CoffeeRTC, BSN 14,298 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,520 (23% Liked)
Another thing that we need is an actual prescription for their controlled meds. The sooner we get this and the sooner we get the med list, the less of a delay.
We still do good old paper MAR/ TAR and orders (we get them printed monthly from the pharmacy). Since most of our admits happen on the 3-11 shift and the pharmacy quits taking new orders after 5pm, this gets tricky. That and the fact that the drs offices are closing around that time. If we can get the orders faxed to us early, review them with the MD and get them sent over to the pharmacy, we are more than likely able to get them on the PM delivery from pharmacy if we donnot have the med in our emergency box.
I've created a special hidden place for supplies for the weekend! I have another nurse that shares this special hiding place and restocks it. After many years of working together, this is the only thing we find that works.
Yikes! This is a messed up situation. No therapy for days? Not OOB? (what about using a lift?)
I've seen some crazy dc AMAs in my day. Some I kinda agreed with the family. I wouldn't have removed the foley unless the MD ordered it. As for a wheelchair?? They cost hundreds of dollars, so I wouldn't have let them borrow it unless I knew I was getting it back within the hour.
AMA dc= no meds and insurance won't be paying for the stay. I'd make sure the family know about that too.
I already agreed with sending out the above resident. but I used to see so many unwarrented hospital transfers that I can agree with calling a supervisor or DON before a send out esp if it is a newer nurse.
I've called drs before when I've had residents with a CHF flair up that might have needed a chest xray and increase in lasix or someome with COPD that might have needed nebs ordered. Doc right off the way is saying "send them to the ER" when it can just be a simple med change.
20 or so years in LTC and I would have sent him too. YES, we do have stat xray services and pharmacy and could start and IV BUT....how long would getting that in place take? In my facility it would be more than a few hours. With it being 9pm already the Xray probably wouldn't have been done and then read until the am. Pharmacy would take at least 3 hours (we have an ebox with some meds) and the IV might not be able to get inserted either.
I love the medics but get a chuckle with how they love to provide diagnosis within 5 minutes. The high temp and sob/ wheezing doesn't always equal sepsis.
If there is an urgent need for safety, I'm calling 911. I try to never let it get to that point.
So, with the LOLs above, it looks like this is a problem everywhere!
Our policy changes. Right now CNAs are to remove any visible matter...crumbs etc from meals. I think housekeeping has a rotating schedule for deep cleaning them. We used to have 11-7 cnas clean them too. As for the lifts...I don't really know.
BTDT. Don't you just love the super late admits? I see nothing wrong with what you did. If the doc refused to accept the patient what else could you do? I'm guessing the ADM might have wanted you to doctor shop?
It is different in each SNF. It depends on the size of the facility. Sometimes just being the RN on duty makes you the supervisor. ASK to see the job description.
Will the RT be there with you all shift? Its been years since I worked in a facility with vents so I really don't remember much. What are the other skilled residents like? High acuity? Is this 11-7? or 3-11?
I think a STNA is a state trained nurse aid aka CNA?
I've worked in large facilities with 200 beds down to a 50 bed facility. The politics are everywhere. Seems worse in the smaller one though. If you are a supervisor or manager, stay consistant and fair. Go by the rules, don't play favorites. Don't get caught up in the gossip. It will pull you in and drag you down. Same applies for the staff nurse.
I've seen this before too. Some places require all OT to be approved by the DON or supervisor...even if it is mandatory and a no brainer (no relief). It is different in LTC since there are little staffing regs. The one nurse to 32 is probably legal. Sounds like they were willing to run with one nurse to the 32 and have you go home. Safe? No.
After the patient is admitted to the hospital for a period of time (I think 24 hours) they are discharged from the nursing home. The NH can then accept the patient for readmission, or not. It's not really an eviction, though I'm sure it feels that way to the resident.
Help me understand "the nursing budget". What is included in it? When you became a DON, how much experience did you have with the budget? What is your role in managing the budget?
I'm guessing the biggest part of the buget is nursing hours with OT and agency (in places that use it) are the biggest part?
I just ask, becasue we are constantly hearing about how staffing needs to be cut and our PPD is too high. I tend to agree that the nursing hours are out of control. Too much OT due to call offs, not replacing staff and the incrimental OT.
So, what else?
One day i will take the plunge again but............
I've been in LTC/ SNF/ Rehab for almost 20 years.
I started as a CNA in my last year of school, worked as a GN then staff nurse, charge nurse, supervisor/ unit manager, one year as an RNAC, fill in DON and now just as a staff nurse/ weekend supervisor. How do I sell this? I've been at the same place for my entire career but worked PT/ PRN at one other. I have no resume
I'd like to look at home health or hospice.
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