JBMmom, RN 5,130 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)
Just wondering how other facilities schedule holidays.We get a list in October, you sign your name and then number Christmas, Thanksgiving and New Years in preference of what you would want to have off. Then at the beginning of November the schedule magically appears and you may or may not have your first preference off, even if other people with a lower preference for that particular holiday have it off instead. It appears to be entirely at the whim of the scheduler and manager. I had Christmas my first two years, this year I got Thanksgiving- but I was bumped to a different position. I've heard other people complaining that they have all three holidays and others got none. I realize no one approach can make everyone happy, but this random (by admission of the scheduler) just seems dumb. How do you do holiday rotations?
First, wow you're in a tough spot. That workload sounds like it would be overwhelming to anyone and your staffing sounds like something that would make it difficult to provide adequate care. I hope you can find something else soon. To answer your question, I know a number of nurses that transferred from my LTC facility into acute care positions. You are not a fake and a failure. You are doing your best with a very challenging first job out of school. When you have an interview for an acute care position, highlight the skills you have developed like time management, communication with patients, staff, families, assessments in a wide demographics range from psych to skilled nursing. Anyone hiring someone from LTC is going to understand that the skill set is slightly different in acute care, but it doesn't mean you won't be qualified. You're gaining valuable experience, just focus on what you bring to a new position. Good luck where you're at and with finding something else, because where you are sounds like a nightmare.
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 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.
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.
I think that there are a large number of people, including some nurses, that feel that being a nurse must be a calling for everyone. And if you have chosen to be a nurse, you have given up the right to: speak your mind if it isn't exactly what everyone else wants to hear, sit/eat/drink/use the bathroom if there is a single light on anywhere in your vicinity, put your family ahead of your job to preserve the work/life balance you try to maintain (like not picking up every free shift or every time asked) or do anything else other than be "on" as a nurse 24/7. It's unfortunate that misperceptions like these make people angry when nurses act like regular people with thoughts, feelings and sometimes arguments. I was not called to nursing, it was a practical decision for me based on previous education and flexibility in jobs, and I am not a touchy-feely person at all. I do not think these traits make me less of a nurse, but it may to some. If people come here and post something and then can't accept what is given in respectful responses the problem is with them, not the people writing a response that's intended on some level to help.
Wow, it was funny to see my old thread pop up again. Here I am 2.5 years later, still at my LTC job. Good luck to you, it can be a great place to work! Hope you find success with your orientation. And yes, ask lots of questions.
My job has changed a bit, I'm no longer regularly on a floor shift. My regular position is a catch all, getting lab results to the MDs/APRN, entering orders, taking care of reports, helping with any care the floor nurses need a hand with, etc. I also work per diem supervising shifts. I'm still slow as molasses on a med pass, so it was a good transition into a different sort of shift- it also changed my hours so I can see my family almost every evening, a bonus when working two jobs.
We have a resident that is pretty consistent in her belief that she is on a cruise ship. Sometimes earlier in the day she knows where she is, but by the afternoon she spends her time asking when we'll be leaving port, will we stop at this port again, how much longer is the cruise going to be, etc. (We joke amongst ourselves that if it were a cruise she should be really angry about the quality of the food and entertainment) She generally pretty happy, so we just roll with it. The other evening we had another resident leaving for a geri-psych facility after some recent outbursts. As the paramedics have arrived to pick her up, the woman that's on a cruise pulled me aside. She said, "You know, that lady should really be in a nursing home! You people don't have time to deal with all of her nonsense and she's going to get someone hurt on this cruise!" I thanked her for her concern and let her know that the woman was making a brief stop in port and we hope she'll be feeling better when she returns. Just had to share, it certainly made me chuckle.
I'd say not getting caught up in drama is a key. No one is out to get you, no professor is that personally invested in making your life miserable, no assignments were given just to keep you awake all night trying to get them done, no test question was written by an idiot professor with the sole intent of keeping you from passing and living out your life long dream of being a nurse. Just put your head down and get it done. Many have survived before you, it's unlikely that your situation is truly that unique that you are the only person ever to deal with nursing school and _____ simultaneously. You are responsible for you. You are responsible for doing your assignments and your readings, or you risk being unprepared even if the professor didn't say "this will be on the test". You are responsible for your learning so that you can provide safe and competent care upon completion of your program. No one else will be with you ever minute of every shift for the rest of your career. Do the work, learn the information and realize that the real world isn't always what you want it to be, but it is what it is. Good luck.
The field of long-term care nursing certainly won't appeal to everyone, but it can be perfect fit for many reasons. The answers to what a normal day is like will depend a lot on which nursing position you fill, at least in my facility. We have charge nurses, medication nurses, unit managers and supervisors. The medication nurses have 4-5 hour shifts with responsibility for passing medications only. The charge nurses are responsible for an 8.5 hour shift on a wing. They will pass medications not covered by the med nurse, they are responsible for doing treatments (wound dressings, skin creams, etc) and doing paperwork, dealing with the doctor, family members, etc. A unit manager is responsible for relaying lab results to doctors and putting new orders into the system and providing general help to the charge nurses. And the supervisor is responsible for all units in the building- not as much direct patient care, but being the next line of assistance when needed by the charge nurses. Long term care facilities are known for being chronically short staffed, the work can be physically demanding and some people consider it a "lesser" nursing job than other work environments. However, for those that find the joy, humor and satisfaction in working with a population that deserves to be respected and well treated as they age, it can be a great spot. You might consider volunteering in a nursing home to see if it appeals to you. The recreation staff would probably love a volunteer! Good luck with your future plans.
We have almost no-one on regularly scheduled MOM, but many residents have regularly scheduled miralax. If there's been no BM in three days, MOM is the go-to med at that point.
And yes, everyone hates the MOM, while the miralax is generally unnoticed in the drinks from the med pass.
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.
The CNAs I work with are the most underpaid staff in the facility. I think they start around $12/hour which I guess is a little low for our area, but the staff are great so people are willing to stay despite the lower pay. The aides we have put such time and care into everything they do for our residents, they are fantastic. Everyone has an off day now and then, and not all of them are wonderful, but most really are, we're very lucky. That's HARD work and facilities should really realize they are providing the bulk of the actual patient time and deserve to be paid much more.
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.
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