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Kittypower123, ADN, BSN, RN 4,523 Views

Joined Feb 13, '09. Posts: 144 (65% Liked) Likes: 286

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  • Nov 18

    I work in LTC. As another poster noted, there is a familiarity with the residents. I like the continuity. I know my residents. I know what they like and dislike, how they take their medications, whose blood sugars vary considerably and whose are more stable, how to deal with the residents when they get agitated, and what is normal for them. Maybe I don't have all the skills an acute care nurse has, but I do perform assessments daily and I do deal with crises and condition changes. I have run codes, used critical thinking, and developed time management and prioritization skills. I love my job and have no desire to work in a hospital. Do what you love, not what someone else thinks you should.

  • Oct 31

    I'm really not trying to make it into DNS vs. floor nurse, but (at least at my facility) it feels like it's already management vs. nurses. I'm told it's possible, no problem if you're a good nurse, but none of the nurses can do any better than I'm doing. Please, tell me how to get it all done. I have loads of things all due at one time, constant interuptions from residents asking for pain medications (for which I have to go back to the med room and wait for the really slow machine to pop them out, after I hunt down someone to cosign for me), five g-tubes, wounds, IVs, etc, accuchekcs, nebulizers, isolation patients (c-diff or MRSA generally), PT/INRs to check, colostomies to change, foley's to check, orders to deal with (write the order in the MAR, fax to the pharmacy, call the family), labs to review and call into the doctor, families to deal with (we have some very demanding family members), charting, and new admissions (each new admission takes about 2-4 hours without doing anything other than the new admit). Not to mention that the machine that gives us the meds breaks down constantly. And if there is a fall or other incident - oh boy!

    I'm one of the most organized nurses there and even the "fast" nurses can't get it all done on time. If you can break down the way the day should be organized to fit it all in I'd love to try it that way. I want to get it all done, I want to not be stressed out, but I just can't seem to figure out how.

    I don't know where the money will come from specifically, but I don't like hearing that we can't afford additional staff, but hey we have really good profits this year! Where do hospitals get the money? Surely something can be done.

  • Oct 31

    I find it interesting that a DON and the facility don't understand the pressure and the stress, that is put on Nurses in LTC
    I would like to challenge all DON's out there to work one week on each shift with exactly the same tasks that the regular floor nurses have and the same time constraints. I really don't want to hear what it was like 10-20 years ago - that's not now. Show me that you can do it, and I'll shut-up.

  • Sep 29

    There are a few things that help your patients and their families to have positive experience. First, don't promise anything that you can't personally deliver on. If it's not up to you, don't promise. Be honest about what you and hospice can and cannot do. Second, check meds at every visit and order any refills needed. If you wait for them to tell you, they will be calling after hours and on the weekend. Third, educate. The patient and family need to know what's coming. They need to know what changes will occur. When they don't know what's coming, they panic needlessly. That doesn't do anyone any good. They need to know which things they can and should do something about (and what to do) and which are natural and do not cause discomfort. Don't make the mistake of educating once and figuring they'll remember. They won't. Educate again, and again, and again. Finally, don't rush. Things will come more naturally and will take less time as you gain experience. That being said, don't rush a visit. Even when you feel rushed and are trying to get out as quickly as possible, take a breath and focus on what's in front of you. The patient and their family deserve your best.

  • Sep 25

    There are a few things that help your patients and their families to have positive experience. First, don't promise anything that you can't personally deliver on. If it's not up to you, don't promise. Be honest about what you and hospice can and cannot do. Second, check meds at every visit and order any refills needed. If you wait for them to tell you, they will be calling after hours and on the weekend. Third, educate. The patient and family need to know what's coming. They need to know what changes will occur. When they don't know what's coming, they panic needlessly. That doesn't do anyone any good. They need to know which things they can and should do something about (and what to do) and which are natural and do not cause discomfort. Don't make the mistake of educating once and figuring they'll remember. They won't. Educate again, and again, and again. Finally, don't rush. Things will come more naturally and will take less time as you gain experience. That being said, don't rush a visit. Even when you feel rushed and are trying to get out as quickly as possible, take a breath and focus on what's in front of you. The patient and their family deserve your best.

  • Feb 10

    Time management can be difficult. You can plan your week, but it won't turn out that way! One thing I do is front-load my week. I plan to get almost all of my visits done in the first three days of the week. I know it won't happen, but if I plan for 4 visits on Friday, I know I might end up with 8. As I plan my week, I try to cluster visits geographically. I also think about which visits should be pretty straightforward (patient is stable, not much in the way of education needs, etc) and which will likely take more time. I think about which visits can be moved to later in week if something comes up and which can't. Having this information in my mind helps me change plans as I go and still be sure patient needs are being met. I'm constantly reviewing my schedule to check my progress and any changes I've had to make. If I have a CC or GIP patient, I see them first. I know they can take more time and I want get them taken care of. Most of time, if something else comes up with them after the visit, I can handle it by phone. It's tough to get time managed well in hospice, it takes time and practice. Use the frustrations with time management to learn. It will get easier.

    As for documentation, that takes practice too. Remember to document decline. For example, on admission patient ambulated with rolling walker, now confined to wheelchair. Also, you don't need to write a narrative for every system. Focus on what is an issue for that particular patient. For example, if you have a CHF patient, what is their b/p, hr, heart rhythm, do they have edema, is it better/worse/the same, are they on oxygen, are they compliant with meds, what education did they need, etc. For us, the assessment is mostly checking boxes and imputing certain stats like vital signs, last BM, Diet and % eaten, pain rating, that sort of thing. The narrative itself doesn't need to be long, just focus on the reason for the visit or the particular issues for that patient.



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