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CoffeeRTC, BSN 15,487 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,556 (23% Liked) Likes: 1,564

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  • Nov 14

    AvaRose, did you find out what happened with the patient?

  • Nov 6

    Quote from Been there,done that
    So..your facility admits patients,recovering from a NSTEMI..with no monitoring equipment available,and Nitro SL not available? Seems like you have bigger fish to fry..including your license.
    You do know this is ltc we are discussing right? Not LTAC. The majority of LTC short term residents are admitted for rehab after a hospital stay. Long term residents are essentially custodial care with some skilled services (med mgmt, sometimes wound care, tube feeds...). Either way, a 50 yo in the hospital for NSTEMI could be sent HOME in the same cardiac condition as, say, the 80yo who is sent to rehab because after being in the hospital they need PT and are unable to care for themselves. In other words their being in LTC is usually due to general deconditioning-they've been deemed safe for hospital discharge.

    If they were able to toilet themselves and manage their own meds etc they would likely be headed home. Not too many private homes with "monitoring equipment." Nitro is a case by case prescription from the attending no different than if the pt is sent home. In an acute situation LTC would be expected to utilize EMS for nitro (if no existing script) and often for the 12 lead. That's fairly standard and not a danger to anyone's license.

    The resident was not admitted to LTC due to their NSTEMI per se, they are there due to sequelae like generalized weakness, gait disturbance or possibly chronic CHF. They are there for rehab, not for cardiac monitoring. The only part of this that I would question is the use of a private transport company rather than 911 for a suspected MI-does the private company have paramedics and capability to give nitro etc?

  • Nov 4

    Quote from Meriwhen
    And perhaps they wanted experienced nurses. LTC/LTAC isn't the no-brainer that people often think it is. It's a tough specialty, in more ways than one.
    LTC and LTAC are two completely different tough specialties -- long term acute care having more in common with stepdown/progressive care than with long term care, or even with med-surg.

    That said I agree completely. Perhaps this facility actually wants expert nurses caring for its residents? I don't know, I've had several elderly relatives who needed long term care, and I appreciated that the floors weren't staffed full of novices.

    Plus, most LTCs don't have the ability to offer long orientation periods -- a few shifts, maybe. So it would behoove them to hire nurses who can practice independantly once learning the basics of that particular facility.

  • Nov 4

    I tend to agree. I work in a SNF- LTC/Rehab. Assessing, charting, and medicating 30 sub-acute patient of all types and ages with multiple comorbidities, with more scripts than CVS, requires more skills than 4 nurses possess. We have 2 per shift.

    Thank God I was an EMT in another life because I've had 3 people circling the drain due to various reasons that had to be sent back to the hospital they came from as 'stable'. Sometimes LTC is more reminiscence of battle field triage with all of the casualties and none of the help of a modern hospital offers.

    I've had patients with drug seeking behavior being self medicated by family after I already hit them with Roxy, a violent dementia patient who almost broke the wrist of another nurse (we have no standing orders to chemically restrain) and a CVA who refuses thicken liquids but constantly aspirates everything.

    We also have a problem with the life safety system alarms going off at random times through out the night waking everyone up. A gas leak threatened to close the facility and took 3 hours to resolve after the fire department and maintenance showed up 3 hours later. Security walked out one night and left all of the external doors unsecured for all of our exit seekers to find. All of this occurred in one month.

    Please, tell me more of this non-complex LTC land of unicorns and rainbows, of which you speak, because it must be somewhere over the rainbow from where I work.

  • Oct 21

    Quote from erinp88
    (We get in trouble if we file a time exception slip.)
    Every so often, I just get REALLY glad I am a union member. My union dues are more than covered by the paid breaks and training I didn't get at a previous non-union job.

  • Oct 11

    Tell them anything that will comfort them.

  • Oct 10

    Can I come and work with you guys?

  • Oct 10

    Those ratios seem high unless it's an 11-7 shift and that's a stretch with 12 ventilated patients. Is there a respiratory therapist on staff?

  • Oct 3

    If your computers go out, you should have a policy that states what to do. We had all computerized medical records and only twice in 3 years had to print out the MAR. Please DO NOT give meds from memory. It is a dangerous practice that could lead to the loss of your license. If I had no MARs and no computer, honestly I would call all the docs and get an order to hold all the meds until the computers came back on. You know they all take way too many meds anyway!

  • Oct 1

    But then you might be missing out on all the fun!!!

    There are times when my shift is stressful and terrible and heartbreaking but if it's a chill day that is low-stress, I am B-O-R-E-D. I'm not learning anything, I'm not earning my money, I'm not helping anyone -- it sucks. Most everyone I work with feels the same way. I will be, however, looking forward to my experience in what I am doing to get me to a position that is, perhaps, more predictable in terms of workload and less stressful and ultimately less death-y (which I've already had enough of). But, that is years from now because I am just starting out as a nurse and I have no clue what I am doing so I will have few days of actually being bored. Though there are days I am like, "Oh god *** was that AND I have to come back tomorrow?!!?" I wouldn't trade it for anything, not even a boring, easy day.

    So, for now, look forward to finding something that is challenging, stressful, full of learning opportunities and providing you the experience you need to get into a "less stressful job" that requires all that you learned from all that stress and experience. You won't get that fresh out of nursing school, though but you can mitigate the stress though. I lucked out -- I got into a fabulous floor specializing off the bat and I can't imagine it being the normal "adult med-surg for 1-2+ years slog" that is generally recommended. That does decrease the stress. The money, though, isn't so great (kids are kind of a resource-suck so there's not too much money to go around -- unless you're in endocrinology).

  • Sep 9

    Quote from carolinapooh
    I'd even recommend another way. "She doesn't have cards yet. Isn't it against policy" or "can we borrow meds from other patients?" or "I don't think I'm supposed to borrow meds from other patients." We use that near deflection technique in the military as a gentler way of telling those who outrank us - hey dude, you're dead wrong, but I'm giving you a chance to save face and look good. Then if they persist - then zing with "I believe that's against facility policy". (Where our answer would be, 'according to the Air Force Instruction blah blah blah'.)
    Please remember that we are dealing with a new grad LPN. Her "deflection" skills and "zingers"may not be quite up to speed. Give a new nurse a break.

  • Sep 9

    I think this situation could have been handled better by all parties. OP, I would advise being very direct in your communications with your charge and others, and lose the snark. Instead of "I didn't bother looking," how about what you told us? "she does not have cards, and I believe it is against policy to borrow from other patients." And if your charge knew that you a new grad as well as a new hire, she could have been more supportive.

    Agree with previous posters about narcotics: be very deliberate with checking, verifying, administration. This can get you fired and reported, even if you are totally innocent of any wrongdoing.

    The ARNP could have picked a better time and method for coaching. In the hall, in a public place, and during a med pass is not conducive to learning! Perhaps she meant well, but I think it only added to your frustration.

    My first job was at an ECF, and I studied meds all the time on my days off. My pharm training at that time was limited, but I was exposed to a lot of meds and learned a lot that first year. Looking back, those patients were probably overmedicated, but it was an amazing learning opportunity for me.

  • Sep 8

    I work LTC so it is some different than a hospital. I can tell you that a patient may be checked, changed and cleaned up and by the time the day nurses and CNAs check them, they can be soaking wet. That is what incontinent people do.

    I am wondering what you use for patients who are incontinent. Any type of soaker pad and incontinent pads uses? Those do help minimize cleanup. I have also seen where one will miss the soaker pad and still get sheets wet, thought that is not normal.

    When I come on at night, we sometimes have to finish what the previous shift did not get done. Sometimes days find a patient wet, they just need to do what is necessary and continue on.

    Believe it or not, night shift can get pretty busy and we usually have a smaller staff than the other shifts. As has been said, unless this is what happens with every patient she has every morning, then just take care of the need and continue on your day.

    Just my view from the night shift.

  • Sep 8

    Any threads by Viva. You are a shining example of keep on trucking no matter what.

  • Sep 8

    Can I be totally honest?

    I like reading the threads started by nurses whom have somehow gotten themselves into a hot, hot mess. I like to think about, what would I do in this situation? I like reading the replies. I like offering advice, if I can.


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