LTC tips please!!!...

Blessed2BeMommy · May 28, 2007

Like a pp stated, you may be able to do a CNAs job, but the CNA can't do yours. When I was a CNA, I tried to make sure that I did everything I could do so that my nurses could do the things only they could do... and I made sure they knew that was my attitude. In return, my nurses were always willing to be helpful when I was swamped and they were having the rare easy day.

Now, as a nurse, I caught myself the first time that I walked out of a room to call the CNA to clean up a mess... and I thought, wow, I never thought about my having to do that. But I HAD to do it... I had things that had to get done that only I could do. And the CNA could do that...

Now, obviously, if I didn't have things that had to be done... I would be right in there with my CNAs doing what I can to help. But they can't pass my meds and they can't do my treatments. I have to do those things. If your CNAs see you working your butt off they won't resent you. If you are just sitting on your butt they will.

And I ALWAYS always always always thank my CNAs at the end of the day.... and I try to always bring a bowl of chocolates that I plop onto the table where all the CNAs sit to chart near the end of their shift. The CNAs I work with make it possible for me to do my job.

nursegraham7776 · May 28, 2007

if you are going to do all of the aide's work then why have the aides? I help my aides out I was an aide for 10 years before i went to school and the aides are no where as busy as the nurses.if you are in a room with a res that needs to go to the BR take them to the Br and put the call light on in the meantime for the aide to finish up you have to be the one to draw the line or the aides will walk all over you.

kmarie724 · May 28, 2007

I work as a CNA in a LTC facility. I think it's perfectly acceptable for you to ask a CNA to do things like toilet residents, take them to another area on the floor, etc. Many of the nurses I work with will do those types of things if they have a few minutes to spare, but I certainly don't expect it. I know they have a lot of work to do. In fact, a lot of the time I wish there was more I could to to help the nurses out. There's no reason to feel bad about asking the aides to do things. That's what we're here for.

Jo Dirt · May 28, 2007

You've got to prioritize and do that first. The way I got a routine down, I would pass out the meds FIRST, and if there were blood sugars and insulins due I would do them, then pass out the other meds,then sit down and chart, then do the second med pass (usually wasn't as long as the first round), then later in the shift I would do treatments and chart.

Let the med techs get V/S and do eyedrops and creams and such.

Not a magical formula to make it easy but they always told me, you have to get your own system going.

And don't expect to be able to do everything by the book in LTC.

Daytonite, BSN, RN · May 28, 2007

whenever i worked in a ltc that had a medicare hall that's where i got assigned. that's where they put rns and particularly rns who have acute hospital experience. organizing yourself is primary. when i was new to nursing i would make a written list of all the things i had to get done and arrange it in the order of priority and time deadlines. with medicare patients you probably need to document some kind of physical assessment on them (get that on your list) because only the licensed nurse can do that. without that documentation the facility isn't going to get paid by medicare. not only that, but your documentation has to address the reasons that are making the patient "skilled". if you don't know what they are, ask the mds nurse or whoever is responsible for admitting the medicare patients. when push comes to shove at least chart about their "skilled" status. that's usually things like oxygen therapy, the fact that they are getting physical therapy, ivs, sterile or complicated dressing changes. i used my computer to create my own report sheets. when i worked these medicare halls i had the patient names, doctors and these reasons for "skilled" care on the word file that i created for these report sheet so i only had to print out a new report sheet with this information for each day that i went to work.

ok, next is the meds and treatments. i included fingerstick blood sugars with the meds. just concentrate on the ones you have to give. i used to make a simple grid with the hours of my shift across the top of the back of my report sheet and just place checkmarks below the hours when there were meds that had to be given. ditto with treatment times. when i did agency work i would quickly go through the mars to see who had what meds at what time. i probably also flagged the mars in some way as well. i worked with a lot of nurses who used drinking straws with the ends sticking out to mark a mar that had a med due to be given. i also used to open the binder and shift the position of a mar over by one set of rings so the mar itself protruded out and then re-closed the rings (someone can pull your straws out if they desperately need a straw). some treatments and meds can be done at the same time you are doing your physical assessment. i knew what my big dressing changes and treatments were because i worked full time. as a per diem though you might want to ask the offgoing nurses what big treatments you need to know about. i had ways of noting that i had completed a physical assessment and charted it on my report sheet. with a whole bunch of patients i stopped trusting my memory. tracking this stuff on paper is much safer.

i loved my medicine carts. they were rolling desks for me. i kept my report sheet on a clip board and kept it on top of the medicine cart unless i took it into a patient room with me.

being an rn means you go about stamping out fires. they come in all shapes and sizes from doctor's calls to a visitor with a complaint. it all gets fit in between all the above. that's just the nature of the job. when a patient says, "i want to go to the day room," i say "ok. i'll get your aide to help you." i want you to memorize and practice saying that. that's all you need to say and then tell the aide, "mr. xx is waiting for you to take him to the day room." as someone else said, a request for a bedpan might be immediate and i would stop to do that and make sure the patient had the callbell and go on my way. you can't worry about someone perceiving you as being lazy. you are responsible for managing the care of these patients. what your subordinate staff thinks of you is irrelevant. just make sure that you are fair. it's not fair for you to be doing their job. you have your own tasks that have to be done. the cnas understand this. if they don't, then write them up and report them to the don so she can start working on getting them otd (out the door). in most of the places i worked they put the better aides on the medicare unit so this didn't happen so much. however, if an aide stood before me and got insubordinate to my face and, in effect, outright refused to do a task i asked of them that was well within their job description, i'd turn real nasty real quick.

ONMELD · May 28, 2007

LTC has got to be one of the toughest places for a nurse to work. I am an EMT and we get a good deal of calls to this one facility in town. It is really a depressing place from what I see when I go there to take the elderly people to the hospital. I would rather work in an ER than to stare at what the future holds for most of us.

allantiques4me · May 28, 2007

I used to work in LTC,brain injury Vent units It was extremely tough.I guess we just have to prioritize the important things first.Time frame for the med pass.And you have to be very organized.Iwould do my whole med pass,then respiratoy care,then treatments,and when I had some down time I would even give bed bathsand complete linen changes,until the Aides started to take advantage and ask me who I was gonna bathe today!I would work through lunch and breaks I dont miss LTC.Rnotoday,Im sure you are not a lazy nurse,it looks like you have a beautiful degree,Is there another area or position you could take that is less stressful?I know i dont miss the stress and aggravation of LTC.I do miss being 98lbs. from the constant running.(lol)Good luck.

starbin, BSN, RN · May 29, 2007

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!!!!

It takes time for u to get organized and will be easier when u know your residents.

I work the day shift. After the shift change in the morning(reporting and Narc. count), the first thing I do is check my residents. Go room to room.....and make sure everybody and everything ( GT feeding, Trach, Oxyegen, call lights, wound vac, head of bed etc. ) is okay. Then I start my treatments (when the residents are still in bed it is easy to do treatments). We don't have med techs therefore I have to do medpass. I have 31 residents on my assignment. (sometimes it takes more than two hours if I am frequently interrupted by other issues like: the pharmacist calling regarding some meds, residents' family member calling, labs, MDs, dieticians, Physical therapists, CNA calling to notify something, residents requiring immediate attention etc.)

After morning med pass..i will quickly review my daily report and prioritise the things to do. If I have time, I will finish up the treatments then do the accuchecks and give insulin. By this time..lunch arrives. We nurses are required to pass the lunch trays and assist in feeding. After the residents eat lunch or sometimes in the middle of the lunch time..I give out the afternoon meds.

Then I make phone calls to the doctors(unless emergency and need to call right away, I do the callings only after lunch) to notify about the lab results or residents' condition...(when applicable). Make appointments for the residents, schedule transport, do all the clercial works......and documentations.

This is the summary...and hundreds of things come in between that keep you engaged. No time for lunch or break......One day I tried to leave the floor for lunch. I was paged 5 times in fifteen minutes. I gave up.

We work as a team with CNAs. They are very good and helpful in residents care. If I see a call light I answer it. If an aid needs help in lifting, I help her. No big deal. If u don't respect your CNAs and value their work, u will never be able to work in LTC. But of course, delegate something that does not require your skill, can wait and or someone else is avalable to do that job.