snoogans 871 Views
Joined: Aug 22, '03;
Posts: 19 (0% Liked)
Some of my LTC bipolar are very manipulating. Until you figure out for yourself what this person is all about... listen to the other staff and take all into consideration and make your own nursing judgement.
One of my ladies was forever accusing one nurse of being horrible to her. Turns out after talking with other staff she wasn't given her 10th cup of water in 5 min.
Some ltc psyche esp bipolar (some don't even have a clue what they ate for B.F.) will tell a different story 10 times over of the same situation.
Bipolar is very misunderstood and compounded with a CVA. Poor guy. good luck
Is the teeth grinding a s/e of psycotrophic meds?
Idealy for my unit, census is 24, 4 aides and nurse for both days and eves, with extra eve person helping out elswhere. Today I had four and was able to get so much extra work done I haven't had time for I even got a break. Residents were well cared for. the ambulatory alzhiemers units one has 20 residents, two aids and nurse, other unit has 14 residents 2 aids and nurse.
We try to have 1:7 or 8 even if the schedule is great, we can always count on someone to call in sick. or want to go home.
the vast majority of nurses at my LTC facility are all for DNR so we are reviewing them on a fairly regular basis, esp quartly with care planning. The floor nurses that actully know the resident do the carplans so we know what is going on. some of my folks are wards of the state and even my 89 mr man with a feeding tube and in chronic pain who aspirates real bad at least three times a year goes up to the hospital for treatment and what do you mean he is a full code the er nurses will ask when I tell them in my report of the code status.
I know this is my major ethical issue I deal with being a nurse.
I give a very simple yet effective speech when families are himming and hawing about iv fluilds/feeding tube/dnr
Even though your loved on goes to the hospital thier condition is very poor. The hospital might not even be able to start an iv. Research shows iv fluids do not extend the life of a dying person. Their body is not drinking, eating for a reason. It is thier time. They may get hydrated and perk up for a few days but just go back to not eating or drinking. They are not swallowing to take an anitbiotic prescribed (usually for aspiration or sepsis)I say a few other things and always get a thank you for being honest.
I firmly beleive there is too much medical intervention on somethings. A 90y.o end stage alzhiemers patient doesn't need to have some other food/formula suppliment crammed down their throat becuase they have lost five pounds. They just need nature to takes its course.
We've done basic cpr about 5 times this year at our place. Most end with the medics calling the er doc after three rounds of acls meds to ask if they can stop cpr.
Love second, I am a eve person. I work days because I have two young kids in school. i would never see them. Drag myself and kids out of bed every mornig at the very last min, go to work with very wet hair that I comb after dropping the kids of at daycare.
I do agree too many people around.
One advantage of working on a Alzheimers/ geri psyche unit with lots of screamer is that admin only comes around once in a blue moon. I saw our administrator 2 months ago rearranging furniture. To make it look nice.
No disrespect towards her I promplty stated that the furniture is in place for a reason and for her to be moving it made no sence, since this is the first time she'd been up here in months and really doesn't understand the daily needs of the residents.
The issue didn't matter really as a couple of residents and staff are constantly moving the furniture around anyway.
Break???? what is that anyway. any time I try to take one, I am called back on the unit, for something that could have waited 15 min more.
I had a family member yell at me because I was in the bathroom and wasn't readily availble to them to answer thier most unimportant question. but I spoke right back to them that I had every right to use the bathroom.
Or if something happens to one of the residents it's always "where was the nurse"
well I was off the unit getting a soda from the vending machine, oh the scandle
Now I just go into the back room and shut the door, mostly to block out the noise from my "screamers" and sure enough before I can even get comfortalbe in the chair
knock knock knock ARGH very frustrating
The list goes on and on.....
Whoops, forgot to mention, in our back up emergency drug kit, anitbiotics and diflucan were always missing.
If someone is an addict and stealing/diverting narcotics to feed their habit they are not thinking of the concequesces (sorry kaint spele gud) of their actions, only getting their fix.
I worked with a nurse who had conditions on his licence from past dirversions. He had to have another nurse give narc's but somehow he mananged to get into the narc fridge and replace topical morphine with a thick lotion. we discovered it during a count when their seemed to be a lot of air in the syringes, not to mention the tips were kind of messy.
Other nurses say/document that a med was given which wasn't. and pocket it for themselves. A float nurse was finaly caught (did rec treatment for drug addiction) after a patteren was noticed that she was the only nurse that always gave prn pain meds twice on her shift even if the pt's hadn't complained for pain for weeks. Or gave perc's for mild pain.
what thirdshiftguy said.
You are so right Rapheal
In our LTC facility pills are disolved and flushed, injectables are squirted into a cup of water, and flushed, patches are cut up and put in sharps container, liquids are poured into a cup of water and flushed. All witnessed by the DON or her designee, which is the supervisor, mds coordinator, nurse manager, or the staff develpment nurse. This is the policy for when we have to waste a lot. Our residents usually have a 30 day supply at a time and if they die, are discharged, or have a change in med.
Another nurse is fine if the med is dropped. Because having something hang around from Friday night until Monday morning just isn't cool.
All I know is somedays the fishes are real happy.
Has she always been like this? If not something could be wrong outside of work.
The nurse that works on my unit on my days off takes all day to do am meds, she isn't capable of doing much else. She may seem to be a slacker. but for her to make phone calls unless it's an emergency takes an hour, and the help of the supervisor. I've worked along side (our skilled unit has two nurses) a slacker nurse. Managment and everyone else used to come to me because they know I'd get it done. Even if it wasn't one of my patients. Finally started speaking up. Things changed for a while then I was accused of not being a team player?!?!?!?
We tried this in our facility. Never worked. No one knew who was boss. The lead aids suddenly began deligating what was not theirs to deligate
Nursing home I onced worked at the call lights were always crazy. One would ring others would go off. One of the patients was in the hopital. One day all the lights lit up. Couldn't tell who was ringing. When we finally found the light, it was in the patients rooms who was in the hopital. Found out later she died at the exact time the call lights went off.
The nursing home I work at now used to be a hopital. I worked the old maternity ward, on evenings. I could swear I could hear babies crying. And so could some of the residents.
In long term care the doc visits are few and far between, often they only ask how the pt is doing and only take a quick look at them from the doorway. The vast majority of problems are taken care of over the phone, more often then updating the md office nurse and they talk to the doc. One doc will call us back and listen to what we suggest and his fav line is "Make it so" when some one is dying and I call for orders. the doc need reminders about tapering psycotropic meds and other meds. Some will actully yell over the phone with any type of suggestion. From experience I know who they are.
I will certainly question a doctor if I think he is wrong. After five years I've learned to do it tactfully. "Are you sure", "wouldn't you like to taper that medication"
It's my license, my career and my future.
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