CoffeeRTC, BSN 18,324 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,691 (24% Liked)
I will be following your post. I too will be taking a SDC position soon and be starting from the ground up!
From a federal legal standpoint;
Nothing about this situation was HIPAA privacy issue. As Someone already mentioned, without disclosing whom has/had scabies there isn't a privacy violation.
Second, federal law, as well as most state patient rights law, mandates that each patient has the right to know their diagnosis and options for treatment. In most cases, patients also have the right to object to treatment.
As a CNA, you most definitely should not have been forced into this position, but your actions, though probably not part of your job description, probably saved your employer from violating the law. I would speak to management about making sure patients are being properly consulted about their medical needs.
^^^^ This a thousand times!
My pet peeve is how areas around a wound are neglected. We are treating an area on a heel or ankle, why do we need to neglect cleaning between their toes on the top of their foot?
I'm assuming a RCA is like a CNA? Where are they charting? I've never seen them doing anything except coding for ADLs.
Can you pull your facility's procedure manual?
I think there are a few posts on her about nights. You might be able to find them with a search.
11-7....depending on the size of the building, you might be the only nurse in house. If so, you will be doing hands on. There generally is a 12 am and 6am med pass. the 6 or 7 am would be heaviest. you might have a few treatments, IV meds, feeding tube and iV tubing changes and then there is chart checks and restocking and other general housekeeping tasks.
We normally have quite a few people awake. Some are just night owls and some are dementia patients.
Again...depending on the size of the facility...it will probably be just nurses and CNAs. No secretaries, housekeeping etc.
Ratios can vary. We run with one nurse for 50 residents and 2-3 CNAs.
Are you new to LTC or nursing? If not, I say two weeks is a super orientation.
As above, get to know your physical layout, phone numbers and who does what and where.
Familiarize yourself with the nurses station...files, binders, charts etc.
Keep a note book and jot down notes.
Get involved. Instead of just watching the nurses do things...ask to do it.
If it is considered unapproved OT, then yes...I can see how it can happen but I've never seen this happen.
We were just talking about this at work. The charge nurse is tasked with finding replacements when we have a call off. This is in addition to working the floor.
Suggestions we have are to update the staff list weekly or at least every two weeks with who is still employeed (yes, sometimes it is that bad)
We are union, so making sure you have it listed by seniority is important too. We also were thinking about having it listed by who is okay with texts. A group text is soooo much easier than 20 plus phone calls.
You are probably right. I am doing an in-service this week. It is just so sad and frustrating. Most of our nurses have plenty of experience in nursing and at our facility but still, cant seem to complete an event report correctly or even critical think on how to provide and immediate intervention to precvent further occurance. They do nothing. A resident falls, they might or might not complete an event report and place the info on report. No follow up, nothing.
How much of this falls on to you?
Fall occurs. Nurse completes an event/ incident report. What do your forms include?
We have a one page event report that nurse completes. Then we have witness statements. Everyone that had contact with that resident should complete one. The nurse and CNA assigned and those that responded to the event.
That is all we do. It gets shipped off to the DON then the risk manager.
The event should go on our 24 hr report and alert charting should be done for 3 days. Neuro checks are hit or miss and so is the charting. No one seems to be doing any immediate corrective action or critical thinking.
A lot of this just seems like common sense to me, but we are having a hard time with this.
I'm tying to come up with some type of reminder check off list for the nurses to do along with the event report to cue immediate intervention. I want to keep it simple.
Anyone have suggestions? or can you point me to a webiste etc?
Before anyone mentions increase staffing and assign sitters or voices a complaint about adding another form to fill out, I just want to mention that I'm still working in the trench and most of my duties include hands on care. I get that no one wants another form to complete, trust me.
Never, ever go into this resident's room alone. There should always be a buddy system and if possible the nurse should be there too. Not easy in LTC. I've taken care of my share of residents with similar behaviors. As a nurse, I would document word for for word what the resident is saying. His behaviors need to be care planned and there needs to be limits set. Family should also be involved and the facility should contact the ombudsman.
Um...not a totally bad idea, but like Ruby said...we need more information.
UGHHHHH. I can just scream about this issue. Can you tell I'm dealing with a similar issue? I find it amazing that the vital signs are done without the equipment moving from the desk. Amazing!
Vitals for meds.....I do, unless i see the CNA just walk out of the room before i'm going to pass the med.
So tonight I've had my fifth evening off orientation and it was my first bad one. I came in to work to know I forgot to give one pill last night (it was ferrous sulfate so it didn't had any consequences on the patient). The worst is that I signed it on the MAR but got distracted and forgot to give it and didn't even notice!
When others go on their breaks at 6PM, I am alone with 1 CNA and 1 LVN for 32 patients and sometimes it's just crazy? Like yesterday a super confused and agitated patient just walked into another patient's room and hit another patient with his cane? And today the same patient walked into another patient's room, pulled down his diaper (sorry I don't know which emglish word is more respectful for elderly people) which was full of feces, sat on a char and started putting his feet in the feces and made a big mess. While I had to handle this, there were many bells, a patient who needed supervision to walk got up and went to the bathroom alone, it was chaos! I probably looked like a headless chicken to the others. For the first time I had to start parenteral nutrition and the pump just kept ringing and I couldn't figure out why. Turns out the tubing was just misplaced. Had to get the other nurse to figure this out -.- Finally, I was alone for passing meds and installing half of the 14 patients for the night and wasn't done at all when everyone came to help; we were 6 in the room to install/pass meds for 3 patients and I almost started crying because I felt so slow and incompetent..
Now I'm scared that next time I'll go to work we'll tell me that I forgot to give a med or something else, or that I did something wrong :'(
I know this is a normal feeling but I've only been working for 5 days and made my first med error, I'm just a little down, needed to vent.
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