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CoffeeRTC, BSN 15,898 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,581 (23% Liked) Likes: 1,591

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  • Jan 20

    Popcorn time!

    Another initial post from a first-timer!

  • Jan 4

    I was mandated so much in my early career at a LTC, that it's a make it or break it issue with me now. I haven't been mandated in probably 20 years, if it happned I'd stay over, but only due to my license. I would seriously hold it against my employer though and give my notice as soon as I could secure another job. Recently they hired a RN that appeared less than reliable to the shift following mine. When I asked my supervisor what she would do if that new nurse didn't show that night, she insinuated I'd have to stay (The nurse did show up). Needless to say, that didn't sit well with me and I immediately found a new job. I'm too old now and will not play the mandation game for any employer; they might stick me once, but then I'd be out.

  • Dec 29 '16

    I have written similar orders in the past, and in doing so, I was aware I might be getting a phone call instead of the on-call. I can say that when a note like that is written, it is done for a reason; providers aren't just monsters that want people to suffer and perhaps the short-term pain from a foot fracture is less damaging to a patient than getting re-exposed to pills they previously suffered with.

  • Dec 29 '16

    Quote from Summers3
    there is an order that specifically states "Do not call the on-call MD for pain meds"
    So, contact the doctor who wrote the order and the not on-call MD and let the doctor know the Tylenol isn't relieving the patient's pain?

  • Dec 16 '16

    LTCs and SNFs are looking for RNs more and more all to meet the expectations of the 5 star rating system. There will always be a need for RNs.

  • Dec 12 '16

    I haven't seen The Family Feud since the 70's....

    Family Feud: What would a nurse want to do to a hot male patient-familyfeud1-jpg


  • Dec 9 '16

    You all have free coffee at your facilities?!

    Free coffee? What's that?

    Time me to drink coffee? What's that?

  • Dec 9 '16

    Quote from peglegmeg
    What if the coffee brand was very good coffee and for a competitive price? Would you then lean towards purchasing it, because it expressed recognition for the nursing field?
    No, I would not. In fact, I would probably steer clear of it, internally rolling my eyes at what is clearly a marketing gimmick (sorry, but that's how I feel).

  • Dec 9 '16
  • Nov 14 '16

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

  • Nov 6 '16

    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 '16

    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 '16

    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 '16

    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 '16

    Tell them anything that will comfort them.