Content That laderalis Likes

Content That laderalis Likes

laderalis, RN 2,284 Views

Joined Dec 8, '09 - from 'northern michigan'. laderalis is a unit supervisor. She has '4' year(s) of experience and specializes in 'LTC'. Posts: 58 (31% Liked) Likes: 52

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  • Nov 22 '13

    If they truly believe the nurse is not passing meds as scheduled and have proof of it then bring it up to the immediate supervisor.
    From your own statement it seems as though this nurse is finishing and with that extra time is helping the supervisor.
    Maybe instead of the other nurses throwing accusations around they should ask this nurse how she is effectively managing her time and learn some new things OR better yet pay attention to what they are doing and they might get done faster.
    I've been the nurse with 20 plus ltc patients, and it turns out if you stop flapping your mouth, pay attention to what you're doing and actually do it, things get done.

  • Apr 11 '12

    Love days off! Or being able to work my schedule to travel for an annual trip with my husband and kids that I have not been able to go on for three years! And finally having a few extra bucks to get a new toy that the kids and I will use at the lake often this summer. Sure, the work is super hard, but there is no way I would go back to an 8-5 MF job.

  • Mar 1 '12

    I always saw each LTC shift like an episode of The Brady Bunch: every episode featured a different kid with a different problem.

  • Jan 2 '12

    The John A. Hartford Foundation was established in 1929 by bequest of its founders, the two brother heirs of the great atlantic and pacific tea company fortune. The mission of the hartford foundation is to "improve health care for older americans."

    The Hartford Institute for geriatric nursing offers the following marvelous try this resources free of charge to help promote gerontological nursing: the general assessment series, the specialty practice series, and the dementia series.

    In this blog entry we discuss the specialty practice try this series, six concise assessment guides that are tailored to enhance the care of older adults within specialized practice settings. These free best practice protocols are versatile and easy to use. The assessment tools were developed by nursing specialty organizations in partnership with experts in the field of gerontology. For your convenience, these wonderful resources are highlighted below.

    Assessment of nociceptive versus neuropathic pain in older adults - Pain has been described as an unpleasant sensation that may have a lasting emotional and disabling influence on the individual. Nociceptic pain is pain that results from direct tissue injury. Neuropathic pain, on the other hand, is pain that results from damage within the nervous system itself. The abnormal alterations in the nerves often remain long after an original insult has occurred. Sources of acute neuropathic pain may include phantom limb pain after amputation, postmastectomy pain, and pain from nerve compression. Sources of chronic neuropathic pain may include pathological changes in the nerves caused by disease or treatments, such as diabetic neuropathy, chemotherapy-induced neuropathies, neuralgia pain that follows herpes varicella-zoster (shingles), and cancer-related nerve injury.

    Pain can significantly affect functionality and quality of life in the older adult. It is very important to distinguish between nociceptive and neuropathic pain, since these two types of pain require different diagnostics and treatment. Two valid and reliable assessment tools that are quick and easy to use in the older adult population to help differentiate nociceptive from neuropathic pain are the lanss (leeds assessment of neuropathic symptoms and signs) pain scale and the dn4 (doulear neuropathique-neuropathic pain) questionnaire. The lanss pain scale consists of two parts: a 5-item pain scale and 2 physical exam findings. The dn4 consists of 2 patient interview questions and 2 patient examination questions.

    Informal caregivers of older adults at home: let's prepare! - The population is aging and this has led to consideration of the long-term social service and healthcare needs of the elderly and their caregivers. Nearly two-thirds of older Americans aged 65 and above will eventually need long-term care services, which will result in a greater economic burden on society. Within the elderly population, the 85 and older subgroup are most at risk for dependency and consume the largest share of long-term care services. This is a major concern, since the fastest growing segment of the u.s. population is the "old old," persons 85 years and older, who are expected to quadruple in number over the next three decades.

    Informal family caregivers provide the bulk of caregiving services for dependent older adults in the community. Often these care needs are complex and the caregivers may not be adequately prepared to manage multiple treatment regimens, recognize early warning signs of infection or possible complications, and coordinate care among a dizzying array of providers. Visiting nurses can use the 'let's prepare' screening tool to evaluate the ability of informal caregivers to safely care for their dependent older relatives at home. 'Prepare' is a mnemonic for the following checklist: prescriptions, readiness to manage at home, early changes in condition, partnership among the home health care team, assistance needed to perform procedures, and realistic expectations and goals.

    Cardiac risk assessment of the older cardiovascular patient: the framingham global risk assessment tools - The Framingham Heart Study is a long-term, ongoing research study that is now in its third generation of participants. The objective of this study is to identify modifiable and nonmodifiable risk factors that contribute to cardiovascular disease. Modifiable cardiovascular risk factors include physical inactivity, obesity, high blood pressure, abnormal amount of cholesterol and/or fat in the blood, smoking, metabolic syndrome, diabetes, and depressive symptoms. Nonmodifiable risk factors include age, family history, and gender.

    Since cardiovascular disease is the leading cause of death in the older adult population, all adults over age 40 should be evaluated for cardiovascular risk. The Framingham Global Risk Assessment tools are an effective way to comprehensively measure cardiovascular risk in older adults.

    Vascular risk assessment of the older cardiovascular patient: the ankle-brachial index (abi) - Vascular disease includes such venous and arterial conditions as hypertension, atherosclerosis, cerebrovascular accident (stroke), carotid stenosis, abdominal aortic aneurysm, and peripheral arterial disease. The ankle-brachial index (abi) is a test that measures the blood pressure in the ankles and compares it to the blood pressure in the arms. This quick, noninvasive test is an effective tool for predicting the severity of peripheral arterial disease. A low abi signifies atherosclerosis that can lead to circulatory problems in the legs. It also indicates increased risk for heart attack and stroke. It is vitally important to screen for stroke risk, since stroke is the third leading cause of death in the older adult population and a major cause of disability.

    To competently assess vascular risk in older adults, a focused physical examination should be performed. Besides the abi, the physical examination should include vital signs, assessment, palpation, and auscultation of pulses, and identification of signs of poor circulation in extremities such as hair loss, thin shiny skin, and thick brittle nails.

    Assessment of spirituality in older adults: fica spiritual history tool - Spirituality is inherent to the human condition, even though some people may eschew religious affiliation or belief in god. Religion and spirituality tend to become more relevant as people age because of increased burden of chronic disease and nearing death awareness. Spiritual beliefs and expressions can be an important source of hope, meaning, and strength to the older adult in times of challenge and crisis. likewise, religious affiliation can provide social support that the older client may desperately need. Although related, religiosity and spirituality are not necessarily synonymous. Religiosity refers to belief in god, standard dogma, human structures, organized ritual, symbolism, and rules. spirituality, on the other hand, is a broader term that encompasses personal understanding of meaning and purpose in life.

    Spiritual assessment is an integral part of the comprehensive history of the older adult and provides a basis for the individualized holistic plan of care. The older client should be asked about spiritual concerns or religious practices and made aware of spiritual resources (such as pastoral counseling) that are available to help manage spiritual distress. Unfortunately, the need for spiritual assessment is often overlooked within our fast-paced health care system. Nurses may feel uncomfortable discussing spirituality. They may also feel inadequately prepared to conduct this type of assessment. FICA is an ancronym that can be used to guide assessment of spiritual needs: F (faith or beliefs), I (importance and influence), C (community), and A (address in care). The FICA Spiritual History tool is a quick and easy means to assess both religiosity and spirituality in a sensitive and patient-focused way and then incorporate the findings into routine patient care.

    Perioperative assessment of the older adult - Since older adults are the core business of health care, it is not surprising that people aged 65 and above account for 55% of all surgical procedures. the perioperative guidelines address the special needs of older surgical candidates, who often present with multiple complex chronic conditions in addition to the need for late-life surgery. Some operative procedures are emergent, whereas others are elective. Advanced age alone should never preclude consideration for any type of surgical procedure. Often, functionality and quality of life in the older adult can be dramatically improved by surgical intervention. The primary goal of these guidelines is to reduce perioperative mortality and morbidity among the older adult surgical population by: 1) promoting safety, 2) preventing injury, 3) avoiding complications, 4) ensuring optimal functionality, 5) preventing delirium, and 6) providing adequate pain control.

  • Dec 4 '11

    Can you ask her what she would want if there was a Santa.

    One of my favorite LTC Christmas memories - we had a learning disabled elderly gentlemen. When asked what he wanted for Christmas he said he wanted a superman cape. Someone searched everywhere and found him one. He was as excited as any 4 year old on Christmas morning and wore that cape for months.

  • Nov 25 '11

    Okay, my preceptor story. While in nursing school we were on the surgical unit - there was this one nurse - I'll call her "Attitude" - who was so nasty to the students and showed such contempt for us, that I never forgot her, she even reduced me to tears one day because I got nauseated taking care of a woman with peritonitis who's abdomen was left open to close by secondary intention. I had to do wet to dry dressing and cover the wound properly. My instructor stood by, as I was unpacking her abdomen - the smell was indescribable! I was a 1st year nursing student at the time, and I had to reach in to all the cavities, where my gloved hand would literally disappear, to get all the wet dressing out. I remember at the time, my "spirit" left my body and it was like I was watching from above. I got through it, never wrinkled my nose or anything. Apparently I chatted with the patient, but have no memory of this. After we were through, I went out into the hall, and felt like I was going to faint - so I slid down the wall to a sitting position. My instructor apologized to me, she said "this was NOT a 1st year patient, I didn't know - I'm so sorry - if you want to go home for the day, you can." When the feeling faint past, I went into the dirty utility room to wash up, and I was teary eyed thinking "What ever was I thinking becoming a nurse - I can't do this!" In walks "Attitude" and says, "Your pathetic, grow up and get a grip" in her most disdainful voice.

    I stuck it out, didn't go home, but I was ashamed that I had such a hard time with the sights and smells of that patient. I decided then to get a PT job as an NA at the same hospital - I figured that would cure me of my squeamishness.

    Fast forward. now I'm am RN, just past the boards, and same hospital hires me for their float staff. They send me to med surge to work with my preceptor for two weeks. I get to the floor, eager to start my day, who walks up to me but "Attitude" and with a sly smile says, "I'm your preceptor for the next two weeks!" I almost pooped my scrubs - my worst nightmare was in my face and I had to "prove myself" to her.

    She pretty much left me alone - except during med passes, and I would come to her with questions. This is how the question and answers would go: Me: "What do I do about blah, blah, blah..." Attitude would look at me with her most bored expression and say "What do you think you should do?" I'd stammer and say, "if I knew that, I wouldn't be coming to you!" Attitude: "yeah, well, what do you think you should do?" So I'd stammer and try to think of an answer, and I would give her an answer - Attitude would then say "yeah, and then..." I would answer some more. Attitude "yeah, so....?" So I would complete my answer and usually answer my question. Attitude "so go do it!" That's how it went for two weeks. I NEVER got her to answer one question. I hated her for that. During my last med pass needing Attitude to follow me around, I got to the last room, Attitude said "Your doing fine, just finish up this last room" and walked away. I got "A" beds meds ready, and as I walked into the room, "B" bed calls me over to ask me some questions. So, I'm talking with "B" bed and as I'm doing so, I give him the meds in my hand. He said "What's this one for?" I told him "It's a stool softener" "B" bed says "but I'm not having trouble going to the bathroom." and on it went, he questioned everyone of the pills, and I answered, and he took them. As I was walking out of the room, I realized what I had done, and I started to panic - I just knew I had flubbed up royally. I went to Attitude and told her what happened, I said "I'm going to be fired, aren't I" She said in her usual bored voice "No, it's my error, I should have been with you." She went ahead and took care of everything. She came to me afterward and said "Well, your dammed good at educating, you convinced "B" bed to take all those meds". Then she said "What have you learned from this experience?" I said "Well, if a patient questions a med, I should go back and double check the MAR" she said "And?" "I should have told "B" bed that I would be right with him, and finished giving the meds to "A" bed first." She said "Barb, you know more than you think you do, TRUST in yourself and what you know, problem solve step by step, eventually everything will fall into place."

    Well, she "passed" me, and I moved onto the next unit. It wasn't until YEARS later - that I said to her one day "Thank you for all you taught me when you precepted me." She said "You taught yourself, I was just your sounding board." I said, "No, you taught me a lot, and I wanted to say Thank you" she smiled and said "Well then, you're welcome." She looked at me and said "Barb, your one of the best nurses we have, next to me of course, I developed much respect for you over the years." I said "Attitude, why do you always come off like such a *****" She said "It's my reputation, so don't tarnish it by telling anyone about this discussion!" and yes, she continued to act like a *****, even to me. I knew better though.

    She had developed faith in me, and she taught me that I did indeed know more than I thought I did - and I learned to think things through step by step - and over the years, I noticed I didn't have to go step by step, I could get from A-Z without thinking about the steps in between. I never made the same med error again - Oh, I found new ways to make them, but never gave an entire cup of meds meant for one bed to another bed. But every error I made, I learned from. And, I can proudly say, that in 20 years of nursing, I've made only 10 med errors.

    Sometimes, things aren't always what they seem. It took me a while to figure that out. She was the best preceptor I'd ever had - and when I began precepting, I used some of her techniques, but I did it with a smile and patience. Nuff said.

  • Nov 20 '11

    I was giving one of my residents her eye drops. She hates getting eye drops. She is a drama queen about it on purpose. lol I gave her the drops in one eye. Then went to go put them in the other eye and she tries whack my hand out of the way(she doesn't hit hard lol) and says "THEY ARE NOT SUPPOSED TO GO IN MY EYE". So I ask her.. "Well where are they supposed to go then?"


    She says in the loudest voice.. "up your ass!"

  • Nov 20 '11

    I had a stroke patient recently. When I asked if she knew where she was, she said, "Yes, but I'm sure not going to tell you!"

  • Nov 19 '11

    Thank you! You get it. We are not a bunch of morons handing out tylenol and colace. It's hard work and getting harder by the day. We have a one page unit roster on each floor. Basics such as MD, code status, and how they take their pills is on the sheet. It's worked for me for years. In one building we used a Kardex system but the Kardex stayed at the nurses' station. Whatever works for you is what you should do. When I worked the floor I would take report in one color and then throughout the day, whatever I added to my sheet for my shift, I'd write in a different color...prehistoric but it worked. We are soon to go to all EMR. Each nurse will have a small laptop or tablet to carry around so ALL the information will be at our fingertips. Good luck.

  • Oct 30 '11

    If I see one more post complaining about what people post, I'll go postal!

  • Dec 8 '09

    Quote from Wisconsin Student
    I'm graduating in May with an ADN and currently have four jobs lined up; two separate OR jobs, ICU, or ER. I just need to figure out which job best suits my needs at the moment. I understand that there are new grads out there having a difficult time finding a job. New grads in my area are also having a difficult time finding a job. When I started in the RN program I got a part time job as an aide on a surgical floor. When I got into my senior year, I got a job as a nurse tech in the OR. It seems that the new grads having difficulties are the new grads that managed to get through school never having had a healthcare job before. I would highly advise anyone entering nursing school to plan on working in the field, in a place where you would like to work after graduation, while you are in school. Dazzle them with your positive attitude, your flexibility, and your excitement to learn. Nursing, like the rest of life, is all about who you know. Network. Network. Network! Go above and beyond during clinical. Seek out new opportunities. Thank your nurses before you leave for the day.

    I'm not chastising the unemployed new grads out there, I'm just trying to lay out the formula that worked for me for those coming behind me. Best of luck to everyone searching for jobs!
    We just let all of the students in our facility go, with no chance of being hired when they graduate in Dec and May-we are on hiring freeze until June...and almost all of the students were excellent, we were looking forward to having them. In fact, the week before they were let go, they were assured jobs would be there, then boom, let go. I hope you have all 4 to choose from when the time comes, but as many hospitals are cutting open slots on their schedule, many who were promised jobs no longer have that assurance. And in most hospitals, student slots are all gone!

  • Dec 8 '09

    I'm graduating in May with an ADN and currently have four jobs lined up; two separate OR jobs, ICU, or ER. I just need to figure out which job best suits my needs at the moment. I understand that there are new grads out there having a difficult time finding a job. New grads in my area are also having a difficult time finding a job. When I started in the RN program I got a part time job as an aide on a surgical floor. When I got into my senior year, I got a job as a nurse tech in the OR. It seems that the new grads having difficulties are the new grads that managed to get through school never having had a healthcare job before. I would highly advise anyone entering nursing school to plan on working in the field, in a place where you would like to work after graduation, while you are in school. Dazzle them with your positive attitude, your flexibility, and your excitement to learn. Nursing, like the rest of life, is all about who you know. Network. Network. Network! Go above and beyond during clinical. Seek out new opportunities. Thank your nurses before you leave for the day.

    I'm not chastising the unemployed new grads out there, I'm just trying to lay out the formula that worked for me for those coming behind me. Best of luck to everyone searching for jobs!



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