Does Anyone feel the same way about these LTCs??

sharlynn · Feb 27, 2008

I would assume the Charge Nurse calls the doctors and notes the orders,and answers the phone doesn't she? Even then , it's an unfair workload. The facility I worked at last, the meds were split with the Charge nurse having fewer patients due to handling the doctor calls and orders. We had a receptionist to handle the telephone, too.

witchypoo · Feb 27, 2008

:redbeatheI'm a charge nurse of a 31 bed unit, I am the only nurse. No ward clerk and 3 cna's, Who are wonderful and are my eyes and ears.

I'm the charge because i'm in charge of all 3 shifts. I give out meds, the average med count is 19 meds on the 9 am pass, The beer's rule is followed by 1 doctor and we love her:redbeathe:down:, I have 5 others who are not in favor of it. :down:

I do all the treatments, and luckily I have only 3 nasty wounds on one client that were hospital aquired:angryfire .

I make all the doctor calls and scheduling for outside appointments and transport arrangements.

I have 4 gt feedings and 1 bolus feeding and 1 iv at present. I am also expected to assist in feeding residents we have 14 feeders, giving out food trays. deal with doctors, hospice, families, residents, dietary complaints, pt, ot and speech,and all the documentation and presently I have 4 on mds daily charting. of course the monthly psych documentation and pharmacy authorization paperwork and my all time favorite getting "doctor ego" :sasq:to remove meds that are not covered by the residents medical coverage, or the pt is not capable of taking ie fosamax to a pt who can't swallow or sit up, that can waste an hour alone.

I do have a unit manager, now in all fairness, my unit manager is divided between my unit and another unit with a new orientee, who definately requires the lion share of attention. Our DON has passed off all her work to the unit mangers.

We have a new administator and so hopefully things will change, She is aware of us not having a ward clerk that the DON is abusing her power and handing off her work. and that I can't constantly pick up the slack from the other shifts because I just can't. :bugeyes: The administrator became aware of this because, I was asked to do one more thing, and I told her "I refused to shove a broom up my butt and sweep as I walk, so you can cut back on housekeeping. and please tell staffing that I would really like to walk out the door at the end of my shift, but I can't take the paper work home."

It isn't always like this and it wasn't always like this. It is as ltc facilities are bought out by hotel management, we will have to deal with it, this is down sizing at it's best and I am to blame because I always did for my residents and I love my work with them. I hate constantly getting less and less time with the residents and more and more with the paperwork, phones and computers, and filling out redundant stupid paper work because the corporation or goverment can't look through a chart and needs to have 15 sheets of paper to cover what nurses note once did on one. I have roughly 15 minutes per resident if you divide 31 into 8 hours, but in reality, it is not even close, and these business models work in other areas but not in nursing. when I started in ltc it was mostly "waiting for God" the meds were digoxin, insulin, colace, lasix and lopressor, everyone was a dnr and the families were grateful. When mds were introduced I was told Lpn's will never do them. been doing them for 15 years now. If they needed an iv they were sent to the hospital now with drg's they are weaker and sicker,we do iv's, tpn's. we have more regulations and unrealistic expectations thrown on us. I asked a state inspector how long it was since she worked in ltc on the floor she told me, she never did i then asked her how could she judge my work when she never did it. It is like the school that teach to the tests it really does a disservice. I may not have gotten to sign the tar, i missed that page, but my initals are on the dressing so I did it, They would rather you had impecible paperwork than actually spend time with a person and that is not just in ltc but in all nursing. and that is just so sad:cry:

TheCommuter, BSN, RN · Feb 27, 2008

I am the only nurse for nearly 70 patients during night shift. I usually have 3 CNAs if I am fully staffed, and 2 CNAs if we're understaffed. By the way, they recently got rid of the medication aide because the nursing home administrator feels that night shift is "too easy."

With my 10 feeding tubes, trach patient, 20 diabetics, dialysis patients, treatments, medication passes, and the mountain of paperwork, I rarely have a moment to sit down. Not all night shift nurses have the time to sleep. I know I certainly don't!

gt4everpn, BSN, RN · Feb 28, 2008

I would assume the Charge Nurse calls the doctors and notes the orders,and answers the phone doesn't she? Even then , it's an unfair workload. The facility I worked at last, the meds were split with the Charge nurse having fewer patients due to handling the doctor calls and orders. We had a receptionist to handle the telephone, too.

Sadly the medication nurse has to handle new orders!!:angryfire

witchypoo · Mar 2, 2008

florida you have my:bowingpur sincerest accolaides, you are a super person:nurse:. as i said before administration and the state regulators have not got a clue what we do on a daily basis. our jobs are easy, we can be replaced a trained monkey could do my job but would he do it with out hitting some one, or throwing excrement. i share in your fustration. you can join me and my co workers in the zen movement read the instructions to completion first then proceed, sit comfortably preferably in you med room since it is the only quiet place on your unit,You close your eyes place your upper arms next to your body and lower arms slightly extended out from your body with palms of your hands facing up take you index fingers and have them touch your thumb now chant and keep repeating until you feel better i swear it works, now that you have had a laugh i hope you feel better.

facetiousgoddess · Mar 2, 2008

Aiyiyi....

Nuff said....We really do it all.......How we stay sane is another matter...

Witchypoo

What is the "beers rule?"

Visions of the old college "quarters" game, but with my residents...

Tres

witchypoo · Mar 3, 2008

The beer's rule is a suggestion for doctors to limit meds. that the elderly should have less than 9 meds daily, it is to prevent drug interactions, and that they can do very well with a limited amount of meds. it is a little more complicated than that but that is it in a nut shell.

gt4everpn, BSN, RN · Mar 4, 2008

the beer's rule is a suggestion for doctors to limit meds. that the elderly should have less than 9 meds daily, it is to prevent drug interactions, and that they can do very well with a limited amount of meds. it is a little more complicated than that but that is it in a nut shell.

ha!! where i work each resident probably gets about 15 meds at day at least!! needless to say alot of the meds they take are unecessary like the vitamins, in reality are supplements going to do anything for a 85 year old??

proud2b1 · Mar 4, 2008

I have 68 res. most of the time.There is usuallt 2 nurses,3 on a good day!We do everthing and rounds with all the doctors that come in constantly.Our don and our"office nurses"rarely lift a hand to help.They are always the first to catch an error,and act like they never notice that we need help sometime.Our poor 11-7 nurses are alone with only 2 cna's.I dont even think that is legal.Anyway,all the ltcf's I have worked,run just about the same.I go back for more everyday.Sometimes it's really frustrating!!:uhoh21:

witchypoo · Mar 4, 2008

where i work the clients also get an average of 19 meds. as i said the beer's rule is mearly a suggestion. i have only one doctor that follows it and unfortunately she only has 4 of my clients. she 23 on my co workers unit and she actually finishes her med pass on time.

I have doctor EGO and he has 12 clients, He has just increased one residents meds to a count of 32 meds, {i think he is working on a pharmacy vacation} on the 9 am med pass. and 3/4 of them are liquid so she has 6oz of meds that you can't mix together and you have to thicken to honey and give her a 1/2 teaspoon at a time and most are bid so it is not like evenings gets a break and i have been trying to get rid of fosamax on this resident she can't sit up with out support, she has to have her meds crushed. she doesn't fit the profile for half the medications, she has an entire half of the bottom draw just for her liquid meds, she really only requires dilantin, colace and lipitor, the rest are supplements and things like prilosec, which she would not need if she was not getting so many meds that upsets her stomach, he has her aricept and namenda, which her alzheimers is beyond because her husband asked about them and now her husband is waiting for a scene like out of awakenings or cocoon, she is like a 6 month old baby, but there is no talking with doctor ego cause you are only a nurse.

I spoke with the medical director yesterday about it and he pulled the chart for a medical review, hopefully now that he is involved things will change. and i won't catch too much grief. but it is routiene for him to review 5 charts from my unit a month and when i am there i stear him to the useless med charts and unsigned and out of compliance charts. the doctors will usually listen to him. He can take away their privalages to practice at our home and 22 others and make life a living hell in 2 of the local hospitals. he is a political md and very well connected and 3 of these doctors are scrambling for admission privalages in the 2 hospitals the medical director has alot of clout in. and they were effected by 2 hospital closures. He also remembers me when i was a snot nosed nurse of 16 running the forensic psych ward at night. and he was the senior resident. he often chides me for not going on since i'm too damn smart to be under some of my supervisiors, and i remind him that i put many things on hold when my son was born. just a fyi my son is severely developmentally delayed.

the director remembered something i once said to him. it was an impossible request and i answered "i'd get to that just as soon as i learned to walk on water" and he looked at me and i then said i'd clairify it for him "as soon as get done with the plagues and parting the red sea." when he was leaving my unit yesterday he told me I'm not making any promises, but i'll try to free you up a little, so start making matoz i'll try to part the red sea.

JeanineLPN1984 · Mar 8, 2008

Talking about the Beers rule, it reminded me in one facility in the early 90's we had a drug holiday on Sundays. The medical director had most of the others doctors agree and the only drugs given out were insulins, dilantins, ABT and absolutely neccesary ones or prn meds( pain etc.). His reasoning was the elderly had impaired renal function and the drugs would work better. The funny thing we did it for a year and a half and I cant remember a time that a patient was harmed because of this.

Anyone else remember this?