CoffeeRTC, BSN 17,353 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,654 (24% Liked)
What part of PA and what type of nursing? This will help us answer your questions?
I work LTC and I don't care how many residents the CNA has..that lady got poor care. We work short alot of times and some things get missed. Mouth care might be one of them, but it doesn't get missed for days at a time. Inct care gets done and above all...we let the residents be included in their care. If that means they get to pick the clothes they want or meal...so be it. I totally, totally understand the pressure the CNAs are under but this was neglect or abusive in a way.
The transfer tech needs to be what PT/ OT listed. often times it is an order, so go by what is listed.
If you didn't see them fall, don't chart that. If you have a witness that saw them fall..you can chart that. It goes on the incident report at our facility.
Res found on floor in a sitting postion in front of the wheelchair. Chair noted to be unlocked, res not wearing shoes. Per resident " I stood up and just fell, lost my balance"
Unless they are new to CNA, for the most part, they should know all of this already. I get where you are coming from thought. I don't have any info or teaching stuff for this, but have educated the staff on the "why it is needed" part of what i ask for and what we do.
example..dehydration. Most of the CNAs or people know that if you don't drink or eat you can become dehydrated...if you've ever had someone dehydrated to the point where the skin is tenting show the CNA this. Show them what you look for beside the I? O
could he be hoarding items. I had a "clean" ocd resident that would hide/ hoard food. Of course it was neat, but rotting.
Have you done labs on this person? What type of smell?
I am considering a move to Pitt from Rochester, NY....anyone from the area be able to tell me what the area's pay scale is for new ADN RN's , BSN- RN's and if possible, how their pay scale works?
Only PT with an order..but we have also had orders that permitted family members to appy heat.
Sounds like the other nurse was just upset that a prn would need to be given right at change of shift.
Sometimes in this case, I would have given it 15 minutes early if the resident really needed it. If it seemed like it could have waited for the patient, then I would have stretched it into the next shift so that it could be retimed so it won't interfer with shift change etc.
Sounds like this person needs a med change too. We all fall into this trap..complaining or commenting on the person that need the prn like clockwork..instead of doing that, look at the pain level and call the md to suggest something different either stronger or longer acting and then seing if it helps.
Using a med like tylenol or motrin or other pain med inbetween shouldn't be overlooked too.
I'm not sure I'm getting the bumping yourself down to LPN duties. Don't you all pass meds and take care of patients?
If they came from a LTC, I would find out what the schedule was there and see if you can follow it. We have down times for all of our people getting dilantin via g tube. 2 hrs one before, one after. It really does put the levels out of wack.
We use santyl on occasion and I'd love to get them to do it once a day (a lof of our orders say bid..they really just need to be using a better secondary dressing)
Years ago..it used to be polysporin powder and santyl mixed...again..we quit using it years ago.
A lot of nurses don't know how to use the santly correctly and end up wasting alot of it.
I always cleans with nss, skin prep the periwound area or apply a layer of A&D or vasaline to protect the periwound, apply the santle cover.
Hospice never does the wound dressings for us in LTC we do our own. (unless they are in to assess the wound itself)
As fas as the facility not using a product because it isn't policy...does this still apply with hospice coverage?
We all know that Dakins isn't a great thing to use, but when the wounds aren't going to get better and the pt is terminal..does it really matter what you are using as long as it is providing comfort, cost effective etc?
BTW...I'm all for the newer wound supplies and treatments, but I've seen dakins wtd do wonderful things for a wound when used short term. Some of you may remember the honey/ betadine dressings used years ago...honey has made a comeback in some areas in some wound supplies.
So, we all get the orders or ask for them or need them...but what does stat mean for your facility? Do you even have them?
Labs...only during the week do we get stat services on the weekends and some holidays stat services are available (sometimes) if you call before 12 noon for them. Sometimes if we can get the blood or urine ourselves, they can send a courrier Sometimes not. We have a lab a few miles up the road and sometimes if we can get someone to drop the specimin off we can get it run. Oh..when we do get someome on the phone to talk to it normally is a few hrs at least until they can come.
Xray, dopper, ekg....all depends. Might be a few hours. They are good about letting us know how long and then calling us asap with the results.
Pharmacy...MUST call and speak with the Pharmacist directly when requesting a STAT. 3 hrs or so for a stat. Some days it might be quicker if one of our nurses call her friend who is a driver and asks about it. (Nice to have an inside)
IV..really no stat service for this..The IV nurses have a huge territory to cover and its impossible to get a stat service on this. We start a peripheral if we can and wait for the IV team to come for the midlines etc or arrange to send out for a PICC
The lack of STAT service when we are getting really, really acute/ younger residents often drive the need to send out for ER services. That and the fact that people are so used to NOW and wanting to get things when they ask for it. This was never a problem with our traditional non acute LTC residents.
Just wondering how your facility is handling them.
I don't go to the doctors either clinic or my pcp
People want things done now or last minute so that is why the clinics are used more than the PCP (especially the really busy, overbooked offices)
Maybe they have a PCP that they go to but thier insurance expired. Are the walk in clinics cheaper?
Some people may feel like they are "bothering" the doctor.
These clinics are everywhere...maybe closer than the reg doc?
As far as kids and insurance..I just looked into getting CHIP insurance for my kids when hubby quits or looses his job. Looking them over and even if we have to pay for it (for alot of people it would be free) it is sooooo much better than what we are paying a pretty penny for now thru hubby's work. The only thing with this is that you have to be without insurance for 6 months.
I agree 100% with your answer. Only other thing I might have added was to ask for help from my co workers (even though we know this might not be an option in real life)
Why do you think this was the question that they didn't like the answer too.
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