JBMmom, RN 5,144 Views
Joined Jun 24, '09 - from 'CT'.
JBMmom is a Scientist, Nurse.
He has '2' year(s) of experience and specializes in 'Long term care'.
Posts: 364 (34% Liked)
I appreciate anyone that feels a strong and true passion for nursing, and I know that a nurse is far more than the sum of a GPA and some standardized tests. However, for those that truly struggle with certain aspects, I hope that they can objectively weigh the likelihood that an education in nursing will lead to success. Standardized tests continue- right through NCLEX, and while much of the material is not all that challenging in and of itself, the application of the material can be difficult. While their passion for nursing may make them shine in clinicals with their compassion and desire, clinicals are often a very small portion, if any, of the graded part of nursing school- leading back to the need to be prepared academically. I do wish success for anyone choosing this path, but sometimes desire alone isn't enough.
Thanks to everyone for sharing their responses and Vintagemother I truly do appreciate that many families have exhausted all other options and dealt with potentially years of issues while trying to provide care. My post was not written in judgment of the families, just sadness for everyone.
I know as well as anyone that has worked in LTC that we should not put ourselves in the position of judging the families of those that require long-term care. The sweet old man that no relatives ever visit may have been an abusive father that severed his own family relationships with a heavy hand. The cute little old lady might once have been a raging alcoholic that showed her children no love stronger than her next drink. And family members may have exhausted all other options for care before ever considering LTC as the final and safest option for a family member in the progression of an illness when they find themselves at our door. However, it was heartbreaking to play a role in the scenario that recently played out at my facility, leaving us feeling more like workers in a kennel that found an abandoned puppy.
As often happens with multiple admissions in a day, the supervising nurse didn't have time to thoroughly read all the admission paperwork, just knew we had a new resident with the primary diagnosis of dementia expected to arrive late morning. Well, late morning came and went, then early afternoon. Not long before second shift two women came in and went to the empty room. An aide overheard the young lady tell the woman, "I have to go to the bathroom, I'll be right back." The aide went to tell the supervisor that our new resident had arrived, and the care giver went to the bathroom but she'll be right back. A couple minutes later, the supervisor headed to the room and introduced herself to the new resident, I'll call her Molly. Molly asked where the woman was they were coming to visit, and the supervisor was a little confused. Molly said her niece told her they were going out shopping but they were going to stop in and visit someone for a minute on their way. At this point the supervisor comes out to find out where the caregiver was and an aide on the other wing said she left a few minutes earlier (no one saw her use a bathroom). Now the supervisor tries to tell Molly that we're at "**" and we're a long term care facility and she's going to be staying with us for a while. Well, that didn't go well.
Molly is a very convincing dementia patient. We've all seen them, they appear to be as competent as you or I in conversation. And for about half and hour we were pretty sure that there was a mistake and she shouldn't be staying. She was angry, but appeared competent, and said either we were going to call her a cab or she was jumping out that second story window in her room because she was NOT going to stay here one single night. Fortunately our social services professional is fantastic. It fell to her to spend a good bit of time after that trying to explain that she was going to stay with us for her safety. There were many tears, some threats, and definitely no acceptance long term, but she agreed to stay the night. We got a wandergard on her by telling her it's the wristband she will use to get her meals. She spent her evening wandering the halls, with her pursue, sitting in different chairs so she could look out all the windows. She agreed that she could use some help getting changed and ready for bed, she goes to bed at 9pm by her account and in the morning she would take a cab back home.
As the supervisor completed the admission the paperwork stated that the family decided not to tell her ahead of time about relocating to our facility because she would probably refuse to get out of the car. I can't imagine that hearing the news from complete strangers was any more comforting to her, but maybe her reaction to family members was potentially going to be worse. I feel badly for all of them, but Molly most of all. I'm trying not to judge, but I wouldn't even do that to a pet, forget a family member. The son is supposed to visit at some point- apparently when they called he said he would come in a few weeks. We'll do our best to get Molly settled and I think for a while we'll just keep a box of tissues on us, we used a lot of them last night.
I wish none of you had similar stories, but I'm sure you do. Thanks for listening to mine.
When I was in clinicals there was an LPN on the acute care floor where I was a student and it was like hitting the jackpot to be assigned to her for the night. She was fantastic. We were so disappointed to hear that not long after our rotation the hospital phased out all LPNs from the facility. She considered going back to school for her RN, but after 20 years really didn't want to go back to the academic environment. She also had some serious reservations about how well she would succeed in, and could she even get in? So unfortunate that the practical aspect of her nursing expertise, along with many others, was completely overshadowed by the lack of the "proper" title. LPN, ADN, diploma, so many very valuable resources being portrayed as inferior to the almighty BSN, while for many it is just because they took the most practical route into a field in which they are very competent. I am an RN in long-term care with many excellent LPNs as colleagues and it's unfortunate that they're sometimes made to feel like lesser nurses, especially when it comes from other nurses, everyone should be acknowledged for providing quality care to those that need it, in whatever setting they are.
Mine was just a quick interaction, I walked into work one afternoon and my favorite resident who was perpetually confused, but always came to hug me first thing, came over. I smiled and she said "I love your teeth, are they new?" I responded, "No, they're my originals." She pulled hers out and said, "Well if you ever need these you can have them." I miss her.
I'm in all of my second week of clinicals, and I'm well aware that I'm not expert on, well, anything. Doing our weekly paperwork we're obviously responsible for looking up all the meds that our patient is taking. I know that there must be many reasons that I'm not seeing in my drug guide for why meds are being taken, but it seems that people are really overmedicated and some of the combinations don't make sense to me. I have one med that says in the nurses notes in Davis "advise patient not to take within two hours of antacid", well it's prescribed for administration at the same time as an antacid. I'm sure I'll bring that up with my clinical instructor. There are also three different depression medications- including an antipsychotic and an ADHD med for a patient with no diagnosis beyond depression- and two of them cause insomnia. Then there are two sleep medications because the patient complains of insomnia.
With full understanding that I don't know everything, and I'm unlikely to uncover any life-changing medication interactions. Do you question every med order that doesn't make sense to a beginning student? With 8 students, our clinical instructor will never get through anything if she has to spend an hour on meds with each of us. And I don't really want to be the dork that comes across as trying to look like a know-it-all if I question things. Will this all just become more clear?
I can only imagine how awful you felt about the mistake, but that's what it was, an honest mistake. It sounds like it could have happened to anyone based on how things went. While we often text the APRN and MD from our facility (at their request) for small issues, anything as major as death is definitely NOT something that should be texted- unless you've set up that expectation from the start. Sorry it progressed that way, but it sounds like the family was understanding. Maybe it was just a good way for you to set up the expectations with future nurses for the best way to contact you. Good luck.
You are going to find variation between nursing responsibilities in nursing homes, however, the basic care you mention above generally falls to the responsibility of the CNAs. Nurses are often responsible for medication administration, treatments- including dressing changes, application of prescription creams/powders, etc. There are admission assessments and paperwork, in some facilities you are responsible for calling lab results to the MDs and making the associated medication changes. There are orders to be filled- labs, x-rays, etc if an outside company comes on site to perform those. There's charting, and more charting. I'm sure there are other responsibilities that I'm forgetting, good luck with your job search. If you search through these threads, you'll find many others with similar questions.
We switched from paper MAR to eMAR within the last year and a half. It's coming up to the dreaded state inspection window and some nurses are getting slammed for signing off meds out of the hour before/after window. In some cases it's becaused a single resident's meds are ordered for 4p, 5p, 6p, etc. and we're trying to get all that straightened out so meds are grouped together and residents are getting them at the same time based on room assignments. And in some cases there are emergencies that require attention and get nurses sidetracked. I know that I have seen a small sign on med carts in another facility alerting residents/family that nurse is doing med pass and to ensure safety questions should be directed to other staff. Anyone else seen these? Anyone have other ideas? I'm just thankful that I'm rarely on a med pass anymore, I'm slow.
In our LTC facility we have a resident known to get combative and spit during care. The POA objected to a surgical mask because he said it would be too restrictive, and his accusation was that we would leave it on for prolonged periods of time. So there is a care plan in place that a towel may be draped over resident's mouth in instances when he is combative or spitting.
I was not on this site for a few days so I just came to the board and some of your posts and threads. I'm sorry that you find yourself in a stressful position right now, and I understand that you're coming here for support and guidance. I could be very wrong on this, but I think you may find that with daily updates, you will have a limited number of responses in a relatively short amount of time. I'm glad to hear that you're finding time to take care of yourself, especially from a mental aspect. The tone of your posts comes across, to me, as quite dramatic. You seem to find yourself swinging between exhaustion and exasperation to elation and happiness. The job hunt process, as you must know, can take a while. Treat it like a job itself, and maybe take it as an opportunity to put yourself in a stronger place mentally and physically for when you do have a new job. Any new job, nursing or not, has its stressors. You've had some time to focus on what happened and how you could avoid repeating that situation in the future. My advice would be- log-off for a little while. We're a bunch of random strangers and whether we provide feedback you want to hear or feedback you don't want to hear, you're living your life, we're not. This isn't intended as a crisis-support center, you can't refresh every 15 minutes waiting for a lifeline (well you can, but that's not the way to approach things). I hope that you find a new job that suits your skills and personality and that you find some calm and peace in your life. Good luck.
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