Help! I'm confused about charting rules

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I am a new LPN currently working in LTC for approx. 3 months. I went to the 6p-6a shift about a month ago from the 2p-10p shift. When I arrive at 6 after receiving report it's a mad rush to get med pass and treatments done before they go to sleep. My facility stresses the fact that this is our residents home, they also stress that we are to knock and wait until the resident responds before entering because there have been many c/o this not being done. But, they also stress that we need to chart on skin issues every shift, those shifts being 6-2, 2-10 and 10-6. Also I need to get o2 sats and morning blood sugars on people who are sleeping. I am so frustrated because there are mostly 2 residents per room so not only am I supposed to wake one but it wakes 2. I feel like it is very invasive to wake someone to look under their folds or stick them with a lancet. Can anyone advise me on how to handle this please?

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Specializes in critical care, ER,ICU, CVSURG, CCU.

Well those are not charting rules, they are assessments.... Check with your facility policy related to 12hr shifts and 8 hr shifts.

impressive they want q shift skin assessments, unless a wound etc noticed during hygiene, dressing, incont care, weekly comprehensive skin assessment was standard when I was DON.

you say you now work 6p-6a.....When doing 12 hr shifts, normally those assessments are done once on each 12 **** is on 6a-6p....then once on 6p-6a.....but again what is your facility policy.

no no way around you have to do your blood sugars

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Thank you for responding so quickly. I don't mind doing the blood sugars so much because the residents that get checked seem to already be used to being woke up in the early am for that, it's the skin issues I'm concerned with. Sorry I wasn't clear on the fact that these are if the resident does have skin issues that were already found or bandages. The policy is that they want me to chart twice, once for before 10p and once for after 10p and before 6a. I realize how silly I probably sound but I just don't like the idea of waking someone during that 10-6 period for something that likely hasn't changed, especially redness under skin folds. What really has me worried is that we have a resident that has a bandage and is very mean when she gets woke up, or anytime really. I think patients expect to be woke up during a hospital stay but waking them up in what is supposed to be their home is what has me worried.

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Full skin assessments are not appropriate on night shift in SNFs, especially if they have ridiculous overkill rules about waking people up.

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what time is breakfast served, and are you covering high readings?

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I agree that NOC shift is not the time to do a full skin assessment. For a facility who wants the residents to have privacy/rest, this policy kinda blows those goals out of the window.

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Specializes in Palliative, Onc, Med-Surg, Home Hospice.
Well those are not charting rules, they are assessments.... Check with your facility policy related to 12hr shifts and 8 hr shifts.

impressive they want q shift skin assessments, unless a wound etc noticed during hygiene, dressing, incont care, weekly comprehensive skin assessment was standard when I was DON.

you say you now work 6p-6a.....When doing 12 hr shifts, normally those assessments are done once on each 12 **** is on 6a-6p....then once on 6p-6a.....but again what is your facility policy.

no no way around you have to do your blood sugars

When I worked LTC, we had to do skin sweeps daily. Once a week, the DON would do the sweeps with the day shift RN. Not all sweeps were done on the same shift, it was divided up. Those residents could get ulcers fast.

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checking blood sugars before breakfast is understandable. but checking skin during sleep time? eh. maybe if the patients are immobile and you do it quick when passing meds, it's kind of overkill

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Specializes in SICU, trauma, neuro.

Your facility confuses me...do they want ICU-frequent skin assessments, or do they want the staff to recognize that these people are in their home?? Seriously, I'm confused. We do q 8 hr full skin assessments in my ICU. At the SNF rehab floor I used to work, we did them weekly. If your policy is to respect these people's home and sleep schedules (which in LTC may be as individual as the residents themselves are!!)...then this skin check policy is stupid, and it's violating the principle that the facility is these people's home.

I don't understand how they can have it both ways...and really they shouldn't. It's LTC.

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I really have so many other complaints about this place. I'm hoping that it is just that LTC is not for me and not nursing in general. I started out as an LPN because my school assured me that it would be easier to work as an LPN while I get my RN than going straight for the RN while working. As an LPN my options seem limited to LTC but so far the only thing that is keeping me there, besides the paychecks of course, are some of the residents that I've become attached to. The place is so short handed and I don't want to add to that problem but I don't know how much more of this place I can take. The rules seem to change as often as my co-workers.

I'm so glad that I found this forum because I really need a place to vent!

Thank you for being here allnurses.com

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Breakfast is at 745am. 1 hour and 45 minutes after I'm supposed to leave, let alone the fact that if I want to get it done before the end of my shift I have to do it earlier than 6. Most of my readings are between 130 and 160 and I have one that is always in the 80's.

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