Mandatory overtime

By Attorney Michael J. Sacopulos and Dr. Erik P. Southard DNP, FNP-BC

Q: We can call in sick up to three hours before our shift. I woke up sick last

I became weak with cold symptoms and past the magic three hours, so I went to work. It was an exhausting shift. I could hardly think straight and my replacement nurse did not show up.

The scheduler said that no per diem nurse will come in for this shift. My supervisor said I will be fired for job abandonment if I went home. I had to work another eight hours. I was really concerned I was not giving proper care.
Who would be liable, if I made a mistake? Does just stating that I don’t feel capable of doing another shift enough to protect me?

A:  While your situation is unfortunate, it is not shocking. We hear of nurses forced to work overtime with some regularity. Your questions need to be examined on two fronts; the duties to your employer and the duties to your patients.  Federal Law states that more than 40 hours per week is considered overtime. Federal Law does not specify hours per day or shifts in a row, but
simply looks at a 40 hour work week. However, many states have specific laws that relate to the number of hours worked in a day. Your question does not specify where you live so we recommend you check with a local attorney.
We can tell you that 16 states have statues and regulations specifically addressing overtime requirements for nurses. How many hours one can work and compensation rates vary by state.  Your questions seem to get at the heart of the
matter. As a nurse you have both legal and ethical duties to your patients. We can tell you that both could be liable if you make a mistake while treating a patient. Your actions will be judged by the normal standard of care for a nurse performing the duties in question. The standard of care does not factor in how tired or overworked you were at the time.

You owe both a legal and ethical duty to your patient to provide quality care. Those duties do not change because a supervisor requests you work a
double shift.  We point out that a number of states have specific regulations that address this topic. Further, the American Association of Critical-Care Nurses
offers some assistance on this topic. While every situation is different, as a general rule we advise that the downside risks of working beyond what you feel is safe are far greater than negative employment consequences. Be safe and thanks for the question.

The President and CEO of Southard & Associates L.L.C. Erik, Director of the Doctor of Nursing Practice Program and Assistant Professor in the Department of Advanced Practice Nursing at Indiana State University, enjoys teaching and serving his alma mater. He continues to work as a family nurse practitioner treating patients of all ages for acute and chronic health conditions.  He is a proud graduate of Vincennes University, Indiana State University and Johns Hopkins University. He is an avid outdoors man and loves spending time with his
family. Erik resides in Terre Haute, IN with his wife Rebekah and daughter Breanna.

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Nursing Assessment

Nursing Assessment

Every patient is assessed by an nurse upon admission. This nursing assessment will cover every system of the body. This is the first time your loved ones wishes and history are recorded.

There are two parts to the  nursing assessment.  If an LPN is deemed competent by the RN the LPN can do the one part. This assessment will cover every system of your body.  Depending upon your nurses experience and time allotted, your assessment can either be thorough or hurried and incomplete.   Every RN has to have their first job, and your family may very well be one of their first patients. In college the RN will likely have clinical experience in a hospital, but that’s not true in every college. They may be receiving training from the LPN.

This the first time your wishes are heard and your history recorded.  It is important to get the nursing assessment done correctly if you should ever go to court over your care. Your care plan will be made upon the information in your assessment. A family may request a copy in writing, but most likely will only be allowed to read certain parts of it with a RN or LPN watching. The facility will most likely tell you they are there to help explain medical jargon; however it is so you don’t take pictures or remove parts of the chart. The nursing home may make copies of only the parts they are willing to let you see.

Depending upon your specific illness or problems, the nursing assessment should take at least 2 hours. It may take more for instance if you have several wounds to measure and dress, or a long cardiac history.  Based upon the assessment the nurse may ask the doctor for more lab work, scans or x-rays

 

 

Body Systems and the Nursing Assessment:

Cardiac:

Your nurse should listen to your heart with a stethoscope.  If you brought cardiac strips, or EKG’s, showing their heart rhythm, they should be attached to your chart at this time.  You will be asked about your cardiac history, medicines and pain.

Respiratory:

Your nurse will listen to your lungs.  Your 02 saturation, which shows how well your body is using the oxygen you are breathing in, will be taken as well.  Your respiratory history and medicine list will be written down, including notations about any shortness of breath and pain you are experiencing.

Neurological:

You may be given a mini mental exam and a neurological test.  You will be asked about your memory, any dizziness and headaches.  Caution:  you may be categorized on your whole visit based on this one set of questions.  It is a big deal, especially if you are not in your peak condition when this assessment is taking place.  While it is necessary to have this done on admission, you may want to request a reassessment later to get a truer picture of who you really are.

 

Categorization means how the nursing population will think about you. It will not be written down, however passed on between nurses. They may say, this one is a drug seeker, or has a history of beating his wife. These things can make a difference in how the nurses view and treat a person.

GI:

This assessment includes your abdomen and bowel status.  Your diet will be discussed, including food preferences and allergies.  Your nurse will listen to four areas of your abdomen, and to your bowel sounds which may vary in pitch and intensity.  Your nurse will ask about your stool habits.

Urinary:

You will be asked about pain and any problems.   You may be asked to give a urine sample.

Skin:

Your entire body should be checked.  Wounds will be inspected and measured, scars noted as well.

Reproductive:

These areas will be inspected and any questions should be asked in a respectful manner.  Be sure to be candid about infection and discharges.

Ambulatory:

Your gait and balance will be inspected.  Be sure to discuss pain or weakness so a plan can be put in place to strengthen you.  In fact, this should be a main focus for any facility.  Tell your nurse of any history of falls.

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Pain Control

Does your doctor know where you hurt?  Here are some tips which will help you communicate more effectively with your physician about pain control.
Types of Pain:
Short-term (accidents and surgery)
Long-term (cancer)
Chronic (back pain)
Ways to treat pain
Medication
Feedback
Tens Unit

 

How to talk about your pain so your doctor will understand:

  • Be specific about where you feel your pain
  • Describe the feeling: sharp, dull, burning, throbbing, steady, intermittent
  • How severe is it on scale of 1-10
  • How often do you experience it
  • How does it restrict your life
  • What you have done to relieve the pain
  • Is there anything which makes the pain appear or worsen

Know your PRN or medicines that you can request if the need arises. Don’t allow your pain to get out of control because you think you can handle it. It then takes more medicine and more time to bring severe pain back under control.

 

 

 

Response to working the holidays

By Kathleen S. Martin, M.S.W, L.C.S.W

Kathy Martin does individual, marriage and family psychotherapy in Palm Beach
Gardens, FL. Her new book God and Psychobabble is available where books are
sold. Have

 

Thank you friend for your question concerning working nights, weekends and holidays.  OUCH!!!!  Who among us wants those shifts!  No one.  One of the problems we have however is that certain jobs must be covered on weekends, holidays etc.  What ever would we do without a police force on duty over Christmas?  I suspect all honest people would have their Christmas presents stolen!  And what about all those drunk drivers and car accidents over the holidays especially New Year’s Eve?  Ambulances off duty?  Hospitals closed?  Nurses and doctors home for the holidays?

Now the number one common denominator for all depression is unrealistic expectations.  What that tells me is that perhaps you entered the nursing field with such unrealistic expectations.  Anotherwards, you chose a field of work that clearly required these undesirable work shifts.  But now you are fully trained and employed as a nurse.  Did you unrealistically think the rules of the game were suddenly going to change?  Of course they weren’t going to change therefore the only change that needs to occur is with you, with what goes on between those earlobes of yours.  🙂

First of all realize

you have chosen

a profession that is of utmost importance hence it is hardly a nine to five job.  It is a job with deep purpose and commitment.  Patients and families of your patients you’ve worked with REMEMBER you for your sacrifice, compassion and work ethic.  That’s a gift given to very few professions.  When I see a former client whose marriage

has been restored or whose depression has been lifted due in part to my efforts, that truly goes a long way in working past the late calls or interrupted family functions.  Take time to meditate on what you HAVE, on the many benefits and blessings derived from your profession, rather on all that you DON’T have the better work schedule.

Next you can realize that we are in a marvelous country where we are for the most part in control of our work situations.  If the nights, weekends and holidays are simply too problematic for you your nursing skills can certainly be used in an office setting.  Many nurses move to office settings due to such family issues or scheduling conflicts for children etc.  Like every job out there we have benefits and deficits.  You might find the office more or less rewarding, more or less stressful, etc.  There might be a change in your pay scale or benefits package however no situation gives us everything we want.  Therefore, compromise is always the key to a well life.  Figure your priorities and the adjust your job situation accordingly.

A final possibility might be to work within the job situation you already have.  Have you approached your supervisor concerning taking turns working weekends or holidays?  I have rarely seen a nurse be pressured to work on both Thanksgiving as well as Christmas.  And if you do get ALL the holiday shifts it is probably due to the fact that you are the most recently hired employee.  Anotherwards, be patient.  In time the shifts should adjust as you acquire more time at your place of work.  You can also talk to fellow nurses to exchange holidays—the Passover shift for the Christmas shift, Memorial Day when you have that big family picnic for July fourth which perhaps has been a less celebrated day in your family.  When you approach supervisors with SOLUTIONS rather than just PROBLEMS they are far more apt to adopt your solutions as it is their job to run a smooth ship!  The most important issue however, is for you to MAKE a decision as to what you want to do and then MAKE that decision work!  Contentedness concerning your job situation will be achieved between those two earlobes of yours realizing no job has it all.  REALISTIC thinking is the key.  Whatever you decide, I thank you for the times you have been there for all of us on those very inconvenient times.

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Working the holidays

Enjoy the holiday, even when you work.

 

Working the holidays?  Have the holidays have lost their luster?  Traditions, holidays and parties make our lives special.   They are a necessary activity for healthy nurses to participate in.  But, we give them up, or at best squeeze into them at the last minute – out of breath and exhausted, as if just barely showing up is good enough.

If you are working the holidays, you will have to find a way to put the joy back into your day.  There are several things you can make it through.  The good news is that you will enjoy it better if you plan ahead.

An important part of your holiday is food preparation. There are many supermarkets and restaurants that sell quality pre-made food. Using these give you a chance to make only your star dishes.   Also, you can also teach older children or family to cook part of the meal.  Or, you may want to cook ahead, and freeze or refrigerate items.  If you are working an especially long shift, you may want to eat out.

Little touches are important.    Don’t forget to decorate the table, and add some nice music.  If eating out, bring items to put on the table to personalize your time.  Don’t worry what other people think; most of them will be jealous.   I have brought a table cloth, candles, and ornaments, and decorated my table.  Many people came by and commented on how nice my table looked, and wished they had the foresight to do the same.

Dress up, and wear makeup even if you have to pack your clothes and change at work.  Always dress for your special days.  It gives you a much needed emotional boost when you look in sync with the holiday.

Documentation is not only important at work, but during your holiday.  Take pictures, videos and keep mementos.  Write in a book or on your computer how it all went down.  You will be glad you did, later when you have enough energy to review it.  You can then create the memory books that you and your family will enjoy year after year.

Consider that even if you had a couple days off, you may still feel stressed during the holidays, so while feeling no stress is an achievable goal, most of your stay at home friends and neighbors are still feeling stress trying to get their long lists done.  Don’t waste your emotional energy comparing the perky energetic people who may have shown up at your party or fest.  Pat yourself on the back, relax, and ask them do a little serving and management for you.  Your job, now that you have arrived is to relax and enjoy.

A lot of nurses will celebrate either ahead of / or after the holiday.  Many are happy with that, and in many ways it can make you feel special to be celebrating against the traditional day.  I would however recommend doing this as a last resort, as a lot of people report this just makes them feel more out of sync with the society.  But, if you are working a 16 hour shift, it isn’t always appropriate to celebrate Christmas with your young children at two in the morning.

It may be too late for this year, but consider the best alternative for next year.  It is important that you schedule your holidays off now for next year.  Pull out your new calendar and mark out your work schedule, and your paydays.  That way you will be able to see quickly what days you need off.  Consider birthdays, anniversaries, graduations and weddings. Request them off now – January 2nd.  Don’t wait until someone else beats you to the day you want.

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Minimum Standards in Patient Care

                      Minimum standards in patient care

Meeting Minimum standards in patient care seems like a no-brainer.  However, nursing homes have taken the very least required care mandated by law, and turned that into something admirable.   Being the least you can be to barely pass isn’t good, it’s despicable.  Nursing homes should be boasting they far exceed these minimum standards.  How much nursing hours you will receive is an important marker.  Does a nursing home only barely meet these standards, or are they exceeding them?

Your mother, deserves to be happy, safe and well cared for. Unlock the secrets they are hiding of infection, abuse, and neglect. Find a place you can trust, danger free and well-staffed. We make it easy to find the ones who will protect your mother. The first line of defense is our calculator, giving your accurate data on every home in America. The second line of defense is our odometer showing you what is accurately happening across the United States.

We give you all the information you need to know in the blogs in four areas such as, “about you“, “Medicines“, “Equipment” and “assessment“.

What are minimum standards?  Minimum standards are what nursing facilities use to prove they are giving good care.  The government sets the standards by noting how much nursing care is needed.  The lowest possible standards are the minimum standards.

What is wrong with minimum standards? The minimum pay rate is $7.25 as I write this in 2016. That standard is not livable, yet the government insists it is. The minimum requirements for marriage is that you have to have reached a certain age, and you must have a pulse. Minimum does not give you a lot. While I can’t guarantee any Nursing home’s safety, I can give you quick and easy to use tools to increase your odds of finding the best facility in your area. Smart Pick Nursing Home will quickly calculate staffing in any Nursing home.

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Emma was a victim of nursing home theft.

 

Emma was born in 1925. She worked hard her whole life, giving to others.  Yet when she was at her most vulnerable a nurse stole her wedding ring.  This is her story.

 

Nursing home theft is common.  Don’t be a victim of theft in a nursing home. 

Emma lived in an orphanage in Chaska, MN.  There is a plantation on Highway 41 close to the Flying Cloud Airport. When Emma was six, she was sent to live in the plantation every year until she turned 18.  The orphanage routinely farmed out the children to earn income.  Emma lived on a plantation with approximately 100 other children.  The orphanage built cinder block one room buildings, where children slept on cots lined up 20 to a hut.  At 5 a.m. the children were lined up and fed, before beginning a long day of work.  They worked from sun up to sundown.  They each had the same quota, whether very young or an older teenager.  If a child didn’t meet that quota, they would not be fed the next day.

Emma recalled when the measles ravaged the camp one year.  She said being sick didn’t mean you could get out of work.  You just worked sick.  She remembered children who died on their cots, overworked and exhausted.  The children’s bodies were just taken away, and Emma never saw them again.

The children working on the plantation weren’t given new clothes, and they didn’t have shoes, as they were constantly walking in the mud of the plantation.  The huts were very hot in summer and very cold in spring and fall.  There was no time to be a child.

Upon becoming 18, Emma was turned loose into society.  She got a job in a dairy.  That is where she met her husband, Albert.  One day he

proposed.  When they were married, he gave her the best ring he could afford, and she cherished it.  She stared at it for hours, hardly able to believe anything as lovely belonged on her finger.

They worked hard, saved and eventually bought the dairy.  In those days’ milk was delivered to your doorstep because of lack of refrigeration.  But as the years passed, the supermarkets took away the need for door to door milk distribution.   Emma and Albert had purchased a home in downtown Chaska and raised four children.

 

Emma and her ring were the source of pride in the family.  She displayed it prominently in every photograph.  Emma took it to the jeweler to be cleaned every year.  She looked at her ring as more than the love her and Albert shared, but also that she was free from hard labor.  It was her symbol of emancipation.  (Story as told to me by Emma while I cared for her and her husband in their home.)

 

It was late in 2001 when Albert took sick and died.  As time went on the family noticed Emma forgot things, such as where the grocery store was, and even their names.  She had also become unsteady when she walked.  The family finally admitted Emma into a local nursing home.  Her forgetfulness increased until she forgot her beloved Albert even existed.

 

One day a traveling nurse gave Emma an extra dose of her evening painkiller, and while Emma slept, the nurse removed Emma’s wedding ring.  The nurse pawned her ring in a neighboring city.  When Emma awoke the next morning, she didn’t remember she even had a ring.  It was her children who discovered it was gone and called authorities.  Thankfully the ring was found and returned.

 

Best Nursing Home Inspection will cover how to prevent theft in a nursing home.  It is possible for residents not to be a victim of this crime.  But you need to have the facts and make a plan in order to stay safe from thieves.

 

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Getting your money’s worth from a nursing conference

Elaborate planning goes into the logistics of getting yourself to conference; the trip, the hotel and the food. But more important is the preparation you need to do in order to get your money’s worth. It is important to take time to study the brochures finding out which topics will be covered. When you don’t plan you will get the left overs. Plenty of people sign up in advance and get the best sessions and they fill or early. By waiting until you arrive at the conference you will be behind every one else right from beginning, with a little hope of catching up.

 

The first thing you want to do is to download any information the association has made available, it will be a topic list. You will benefit by looking up speakers online getting to know their views in advance. When you look at websites don’t forget to look at all the links, especially the ones at the bottom at the site. They may not look especially interesting, but many informational of gems are hidden there. Make a file and print things out. Then highlight things that interests you. Write down any questions. Feel free to contact the conference well in advance for the answers you need.

 

Before you leave home, drive to an office supply store and purchase a business card kit. Make up lots of cards containing your name and email address. You will meet many people, if you collect cards and are diligent to write a little something about the person who gave you the card on its back, this will ignite your memory after you get home. Lasting contacts are made when you email a few days later. Networking is just as simple as that.

The main topics will be held in a large room, and there could be thousands of people in attendance. The secondary sessions will be in satellite areas meeting at different times throughout the conference. It is ultra-important to know which sessions you want to attend, as seating may be limited in the smaller sessions. Most sessions will hand out CEU’s. . Make sure you get your paperwork. There is usually a question and answer time at the end of breakout sessions, so be prepared in it advance.

 

When you get into any session look around and find interesting people to sit next to. Stay away from bored looking people, if you happen to find yourself next to a complainer just move to a different seat. You’ll be able to strike up a conversation easily and, score possible friends.

 

There will be booths with representatives, jobs, schools uniforms, and a host of other things. Each vendor is vying for your attention, but since you have already checked the website at out in advance, you already know most of the best vendors. But scope them out and zero in on the most interesting ones first. They will hand out freebies and information. Now is a time to ask vendors for their business cards and find out if they will be around when things quiet down. Remember during the crush of the crowd you may not find an opportunity for the extended talk, but you can set up a meeting for later.

 

When you apply yourself to the process, you will leave conference changed person. You will have coveted business contracts from other nurses and professionals. You will also have new CEU’s use for renewing your license. Your future has been expanded. Make sure mixture you maintain and follow up on the many things you learned. When you get home you can measure your successful experience against the price of a ticket, knowing you have invested in yourself. Then you will know that you have gotten your money’s worth.

 

 

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