ADL care plan

well Yes I do update the CNA careplans also, and I just finished looking at the nurse practice act in our state and we had a survey team in and I asked the surverors and of course they told me I could work on them and yes just seems like I do them and hand them over and there is really no discussion but I guess I at least talk to the family and residents and try not to put unreasonal approaches but I have been a nurse 20 years and worked the floor many days so I do know what the nurse aides and nurses will and will not do. and I talk to the nurse aides a lot because you are right they are the ones taking them to the toilet, feeding them, etc... and I cant seem to get thru to them to please chart to get credit for what you do. They had been putting totally independent on someone that can not see--- Hello!!! Then I asked 3 people today nurses and aides do you have to cut up her food?, do you have to help her get dressed, (the response was, she sleeps in her clothes) dang -- She did not a little over a year ago when I was working the floor, because we helped her get in her pj's? I do teach the majority of our nurse aides but it is just a little 54 hour course and I try to give information etc.. , If I dont at least initiate those careplans we will get a defiency but I never ever sign that I am doing that because I expect them to review the mds and the careplans I am only human I do make mistakes and have had DON's tell me you need to do a correction on such and such in the past and I gladly do because I go to work wanting to do the best I can even if it is paper work, but I do get my hands dirty, today I toileted a couple, obtained weights for my mds people that were do. Made rounds with one of the docs - so the nurse could listen to the staff meeting. In a small facility we do it all sometimes we take residents on transports, god forbid take laundry to get washed when equipment breaks down. I do venipuncture when someone has a difficult stick. Believe me I am not afraid to say that is above my scope of practice, because I have several times when we had no DON for almost 6 months and I was ADON, and I called my state board and went on maturnity leave early due to the situation and Had a new baby at home and was called all the time just to ask how to transmit and mds. I am far from perfect and that is why I am back in school. I want to be a better nurse and for 2 days have been avoided regarding training for the restorative program.

This whole thread is the Stephen King novel of MDS world, imho. Every new admin and DON has their own idea of how I should write THE care plan, and the floor nurses who see the patient most frequently can't even grab a pre-printed UTI care plan and personalize it. Most of the time, they can't even tell me if the patient is even continent! Thank the good lord that no one relies on the care plan for the actual care the patient receives! (Seriously, I have written Nobel Prize eligible care plans that DON's feel comfortable criticizing because of what the surveyor won't like!)
ST

oh susan I could just hug you!!! I so understand I tried to just get the nurses to pull out preprinted cp's on antibiotic therapy. that was a nightmare then I am trying now this new form to notfy of changes of condition, I dont do the ordering any longer and they today told me oh have you ordered that form thing since it was part of the plan of correction?? and I just went up there to put a few admission/discharges in the computer since I am not there everyday due to RN school --- They did finally hire a new ADON but how much you want to bet I have to train her for the most part. lets see I have trained more than I can remember, and trained more than I care to say on our facility systems (DON's) not saying I am smarter, (I know I need education that is why I am in school) but as a general rule most LTC facilities have systems , QA, Infection control, Skin Integrity system, not to mention how to do a schedule, and general inservicing, when there is a problem. that is just part of it of course you know. My mom is a retired RN, DON/ nursing consultant- she told me today honey you focus on that school and your kids. She is so right I just hate to see the damage and have to clean up the damage when people that dont have a clue are running the show. and seems like everytime before when I would go away for vacation or a baby - I would come back with every stinking MDS left undone. they even called me because they had no clue how to even transmit them. why I continue to do it is I love the residents so much. The nurse aides I have trained and other coworkers that really care about the residents make me go and try to do a decent job. I love teaching the nurse aides but I get yelled at that I most not be teaching them right-- I just want to say well you can lead a horse to water you might make him thirsty but not always will he drink. (if they would pay our nurse aides more they might put forth more work and we not have such a shortage.) they can go to mcdonald's and get insurance we dont even have at our facility. And of course I have not said those things because that would be concidered insoborinate lol. Anyway thanks for letting me vent back to acid base balance good night!!

yes, that is correct. Never be too specific in a plan of care. If it changes, which it does frequently and no one gets to the CP to change it, you've got yourself an F tag.