LTC-What is meant by "The skilled nursing area of LTC" - page 2

by Blackcat99 2,992 Views | 14 Comments

What is meant exactly by "The skilled nursing area of LTC". What would the nurse be doing if she were working in the "Skilled nursing area"? Thanks... Read More


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    Before I started working in Long Term Care I had this idea that it would be mostly passing meds and doing treatments. That is what sucks up most of my time, but I did not expect all the assessments, careplans, calling Dr , vital signs q shift (really?) , etc that need to be done as well. I cant believe I made it through my shift last night without having to call the Dr, order tests, or some other intervention. I did put 2 residents in the Dr book however. I think the Nurse to patient ratio needs to be cut in half for what is expected, I am in the middle of med pass at dinner , trying to get all my diabetics covered and then I have a resident O2 sat go down to 81, wont comply with her nasal cannula, physically fights me off when I try to take her O2 or put her cannula on. If I have to intervene with a sick resident, Im in big trouble with my med pass. There isnt even anyone there to answer the phone, I thought that the Nurse was not supposed to be interrupted during med pass? (Thats a joke)
    BrandonLPN, VANurse2010, and Blackcat99 like this.
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    I'm starting a FT 2nd shift job on a skilled/rehab hall. I'll have 10-15 residents and 1-2 aides. I've worked Dementia, LTC and Assisted Living, but not Rehab. I'm looking forward to having so few residents since I've always had 20-30 in the past.
    Blackcat99 likes this.
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    The skilled part of ltc, as it was explained to me, is when a resident requires the skills that only a nurse could provide, assessment and evaluation. Requiring assist with adl's, med pass, and anything that could be taught to an unlicensed individual such as insulin shots to a family member are not considered "skilled" in terms of meeting the Medicare A definition. You must have to show that the explicit skills of a nurse are required around the clock to meet the residents needs and nothing less will suffice.
    sallyrnrrt and Blackcat99 like this.
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    Whoa! I did NOT realize that a "SNF" admitted patients that were only 3'rd day post-op! And a ratio of 30:1....!?!?! (re: Brandon's post) No WONDER I'm so skeeerred to accept my job offer!
    Last edit by nervousnurse on Mar 1, '13 : Reason: clarify/ misspelling...as always..LOL!..
    Blackcat99 likes this.
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    Quote from CapeCodMermaid
    In Massachusetts, that is not true. We are called a skilled facility because we provide skilled care, but not all residents have what's considered a 'skill'.
    You will learn all sorts of new things working on a short term floor. We've just started to put in our own PICC and MID lines something you'd NEVER do if you worked at a hospital. The business is changing and those facilities and nurses who can change with it are the ones who will thrive.
    The business is indeed changing. I've been a nurse for 17 years now (jeesh) and 6 years a CNA before. LTC was what assisted living is now - but even that is changing with CNAs becoming med techs, etc..

    The reason why things are changing has to do with the cost of care. Hospitals are more expensive than LTC/Skilled Nursing Facilities. Nurses in SNFs take care of more patients. More patients equals less cost in salaries, lower reimbursement costs for insurance companies. And the more services a SNF can provide the better it is for insurance companies.

    It's definitely more interesting for nurses - lots to learn, but infinitely more frustrating and even scary at times given the acuity of the patients. SNFs that want to thrive in this environment have to be very supportive of their nurses with inservices on new procedures/equipment, appropriate staffing, and a teamwork environment. Otherwise, I foresee problems ahead.

    Facilities that have both LTC and skilled rehab patients need to make sure their LTC staff are equally comfortable taking care of both - requires different skill sets. I can't tell you how often we would have a rehab patient admitted to our LTC floor because there were no beds - and the admission orders or care given were inappropriate or lacking. (I worked both and would find that no orders were in place for hip precautions, PICC lines, labs such as PT INRs not scheduled, on and on and on.)
    Your staff should be IV certified.

    And there needs to be recognition that tasks that now can be performed at the bedside take TIME - one of the reasons their are teams in place to do blood work and PICC lines is to free the RNs up in the hospital to take care of their patients.

    Supervisors need to have a very hands on role to make sure their nurses can adequately and safely take care of the amount of patients they have and meet all the requirements of the business - charting etc - all key to successful reimbursement.

    I'm not so sure the changes are good changes by the way. Interesting, challenging but these settings already have staffing challenges and concerns over the quality of patient care as it is. Turn over in staff may be huge and patient care could be very unsafe. Time will tell..,
    Blackcat99 likes this.


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