nursing home rn's

kcochrane · Jan 17, 2010

In my facility most RNs are charge nurses. If there is more than one RN they will alternate between charge and passing meds. The charge nurse does the care plans, creates assignments, montors patients on report, transcribes orders, helps with treatment, perform weekly skin assessments, liason with the MD/NP and other types of paperwork. On occasion they might do a IV, but that is rare since most requirement one go to the hospital.

That's all I can come up with at this time.

You could see if you could shadow one to see what they do, since I think it really differs. Good luck!

Nascar nurse, ASN, RN · Jan 17, 2010

Not all nsg homes are the same. Above poster talks of a rare IV. My facility may have several IV meds daily, plus wound vacs, complicated wound care, etc.

pedsrnjc · Jan 17, 2010

My day starts at 0545 am when I walk in, I excahnge pleasantries with the housekeeping staff, 0553 clock in, check for notes on my desk re: patient conditions,ect. Then I check staffing and if needed, I figure out a very complicated union wop (go home) schedule. 0600 Read report boards and greet LPN's, 0610 get extremely long report from previous charge nurse 0643 prepare lab reports for the doctors, 0650 prepare coumadin report sheets for doctors and address any other notes that have to be sent to doctor. 0700 sort out memos, labs and coumadin flow sheets into piles: doctors who answer memos and doctors who don't. Put the 'do' doctor memos into box to go to clinic; leave 'don't' doctor notes on desk to go help CNAs with a dememtia resident with sexual aggressive behaviors get peri cares. Sing "Jesus loves the little children", resident stops pulling on his stuff and sings along. (he was a minister). Head toward desk to finishing the memo thing. LPN calls for me, *** is acting "weird", assess ***, he's dying, looks like fast. Head to his chart to check his code status, DNR. Call family gently explain that *** is not doing well and might die, do they want me to send him to the hospital or keep him comfortable? Comfortable, will they be coming in? yes. Check ***'s orders, only oral oxycodone, can he still swallow? no, write a quick note about what I need to tell doc and grab 'don't' doctor memo's Omy goodness, it's 0830 already.

Head over to clinic to chase down don't doctors. ***'s doctor is a 'don't' Catch him right away! Wonderful luck. Explain that *** is dying, family just wants comfort, can we have sub-Q morphine? MD gives small dose hourly, know it won't work, but gotta try before asking for more. Rush back to ***'s LPN and tell her order, oh crap he has*** pharmacy, will they bring the morphine right away? call them, get a yes answer. Hold ***'s hand while waiting for morphine and family to arrive, see pain, ohh, morphine hurry. Hug daughter, explain what's going on. Morphine's here, LPN gives. Alarm going off across the hall rush over in time to prevent her from falling, CNA comes in, thank her for taking over. I have a phone call, family member didn't think mom's call light was answered in a timely manner during change of shift yesterday. Thank her tell her I will fix it. Jot down need for call light audit during change of shift.

&&& resident is call ing "help", ask LPN if she's had her pain meds yet. Ask LPN to medicate, thank her. Asked to look at a pressure wound, yup it's pressure. Give direction on care. Goodness, it's 1107, if I don't get to the clinic soon I won't catch the don't doctors before they take lunch...Hear screaming from ***'s room, rush in he's really in pain, still 15 minutes before next Morphine dose, daughter's crying. Instruct LPN to give next dose, I'll get order. Grab "don't" doctor memos and rush back to clinic, get better morphine order and some ativan, It's my lucky day! Other don't doctor is right there, show memos and get orders, rush back, give morphine order to LPN, rush into office chart. 2 minutes of deep breathing...still lots to do. "do" doctor memo's are now back with orders. Prioritize orders, start processing.

CNA says so and so just fell, assess so and so, like an idiot get blood on my ungloved hands, secretly say "stupid,stupid" Wash hands thouroghly. Direct LPN on how to care for abrasion, get into office and chart. Fill out fall report. Chase CNA's down to get more details. Change care plan.

1300, go check on ***, he's much more comfortable, he's started to mottle. Take daughter to my office and gently explain dying process, answer her questions, pray with her. Go get her more coffee.

Start processing orders. 1400 next charge nurse walks in, give report, sorry for not having orders processed. 1415 tie up loose ends, go say goodbye to ***, daughter says I'm glad it was you here today.:redbeathe 1430 clock out, smoke on the way home, beat myself up for watching someone die of smoking and then going home and smoking, why can't I quit. Crank up music, overall, a pretty decent day.

Long term care isn't for everyone, it's a high calling. Here's how my most recent work day went, I know it's not like this for all LTC nurses, but this is what I do, and I love it!

spoon64 · Jan 18, 2010

Okay i read this and then read it to my husband. Went away and came back and read it again.....I DO BELIEVE YOU LOVE YOUR JOB....Thanks for a FLASH FROM THE PAST....I used to work in a nursing home facility in Central Florida as a CNA with an awesome team of RN'S and LPNS....and this scene was seen often ....But very rewarding in the end.....kudos to you

kcochrane · Jan 18, 2010

Not all nsg homes are the same. Above poster talks of a rare IV. My facility may have several IV meds daily, plus wound vacs, complicated wound care, etc.

Wow..I might have stayed at my facility when I graduated from RN school if they had that experience. Good reason for the op to shadow. Even in this areas each LTC facility really differs. At some LPNs are in charge. I'm lucky that I did get trach, oxygen and tube feeding experience.

LPNfurever · Jan 18, 2010

It is a high calling!! Im a new grad and I love long term care...my med/surg nursing friends go on and on about so and so who OD and had to be kept in restraints, or how whats her name has some rare bone disorder (they maybe have 5 pt) then when I tell them about my crazy (apparently boring) day (with 20+ pt) they roll their eyes. The fact is that nursing home work is a completely different animal and just as demanding if not more demanding then med/surg. :)