GrandmaSqueak

What makes a good DON depends on who you ask. Staff nurses want someone who supports them and helps out when it gets really hectic. Administrators want someone who looks after the bottom line. Being a night shift nurse, I agree with Blackcat99.

Thank you. Yes, it was titrated up to that level and she has end-stage cancer. I'm more at ease with it now, thanks again.

Last night I had an order to give Roxanol 40 mg po/sl q30 min prn. The evening shift had been giving it every hour. When I went to check on my resident at the onset of shift, I told the visitors (not family or POA) that she appeared comfortable and I would check her frequently and give the Roxanol at the first sign of discomfort. The resident was not responding to tactile or verbal stimuli. The male visitor said that the Hospice nurse said she should have it every hour and wanted it continued through the night. He was very brusque in his manner, which I attributed to worrying about his friend. It did bother me that he brushed my judgement aside. By 0430, the resident's respirations were less than 10, so I called the Hospice nurse. She said to expect the respirations to become less and less, but to keep giving the Roxanol. She said it should be given every 30 min, but since it had been every hour, keep doing it that way. That's how the Doctor ordered it. 1) This is the highest dose of Morphine I have ever seen. I'm not comfortable giving it. 2) The resident was unresponsive the whole shift. She moaned when turned and I know she needed the Roxanol then. But how do I know she needed it when her respirations were even and unlabored, or when her respirations were 8 with 30 sec apnea episodes? 3) I don't feel that "That's how the Doctor ordered it." is a good enough excuse to not question the dosage. 4) I agree with keeping my resident comfortable during the dying process, but I do not want to participate in Assisted Dying. Hospice nurses: Please educate me.

I'm not sure the expense would be worth it. Looking at the article, I was thinking he put her in the front seat so he could use the carpool lane.....

The BON will probably not want you working with controlled substances while on probation. I worked with a nurse who was busted for diverting and using Demerol. She had to go to rehab and 2 years of probation. She worked in a blood mobile. She was already an amazing IV starter. I think her experience made her stronger and a better nurse.

If I had it all to do over again, I'd a Funeral Director.

As llg stated, resident hearing loss may have something to do with it. High frequencies are among the first to go, so it is easier to hear lower (male) voices. My experience has been that the elderly ladies often do not want male caregivers. They might be more receptive to a male nurse, but they often don't like the male CNA's for pericare or showers. Of course, there are exceptions. I'm glad you are using your education and looking for ways to improve your performance. Never surrender. Never give up!

Two -- One for narcotic diversion with intent to sell, the other for diverting and using IM Demerol while on duty.

The LTC unit I work on has 2 day shift nurses and 1 night shift nurse. I'm night shift and I give report to both at the same time. They are each assigned their own hall, so if one is late I can start with the hall of the one who is there. It helps them assist each other to know what is going on in both halls. We've done it this way since we opened 2 years ago, so it hasn't been a change for anyone. Since this is a "new rule", people will object because we don't like change.

You say it's in a better location and suits your needs. If you can live with the pay cut, I say go for it. 30 residents on over-nights is pretty good, depending on how many CNA's you have. It will be a challenge and sharpen your skills. If you plan on hospital nursing in the future, or if you plan on furthering your education, the experience will be great. I wish you well in your new adventure.

I agree with LTC_LPN. I usually advise people to give it 6 months, unless the place is a complete nightmare. It sounds like you are getting your bearings. Each shift gets a little better.

My initial response to your post is: Did the on-coming shift do touch walk-through? I always encourage my CNA's to do touch walk-through instead of just receiving a verbal report. If they had actually gone into the rooms, they could have asked the previous shift to finish their assignment without interrupting the nurses' report. If it is a repeated situation, then they could call it to the manager's attention. I feel that not doing touch walk-through is like saying "I trust you. Whatever you left, I will take care of."

My advice is to contact the Calif BON. They will send you the information you need. California is not on any of the interstate contracts as far as I know. But, since you tested there, I don't see a problem with being licensed there.

I feel your pain. I once worked 2 weeks at a brand new facility. It was beautiful, but the call bells for the hall I worked rang at the front nurses' station. There was no nurses' station on my hallway. I did my charting in the room at the end of the hall which was supposed to be a resident room. It had a desk and a phone. I made my concerns known and was told it was in the plan to fix that. When payday arrived, I didn't get paid. I asked about it and they said they had no record of my shifts. I had signed in every night at the front nurses' station and was able to verify my hours with the DON. The HR person was very rude. They told me I could get my check on Tuesday. I told them I'd be back on Tuesday to pick up my check, but I would no longer work there due to safety concerns and being treated poorly. Yes, I quit without notice. Life goes on....

I enjoy the information I get from reading the posts, but I see no particular reason to purchase a membership. Thanks to the above comments, I tried the survey and agree with /username, BSN, RN