My DON is a Gem!

While I'm happy for you that the DNS listened to your concerns, I am concerned about starting a med pass at 5 am. For most people that's too early to be awakened. And, at least in Massachusetts, taking an apical pulse is not standard practice for anyone on Dig. As one doctor said to me, if they have no symptoms of dig toxicity, their hearts probably needs the extra 'squeeze' . Just a thought.

I'm a big proponent of less is more when it comes to meds. Is your medical director as much of a gem as the DNS? Can you shift a lot of the meds to the day shift? At one place I worked, many of the meds were given on 3-11 (not to say that isn't a busy shift) ...there is no reason a once a day med has to be given on the day shift.
As far as the blood sugars, the latest studies show that unless the resident is on insulin, doing daily or 4x's daily blood sugars don't improve the quality of life. And...if someone is getting coverage based on a finger stick, their whole insulin regimin should be looked at. I don't have all the answers, but we got cited once during survey because the lab tech came in to start her draws at 4am and that was only once a week.

Sue, it sounds like you're in a great place with great people and a great job!

Relax and enjoy your good fortunt. It is indeed well-deserved.

Sue,
I am so glad that you landed in such a nice facility. I agree with you on apicals for dig even tho here in MASS it usually is not done. I also like the early chem BG's esp for total feeds and those brittle, dementia pts who don't care what time it is, they are going to eat their stashed cookies, steal 2cal off of the med cart, LOL.
There is something sad behind all of our comments tho. Why are we all so astounded that a LTC facility has a DON who doesn't get ****** off at a suggestion by a nurse? Staff actually helping one another? Not very common. Respect for all staff? Also not common. Isn't that so sad? I love the elder population and would have happily done LTC and sub-acute forever, but I can't cope with the Napoleonic egos of some of the mgmt types, the fear of drug seeking family members of pts and staff lying in wait for nurses coming off shift (happened to co-worker) or violent CNA running me off the road for having the misfortune of witnessing pt abuse by said CNA (happened to ME!!!) The elderly are so vulnerable and in too many cases nurses are just leaving the industry burned out, chewed up and spit out. You are lucky that you found what may be a rare and decent place. BTW, did you see the news about the 100yo woman, a&o in Dartmouth, MA? She was murdered in her bed at a LTC facility near here. Talked to a few former co-workers there and for some reason no of us felt very shocked or surprised. Now that is sad.

Maureen

PS- Sorry to be such a downer. Maybe I will find a great facility like yours and be happy again. Your situations does give hope.

Very well stated. Other than getting run off the road by an angry CNA, I've pretty much experienced everything you mentioned. I think I could have been happy, too, working in LTC for much longer than I did but I could no longer take the disrespect I felt from management. We had staff who attacked each other verbally; it almost seemed like a game sometimes to see if the oncoming day shift could make the night staff cry. There were problems with gossip and the DON would preach about maintaining professionalism and not talking about each other. Yeah, right. She was the worst, gossiping about some staff during meetings! Then she'd turn around and blame the staff for poor morale.

My former DON once was responsible for a med error and she actually changed someone else's documentation to cover her backside. There were other incidents as well. I could not believe the lack of ethics. Shoot, I've written myself up for making a med error---it's not fun but it's the right thing to do. I am still outraged that the person who was supposed to be the nursing leader of the institution could not admit to an error, potentially put residents at risk and yet saw nothing wrong with changing someone else's charting so she could appear infallible. I could not handle the CYA mentality and ended up leaving a short time later.

The saddest thing is, it's the conscientious nurses who leave and the little Napoleons who stay. I left. Several CNAs left at the same time. The facility loses at least two staff members per week. They are advertising again for more help. Those who are left are working harder and getting even more burned out than they were before. The DON could care less. She sees nothing wrong with hiring and firing capriciously, with signing on staff who won't stay and outright lying to new staff about their work hours and expectations.

This really hits home for me because just yesterday I visited with a former resident who told me how much she appreciated the care I gave and how she wishes I'd return to LTC. I can't. I've been far too burned and don't want to ever repeat the experience I had at my former institution. I had thought maybe I was just at a very bad place but I'm afraid that the bad places far outnumber the good. It should not be that way.

Ultimately, care suffers. And that's the saddest part of it all.

If your pts don't mind being woken up an hour earlier for their meds, it'll really be great.

yup, take your time, proceed with caution....etc.....when you have the time...lol.....perhaps you can check out a patients meds and see a place to suggest a cut back....or other change......tiny little changes do add up in the end.....what is the ratio on the day shift? this is often (in my experience) the problem that impacts the noc shift....if days has too many patients per nurse, stuff gets shifted back to nocs....good luck