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This is a discussion on New Grad in SNF in Geriatric Nurses / LTC Nursing, part of Nursing Specialties ... I am a new grad that recently got hired at a SNF and want to know if this is normal. I had...by rene2010 Feb 25, '12I am a new grad that recently got hired at a SNF and want to know if this is normal. I had orientation last night for the 10pm to 6am shift. The nurse that was orienting me first got all the meds for the night, then about 11pm charted that every resident had 0 pain, was sleeping, 0 interventions, and that every resident voided 2 times for the shift. He then went to pass meds, which included a breathing treatment, which the order stated to check lung sounds before and after the treatment, which he didn't do and just charted "clear." He went to give a bp med, which said to hold if sbp <115, and when I asked about checking the bp he said this pt always has around 140 so no need to check. He also said even though state wants us to wash our hands between patients there is no time to do that so he never did. He had a couple residents that asked for something, which I offered to do and he told me not to because that is the CNA's job (which was nowhere to be found, so I did it anyway and it was things that took just a few seconds to do). After med pass, we sat down to chart assessments. He just copied the assessment from the notes the day before and when I asked he said there's no way to actually do all the assessments because it would take too long so he just copies them. He wanted me to do the same and I told him I feel uncomfortable and will not just copy the shift's before notes as my assessment when I haven't even been in that patients room. Every time I would question anything he would make remarks to the other nurse or CNA like the orientee wants to know why we don't do this while everyone laughed about it. He was complaining I wasn't doing any charting so I told him to tell me which patient to do and I would do it. He gave me one and at top there is a place for vitals. The CNA's vital sign paper only had pulse and bp, so I asked him about the temp and resp. He told me to just write a temp and resp that are within normal limits. I said "you want me to just make them up?' and he said yes unless I want to bring my own thermometer, which I find strange that the place would not have any thermometers. Then, he started making remarks to the CNA about how the orientee wants actual temps to chart and laughing again. Besides this the call light alarms were going off constantly at the nurse's station and when I asked is anybody checking call lights, he said that is the CNA's job, but apparently they weren't checking them either. So by now it was 4 am and I just told him I need to leave and left. So, is it just me or is this how it usually is in a nursing home?
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- Feb 27, '12 by Kittypower123Do things right, there are ways to make things go faster, but recording meds given before they were is wrong, as is reporting there was no pain during the shift at the beginning of the night (in fact, I believe it is considered false documentation - someone correct me if I'm wrong). What if you mark that a patient has no pain then give Norco for pain? If state audits that MAR, they are going to wonder what is going on. Unfortunately, there are lots of patients and little staff (especially during the night), but we still have to do things as best we can.
Handwashing is non-negotiable (either with soap and water or alcohol based hand gel). Vital signs means ALL vital signs - including temp and respirations - none of it should be made up. If something is going on with the patient VS can be an important clue. As for not doing something because it's "the CNA's job" - it is everyone's responsibility to care the patients. I never ask the CNAs to do something I'm not willing to do myself (of course because of time constraints I frequently am unable to those tasks, but I'm willing to when I can and need to).
- Feb 27, '12 by CapeCodMermaidOMG---this is NOT how things are usually done in a good facility. He sounds dangerous and he wouldn't work for me for more than 5 minutes.
You shouldn't have left 2 hours before the end of the shift.
Can you nicely let the DNS know what's going on?
- Feb 29, '12 by Aem1215This is not just you, and this is not how LTC usually is. Please do those patients a favor and approach the DON about this guy!