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Joined Apr 12, '12 - from 'NC'. whatdidigetmyselfin2 is a LPN. She has '4 years as a CNA and newer nurse' year(s) of experience and specializes in 'Long-term/Geriatrics'. Posts: 48 (35% Liked) Likes: 33

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  • Dec 21 '14

    Quote from Subclavian Steel
    What are the best corners to cut to finish your work in time without risking your license?
    First of all, the 'risking my license' mantra is overused and inaccurate. Most nurses who have had action taken against their nursing licensure were working at hospitals, not LTC facilities or SNFs. In addition, the vast majority of offenses that led to revocation of nursing licensure revolve around addiction: impaired practice, drug diversion, theft, and failure to complete state-ordered impaired nurse programs.

    Before we proceed further, look at the big picture. It's a SNF. In other words, it is the home of the residents who live there while they are there. This is why they are called residents.

    Low-acuity residents do not require full head-to-toe assessments more than once per week. Manage your time by spending no more than 10 minutes with each resident. If you are working a Medicare wing, the residents will need a full set of vitals once every 24 hours. Also, low-acuity residents do not need to have their vital signs taken multiple times per day.

    Look at the big picture and be mindful that you are not dealing with an acutely ill patient population. If they were truly acute, they'd be in an acute care hospital. Also, this might sound brusque, but the residents are not your personal friends. Be friendly and professional, but limit the conversation. You do not have all day to spend in each person's room.

    Most adults in our communities have chronic illnesses such as hypertension. Would your neighbor with HTN who takes Amlodipine daily and Metoprolol Q12 hours check her blood pressure and pulse around the clock? No! She's just swallowing her pills, and nothing bad happens because she's not acutely sick. It is the same concept with SNF residents who have chronic stable disease processes that are managed in their homes (a.k.a. the LTC facility).

    Therefore, unless parameters are attached (e.g. "hold if SBP is less than 110), there's no need to do constant vital sign checks before medication administration. The main exception is digoxin: a 60 second apical pulse is needed. Constantly performing vital sign checks before giving medications is unnecessary and will suck up your precious time. And believe me when I say you need this time for other tasks in the SNF setting.

    Other than obtaining a full minute apical pulse prior to administration of Digoxin, or checking BPs for medications that have physician-ordered parameters for systolic and diastolic BPs, it is a poor use of time to constantly vitalize stable SNF residents. You are not working in acute care, and you do not have the time or tools to practice textbook-style nursing. You have entered the real world of nursing that has time constraints and operates on efficiency. Remember that.


    A textbook world of nursing exists alongside a real world of nursing. If you try to apply textbook principles to SNF, a healthcare setting that is famous for scandalously high nurse/patient ratios, you will burn out to a crisp. I'll repeat myself: these residents are living at home. They are not acutely sick. They do not need full head-to-toe assessments several times a day. Hence, approach this healthcare setting as if you are in their home. Good luck to you!

    I worked in SNFs for six years. With 20+ residents, there's no time for head-to-toe assessments. Again, good luck!

  • Dec 11 '14

    other "team" members that love to say "I'll tell your nurse" or "Your nurse will do it" We are talking about opening mail, getting an extra pillow, plugging in a cell phone to recharge or just even flushing a toilet.....OMGosh.

  • Nov 23 '14

    Do not trust anyone. Especially regarding medications. Give your meds as ordered by the physician. Assess your own patients. Always report to your supervisors and document everything.

  • Nov 10 '14

    In an effort to satisfy my fellow students who would like my study docs, I have attempted to attach them here. If this doesn't work I'll try again. I got an enormous amt of responses from my last post and I'm so sorry if for taking forever to get to the people I haven't sent to yet so even though I didn't really want to post them on here, I decided to do it anyway because the month of June has been rough for me and I do work full time so I hardly get time to respond to everybody. I try to do as much as I can on my phone but i've been getting more responses, so hopefully this will work and anyone that wants them can just save them from here. They're very simple and some things may look repetitive but believe me, they've been checked out and they work. Happy studying ;-)

  • Nov 10 '14

    Now everyone won't have to rush to finish before July 2015!

    I appreciate the feedback we received about my earlier announcement of changes in the nursing theory examinations. After careful consideration, we have decided to continue to offer nursing theory examinations as one of the options for completing program requirements in the nursing theory series.
    Beginning with the Fall 2015 trimester, students who have completed the prerequisites will have three different options for meeting the nursing theory requirements in the associate degree curriculum:

    1. Enroll in an 8-week online course.
    2. Enroll in a 16-week Nursing Theory Conference + Examination (NTCX). This requires completion of an online conference in the first 8-week term, and sitting for the examination on a date during the next 8-week term.
    3. Study independently and register for an examination when ready.


    These three options are intended to meet the needs of our students. You may elect to utilize all three options as you progress through the curriculum. The faculty and staff at Excelsior College and in the School of Nursing value flexibility in higher education, and are pleased that we can offer all three options.

    Regards,

    Mary Lee Pollard, PhD, RN, CNE
    Dean, School of Nursing

  • Oct 15 '14

    Oh, they are concerned with liability.....but when something goes wrong, they'll throw the nurse(s) under the bus. That is why you should carry malpractice insurance at all times, wherever you work. It doesn't mean you're not a careful and conscientious nurse, because you are---it's to protect you in case something goes sideways and you get blamed for it. And with the working conditions in many LTCs, it would be foolish not to carry insurance.

    This is not meant to scare you. LTC can be very rewarding despite staffing problems, overgrowth of management and lack of mentorship. You will learn FAST how to improvise, how to optimize your time, even how to handle your CNAs. And at the end of the day, you'll have the satisfaction of knowing that you did the very best you could, even though you wish you could do more.

  • Oct 13 '14

    Most of my coworkers are on some form of anti-depressant. I have a long history of GAD and depression which has worsened while working in the ED. I stopped taking Lexapro because I could no longer afford it while in nursing school . I've been fighting going back on it but I am not doing myself any favors. My sleep schedule is nonexistent, I have frequent panic attacks, spend a lot of downtime in bed...life shouldn't be a series of living day to day like it is for me. You miss out on too much. Therapy is great if you can afford it/feel ok with it. My mom is a therapist and I know all of her coworkers (only place I could afford to go for therapy) so that is out for me.

  • Oct 12 '14

    The good administrator, who had been firm but fair? No, I would not enjoy watching her fail on the floor. I would feel empathy for her and do my best to help her adjust.

    The one who had been clueless and indifferent and never supported her staff? Crash and burn, baby.

  • Oct 12 '14

    Quote from macawake
    I think that it’s a bit misplaced to direct one’s discontentment against middle managers.
    I think that a more appropriate target, is those who have the actual power to create a meaningful change of employee working conditions.
    Except the PP did not say this was a "middle manager" at all. She said "administrative role". Can guess, but may or may not be correct, as to what that is/was.

    I have been a charge nurse, and nurse manager, and floor nurse, and.....other things. What I CAN say, emphatically, is that while the grass is always greener on the other side (without a doubt!) when someone has taken a less-than-caring attitude toward actual problems those in 'subordinate' positions face, it shouldn't be a surprise when that comes back to bite in the end.

    As a nurse manager, I had to do juggling that my staff did not always understand, nor appreciate. But I CAN absolutely assure you that if I was ignoring or belittling a problem that they brought to me, I couldn't deny them a smirk if *I* was faced with the very same thing upon dong a floor job!

    Only seems fair, to me.

  • Aug 17 '14

    Quote from Medic85907
    I would recommend you hurry and get as many Nursing Theory exams completed as you possibly can before July 2015 and the new "course" requirement goes into effect.
    I haven't heard of the new course requirement...I looked on EC website and couldn't find any information. Can you please explain or link? Thanks!

  • Aug 5 '14

    Update: It's been 4 months since I started to work at this SNF and it's still humanly impossible to finish all meds within the "correct" time frame. At this point I sincerely believe SNFs have nothing to do with patient care. For god's sake I have to bring in my own blood pressure cuffs because the ones in the facility can't even be inflated. I told the central supply to order some new ones and it took them almost TWO MONTHS to get that done due to "budget problem." Oh well, I guess it's about time to start job hunt again.

  • Jul 26 '14

    The order shouldn't have been d/c'd, unless specifically written to do so. The #60 was meant for the pharmacy. The DEA regulates how often a hard copy Rx is to be signed by the MD. After 60 tabs have been dispensed than the MD needs to sign a new Rx for the pharmacy, they cannot fill the order until they have that hard copy or have spoken directly to the ordering MD. We've never d/c'd an order when there are no refills left, we just have the MD sign a new hard copy Rx and send it over to the pharmacy.

  • Jul 16 '14

    Do you speak any other languages? Certificates? Volunteer hours that are medical? Talk about being a loyal employee, fast learner, compassionate nurse. Not sure if I helped but I hope this helps!

  • Jul 2 '14

    The focus is absolutely on making money instead of serving people.

    Exhibit A: HCAHPS/Press Ganey scores. Are they for improving patient satisfaction, or are they for improving patient satisfaction with an emphasis on maximizing reimbursement? I wonder if patient satisfaction was as big a deal before CMS indicated that it would affect reimbursement. In truth, I do not know. But if I had to wager a guess I'd say NOPE.

  • May 15 '14

    I often tell my admissions people to accept only orphans...no one with a family. So far they have not complied. I've had family members screaming in my face. One family told us to stop feeding their mother because (and this is NO joke) tired of spending their money to keep her alive. It was HER money they were spending and I told them as much. I also told them it is illegal to starve someone to death. Strangely enough this was the same family who demanded to speak to me because "Mom's BMs smell bad"....and yours smell like roses I assume? Smile at them and do the best you can.


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