TwoLayi

In the long-term acute care hospital I work at in CA all the nurses have been at 1:6 for tele and 1:7 med/surg every day, every shift for the last two weeks, with CNAs at 1:20. Alot of nurses think our facility is taking advantage of the situation because we don't have an ER, so technically we don't have to keep admitting patients without enough staff. Plus word on the street is that general acute care hospitals in our area are not or are rarely increasing the ratios. Plus most of the time, the charge nurse/relief nurse has patients so we don't get a break either.

If I was the OP, I would give a very vague answer and quickly change the subject. Such as " After nursing school and passing the NCLEX, I took a little time off. Since then I have been actively seeking full-time employment. I was was thrilled/excited when I saw the open position at this hospital because XYZ. Can you tell me more about the orientation process?" I would end with a question, so the interviewer can't try to dig deeper.

This patient had expressed a fear of dying in the hospital, prior to this prognosis. And at this point, the patient could go home on hospice. Also after the prognosis, the patient bought online tickets to event that is 6 months away, so I was a little concerned about that. Thank you for the examples! Now I know where to start.

I am looking for advice on how to respond to a patient who is in denial about their terminal illness. Patient is in an acute care setting and prognosis gives the patient about two weeks to live. MD has communicated all this to the patient and family. Patient has chosen NOT to go on hospice or change code status to DNR. And yes social services has been involved to discuss all this with the patient and family. The problem I am having as a nurse is responding to the patient when they talk about the future and getting better. I know denial is a stage in death and dying, so do I just play along with this fantasy? Usually, when this patient talks about the future, I just smile and nod. I feel like I am almost lying to the patient, but I don’t want to be cruel either. Any advice on what I might say to the patient to help them be more accepting?

Oh, I didn't realize that, but it makes sense. I have never been on it myself, but have worked with other coworkers who were.

I would look into SNF positions again, specifically MDS positions, which doesn't involve patient care or handling of medications. Also in the bay area, there are home health agencies-not through the hospital system, that have positions that are called "pediatric home health" or "school nurse". It is 1:1 respite care in the home or 1:1 nursing at school. It seems most of these agencies are desperate for nurses because they pay VERY little (for CA) due to federal reimbursement.

I did not mean legal as in breaking the law. But say a nurse administers medication and fails to document it right before her lunch break. The relief nurse comes, sees a medication is due, so he administers it and documents administration in the EMAR. And the patient dies from it. Who do you think will be charged with negligence?

I don't believe you did anything wrong, RT should have documented the administration of the neb treatment. I see a lot of responses saying that a lot of RT's don't document on time or wait until the end of their shift. This still doesn't make it right or legal! The scope of practice for RN's and RT's are very similar and the responsibility for the patient ultimately falls on the RN. Meaning if you were ever taken to court, saying that RT wasn't available WOULD NOT be a valid defense.

Nurses can be prescribed controlled medications and a medical review officer does review positive drug tests. Being prescribed a controlled medication does not prevent a person from becoming a nurse or getting a job. I think the real issue is why this nurse was being drug tested in the first place. Did the OP's employer suspect they were working on the job impaired? If the OP was displaying odd behavior or made an error, the employer might have ordered a drug test and reported the findings to the BON. If so, the BON may make the decision that the medication and/or mental health issues pose a danger to patient safety. If it were a pre-employment or random drug test, I don't believe the employer would be reporting this information to the BON, but I could be wrong.

From Texas BON "Texas Senate Bill 823 (1991) amended Section 671.001 of the Texas Health and Safety Code and gave RNs the legal authority to assess a patient/client and make a determination of death, unless the pronouncement is clearly prohibited under the Health and Safety Code (such as when an inquest is required). The bill specifically requires the RNs employing agency/facility to have written policies jointly developed and approved by the nursing and medical staff to direct the practice." HEALTH AND SAFETY CODE, TITLE 8. DEATH AND DISPOSITION OF THE BODY SUBTITLE A. DEATH, CHAPTER 671. DETERMINATION OF DEATH AND AUTOPSY REPORTS, SUBCHAPTER A. DETERMINATION OF DEATH Sec. 671.001. STANDARD USED IN DETERMINING DEATH. (a) A person is dead when, according to ordinary standards of medical practice, there is irreversible cessation of the person's spontaneous respiratory and circulatory functions. (b) If artificial means of support preclude a determination that a person's spontaneous respiratory and circulatory functions have ceased, the person is dead when, in the announced opinion of a physician, according to ordinary standards of medical practice, there is irreversible cessation of all spontaneous brain function. Death occurs when the relevant functions cease. (c) Death must be pronounced before artificial means of supporting a person's respiratory and circulatory functions are terminated. (d) A registered nurse, including an advanced practice registered nurse, or physician assistant may determine and pronounce a person dead in situations other than those described by Subsection (b) if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person. Those policies must include physician assistants who are credentialed or otherwise permitted to practice at the facility, institution, or entity. If the facility, institution, or entity has an organized nursing staff and an organized medical staff or medical consultant, the nursing staff and medical staff or consultant shall jointly develop and approve those policies. The executive commissioner of the Health and Human Services Commission shall adopt rules to govern policies for facilities, institutions, or entities that do not have organized nursing staffs and organized medical staffs or medical consultants.

I believe you are correct.

Playing the Devil's Advocate... Hi All, ICU nurse here with several years of experience. Recently I have been precepting a new grad to our unit. I let her observe at first because I don't really know how much she learned in school and what she feels comfortable with. But I am starting to get worried because she has taken no initiative. She just follows me around, asks zero questions, looks distressed when I do explain things to her and has failed to even introduce herself to our coworkers. And then when I gave her permission do very basic nursing stuff, she went to the bathroom and cried.

I once did in home care for a child who had petit mal seizures. In that case, there wasn't alot I did as a nurse, except record and document the time it started and stopped. With the child, they had a particular "tell" that indicated it was occurring, not sure if that happens with everyone. Also keep in mind safety and any meds they are taking for it. In addition, CHADD is an organization that can provide you more info about ADHD. And I would just review normal milestones, because these are healthy children Also keep in mind emotional/psych issues which I think will be most important will this particular population.

I realize this is an old topic but I felt I needed to add my two cents I was a RN floor nurse at an SNF and I really admire all the DON's who said they work the cart. I am not saying it should happen on the regular, but it shows real teamwork. In fact, I just quit my recent job because I was constantly mandated to stay overtime and some weeks I was forced to work 72 hrs, or lose my job. I was stressed, burned out and very unhappy. I could never make plans after work and constantly had to cancel appointments And it really pissed me off when our DON, would come in at 9 am and leave at 4 pm, when I had been there since 7 am and would probably be staying until 9 pm. If my DON had taken the med cart, even if for a few hours, I would've seen her in a different light. I would have felt we were in it together. But she didn't, that is why I am leaving and the other RN's have left. And this facility will lose a star(s)