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michelle126, BSN 12,204 Views

Joined Jan 22, '03. michelle126 is a RN. Posts: 3,467 (22% Liked) Likes: 1,470

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  • 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.

  • Mar 21

    Quote from Canucks
    OP, don't listen to all these angry nurses who got their panties wet after reading your posts. Not everyone is cut out for LTC nor is it an ideal place to work at due to several undesirable circumstances. Kudos to you for speaking your mind. Keep your head up and apply elsewhere! Things will get better eventually. And to all the nurses that were telling you to get out of nursing, SHAME ON YOU for bullying your fellow nurses. Is that the way you treat your patients? /eye roll/
    Uh... the OP disparaged an entire specialty -- one in which many AN members practice -- by saying "it isn't a job to be proud of"..... and she gets kudos? Those of us who know better corrected her, and we're bullying her?

    Got it.

  • Mar 21

    Quote from purplegal
    Which would be worse for you?
    Having a nursing job in a LTC facility or not being a nurse at all?

    Because I fear that these are my only options. And they're both ugly.
    At the same time, I have to gain experience outside of the hospital I lost my first job at for a year, before I can go back. The public health, school and clinic jobs have not responded. One job, a pediatric home care job, called back but I wasn't able to reach them when I returned their call and am not sure that peds is a good option anyway. I fear being associated with a nursing home, as it is not a job to be proud of, and am worried there are jobs outside of nursing I would do better at. Sometimes I am terrified I may end up doing something besides nursing, in which case, life would be pointless.

    Anyway, which would be worse for you? Working at a nursing home or not being a nurse at all?
    Please tell me I read that incorrectly.

    And please DO NOT EVER apply to where I work or may have family or , actually ANYWHERE in nursing. I think you would be better off filing papers somewhere.

    That is one of the most egregious statements I have seen on the board, and trust me there have plenty.

    Every area of nursing is needed and NONE are below any of us. Shame on you.

  • Mar 17

    If talking with administration doesn't work, you can report the issues to the state. The state will investigate and the facility will have to deal with it. It might be too late for your dad, but it might make a difference to someone else's.

  • Mar 17

    I recommend demanding a meeting with the administrator, DON and the unit charge nurse and review this list of concerns.They need to know they have serious shortcomings with the education and experience of their staff and a lack of communication .Your dad co u 's have to go back there.You won't forgive yourself if you don't say your piece.These things need th one dealt with..

  • Feb 28

    Did the mandated time put you >40 hrs for tge week?

    If so, forget your facility's admin. Take it to the federal dept of labor. If you are non exempt, OT is not optional.

  • Feb 28

    There is likely a lot more to this story than written.

    No doubt there are some facilities that may dump patients for minor reasons or unfairly.

    However, the times I have seen it happen it is because the person is beyond what the facility can handle. I am talking behaviors that endanger themselves, peers and staff. The hospital psychiatric resources are stretched thin and/or not available.

    We have some at our facility that are almost to that point and we have had some that were beyond that point. We could not take them back. It wasn't financial.

    I won't elaborate because I don't want to be identified but sometimes resident's are just not manageable in some care settings.

  • Jan 11

    I was going to post a detailed description of how I handle this, but everything I do requires a functioning management system that you say does not exist.

    So if I were you, I would find another job ASAP. Without management or coworker support you would simply be launching a quixotic effort that will likely end up with you being the one getting canned.

    In the meantime, talk to some trusted coworkers and see what they have been doing. Then do that.

  • Dec 18 '15

    Update: I wanted to thank you all for your input. As of 12/19/15 my DON will no longer be employed by my company. He was offered a "leave or get fired" type deal. It feels like Christmas came early.

  • Nov 16 '15

    Oh the joy of shift change on the ortho floor. It is important to let your patient know that if they are hurting they can take pain medication and how often they can have it. It is also ok if they decide they don't hurt and don't need narcotics (some surgeons put in local pain blocks and patients don't feel pain at all 24hrs+ after surgery!). However it Is always a good idea to encourage pain medication before therapy even if they don't hurt right now. It is also good for you to tell them you are going off shift soon, if you don't take it now they'll have to wait for the next shift whenever they're ready.

    Our floor we had to wake up all joint replacements at 5am and have them out of bed and in their chairs before 7am. Their therapy was at about 830am. The class they went to presurgery would encourage the importance of pain pills atleast 30mins prior to therapy which wasn't always feasible and shift change was 7am so pfft. Peoples pain pill schedule just didn't line up correctly all the time and it isn't easy as the oncoming shift to give pain pills all at the same time within an hour of clocking in.

    I encouraged patients at night to take their pain medicine if they were awake and wanting it no matter if it mismatched their therapy schedule. Near shift change though I'd make a final run through between all my patients and if they could have pain meds id ask of they wanted it or if they wanted it closer to therapy. I let them know if they were waiting til closer to therapy that it WOULD NOT be me who gave it to them that the day shift would and I'd pass it on in report to bring it with morning meds (they have a morning med pass anyway and it gives the patient a time frame of when they'll get it).

    If my patients were not hurting all night and didn't want pain meds in the morning I'd tell them the same thing. You should still take something before therapy and day shift would have to give it.

    No matter what you do the next shift is always going to be slightly miffed at you. You could medicate everybody before report and the next nurse will be upset that everybody is due for meds at the same time or they'll be miffed that you gave that pain pill at a weird time and it isn't lining up with therapy or they're just miffed you didn't medicate.

    For the sake of making your hand off quick do make sure though that you ask your patients one last time "I'm leaving in 30 minutes do you need a pain pill now!?"

  • Nov 10 '15

    Gone during the survey and leaving a new hire in charge? I would hazard a guess that the DON might be resigning instead of returning to work. After the survey, if according to the way things usually go, she may be forced to leave permanently anyway. You will be doing yourself a favor by starting your job search now. That's how I see it.

  • Nov 10 '15

    First off I'm concerned that you're an Agency nurse as a new grad...scary stuff.
    Secondly, you get to know the docs. I've had several over the years to "write whatever you want and I'll sign off'. I drew the line at medication orders, but always wrote my own wound care orders. Some of the other docs wanted to be called for A&D to the buttocks....they are all different. When in doubt, call or fax them for a signed order.

  • Nov 4 '15

    I refuse to be interrupted for anything short of a true emergency when I'm actually in the process of pulling an individual's medication and delivering them to the patient. I've learned from experience that this is where I'm most likely to make mistakes. I'll explain to the person that I'll get to them as soon as I've finished, but can't stop in the middle for safety reasons. There is very little that can't wait the two minutes this takes.

    With our eMar, it is very easy to see who still has meds due, so stopping between patients isn't a problem. Before we went to eMars, I marked down the side of my brain sheet who had meds due at what time during the first med pass (when virtually everyone had meds due), and then crossed it off as I went along, so keeping track wasn't a problem.


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