CoffeeRTC, BSN 17,357 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,654 (24% Liked)
I think people were asking if it was homework because most experienced nurses would see that it is a med error. At first it just screamed "homework assignment"
IVFs are medication. Giving the wrong med or dose is a med error. Plain and simple. Every facility has their own policy on how they deal with med errors. At the very least, stop the iv immediatley, assess the patient and then call md for further orders.
What is POS? ED and AED?
We are still paper charting. Only nurses check them every month to make sure the orders are correct.
I think that is a great breakdown of the shift work. I think the ratio really depends on the acuity of the residents. If they are more LTC and less skilled, then you might have more meds, but less assessments. The med pass is what needs streamlined. There are way too many meds on stable LTC residents.
I am glad you found your happy place. My experiences have only been in LTC. I'd just like to mention that not all nonprofits are the same. I worked for a huge for-profit chain. While at times, it felt like it was all about the $$. Looking back, it really wasn't all that bad. There were systems put in place, a clear organizied corporate structure and a policy for everything. Sounds overy structured? yep and I really miss it.
Now, we are owned by a nonprofit. There is no structure. There are random consultants, there is little consistency. While a huge corporations isn't "making all the money" someone still is. We run short on supplies, we are accepting diffuculty admissions, vendors have changed...now much cheaper etc.
When we heard "nonprofit" we were all thinking more resident centered care. What sets nonprofits apart is who is running them. The Babpist home up the road....The have a mission. They have fundraisers and donors. We do not.
I work in LTC. The Assessment coordinator/ RNAC or the social worker sends home a form letter to the family letting them know that a care conference will be held on a certain date. We ask that they confirm that they will be able to attend. We try to give them at least a weeks notice or more depending on what type of care conference they are having.
Normally, there is a nurse from the unit, a CNA, dietary, therapy representative, social worker and activity director in attendance. At this meeting, the plan of care is reviewed and we discus how the resident is progressing if on thereapy or if there is any decline. When possible, the resident is also in attendance. We discuss any other issues at this time. (family complaints, etc)
Sounds like she needs something more than just when the pain is unbearable. I would have given the tylenol and then called.
What ended up happening? did you get a different order.
I am considering taking a Risk Manager position in a smaller facility. Being pulled to the floor is one of my concerns. (I'm actually a staff nurse there now)
Sound like the ADON needs to go and maybe the rest will follow? Any way to use temp or agency nurses to fill in the slots? Is the DON on board with getting rid of the bad seeds? I second starting a paper trail. How the heck are they getting by without and MDS nurse?
I've had a similar thing happen to me. Its been a while so I don't remember the exact details. I reported missing narcotics and it was reported to the state. Someone from the department of health did call me at home for more information. I only work part time so it was easier for the call than having me go into work.
Did you call back??
Every body is so danged sensitive these days and I think people go out of their way to get their panties in a wad. If it were my family member in a long term care / skilled nursing etc where they are not necessarily going anywhere for a while and the staff was telling me that there was an issue with them having an odor problem then (and maybe this in just my reasonable nurse brain speaking here) we look for ways to solve it. We don't shoot the messenger and get her suspended. Maybe Aunt Mable needs a stronger deodorant. Maybe the room is too hot. Maybe we don't realize that she asks for 4 blankets at night and she sweats like a mma fighter. Maybe she refuses her bath for everyone but this nurse. Maybe there is a little infection going on. There could be a much bigger picture going on that needs some cooperation of the family and the rest of the staff - not suspensions and hurt feelings because someone voices a concern.
It all depends. Pressure ulcers are preventable. We all know that. In a perfect world with adequate and above average staffing, great food, plenty supplies, restorative nurses where all the residents get the best care, your numbers still might not be 100%. Some residents just decline. The hospice patient that hasn't eaten in days and is in so much pain that the staff decides frequently turning causes too much pain...your in-house aquirred numbers are unavoidable. We all still strive for that number.
Same with skin tears. Accidents happen.
If you went to the DON, have you gone up the chain to the Administrator too?
It looks like you will be in charge of the unit but also working the cart. That is a good staffing mix. We have 50. 1 RN and 2, maybe 3 CNAs.
We have quite a few skilled patients and a frequent revolving door of short-term rehab patients. For the most part, your LTC aka stable residents would be getting vital signs done on 11-7.
We do vitals q shift x 3 days for new admits, accidents/ incident reports and residents on antibiotics or those with a change of condition. If the MD has no parameters or there are no clinical changes, you will use your nursing judgment on when to call the MD. For the most part..I wouldn't be bothering the MD at night for a simple drop in BP.
Nights can get very busy in our facility. Many of our geri-psych residents are up, we do our tubing changes on 11-7, some IV antibiotics running, some wound care and a heavy 6 am med pass. It can also be slow at times.
I have 3-4 of these type of patients in my SNF right now. Very frustrating.
420 is a police code for pot/ Marajuana.
Edibles are an edible form of pot. Could be gummy bears or brownies.
I think it is funny that I'm responding to this. I honestly have no experience.
I could see my husband responding like the OP. While I've never tried it and it is illegal in my state, I'm not over the top about it. I think what I'm still trying to understand is how do you know someome is "high" unless they are visibly impaired?
What does 4/20 mean? Edibles? Please translate for us oldies.
OP, I understand your worry for patient safety, but if your Charge is aware of your concerns and has taken steps to follow up on them, and has declared the matter at rest barring new evidence, follow her lead.
Just do your own job. The Charge is responsible for the floor as a whole and for Jon.
Or go over her head to the Manager. But be ready for some stormy weather if you do that.
BTW, I think the way so many here have jumped down OP's throat is typical treatment, terrible treatment, of someone who cares about the unit as a whole. Nurses love to crucify their own and love to complain about problems but never try to help correct them.
I've been a "lame" LTC nurse for almost 20 years. I used to think I need to try acute care to get the "real nursing" experience but have since wised up. I wonder what people think of when they hear LTC? Old confused grannies that wander around the hallways? Old folks just laying around with contractures and bedsores? Horrible smells? Tons of bingo????
It really isn't like that. Most of our LTC residents are up, dressed and out of their rooms every day. PT/OT/ SP or restorative nursing for most on a daily basis. Yeah, we have a ton of bingo. On the skilled side...we have complex wound care, TPN, IV antibiotics, PCA pumps, trach care etc. Nope, I'm not hanging cardiac drips or intubating folks, but we run like a sub acute unit in addition to our LTC stable folks.
I enjoy what I do. I'm really good at it too. We don't eat our young, but we sure do run nurses out that are not there for the right reasons.
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