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CoffeeRTC, BSN 13,721 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,502 (22% Liked) Likes: 1,493

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  • 12:07 pm

    An I&D is a sterile procedure. The patient does not need another organism entered into their bloodstream during the procedure. The doc does not need pus all over their hands. The culture would also be contaminated and useless.

    You don't need a policy specific to your facility. This is evidenced based protocol. In the future , let this doctor ( ? )know that . Be firm that you expect them to don sterile gloves. Doctor also needs to wear full PPE to assure the PUS does not squirt into their eye or any other place.

    Now.. go do some serious teaching.

  • 12:04 pm

    I have had a coworker call out for not enough sleep. She wasn't punished... it was her PTO...

    ...but none of us felt very kindly towards her after absorbing her shift, her excuse spread through the gossip channels, and people stopped being willing to trade shifts with her, cover for lunch, etc.

    You had time to sleep.

  • 11:22 am

    The order probably should be rewritten with an Action Plan. Many RTs, Asthma Educator RNs and Asthma educators will instruct patients to take their Albuterol or Levalbuterol inhalers 15 minutes prior to exercise. This is pretty standard per the EPR 3 Asthma guidelines and should be listed on an Asthma Action Plan. Actually, the Asthma Action Plan should accompany any script to be used as a guideline. This is extremely important. The plan should fit the child and the activity and not some tired old only q6 prn and only if wheezing order. This just limits the child and enforces poor coping/management techniques.

    The number of puffs will be determined by the child's severity (see the EPR) and response from an Exercise Test which may have been done in a PFT Lab. Again the old 2 puff orders do not fit everyone. It is not uncommon for kids to be discharged on 4 puffs of albuterol and tapered as their maintenance medications are regulated. In the hospital, asthma protocols start at 8 puffs of albuterol q 2 hours.

    Take an Asthma educator class. I think the AE-C should be required for all school nurses since asthma can kill and is so poorly understood by several health care professionals and EMS providers.

  • Aug 19

    You sound like a wonderful caring LTC Nurse who knows how to get the job completed. As a LNHA and BSN I can tell you I have had my fair share of employees not wanting to do their job...I have even had my car tires slashed (had to tie my two Akitas up to my car to keep those employees away.
    Holding people accountable what I call follow through is very difficult, time consuming and sometimes I just want to give up but do not.

    When I give difficult people assignments I break it down into chunks of time. So for the first 2 hours I want them to completed the following tasks A, B, C... I am organized so for the last 10 mins of their 2 hour duties I will actively search them out so they can show me their work. I then give them instructions for the next two hours (this even includes a break and I really watch them during that time. If they abuse it I ask them to come and tell me they are going on break and come tell me they are off break) Micro managing...YES!!. Most people do not like this type of leadership and I find that the good ones like it because all of us are held accountable including me. The ones who just want to slide do not come back after about a week (if that). They want to be reassigned, they quit, they complain to upper management. I have had employees call the 1800 I hate my Boss on me.

    I follow the rules; the time and attendance policy is with me at all times. The written directives for what they do on 2 hour increments that include built in breaks is within policy/procedure and usually is welcomed.

    Usually I find that it takes a couple of months to have a decent running shift and then I treat the employees to pizza, crock pot of stew and home made bread on a monthly basis...I save those daily assignment sheets so when we have our pot luck I can tell/show them how hard they are working (if they are still here).

    If the management staff are not behind you in this endeavor then I would look for another place of employment as this type of environment is difficult to change and you must be supported by them. Invite management in early AM or late at night when you are following through with your tasks list this shows the employees you are supported and follow through and have management buy in. Have your DON include this as part of a QA improvement. This is a much better way then a shift meeting turns into a grip session with employees complaining of too much to do and the charge nurse riding them.

  • Jul 29

    Hi all!
    I'm an LPN who has worked for geriatrics almost 2 decades. LTC setting. Need a change. Physically and mentally. Saw a job post at different company for UR and thinking of applying. Trying to look online for any info as to what you actually do. I get reviewing/collecting info etc but WHAT do you do? Read nurses documentation? Doctor prog notes? Anyone willing to (if it's even possible) walk thru a typical day/case review? Physically my body is feeling the effects of the job but mentally feel like I'm just getting started and am looking for new challenges, if that makes sense.
    Thanks in advance. ANY info would be helpful from anyone....

  • Jul 29

    I was orienting there. Red flags all over. I agonized over it for 2 days and realized there was NO WAY I wanted to work under those conditions, so I let them know that. Feel so much better. : )

  • Jul 29

    The pulse ox is merely a tool. If the resident was fine but the tool showed a low sat, what would you do? Always rely on what YOU can assess yourself

  • Jul 18

    DNR means, in my facility which is a rehab/LTC, I'm not going to hook them up to the AED, should they be found not breathing with no pulse.
    It has NOTHING to do with treatment before that point. I would do the same for them as I would for a patient that is full code. Hospice, however is another ball game. DNR does not mean hospice.

    DNR means do not resuscitate, NOT do not treat.

  • Jun 27

    Quote from rkitty198
    NOT true. Remember when hundreds (I think even thousands) of people had their privacy control settings disabled and their entire account was able to be seen. Those security account settings are not foolproof. ?
    THen check it every morning when you get up to make sure your settings are secure, or get off Facebook.

    I'm continually astounded when people who post on public internet sites have an expectation of privacy.

  • Jun 27

    What a wonderful medical director!!
    Just be aware that many stable diabetics are put on sliding scale insulin in the hospital because they have some sort of infection or are on prednisone. Try to get that discontinued as soon as possible. If they are going to need it when they get home, make sure they are able to use a glucometer, figure out how much insulin to give, and have the sight, dexterity, and cognitive ability to do it. If not, teach a family member.

  • Jun 23

    Here are some (in my opinion) more neutral responses:

    "Aww, aren't you sweet!"

    "Aww. I think you're special too!"

    "Aww.. You're gonna make me blush!"

    "Aww.. Thank you!"


  • Jun 6

    Maybe just flat out tell them that since you're employed by the school district, you've been advised not to comment on controversies.

  • Apr 13

    I learned real quick not to cater to every little thing and encourage self-care. I would make sure an order for wet-to dry was in place if unable to maintain the wound vac and make him wait till end of shift to put it back on if it happened more than once, but I'm not the bright-eyed nurse I was going in to LTC! Oh-and it should not "fall off", talk to your wound vac rep for suggestions if you're having problems. Mine would personally come down and trouble shoot with me. If it continues to "fall off"-he's purposely taking it down to be a jerk.

  • Mar 31

    OK, so now it's time for MY rant.

    I have worked in LTC off and on now for over 20 years. I also worked in hospitals for the same amount of time (usually, at the same time). I have noticed the bad rap LTC gets from others, and I am getting fed up with it. These people have no clue what it entails to be in LTC. Well, I plan to correct this NOW.

    Let's start by comparing the job with something in the hospital that would be close - triage. Every time you look at the residents under your care, you are constantly doing triage, and like the triage nurse, you are going off what your eyes are telling you. And when you DO find that something that is just not right, you have decisions to make.

    1) Does the resident have a PRN ordered for what is wrong?
    2) Can what is wrong wait until morning, or do you need to call the Dr. now?
    3) Is it serious enough to advocate to the Dr. to send the resident to the ED?

    So, critical thinking is a must for LTC, since when it happens, it could be anything, not just what they were admitted for. The Dr. will expect you to tell him what is wrong, and how you want to fix it. He is not there, you are. He does not see the resident everyday, you do. So, you better know SBAR. Actually, in my experience, the nurses who come from the hospital to LTC that have the least amount of problems is ED nurses. I guess their mindset is similar.

    Time management needs to be honed to a razor's edge. If it isn't, you will sink. It isn't a joke. My time management skills had to get better than what they were for Med/Surg, and the ratios at that time were 10:1 on Med/Surg. Also, prioritization skills have to be very good. Again, it is another killer (sometimes literally).

    Another skill set you will use is thinking outside the box. I seriously believe the person who came up with the saying "necessity is the mother of invention" was a LTC nurse. You do not have the same ancillary staff that the hospital has. You have restoritive, PT, OT, ST, soc svcs, activities, and that's it. No pharmacy, RT, X-ray, ED, or hospitalist. And that is on day shift Monday through Friday. If you work noc's (like me), congrats! Those extras are part of your job, along with housekeeping, laundry, and dietary.

    Let's not forget the hat of charge nurse. You are responsible to ensure your aides are doing their job, and for delegating extra duties as they arise. So, supervisory experience helps.

    Oh, and caring, LOTS of caring for fellow humans. No, I am not insinuating that nurses in non-LTC positions don't care. What I am saying is that you are going to be taking care of these people for a VERY long time. I have several residents who have been at the facility for over 10 years. It is not like that in the hospital. It is the biggest reason LTC nurses love their job. Does an OR nurse care about their patients? As far as for their health and safety, absolutely. Do they care about their grandchildren? Or that their high school buddy is going to visit next month for their birthday? No, nor should they. But the LTC nurse does. Over the years, you will become like a granddaughter/grandson to your residents. You need to care. Don't buy the hype "don't get too close", it is impossible not to.

    Let's not forget stress management. Actually, I know the nurses get stressed out, but all nurses do from time to time. I am meaning the resident's stress. Anyone who has worked in LTC knows what I mean.

    Sorry, I am starting to wind down, I promise

    Lastly, we all know what the nursing home's primary job is - to make the resident as comfortable as possible until their death, so end of life training is pretty important. If you haven't had any, ask your DON to have a local hospice provide this. This will help you to understand what the resident is going through, and why the comfort meds are so important at that time. If not, the resident will normally not get the meds when they need them, and might not be able to achieve a healthy death.

    As you can see, it takes a lot to be a LTC nurse. And believe me, we ARE nurses.

  • Mar 31

    I am sorry that you went through that. And my prayers go out to the family.

    You did what you were supposed to. The POA stated not to send her, and the Dr. gave you an order, which stabilized the resident. You stated the resident became stable. If the daughter wanted to make those decisions, she should have advocated to be the POA.

    The family dynamics is what is going on. It happens often at this stage of our residents' lives. Not all family members will agree, and they will blame the staff, instead of arguing with the POA. I know it sucks, but this will not be the last time it happens.The only thing I could suggest would be to ensure all of the calls and responses are in the chart.