New Night Nurse in an Assisted Living

[Rtwilley3473]

Hi everyone!

I am a fairly new nurse. I graduated June 2016, and worked 8 months in a

Cardiac Step Down unit before immigrating to Israel. Although I am still in the process of changing my licensure to Israel, I got a position for a night nurse in an Assisted Living. Basically, the clients are meant to be very independent, and those who aren't usually have private care takers. Since I don't have my license here yet, I can't give any medications even besides over the counter APAP or the Israeli equivalent. So, I am essentially meant to just be there in the

case of any emergency.

Although I have managed quite a few number of emergency situations in my clinical and working experience, but I am nervous because I haven't worked a sick call kind of job before. Also, this is the first nursing job I have held since I came here in February, and I am nervous about the concept of being the sole person to make a call about sending the patient to the hospital during times when there is no on-call doctor. As a new nurse, it makes me feel more comfortable just to want to send people to

the ED, but that is obviously not always best for the patient.

Any advice from people who have been in assisted living positions on sending patients to the ED? On identifying things that can wait until the morning versus things that need immediate attention?

Or just general advice for new nurses?

Thank you all in advance!

[crashcartqueen, BSN, RN]

As an ER nurse, I often get patients from skilled facilities who did not need to come to the ER. However, I understand that the nurse responsible for sending them may have limitations on resources. Do you have an in-house physician on-call to advise you? If so, they will be a great resource for you to determine if the patient must be seen. If it is all you, things like chest pain, shortness of breath (if new and there are no breathing treatments or medications available in house), falls with unexplained cause or obvious trauma (facial contusions, shortening), SI/HI, profound mental status change (if mild consider UTI, could be handled in house if timely testing is available), and stroke-like symptoms should be seen promptly.

[Blackcat99]

I am thinking that many residents at assisted living are alert, oriented and able to make their own decisions. If I didn't think a resident should be sent out to the ER, I could suggest to the resident other options. That being said, if an alert and oriented resident insists on going out to the ER, then out to the ER they go.

[amoLucia]

Assisted living facilities are NOT anything like a hospital or even a nsg home. Consider them more like an apartment complex with sick people living there. This is even more true for Home Health situations.

You are there just to basically provide supervision and some limited intervention. WHY, oh WHY, you ask???

Concepts to remember - 1) any 'official' or 'legal' rules are usually broad and not too specific (like they would be in a hosp/NH). Rules fall under varying authorities, maybe state DOH, municipal fire code, corporate rules, etc

2) it is the pt's HOME. You can't really tell them what to do, like so much as you can't tell ME what to do in MY own house.

3) support systems are usually limited. Spouses or other family & friends may be non-existant or as sick if not SICKER than the resident.

4) finances are freq very limited. But you'll never know. BIG SECRET! And that may really hamper the availability of resources.

5) the needs of the resident are much more needy than the facility can provide (altho ADMIN will try to keep the indiv unit occupied at all costs!).

For us staff who have had real experience with ALF facilities, we have HORROR stories that could make script for some eye-opening realty TV.

In general, the healthcare person can't do too much for any resident, like maybe no meds can be given. If pt falls, the HCP can usually only call 911 for emerg care. Same for any heath emergencies like chest pain, SOB, seizures, low blood sugar, signif bleeding, etc. And if the resident thinks NO, DON'T CALL, the HCP can't force the issue. Even maybe not allowed to call the resident's family!

A nurse or aide can prob call a supervisor for assistance, but that means a delay.

To Rtwilley - you ask a good question about when to 'send them out'. Talk to your Director or Administrator about what the facility policy is. That will help to guide you. You need to remember NOT to let someone take advantage of you - your job description tells you what you're responsible for.

On 11-7, you may have some administrative responsibilities, like paperwork. But there could be some higher level responsibilities also that the Admin has agreed to provide for.

(Just for my own curiosity, I'd ask what happens when a private care taker is not there.)