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taivin

taivin

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  1. taivin

    advise needed

    That's fine, but she didn't keep her mouth closed... That's the violation. Chills ran down my spine when I read your post OP. I knew what would happen before you told us. Live and learn. Someone you told doesn't like you. In nursing gossip can harm. I've learned from very early on to keep my big mouth closed no matter how tempting. Sorry for your hard learned lesson. You'll survive; you have lots of experience.
  2. taivin

    Should Obama care be repealed?

    All I know is when it comes to health coverage many people think it should be free. I am one of those whose premiums doubled. It's been a disaster. I'm so glad that all the other people are getting free health insurance while I pay for it. Not happy. I was fine with paying $320 a month. That's the thing, a lot of people scream when they have to pay over $50 a month for coverage. I'm on a family plan. Obamacare was good for some but more of a disaster for those us who have to pay for their care. It's hitting the middle class hard. That's essentially what it is...take from the rich to give to the poor. The thing is; I'm not rich. I voted for Trump
  3. taivin

    Getting Licensed in California with a Criminal Record

    http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0ahUKEwjog473xeTRAhVP7mMKHeYnBn0QFgg3MAQ&url=http%3A%2F%2Fwww.nolo.com%2Flegal-encyclopedia%2Fcan-application-forms-ask-me-criminal-arrests-convictions.html&usg=AFQjCNFsMVA-h8oYufWyfwMkQp1EVvEBvQ CA is already tough enough to get a license in.
  4. taivin

    Annoying words/behaviours during report

    It's just short nurse talk. Why does it upset you so much? I'm not into watching out for dangling modifiers and subjunctive clauses while giving or getting report. As long as they're giving me the whole picture, I don't care about their English Composition abilities. Well...the verb tenses should be correct.
  5. taivin

    Nurses discretion to hold Tx?

    This resident is having ace wraps at night? Do they scratch at night? Why are they wearing ace wraps at night? Am I reading it wrong? BTW; look up your own state's Nurse Practice Act, to find your scope of practice in the state you live. :)
  6. There are some things in a marriage that should be respected. If the trust is not there, than the marriage is not either. I do not insist on delving into every nook and cranny of my husband's life, his files, chats, texts, etc.... If you have a need to check your husband's cell phone to feel secure, than it is what it is. I am one of those who doesn't have an ugly green monster rearing it's head if I saw a screen lock on his cell. I am secure in my relationship and could care less what his passcode is (if he has one). That's how interested I am in his cell...I don't even know. Life's short...enjoy
  7. I hear you loud and clear. My mother just passed on from CHF that was caused by HT. My family and friends are constantly posting their muscle laden, fried in lard, servings large enough to stop a herd of wildebeest's recipes. I don't post back. I do try to educate about the "silent killer." I put many health related diet stuffs on my FB page, hoping that maybe some of my friends/family will notice. No, it's not our job to police our friend's FB pages, but I don't know how much longer many of these people are going to live healthy! I had a small get together not to long ago with my sister, her husband, nieces, nephews...I noticed that my brother in law only had 1 beer when he usually had 3 (limit). I asked why and he said his doctor told him to lose weight and that he had better get his BP under control. So I brought out my trusty BP cuff and had a BP party. My sister and her husband's blood pressure were out of this world...I can't understand how they were vertical! Neither one of them wants to take medicine for it because they want to stay pill free. I told them go ahead and be pill free, but plan on joining mom in a few decades if not sooner. There are ways to teach. I've sent private messages to some of my closer friends but to no avail. They respond with the I know, I'm trying, etc... It isn't until something serious happens, that's when people will wake up. It's true people are going to do what they want to do...that doesn't mean we can't try As nurses we wear many hats...Keep the faith
  8. taivin

    Narcotic counts in the home?

    If something appears amiss then find out what's going on and contain it. If it needs to be reported, than report it. This is one of the aspects of home hospice I enjoy...autonomy. No one is hovering over your shoulder, no cameras, etc... You are on your own and accountable to yourself in the private homes. As far as counting (especially with the comfort kits these days), have rarely done it in the private homes except to see what I need to reorder, what's working, what's being used most for what etc... I'll go in and look and compare the narc sheets the family fills out with the inventory, but I don't involve the family unless they want to save for the initial and ongoing teaching about dosage, drugs, etc... We have narc sheets where family members are to write down how much and when, but as far as going in and actually doing a narc count...no. With the liquid morphine sometimes if I'm suspicious, I'll squirt a little out to make sure it's not just water...yea, I've run into some real doozies out there. The liquid morphine doesn't have a smell I can smell, but it's bitter to taste. You do have your nurses who divert in hospice, but what I've found is it is the family members who are the ones that will have the accidental spill over the sink, and the morphine that somehow turned to water. For the most part with my experience I haven't run into too many problems in this area. The main problem I've had is family who don't want to give the morphine because they feel it turns the parent/whoever into a drug addict. Lots of teaching in this area sometimes. Don't always assume that families are all in for the morphine/Ativan/etc..., when pain/anxiety is a factor and/or comfort.
  9. taivin

    Falsifying documentation

    You need to talk to the nurse first...before talking to management... It's called simple courtesy and it's protocol in many places. Are you going to go run to management every time you see something or hear something amiss? Sounds like you're going to be in the manager's office a lot.
  10. taivin

    Starting clinicals - Question

    Hi; good for you on the 4.GPA. As far as clinical protocol, it all depends on the school. I was in a BSN program and we started in LTC. Also at every clinical we had to develop our own care plans after picking out patients in the facilities we were at; nursing Dx and theory. Our instructors just were around but expected us to take the reins. The RN your quote unquote "assigned to" is the lead person in my program. This is important, not all RNs want to be saddled with a nursing student. Then there's the instructor themselves. It can be a challenge. I'll never forget my first resident (in LTC), my first clinical, I had a diabetic and there was a sliding scale. The RN I had was gone. I went to my instructor and asked her what the extra orders meant under the sliding scale and showed it to her. She told me to do nothing. When I saw my RN I alerted her to the sliding scale and I left. The next day my instructor was pulled into their DON's office. I don't now what happened, but always look for that sliding scale coverage with diabetic clients. Now decades later, I have to wonder how much experience the clinical instructor had and if I had smart phone back then, I could have looked it up. We were taught from the ground up with transfers, feeding, wound care, etc... you find all that in LTC/SNF or med surg. Keep an open mind, there are no stupid questions, and for God's sake if you don't know, say so. Stay above the fray and learn as much as you can. Let us know how it goes. Don't let the nurses know you're a 4.GPA, I was as well... Keep your pharm book with you, and don't give any medication you don't know what it is, why it's being given to your patient and why and how it works for the Dx you are administering the med for. Route, correct identification of med and amount. Find out how they take their meds and check 3x before giving. Is it a new med, etc... you should know the drill. Who, what, where, when, why and how much...always check hand IDs, if no ID like in LTC, ask staff to identify them for you. If possible, look at the original order. Here comes the big one...if they can do it themselves, let them. The nurses who took students were paid extra...I don't know how much but it was in their union rule book. Unions forever! Good luck!
  11. taivin

    Is not answering the phone for work bad?

    I use to do over time (they called relentlessly). It got to the point where I was pushed into another tax bracket and instead of the government taking out 34%, they started taking more. After that I stopped overtime. I was tired of being harassed on my day "OFF," I was tired of supporting the government, I was tired. If management had our backs, they would have contingency plans in place for the chronic call offs. Also ask yourself; why are there so many call offs? At this one place I worked, you could set your watch as to when and who was going to call off. Don't feel as if you're stuck between the devil and the deep blue sea. I screen my calls on my day off. If I don't recognize the number; I don't answer. You don't have to answer the phone on your day off, and you don't have to give an excuse why you didn't answer your phone if questioned at work about it. If you answer the phone on your day off you don't have to give an excuse. Thank them for the opportunity and politely decline. This advise only pertains to staff that have a regular schedule with no special p/p attached concerning o/t and It's not intended for on-call/management with salaries/etc... You may get a call when you get home from work. It's usually about a patient or the never ending "Do you have the narcotic's key?" (which has all the other keys on the ring as well) . Not so much these days, as everything is electronic. These places that have a so called mandatory over time clause; I don't beleive it's legal. If you want to work there and it's their p/p, then that's your decision. It's like we have to be drug tested but the public school teachers don't??? The future of our youth is in their hands and they don't have to be held accountable. I don't agree with m/o or drug testing anyway, but if you're going to drug test us because we deal with a fragile population...well. OK; teacher rant done. To save anyone some time; I know about the bills and the protests, Teacher's Union, the injunctions, special need in Skinner vs Railroad blah blah public employees, etc... concerning the drug testing of public employees. Go Patriots!
  12. taivin

    Not confident in some nursing skills

    I've worked in two huge LTC facilities starting off my career in nursing; they were both med-surg on steroids. Previous poster took the words right out of my mouth...critical thinking skills and time management; both are necessary. It is almost impossible to have competent time management without critical thinking skills. The word worry...eliminate from vocabulary, review skills that aren't practiced on YouTube and/or other sources. I know a women who was in an accident and ended up in a wheelchair. After two years of being in an AFCH, she re-entered the world of the living. Her driver's license had expired while institutionalized. She was 55. There was much to do for this female to enter back into the world; it wasn't until 7 years after the accident, she went to test for her driver's license (had to do both written and driving). She passed the written part. I will mention that the family would not let her practice in their cars. She had ended up near family over 2,000 miles away from where she called home. Her family believed that she was delusional. I mean, why would a person in a wheelchair want to drive? She arranged with her mother for the mother to drive her to the DMV and use the mother's vehicle. On the day of the driving test; she told me she wasn't nervous at all. She knew how to drive (didn't need special vehicle; regular car was fine). She went through the pre-driving exercises with the DMV driving examiner and when he told her to start vehicle and go, she told me it was if she had never stopped driving...passed with flying colors. Her family was shocked when she passed and received a driver's license. I see confidence with determination using a non-stress approach. If you hadn't swum for 10 years, and someone threw you into deep water, would you drown (assuming that you knew how to swim) ? You may have only practiced some of these skills you refer to once or twice, but you have done them. It's true we get better with practice. You need to stay updated and educated, as things in our business are always changing. Take a proactive approach to your work; don't wait.
  13. taivin

    medical assistant scope of practice

    http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0ahUKEwj2mrLX_7fRAhVpiFQKHR3uDTgQFggoMAI&url=http%3A%2F%2Fwww.aama-ntl.org%2Femployers%2Fstate-scope-of-practice-laws&usg=AFQjCNFhOrLuuOq6YbchhdevHvAa8Pjjgg In your search bar put in 'scope of practice for medical assistants per state.' I know there are state regulations, but I read an article about federal regulations a while back. That's all we need is the feds adding additional regulations to nursing staff. If you put MA in your search, you will get all kinds of things, since MA can mean many things.
  14. taivin

    Panic attacks following never event.

    There is a list of "never events" listed on the CMS site. It's called a never event because it's never suppose to happen. If one of the events happens and the patient is harmed; the hospital must foot the bill for recovery from event. If you are a practicing nurse you should know what the never events are. Falls, UTI associated with a catheter, air embolism, any injury incurred at the hospital while patient admitted, advanced bed sores, etc... It doesn't matter what unit or facility you work in...the never events apply to all staff in any facility. The NQF updated theirs in 2012 and CMS has their own parameters that are directed at healthcare staff. Educate yourself to protect yourself.
  15. taivin

    Hospice Admission Nurse....appreciate any advice and tips

    Just skimmed the above advice. As an "admissions" person you probably won't be putting in foleys, IV's, etc... (that's for the caseworker). I'm not saying you could be doing an admission, and some kind of emergency would come up and some sort of actual bedside nursing skill would be needed, but admissions is more about paperwork, history, reviewing it all, and setting everything in order. Your job is to make sure that the family actually does qualify for hospice, all T's are crossed and I's are dotted; you go through it all. A thorough head to toe on the patient is imperative as well (to check for pressure sores, bruises, IV's, fractures, etc). Your own baseline is good to start off with. Question yourself as if it was you in the position; do they need a pressure relieving pad, turning schedule understood if bed bound, do they need a bsc if there isn't one ordered already, if patient still ambulatory is the house fall proofed...so much. I'm sure your company has a check list. If they don't; create one yourself. There are many signatures to get; many, many, questions are asked. You set things in motion such as ordering the comfort kit, the supplies that your hospice can give weekly, do they currently have necessary medications, etc... You are the face that introduces your company and teaches the family your hospices philosophy and services that are available to them. What is covered by the health insurance, etc... As for posting the DNR on the fridge, I don't do that unless they actually want me to. In many cases the kitchens are open areas visible to anyone entering, walking around, etc... What I do is pick out an area for the family to have a "command center" (cc). My cc idea came about to me one time I was working with this beautiful family when I first started out on my own as a caseworker. The layout of their house was open, so from the front room you could see the fridge directly. The hospital bed was set up in the front room; the person's house was on top of a hill that overlooked a fantastic view. What a view! Placement of the bed for the patient in the residential home is a critical decision (another topic); this allows for easier access of visitors and family instead of sticking the person away in a back bedroom, unless the patient wants it that way. No one yet that I've journeyed with has wanted to... anyway; the DNR had been posted on the fridge by the admission's nurse. On my first visit the son approached me, and asked if we couldn't be a little more discreet, and post the DNR somewhere where it wasn't so glaringly obvious. He told me that they all knew their mother was a DNR, but they didn't need to be reminded of it every hour of every minute (ours are bright green). So the cc idea came to me, and I posted it at the end of their kitchen island on the overhanging kitchen cabinet, along with putting all supplies, binders, medication documentation, etc... all right there in one place (including the 24 hour hospice phone line). I believe the family is entitled to privacy rights concerning the placement of the DNR as well. Posting it in areas visible to visitors and the like who do not have authority to have access to the patient's records appears to be a violation of their privacy rights. The DNR needs to be in the patient's possession (in the house) and available for review by authorized health care staff and family. As RNs, one of the more important hats we wear are as educators. Patient and family must understand why the DNR is in place, and what to do in case of any emergencies. In my state at the hospice I worked last, a correct DNR must be in place to qualify for hospice services paid for by CMS. It's not enough just to have a DNR, but that the DNR not have life supporting measure checked (as many do). It's often when admitting the person at their home, that you find life supporting choices have been checked. This is a much debated subject. This area can be a tricky one, since I'm usually shocked that whatever doctor/nurse didn't teach about why we don't check the box to give fluids for lifesaving measures, and some of the other ones that should be for the full/partial CPR area only. That's why as an admissions RN you need to make sure you go over the DNR carefully. If a change needs to be made, you do it right there as you should have DNR forms that can be redone with the family and then delivered to the doc for signature. (in my state anyway)...every state has different laws and then there's CMS rules, regulation, requirements. Also, many hospice companies have p/p that supplements the regulations for the facilities and the familie's convenience. In my experience it's two box that that are always checked; give antibiotics (Abs) can be given for blah, blah and supplemental nutrition via g-tube for life sustaining measures. I reassure the family and patient that checking the comfort care box can includes Abxs if a urine infection or cold presents to make the person comfortable (which we do if family wants), but that the two boxes can't be checked to qualify for hospice in the company I was with. Perhaps others can comment on this aspect from their experience and state'/CMS regulations/standing/rules. l Now I see how the previous poster's post turned out to be long...as I start explaining one thing, other things pop up in my head, as everything is related. Back to the posting of the DNR. It's important for the family to understand the DNR. I tell them call us not 911 if anything happens. Along with the DNR posted in the cc area, I also tape up the 24 hour hospice phone number for the family/patient to call for help/advice/anything. The DNR can also be put as the first page in the medication binder or what ever tool your hospice uses for record keeping at the house. The regulation in my state is that the DNR must be with the patient in the residence (accessible to all interested parties able to view patient's records). Now when the patient goes from hospital to home the DNR must be reviewed. If the DNR is changed, then it will become active after a doc signs off on it, which usually isn't a big hurdle...usually. It's not enough for the family or patient to sign off on it; a doctor must sign for the DNR to be active. Passing away at your home is a journey that should be taken with pride and dignity. Usually people have built their homes for many years and it's the very foundation where their children were raised; where they went through the stages of their lives. It is only fitting to take the biggest journey of your life at home. I am a huge advocate of passing at home. Review many of the questions and discussions on this site for hospice; lots of good reading. Good luck to you...
  16. taivin

    Quitting job during orientation?

    I know some people have been LUCKY getting what they want, but if I had a L/D nurse who hadn't even had a year of med/surg I would say give me another nurse (it happened with my second child). It was painfully obvious she didn't have a clue what she was doing. I can forgive that in med/surg, but not L/D. My girlfriend networked during school and got a L/D nurses to precept her into the position. You weren't happy with two jobs now...if you knew your hearts dream was with L/D you should have networked into it. Do have any idea what L/D nurses do? I am most sincere in that question. I believe far beyond your scope at this point. As far as your kids; don't be disillusioned that you will only have one sitter in your career. Do the med/surg; learn all you can, and network into the hospitals L/D, or apply elsewhere after a year...the posters telling you to do the year of med/surg, are the ones who know what's up. If you concentrate on how unhappy you are; your dream will come true. You can enjoy helping people in med/surg, if you realize that's what it takes to realize your dream