any means feel that they all are like this. I work at a facility that's advocating culture change, and it's a slow process, but believe me when I tell you, our DON is all about pt advocacy, and also defends her nurses as long as they're in the right. There are alot of other agencies that you can go to to blow the whistle other than directly to the state during a survey. That's kinda' like cutting off your nose to spite your face.

He's not our Medical Director, although that guy is almost as bad sometimes. At first, I just thought this was a "southern" thing, as this NEVER happened to me up north. I just want to figure out a good way NOT to enable this man to do this anymore, to myself and my colleagues. It's out of line, rude, and just plain unacceptable. I need a good idea of how to take away his power to talk to us like this and get away with it. My DON said she'd talk to him, and she has before. She defends her nurses, but she's in a tight spot herself, because she's a nurse, and he seems to disrespect all nurses in general. She suggested documenting his behavior, but I don't feel the pt's chart is the right place for this, and yeah, it'd probably get me fired, so that's not gonna' happen. LOL.