CoffeeRTC, BSN 16,182 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,612 (23% Liked)
I will try and be helpful
If this is LTC...it is just way to common. What are the reasons they are calling off? What is staffing like?
We have been running very short. CNAs are doubling or splitting 8 hour shifts so they are working 12-16 hours 3-7 days a week. Yes...I said 7. Many are single parents or parent with a few children. They have bills, they need money. CNAs don't get paid enough as it is. These ones that sign up to work extra are making it so that we are not short staffed by filling the holes. They get burnt out very fast. Now...add in a call off for a legit reason or even something not (too much partying the night before) Cue the resentment and increased fatigue by the staff...cue the cycle of call offs.
So...adequate staffing and a good prn call in staff.
Generous time off or flexibility for illnesses or emergencies.
Staff appreciation ...little things add up.
Enforcement of discipline process when there are call offs.
Giving the levimir instead of the sliding scale coverage was a med error. Was the doctor called to adjust the 9pm dose to the 15 units? why not? What was the 9pm reading? They didn't get coverage for the 4:30pm reading. The doc probably would have just ordered the 15 units and to continue with the regular sliding scale coverage.
bottom line..orders were not followed, a med error occured, nurse was practicing medicine by not giving what the doctor ordered.
Oh...answering the OPs question.
Sometimes they might be upset that we didn't call sooner. Often times, it isn't our fault. Resident might have refused (well documented) or maybe the condition changed quickly or maybe I just walked into this mess.
DNR doesn't mean...do not treat.
I have been in LTC for many years and it has been ages since I had difficulty with the local EMS. We utilize private company for most transports but if they are busy or we need help stat then we call 911 and we have help within 5 minutes.
When I hear a coworker complain about the EMS, I have to ask a few questions first. Many times, it is our (nurses) fault. Yes, I am willing to take the blame or at least put it on my coworkers. When we decide to send a resident out, unless it is an extreme emergency, then we should have a complete or at least focused assessment including baseline for that resident, I would expect a clear path has been made and if there is time, basic paperwork and having the resident cleaned up if needed. Greet the emt/ medic and give them a brief report...not just point the way.
We are not "stupid or lazy" but sometimes things get crazy. I work part time so I might not know complete histories, but I am willing to share assessment and reason for transport and every bit of information I do know. Sending a resident out for AMS and not checking vitals, O2 sats or a finger stick on a diabetic???? Yeah, If I was EMS, I would be pissed.
Sounds like a horrible first day. What makes you think they are treating you that way? do they offer more help? Do the other nurses hover?
I would suggest trying to be organized. Now that you've been there for a while, are you familiar with where things are located?
I would walk around, look for things etc. Get familiar with your unit. Where are the supplies, where are the list of phone numbers, etc? Organize your med and treatment cart at the start of the shift, load it up!
Make a list and try to organize your shift....ask the other nurses what they do. What works for them?
Being the new nurse stinks and it takes a while to get a routine of your own. Its worse when the other nurses are not working as a team with you and offering help.
I agree with the others. This week with the norovirus and C diff outbreak, I've stepped up my game. Wiping my shoes and leaving them in the garage and changing as soon as I got home.
you should be able to find this on the state's website.
There is a Facebook Pittsburgh nurses group that is fairly active. Check it out if you are on FB.
Have you ever looked at the consent forms for those trampoline parks? You sign everything away when you let your kids go there.
Back story..I work part time in a LTC facility and have quite a few years experience at the same one. Doesn't really matter since a different company took us over about 2 years ago.
I've been working more hours lately and wanted to check on my time off due to calling out two days. (My fault for never checking on this before) I normally have accrued about 40 hours of vacation per year. Old company...it would be added to the bank with each pay period. I also got sick time that came out two two days per year.
Found out new company only issues time off on your anniversary date. My rate is 0.0769 hours of vacation per one hour worked. Seems a bit on the low side?? I have no sick time but can use the vacation hours for calling out.
So....what do you get as a part timer? Again...this is LTC. Is it vacation/ sick or PTO to be used for what ever?
I'll bite. I've been in LTC forever and wouldn't really recommend a SDC position for a new grad. Your masters is a nice bonus, but you really should know how to be a nurse and have experience in nursing to teach nursing. The critical thinking and mastery of skills that you will be teaching comes with experience. Sure you can probably do the job, but would you want someome just teaching from a book without experience? Think back to nursing school.
Think about why a facility would want a new grad in that position too? What else is going on that no one else wants the job?
We see a lot of these type of residents now too.
We've switched them to liquid when possible and crush the meds when we can. If they complain about the taste, I use jelly instead of the pudding or apple sauce. If they refuse to take it, our MDs will d/c it or cut the dosage.
Sad to say, but make sure you have easy access to your narcan. We can't have eyes on them at all time. Our residents are getting younger and we are seeing these issues more and more.
What about a behavior contract? Have you gone that direction?
I don't think that the OP mentioned what type of facility this happened in, but it has LTC all over it. Before anyone jumps all over me, I have to say that I am a LTC nurse with many years of experience. There are good and bad facilities.
I have seen this situation occur way too many times. Dressing is signed off as being done, heck there even could be a nurses note written. Dressing wasn't done. If the patient is A and O X 3 and made a complaint about it then it should be investigated.
There are many reasons it might not have been done. We aren't all super nurses and maybe it was a rough shift and there just wasn't time to get it done. Things happen. It is what happens next that is important. In our place, we would initial and circle it and then make a note on the back of the page. Pass it on to the next shift and ask for help getting it done.
I've seen people out right lie about things like this. I followed on nurse that never did BID dressings. It wasn't as if she didn't have the time or wasn't trained on how to do them. I reported it and it was denied. She even went as far as changing the piece of tape with a new date but not the actual dressing. I solved this by signing the inner dressing then applying the guaze and then signing and dating the outer dressing. Point is...it happens.
All you can do is follow your facility's policy for this event. Report it and hope it gets taken care of by the management.
Sounds like this can be a LTC facility? I'm still trying to figure out your other role.
Have you approached her directly? If this is LTC, there should be an administrator or even executive director. If you've already approached her, then I would move on up the chain.
No secret that it is Norovirus seaason!
A lot of times the symptoms are the same so we are ruling out both Norovirus and C Diff.
What brand/ type of products are you using at your facility/ hospital?
We all know that bleach and hand washing is best for the C Diff. I was just looking at our sanitizing wipes and they are alcohol based??!!
Our P&P lists bleach based cleaner for both organisms.
I did go to the CDC website to look and it does look like "ethanol based had sanitizers (60-95%) is the preferred active agent for the Norovirus gastroenteritis." So I googled our wipes and they are listed as "isopropyl alcohol..55%
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