Latest Comments by CoffeeRTC - page 34

CoffeeRTC, BSN 15,889 Views

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

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  • 3

    Yep...it has changed big time...15 yrs ago when I started...no one was really discharged unless they were going to the funeral homes!

    Even over the last 2 yrs or so, the acuity has changed. We are getting residents 2 days after knee and hip surgery for rehab. We are getting trach, G tubes, central lines, picc, TPN complex wounds with wound vacs, wounds with drains, behavioral issues.....you name it we take it.
    Staffing hasn't changed from the LTC to the rehab/ short term stays either. That is the big problem.

    Lets talk about the no return to hospital push too. See all of those sick people that get discharged early from the hospitals.....we need to make sure we don't send them back to the hospital.

    It is crazy.

  • 1
    xtxrn likes this.

    nah ah...google hates me

  • 5
    agldragonRN, OCNRN63, NotFlo, and 2 others like this.

    Quote from nightengalegoddess
    I think you need to work in a real hospital. We need more of you.

    Yikes...really? We aren't all that bad.



    I'm glad people like me and the OP do work in LTCs and do care.
    Why couldn't you just call and get it clarified yourself? I understand that they might just want one nurse making calls to the doc, but if you want something done right........

    You are correct tho, but I will be honest..at our place it is normally written as Bactrim or Bactrim DS.
    As far as the tylenol example...tylenol needs an excact dose. Ours is generic and comes in 325mg so for the most part all of our orders are tylenol 650mg po prn or if it is extra strength it is writtin as Tylenol 500mg .

  • 0

    The Assistant Director of Nursing and Director or Nursing? If they didn't know about it...why didn't you then tell them about it, tell them you wrote something up, re do the write up and then give them the opportunity to deal with it?

    Don't get me wrong..I'm all for advocating for my residents etc, but do the chain of command thing first...then you can call the state.

  • 1
    nightengalegoddess likes this.

    I think we need more info.
    By extended care is that LTC or assisted living?

    Have you approched the nurse precepting you? maybe she feels threatened by you?

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    I only work PT in LTC, but I see a lot of full time nurses get burned out on this issue. We are the ones passing the meds and who know our residents, but getting the docs and family on board with pain control is another issue.

    This person either needs an up on the duragesic patch or different long acting meds. What about Mscontin, oxycontin etc?
    Maybe the neurotin needs increased too. Sometimes they are on such small doses of neurotin why even bother with it?


    When people pull out the "they are addicted" so what I say. We are still controlling the amt given by only giving the meds per order. If they are odered every 3 hrs...I will give it when asked.

  • 0

    Quote from seizetheday
    You obviously know these nurses in my grandmother's LTC better than I do. I guess I am just naive, ignorant and very gullible because I believed what they told me and despite having spent 3-4 evenings a week at that LTC for 10 years I have absolutely no idea what happens on her unit. I guess they lied and really left acute care for the faster-paced, harder, environment of LTC and just lied to my face when they said they were burning out on acute floors and preferred the pace of the LTC. You are right, no LTC nurse could possibly have a different experience than yours.

    I do beleive you. This place could be that nice. Its good that she is in a place where the nurses are not running around crazy. You commented on what you knew to be true.

  • 0

    Quote from seizetheday
    I don't think I implied that walking is sedentary or did I say LTC was slow-paced. Every LTC nurse will have their own experience. According to the ones I have spoken to and observed at my grandmother's LTC, they do state they prefer the pace of LTC to hospital and that is slower, although not slow. They chose to go to LTC in their later-careers for the change in pace. You may have had different experiences but that doesn't negate theirs. I was responding to the OPs question not telling you what your experience was. Perhaps in other places they do run non-stop and never sit down, however this isn't the case at the LTC I have experience with. The med cart has so much on top that if they ran with it, there would be trail of cups, straws and papers on the floor. They walk the med cart to one location and do meds for about 6 rooms then move the med cart and repeat. They stop and chat with residents, the evening nurse actually often sits and watches TV for 20-30 minutes with my grandmother each evening. What they mostly get stressed and upset about isn't the pace or the residents but the admin and the politics, frustrations with CNAs and staffing woes.

    wow...sign me up to work here. This place is def an exception to most LTCs

  • 0

    Yikes. So just wondering about this? Did you go up the chain of command before you called the state? I always make copies of write ups and would have presented them to the hirer ups or told them I would have re written the "lost" documentation.
    Sounds like there are more than just this issue at that place?

  • 1
    chevyv likes this.

    Quote from chevyv
    Can someone tell me more of what an MDS coordinator does? I do MDS's at work but I'm only going through the nursing part. I don't look at the MAR's to find errors. I thought (and I'm very new to the whole process) that is was basically keeping us on track with proving our billing mathes our pts and whats going on with them. Anyone with knowledge care to input?
    The MDS nurse or assessment coordinator or medicare nurse or RNAC does many things. For the most part they coordinate the assessment process which includes care plans and the MDS (minimum data set). The MDS shows the insurance co and medicare/ medicaid what level of care the resident is getting. They reimburse the facility based on that. In order to complete the MDS, there needs to be proof of care. Looking thru the assessments completed during a set period of time includes looking thru nurses notes and all documentation including the MAR and TAR. Often times when you are looking thru notes, md orders, labs and MARS/ TARS I would pick up on a ton of things that could have been over looked. This is how the error could have been found.

    In some places the RNAC or MDS nurse does more than that just the MDS and care plans. They can be considered part of management, salaried or hourly, they can be incharge of other things like restorative, infection control, incident reports, wound teams, nutrition and behavior teams. It all depends on how the facility is set up. In mine..the RNAC is somewhat an ADON or DON stand in and part of management. So being in the know and involved in a situation like this isn't unheard of.

    My take on the whole isssue is that the OP can be concerned that it will just be swept under the carpet. Lets face it...things like this happen and happen in LTC.
    To be honest..I forgot what the origional question was??

    OP..can you just ask the DON or ADM what is going on with the situation if you are concerned about it?

  • 3

    LOL...I'm "24" to most people but actually well older than that.

    Are you in LTC? There are a lot of threads on subjects like this and have dealth with it myself.

    First off....I agree..pick your battles. Be respectfull of the rest of the staff. You do get more flies with honey....Let everyone know your willing to help or show them the correct way or get them help if they need it. Give verbal warnings first (unless it is an abuse etc situation where it is more serious). You don't need to be thier friends, but you need to work with them every day.
    What about asking other managers for help on dealing with staff issues?

  • 2

    It doesn't sound like she is as into you as you are into her. 4 months. I would come right out and ask her what she wants from this relationship.

  • 0

    Don't forget all the alarms and bells that you hear in your dreams.

  • 0

    Does it have to be spent on the care or could it be something for the nurses? A nice couch for the break room or a fancy coffee maker?
    Maybe something for the patient or visitors lounge on your unit?

  • 0

    Some capsules crack when you try to open them...the size of that piece would be very small if that is the case.

    Think about where that capusule goes when the patient swallows it. Then only thing it might do is clog the tube. As mentioned, warm water flushes will disolve it.

    Best option...get the med in a liquid form. This might not always be a choice in LTC tho.


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