one year at a LTC...still wanting advice

1. Trust me, your instincts will tell you when a place is a decent SNF. Ask to talk to floor nurses prior to working like during the interview.

2. Red flags of micro managing are usually picked up once you start working for a place. Look out for new policies being made up everyday.

3. Decent ratio depends on where you are, what shift your doing, and so forth. The most I've seen at night is 1:30, sometimes I've had that much working 3-11. Hopefully there is better. Most important you have to be comfortable.

4. Documentation ehh? I suggest you make friends with the MDS nurse! Used to do MDS, and we read a lot of bad notes! Generally Medicare pts are qshift, and if they are getting PT/OT/ST/RT chart it. Example, Pt rec'd PT this shift. Also chart O2 usage. Chart on FC, IVs (what type, what drug, yada, yada). Chart wounds (measure please)!!! Are they better, worst? ADLS: Is the pt total care? Does he eat by himself? As always chart what you did for the pt. And please, please pt's on psych drugs NEED to have documented behaviors. I cannot tell you how many times I've had a nurse tell me a pt is combative, but the notes say nothing, and the MAR has a bunch of Ativan entries!

P.S. I kid you not I once read a nursing note that said, "Pt ate a big ole piece of bread." I almost fell out of my chair laughing! So much for I&Os!

I went from LTC (hated it) to more of a rehab kind of facility and LOVE IT! (Well, most of the time anyway). On charting, example: Res up in w/c per normal routine. A&Ox3. Voices needs without difficulty. Able to use call light for asst. 2 asst transfer, 1 asst ADL's. Feeds self. Appetite fair, ate 50% of meal at lunch. Remains cont of bowel, incont of bladder. 1cmx1cm o/a on L buttocks healing c no s/s of infection, no drainage noted. Peri wound pink and blanches to touch. Drsg dry and intact. Continues PT/OT. C/o moderate pain (4) r/t fx R hip. PRN given c good results (1). Will continue to monitor et update as needed.--Once you get accustomed to hitting the highlights of daily care, you'll be amazed at how quickly you can chart all of the necessary info. It took me FOREVER to "find my voice" with charting. For the longest time, I would glance over previous NN's to get an idea of what to write. I still have to pause and think about what I'm charting, especially with behaviors. Seems they don't like words like "agitated" or "constipated". Instead of agitated, I'll chart "res resistent and combative with care, redirection attempts by staff unsuccessful" and instead of constipated "res c/o difficultly moving bowels, prn MOM admin per order", or something along those lines. I think creative writing should be a required course in nursing school! As far as staffing, right now I have either 16 res and 1 aide, or 25 res and 2 aides (depending on which unit I'm on), which is sweet! (I work nights). I came from a facility where I had 60 res, another nurse, and 3 aides. (not so sweet, it was AWFUL, and they micro-managed us to death). There were no warning signs, as they promised the moon just to get me in the door. (Don't they all?) Anyway, you'll get there. I only have 6 months on you, and every day I gain confidence in at least one area of nursing. (Let's not discuss the areas I lose confidence in!). Every day is a learning opportunity. Ask questions often and listen carefully to the answers. Someday, new nurses will be looking to us for advice!