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CoffeeRTC, BSN 13,736 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,504 (22% Liked) Likes: 1,494

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  • 11:52 am

    i work just a few days a month in a ltc setting. I'm 42 (if that matters to the op, lol) and I like to "look up" my residents. I will punch in if it is less than the 15 minutes. I like to go thru and check out newer patients and look over our report book for the last week. Often times turn over is very high with our patients. Can't tell you how much I learn on my own as opposed to report.

  • Aug 29

    Yikes, I couldn't imagine doing agency in LTC and not having LTC experience.

    Will your agency send you to the same facility? Is this a long term assignment?

    I have to agree...the 1:10 is a lie unless they are including nurses in with the CNAs? Even then it doesn't add up.

    I would go thru and read some of the "new nurses in LTC" threads in the Geriatric/ LTC section.

    Will you be house supervisor and/ or work the cart?

    Organization is key. I work part time, so I try to come in a few more minutes early and read up on the 24 hour report for the last week or so. Get a census sheet and take brief notes. That way during report you have an idea what is going on with the residents. I like to know who is A&O, crushed meds, thickened fluids, fluid restrictions, IVs and any on going issues. For the most part, most of the residents are stable and do sleep at night. Its helpful to know the last prn pain med. (most get them on the 9pm round, so I will then know who is due early in the shift)
    Start with the 12 a med pass and get the few treatments that need to be done then. Some IVs need hung then too.
    After that i do the restocking/ checking the supplies and getting a list together for ordering.
    Charting
    Checking the lab book (labs from the PIC lines, specemins etc)
    More charting

    6 am med pass is a bit heavier with am accu checks and meds.

    11-7 does the line changes too.

  • Aug 23

    norco/ vocodin, percocet, oxycodone, oxycontin, Roxinal ....meds we see a lot for pain.

  • Aug 23

    Yes!!!!! I argue this point all the time. If I was unable to transfer myself for what ever reason and I had to wait forever for someone to answer my call bell and help me to the bathroom, I would be incontinent. So when the CNAs are doing their charting and marking incontinent because they were....look at how it skews the #s!

    Sometimes it is a fact. 2 CNAs, one nurse and 10 residents that need max assist at once....do the math.

  • Aug 23

    As a LTC nurse, I find this very frustrating and a common occurance. I've seen it happen a lot.

    if ther is one nurse that is the only person that medicates all the patients all the time and you have really good, top notch nurses on the other shifts that do their jobs and medicate PRN....There probably is something up. It escalates too. Maybe their med isn't helping them like it should (because they really aren't getting it) so the doc gets called for an increase. I've see this happen. Or a resident that might get it once a day now seems to be getting it every 4 hours like clock work when the nurse is going a double. Normally it is the more confused or non verbal resident this would happen on.

    Diversion is so easy in LTC but hard to prove. What we try to do to prevent it is d/c meds that aren't used a lot. Change up the nursing assignments. If you can interview residents do that to get as much information as you can.

  • Aug 22

    After you check the policy and procedure manual and get the go ahead, the biggest thing to remember is that they need to be replaced asap or stat. Many moons ago when it was common to use a foley for a g tube and we were able to replace them in house. These might have been used on the dementia residents that pulled at everything under the sun. At that time, we used a betadine scrub, lubed up the tube and inserted it. Wait too long and you were meeting resistance. We would follow up with checking placement and getting an xray.

  • Aug 22

    norco/ vocodin, percocet, oxycodone, oxycontin, Roxinal ....meds we see a lot for pain.

  • Aug 19

    This is right on line with the "offers you candy, reports to family that candy is stolen"

    Showers/ baths are a big one. Document, careplan, document and make sure family is aware of all of it.

  • Aug 7

    Wow.

    A few things. Before you send a resident to the ER, if it is non emergent, make sure you are sending some information to them about the resident. Transfer sheet should cover the basics with a brief history of what is going on, baseline for ADLS, LOC, diagnosis list, etc. We also call to give a verbal report to the triage nurse. This is important especially if you cannot get the paperwork together fast enough. If you are giving them a good picture on what you suspect is going on and their baseline that helps tremendously. Let the ER know that you did xyz before sending them.

    When EMS comes for pick up, give them the same report. Treat them like another part of the care team....they are. Sometimes we bounce ideas off of each other. (and take bets on who is right, lol)

    When the ER calls to tell you they are sending the resident back...ask....hey, what were the results of XYZ labs? i need a copy please! If you send someome out for cardiac S/S...ask about the EKG, troponin levels, labs, chest etc.

    i think that some ERs just get sick of getting residents that are dumped and sent blind (without report) and when they show up without family or with dementia, they might look for the quick fix and send them back thinking the drs in the LTC will deal with it in the morning.

  • Jul 18

    I was thinking mattress too! Have you took a culture of the wounds?

  • May 10

    So, you are supposed to tell staff to keep their cell phone in their lockers at work, but to take a picure of the offenders you need a cell phone??? Wow. I've seen many a crazy rule but what the what?

  • May 8

    We seem to have good relationships with all of the hospices that we use.

    We are a SNF and may only have 1-2 residents at a time. Any isses we've had seem to be resolved by communication.

    A few things that we had to work out dealt with communication. When we get a respite admit, we rearely get a good listing of the medications or basic chart copy from the home.

  • May 8

    We do it as you described. One page per med. Started when you get the med and just signed off with each does. We then have a page at the start of the book/ binder that we sign on at the start of the shift and off at the end of the shift. Each nurse has a spot.

    I might have at least 20 or more different carts, boxes of patches, injectables or liquids on my cart. I couldn't imagine doing all of that double charting. Is this a pharmacy consultant or nursing? I'd want to see the reg or back ground for the new requirement.

  • May 7

    LOL. I totally got this post from the get go. Some days I really don't have time to pee when I want to and yes, we end up holding it untl we almost burst.

    I really love when my co-worker will say the same BUT she oldly has enough time to smoke?? Hmmm. I guess I do have my priorities wrong, LOL.

  • May 5

    Recently changed my name to stay more private.....Coffee RTC...how doesn't need coffee round the clock ?


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