I have a typical story, new grad working in LTC after a short orientation. Shift is 10p to 6:30a (reality is more like 9:00p to 8:00a), alone with two aides - some good, some not so much. Of the four aides I have worked with, the two I was told were "great" scare me the most.
My anxiety level is tremendous. It seems like I am finding out in a roundabout way of what to do or even more importantly what NOT to do. Example. Second shift on my own after orientation, pt had 2300 Carafate. No carafate to be found anywhere. Swing nurse who was there late charting first told me "get one from another pts card". That felt wrong (and no other pt was getting it anyway), so I asked what my other options were and she said to call the pharmacy. I did, they said it would be delivered next day. Gave the other 2300 meds to the pt, who laughed and said this has happened before and no big deal. I went back to ask the swing nurse what else to do and she had left.
I later circled it on the MAR and noted, "med not available, pharm called pt aware no adverse effects noted"
Now a week later I get written up and was told that you NEVER say a med is unavailable (even though it WAS unavailable!!!) and I did not call or fax the MD. I now understand I should have notified the MD about the carafate and I take responsibility for that but I am wondering what else I am missing or doing wrong trying to muddle through this by myself? Information at this facility is conflicting at best and I am not entirely sure what to ask.
Question. What are common LTC rules and procedures that I should know about and be following? I need this job for the moment for experience and paycheck that my family needs and just want to make it without getting into more trouble and it possibly being worse than this carafate thing.
Seriously! We are all LTC nurses, and we are all faced with legal /ethical delimas everyday, most of us go home after every shift questioning the decisions that we made, and hoping that when we go in for our next shift that we don't get called to the DONs office to be bi*ched out, or fired for something that we did or didn't do, or a choice that we made.
Fact is LTC nursing is hard period, we are short staffed most times, we must cater to not only our Residents, but to their families, the administration, the pharmacies, hospitals, the Dr.s and whom ever else we may encounter, all while giving medications to 30+ residents in a 2-3 hour time frame and doing skin assessment, dealing with falls/behaviors and then set down and document every little thing that happened during the past 8 hours.
You know thing will be missed, skipped, forgotten, and overlooked. We are not programmed robots, we are LTC nurses! We simply do the best that we can with the situation that presents itself to us.
None of intentionally puts our license, job or Residents at risk! None of us intentionally tries to make our facility look bad!, None of us intentionally wants a Resident to miss a medication, or have a skin breakdown, a fall, or a low blood sugar. But they all happen all the time at every facility.
All we can do is go in and pick up the peices that the previous shift leaves us, do what we can do in our 8 hours, and then present it to the oncoming shift to take over. LTC is a never ending circle, and even though we are not "Stepford Nurses", LTC could never function without us.
So "HERES TO US" May all of our choices be the right ones!
Finallydidit, thank you for your entire post. For many of the things you stated above and other personal reasons, I made the difficult decision to give notice and start looking for another job right away. Life is too short and the LTC battle is not one I want or need to fight at this point in my life.
Major kudos to those of you who keep fighting the good fight on behalf of those most vulnerable patients and thank you to everyone on this board for your input :)
Specializes in Geriatrics, Hospice, Palliative Care.
Finallydidit, if I could give you 100 kudos for this post, I would! LTC is full of dilenmas, and staff is often too short to do the right thing *every time*. Our facility is pretty good - we've got a well stocked pyxis, so getting meds isn't too hard. I'm a nut about reordering meds, and sometime the other nurses gripe about this, if the cart gets too full. BUT - if I don't do it, it often doesn't get done, and then is is a PITA to get the med from the backup (case in point - when I returned from my week of vacation, meds missing galore, including narcs).
At then end of my shift, I'm happy to know that I did the best that I could do for my patients...and then for the facility and myself. If that means borrowing, I will do it, and then replace when the med is in, since that is the best thing for the patient. I am aware that it isn't right, but sometime you gotta go for the less "not right" and hope for the best. I applaud Asystole for working hard to fix the systemic problems so that she can always do the right thing, and hope to some day be in the same position to do so; until then, I make the best of what I am left to deal with .
ETA: It occurs to me that we haven't really helped with OP with her question about what other landmines in LTC to avoid...so I will try to do that:
1. If it happened on your shift, deal with it. Skin tears are almost a fact of life in LTC. Do the incident report etc so that the next shift doesn't get stuck with it. I finally got tired of cleaning up from day shift's skin tears (apparent from finding dried blood on the skin and sheets at 1530) and mentioned it nicely to the sup, who told the day sup.
2. NEVER NEVER NEVER attempt to cover up a fall; I've seen it happen, and those folks are no longer employed.
3. There is a lot of pressure in our facility to cover up med errors...stupid me went along with this culture one time, and I got burned. Please learn from my mistake and don't do it.
There must be more, and I would appreciate the education!
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Seriously! We are all LTC nurses, and we are all faced with legal /ethical delimas everyday, most of us go home after every shift questioning the decisions that we made, and hoping that when we go in for our next shift that we don't get called to the DONs office to be bi*ched out, or fired for something that we did or didn't do, or a choice that we made.
Fact is LTC nursing is hard period, we are short staffed most times, we must cater to not only our Residents, but to their families, the administration, the pharmacies, hospitals, the Dr.s and whom ever else we may encounter, all while giving medications to 30+ residents in a 2-3 hour time frame and doing skin assessment, dealing with falls/behaviors and then set down and document every little thing that happened during the past 8 hours.
You know thing will be missed, skipped, forgotten, and overlooked. We are not programmed robots, we are LTC nurses! We simply do the best that we can with the situation that presents itself to us.
None of intentionally puts our license, job or Residents at risk! None of us intentionally tries to make our facility look bad!, None of us intentionally wants a Resident to miss a medication, or have a skin breakdown, a fall, or a low blood sugar. But they all happen all the time at every facility.
All we can do is go in and pick up the peices that the previous shift leaves us, do what we can do in our 8 hours, and then present it to the oncoming shift to take over. LTC is a never ending circle, and even though we are not "Stepford Nurses", LTC could never function without us.
So "HERES TO US" May all of our choices be the right ones!
I am sorry for your write up. I have been told when you do not have access to a medication by hook or crook, you call the MD and get an order to hold the medication at that time until medication is available.
Of course you are not suppose to borrow. The facility should have a local pharmacy available for where you can get medications from when needed. Does the pharmacy provide your facility with an emergency pharmacy/medication box that contains medications that might be needed after hours. Also maybe you could have called the doctor, told him the medicine was not available and maybe gotten an order to hold medicine at this time. It takes all shifts to stay on top of medication reorders in a LTC facility.
Finallydidit
141 Posts
Seriously! We are all LTC nurses, and we are all faced with legal /ethical delimas everyday, most of us go home after every shift questioning the decisions that we made, and hoping that when we go in for our next shift that we don't get called to the DONs office to be bi*ched out, or fired for something that we did or didn't do, or a choice that we made.
Fact is LTC nursing is hard period, we are short staffed most times, we must cater to not only our Residents, but to their families, the administration, the pharmacies, hospitals, the Dr.s and whom ever else we may encounter, all while giving medications to 30+ residents in a 2-3 hour time frame and doing skin assessment, dealing with falls/behaviors and then set down and document every little thing that happened during the past 8 hours.
You know thing will be missed, skipped, forgotten, and overlooked. We are not programmed robots, we are LTC nurses! We simply do the best that we can with the situation that presents itself to us.
None of intentionally puts our license, job or Residents at risk! None of us intentionally tries to make our facility look bad!, None of us intentionally wants a Resident to miss a medication, or have a skin breakdown, a fall, or a low blood sugar. But they all happen all the time at every facility.
All we can do is go in and pick up the peices that the previous shift leaves us, do what we can do in our 8 hours, and then present it to the oncoming shift to take over. LTC is a never ending circle, and even though we are not "Stepford Nurses", LTC could never function without us.
So "HERES TO US" May all of our choices be the right ones!