CoffeeRTC, BSN 16,128 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,608 (23% Liked)
We admit residents from any local hospital and it all depends on the insurance of the resident on where they like to return. Your admissions or business development person should have contacts at the local hospitals. Reach out to that person.
Home health would probably be more flexable. How about dialysis? They do 10 hour shifts around here and have nights, Sundays and holidays off.
LTC/ SNF... if you have a choice in your area, do some research on the facility.
Check your facility policy and procedure manual. It might be under irrigating a foley. Are you sure it is a bulb syringe and not a piston syringe??
You clearly don't know how LTC works.
experienced nurses have....more experience
Some LTCs are more like sub acute care....faster paced, more time management needs, clinically complex residents. It takes time for newer nurses to be trained.
I find there is very little patient education in my facility. Yes, we are so rushed just getting the basics done. That will never end, but when I'm getting ready to discharge a newly diagnosed insulin dependent diabetic that will need to go home with injections and accuchecks and I ask if they are comfortable with the injections and they've never been taught or performed one I get a little bit crazy.
Education can be short little sessions with the resident or family over time. It doesn't have to be a big class. We have forms that we can document what education we provided the family or resident but we have no real program or materials.
This really is a need.
Sounds like in those 5 minutes the patient lost their pulse? So then yes..CPR was warranted. A lot can happen in 5 minutes! Breathing and pulse, no CPR. No breathing and pulse...rescue breathing. No pulse CPR.
Not all LTCs have AEDs...most do. Most are located on each unit, close to the nurses station. If it is a large facility, they normally have them one each unit, near the front lobby and or in the dinning hall or activity room. As soon as things start looking bad, I would grab it and a cart if you have it (ours has a suction machine, O2, ambu, back board ) and head down to the room. Don't wait until things worsen. Now....the tricky part is having some one use a phone to call 911 etc. The phones in our hallway only take calls in bound. To call out, you need to head up the the desk or yell for help.
Nope! Long time LTC nurse and I would have done the same. You gave a prn and carafate and they were still complaining of pain, diaphoretic, abnormal labs....Yep. As long as you document what you assessed and the interventions you tried and the calls to the doctor, it should be fine.
Do you have any consultant psych services? I'd ask one of them or maybe you can get someone thru your pharmacy to come in and talk about meds or dose reductions?
Would something like Adaptic be similar?
Head on over to the LTC threads....tons of good info!
Get to know your doctors on staff. Some DRs what to be called with every little thing, some don't. Each facility will have their own method of communication with the drs. Some of our docs want everything faxed to them during business hours. I will get a huge list together with the request and some suggestions and fax it to him. If I don't hear back in a hour or so, I call the office staff. Another doc, I need to call the office with my requests/ concerns.
Falls/ incidents/ injuries/ critical labs etc/ changes in conditions that require treatment get a call/ page asap.
Family issues that are not critical can be added on the list or added into a call later on.
Once you get your butt chewed out for calling or not calling you learn real fast
Very similar to what I am experiencing now
Resident requested 2 cigarettes and a lighter from this RN. This RN reeducated resident on the smoking policy and assigned smoking times. Resident raised his voice, kicked me and yelled "F@#$ You. I don't give a F@#$ about those rules. When I get out of here, I'm going to kill you and your babies!" This RN calmly told the resident that it was inappropriate behavior and again reminded the resident that the next smoking time is in 45 minutes.
.....as I slowly backed away and called the MD for an order for a U&A. This came from a little old lady in a wheelchair that had no means of killing me and was a long term resident.
yep...all depends on your setting. In a LTC setting, my answer will be different
i would retake the vitals first and assess . Really, this is an issue I'm working on with the staff. I was called to assess a resident who "is dying and turning blue." Resident had PVD and discolored lower extremities and was cool from being outside and couldn't breath because they were just smoking. Yes, really.
On the above.... call the md/ find code status/ grab our "code cart"/ 02/ 911 and then worry about the paperwork later.
Head on over to the LTC forum...lots of advice on time management in the rehab snf setting.
I've been in SNF for the last 20 years and wouldn't have expected you to do the incident report. Things like this happen. It is life. You are a new nurse and just getting the hang of things. It will take time. 18-22 people isn't bad, so the grass probably won't be greener. If you are still on orientation, you should have a preceptor or someone to help you/ train you. Where is that person?
Do you have a charge nurse or unit manager? When i work 7-3 I refuse to answer the phone unless it is paged to me. During the day, the office staff will answer the phone and direct it to other departments. This helps a ton!
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