Latest Comments by CoffeeRTC

CoffeeRTC, BSN 14,843 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,537 (23% Liked) Likes: 1,540

Sorted By Last Comment (Max 500)
  • 0

    It happens.

    What will happen is that with any incident where the resident is transfered to the hospital (and other reasons) we need to report it to the state.

    They will investigate a few things or need more info on this. Starting with were they at risk for falls? (did they have a previous fall, were fall assessments done quarterly, with admit and with any sig change?)
    If you knew they were at risk..what interventions were put into place? Was there a care plan?
    After the fall...what did you do? Was policy and procedure followed? Was proper first aid administered?

    If you didn't document any of this or if it wasn't put into place knowing this person had a fall....yeah, there could be a problem.
    A LTC nurse cannot be everywhere at all times and some accidents are not preventable. It happens.

  • 3

    Every single minute of OT is scrutinized. (it should be, but the big offenders should have been dealt with long ago) Our supplies are already at a minimum. The must punch out for lunch thing is getting a big push..even for the staff that have been grandfathered in and have been there for more than 10+ yrs (we are now loosing that 1/2 hr per day out of our pay). Admission inquiries almost always get a "yes" no matter what the current or PMHx is. .....the list can go on.

    Yes...its a business, but this is from the government.

  • 0

    What???? Confused on what you want to know.

    At the very least, the "RN Supervisor" is just RN supervisor. Most often they will be responsible for overseeing the care that the LPNS and CNAs are performing and sometimes other RNs.
    Each facility is going to have a different form of job duties assigned to a supervisor. Most places will pay you more than the regular floor or staff nurse, but it might not be that much.
    In a lot of places I worked, I could have been the only RN in the building, I assumed responsibiliyt of the entire building. The next higher up in command was the DON.

    What specifically do you want to know?

  • 0

    If the CNAs refused to adhear to the turning and repositioning what is being done about that?? The nurses need to be making sure it is getting done.

    How often are the wounds being measured and assessed? How often are you evaluating the treatment orders? What about the often are you doing it?

  • 0

    Agree with Nascar..picking your residents is a lot better than the alternative!

    Most referals etc are coming over via fax or computer email anymore.
    On the weekends, the staff nurse/ supervisor/ charge nurse handles admissions and referals. We admit at all hours of the day too.

  • 0

    Well, as a mom of 5 I can tell you that it is uncomfortable, but it is part of the care provided. Not an OB nurse, but I would say that what ever the policy is thats is what it is.
    Sometimes we do things that are uncofortable to our pts..(foley caths, IV inserts etc) This is the reason I can't give injections to little kids..vaccines are necessary, but they hurt..same concept as your above question.

  • 1
    Esme12 likes this.

    We use alot of Miralax and I've never heard of sticky stools with it???

    If he is inct, you should be using some type of barrier cream to begin with. If there are no issues with skin integrity at the present...good old cheap A & D will solve your problem. It is greasy and would keep it from sticking.

    Yrs ago we used a product called ILex on excoriated skin...When you used it correctly it was great..apply the paste then cover with your barrier creams...don't rub off the ilex. When you wanted to remove the Ilex..use mineral oil.
    So...mineral oil or baby oil might be a good way to get off the skicky stools too.
    Ask the family why they only want TP and wipes to be used. If it is a home care situtation, they probably don't want to do the laundry on those???

    The shaving cream is a good suggestion and works and it is great when cleaning up the smelliest things can hurt the skin (maybe not the ones with moisturizers and the newer formulas) so you need to be careful with that.

  • 0

    have no clue, but I think it is a great idea and wish my office had one.

  • 1
    LTCangel likes this.

    Quote from nerdtonurse?
    I've done the "over the top" like wooh -- sometimes, that works. Sometimes they just want an older nurse because they don't think anyone under the age of 40 knows anything. In ICU, we run into a lot of families who think there's a doc sitting in the unit all the time (only if there's food does the MD do that), and want us to call them all the time.

    I had one memorably horrible family when I was in telemetry, and they all jumped the nurses about stupid stuff -- the window wouldn't open (sealed shut, presumably to keep the nurses from escaping), TV screen wasn't big enough, ice wasn't cold enough (still can't figure that one out), too hot, too cool, where's the doc, etc. The patient was the family matriarch, and a cough was pneumonia, a sneeze was the flu, a headache was meningitis, etc. In all the time for nothing. It got to the point where the house supervisor would just schedule a drive by of the room about every 6 hours to get the current list of BS complaints, which she just tossed. Finally, after one of the family members hit the code blue button in the room because we didn't bring ice water fast enough (the CNA was coming down the hall with it, we reviewed the tapes and it was 90 seconds between when they asked for the water and hit the big blue button), the doc came in and dc'd the patient at 0100. I'll always remember what he said, "We've got 38 patients on this floor, and we can make 37 of them happy, and you'll be unhappy, or we can make all of them unhappy because the nurses are always running and doing stupid S**** for you and you'll still be unhappy. So...go home." The family had an apoplexy, but they were discharged, and we fed that doc all the goodies in the station for days....They went on the ER's "don't admit unless she's actually sick" list.

    This is what it is all about. The family wantst to know that mom is getting the best care. Somewhere down the line, someone might have dropped the ball or they had a bad experience. Hovering and nit picking is the only way they think they can have control of the situation.
    First impressions are HUGE. Since for the most part, this pt will be around for a while (weeks to months) you need to try to get this family on your side, but still remember that your resident is the patient.
    Be professional and firm. Don't let them push you around but give them the power to be included in the care.
    Those "note books"....I love them!!! If you have shifts of families...encourage them to keep a book to communicate with each other..that way you don't have to be tied down discussing things with each of them. Heck....I give them a pen or pencil and tell them to go at it! Don't be afraid of them because you are going to be doing your own legal documentation of any thing that needs to be documented!

    After all of this and all of the suggestions that we all give you remember that not every family can be reached. Some people just aren't good people...they love to complain, they don't want to be part of the team.

  • 0

    Will admissions be your job? Most places have an admissions coordinator that does this.
    You will still need to use the phone...calling docs, labs, families, making appts, calling the pharm......

  • 0

    lol...No wants to or likes to talk about pay in this area.

    What city are you looking at?

    I can tell you PGH LTC rates.

  • 3

    Having time to spend with your patients and leaving your shift knowing they got the best care you can give

  • 0

    What setting are you in..LTC?

    If so...make sure that the med carts are stocked and ready. If you can..get the water set up and the drinks on ice etc. Don't forget the lancets, accucheck stuff and syringes.
    Make sure that the treatments supplies are stocked too.

    You'd be surprised on the things you can call for at night. Ask around. I never knew that I could call the lab or order certain supplies at night.

    Make a list of things you are running low on (meds, tx supplies, forms etc)

    Have the vitals list written down for the next shift. (update the list so that those that don't need it can come off)

    Make sure the tube feeding and IVs are running and full.

    Let days know who is going out for appts and when. Make sure a chart is copied and ready for them to take.
    Same goes with discharges..get the stuff ready...have CNAs pack up the resident if they can.

    Most of the above is already the 11-7 nurse's duties.

  • 0

    What a horrible shift. Sounds a bit like LTC? BTDT and have a t shirt.

    I wouldn't have written it as an order..maybe in the notes? Eh.
    Don't ya just love how someone can come in and pick apart everything?

  • 1
    xtxrn likes this.

    300 tid isn't that big of a dose.