dallet6 5,866 Views
Joined: May 13, '08;
Posts: 243 (12% Liked)
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If its late it will come up asking for a note to explain why it was administered late usually. Depends on your system. Do you have alot of people with meds scheduled at specific times rather than just pm or hs or such?
We have to spend the week doing trainings for our new computer system. I didn't work the floor today, but at the desk I saw that one of the supervisors brought cookies...
I have to agree. You verbally abused a resident by your own admission. Most states requiring no warning, you would get fired and the state would get called with an investigation required. Everything they did to you was wrong, but unfortunatly you got fired for a legitimate reason.
I do this as well. when I'm on a floor where I know the resident's and their meds and how they like them, I can do those extras. When I'm working on the floor with faster turn around and residents with higher accutiy needs, I still feel like I need to do them. But I get so behind when I do. The residents' don't understand or even care that you are doing a med pass when they need someone to do something for them and there's no aide around. I feel guilty as hell when I'm doing a med pass and a resident tells me they need to use the bathroom. I have to tell them I'll go get their aide, who is often taking someone else to the toilet so they can't run right in there. I do what I can for people, and then feel guilty about what I can't do.
We recently stopped having to chart transfer and adl items. MDS checks transfer status and keeps it updated in their computer. They said what we did was a waste of time and not helpful to guidlines. Half the people weren't recording things right. Someone would write they were independent, while the next person would write one person transfer. Along with the chart change, everyone also had to attend an education class on what each type of assist actually truly meant.
they showed us that today, but then said we couldn't use the one from the day before. After quite a bit of negative comments, the trainer realized it was an actual problem and said she'd discuss it with the DON. I hope they are willing to let us do that as well. When I first started we used to use wrist cuffs, but found such a sharp discrepancy from manual they aren't allowed to be used except in cases where there's no choice.
Everyone is telling us we'll love pcc, fingers crossed!
Do you not have a charge nurse? Our charge nurse is the one who is in charge of making the calls and doing the paperwork if someone gets sent out or passes away. Also, they transcribe orders that come in from the dr. We don't. We write our own protocol orders and stuff like that and do checks on new orders in the mar to make sure they are correct, but we don't go back and forth to the office to look at new orders that are being written during shift. If its a stat order they let us know, otherwise, its usually given at the time its next scheduled. I don't know if I'm explaining that right. I don't know what a treatment nurse is, but if they are a nurse who is doing their own assessment, why aren't they the ones doing the alert charting? If our wound care nurse sees a resident during the day they update in the chart if need be, they don't tell us to do it. Does physical or speech therapy also tell you to update what they have done with a resident?
Also curious, you have a resident where they have required q-shift skin checks? wow I'm surprised they don't get irritated with having to remove all their clothes and have their bruises etc measured and checked 3 times a day!
REally? more? LTC here would start you out from 22-25 most likely. No idea what the top out is but probably no more than 30 for a floor nurse. Hospital nurse starts at around 26-27
I work in a typical ltc facility. We have a combination of medicare A, medicaid and private pay residents. We are going to pointclickcare program in 2 weeks and just started training today. In the past when we gave blood pressure medications there were only a few where we would get bp's before giving them everyday. The house dr. may order weekly bp for people who are on the med for a long time etc. This program won't let you give bp meds to anyone without having taken a bp to enter. The day staff is trying to figure out how to get our med pass done on time if we can't start it right away. The aids do our vitals, but even if they went on got vitals on all their residents first, instead of getting them up, dressed, groomed and to the dining room, we still wouldn't be starting our med pass for awhile, not to mention the residents would not appreciate being late to breakfast and having to wait to toilet. The aids rule is they are supposed to have vitals in by 8, which also isn't always practical for them. So-they have them in by 8..I give no meds till them? Other option being the floor nurses should go do their own vitals on 20 residents? Before med pass? Do you see where I'm going with this? To further complicate things I believe we only have one or two bp med that even have a hold parameter. This isn't the only facility I've been to, and the others didn't do vitals before dressing or feeding either.
Anyone use point click care? Anyone have a facility where you don't give meds until however long it takes you to get vitals on all your residents? Noticing that some of you have 30-50 residents I'm sure that would be impossible.
No idea, the aids do that. We have a bath aid who specifically is in charge of the baths
I still can't figure out how you could go through all the mars, tars, pull cards, do chemstix, give insulin, change dressings etc. on 50 patients in 2 and a half hours. Our AM med pass is 6-10 although you usually can't start till 6:30 because of report and such. With 19 patients it usually takes me 3 hours. I'm on call so I'm frequently working with new residents and it often takes awhile to figure out the new people's meds. Not to mention the ones who will just flat out tell you not to give them meds except at breakfast. Stick your skin checks in there...I don't think its physically possible.
As a new grad I started on NOC shifts for the first three months of my job. I received 7 shifts of training before I was on my own. When I started dayshift, I got new training, as it is completely different from nights. We get 3 days of orientation per hall, however, I actually only got 1 before I started on the hall I worked. The second day a nurse called in. That day at least I worked the cart with someone else though, who was supposed to be orienting me but had only finished two days of training herself...
My rule is cover your basics for your Med A, MDS, cover alerts and anything new. Cover it briefly. We have some nurses who chart about things that we just don't need to know about. If you have time to do that, you probably have time to do something else. I can guarantee you there's always something that needs to be done. As far as relying on your CNA's-I rely on them no matter what shift I work. That's part of their job. I don't check every toilet when someone goes on my hall to see what size bowel movement they had. I don't go measure the amount that each of my resident eats at every meal, that's dietary's job. If a resident has something going on where these items are relevant more than just a normal thing, I will check them. As a team everyone has a job and we work together.
So, went off topic a bit. But as far as your reference goes. If you are monitoring the output on the resident with the foley, then yes I would probably check it myself, however, if its just a normal end of shift cath bag dump for a resident with no issues and a permenant indwelling cath, I wouldn't be measuring it myself. As far as color, when you do your shift rounds its a quick look to see if color and such are what they should be.
No that's common. I, however, would not feel comfortable being the only nurse on staff. My facility is one of the best in our state (not , exaggerating we are listed as such), so our ratios are better than other places in our area. We have a 75 bed capacity, although we usually never have over 70. Noc shift has 2 nurses and 5 CNA's. Dayshift nurses are on a ratio of 17-20 residents to 1 nurse. Most in the area have 24-27.
I agree. You're a team, forge a relationship with them by being on the floor talking to all your staff directly, not just sitting in an office only responding when they are desperate enough to come ask for help. Charge nurses have alot of responsibilities where I work. But you should never be so busy that the rest of your staff feels you are unapproachable. We just hired a new weekend charge at my work, we are all holding our breath to see what type of a leader she is.
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