I have worked LTC in the past years but mostly days and eve.. Just started a very prn nite position after many years in a local facility and would like opinions please.
I have a couple residents who get Tylenol round the clock q6hrs or q 8hrs. I would not necessarily want to be awakened for that medication if I was in their position. These are AAO pts. I am unfamilar with rules when it comes to this. I appears the diagnosis justifying this medication is usually arthritis. What if I don't wake them up and circle it and indicate 'pt sleeping' would this be correct? Would the state have an issue with that?
I also have one resident on Benadryl q8hrs and is always sleeping when I come on shift. She has been on it forever...really needs to probably be reviewed for continuation (in my opinion) but again if she is sleeping could I circle it and say 'pt sleeping'? I am not sure of the rules governing this.
We also have a security system whereby certain residents have arm bands that set off an alarm if they go out a door. Nites is assigned to do a battery check on this band! Why do we need to wake pts up to check a battery? I know it needs to be checked but it is only checked once in 24 hrs and it is assigned to nites....but there is 1 nurse on nites for 60 pts and if I am lucky I have 3 aides and usually only have 2 1/2 (one CNA goes between 2 floors) and I have to do vital signs on anywhere from 6-10 pts usually for various reasons....the CNA's can't do them in this facility
I have to start my med rounds at 430am because I have to give meds to 40-45 pts and most are crushed in pudding so that takes extra time. Most of my meds are Synthroid and Prilosec! with some cardiac meds thrown in but not many. If it is a med that is given once a day it is assigned to nites. I am not opposed to doing things on nites believe me! ... however was just wondering why if there are more nurses on days (2-3) why is nites asked to give so many meds that should not require waking up a pt between 4:30-6am to give them.
Is this a common scenario in the facilities any of you work at? I think that most people think nites needs something to do ...I have so much charting and routine checks (accu chek, narc box, filing etc.) that is assigned to nites I certainly don't sit all nite except to do my charting in the morning. Let alone I barely have time to get to know the pts. Just say good morning and push pills is about the most contact I have with them!
I'd feel so much better if I had to wake a resident for a tylenol, but get this, I have three different residents right now, and I kid you not, that our doc has ordered artificial saliva 1 teaspoon, another resident has an order for saline nasal spray and yet another has an order for artificial tears all at 0100. We have asked her to change the order to more appropriate times, HELLOOOO, like when he's awake because we just don't wake them for this kind of bull.... She's the kind of doc that if you suggest something to her, she just won't order it that way because she's on a power trip and she didn't think of it herself. I swear, she's the devil.
I'd feel so much better if I had to wake a resident for a tylenol, but get this, I have three different residents right now, and I kid you not, that our doc has ordered artificial saliva 1 teaspoon, another resident has an order for saline nasal spray and yet another has an order for artificial tears all at 0100. We have asked her to change the order to more appropriate times, HELLOOOO, like when he's awake because we just don't wake them for this kind of bull.... She's the kind of doc that if you suggest something to her, she just won't order it that way because she's on a power trip and she didn't think of it herself. I swear, she's the devil.
I work nites and have to give pain meds to residents while they are sleeping, but the way I see it, if I didn't give it to them just because they were sleeping then when they woke up, they might wake up in pain. Giving the med while they are sleeping gives it a chance to work when they are getting up in the morning and have to do PT/OT etc. Its ordered for a reason, so it should be given. But most of the QD meds are given at 8am when they are awake. I give a few pain meds and narcs and mostly reglan or prilosec before meals.
I work nites and have to give pain meds to residents while they are sleeping, but the way I see it, if I didn't give it to them just because they were sleeping then when they woke up, they might wake up in pain. Giving the med while they are sleeping gives it a chance to work when they are getting up in the morning and have to do PT/OT etc. Its ordered for a reason, so it should be given. But most of the QD meds are given at 8am when they are awake. I give a few pain meds and narcs and mostly reglan or prilosec before meals.
I work nights(11p-7a) and have the same concerns. I have 3 residents on the unit that I normally work on that are assigned tylenol(Q6h ATC)and are scheduled at 2am. Ridiculous. I suppose that getting the order changed to "while awake" would solve this. But, maybe not because these pts are A&O and there have been times, when I, along with other nurses chose to circle it and write on the back "pt sleeping". Guess what happened next? 2 of those residents complained the next day stating, "I didn't get my tylenol lastnight".....What gets me with esp. these three pts, is that they all get Ambien HS and all request it at 10pm...And they want to be awakened between 1-2am for tylenol???
Our facility also started changes the times on Synthroids/Prevacid to 6am. Forget that too, because almost all are on Prevacid and may on Syntroid, and most have trouble taking their meds when awake, never mind trying to get them to take it after being awoken from a sound sleep. This was recommended per pharm also. They nixed that pretty quick because many pts either spit them out or started choking, not swallowing etc.....Breakfast comes usually between 8:15-9-15, so days has time to give them starting at 7am.
Another stupid order for nights is that our aides must do foot audits every Tues 11am-7am. Are we not supposed to be checking the residents everyday during personal care??? Or why not doing these weekly foot audits on their shower days? They think that nights has it easy, so they keep piling new things for both the nurses and aides. I don't know about other facilities but the amount of paperwork that has been designated for nights to do is crazy. Lastweek alone, 2 days I left late. One day at 8:30 and the other at 9:45am....and they are complaining about OT!!! I say too bad. We have 5 units of 30-32 pts each wing. At nights, one nurse works the middle(which is 2 units and 60-64pts)....So, that is double the work. The other units are supposed to come and help with the paperwork, like helping on consults/labs for one side but it still ends up being alot of work. Between the paperwork, g-tubes/meds/charting etc..., it's still too much for one nurse.
My point? Night shift gets dumped on, everything that the other shifts don't get to, don't worry, nights can finish it............I know this first hand because I work 2 doubles a week going in at 3pm and working until 7am(16hrs)or later in am. I have seen some nurses/aides say, "leave it, nights can do it"...................Bull!!!! And what happens when a problem arises? Somebody falls, goes in distress, add that to your work. I had 3 pts up the other night, because they kept trying to climb out of bed. So, they were at nsg station in their wheelchairs with hopefully a lapbuddy or sr belt. Ya know because they are trying to cut down on restraint use. Let people like them fall out of wc or bed, the state tells us, "It's the patients right to fall"...Yeah right....
Well that about sums it up for my facility, how about yours?
JUDE
I have worked LTC in the past years but mostly days and eve.. Just started a very prn nite position after many years in a local facility and would like opinions please.
I have a couple residents who get Tylenol round the clock q6hrs or q 8hrs. I would not necessarily want to be awakened for that medication if I was in their position. These are AAO pts. I am unfamilar with rules when it comes to this. I appears the diagnosis justifying this medication is usually arthritis. What if I don't wake them up and circle it and indicate 'pt sleeping' would this be correct? Would the state have an issue with that?
I also have one resident on Benadryl q8hrs and is always sleeping when I come on shift. She has been on it forever...really needs to probably be reviewed for continuation (in my opinion) but again if she is sleeping could I circle it and say 'pt sleeping'? I am not sure of the rules governing this.
We also have a security system whereby certain residents have arm bands that set off an alarm if they go out a door. Nites is assigned to do a battery check on this band! Why do we need to wake pts up to check a battery? I know it needs to be checked but it is only checked once in 24 hrs and it is assigned to nites....but there is 1 nurse on nites for 60 pts and if I am lucky I have 3 aides and usually only have 2 1/2 (one CNA goes between 2 floors) and I have to do vital signs on anywhere from 6-10 pts usually for various reasons....the CNA's can't do them in this facility
I have to start my med rounds at 430am because I have to give meds to 40-45 pts and most are crushed in pudding so that takes extra time. Most of my meds are Synthroid and Prilosec! with some cardiac meds thrown in but not many. If it is a med that is given once a day it is assigned to nites. I am not opposed to doing things on nites believe me! ... however was just wondering why if there are more nurses on days (2-3) why is nites asked to give so many meds that should not require waking up a pt between 4:30-6am to give them.
Is this a common scenario in the facilities any of you work at? I think that most people think nites needs something to do ...I have so much charting and routine checks (accu chek, narc box, filing etc.) that is assigned to nites I certainly don't sit all nite except to do my charting in the morning. Let alone I barely have time to get to know the pts. Just say good morning and push pills is about the most contact I have with them!
like when he's awake because we just don't wake them for this kind of bull.... She's the kind of doc that if you suggest something to her, she just won't order it that way because she's on a power trip and she didn't think of it herself. I swear, she's the devil. 
night owl
1,134 Posts
I'd feel so much better if I had to wake a resident for a tylenol, but get this, I have three different residents right now, and I kid you not, that our doc has ordered artificial saliva 1 teaspoon, another resident has an order for saline nasal spray and yet another has an order for artificial tears all at 0100. We have asked her to change the order to more appropriate times, HELLOOOO,
like when he's awake because we just don't wake them for this kind of bull.... She's the kind of doc that if you suggest something to her, she just won't order it that way because she's on a power trip and she didn't think of it herself. I swear, she's the devil. 