But you kinda did. The formula is a re-imbursible "medication" being paid for for medicaid. You stated that you pour it in the feed bag, even though it's been prepared by the mom, NOT you.
I get it, I do. I have been a PDN nurse. I never poured formula prepared by someone else. I would mix up what I would need for my shift and use that.
How would I break down the 10 scoops and 1860mls of water for an 8 hr shift?
A new 485 with new agency should have been made in May,but we haven't had a new one since.....
The math for my PDN case was simpler, LOL! The fact remains that you DID give a "medication" prepared by somebody else, even though you said you never ever do that.
How many nurses stand to be affected by this cutthroat decree?
How would I break down the 10 scoops and 1860mls of water for an 8 hr shift?
A new 485 with new agency should have been made in May,but we haven't had a new one since.....
If this agency is "cleaning house" on those with a valid reason, then it needs to happen; pts in PDN are sicker than ever and need consistent, competent care; just because one works in PDN doesn't mean they can't adhere to best standards and practices just because they are in someone's home.
They differ from agency to agency.
I only had an hour orientation when our cases transitioned to the new agency.
With this agency,we don't count narcs.
We were told"We dont want the nurses held responsible if something happens".
That went well until a bottle of Oxycodone went missing......
The math for my PDN case was simpler, LOL! The fact remains that you DID give a "medication" prepared by somebody else, even though you said you never ever do that.
How many nurses stand to be affected by this cutthroat decree?
How would I break down the 10 scoops and 1860mls of water for an 8 hr shift?
A new 485 with new agency should have been made in May,but we haven't had a new one since.....
That can be rectified through teachable moments and getting the supervisor and provider involved so that the plan of care can reflect the best care.
Yes, there are many "gray areas"; however, that's no excuse to not assess and use the nursing process while we are in someone's home... I ALWAYS had practiced best practice and documented any changes and kept my supervisors and provider in the loop, no matter what shift I was on, and I worked all three shifts in PDN-no excuse.
How would I break down the 10 scoops and 1860mls of water for an 8 hr shift?
By using simple math for the water and the scoop ratio; dimensional analysis, OR better yet, contact the physician's office and they can break it down for you.
A new 485 with new agency should have been made in May,but we haven't had a new one since.....
Then that's when you notify the supervisor and go from there-most supervisors are inundated with tons of cases; you pester then until you make sure you are adhering to the right POC-because things may have changed, and even following an "expired" POC may have consequences as well.
I only had an hour orientation when our cases transitioned to the new agency.
With this agency,we don't count narcs.
We were told"We dont want the nurses held responsible if something happens".
That went well until a bottle of Oxycodone went missing......
There was no signed release form In the home.
Then if there issues with the agency(ies) then it's up to you to advocate for a) more and proper training; b) if something doesn't go weight by notifying the right agency and provider-and go higher up the gain if you are ignored.
By doing those two simple things and having documentation on doing so probably would've prevented you possibly losing your license, because that's where you are headed, regardless of the politics and other flimsy examples that you produce on here, YOU, and other nurses, are left holding the bag and possibly losing your licenses for failure to follow proper procedure and potentially harming a pt who was not to have cow's milk...what if the pt ended up with a serious allergic reaction? What would've you done?
Don't you comprehend the serious actions that you have participated in?
I have no argument with PDN nurses here. My eyes have been opened.
But if a new nurse is oriented in a "this is the way we do it" way, she might think it's ok.
If every other nurse on the case provides the same care in the same way, she might think it's correct.
In this "whatever makes the customer happy" atmosphere, I can see why the OP thought it was OK to let the Mom call the shots.
The OP was wrong and she's in big trouble. I just completely understand how she got there.
I understand too because I have worked with nurses that have NO idea what to do in a PDN situation, but they are just a warm body and are not doing their due diligence; some have lost their licenses because they were too "customer happy" and the parent turned on them...these issue were brought up by one of my agencies, and trained on those pitfalls, other agencies, not so much.
Regardless of the agency, as a new grad that has started in PDN as a LPN, I self studied, utilized resources and looked up statutes and standards to care; I advocated and taught to ensure that my pts were safe and their caregivers were mostly doing the right thing-of course there are going to be differences and preferences; as long as the safety wasn't compromised, I made sure the agency and the provider knew so that as longs as it was acceptable, it was in the plan of care.
I made sure every bring that I did was prudent-I have pts and a license to protect; those aspects helped me be a competent and better nurse and stronger nurse.
Falling in line and "following orders" didn't fly in court or in any setting; and it doesn't have a place in PDN; I don't blame any company that wants to do a 180 and comply if they want to make money-failure to comply to cMs standards are a serious offense.
I don't blame the nursing supervisor for being prudent and doing what a prudent nurse is doing to ensure safety for pts...I can't find fault with that either.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
When I discover that the mom is doing something different than the order, I talk to her about it. If she stands her ground about the discrepancy, then I take the necessary steps to get the order changed by the doctor, with an intervening written communication note to the nursing supervisor.
This is what I would do, too.
I recall a situation with an adult client when I needed to replace the Foley and was told to use petroleum jelly as a lubricant, and "every other nurse I've had in years does it that way". I had no reason to doubt that statement, I wouldn't immediately assume they were all bad nurses in general. I refused to use petroleum jelly nevertheless. Using formula prepared by someone else is something I likewise wouldn't do, but the situation you describe doesn't sound much different from other conflicts I'm aware of in PDN.
I recall another situation when someone wanted to use sea kelp extract powder or some other weird dietary supplement (patient on regular diet) I got a stern talking to by another nurse who said we needed an order for that. I thought that excessive at the time, but later realized she was right.
I've had nursing supervisors who are accepting of habits private duty families develop over the years, and some who are "strictly by the book". Families can threaten to switch agencies, so there is some pressure on supervisors to "look the other way" as well. I have not seen a supervisor report all the nurses on a case to the BON, but I imagine there will be some repercussions in terms of the family continuing with that agency.
She's right. Mom can prepare the formula in front of me or I can prepare it myself. No other choice would be acceptable to me, not even the mom pouring formula she mixed earlier into the bag because I am still the one administering it. Mom can either do it my way or find someone else to care for her child. I'm not willing to put my license at risk to accommodator her.
smartnurse1982
1,775 Posts
How would I break down the 10 scoops and 1860mls of water for an 8 hr shift?
A new 485 with new agency should have been made in May,but we haven't had a new one since.....