CoffeeRTC, BSN 16,453 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,618 (23% Liked)
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%
Wow, it has been years since I have see this! We used Polysporin and Santyl.
Google it and you will find a bunch of links. Collagenase SANTYL(R) Ointment | The Continuous, Active Micro-debrider
after cleaning the wound, we would sprinkle the powder and apply the santyl.
Most of us, especially after working in healthcare, have MRSA in our groins and arm pits etc. It's a community bacteria. We did a test when I was at university and swabbed each other. A good 60% of us had it in our nose, groins, armpits. It's susceptible patients that are at risk and it's just unfortunate. It doesn't mean you have to not work.
OP....come back and explain yourself! Why is this so important to you?
When the DR is out, does care suffer? Do other Drs pick up the slack or is there a huge delay of care?
As far as worrying about the paramedic, their base would be sending out calls if they needed them back asap? EMS crews work in pairs in my parts, where is the other one while this is happening? If anyone should be concerned, it would be his partner.
We have very little standing orders in LTC except with our diabetics Totally different world than acute care, but often times we get new admits that are newly diagnosed.
A critical reading is retested via finger stick (stat labs take at least 3 hours) and then treated via standing orders. No wait time. (5 minutes tops to access the needed meds)
GI bug is hitting our ltc bad. Good thing I haven't been working for a while. Bad thing..3 of my kids have been down with it.
Rarely to I get sick. I had it a month ago. Not sure if it is the noro.
Is this in addition to an event/ incident report? Why is is so long? Is is all about the falls or is there other material on the form that doesn't really apply?
I've filled in for our risk manager and I have a new appreciation for what they go through when investigating events. Since I am also working on the unit, I have a good idea of what the resident is like. Someone that doesn't work the floor, won't have this picture of the resident or unit. I really don't like the forms we use for events. They are way to broad and leave it up to the nurse or witnesses to fill out a narrative of the event. Things get missed and not noted. That being said, I can see how things need to be streamlined.
We have bed/ chair alarms, but I'm not sure if it really does cut down on the falls. The alarms are only effective if 1. they are actually turned on and 2. you have the staff to respond to the alarm. As far as interventions.. start from the top and work your way down.
When does the fall occur? is there a pattern? toileting issue, pain, hunger etc. Are they trying to get up to leave for work? (we had a dementia resident that was trying to get up to get ready for work around 4:30 am...solution was to get them up and dressed, out of bed and get an early breakfast)
Where does it occur? Are they being left in the dinning room unattended after dinner?
Look at positioning....are they trying to stand up because they haven't had a position change and are getting sore?
Are the W/C or bed wheels locked?
Are they bored? Is activities involved?
We don't use restraints either. We have 1 or 2 residents in a geri chair for comfort/ request and on occasion use a merrywalker (resident can get in and out of it on their own) so it can be tricky to prevent falls.
Yikes. I need to recheck our policy. We do accept meds from home, but it normally for our respite patients that are only there for a week. I don't recall using narcs from home except with a hospice patient. I understand the position you might have been in. Often times we get admits on the weekend, pharmacy is taking forever to even answer the phone, doc is taking forever to call in scripts (if they didn't come with them from the hospital), you have the order for them, the resident is clearly in pain and has a need for them, it is easy to look the other way while they pull one from their purse or family might bring them in from home. BUT....I also see how this can go wrong, and it not being legal etc.
Don't stop caring and remembering why you are there. It is so easy to focus on the daily tasks and responsibilities and get over whelmed.
...and I'm the nurse that gets those patients admitted to my SNF for rehab....minus the Ativan, minus the Ambien, minus the Dilaudid/ Percocet/ Vicodin.
Yep, they were on all of those in the morning and might have even got their prns that morning. Now it is 7pm and I'm in the middle of doing their admission. Try getting an order for any of those.
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