New to ltc, questions after 1st orientation

itsmejuli · May 23, 2011

Just because others don't wash their hands and wear gloves doesn't mean its ok.

Forever Sunshine, ASN, RN · May 23, 2011

1. Isolation precautions for c-diff are gown and gloves. (And of course hand washing upon leaving the room)

If I'm just going in to give meds, I'll wear just gloves and make sure not to lean up agaisnt any surfaces.. (the bed, sheets, chair, table etc)

2. Yes you should wear gloves for those things.. especially when your med-pass is being observed. And make sure you perform hand hygiene before and after putting gloves on.

SneakySnake · May 23, 2011

Thank you both for your replies. I was only observing yesterday and yes I did wash frequently (the nurse just acted annoyed with me) and I will be wearing gloves (need to learn where they stock them...none were on the cart) when it comes my time to do those tasks. The C-Diff thing has me a little freaked out:uhoh3: I asked if the resident was on any type of isolation/contact precautions and she said "no this is not like at the hospital". My father passed away last year due to complications of a nosocomial infection. Really made me wonder if ltc is the place for me? I have 3 more days of orientation.....

westieluv · May 23, 2011

As far as the number of scheduled days, if you really only want to work 1-2 days/week and that's what they told you in the interview, then you have every right to remind them that that's what you were told and that your limit is 2 days/week. My experience has been that most LTC facilities are short staffed and will try anything to get you to be there as much as possible. It's up to you to set limitations from the start. For example, I hired in to the facility where I work now on a part-time basis with a set schedule of two days/week during the week and every other weekend. Almost immediately after I got out of orientation, the scheduler was ringing my phone off the hook at all hours of the day and night and trying to make me feel guilty for preferring to stay home with my family on my days off. I let her know in no uncertain terms that unless I called her, I would not be interested in picking up any additional shifts. Period. The phone calls stopped, and she never even asks me to work over anymore either.

optimist · May 23, 2011

Ive done LTC for a while now and sadly these are rather typical. I was aghast the first time I heard through the grapevine that one of my pts had cdiff (wasnt passed in report) and there was no isolation. The admin gave me some ramble about resident privacy yada yada. I felt it was my duty to tell my aides to use extra precaution and educate them to transmission prevention. Now as far as not washing hands, that is simply unacceptable.

nursetiffany. · May 23, 2011

eww...not at the ltc facility i work in!

NamasteNurse, BSN, RN · May 23, 2011

No gloves on the cart?! That's not normal anywhere. IMHO it's places like this that give LTC a bad name. I'm really fuming right now! This is why nurses worry that they "will lose their skills", because SOME LTC's allow this to go on. It's totally unacceptable! I would exemplify professionalism from myself and staff no matter where I worked and not worry about anyone 'getting annoyed' at you for hand washing! You should also bring in some hand sanitizer and have that on the cart as well. Nosocomial infections are rampant in LTC and this place you speak of is the reason why! Humph!

MisMatch, LPN · May 23, 2011

The LTC facility I work in has precautions for C-diff, MRSA & VRE. Gloves and gowns are stocked on the door of the room with that patient. Gloves and hand sanitizer are everywhere. Personally, I wear gloves for checking blood glucose and antibiotic eye drops for those with eye infections, but not for routine eye drops and nose sprays. Protocol is to sanitize hands between each patient, soap & water handwashing after three patients.

As for scheduling, nip this one in the bud! Let them know what you were hired for, and demand that they schedule you no more than that. They will push you to work as much as possible. If they told you 1-2, already are scheduling you 2-3, guarantee they will be nagging you to pick up 3-4 and calling you to work on your days off.

Forever Sunshine, ASN, RN · May 23, 2011

As for scheduling, nip this one in the bud! Let them know what you were hired for, and demand that they schedule you no more than that. They will push you to work as much as possible. If they told you 1-2, already are scheduling you 2-3, guarantee they will be nagging you to pick up 3-4 and calling you to work on your days off.

Don't feel obligated to pick up the phone either.

nursestudent743 · May 23, 2011

Sounds like where I work. No one but me wears gloves during glucose checks. Cdiff residents have precautions outside their doors, but no one uses them. Just do what you know is right. You won't be the one catching something or passing it to others! As for the schedule you need to nip that in the bud if you don't want extra days. I hadn't even been at my job for a week before they were trying to get me to pick up extra shifts. Just tell em no, and don't answer the phone. On the positive side I love my job and the residents just make it so worth it.

CapeCodMermaid, RN · May 23, 2011

Precautions for infections are handled differently in long term care. BUT...CDIFF is one of the worst infections there is. We use gloves and gowns for any patient contact and most of the time put the person in a private room. MRSA in the nares is not a big deal and MRSA in a wound is contact precautions.

Wash your hands as many times as you think you should. I tell all my nurses to always wear gloves when using the glucometer. Gloves with eye drops, too, although the end of the glove can be covered with a clean tissue to prevent injuring the delicate eye area. Don't forget to have the residents wash their own hands....we had an outbreak of conjunctivitis...duh...none of the staff thought to wash the residents' hands. Once we did that, the infections cleared up.