Latest Comments by michelle126

Latest Comments by michelle126

michelle126, BSN (11,023 Views)

Joined Jan 22, '03. michelle126 is a RN. Posts: 3,424 (22% Liked) Likes: 1,405

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  • 0

    Is this a thing? Addiction is a disease, but really? So far, we've had a court appointed rehab stint and many call offs due to being "so wasted" last night. What about coming to work saying "I was so wasted last night I still feel it" and before managment can get wind, complain about being sick and leaving early?

    How is this a protected illness?

  • 1
    CassieMorris likes this.

    I did give the roxanol after all, she had the need for it (copd) but I also looked at the resident...O2 was re applied, comfort care given etc and big aggrivating factors removed (anxiety due to incontinace and fatigue from being out of bed). When these issues are addressed and anticiapted, of course there is more overall comfort.

  • 0

    Turns out is was too much being RTC. Resp dropped to 8-12, over sedated.....aka...not necessary.

  • 5
    NurseEmmy, dream'n, icuRNmaggie, and 2 others like this.

    Well, after being in LTC for more years than I want to admit, I do have my system for these issues.

    First off, there is no reason why nurses should be signing off and applying routine moisture barriers on intact skin for all incontinent residents. This drives me insane! Change it has met on deaf ears. Everytime we get a new DON, things change then change back.

    I am very actively involved in the resident care, but a lot of times it is impossible to always be there. I am fortunate to have a great team. Not all inct care requires assist of two. We don't have many totaly dependant residents. But it seems like everyone has an order for it. Last week, I had to DC 3 orders for barrier creams on totally independant residents.

  • 0

    But....how did he get ther phone #? did she give it to him? I'm jsut confused as to how this is harrasment.

  • 2
    icuRNmaggie and canoehead like this.

    The leaving a pill question made me thing.

    What about creams/ lotions? WWYD?

    Our LTC still has nurses signing off for moisture barriers (They seem to vary with basic zinc, calmoseptine, or what ever brand they seem to be ordering)
    They have this in treatment book so, technically the nurse needs to apply them if they are signing off, right? Some are okay to leave at bedside, but some are in the tx cart. I've seen little med cups with cream left on the res bedside table or dresser or in their drawer for the CNAs to put on with inct care.

    Same for the millions of skin preps we do on heels.

  • 1
    Lovethisworld likes this.

    Vent:

    I consider myself well seasoned, but I was made to feel 2 inches tall by a hospice nurse and really didn't stick up for myself or resident.

    I don't work this wing a lot, so I thought i might have missed something. A resident was newly admitted to hospice services and the nurse was in to do a follow up visit. When she walked in I gave her a "everything is fine report" There were no issues (pain/ sob/ changes in adls etc) I last saw the resident about an 1/2 hr prior.
    Hospice nurse comes in and wants me to give her the roxinal stat, then follow up with ativan if not effective. She was sitting in her WC "lethargic" and with resp of 38 and HR 120. Sats were low and dinner was un touched.

    I got the third degree...How long has she been like this, why isn't she eating, doesn't anyone feed her? is there a nurse that can make sure she is getting her medications??
    Okay...situation looks bad, so I gave her a quick does of Roxinal. This was her first time ever getting the med. I'm totally on the hospice bus (would love to get out of LTC for hospice one day) and have had a great experience with many hospice companies personally and professionally.

    After getting the third degree I also re assessed my resident.

    She was just recently incontinant and asked the CNAs to get her back to bed and changed, she didn't eat dinner because she fed herself a huge dinner that family brough in prior to our dinner and her resp/ hr was up because she took her O2 off herself. (the CNAs were just in there before the hospice nurse came in and told her they would be back in 5 minutes to get her into bed etc)

    Now....in the mean time, the hospice nurse got orders changed and make roxinal ATC and increase the PRN dose and also made mention this resident is a full assist with feetding and is starting to decline. She also gave me an education on meds.

    I did let her know that this resident does have these periods with dyspnea and gets tacchy esp when she gets confused or wakes up from a sleep. She normally is ind after set up with feeding. I didn't push more, because i had not seen her in week and since she started hospice services. I can kick myself. I did call the very involved family to fill them in on med changes and got the support I needed.

    So...end of rant. I wish I stood up more for myself and resident. I just hated to be looked at as "one of those nursing home nurses" because I'm not. Now I need to make sure we don't over medicate her because of an agressive call on the hopice nurse.

  • 1
    vintagemother likes this.

    Quote from dmb219
    I've been a nursing supervisor in a large ltc facility for 18 years. My job is demanding and stressful. The DON position is overwhelming in my opinion. It is very demanding during working hours and you are on call 24/7 unless you have arranged for someone to cover you. If you are looking for a management position and want to dedicate a BIG part of your life to your job, you may do well with it. If you want to work your shift then leave work until the next day A DON job is not what you are looking for.
    Yes to all of the above! Job duties for a supervisor/ manager will vary from facility to facility and depend on the size of the facility. It will also depend on if you are salary or hourly. I prefer to stay hourly unless the comp time is real. I never worked an 8 hour day.

  • 1
    BecomingNursey likes this.

    hm....have they been using the cpap regularly? What about nebs? IV access would be nice, but EMS will be sticking a nice big old cath in first.
    Were you thinking more chf or COPD? is 86% good for this patient?

    EMS wait time is less than 5 minutes for me, so when I decide to seen, I don't have much time to treat/ make calls and get the paper work together. Not a bad problem for anyone to have

  • 1
    Nurseynurse369 likes this.

    The above poster had great advice. I am kinda in the same boat. Fear of the unknown holds us back. I've been at the same place for 15+ plus years. I think I get paid well, it is close to home and l and am somewhat on top senority wise. What is pushing me to go?? A new company took over. I welcomed the changes, but not in the direction we are going. Not all non profits are the same.

  • 0

    This will be interstesting to see if anyone responds. Ohio valley area/ Western PA...50 beds, DONwas making 85,000 ish.

  • 0

    This can be very frustrating especially when you get more than one resident that needs the 1:1. Have you reached out to the family to find out what calms him? What worked/ didn't work in the past?

  • 0

    No. I prob wouldn't have either. Id assess for resp depression.

  • 3

    So, I know you don't get to see your patients for that long like we do in rehab or LTC, but my next question would be, "why did it clog?"

    Often times, pills are not crushed well and disolved. Solution...warm water, let them sit then give them, make sure you flush well before and after giving meds (check for any fluid restrictions) and/ or see if you can get liquid meds ordered.

    The tube feeding solution...some are just thinker than others and some just curdle in the feeding tube. Again, flush well. Flush at least q shift.

    Another issue I see is that many nurses will flush or admister the free water via graity or on the pump. There isn't enough pressure to really clear the tube. I recommed flushing with the piston syringe at when you give the water flushes.

  • 1
    IowaKaren likes this.

    Resident came from home. Had dry flakey scalp with some accumulation on the hair. (Perfect for feeding the lice!) Those lice combs are kinda sharp and just shampooing a bit aggressively pulled up some skin.
    I'm a bit mad that all staff with direct contact weren't notified. (I found out by chance)


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