LTC nurses, need your input

[Annewr]

Maybe I posted this originally, in the wrong section. In 12 hours I have gotten no responses which is unheard of on this forum:) Okay, the short version. Have worked in almost every nursing envir. am new to current facility, but have done LTC in the not too distant past.

Question, need job descriptions you might offer for the unit mgr on rehab, medicare, short-stay units. Who does MDS's, care-plans. Do you do I & O's? How long do you allow call lights to go unanswered for? Do you answer call lights? (At this place, apparently, the nurses don't....????!!!)

I am near having a stroke at this great little facility I took a part-time position at. It seems there are vital activities that no one particular person is responsible for, so no one accountable. I am not really sure what I should be responsible for-please note, I DO answer call lights, am willing to do almost every task including cleaning the floor if nec...:) Very old culture. Don't want to step on toes. But want to provide great care, promote team work, decrease incredible overtime usage, and i mean incredible!!! (11-7 nurse left at 9:45 a.m., no deaths on her shift, can't figure out WHY she was still there? Admission time consuming, but should SHE have stayed to complete, or should day shift mgr finished it?) How many patients do the staff nurses have on their team? Who does treatments, orders/re-orders meds, does kardexes for new month, calls the docs, notes off orders?? If you could include your state, size of facility, your role, length of time in that role, suggestions, etc. I really feel the need to have broad knowledge before my discussion with DON about changes that might be implemented, or maybe I just need to shut up and be grateful for a great paying job, with little apparent stress??? I like to EARN my pay. I want to be efficient. In this environment however, I don't seem to have clear guide-lines. Any and all info will be helpful. Please respond if you have direct experience with this type of unit.

Many thanks for your anticipated responses to this post!!!

[Forever Sunshine, ASN, RN]

MDS is done by the MDS coordinator. Care plans are initiated by the RN upon admission. LPNs in my facility.. update the care plan when new orders are given.

I&Os are done by the CNA. I answer call lights when I can. Can't always if I have a lot going on. Its hard to even tell how long call lights go unanswered for.

Sometimes when I worked 11-7 there would be massive amounts of charting and audits. Even now on 3-11 I find myself .. at worst.. staying at most 2 hours over my shift finishing things up.

On 3-11 I have average 25 residents. I do meds, treatments, nurses notes, I help with orders, I call MDs for my own residents if I need to. The charge nurse does most of the orders, lab values, other things, MD calls, CNA assignments, etc.

[CoffeeRTC, BSN, RN]

It really will vary on the size of the building and what shift. If you can let us know we might be able to give you a better guess on what to expect.

I work in a smaller facility with 50 beds. The RN is responsible for supervision and hands on care. LPNS do the same except for IV push meds and some supervisor duties are on the RN. Meds, tx calling the docs, taking off the orders on my shift, lab work for stats, attempting to start IVs (we have a team that comes in). Admit assessments and some initial care plans. Call lights are everyones responsibility..assisting with toileiting as time requires and helping with meals too.

CNAs will record the I/Os, do vitals and all ADLs.

Right now the MDS and careplans are done my the RNAC or MDS nurse.

Montly TARs/ MARS or kardex.. we have nurses that will come in extra to work on them, but 11-7 double checks them.

As far as staying over that late for an 11-7 shift...wow. Things get busy, but nursing is 24/7

[bubblymom373]

We have a Medicare/ short stay wing of about 25 beds. Unit manager = Medicare nurse. She does the care plans and MDS on these residents and oversees general care.

Floor RN on that wing does meds treatments, charts I and O, calls or faxes MD. Will add to and delete things from care plans as needed. Will process some orders if time. Will assist in answering call lights.

Unit Clerk does orders that come in, sets up appointments and helps with new admit orders

CNA keeps running tally of I and O, and should be answering call lights within 5 minutes.

Night RN double checks new orders and processes any new orders left from other shifts.

Our regularly given meds come on a scheduled day monthly from the pharmacy and are checked by nights before being put in cart. All prn meds are reordered by the nurse on the floor when there are 8 pills or so left.

There is one person who is responsible to check the new medication sheets for the next month.

As far as overtime. We have the same problem at my facility. Only these nurses punch out and then stay for one to two hours to finish charting. Even if you offer to assist the things that are left to be done are things that nurse can only do, ie: chart assessments etc. We have been told things that don't get done are to be left for the next shift but often they are overloaded too.

Hope this helps.