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LTC tips please!!!...

Nurses   (2,275 Views 20 Comments)
by RNOTODAY RNOTODAY, BSN, RN (Member)

RNOTODAY has 18 years experience as a BSN, RN and specializes in NICU, ER, OR.

20,973 Visitors; 1,116 Posts

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I recently picked up a per diem job in a LTC facility for extra money. I have never done this type of work before, not even med surg... anyway...

I think I need some tips. I can do the work, but it is alot of patients, and I just need to know how others organize their day. It seems like so far, nobody there has a pattern going that I can learn from. We have med techs most of the time, and at first I thought this was a good thing, but now I am thinking I would rather give the meds out myself, as it would let me get to know the patients better for the day. Plus they dont do narcs, g tubes, or insulins. So, how do you know what you need to do for the day? Do you just go to your med sheet, check pt by pt, and write things down to remind you? I have a treatment book to go by... but....

And the other thing I am having "trouble" with.... The skilled floor I work on has about 36 pts... I go along, doing tx's, etc... and someone needs this or that, or needs to be tioleted, etc... and before you know it, I am in there for 10-15 minutes..... now dont get me wrong--- I know this is my job too---but the other nurses, when in this situation, will call one of the aids to help the resident. I have trouble doing this!!! I cant seem to "not" do it, since I am in there, and have "discovered" the need or problem, you know? I guess my question is, what is the "etiquette" on this, when is it ok to ask the aids to step in? If I did this all day, I would never get done, I can allready see. It just so happens I am orienting w/ another nurse, so I do it.

Thoughts, please.... I mean, they are very busy too... but I cant exactly ask them to help me with the stuff that only I can do, know what I mean?

Thanks!!!

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allantiques4me specializes in Brain injury,vent,peds ,geriatrics,home.

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Rnotoday.Hi .I think you should delegate ,Do you guys have some type of report in the beginning of the shift??Communication needs to be a priority.You being the Rn ,I would think you should be able to communicate what needs to be done.Including with the Med techs.What does your job description read??You seem to be having a little bit of a hard time with some of these positions youve been taking.Try to research the policy manual.Good luck.

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I help out when I can. Help with transfers, incontinence cares, etc. If I am in the process of doing something that I have to get done (med pass, treatments, etc.) I call a CNA to take care of whatever issue they need to take care of.

I used to correct problems when I came across them, like call light out of reach, HOB not elevated during a tube feed, linen left on floor, and the list goes on. I now call the CNA in to fix the problem. It's not that I can't do whatever it is, but if I continue to fix things, they won't learn to do it the correct way.

(I find it very irritating to see a nurse flipping through a magazine, telling an aide that is in the middle of toileting someone, to go answer a call light or something. HELLO. Anyone can answer a call light.)

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RNOTODAY has 18 years experience as a BSN, RN and specializes in NICU, ER, OR.

20,973 Visitors; 1,116 Posts

Rnotoday.Hi .I think you should delegate ,Do you guys have some type of report in the beginning of the shift??Communication needs to be a priority.You being the Rn ,I would think you should be able to communicate what needs to be done.Including with the Med techs.What does your job description read??You seem to be having a little bit of a hard time with some of these positions youve been taking.Try to research the policy manual.Good luck.

Yes, of course there is report.... but the report doesnt give you tips on organizing your day... and I know how to delegate, and the aids have their own assignment anyways, I was just asking how people handle things that pop up while doing other nursing duties. What would my job description tell me about this?

I am just concerned as being perceived as a lazy RN who would rather call an aid to do something I can do myself... I am not that way, so was asking at what point do others just draw the line and say: "you need to take care of this, as I have other things to do" despite me being right there.

And what would the policy manual say regarding this?

Jetscreamer, thanks your reply was helpful!!!!

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RNOTODAY has 18 years experience as a BSN, RN and specializes in NICU, ER, OR.

20,973 Visitors; 1,116 Posts

Let me just clarify:

I am speaking of, say I am in the middle of treatment rounds for 30 patients. Pt so and so says "I want to go to the day room". This pt has a walker, needs a portable o2 tank, you get the picture. I would be there a while.I feel silly asking someone else to do it, since I am right there,and plus since I have to hunt them down to find them anyway. But, I have my treatments to do, and nobody can help ME with that. I was wondering where other nurses in this field draw that line and go get an aid......

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not now has 3 years experience and specializes in LTC, med-surg, critial care.

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After a mere two years in LTC all I can offer is: delegate, delegate, delegate. You have 36 residents, you can't do it all. I can knock out a med pass to 50 residents in an hour and a half because I don't stop unless it's something I can do in a minute. Change a channel? Sure. Help with your shoes? No problem. You want a pitcher of ice, a soda and a snack? Let me get someone to help you.

I also don't do my med pass in order. I hit all the residents that are parked at the nurses station first, then make my way down the hall. If a resident is passing me on their way to dinner or activities I jump to their MAR and pass the med before they're on the other side of the building. I used to keep track by taping a census to the med cart under the MAR and highlighting who I already passed meds to. Now I can do it by memory, heck I can practically do the med pass by memory, but that's because I've been working with the same residents for two years.

If I can't find a CNA I usually just ask "I'm in the middle of passing meds can you wait one minute so I can find your CNA?" and call out the CNA's name as I'm moving on to the next resident's MAR, the CNA hears me and I tell them what needs to be done (if you don't want to call out their name you can hit the call light for them to get the CNA's attention). The residents usually don't mind waiting, they aren't in a hurry.

Don't be afraid to ask the CNA's to do something for you. You can do a CNA's job but they can't do yours.

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Some things you do right away, if someone needs a bedpan , they need it right now, you are standing right there, do it. But something that is not urgent or is going to take a few minutes, you don't have time to stop and do. Another thing to consider is whatever you start doing you will have to continue doing. The more you do now the more your techs will expect you to do in the future. It is not being lazy or superior if you ask the aids to do what they can do, since they can't do the things you have to do.

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withasmilelpn has 18 years experience and specializes in Rehab, LTC, Peds, Hospice.

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I always help out as much as I can, but I keep my priorities straight. Your med pass is supposed to be done in a certain time frame right? That can be difficult to do even without distractions at times. Bedpan fine, walk to bathroom probably not during my med pass. Little things like raise a bed, sure no problem. I also will tell my patients I will be glad to do such and such but it may be x amount of time before I come back. Don't worry about the CNA's perception of you, though. Some of them will think you are lazy no matter what you do, they haven't done your job and don't have a good perception of what a nurse does anyway. The good ones will recognize your efforts and appreciate you. But I find the only opinion that matters is my own, when I leave I know I did the best I could for my patients! (And definitely answer the call bells, I can't stand nurses or CNAs that don't!}

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arpeggiated specializes in Med/Surg.

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I used to correct problems when I came across them, like call light out of reach, HOB not elevated during a tube feed, linen left on floor, and the list goes on. I now call the CNA in to fix the problem. It's not that I can't do whatever it is, but if I continue to fix things, they won't learn to do it the correct way.

Until your patient aspirates his feed!

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New LPN grad here and accepted into the ADN RN program. Starting in March 08 and graduating December 08. The program I'm in is a nursing career advancement program. You have to become a CNA, then LPN then if you make it . . . RN.

I must have worked at a horrible long term care facility, but I must say . . . at one facility, I never saw a nurse or a med tech do anything but pass meds and a little charting. The other facility I worked at, only one nurse would ever do anything to help - she did that when a patient had thrown themselves on the floor and he was such a big man one CNA couldn't lift him from the floor, especially with him fighting against being placed back into his bed or a chair.

I understand that med pass, treatments and documentation are a priority for the nurse and must be done, but I saw a lot of setting around and chatting going on when nurses could have been doing a little more to help with patient care.

I decided that I would be a nurse that would do more, however I know it is a fine line to walk, because some lazy nurses will not like that (it could make them look bad) and I also don't want staff to come to expect me to do their work for them, but I really can not see not answering a few call lights and doing what I can when I do have time to help. Also, I plan to make a point to check patient rooms to make sure things like HOB is not left down on tube feed patients and that call lights are in reach, dirty diapers are not left in rooms, etc.

If I can set a good example for other prospective nursing students and provide a higher quality of patient care, I will.

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i can think of one of way to make things easier for you. in a piece of paper, make four columns, go through med book and write down name and room numbers of patients, then patients who needs blood sugar checked and whether or not on sliding scale or scheduled insulin and amount, next column patients who gets scheduled narcotics, then last column patients who gets meds via g-tube. get report, count your narcotics. if you have extra time, go through treatment book and start flagging patients who needs treatments. if you dont have extra time, then start with your blood sugar check, and give insulins. then start from the beginning and pull out narcotics for those who gets scheduled narcotics. if a patient has g-tube, then give both narcotic and regular meds at the same time. after that, start giving meds via g-tube. after that, start your treatments.

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Until your patient aspirates his feed!

I don't let it wait a half hour until they do it. I call them into the room, maybe takes an extra minute. If I can have them correct it, they might remember to do it and the patient in the end spends less time during a feed with the HOB down as they don't leave it down in the future.

I had a new nurse tell me something she told her CNAs, don't know if it'll help, but she asked them to turn around at the doorway and do a quick check that everythings done.

ie: call light, hob up if needed, rails up if ordered, garbage off floor, room tidy, etc.

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