CoffeeRTC, BSN 18,603 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,715 (24% Liked)
Think about the time it takes to prepare the medication and quickly assess the patient prior to medication administration. By the time you complete this initial process, return to disconnect the nebulizer, reassess, then document, would that not equate to at least 15 minutes after adding actual inhalation time? After all, you are having them to cough and deep-breathe after, correct? This will kill 15 minutes easily if done correctly. Factor in a productive coughing spell, and there you have it.
In LTC, time is limited or non-existent. But CMS doesn't care about that. The proper process is expected since they are funding the care of most of these residents; it is up to your facility to ensure that you have adequate staffing to properly care for the specific resident population.
As a state surveyor, we observe and time this process because of the regulations, and believe it or not, CMS-appointed surveyors come down to observe us as we observe you. If I was standing there with my pad and pen, observing you, I assure you that the process would take up the entire 15 minutes as you carefully complete each task...even if you stop the timer as you proceed to another patient, and restart it upon your return.
On a rare moment when you have nothing left to do, go in and administer one of your neb treatments without leaving the bedside, timing it from start to finish, and compare your findings to what you believe takes only 5 minutes.
I was feeling very glam last week at work. I was helping the CNAs shower a combative resident. He tried to pinch my backside and then said I had a "luscious behind"
I work LTC: Resting in bed with eyes closed. VSS, afebrile. Continues on IV antibiotics with no n/v/d. Resp easy and unlabored on room air. Denies pain. Dressing to left lower extremity clean, dry and intact. IV dressing clean dry and intact. No redness, warmth, edema. Both lumens flushed per protocol. Resident remains continent of bowel and bladder. Assist X1 to ambulate to the bathroom with wheeled walker. Bed alarm inplace and functioning. Fall mats intact to both sides of bed. Call bell within reach.
Maybe one of the mods can move this to the Geriatric/ LTC forum for more responses?
It sounds like that patient would have picked on you or another nurse for any reason. I used to get this a ton and still do. It only bothered me when people would think "you are too young to be in charge." (I was a house supervisor in a LTC)
If you are confident in your abilities, no one will see your age.
Now that I'm starting to get the grays and wrinkles around the eyes.....I miss the "you are too young"
I have no info on this, except Pitt is a reputable school.
If you are on Facebook, there is a Pittsburgh Nurses group with frequent questions about online BSN programs. Try there!
It really all depends on where you are working. Some unit managers function as mini DONs with 24 hr accountability of the unit and others are more of just more of a supervisor.
Where I work, we make out shift assignments for the CNAs and nurses, check the daily staffing needs and fix when needed, follow up with all calls to MDs and families, schedule appointments and pick up arrangements, supervise staff, take off orders and follow up with labs. Meetings, meetings and more meetings....daily clinical review, morning and afternoon stand up/ stand down, care plan conferences.....etc.
What is the policy of the facility? Are nurses in LTC responsible for the patients in the assisted or independent living? If so, where do you go to find out medical history? I wouldn't feel good in this situation either.
Staying over to do charting isn't a sign of diverting narcotics. Picking up a lot of extra shifts is sometimes associated with diversion. People who get their fix at work want to be at work.
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.
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