LTC Emergencies - Not prepared!

Chin up · May 16, 2011

Speak with your staff development coordinator immediately. She is the one to go over this with you. In fact, they usually do mock codes throughout the year, if you do not have a SDC, see the DNS. You should not be starting solo, until you feel comfortable. Codes in particular are usually covered frequently. Take a deep breath, let it go and go talk with your SDC. Peace!

croppyRN · May 16, 2011

Thank you Chin up. I had a feeling I wasn't ready for this, and that I would need to speak with my DON before going it on my own. I appreciate your advice. I'm so nervous and wonder if everyone feels this way, or if the extreme nervousness is proof that I won't be cut out for this type of nursing? I will never understand why the LTC places give so little orientation compared to the hospitals. I know it is just the way it is, but just because they have been doing it this way all along doesn't mean it is right.

Chin up · May 16, 2011

It is not right. You should have at least 12 weeks and longer if requested. They are going to try and get away with whatever they can. You have to let them know you are not ready and need more training. I shake my head in amazement, because I know, they know, you can't possibly be ready in a few weeks. Most aren't ready after 12 weeks, but are thrown in anyway. You are not the first and won't be the last. What you have to be is your own advocate. They will train you longer if you insist. You are not being unreasonable and they know it. Please talk to her today and let us know how it works out. I am sure she will accommodate you. If she does not, she just doesn't care. Peace!

SitcomNurse, BSN, MSN, EdD, RN · May 16, 2011

Our facility has a standard 4-6 weeks, but if the INDIVIDUAL needs longer, then we do that. We also fast track people with experience. Get them onto the floor faster, out of the 'clinical' aspect quicker.

Our Supv.'s are very on top of who needs what, who should have a longer time on this or that aspect. Pick out the weaknesses and work with the preceptor in the facility that best emulates that aspect of care.

I wish they would have done that for me in some facilities I worked in. But then, maybe thats why we worked so hard for change

Dont let anyone push you into something that is hazardous to you or the patients you serve.

exit96 · May 16, 2011

Thanks for the heads up, I am orienting at a LTC as an LPN right now. (I am a new grad and will get my RN in December) This has not occurred to me yet, but I am assuming that there is a protocol established as far as "code team" or something to that effect. Absolutely let them know of strengths and especially weaknesses so that there are no gaps in care. Good Luck!!

exmil77 · May 16, 2011

This is what bothers me about LTC sometimes. I was out of LPN school about a month, and I interviewed for a PT job at a LTC facility. I was told I would have TWO days of training, and would then have 60 patients by myself (with 2 CNA's). Really? Two days and then Im on my own? No thanks.

Nascar nurse, ASN, RN · May 17, 2011

My opinion...The first rule regarding codes in LTC is to do your best to not let it go there. If they are a full code I try to ship them out at the first sign of circling the drain. I have been known to call 911 FIRST, then call family, MD and notify supervisior. I know some of you would get in big trouble for this, but it has saved a life more than once. You just have to be right - no calling 911 first for something silly like constipation (LOL, but have seen it done).

In the event of a code in LTC it tends to be all hands on deck as soon as someone calls the code. The nurse usually starts directing traffic - assign someone to go get backboard, O2, suction, etc. Assign someone to call 911 and prepare to direct the responders to the exact point you need them. Assign another nurse if available to start transfer papers. Assign someone to start CPR. Many of these tasks can be done by staff other than a nurse. In LTC there is rarely more to be done that BLS and hope the heck responders don't get caught by a train!

Hope this helps.

debRN0417 · May 17, 2011

Make sure you know the code status of your residents. I have seen many residents coded who were not supposed to be and many who were not that wanted to be (notice I didn't say should have been).

Long Term Care Columnist / Guide · May 17, 2011

"Full code" in LTC is all too often a contradiction in terms.....in most facilities I've worked in, there are NO drills, the crash cart is a joke and the nurses just call 911 whenever a resident crumps.

It terrifies me whenever I admit someone who wants full CPR; in assisted living we don't even have a crash cart, let alone an AED or even CPR-trained staff. Personally, I'm a DNR and think pretty much everyone over age 50 who isn't JackLaLanne ought to be as well; but it's not up to me, so I do a LOT of praying when one of my full-code residents falls ill. I don't blame the OP for being nervous!

casi, ASN, RN · May 17, 2011

I've bugged my facility to get a crash cart of sorts but they refuse.

So first and foremost know where your emergency equiptment is. When ever I am training in a new nurse or see a new aide being trained in I show them where everything is. The last thing I want to have happen is have a full code crash and have to explain to the CNA where the ambu bag is.

In code situations as someone else said, get them out of the facility before it comes to that. It is okay to trust your gut instinct. I've had a lot of gut instincts that I've followed against supervisor advice and had those patients land in ICU.

Kentondpeacock, RN · May 30, 2011

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