sandigapeachlpn

surgical procedures! when i was an office nurse i had to assist the family doc's with sutures, i&d's, skin lesion removals, cryo for plantar's warts.... but the thing that got to me the most was the toenail removals, watching them inject the toes with lidocaine and cut right straight down the middle with a scapel, then peel off the halves of the nail in strips. the local never quite deadened the toes all the way. hence the patient would be coming off the table and breaking my hand while i gave support. seeing anyone in that much pain makes me want to pass out. give me my clean post op incisions anyday!!!!

i have been at our facility for 4 years as of july. it's funny because i felt like a fish out of water after being in a doctor's office, and before that a floor nurse. i had a really difficult time too, with judgement calls and had very little confidence in myself. i was used to having a charge nurse or a doctor tell me what to do in any tough situation. now i am charge over night shift and i call the tough situations. please don't feel inadequate. if you like ltc then stick with it. if there is something you are rusty at, then find somene and ask them to walk you through it. i have good diagnostic, assessment and administrative judgement, and my real weakness is emergencies. one of the things that i do is rely heavily on one of the nurses that i work with frequently that has had years in the er. i tell her that i need her expertise from time to time and it makes her feel proud , on the other hand she gets flabbergasted with policies and staffing, those are my strong points. i have been a nurse for 7 years and i will never feel inferior for asking for advice or putting two or three heads together when i am whipped and frustrated. one thing i have learned and that is you have to have a routine in ltc. do you have mars that you can pull out to the left and right? i flag my mar pages out to the left for my meds, and my treatments to the right. when everything is back in the middle at the end of shift i know that i did it all. i hope this helps. i would love to work with you too, because i have been there.

I was doing my power charting the other night. i was in my robot mode going down the list on my alert charting board. i picked up the name placed it on the 24 hour report and documented 'no problems, sleeping" ( i work noc), then i realized that she had expired on eve shift, i was involved in shipping her out. think i am alittle stressed? i am on vacation this week thank god!

i also am charge over noc shift in our facility. there are so many aspects in this thread that i hope that i don't get too sidetracked. first of all, in regard to the management deal; yes i of course have a couple cna's that think they are royalty. from time to time i pick my battles and stand firm, disrespect, insubordination is major with me. patient/resident care cannot be compromised. the best approach i have found so far with our crew is this: if i can jump in and help you when the going gets tough then you can jump in and help me when the going gets tough. my concept to everyone on noc's is that we are there for our residents and we are there to help each other get our work done. since we have less staff on noc we have to have this philosophy or people would be on the floor. if i help change a resident or assist the cna with their rounds then they feel that i understand their world. on the same token when i am having a bad night and drowning i might ask them to run and get a 02 sat or make copies, etc. things i normally do myself. if i have a problem with this then i look at them and remind them of how i answered their 15 call lights, bed alarms, and changed people last week when they weren't feeling so hot. anyway, this has worked very well for me. i also take breaks with them, and interact more at times with the aides than i do the nurses. alot of this is also due to the fact that i am married to a cna. the other cna's respect me more because they know for a fact that i don't look down on them or belittle them. don't get me wrong i am not saying that you do that. i am just saying that like the cna's in this thread i have seen it way too many times at my own facility. due to my repoire with the cna's many of them feel that they can tell me about issues or problems with other staff and they know they have an adversary. on the other hand i have as i said my two aides that will refuse certain things. i have one in particular that has actually said ' I AM NOT ANSWERING THAT LIGHT IT'S YOUR TURN.' " i don't do baths" " i don't feed" i have worked on her ego a long time, and she is doing much better. first and foremost the number one thing that works for me is leading by example. unfortunately, some of the other nurses lead by the worst example. and those nurses just make me look a lot more attractive as a supervisor.

i also am charge over noc shift in our facility. there are so many aspects in this thread that i hope that i don't get too sidetracked. first of all, in regard to the management deal; yes i of course have a couple cna's that think they are royalty. from time to time i pick my battles and stand firm, disrespect, insubordination is major with me. patient/resident care cannot be compromised. the best approach i have found so far with our crew is this: if i can jump in and help you when the going gets tough then you can jump in and help me when the going gets tough. my concept to everyone on noc's is that we are there for our residents and we are there to help each other get our work done. since we have less staff on noc we have to have this philosophy or people would be on the floor. if i help change a resident or assist the cna with their rounds then they feel that i understand their world. on the same token when i am having a bad night and drowning i might ask them to run and get a 02 sat or make copies, etc. things i normally do myself. if they have a problem with this then i look at them and remind them of how i answered their 15 call lights, bed alarms, and changed people last week when they weren't feeling so hot. anyway, this has worked very well for me. i also take breaks with them, and interact more at times with the aides than i do the nurses. alot of this is also due to the fact that i am married to a cna. the other cna's respect me more because they know for a fact that i don't look down on them or belittle them. don't get me wrong i am not saying that you do that. i am just saying that like the cna's in this thread i have seen it way too many times at my own facility. due to my repoire with the cna's many of them feel that they can tell me about issues or problems with other staff and they know they have an adversary. on the other hand i have as i said my two aides that will refuse certain things. i have one in particular that has actually said ' I AM NOT ANSWERING THAT LIGHT IT'S YOUR TURN.' " i don't do baths" " i don't feed" i have worked on her ego a long time, and she is doing much better. first and foremost the number one thing that works for me is leading by example. unfortunately, some of the other nurses lead by the worst example. and those nurses just make me look a lot more attractive as a supervisor.

i had a new admission come in that previously was on the other hall apprx 2 mo ago. she had lit her ciggie with her liquid 02 on and became enflamed. she came in due to facial burns and then she was dc'd to assisted living. i was off for three days and she is back. i didn't get to read her h&p so i wasn't familiar with her history. i had only seen her from the hall when she was on the other hall so i was totally blown away when i went in and assessed her and met her. she has scarring around the nose okay that's not so bad. but she also has facial paralysis so that her mouth is mishaped over to the left. she also torched her left nare and there is a hunk of nare missing. the thing that got me was her dentures. floating puts it mildly. with the abnormality of her oral cavity and facial structure her upper dentures HAVE NO WHERE TO CALL THEIR OWN. the entire time i was talking with her i was trying to focus on her verbalization and all i could do was watch her dentures turning summersaults in her mouth. she kept telling me she needed her RICKS. i tryed so hard to understand her and could not due to the flying dentures and got a piece of paper towel for her to translate. she spelled VICKS . she wanted to put it into her missing nare. i explained that i did not have a dr order for vicks and if she would put her nasal cannula back in she would be able to breath better. then she had trouble putting her cannual back in place... so i reinserted it ..... i had a tough time trying to get the effected side in with the missing nub of her nare, she constantly picks at the nare also making the nare a bloody stump. anyway, she got so aggravated at me because i didn't have any vicks, she went over to the roommates dresser and took her calmoseptine (which is a pretty shade of light pale pink ) and applied it all over her nostril. of !/4 of the remains. the calmo is our house barrier cream for incontinence. WELL SHE SHOWED ME!!!!!!!!!

in our long term care facility we are encouraged to wear bright vivid scrubs. The theory is based on the effects of alzheimers/dementia and the ability to see white as opposed to the other colors of the spectrum. in our lock down unit the toilet lids are black so the residents can distinquish them from the floor. when i started at the facility i only had white as i was required to wear white as a floor nurse in the hospital. so i had to train myself to change and let loose with the color. it is interesting though.... the lucid residents always take note if i am wearing all white, especially if i wear my dresses. they always make comments about me being professional. and then on the other hand when i am close to a demented resident many times i have found them touching the hem of my jacket or uniform top and gazing at the designs, or material. the best example of what color can do to our residents though happened with my husband. he is a cna in the alzheimers unit and quite a rebel. never to be outdone, he went and purchased the first black scrubs ever worn in the facility. we the staff thought they were cool, but i did worry about the darkness of the scrubs and if that would have an effect on the res. needless to say one of our more colorful res at that time was quite a PIA at times but of course he had his moments. one night my husband entered the room and he started screaming 'GET OUT , GET OUT I DON'T WANT TO GO ' thereafter we nicknamed him the grim reaper. one night i was working the unit and i was wearing navy scrubs. i walked into the activity room to give a med, and one of the res saluted me and stated " i have the utmost respect for you officer". all in all, i have to say i love wearing all white. i was so proud when i finally didn't have a student uniform on and i felt that i had finally earned the right to wear white. if they still wore hats i would wear one. i am 37 and have been a nurse for 5 years. the other nurses rag me and say the hat was for the birds.... but i still wish that we would have kept that tradition.

okay these aren't as good as some but two things come to mind since i have been in nursing. the grossest things were in a small 3 md family practice in a very hick town. oh btw i love little hick towns. anyway, the people in the surrounding area pretty much treated us like their mini er. i was called to the back for an emergency that had walked in the back door. they had him come in the back because of the nail sticking out of his back. he was working on site building a house ;on the roof and somebody close by got careless with their nailgun. the nail was 9-10 inches in length and was embedded all the way up to the head of the nail. i am way upset looking at our 3 dr's and gently suggesting that he needs to 911 out of our little office setting. the poor guys afraid to breath, sit, move, etc. then my brilliant dr's inform me that they want me to xray him before he goes, it will help out the er! i have never been so freakin' careful during a cxr. the next one i will never forget was a guy that cut sheet metal for a living. he calmly ambulated back to the triage area and told me he had cut his finger. i noticed of course that he had a big towel over his hand. he showed me the wound. it was relatively clean. and i felt that i had handled it well explained that since he was alone with no escort that we would have to send him by 911. then he pulled out his finger---what was left of it and handed it to me from his pant's pocket.

the other night i was working with one of my best cna's. she had been working doubles for a few days, has two small children and can get a little loopy when sleep deprived. gee, can't we all. she is very sharp, intuitive and conscientous. she walked up to me after her last round, dead serious and started talking to me about one of our residents who has quite a distended abdomen due to various, reasons, ascites, etc. .... she questioned me " do you think that the reason ------';s stomach is so big is because she is compacted?" i made trash jokes the rest of the night.

i got really lucky in our facility. our DNS had to come in along with some of our RCM'S and work 2a to 6a to help out on Noc's. At that time we had a pretty heavy load for 0600 med's. After they had to try and pass that many med's along with all the BS, ETC. they changed our 0600 pass to only the absolute bare minimum and added the rest to 0700, since these resident's are going to get 0700 pills anyway. It has made a major difference in our last hour. And i personally don't set up med's. Not only is it grounds for dismissal but for me it creates more of an atmosphere for med error.