CoffeeRTC, BSN 16,479 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,618 (23% Liked)
...and I'm the nurse that gets those patients admitted to my SNF for rehab....minus the Ativan, minus the Ambien, minus the Dilaudid/ Percocet/ Vicodin.
Yep, they were on all of those in the morning and might have even got their prns that morning. Now it is 7pm and I'm in the middle of doing their admission. Try getting an order for any of those.
I'm not quick to say quit, but I can't see this being good. I've been in LTC for ever but I would never be able to work with that ratio. I have 50 where I am now. Most are skilled and about 10 or so are LTC with not that many needs. We staff with 2-3 on...never less that 2 on the 11-7.
If they said there would be two on 11-7 and they are now staffing with one, I can't see this being good. I don't think explaining this in an interview would be bad.
and I was thinking about taking a sdc/ Risk Manager job
I don't think that the OP mentioned what type of facility this happened in, but it has LTC all over it. Before anyone jumps all over me, I have to say that I am a LTC nurse with many years of experience. There are good and bad facilities.
I have seen this situation occur way too many times. Dressing is signed off as being done, heck there even could be a nurses note written. Dressing wasn't done. If the patient is A and O X 3 and made a complaint about it then it should be investigated.
There are many reasons it might not have been done. We aren't all super nurses and maybe it was a rough shift and there just wasn't time to get it done. Things happen. It is what happens next that is important. In our place, we would initial and circle it and then make a note on the back of the page. Pass it on to the next shift and ask for help getting it done.
I've seen people out right lie about things like this. I followed on nurse that never did BID dressings. It wasn't as if she didn't have the time or wasn't trained on how to do them. I reported it and it was denied. She even went as far as changing the piece of tape with a new date but not the actual dressing. I solved this by signing the inner dressing then applying the guaze and then signing and dating the outer dressing. Point is...it happens.
All you can do is follow your facility's policy for this event. Report it and hope it gets taken care of by the management.
Wowsa! As an agency nurse, I would make sure you know where the AED is in every facility. I give offer that info to all agency staff I tour/ orientate to our facility. I would think that not being able to call out to 911 or overhead page has to be some type of citation...delay of care, quality of life, etc..
whats the rationale behind splitting the bottle into two?
To me thats really dodgy, and puts everyone involved at very high risk of ending up with a narc discrepancy
Not trying to have a go, just curious
We try to toilet residents every two hours. Same for the incontinent residents...check and change every two hours. Does this always happen? Sad, but no. Staffing is the biggest barrier we encounter. Two CNAs to take care of 24-48 patients?
Incontinence care is more than just changing a soiled brief. Making sure proper peri-care is provided is important. Hydration in also key. Lots of elders do not drink enough fluids. Private duty care would be awesome
I will try and be helpful
If this is LTC...it is just way to common. What are the reasons they are calling off? What is staffing like?
We have been running very short. CNAs are doubling or splitting 8 hour shifts so they are working 12-16 hours 3-7 days a week. Yes...I said 7. Many are single parents or parent with a few children. They have bills, they need money. CNAs don't get paid enough as it is. These ones that sign up to work extra are making it so that we are not short staffed by filling the holes. They get burnt out very fast. Now...add in a call off for a legit reason or even something not (too much partying the night before) Cue the resentment and increased fatigue by the staff...cue the cycle of call offs.
So...adequate staffing and a good prn call in staff.
Generous time off or flexibility for illnesses or emergencies.
Staff appreciation ...little things add up.
Enforcement of discipline process when there are call offs.
What are you giving at 1 am?? I would kick someone if they woke me up for meds.
We have 50. I might start at 5:30 am and be done at 7. This would be accu checks, synthroids, prilosec, iv meds and g tube feeds....probably for about 25 or so getting meds.
12 am pass was very light, but I would also change tubing, g tube dressings, IV meds, neb treatments....and probably be done 1 am -130.
Your pharmacy should have a policy in place.
I work LTC. We get meds delivered from an off site pharmacy. The case comes in and has an inventory sheet. We are supposed to verify that we get is on the sheet (blister packs etc) We get a copy, the delivery driver gets a copy. We also sign the hand held computer and a paper sheet for them.
I had to call off once for "having a baby." She was a few days early
My favorite of all time came from a CNA's husband "yeah, she won't be in tonight. She has a real bad yeast infection." He went on to describe all the issue she was having in full graphic detail.
Ruby Vee hit the nail on the head. Critical thinking....is asking why and what else? In LTC, you do more focused assessments and a lot of times you can miss the big picture. It is also about priorities. There are a million things to do, but if you have someone that needs meds, ivs, labs....those simple dressing changes are going to have to wait.
For the most part, we do not wake the residents just to check them. Sometimes there is not need to wake them to check on them. Unless they are on vital signs q shift or more frequent, there is no need. If they have a treatment or iv med timed then that would be a good time for a mini assessment. I do visuals every 1-2 hours when I work 11-7. I'm normally down the hall helping the cnas or giving a prn anyway.
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