http://allnurses.com Discuss nursing care of older adults living in group homes, senior communities, assisted living facilities (ALF), nursing homes (SNF); long term care nursing regulations; sharing ideas and networking en Fri, 20 Nov 2009 22:58:47 GMT vBulletin 60 http://img.an-file.info/misc/rss.jpg http://allnurses.com http://allnurses.com/geriatric-nurses-ltc/was-fired-today-440003-new.html Thu, 19 Nov 2009 18:04:26 GMT Today I was fired after being employed at a nursing facility for one week!! The administrator and... Today I was fired after being employed at a nursing facility for one week!! The administrator and DON fired me because apparently my preceptor nurse told them that I did not mix my liquid medications with orange juice. I mixed potassium as I always know to do but others I knew not to mix in juice, but the preceptor said that all liquids are to be mixed. I thought it was strange when I would take my residents their medication and they would ask me where is the liguid medicine and I would tell them its in their juice. Most would turn away and say that they weren't going to take it like that or that the other nurses know not to give them their medicine to them in that form. 2 or 3 residents threatened to report me if I did it again. All in all I was mad a complete fool this moring and was given my walking papers. I was supposed to been training today but DON told me to report later today so she could speak with me. I am just really speechless because I have been so careful in my nursing career and have even had to pass a few meds with State at my previous facility. But this facility felt that I would get them into serious trouble administering medications there. Last time I was fired from a job I was 15 years old and it was because a co-worker said I stole money in which later I was proven innocent when the cameras showed it was the co-worker who reported me. ]]> Geriatric Nurses and LTC Nursing TrickieTam http://allnurses.com/geriatric-nurses-ltc/was-fired-today-440003.html http://allnurses.com/geriatric-nurses-ltc/just-got-dream-439876-new.html Wed, 18 Nov 2009 23:05:12 GMT I'm so excited. I still don't have a start date but am told it should be around the end of this month or beginning of December.

This is a dream facility. The nurse manager and the DON are WONDERFUL! I knew when I went in to fill out an application that it was a warm and welcoming environment and they were unbelievably welcoming to me.

I will only have about 20 patients and something I guess is unheard of....unlimited orientation. They are all so supportive and they said they don't ever want anyone to feel uncomfortable so it's as long as I need! Oh and the DON even said early in the interview that they understand if a mistake happens, they want to work with you that both you and they learn how to prevent this in the future. (I didn't even ask so I was doubly impressed)

They are ending up creating a postion for me out of 2 shifts 3-11p and 7a-3p. Originally they thought they had an opening for the 3-11p but a nurse who has been off for 6mos for knee surgery decided to return just the day of my interview but they think I will fit in so much the DON is working to make it work!!!

It's mission based and the atmosphere is just indescrible. They even have a small aviary for the patients and in warmer weather an outdoor patio area with waterfall accents. All of that and they seem to want to "sell me" telling me how happy I will be and the low turnover. I could tell that right away though.

It's funny b/c orig I hadn't had that "warm/fuzzy" since my rotation at the burn unit. And before starting nursing school I actually thought of this exact facility as I heard of it through my church. It's unlike many of the revolving door LTC's that are abundant here. Anyway through nursing school they try to push you more to the hospital and though I still have an interest in BTU....who knows, I think being supported and *wanting* to go to your job makes all the difference.

I was lucky enough to meet the mgr for my desired shift when I went in that evening to fill out the application and she offered me a tour and I got to meet some of the other nurses who blew me away with their enthusiasm towards me. It then took awhile to meet the DON since she is swamped and now between creating a schedule for me and getting all the mandatory testing completed I guess it will be awhile longer and even though I want to be working, I feel truly blessed I found this.

Anyway I wanted to share the joy :dance: ]]> Geriatric Nurses and LTC Nursing kittyhawk http://allnurses.com/geriatric-nurses-ltc/just-got-dream-439876.html http://allnurses.com/geriatric-nurses-ltc/incident-reports-vs-439736-new.html Wed, 18 Nov 2009 05:54:30 GMT Hi. At my workplace, we were given new incident report forms to fill out. These forms require the... Hi. At my workplace, we were given new incident report forms to fill out. These forms require the nurse to take vital signs six times: immediately after the incident in the supine, sitting and standing positions. Plus, 5 minutes after the incident, we are to take the vitals again in the supine, sitting, and standing positions. I did not know we had new incident forms to fill out, and I only took the vitals once, since it was the usual procedure in the past. Plus, none of us nurses were inserviced on these new forms. I was off from work today, so I don't know what will happen to me because I didn't do it (the resident was sent to the hospital), but I found it odd that vitals had to be taken so many times during an incident. Six times? Is this a common procedure at your LTCF for incidents? What if the resident cannot be put into the sitting or standing position due to an injury after an incident?

In addition, the new report is 10 pages long, and often asks the same questions on different pages, such as what time the incident occured (I think I answered that 6 times!) and what time I last saw the resident, for instance. Plus, it requires us to have a medication evaluation by the pharmacy for side effects that might contribute to a fall. For a document that is supposedly internal-only, it was very time-consuming and redundant. Is this what incident reports at your LTCFs are like? ]]> Geriatric Nurses and LTC Nursing Plagueis http://allnurses.com/geriatric-nurses-ltc/incident-reports-vs-439736.html http://allnurses.com/geriatric-nurses-ltc/what-can-i-439466-new.html Mon, 16 Nov 2009 23:55:14 GMT So, we're having a dinner at work for any employee who's been there for more than 10 years. As the DNS, I have the largest number of attendees. I was told today that I have to come up with something to say about each one of them! Hmmm....that one has been here since I was 3 and takes 5 hours to do a one hour med pass....oh and that one....had oral sex with a resident but still has a job because of the union...I don't mind public speaking but this is too much. Can anyone help with something that sounds nice but isn't over the top? ]]> Geriatric Nurses and LTC Nursing CapeCodMermaid http://allnurses.com/geriatric-nurses-ltc/what-can-i-439466.html http://allnurses.com/geriatric-nurses-ltc/state-survey-bad-439413-new.html Mon, 16 Nov 2009 19:14:48 GMT I work in a facility that was on the verge of being closed down a year and a half ago. The place... I work in a facility that was on the verge of being closed down a year and a half ago. The place has a bad reputation but from the day I started I could see the potential in the place and the dedication of some of the staff. It just seems as if theyre just not sure of how to correct some of the problems. Most of the issues are simple issues such as keeping track of BM's, intake (even though they dont track output). Things that are common in other facilities. My frustration is that theyre trying to scramble to cover things up. For example, I was asked to add up the fluid intake of all the residents at the end of each day (I work night shift), which is fine, but my 4 weeks of orientation was on day shift, and not once did I see any aides or nurses go around and see what people actually ate. When you look at the books its obvious that they just filled in random numbers. Due to a heated discussion this morning between the floor secretary and the DON, I overheard the DON mention that if theyre under 1500cc intake for the day then the Nurse Manager is supposed to do something about it. I wasnt even aware of that facility policy because when I was orginally approached about it adding up the consumptions (this policy was just put into effect last week), the only instruction I received was to "add them up". Well, with all the numbers that were put in, most of the total amounts of fluid intake for the day only add up to 1440cc for the day. I suppose they'd be over 1500cc for the day if any snacks were actually recorded in the books, but there arent any. Ive also seen places where the nurses have to record the amount of fluids given with each med pass, but they dont do that here either. So if the state actually looks at all the totals for the month, these people have been under 1500 since the 1st...they'll question why is the Nse Manager just now doing something about the situation. Its the middle of the month! I tried to clarify what the DON said, but she didnt want to be pulled into the discussion. Unprofessional. I just dont understand why they want to give the illusion that theyre doing something when they really arent. I dont know, there's some good staff there, my night crew is great. The residents are great, its not their fault they couldnt go to a more high scale facility with a better reputation. They still deserve good care. I dont know whats going to happen, but I hope theyre able to stay afloat. ]]> Geriatric Nurses and LTC Nursing dulcemorena http://allnurses.com/geriatric-nurses-ltc/state-survey-bad-439413.html http://allnurses.com/geriatric-nurses-ltc/need-kardex-samples-440007-new.html Mon, 16 Nov 2009 10:00:30 GMT Hello, I am new to the site. I am also looking for any kardex samples that anyone is willing to... Hello, I am new to the site. I am also looking for any kardex samples that anyone is willing to share. I work in a LTAC 36 beds. We want initiate the use of a kardex. Any samples would be greatly appreciated, . Thankyou:bugeyes: ]]> Geriatric Nurses and LTC Nursing duchess921 http://allnurses.com/geriatric-nurses-ltc/need-kardex-samples-440007.html http://allnurses.com/geriatric-nurses-ltc/were-out-ideas-438881-new.html Fri, 13 Nov 2009 17:33:45 GMT We're out of ideas on how to handle this situation and I hope you can help us out.

We have a resident with Alzheimer's who is refusing to take showers. He can get very aggressive and will physically attack anyone who tries to talk to him about showering. The problem is that he's filthy and really smells bad. When he's incontinent of stool, he refuses to take his clothes off let alone shower. His wife becomes very agitated and starts screaming at the care staff, even going so far as to push them away.

We've tried everything from trying to talk to him, bribe him, even had several male care managers try in case he was too proud to allow a woman to bathe him but he still refused. We tried to talk to his family, but when they confronted the resident he insisted he did take a shower. They don't seem to want to get too involved.

Meanwhile he's very, very dirty and we're getting concerned for his health.

I work in a facility that frowns upon any form of restraint...either physical or chemical (meds). He does take low doses of antipsychotics and antianxiety meds.

I would appreciate ANY ideas you may have that would work. Anything that worked for you?

Thanks in advance ]]> Geriatric Nurses and LTC Nursing laurasc http://allnurses.com/geriatric-nurses-ltc/were-out-ideas-438881.html http://allnurses.com/geriatric-nurses-ltc/the-activities-dept-438756-new.html Thu, 12 Nov 2009 23:50:20 GMT Is it me or does the Activities department have the easiest job in the planet?? Watch movies, paint... Is it me or does the Activities department have the easiest job in the planet?? Watch movies, paint nails, bake cakes, coloring and listen to the radio, so easy!! ]]> Geriatric Nurses and LTC Nursing Ling07 http://allnurses.com/geriatric-nurses-ltc/the-activities-dept-438756.html http://allnurses.com/geriatric-nurses-ltc/geri-psych-unit-438728-new.html Thu, 12 Nov 2009 21:00:31 GMT Wondering what a geri-psych unit is like. Anyone ever worked on one of these units? Do you have... Wondering what a geri-psych unit is like. Anyone ever worked on one of these units? Do you have IV's, G-tubes, trachs? Or more just medication management and behavioral therapy? Much different than a regular psych unit? Thanks for any replies! ]]> Geriatric Nurses and LTC Nursing PAERRN20 http://allnurses.com/geriatric-nurses-ltc/geri-psych-unit-438728.html http://allnurses.com/geriatric-nurses-ltc/getting-narcotics-residents-438493-new.html Wed, 11 Nov 2009 20:56:17 GMT Ok, the FDA has decided to make new rules (Or inforce old ones I think) that now to obtain... Ok, the FDA has decided to make new rules (Or inforce old ones I think) that now to obtain narcotic for our residents our pharmacy has to have a actually written order from the doctor. Before if I took an order for Vocodin or any narc I could write the telephone order, fax to pharmacy and they would send. NOW its a big to-do. They need the written script! even when reordering these meds. It started out with just the Class C-II now its all the narcs! This is a pain, Residents are not getting their meds. We reorder, they fax DR he doesn't respond on time, and the resident is out of med for a couple of days! I know if state came in we would get cites for not giving the med. What do other nursing homes do? Is there a better system? The nurses are the ones calling doctor and pharmacy trying to get meds inbetween the med passes.


Thanks!
Kathy ]]> Geriatric Nurses and LTC Nursing kappykatlpn http://allnurses.com/geriatric-nurses-ltc/getting-narcotics-residents-438493.html http://allnurses.com/geriatric-nurses-ltc/stay-ltc-accept-438318-new.html Wed, 11 Nov 2009 01:05:00 GMT As I've previously posted, I am a new grad and have been working in LTC for approx. 6 months. Not really loving it (too many pts, never-ending med pass, etc) but I have been learning a lot, even starting to become attached to a few residents. A couple of months ago, I applied at a peds office for RN position, was turned down because they hired from within (it's owned by a hospital), but they said they were very impressed and would call me if something opens up, and they did!! :yeah:

Now I don't know what to do. I'm thinking about accepting this new position, but is it the best career move for me? Wondering if a future employer would be more interested in a nurse who worked in LTC or dr. office? Will it look like I bounce around too much? My ideal job would be in a hospital setting (but everyone knows they're not hiring us new grads!). I'm so torn, I don't know what to do. Any advice? ]]> Geriatric Nurses and LTC Nursing dekagirlsRN http://allnurses.com/geriatric-nurses-ltc/stay-ltc-accept-438318.html http://allnurses.com/geriatric-nurses-ltc/im-nurse-manager-438130-new.html Tue, 10 Nov 2009 14:30:09 GMT 44-bed unit, 6 weeks after getting in on nights as a floor nurse! Yippee ki o ki ay! 44-bed unit, 6 weeks after getting in on nights as a floor nurse!

Yippee ki o ki ay! ]]> Geriatric Nurses and LTC Nursing SuesquatchRN http://allnurses.com/geriatric-nurses-ltc/im-nurse-manager-438130.html http://allnurses.com/geriatric-nurses-ltc/new-don-cleaning-437758-new.html Sun, 08 Nov 2009 21:46:21 GMT I would like to hear stories of people who saw a home get cleaned out of staff because a new DON... I would like to hear stories of people who saw a home get cleaned out of staff because a new DON came in. It happened to me. Great eval's then when she came on I couldn't do anything right in her eyes. I have seen at least 20 nurses get fired in my short 7 year career and at least that many people just from the last home I worked at in the last 18 months.

Is this the norm in the nursing business? I have also seen DON's come and go on a regular basis. Why the high turn over? and this was a nursing home. ]]> Geriatric Nurses and LTC Nursing trimm http://allnurses.com/geriatric-nurses-ltc/new-don-cleaning-437758.html http://allnurses.com/geriatric-nurses-ltc/tcu-nurse-manager-437654-new.html Sun, 08 Nov 2009 12:27:40 GMT Hello All

This is my first post so I'm not sure if this is the best place to start this thread.

I am considering applying for a nurse manager position on a transitional care unit (19 beds) that is part of the hospital (222 beds) where I currently work in the ED as a staff RN. I'm hoping that I can get some idea of what they might offer in terms of salary so I know whether to even apply or not.

I have been an RN for 2.5 years with 6 months of that full time in critical care, then 14 months full time in patient placement at a different hospital, while at the same time I worked for my current employer as an occassional RN where I floated to all departments/units except OB and OR, and most recently I have been full time in the ED for the past 4-5 months. I live in Michigan and currently make $25/hr., not including my night shift diff.

I have been approached by management to apply for the nurse manager job so I'm confident that I will satisfy their experience requirements. In addition, I changed careers in my late-40s and do have a little experience in management outside of healthcare, plus a ton of "life experience" to bring to the table.

I have tried a few of the online salary calculators but there is a lot of discrepency between them. Any input I can get will be greatly appreciated! ]]> Geriatric Nurses and LTC Nursing GM2RN http://allnurses.com/geriatric-nurses-ltc/tcu-nurse-manager-437654.html http://allnurses.com/geriatric-nurses-ltc/if-you-could-437610-new.html Sun, 08 Nov 2009 02:37:23 GMT If I could create a perfect nursing home, it would be like: -NO CNAs with attitudes. You can... If I could create a perfect nursing home, it would be like:

-NO CNAs with attitudes. You can not have a nasty attitude and work in Geriatrics. It takes a lot of patience and compassion to work with the elderly and if you have a nasty attitude, how will that work?

-CNA/Resident ratio will be 5:1. I think it's unfair to give CNAs 10+ residents. Many of them are stressed out because of all the work. I would want them to spend time with the resident. Have them play games with them. I would want them to create a bond with the resident.

-Nurse/Resident ratio will be 10:1. The workload for the nurses is ridiculous. I'm not a nurse, I work with the administration side of things, but I can clearly see that the nurses have a lot to do. Like the CNAs, I want the nurses to build a relationship with the resident. How can you create a relationship with a resident if you're busy talking to pharmacy, passing out meds, charting, paperwork for administration and serving the residents for whatever need?

-I would pay CNAs $15 minimum. I think some of them would care more about their jobs if they made a little bit more.

-NO CELL PHONES ALLOWED. They must be locked up somewhere. It annoys me when I see a nurse on a cell phone.

-An equal amount of male and female nurses. Too many female nurses creates too much drama.

-No residents in the hallway!! That irriates me!!!!!!! That is a pet-peeve of mine. I do not like to see residents sitting in the hallway like they're useless. All residents must be placed in an activity room or sitting in their room watching TV. If a resident is in the hallway longer than 5 minutes, then the CNA will be written up.

-There would be a gated park outside of the building for the residents to sit around and get fresh air. GIVE THEM FRESH AIR!! Sometimes I want to shout this out loud when the nurses are wondering why a resident wants to escape. Give them a change of scenery!!

So there you have it, my perfect nursing homes. :) ]]> Geriatric Nurses and LTC Nursing Ling07 http://allnurses.com/geriatric-nurses-ltc/if-you-could-437610.html