Emergency in nursing home.

Sour Lemon · Dec 17, 2018

I read allnurses article and advise almost every day. I am not a new grad but recently changed from home health to skilled and rehab center. I am scare because of pt ratio;I have minimum 27 pts. I finished nursing school almost 6years ago. Please, help me to survive in new job. Thank you for any suggestions.

Prioritize. Know your facilitiy's policies. Throw in a little common sense.

caliotter3 · Dec 17, 2018

Ask for help and advice, but don't become "needy". Offer help if you get a chance. Develop strong relationships with your coworkers and part of your battle is won. Of course, usually easier said than done.

Make yourself some 3 X 5 cheat sheet cards with steps to deal with possible crises. For example: High blood sugar, low blood sugar, cardiac arrest, info to pass to md for change of condition (SBAR), steps to follow for a fall, when to call family, list of emergency contact numbers (DON, ADON, fire dept, police, etc.). Keep these on a little ring and carry in your pocket or have nearby or on your cart. Just having a reference can give some sense of relief.

verene, MSN · Dec 17, 2018

Does your facility have emergency binders? One unit I work on has really nice binders - each a different color that correlates to the emergency situation (e.g. "Code Green - out of control patient" is in a green binder, "Code blue - medical emergency" is in a blue binder). The first page is a step-by-step cheat sheet (including who to call and what steps can be delegated) followed by premade packets containing all the paperwork you'll need for that particular situation. Emergencies are still stressful and can be a bit messy, but it helps to have all the important bits in front of you so you don't have to think through order of who to call or which forms need to be filled out afterwards. If you don't have an emergency guide at the facility I'd strongly consider making your own. Also - prioritize - patient and staff safety always come first, a missed piece of documentation can usually be filled out after the fact. And finally - rely on your teammates - learn to work well with them, and know their strengths/weaknesses so you can split/delegate work during an emergency to those who are most competent for a given task.

JBMmom, MSN, NP · Dec 18, 2018

I'm not sure if you're asking about when emergencies happen in a skilled rehab facility, or you consider it an emergency that you're starting to work in one. If it's the former, you will likely not be in charge of the facility (at least at first) and you should be well educated on the resources you have to get through emergencies. As verene mentioned, most facilities have clearly outlined procedures for dealing with routine and emergent situations. You should at least have enough orientation time to get you familiar with where these resources are, and in most facilities, your coworkers are your best resource.

If you mean it's an emergency that you're starting a new job, with all due respect I think you need to examine your ability to handle change. Yes, a 27 patient assignment can seem overwhelming and one of the challenges in skilled nursing is the high patient:nurse ratio. However, you will learn how to prioritize the work, and you will gain valuable assessment skills while working in an environment that builds your autonomy in practice. Just read through the numerous threads here and you will find valuable information on how new nurses in similar environments found success. It will take some time and you will have some frustrating and maybe overwhelming, days, but you can be successful, especially if you approach it with the right attitude! Good luck to you.

River&MountainRN, ADN, RN · Dec 18, 2018

27 isn't great, but it's certainly doable.

I've done 40-50 before and that was just hell! Prioritize learning the residents (what they look like, their names, their preferences for taking pills, and whether they have any special diabetic/time sensitive meds). Kill the aides with kindness: even if they test you at first or give you a hard time at first, be polite (but firm) with them. When you're desperately outnumbered, you need all the help you can get.

Golden_RN, MSN · Dec 18, 2018

Each SNF I've worked at assigned 20-40 residents/licensed nurse so it is doable. There are lots of variables, like the amount of charting you have, whether you have a treatment nurse and # of CNAs.

My advice: prioritize, develop great relationships with the CNAs, know how to access policy/procedures & look for a mentor (maybe a DON, ADON, MDS nurse or other experienced nurse in the builidng). Best of luck! I loved working on the floor at a SNF.