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SitcomNurse 6,554 Views

Joined: May 27, '05; Posts: 280 (32% Liked) ; Likes: 247
Inservice Education Coordinator; from US
Specialty: 22 year(s) of experience in Geriatrics and Quality Improvement,

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  • Oct 21 '14

    I'm sure there are nursing homes and LTC facilities that provide new hire orientations with meticulous structure and superb organization. However, in my personal experience the lack of organization is par for the course.

    I've worked in several nursing homes. The new hire orientations are generally short (a couple of days) and consist of following another nurse around as he/she pushes the medication cart. During this period I'm trying to learn as much as I can about the important paperwork, the locations of crucial things, and the overall routine of the floor.

  • Oct 17 '14

    I can say as someone that has taught for over 6 years in the clinical setting to pick up a book called "Fast Facts for the Clinical Nursing Instructor: Clinical Teaching in a Nutshell". It is very helpful and consistency with students is key. I would also get to know the Faculty that you are working with and have them help you integrate into your system at your school, since academia is very different than the hospital setting. Good luck and have fun!

  • Aug 30 '12

    A "three strikes" policy re: med errors is absurd. All it will result in is nurses who lie and are good at covering their tracks.

  • Jun 21 '12

    Long-term care nursing is a specialty that involves helping patients who need extended care as they deal with chronic illnesses and disabilities. Long-term care nurses coordinate the care of patients, perform nursing skills, respond to changes in condition, and provide physical and psychosocial support to patients and their families. In most long-term care settings, patients are referred to as residents because the healthcare facility is also the place where they live.

    In most long-term care facilities, the nurse collaborates with physicians, social workers, dieticians, speech language pathologists, physical therapists, occupational therapists, case managers, pharmacists, respiratory therapists, and other members of the interdisciplinary team. The interdisciplinary team is necessary in long-term care due to the elaborate complexity and extent of patient issues that now manifest in this setting.

    Long-term care nurses care for patients across the life span with numerous afflictions and diagnoses, although the majority of the patients are elderly. Patients with chronic disease processes such as hypertension, coronary artery disease, hypothyroidism, diabetes mellitus, chronic kidney disease, osteoarthritis, and chronic obstructive pulmonary disease receive care from long-term care nurses. Patients who have been afflicted with progressive illnesses such as Alzheimer's disease, multiple sclerosis, Parkinson's disease, and AIDS wasting complex are also cared for by long-term care nursing staff.

    Depending on the type of facility, long-term care nurses may perform skills such as vital sign checks, intravenous therapy, enteral tube feedings, wound care, range-of-motion exercises, indwelling urinary catheter care, respiratory therapy, cardiopulmonary rescuscitation (CPR), ostomy care, tracheostomy care, management of stable ventilators, and medication administration. Long-term care nursing staff members also assist patients with activities of daily living such as feeding, dressing, toileting and bathing. Moreover, long-term care nurses provide education, help apply adaptive equipment, and document all care that has been provided.

    A person who wishes to become a long-term care nurse must have completed a nursing program and have attained licensure. Licensed practical nurses (LPN) and registered nurses (RN) may obtain employment as long-term care nurses. Long-term care nurses are employed at nursing homes, assisted living facilities, long term acute care (LTAC) hospitals, adult day care centers, skilled nursing facilities, and retirement communities. They function as bedside nurses, unit managers, staffing coordinators, case managers, directors of nursing services, house supervisors, wellness directors, infection control nurses, wound care nurses, minimum data set (MDS) coordinators, and nurse educators.

    Certification in long-term care nursing is optional, but highly desired. Both registered nurses (RNs) and licensed practical nurses are eligible to attain professional certification. The National Association for Practical Nursing and Education Service (NAPNES) offers certifications for LPNs, while the American Association for Long Term Care Nursing (AALTCN) offers opportunities for RNs to become certified.

    Long-term care nursing is a rewarding specialty that requires an extraordinary level of patience, knowledge of nursing interventions, analytical thinking, and compassion for helping people deal with chronic issues. The the long-term care nurse is a professional who experiences multiple joys and challenges during the course of a routine shift. Therefore, long-term care nursing is a specialty in its own right.

  • May 25 '12

    do you mean hip fractures post surgery? post ORIF or THR? I work on a surgical/orthopaedic ward in Ireland ( on nights )... hip replacements are never rolled onto the operated side! they are log- rolled with abduction pillow in place onto the un operated side to place bedpan, knee replacements are only rolled if they are too frail to lift up also on to the un operated side while one nurse supports the operated knee, if patient is able to lift up instead of being rolled then bedpan is placed from un operated side for infection control reasons.... hope this helps... I am new to this site and will be interested to read what other contributors have to say.... As I said I also work nights and don't see the physios but our physio therapists usually assess the patients pre and post - op and leave detailed notes in the multidisciplinary chart ( and much more legible than those of the medical team!!) with instructions re moving and handling and mobility...

  • Jan 31 '12

    In addition to Talino's suggestions, I add: "A SCSA is required to be performed when a terminally ill resident enrolls in a hospice program (Medicare Hospice or other structured hospice) and remains a resident at the nursing home." RAI Manual pg 2-21

  • Jan 11 '12

    I'm sure nothing like this ever happens, right?

    check out more nursing cartoons: About A Nurse Cartoon you can find the forum listed in the nursing tab in the yellow navigation bar If you enjoyed this, please click like below

  • Jan 11 '12

    I'd have her go talk with nursing schools - BSN and ADN.

    Since she is in high school, I would not have her go the LVN/LPN route.

    Personally, in looking back, I'd have gone BSN right out of high school.

    But . .. . I didn't know I wanted to be a nurse then.

    I agree - congratulations on a daughter who wants to go to school!!!

  • Aug 23 '11

    alternet august 18, 2011

    a radical new definition of addiction creates a big storm

    a sweeping new definition of addiction stakes out controversial positions that many, including the powerful psychiatric lobby, are likely to argue with.

    if you think addiction is all about booze, drugs, sex, gambling, food and other irresistible vices, think again. and if you believe that a person has a choice whether or not to indulge in an addictive behavior, get over it. the american society of addiction medicine (asam) blew the whistle on these deeply held notions with its official release of [color=#1c8585]a new document defining addiction as a chronic neurological disorder involving many brain functions, most notably a devastating imbalance in the so-called reward circuitry. this fundamental impairment in the experience of pleasure literally compels the addict to chase the chemical highs produced by substances like drugs and alcohol and obsessive behaviors like sex, food and gambling.

  • Aug 23 '11

    Just playing devils advocate here..don't get to quick with the flaming..

    Your car breaks take it to the shop...they give you a big ole bill for a couple thousand dollars for repairs. Do you just pay it and drive off. Probably not. You want an explanation of what the problem was, what they did to fix it and why the heck did it cost so much to fix it. Like it or not, medicare and insurance companies expect the same.

    COPD and PN (pneumonia?) follow up does not require the 24 hour services of a SKILLED PROFESSIONAL nurse to manage - this can be done at home. It is the weakness that followed the illness (along with that recent hip replacment) that makes the resident require the SKILLED professional services of the therapy department. Hey, I didn't make these rules but they are rules that we all have to live with. Generally if they are there for medicare or insurance, they are only there until therapy is done (not til nursing is done).

    Why bother saying if their gait is steady/unsteady. Why not "Able to walk 50 feet with w/w and one rest stop independently". Or, sometimes I just use the resident quotes "I'm doing so much better this week. I can get all the way to the dining room without getting short of breath".

  • Aug 23 '11

    I would say yes, but then immediately note that it was dismissed by a higher authority.

  • Aug 8 '11

    ]Glad we can agree (i mean it) on the whole, just hate to see someone feel that they are being "made" to better themselves via an additional "Nursing Certification". All learning, all education, is good and valuable...
    ]I just hate to see so many moving away from placing a value on "Nursing education vs Higher education" But Hey-

    ]I'm just saying....

  • Aug 3 '11

    I actually wouldn't be that concerned about a COPDer satting in the high 80's..they need a lower O2/higher CO2 to keep their respiratory drive alive. That said, I'm sure they drew ABGs and did other assessments during the rapid response, so obviously something was going on.
    If the patient is alert and oriented, and understands the consequences, he has the right to express his end-of-life wishes and refuse any medical treatment he wants. I would have allowed him to pass peacefully as per the wishes he expressed.

  • Jul 8 '11

    Quite a few NS threads lately, so I thought I would share a few things I've learned.

    I'm a former phlebotomist/EMT/UAU and lab tech. I was originally hospital-trained, and have a tad over 100,000 veinpunctures performed. I've had 1 NS, in 20 years, and it was an uncapped syringe left in a room- not one I handled.

    Body mechanics are a significant part of preventing self-inflicted sticks. I do not sit, when sticking, as the natural reaction, if bumped, is to move the hands up and forward- which will drive a needle neatly into one's hand.

    When sticking, first and foremost, the needle goes nowhere but into the patient (or maybe the bed). That means that if the patient moves suddenly, they get jabbed; a bomb goes off in the parking lot, the patient gets jabbed; lights go out, the patient gets jabbed- maybe the mattress, as long as it isn't in the direction of your hand; a fire-nado-caine-alanche comes down and consumes your hosptital, yep, you guessed it.

    What we are trying to mitigate is the startle-response. When adrenalized, our bodies experience a systemic contraction and some level of stabilization-response, such as extending/retracting the hands. What you want to train-in is a rigid locking of the sticking arm perpendicular to the torso. Along with this, applying firm, downward pressure with the sticking hand stabilizes your needle entry, and also connects you to the patient.

    The untrained response, relating to that connection, when the patient moves or when we are startled, is to draw away from contact with the patient. The problem is that we have lost all foundation at that point. Our desire being to hold the needle in mid-air, so that no one-particularly the patient- is injured, results in a free-floating missle, ready to be driven into any on-coming surface. That surface is typically us, as either we retract our arms and hands to shield our core torso, or we hyper-extend to catch an anticipated fall.

    Most of this is situational, but can be addressed by changing how we perceive a situation, rather than hard and fast rules or safety devices. Primarily: how may I best position myself so that I am not readily in-line with my needle? Secondly: your needle always faces your patient. Our gaze is normally a tandem effort, our eyes move in unison in the same direction. Manually, we have (generally) learned to move our hands together. Adapt your sticking so that your mechanics are more parallel, not intersecting. I.e., when sticking, your needle is always between your patient's body and the dominant side of yours, never pointing towards the non-dominant side.

    If, for some odd-ball reason, you must move with an exposed sharp, hold it in the dominant hand, across the chest and pointing toward the non-dominant shoulder. Face your dominant side, and move with that side of the body leading. If bumped or startled, the sharp will be pressed parallell to the body, with the head ducking further towards the dominant shoulder, away from the needle.

    Regarding gloves/no gloves, I will simply say that is a performance-bias issue. We do what we want to do until we are conclusively shown that it causes problems.

    Just a mini-rant, that hopefully will help someone to evaluate their mechanics. I always find it interesting when the practical skills are said to be better suited to OJT, unnecessary, etc., when basic safety is such an issue in this profession.

  • Jul 8 '11

    Never clock out and work for free! It is not volunteer work, so you should be paid. What if something happens to someone and you have to respond? Being "off the clock" you might not be covered! Things will never change if you aree to do 10 hours of work for 8 hours of pay. Work hard, smart, but on the clock while you are working.