CoffeeRTC, BSN 20,458 Views
Joined: Jan 22, '03;
Posts: 3,743 (24% Liked)
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RN LTC; from
Yep...exactly as Capecod stated. I've had a few AMAs over the last year or so. They get nothing to leave with. I also inform them that any care, meds, treatments etc that they got won't be paid for while they were in the LTC.
Quite a few people came in thinking it woudl be different than what it was...doctors there 24/7, cafeteria food, wifi (we now have it) or the rooms were too hot/ cold/ small etc.
I'll go farther...no staffing regulations that can lead to inadequate staffing. I don't know of a law or mandate for LTC for any real staffing ratios. I would love to see it be acuity based.
retention is another issue in LTC
poor heathcare benefits for the workers
no real career ladder like in the acute setting.
making do with less. Less medicare and insurance coverage trickles down to the residents. We no longer carry pull up depends...cost too much to have both types.
hahah...if it was my place, they would have tried to have you start that day! I would call today, Friday and just ask.
Yeah, we all have had a difficult resident or two that just seems to make things hard or heck..is annoying BUT..I would approach her first like what Nascar mentiond. That way she feels like you do care and are giving her the attention that she wants/ needs.
I agree somewhat with Capecod BUT..if it is the same nurses that are calling off and making the problems...that needs to be dealt with according to the P and P and progressivly. Why does the rest of the staff have to deal with the problems of just 1 or 2? Now...if it is a staff wide problem..yes..on call rotation with pay of course.
Wowsa...7 pages on this already? Getting back to the OP...
It comes down to nursing judgment. My 2 cents comes from a LTC/ heavy rehab experience. Some days when I'm on the cart it seems like all I do is prns. If you are in this setting, sometimes you can get a good bit of your res on the same-ish prn schedule so that you are not running in circles. Sounds like you were doing your assessments at the start of the shift? Those assessments usually include asking about pain. Great. If you can medicate at the start of the shift then middle then towards the end..it makes it easier. There are the ones that will ask for the PRNs..when someone asks for a PRN for pain I try to get it to them within 10 or 15 minutes if not quicker. Using nursing judgment in your above situation..could you have gotten your assessment and meds done on pt A done within that time frame then peeked your head into pt B and let them know you will be along asap?
Most will be satified with just being told I will be back in xyz minutes asap. Laying around in pain and not knowing the request was recognized is when you get and upset family etc.
Getting back to the OP's questions...If I worked for the same family for a few years I would probably be a bit upset at first and wonder why they want to start video taping now? Has there been any problems or issues before? I'm assuming this is what has upset you? If you have been like family since then it is kinda a bit of a slap in the face. Something must have changed?
As Wooh said, if we were doing any harm by giving Dilantin with other meds, it would be reflected in the blood work. Are you honestly telling me you have a separate med time for Dilantin?? Even the pills??! That just seems like a dangerous waste of time to me.
Reminds me of the facilities that wake up all the poor 80 year olds to give them a synthroid at 6am....
Ok, a resident in our LTC facility is diagnosed with VRE in the hospital. She has a colostomy. I take the order from the doctor, Bacitracin 10 days... reculture rectal swab x3...ect. I hang up from the doctor. Then it dawns on me.... rectal swab? she has a colostomy? I am a new nurse so wasn't sure about this... I ask my fellow vetran nurses and get all kinds of answers.... "hmmm, I'm not sure", "yes, you do a rectal swab, the bacteria is still carried in the rectum" "No, you swab the stoma, you have to test stool" What is the correct proceedure? I would have called the lab and asked but it was after hours. she does not have to be restested till after completion of anbx, but I want to know the correct answer!
Yes, in the acute care..you need something. Most often..pain meds work better than the psych ones (unless you are using enough of it)
bwhahahahah. Some shifts I might have 5-8 residents with qid neb tx (and some prn). you do the math and add on the 20 other residents. I do have to say that I am OCD about checking breath sounds before and after (not always with the chronic copders that are stable) and I like to have them all going at the same time, LOL.yeah it is noisy.
We were told that in order to get credit for the nebs that the nurse needs to be in the room too. As far as the self med rational...easy way around it. Get an order for "res may administer neb tx", get an pt ed form, go over it with the resident and then care plan it all. Bingo! We also have a page in the MAR for the breath sounds before and after, rr and time it takes for the tx.
I dunno, I tend to listen to the families. If they say mom needs xyz, I would go in and assess the resident. I will then use nursing judgment and educate family as needed. A lot of times they might not have complained to the nurse or the family might just want mom to be very comofortable and didn't know that we might have already done xyx for the resident.
I think the OP might be talking about the situations where daughter doesn't want to leave until mom is sleeping or relaxed. If they have dementia, you might need to creat a diversion so that the daughter can leave. Maybe the daughter feels powerless? I've shoo'd many a family member home and reminded them to call when they get home and check up on mom or dad. Talk to them, show them you really do care and are on their side.
I dunno. I've been in LTC for the last 17+ years. I like what I'm seeing now with the change. Granted, most of my residents/ patients are more rehab than LTC, but I'm still dealing with dementia.
I haven't been bit or pinched in quite a few years, the falls and injuries from the restraints have gone down since we got rid of the side rails, posey vest restraints, wheel chair restraints etc. Those vest restraints and hand restraints were horrible...can't tell you how many times I found someone all tied up and a mess.
When was the last time I saw an Alz pt all curled up in the fetal postion with without hand, knee contractures and bed sores??? years!
How about the patient that is soooo snowed they are drooling, need fed, changed etc?
Dose reductions are what kills me now. We finally get a med regime that works and some consultant wants to dose reduce. We aren't even using that much med to begin with. .25 of Ativan is a spit.
Now..it is different in acute setting, I do understand that. If the hospitals would devote some extra money to get extra staff or sitters or the low beds and use some of the techniques that we use in LTC, the agitation, agressiveness, feelings of being out of control etc could be reduced. I know it is easy to give the pill to snow them then do the hand restraints etc so they aren't pulling out the ivs, tubes etc, but in the long run..its just setting them back. Instead..look at why they really need the treatments...its it really necessary?
Sorry...I had to chuckle or LOL on this response. If I had to call the doc with every late med (In LTC) I should just sit at the desk and forget about passing the meds in the first place.
The med was a once a day med..two hours wasn't going to hurt. What was the risk of not giving the med? Patients have appts and are always on and off of the floor. Try calling the doc every time a med is late because of this one.
This is why I think the LPN is stuck in LPN/LTC land. In LTC, she would have to call doc and get an order to give it late, so that if the state audited that chart, they wouldn't get a "ding".
Then...why don't the nurses fill out the reason for the meds? I'm a nurse in LTC and love the idea. I'm not sure what the fuss is about ..if the nurses don't want to fill it out, why can't they ask the docs or NPs for the dx for the meds?
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