Latest Comments by kwvath

kwvath 1,844 Views

Joined: Mar 9, '09; Posts: 15 (27% Liked) ; Likes: 4

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    Thanks. For those that take to the soiled utility room...really? Carry a nasty bed pan through the hall? How does that work?

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    According to recent CMS updates, I read that facilities who are washing bed pans in resident sinks will receive an automatic F441 citation.

    When I came to LTC from the hospital several years ago, I remembered that I was amazed that facilities were washing bed pans in sinks but quickly found that nearly all facilities do so because many of them are equipped with residential-style toilets rather than hospital-grade with the built-in bed-pan-washers.

    I quickly priced these types of toilets and they are well over $500/piece which I anticipate will be a hard-sell for our administrator.

    How are your facilities balancing the "culture change" aspect of moving towards a more residential feel with practicality and specifically dealing with this regulation?

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    I am a former ICU nurse working as an ADON/Unit Manager at a SNF. When I worked at the hospital we had a clinical ladder program (RN I, RN II, etc.) that encouraged personal growth, employee retention, and increased job satisfaction.

    In all my searching, I have only found Clinical Ladder examples for acute care/hospital settings. However, I can only imagine what a huge impact this type of program could have on skilled nursing facilities.

    Does anyone have any good examples of a Clinical Ladder model for long-term-care settings? Ideas? Comments? Suggestions?

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    Our facility works 12-hr shifts. Each employee works 72hrs/pay period and gets paid for 80. If the employee calls off, they loose their 8 hrs of bonus pay for that pay period.

    Amazingly, the staff still call-off but the call-off rate is much lower than I have had at other facilities. I thought it was a good idea.

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    It is my understanding that insomnia is not a behavior per se. However, according to a state surveyor who was recently in our meeting, she informed us that we must be documenting non-pharmacologic interventions (darkening room, adjusting get-up times, ear plugs, etc.) prior to administering a PRN hypnotic (like Ambien). Our facility chose to document these interventions on our Behavior Tracking form. We almost got cited for not documenting these interventions but were able to show other documentation that convinced the surveyor that we were in fact attempting other interventions prior to the PRN Ambien.

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    RUN. I work in a very poor facility but it is not even close to being as bad as the one you were in. Glad you got out.

    I am an ADON in a LTC facility and am getting ready to start the AIT program. It varies from state-to-state but if you have a bachelor's degree it is a 9mo program/preceptorship and 9mo program for a master's. I wanted to go into the AIT track because I saw the flaws and wanted to make the facility better. I didn't feel like I could ever make the changes I would want to make, even if I advanced to DON. Our admin has no nursing degree and is fabulous. She has made a ton of good changes. Keep your chin up.

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    NannetteMorgan likes this.

    I agree with OneKidneyNurse - I have always heard that you put the college degrees first, followed by the professional license - the thought is disciplinary action may take away an RN license but they will not take away your college degree.

    Also, I agree with several of the other posts: RN is all that is necessary when charting. I would leave off the college degrees with common charting or signatures. As far as "showing off" when using it with other professional writing or business cards...I wouldn't worry about it. We worked hard for that degree and it does give others an idea of what types of training we have. I have my BSN but I don't look at those who sign the MSN as if they are trying to show-off or put me down. They just have more formal education-not necessarily more experience. They worked hard for their degrees - why not write it behind their names?

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    I am an ADON at a skilled nursing facility and am specifically managing the Transitional Care Unit at our facility. Our nurses are constantly saying that they are understaffed and our corporate admins are always saying, "no, you're over-staffed." I have searched the literature and have found very little in regards to guidelines on best practice. I would like to know how you all staff your TCUs and include some of the following information so we can all help each other and do a little informal research:

    1. Nurse:Patient ratio for 1st shift (day shift if 12hr shifts)
    2. Nurse:Patient ratio for 2nd shift
    3. Nurse:Patient ratio for 3rd shift (night shift if 12hr shifts)

    4. Nursing Assistant:Patient ratio for 1st shift
    5. Nursing Assistant:Patient ratio for 2nd shift
    6. Nursing Assistant:Patient ratio for 3rd shift

    7. Number of TCU beds
    8. Typical case load picture (Number of GTs, IVs, TPN, trachs, average age of patients, dementia, etc. for unit)
    9. Staff makeup (number of RNs, LPNs, etc.)
    10. Layout of unit (square-shaped, star-shaped, hallway, etc.)
    11. Do you have similar complaints and problems? How have you solved them?
    12. In which state are you working?

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    CathiP likes this.

    New ADON with 3 years ICU experience and no LTC - started at $62,000/year.

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    Thanks for the input! Unfortunately, we are already doing that. It works well but the things that are falling through the cracks are the things that aren't being addressed or aren't being brought to the doctor's attention (i.e. progressive mental status change leading to decreased oral intake and before you know it they are hypotensive and then that is brought to the doctor and she starts an IV).

    What we are trying to do is find a way we can pick up on the subtle changes or smaller issues so that we can address them before they become big issues.

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    I am a new ADON in an LTC center and am the unit manager for the Skilled/Rehab unit. In the month I have been there, I have found that serious care issues are falling through the cracks and changes in condition are being missed.

    In an effort to stay on top of these changes and improve the quality of care, I have been working with my assistant nurse coordinator in developing a plan to implement DAILY NURSING ROUNDS. He and I plan to review 8-10 patients each day from 0900-1000 on Monday-Friday. This way each patient would be reviewed once by the end of the week (full house is 42 patients).

    We plan to review nurse notes, weights, nursing assistant documentation, compare the MARs with the orders, the treatment records, changes in continence, mental status, labs, pain, and general appearance of the patient's room. Unfortunately, this allows only 6-7 minutes per patient if we are hoping to round in one hour or less. Daily rounds on each patient would be ideal but that's just not realistic.

    Does anyone have any suggestions on either improving this system or implementing another system that would address the same problem but possibly in a different way? Thanks for your assistance!

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    Anne36 likes this.

    I am an RN and just started a job at an LTC center this past week as an ADON. My former job was in critical care.

    QUICK QUESTION: I was extremely surprised to find that not a single patient had any type of ID bracelet or name badge. I was hanging an IV for an LPN and was looking for a bracelet. I did not know the patient, the patient was confused, and I had no way to identify the patient other than the name on the door. My immediate thought is that this is extremely dangerous. Or, am I out of line and this is a common thing in LTC?

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    I was just hired for an ADON position (I am an RN/BSN) at a 100-bed LTC facility. It has been a failing facility on the verge of being shut down for the past several years. They have just had a complete turn-over in administration and the current team is re-hiring their team members and trying to turn the place around. I will be the unit manager over the acute care wing. The reason I took the job is that I love a challenge and this seems to be a big one. But, the administration is fairly young, energetic, and seems to have a hard-working and positive attitude. I am REALLY looking forward to this challenge. I am coming from an ICU background. I am fairly young and new to LTC...but I do have lots of energy and am excited about this position.

    I wanted to ask for some practical and specific advice on how to quickly get some momentum going and energize my unit. How can we get the staff to feel that "the train" to a high-quality, patient-centered, LTC center of excellence is "leaving the station?" All aboard! I am wanting to really create a since of positive energy on my unit. How can I do this from the first day I arrive on the unit?

    Thanks in advance!

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    I commuted 46 miles for 2 years to my ICU job and it was a great chance for me to energize, gather my thoughts, and get ready for the day/night. On the way home, it gave me a chance to defuse and leave work at work before I got home to my wife. Had a similar situation as yours and I think I did have a better experience there. Only problem was gas prices. That can be a significant budget chunk. Also, I am a buckeye myself and know that OSU is an excellent hospital and you will probably get a much better "first-experience" there rather than at a podunk facility. Nothing against podunk facilities but may not be the best spot to get your wings. Best wishes and go buckeyes!

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    PeacefulHeart likes this.

    No worries Peacefulheart. I know that the media says that the recession hasn't hit health care but it has. I am an ICU nurse and was wanting to switch jobs and it took me forever to get a new one. I finally got one but it took calling places one-by-one. There seems to be a general slowing of everything...even hiring in health care. Be patient, spruce up your resume, and be proactive in calling these places. Everyone is just scared right now and all are slowing their actions...