How safe are these practices? Help, new grad RN in LTC - page 2

Hi, thank you for reading, I will try to make this as short as possible. 1) started my noc shift; pm shift nurse told me about this non-compliant pt about her blood sugar being 400, and that she administered 10 units of... Read More

  1. 0
    You're going to find a lot of that in some LTCs...with the fall; don't wait. If you do an exam and determine there may be a break of course you call the MD and send the resident out. Don't wait... Eve and Noc have a responsibiltiy to inform the MDs (or their on-call) when emergent things happen no matter what time it is.

    With the BS...maybe that's her history and the parameters need to be changed.

    Good luck to you.

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  2. 0
    While you are orienting and beyond, one thing that should be your priority--
    Think about your practice, your patients, your interventions. Do not get caught up in "well this nurse told me that this nurse does such and so...." LTC is not easy, and the less you get involved in the gossip and bad mouthing the better. If there are people at the nurse's station that are doing hair or whatever....and you need to delegate something to them, delegate. Should they not comply, then that is another thing entirely, and can be disciplined. You can look to report to get a good backround on a patient's day. It is not an indication on how the patient is doing at present. You need to make your own decisions on your assessments based on the MD orders. And in this case, YOU assessed a patient that had a FBS that was indicative of a call to the doctor. You did not do so, even though along with that there was a change in vitals. That is some alarming changes that would indicate that the priority be on calling MD, and perhaps sending patient out to the ED for follow-up. NOT concentrating on "well this nurse lied, the girls are doing hair, nurse one said that nurse 2 is a liar, and I need to do neuro checks......" Most critical first. Always.
  3. 0
    Quote from Linka
    thank you for reading, I will try to make this as short as possible.
    1) started my noc shift; pm shift nurse told me about this non-compliant pt about her blood sugar being 400, and that she administered 10 units of regular insulin. husband's patient walks up and asks me to check on her because she is feeling sick, pm nurse still on the clock. pt has low BP with high pulse pressure, i think of checking her blood sugar, it's 591!! i thought i was gonna collapse. the pm nurse was supposed to call MD if blood sugar is more than 400, but she didn't. also, within 3 hours, her BS was down to 300, in the morning it was already 130. did she lie about only administering 10 units? was I supposed to call MD? what if the pt died on my shift because i believed that her bs was under control? this pt has a hx of liver disease, chronic renal (dialysis) and DM. this high blood sugar was after she went out with a pass and went to a buffet. isn't she liability???
    2) that nurse also had an unwitnessed fall and never started her neuro checks; i did and charted it, i couldn't call MD or ask for X-rays at night time...
    3) LVN's at night do their hair, nails and make-up at the nurse's station. not only highly unprofessional, but they are getting paid to do something else. one of them hangs out in anempty patient's room the whole night shift while I am STILL orienting and could be learning from someone for a change!!! the whole management is crazy over state coming in right now! idk what to do!
    1) I can't believe it's ethical to call the evening shift nurse a liar about the blood sugar and amount of insulin she gave. YOU should have called the MD for the CBG >400 that YOU checked on YOUR shift and just reported objective facts about the earlier CBG.

    2) You CAN call the MD for the pts fall and it SHOULD have been reported to the MD whether day or night. There is always someone on duty and your local hospital is open 24/7 correct?

    3) You need to stop worrying about what others are doing (makeup, nails, etc) and start worrying about what they're not doing.
    It doesn't mean a thing that the previous nurse didn't do this or that but when the patient is in YOUR care YOU are responsible. Unfortunately, you have to pick up the slack for what the prior shift didn't do and make the appropriate calls and start interventions.
  4. 0
    1) No matter what you believe, you need to go by what whas charted. All of the residents have rights...if they want to go out on LOA and eat it up, so be it. When they come back, an assessment should be done. After you found the RBG of 591. you should have called the doc no matter what time of the night.

    Same thing for a fall/ xray.
  5. 0
    I had a diabetic resident who ate the goodies her family brought to her. I spoke to other nurses about it and they said it was her right to be noncompliant. They told me to document and go on my way, since the doctor was aware. You can't put handcuffs on the resident when she goes to the buffet. You just have to deal with her physical condition when she gets back to the facility. Of course, that doesn't mean you can't counsel her, and document that counseling, concerning proper eating habits. She probably knows the lecture backwards and forwards, but she earns the right to hear it again, whenever she comes back satisfied.
  6. 0
    Doesn't matter what eve nurse did. You call doc and say BS 591...had 10 units of insulin....what's your advice.

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