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CoffeeRTC, BSN 17,600 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,672 (24% Liked) Likes: 1,713

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  • Aug 17

    Quote from Glycerine82
    So we have to fill out respiratory flow sheets. On these sheets we document that we gave a nebulizer treatment, lung sounds, 02 SAT before and after and how many minutes we were with the pt.

    Everyone writes 15 minutes....I'm in there MAYBE 5 if There are a lot of meds.

    I don't want to make waves, but I really don't want to say 15 minutes when there isn't any way I could actually do that and still give meds.


    I mean, if they did the math that would give me like 20 seconds per patient

    Help! What would you do?
    Think about the time it takes to prepare the medication and quickly assess the patient prior to medication administration. By the time you complete this initial process, return to disconnect the nebulizer, reassess, then document, would that not equate to at least 15 minutes after adding actual inhalation time? After all, you are having them to cough and deep-breathe after, correct? This will kill 15 minutes easily if done correctly. Factor in a productive coughing spell, and there you have it.

    In LTC, time is limited or non-existent. But CMS doesn't care about that. The proper process is expected since they are funding the care of most of these residents; it is up to your facility to ensure that you have adequate staffing to properly care for the specific resident population.

    As a state surveyor, we observe and time this process because of the regulations, and believe it or not, CMS-appointed surveyors come down to observe us as we observe you. If I was standing there with my pad and pen, observing you, I assure you that the process would take up the entire 15 minutes as you carefully complete each task...even if you stop the timer as you proceed to another patient, and restart it upon your return.

    On a rare moment when you have nothing left to do, go in and administer one of your neb treatments without leaving the bedside, timing it from start to finish, and compare your findings to what you believe takes only 5 minutes.

  • Aug 16

    CcM, your my kind of DON, we share the same work ethics and compassion......
    With your experience, you would make an awesome nurse inspector for CMS/DADs.......

    After 45 years I'm vacationing in a physician's office, and at 68yr/age.....I probably can do this for a few more years.....

    My best wishes for you.....I have always enjoyed your post and contributions.....

  • Aug 3

    Would we like to review the difference between distilled and sterile water?

    Distilled - water without dissolved minerals, can be loaded with germs.

    Sterile - water without microorganisms, can have any amount of dissolved minerals.

  • Aug 3

    From a federal legal standpoint;

    Nothing about this situation was HIPAA privacy issue. As Someone already mentioned, without disclosing whom has/had scabies there isn't a privacy violation.
    Second, federal law, as well as most state patient rights law, mandates that each patient has the right to know their diagnosis and options for treatment. In most cases, patients also have the right to object to treatment.

    As a CNA, you most definitely should not have been forced into this position, but your actions, though probably not part of your job description, probably saved your employer from violating the law. I would speak to management about making sure patients are being properly consulted about their medical needs.

  • Aug 1

    This may differ based on the shift too (I work 7p-7a) but I always pop in and introduce myself before looking at anything. A quick visual gives you info like how they appear (writhing in pain? Are the drowsy? Are they diaphoretic?) Speaking to them "Hi my name is smf0903 and I'll be your nurse tonight. How are you feeling?" <--their answer gives me a few quick answers. "I'm going to look over your chart and then I'll be back. Is there anything I can bring you when I do?" <--this can save me a step or two when I do come back and let's the patient know that I WILL soon be back into their room.

    I don't do a full assessment until I've skimmed the chart. Usually by then there are meds to pass and I like to know things before passing meds (labs, vitals, etc). Then I do my head-to-toe assessment.

    I'm not sure there's a wrong or right way, you find what works for you

  • Aug 1

    I guess I don't get what the issue is?

  • Aug 1

    If I can give my humble opinion: Don't create a problem you can't fix. Yes, dead skin is a nuisance and a medium for bacterial growth, so we want it to come off as soon as possible. Just don't tear it off before it's ready to come loose. There is no good reason to traumatize healthy tissue (which the dead skin is attached to), as it creates openings in the skin barrier, which can lead to infinitely worse infection than simply leaving the dead skin on until it comes off with the most minimal of "coaxing." I'm not saying you shouldn't clean the wounds, but you should respect the integrity of the surrounding skin; don't open anything up unless you have no other choice. Remember your mom telling you not to pick at or pull off a scab? Same principle with wounds: When it's ready to come off, it really won't take any coaxing, just a light wipe. (Mind you, I'm addressing cellulitis, not decubiti--that's a slightly different ball game).

    Sorry, I'm old school. I never, never rip or tear anything if I can possibly help it. They have cellulitis because of breaks in skin integrity (sometimes tiny ones); don't give the skin flora new opportunities to get inside.

  • Jun 26

    I've been in the business since the '80s. Limited duty was only offered to employees who were injured on the job, never for post op people or those who were injured on their own time.

  • Jun 1

    Quote from JKL33
    I have a great idea. How about researching the number of nurses who have come down with deadly diseases, or any kind of sickness at all, because they took a drink of water while in a "patient care area" AKA the nurse's station.
    True that!

    They should just come out and say what it really is, protection of their electronics, and stop treating us like little children that have people's lives in their hands every shift. I will never understand why we get lied too on such obvious things...

  • Apr 26

    Hard for me to see how you did the wrong thing, except in one area that I'll get to in a moment. From what you've described, your mom received care well beyond the level she would have had you left her in the care of others. Your fear is that you somehow hastened her passing - you might want to consider the possibility that your repositioning at that exact moment actually bought her some extra time, albeit just a few seconds. Equally plausible, no?
    And, for the record, yes, I had the honor of being my mother's caregiver for the last 4+years of her life, and yes, I had a client pass while being repositioned - several months ago, and I was doing a brief change. Pt. arrested as I was putting the fresh brief on, and I buttoned everything up only to find the pt. had gone completely limp. Got pt. on their back, called for an RT first (1st person I saw) who flagged the charge nurse down, who knew the pt. was on hospice and was DNR/DNI. So - no CPR, and we did a quick prep while the desk nurse notified the family and hospice. Tends to be something of a shock, even when you're not a family member.
    As far as my criticism - just on one point, and it's very common. When you accept the role of caregiver you absolutely MUST TAKE PROPER CARE OF YOURSELF, and it sounds like you weren't and aren't. Yeah, you're grieving; been there, done that. It takes a bit to assimilate all that's gone on - true dat. But - you still have one last obligation to your mom, and that is to continue on and have a good life. Counseling if you feel you need it, but more importantly to be good to yourself. Cut yourself some slack, sit down with some trusted friends and talk about the good times both past and future. I've no doubt your mom would want you to. Take it from one who's been there.
    ----- Dave

  • Apr 19

    The state forums are awful. They used to be really nice, but I agree that they are now all about this or that school waiting list or the New Grad program at hospital x,y,z. I wish they'd separate that stuff from the state forums again.

  • Apr 19

    I went back and read the thread you started about a year ago in which you also insulted the LTC specialty. You fell over yourself apologizing when you were called on it then. Those apologies don't seem to mean much, as this is truly the way you really feel, about all of those nurses and about yourself. How do I know this? Because here we are, exactly one year later, having the exact same conversation.

    Brutal honesty here.....I have no patience for this. If you hate it, go do something else. You are past the year mark. Reapply at the hospital that fired you if you would rather be there, but knock off this "poor me" stuff. It is unattractive and habit forming. You aren't a victim of anything but your own imagination at this point.

  • Apr 18

    You're impressed by flexiseal skills?

    LTC friends, I would not be insulted by her post... she's clearly being facetious,.

  • Apr 18

    I'd start by referring to Ativan as a benzodiazepine and not an opiate.

  • Apr 14

    For someone in casual conversation I would have a hard time not smiling and saying "Wow, that is really creepy" in response to the comment in the OP.


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