[NickiLaughs]

I work at an assisted living. I just received a call from the other nurse working there that said that we got one of our residents back from the hospital and this resident now get's their blood sugar checked 4 x a day with sliding scale.
We are already there 7am-5pm. Now the administrator wants us to come back at 8pm to do the last blood sugar check on our work days. I'm sorry, but I already work 10 hours a day and living 1/2 an hour away. I'm not coming back. Our contracts say that we are oncall 24/7, however, that's for emergencies, not a normal established order!! Also, this lady has an order for PRN IV therapy. (we don't do that at our assisted living!)
Am I just losing it or is this totally nuts? Please respond!

[flwannaB]

You're right. That is ridiculous. It may be time to look for another job.

Originally Posted by NickiLaughs

I work at an assisted living. I just received a call from the other nurse working there that said that we got one of our residents back from the hospital and this resident now get's their blood sugar checked 4 x a day with sliding scale.
We are already there 7am-5pm. Now the administrator wants us to come back at 8pm to do the last blood sugar check on our work days. I'm sorry, but I already work 10 hours a day and living 1/2 an hour away. I'm not coming back. Our contracts say that we are oncall 24/7, however, that's for emergencies, not a normal established order!! Also, this lady has an order for PRN IV therapy. (we don't do that at our assisted living!)
Am I just losing it or is this totally nuts? Please respond!

[suebird3]

Originally Posted by NickiLaughs

I work at an assisted living. I just received a call from the other nurse working there that said that we got one of our residents back from the hospital and this resident now get's their blood sugar checked 4 x a day with sliding scale.
We are already there 7am-5pm. Now the administrator wants us to come back at 8pm to do the last blood sugar check on our work days. I'm sorry, but I already work 10 hours a day and living 1/2 an hour away. I'm not coming back. Our contracts say that we are oncall 24/7, however, that's for emergencies, not a normal established order!! Also, this lady has an order for PRN IV therapy. (we don't do that at our assisted living!)
Am I just losing it or is this totally nuts? Please respond!

To be honest, no....this is NOT nuts. Of course, most of the rezzies get knocked down to BID accuchecks. We have 25 of those. But, for the qid accuchecks (all one of them), we set them at 12-6-12-6. Perhaps you should contact the MD, ask him to change the order to BID, and DC the IV?

Suebird

[traumaRUs]

Not necessarily another job. To me it just seems as though this pt no longer meets the care requirements of your assisted living, so their care level needs to be bumped up. If this isn't possible at your facility, then they need to change to another higher level of care facility. I'm an ER case manager and this is something we try to prevent. You are right that if this pt requires this much care, they are beyond the assisted living stage at least at this point in time.

[VivaLasViejas]

I also work in assisted living, and we have several sliding-scale diabetics whom we manage just fine. We have very detailed instructions for the caregivers as to when SS insulin is to be given, how it is to be given, and what to do if blood sugars fall outside the parameters (which are individualized and specific to each resident). Each staff member who is delegated to perform these tasks is trained rigorously and knows exactly what to do if symptoms of hypo- or hyperglycemia appear. They also know to call me with any questions or concerns; most of these can be handled easily over the phone, whether day or night.

I have one med aide who is delegated to fill insulin syringes; otherwise, I do them each week as the need arises, and that of course keeps me up on how much insulin each resident is using, and enables me to contact their MD for a change in the program when appropriate. For example, I have a resident who's had horrible complications with her diabetes, and whose blood sugars were consistently high in the evenings; I got her on a small dose of Lantus every night, and her use of sliding scale insulin has decreased to near nothing (and without dropping her AM sugars).

I don't know how many residents you have or what your staffing is like, but I do know that sliding-scale diabetics CAN be managed in the ALF setting........it just takes some creativity, flexibility and of course, planning ahead. As for the IV issue, I've never seen it in assisted living either, but with home health agencies in most cities and towns, it seems that it could be done without too much hassle for the staff; it depends on what, exactly, "PRN" IV therapy consists of and what purpose it serves. Does the resident have a PICC or other long-term IV access, and if so, how is it maintained? What sort of medication(s) does he/she receive through the IV, and how do you know when to give it? Is it something that would conceivably need to be given more than once or twice a day, or is it just once in a rare while?

Feel free to PM me with more specifics if you'd like; there is more than one way to de-fur a feline, and as a proponent of 'aging in place', I've learned a few tricks to help keep ALF residents in their homes as long as possible.

[NickiLaughs]

THank you for responding. For further information: At my facility the LVN's are the only one's allowed to do accuchecks, otherwise it would not be an issue at all. The resident does not have a central line or anything. We would have to do the IV insert ourselves and do not have the equipment. (i'm the only LVN there that is IV certified.) My administrator basically said on top of the 10 hour shift she wants us to come back at 8pm and get paid a total of 15 minutes (no OT mind you) which wouldn't even pay for my gas to drive there and back. I believe my administrator is just trying to save another move out because census is low.

[VivaLasViejas]

Originally Posted by NickiLaughs

THank you for responding. For further information: At my facility the LVN's are the only one's allowed to do accuchecks, otherwise it would not be an issue at all. The resident does not have a central line or anything. We would have to do the IV insert ourselves and do not have the equipment. (i'm the only LVN there that is IV certified.) My administrator basically said on top of the 10 hour shift she wants us to come back at 8pm and get paid a total of 15 minutes (no OT mind you) which wouldn't even pay for my gas to drive there and back. I believe my administrator is just trying to save another move out because census is low.

Well, now that's something entirely different, and I don't blame you a bit for being less than enthusiastic about what the administrator wants you to do. (In fact, I'd be tempted to tell her to go chase a cat........but that's just me ). I do understand where she's coming from trying to avoid a move-out, but there are things we CAN do in assisted living, and things we CAN'T do---no matter how much we might wish it. This situation sounds like the latter........IF you had staff delegated for the blood sugars, and IF you had home health set up to deal with the IV stuff, it could possibly be managed, but with the scenario you've given me, there's no way. Unless, of course, you are willing to make the kind of sacrifices the administrator has asked for, and considering the stress level you are probably already experiencing (not to mention the price of gasoline!), she is WAAAAAAAY out of line.

I'm sorry this is happening to you. Good luck.

[NickiLaughs]

I'm so glad I found others who agreed. My administrator was furious I said "no" when they tried to call me in to do it tonight because the other nurse also refused, she stated she'd do it tonight; but that after tonight they needed to find an alternative solution, such as an on-call home health nurse or something. The administrator apparently is fuming, and stated that "we'll see about that tomorrow in the meeting with the company owner." My view is if she gets her way, her 2 best nurses (mainly because we're the ones who never call off) will be putting in their two weeks. So, it's really overall her loss, and perhaps my opportunity to finally try to get a job in a hospital!
Thanks again.