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CoffeeRTC, BSN 20,408 Views

Joined: Jan 22, '03; Posts: 3,743 (24% Liked) ; Likes: 1,817
RN LTC; from US

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  • Jun 15

    The 50:1 on 11-7 isn't the real problem. I've worked in LTC for the last 20 or so year in different roles and on different shifts. We generally run about 48 residents. I would say that 12-15 are skilled or higher acuity. We staff with 2-3 CNAs on 11-7. The CNA staffing will make it or break it for you! We generally have the 3rd CNA scheduled when we have a lot of active dementia residents with their day's and nights mixed up.

    As for the orientation...yes!!! you need more!! Demand it.

  • May 11

    I definitely recommend working some day shifts. You would see a lot more and understand what happens during the day and why some tasks need to carry over into nights. That said, I've only worked in facilies that do 8 hour shifts. I think starting at 7 will give you a little peek, but I still encourage and schedule a few shifts of orientation on days.

  • Apr 19

    I echo what everyone said above. POA only takes control when the resident is unable to answer for themselves. Do they have a living will that helps guide the POA for decisions?

    What about the hospice agency covering? Have you reached out to them? Are they providing support and education to the family?

  • Apr 15

    Honestly, 5 hours of paper work for one admit? That's extreme overkill? What assessments are included? Are you doing more than nursing assessments?

  • Apr 3

    Athletic directors can be anyone with a sports background and don't always mean they have any medical or athletic training. My husband is an AD and he is clueless on these matters.

  • Mar 22

    Yeah, I don't think most places would accommodate you on this one, especially since this is the overnight shift. We often have nurses pick up a different shift. If they come in 15 minutes early, they really can be "trained" on the night shift. The facility layout is the same, the residents are the same...there will just be a few different tasks that you may need to perform.

  • Feb 20

    Post in the LTC forum for more answers. This is a great question. We do a two step PPD on all readmits.

  • Feb 15

    NO, No, No!!

    Only thing I've seen in an emergency epi pen given this way.

  • Jan 25

    We haven't used side rails for at least 8 years. I honestly was surprised they are still used in LTC. A nearby facility just had a death due to entrapment.

  • Jan 10

    So, for those of us that are still using paper charting in LTC, maybe we should explain the process.

    The resident is admitted. Has orders on paper from the hospital. Orders are handwritten onto the paper admit order forms, then faxed to pharmacy. New orders are hand written by the doctor or more often than not, verbal orders are taken by the nurse and and then faxed to pharmacy. The faxed to pharmacy part is what scews up alot of things. Are they being faxed? I always wait for the confirmation that the fax went through. The next part is up to the pharmacy. The need to enter it into the profile.

    At the end of the month (at my facility it is the 24th) we get a print out of the next month's orders, MAR and TAR. These orders need to be checked with the orders in the chart and then clarified or adjusted as needed.

    Lots of potential for error but some ways to put in some checks and balances.

    Are the admit orders verified by a second nurse?
    Are the monthly orders checked by a second nurse?
    Is 11-7 doing daily redlining of all the charts to check the new orders?

    Our policy is to do all of the above AND we also go over all new orders in the moring clinical meeting to make sure that the orders were transcribed correctly from admit orders from the hospital.

    To answer the OP question....no.

  • Jan 10

    So, for those of us that are still using paper charting in LTC, maybe we should explain the process.

    The resident is admitted. Has orders on paper from the hospital. Orders are handwritten onto the paper admit order forms, then faxed to pharmacy. New orders are hand written by the doctor or more often than not, verbal orders are taken by the nurse and and then faxed to pharmacy. The faxed to pharmacy part is what scews up alot of things. Are they being faxed? I always wait for the confirmation that the fax went through. The next part is up to the pharmacy. The need to enter it into the profile.

    At the end of the month (at my facility it is the 24th) we get a print out of the next month's orders, MAR and TAR. These orders need to be checked with the orders in the chart and then clarified or adjusted as needed.

    Lots of potential for error but some ways to put in some checks and balances.

    Are the admit orders verified by a second nurse?
    Are the monthly orders checked by a second nurse?
    Is 11-7 doing daily redlining of all the charts to check the new orders?

    Our policy is to do all of the above AND we also go over all new orders in the moring clinical meeting to make sure that the orders were transcribed correctly from admit orders from the hospital.

    To answer the OP question....no.

  • Jan 9

    So, for those of us that are still using paper charting in LTC, maybe we should explain the process.

    The resident is admitted. Has orders on paper from the hospital. Orders are handwritten onto the paper admit order forms, then faxed to pharmacy. New orders are hand written by the doctor or more often than not, verbal orders are taken by the nurse and and then faxed to pharmacy. The faxed to pharmacy part is what scews up alot of things. Are they being faxed? I always wait for the confirmation that the fax went through. The next part is up to the pharmacy. The need to enter it into the profile.

    At the end of the month (at my facility it is the 24th) we get a print out of the next month's orders, MAR and TAR. These orders need to be checked with the orders in the chart and then clarified or adjusted as needed.

    Lots of potential for error but some ways to put in some checks and balances.

    Are the admit orders verified by a second nurse?
    Are the monthly orders checked by a second nurse?
    Is 11-7 doing daily redlining of all the charts to check the new orders?

    Our policy is to do all of the above AND we also go over all new orders in the moring clinical meeting to make sure that the orders were transcribed correctly from admit orders from the hospital.

    To answer the OP question....no.

  • Jan 9

    So, for those of us that are still using paper charting in LTC, maybe we should explain the process.

    The resident is admitted. Has orders on paper from the hospital. Orders are handwritten onto the paper admit order forms, then faxed to pharmacy. New orders are hand written by the doctor or more often than not, verbal orders are taken by the nurse and and then faxed to pharmacy. The faxed to pharmacy part is what scews up alot of things. Are they being faxed? I always wait for the confirmation that the fax went through. The next part is up to the pharmacy. The need to enter it into the profile.

    At the end of the month (at my facility it is the 24th) we get a print out of the next month's orders, MAR and TAR. These orders need to be checked with the orders in the chart and then clarified or adjusted as needed.

    Lots of potential for error but some ways to put in some checks and balances.

    Are the admit orders verified by a second nurse?
    Are the monthly orders checked by a second nurse?
    Is 11-7 doing daily redlining of all the charts to check the new orders?

    Our policy is to do all of the above AND we also go over all new orders in the moring clinical meeting to make sure that the orders were transcribed correctly from admit orders from the hospital.

    To answer the OP question....no.

  • Jan 9

    So, for those of us that are still using paper charting in LTC, maybe we should explain the process.

    The resident is admitted. Has orders on paper from the hospital. Orders are handwritten onto the paper admit order forms, then faxed to pharmacy. New orders are hand written by the doctor or more often than not, verbal orders are taken by the nurse and and then faxed to pharmacy. The faxed to pharmacy part is what scews up alot of things. Are they being faxed? I always wait for the confirmation that the fax went through. The next part is up to the pharmacy. The need to enter it into the profile.

    At the end of the month (at my facility it is the 24th) we get a print out of the next month's orders, MAR and TAR. These orders need to be checked with the orders in the chart and then clarified or adjusted as needed.

    Lots of potential for error but some ways to put in some checks and balances.

    Are the admit orders verified by a second nurse?
    Are the monthly orders checked by a second nurse?
    Is 11-7 doing daily redlining of all the charts to check the new orders?

    Our policy is to do all of the above AND we also go over all new orders in the moring clinical meeting to make sure that the orders were transcribed correctly from admit orders from the hospital.

    To answer the OP question....no.

  • Jan 9

    I took it as an elective in my last semester of BSN school. I loved it!!! It was a bit easier and kinda fun and a great way to learn different assessment skills and critical thinking. I took the tests and passed and got my NR-EMTB. Sad thing was that I never practiced as an EMT. To this day, 20+ years later, I still have some of the nemonics for assessments in the back of my head. That and I was awesome at CPR with all the practice we did in practicals and clinicals for that class.

    Do it!!


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