Latest Comments by CoffeeRTC

Latest Comments by CoffeeRTC

CoffeeRTC, BSN 12,470 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,473 (22% Liked) Likes: 1,484

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  • 7
    LadyFree28, LTCNS, 4boysmama, and 4 others like this.

    I work LTC and all I do is assess. Is it a head to toe every time? No. In my role as supervisor or floor nurse I do complete head to toes on admission and get a heathy history with the 10 million questions done. Ever other time I interact it is a focused assessment. We assess with our eyes and ears every time you have an interaction. Just because I might not be using my stethosocope it doesn't mean we are not assessing.

    In LTC, there rarely are drs in house (unless they are doing rounds) so we are also formulating a diagnosis too. If I'm calling a dr, I better have a good idea why and wil most often be asked "what are you thinking about this?"

  • 0

    Am I over reacting on not?

    I work in a small facility so the gossip and rumor mill is always in full swing.

    A nurse aid mentioned to me that one of the nurses was a bit angry with her salary and was talking about other nurses and ancillary staff (including department heads) salaries and hourly rate. She was very specific with what we are all making. The union staff..no secret since it is posted. I think the new hires have a basic rate too, so I guess not a secret but department heads (salaried) and older staff??? Shouldn't be public knowledge.

    I guess my issue is that, yes, it is actually in our employee handbook that salaries are a private matter and should remain that way. We all know that it talked about but I'm some what perplexed on how the information can be so specific on so many people non nursing. I'm confident that they wouldn't be sharing their salaries and it makes me wonder who exactly is sharing this information? The administrator? DON? (why would she know that other departments make).

    WWYD? Compliance issue? Bring this up with the administrator who might be the leak, blow it off and only bring it up if it becomes an issue?

  • 2
    bluegeegoo2 and amoLucia like this.

    I've never ever seen vital sign equiptment callibrated in LTC. The only thing I've seen checked are the scales.

  • 1
    loveschoolnursing likes this.

    All of the above!!!

    It has been years since I did clinical in a nursing home but I have years of experience in the nursing home

    If you have free time..buddy up with a CNA. You will help them and they will help you!! Just watching them and how they interact with the residents you will learn a ton. For most students this can be your first time to practice on real patients the skills you have been learning. Basic vitals and assessments..learning how to interact and interview patients and the baiscs like transfering someome from a chair to a bed, walking with someome with a walker, basic adls....then there is the med passes!

    Lots to learn, just be open to learning and ask questions!!

  • 2
    IowaKaren and SororAKS like this.

    We had a resident that would urinate in the lobby. He loved the fake trees, trash cans, and the water fountain. We ruled out UTI, did q 2 hour toileting, everything. 1:1 was the only thing that worked. Frustrating.

  • 0

    Stop sign? or some type of sign or diversion?

  • 0

    Before I reinvent the wheel....

    We seem to be running out of supplies, alot. Anything from Kleenex to body soap, gloves and treatment supplies. Does anyone have a general formula on how they order these?

    I'm trying to be part of the solution and think this through and help come up with some suggestions.

    I haven't done the ordering in years but when I did...we would look at the census trends. When ordering wound care supplies, I would review the orders to find out what was popular...did we have any residents with a large amount of wounds or who needed extra supplies (ex..a resident with a huge stage 4 that needed packed with 4 rolls of kerlix 3 times a day and also required 4 abd pads with each change)....I would consider upping my kerlix and abd order.

    What about personal care supplies? Body soap..average one bottle per resident per week? Assuming they would get 1-2 showers a week, washed daily and inct care prn.

    Maybe it is just using common sense? (it is to me)

  • 0

    Make a few phone calls. When was your cert to run out? Do CNAs need recertified?

  • 0

    Have you figured out what was causing the mental changes?

    I can't belive I am going to type this BUT...I was watching Dr Oz ( yikes, right?)

    There was a segment about parasites causing menal changes. I did a google search and found a good bit of info on it.

  • 1
    Fishmm likes this.

    Is this an after the fact question?
    I would do my assessments, call MD. A chest X-ray and ekg could take hours. Do they have nitro? Cardiac history? What were vitals like? Did you rule out gastrointestinal? Anxiety? Resp issue?
    If it's a 911 situation, I don't wait for the MD to return the call...5 minutes can make a difference. I'd also get the AED and crash cart ready.

  • 0

    Sounds like a nice bit of training and that they are willing to invest in their employees. Good luck!

  • 1
    ShaneTeam likes this.

    Welcome to LTC! First step is realizing how different it will be. A lot of how crazy it will be will depend on what type of facility you will work in. Larger facilities might have more support staff and of course more nurses. Smaller places you might need to wear a few more hats.

    Read thru some of the new grad posts already in the forum. Good tips.

    Even though you have some time in, ask for as long of an orientation as you can get. Will you be more of a supervisor or floor nurse working the cart? Ask to get training in both areas. Keep cheat sheets. Depending on what type of facility, some of the residents will be long term and you won't have many changes. My sheet has room number, name, Dr, code status, top dx (they will have tons of them, but what are we treating them for?) and a spot for IVS/ Accu Checks. How do they take meds? Whole or Crushed? and if they need anything special...thickened liquids, etc.

    In LTC, you will be doing focused assessments. Rarely do you have time to do a full head to toe like med surg.

    Get a cheat sheet for important phone numbers or extensions. Big places can be confusing. In a new place, I find it useful to have drs phone and fax # handy along with the pharmacy's. I also make notes about what drs like certain things. All of our drs are so different.

    My biggest piece of advice.....not be afraid to ask questions!!!

  • 8

    Sounds like Dad w wanted out of work!

  • 0

    What was the biggest hurdle besides actually getting the job?
    How did you manage to get your foot in the door?

    Many of us who have done LTC / skilled nursing and even semi sub acute are very familiar with complex wound care, wound vacs, IV meds, IV starts, blood draws, NG tubes (including inserts) G tubes, Resp treatments, med passes from hell, family issues, dealing with cranky doctors etc.....sooo how does this experience help?

    What do you feel you needed to re-learn?

  • 0

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