OnlybyHisgraceRN 12,803 Views
Joined Mar 29, '12.
Posts: 755 (52% Liked)
First, let me say that I acknowledge your feelings and understand your need to vent.
Now for my two cents: There are two sides to a story. If it was neglect I don't codone it at all. In LTC the resident to nurse ratio ranges from 1:20 to 1:60. CNA's are expected to take care of up to 10-15 patients a peice and these residents require total care.
Are some residen'ts neglected in LTC, yes. I've seen it. The reasoning behind it is either due to lazy staff or just because there is not enough staff to go around.
I've worked in LTC for 2 years and I can say it is soul crushing. In this gentleman's case, it could have been much worse. Thank God he got to the ER just in time to be placed in your care.
Just know that there are crappy and excellent nurses in every specialty, including LTC.
Seriously. I'm the nurse who does her very best each and every shift. I'm the nurse who prays for my patients, staff and family members. I'm the nurse that has the upbeat bubbly personally on a unit full of uptight, ICU nurses. I'm the nurse that makes mistakes but learns from them. I may appear like a chicken little at times, but I'm truly doing the best that I can. I'm not the best nurse in the world but certaintly not the worse.
I shared this one before. One time I was walking my blind patient to the dinning room.
As we got to the table she bumped into the chair. I stated : " I'm sorry, I guess this is like the blind leading the blind".
LTC can be very overwhelming, especially for a new grad. One thing that helped me when I was in LTC was having a list of the residents' names and writing down how they took their meds. That is a battle in itself. Some meds need to be crushed, some taken with certain beverages, you will have to know how the resident takes their meds so it will save you time from running back and forth. Ask the previous shift to quickly give you this information.
Make sure your cart is stocked before you start, once again can save you time. Ask your CNAs to get vital signs for you, for your patients that take BP meds. Once again, a time saver.
It will take time to have a routine. Some meds can be grouped together as well. If you have 5 and 7 pm meds give them both at 6, you have an hr. window, use it.
Jot every thing down as you go. Cluster your tasks. It will take time, hang in there.
I'm going to pick on myself for a moment. I have to admit that sometimes I blurt things out without truly thinking about it. Today I said something ( without thinking) to a patient that was purely stupid.
Long story short: My patient had to drink a medication that did not taste so good. She had to drink a whole cup and the only thing I could do to make it bearable was to add a little ice.
Patient: "This taste horrible"
Me: "Just imagine it is a magarita on the rocks"
Patients' husband: " That is not a good idea, since we are both recovering alcoholics"
Me: " Oh you are right...bad idea, never mind.( then I proceed to use more therapeutic interventions)
Needless to say I learned my lesson, never assume anything.
I now except my award for blurting out the most stupid thing ever!
due to documented evidence of increased risk of infection, real nurses who do patient care do not wear nail polish or acrylics. no nail polish or acrylics in patient care. try not to swoon over this.
Since I'm a total girly girl, I do wear nail polish. I get gel manicure. The gel polish does not chip like regular polish does. It lasts for 2-3 weeks ( no chipping). Even though I wash my hands a thousand times a day the polish is still shiny. Best 40 bucks I've ever spend.
Thanks guys for posting. I know I'm not the only one. I have another funny for you all.
Last week I offered a nurse and a doctor a mint. The nurse accepted the mint, the doctor stated " no thanks" .
Me: " It is always the people who really need a mint that refuses"
I honestly made a general statement, but since the doc refused a mint, I hope she didn't think it was directed towards her.
I'm sure her breath smells fine.
why does everybody come to an and ***and moan about staffing in snfs and ltc and i don't ever see anyone saying what they did about this? is there anybody out there who has promulgated some sort of action to effect change in these situations? please, i wanna hear about it! everyone wants to hear about it!
you know, when you make out a variance report ("meds for south wing given two and one half hours late due to new admission assessment," "no weights done on first of the month, insufficient staff," "mds done 4 days early as i will be away on vacation and there is no one to cover me," "foley catheter care on five residents not done this shift, no time due to extended med pass.") it goes to your risk manager. if you are part of a corporate structure, it goes to the corporate risk manager.
risk managers get very cranky about this sort of thing, because they realize that when there are a lot of these, they indicate system-wide risk exposure, and that means money (fines, judgments), and that gets management's attention. if everyone does them, especially if you are in touch with colleagues from the other facilities in your network, you could <gasp> have an effect for the better.
if you are really ripped about the situation you're in, and you get no response from the risk manager maneuver, you could make anonymous reports to the state. but do something. act like professionals, the professional advocates you are. it's for the residents, see.
At the onset, when administrative bureaucracy came up with the requirement to document :
Q 15' checks for ANYTHING
Q 2 hour checks for restrained patients... checking the restraint site, checking the toileting needs, checking the need for continued restraints, checking the vital signs...
We unanimously agreed...
They are MAKING us lie! The very act of initialing all of their precious little boxes .. makes it too time consuming to perform the tasks!
This is not just LTC... it is everywhere.
Any one that doesn't see that .. has their head buried in the sand.
Kudos to you for having the guts to bring this issue into the real world.
Just because some nurses assert that they do not falsely document does NOT in any way imply that they are saying they are "perfect" and it is unfair and misleading to suggest that they do.
OK I am going to disagree. A proper slow code is an art. How to make it look like you are doing something when not really trying to save the patient. As far as I am concerned the slow code will be needed as a self defence mechanisim for health care providers so long as our society maintains it's irrational refusal to talk openly about end of life issues and accept that dying is part of life.
I am a full time rapid response nurse. I am the code administrator for my hospital and the alternate code team leader until / if the "code chief" (usually a senior med or surg resident) arrives on the scene. Occasionaly I will run the entire code like the few times there have been two codes going on at the same time or the code chief doesn't show up for some other reason.
ON several occasions I have refused to code a patient at all. Other times I will let the team know this is going to be a a "show" or "slow" code. In every instance I had reason to know the patients wishes and knew that being coded was aginst their wishes. For example one man with severe necrotic bowel, literaly rotting from the inside out did not wish to be coded. When he was alert and oriented early in his hospitalization he made the informed decision to be a DNR. Later, when he could no longer make his wishes known, his estranged wife changed his code status to full code. The real problem is that she would be allowed to do that at all. That his weak kneeded-fearful-of-a-lawsuit physicians agreed to the change in his code status is another major problem that needs to be adressed. However all that is water under the bridge when "code blue" is called on him.
If the patient has made an informed decision to be full code I will code the heck out of him. I will not go aginst a patient's informed decision and wishes. I hope it doesn't cost me my job (so far not an issue) but if i does it does.
I have seen something similiar in my 3 years of nursing. An elderly man coded, and initially everything was being done, but then the the doc decided to verbally end the code, but everyone involved kept documenting as if the code was still happening. Needless to say, I was shock but apparently it happens.
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