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tinkertoys

tinkertoys

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tinkertoys's Latest Activity

  1. tinkertoys

    Med crushing

    I have a couple of patients who will spit out their meds without fail unless they're crushed finely, mixed in a little pudding, and then thinned with a supplement shake. I give it to them in their little med cup with a straw, adding more shake as needed until it's all gone. They don't even know they've taken their meds, plus they get a calorie boost! I try to find out what their favorite flavor is (usually chocolate or strawberry). It also helps if the shake is really cold.
  2. tinkertoys

    Ever provided hospice care to your own loved one?

    My heart goes out to you{{{:kiss }}} God bless you for you love and dedication. Your husband is a very lucky man to have you! Even though you are an experienced nurse, in this case, you're not a nurse... you're his wife. As hard as you try, you will not be able to be objective, and treat him as you would a patient. Please, PLEASE seek out a hospice group. They will help and support you both as much, or as little, as you need. Let them help you, and do what they can do for you both, so you can be to your husband what noone else can be. This time will pass too quickly. Don't let it go by in a blur of stress and exhaustion because you tried to do it all... He needs you right now. But not as his nurse... as his wife. May God Bless you both. Terra
  3. tinkertoys

    Vital signs? How often do you take them on your LTC unit?

    Our protocol is V/S Q shift x 72 hours for new admissions. After that, everyone gets a full set of V/S weekly. If a patient is ill or on alert for some reason, V/S q shift for at least 72H. Temp q shift if on antibiotics, AP and BP if appropriate for meds. We would never dream of calling a MD without first getting V/S If possible, we try not to disrupt their sleep, activities, etc., but sometimes it's necessary in order to give the care our patients deserve. Our patients are mostly skilled care. Maybe regs for patients who are physically stable and on very few meds are different...I don't know...
  4. tinkertoys

    charge nurse dilemma

    I agree with much of the above posts... there may be a problem with perceptions that need to be dealt with, but the bottom line is that her patients are her responsibility. If the patient is c/o pain, it is her responsibility to assess and act on that assessment. If she is uncomfortable with what she finds, or has questions, then she need to consult with you. But consulting with another nurse DOES NOT RELIEVE HER OF HER RESPONSIBILITY TO HER PATIENT!!! It appears to me that her actions are both negligent in regard to this patient (and who knows how many others), and blatent insubordination, neither of which can be overlooked, regardless of the staffing situation. Her actions and attitude need to be brought to the attention of your DON. She may have some insight into the situation that you do not have, and together you can come up with the best way to address the situation. But it does need to be addressed. Otherwise your relationship with this nurse will continue to deteriorate, and you will be doing her (your)patients a great disservice... because, ultimately, they are YOUR patients, too. I hope that you are able to resolve this issue with this nurse. You sound like a good and caring nurse, and you're working very hard to do what is right for your patients and staff partners.... I know I would be proud to have you on my team! GOOD LUCK!!!
  5. tinkertoys

    Days off after midnights

    i'VE WORKED NIGHTS FOR THE PAST 7 1/2 YEARS, FIRST ON 11-7, THEN 7P-7A. USUALLY I WORK 3 NIGHTS IN A ROW, AND TO KEEP FROM TOTALLY LOSING MY FIRST DAY OFF TO SLEEP, I TAKE A NAP WHEN I FIST GET HOME. THAT'S ENOUGH TO LET ME GET THROUGH THE DAY, AND I GO TO BED AT A "NORMAL" TIME. AFTER MY OFF STRETCH (USUALLY 3 DAYS), I SLEEP IN, PIDDLE AROUND THE HOUSE A WHILE, THEN GO TO BED FOR A COUPLE OF HOURS BEFORE GOING IN TO WORK. BASICALLY, DURING MY WORK STRETCH, MY HUSBAND IS TOTALLY IN CHARGE OF EVERYTHING :kiss ALL I DO IS WORK AND SLEEP. MY WORK SCHEDULE IS SUCH THAT EVERY OTHER WEEK I'M OFF 6 DAYS OUT OF 7, AND THAT'S WHEN I "HAVE A LIFE":roll THIS DOESN'T WORK FOR EVERYBODY - WE ALL HAVE TO FIND THE SYSTEM THAT WORKS FOR US. AND THEN TRY TO KEEP WITH IT. GOOD LUCK!!
  6. tinkertoys

    12 Hour Shifts

    I work 12 hour shifts - 7p to 7a. My schedule is pretty set... on a 2 week schedule, I'll work 6 days out of 7 the first week, and the second week I'm off 6 out of 7, and the one day I work is usually either 7-11 or 11-7. That first week is really killer.. all I do is work and sleep. But then I have almost a whole week when I can be a 'normal' person. True, the first day off is lost to sleep, but all in all, I like it. I've never had much trouble sleeping, but some people just can't adjust . To each his own, I guess.
  7. tinkertoys

    nurse staffing for LTC

    THAT'S CRAZY!!! There's no way one nurse can keep up with 92 patients. I'm assuming you're working 10p to 6a... The problem is most likely the universal misconception(even with people who should know better) that your patients actually SLEEP at night. As it is, there is precious little time for luxuries such as potty breaks. And it only takes One incident to throw everything hopelessly behind. I would object to this proposal, in writing, to your DON and administrator. Remind them of all you are doing while they're at home tucked into their cozy beds. They're putting your patient's welfare at risk, and if anything goes wrong, it's YOUR license that will be on the line. Our staffing ratio is roughly the same on 11-7, and in an emergency, we pull together to take care of business, but we're NEVER short to that extent for more than a couple of hours. It's just not safe! Good luck, and keep us posted.
  8. tinkertoys

    Does your HN/NM cater to his/her dayshift?

    In our LTC center, we have a schedule for med administration,so we know at a glance what time meds should be given for each room. In general, we try to give all AM meds at the same time, so as to disturb the pt as few times as possible with meds. If a med needs to be given before breakfast, 11-7 gives them. Otherwise, they're given at 8 or 9.If a pt objects to the early meds, or there is other justification (can't get them awake enough, etc.),we give only the ones necessary. Occasionally, someone will schedule all 47 QD meds for 6 am because they get a fingerstick. If that happens, we just change it back, and there's not usually a problem. We try to keep the nurse who prepares MARs for changover up to speed on things. It saves us all a lot of heacaches.
  9. tinkertoys

    hospice in LTC?

    I have just been told that LTC centers are being strongly advised to offer hospice for their terminal patients. This confuses me. First, I feel that we do a good job of supporting our end-stage patients and their families. We have MD's that work with us to provide adequate pain control. we try to keep in good communication with families, to keep them informed, and we do our best to see that our patients don't die alone. I understand that hospice has a more organized support structure, but I truly don't understand what purpose would be served by involving hospice with our patient's care. It seems to me that that would take the pt's care out of our hands, and make us little more that a housing provider. I have also heard of hospice patients that were told that if they signed with the hospice, they were not to go to the hospital for any reason. Please understand-- I have the utmost respect for hospice. I believe it provides a much-needed service to our terminally ill and their families. I just don't see where it applies in this case.
  10. tinkertoys

    Anyone in Tennessee???

    Hi all! -- Great to see so many nurses from Tennessee!!! And Columbia State students, too! Graduated from that program 4 years ago ( Columbia campus). Have been working in Long Term Care since graduation, and love it! I'm originally from West Virginia... moved here 18+ years ago. I still have occasional problems with "culture shock", but I don't miss the snow and cold weather at all!
  11. tinkertoys

    Nurse Practitioner in LTC

    We have recently added a nurse practitioner to our staff, and are having some problems. I don't think this was very well thought out prior to her hiring. The MD's are not really thrilled about having her here, and we, as nurses, are just not sure where she fits in. The presence of a NP was suppose to relieve the MD's and staff nurses of some of the day-to-day routine med adjustments, wound eval and tx, initial assessments, etc, but so far has only added do our work and level of frustration. If any of you have an NP on staff, I would really appreciate any advice on how best we can utilize her skills. At this point, the only real advantage we have seen is that we now have someone in-house that can do podiatry care and insert PICC lines. There's got to be a better way to do this!
  12. tinkertoys

    Bowel Protocol

    At our Center, we try to have in place for our pts PRN orders for MOM 30cc qd prn, and fleets enemas qd prn. Our 3-11 nurse makes her BM list at start of shift, listing all who have been 2+days without BM. CNT's are aware, and mark off those who go during shift. Then on last med-pass, gives MOM. If no BM next day, MOM is repeated. If still no BM, pt gets fleets enema next day. Most of our pts get colace daily, and many also get sorbitol 2-6 Tbl/day according to BM's. A few have QOD dulcolax orders. When all our nurses follow our protocol, we have pretty good results. There are always a couple of pts with chronic problems who need regular disempactions, but that has decreased with our protocol.
  13. tinkertoys

    Resident with hip fracture

    No, this is NOT the way this patient should have been treated!! She should have been examined immediately by her nurse to check for injury, especially for the possibility of a fracture, and the MD notified right away, with emphasis given to the patient's c/o pain -regardless of whether or not she could be specific about the site of her pain. At her advance age, it would be a wonder if she HADN'T sustained a fracture! I can't think of a single one of my doctors who would not have ordered x-rays immediately, and been very upset that it took 24 hours to get the results. I am not surprised that there will be no surgery. At her age, chances are that she would not survive surgery, and at her advanced age, the fracture may not heal regardless of whether surgery were performed. I am surprised, though, that she wasn't even placed on fracture precautions, with staff being taught ways to care for her without causing further injury or increased pain. She most definitely does not need to lie on the affected side, or to put weight on that leg. And the hip needs to be kept as immobile as possible. It IS possible that tylenol could relieve her pain. We all have different pain thresholds. But she should be monitored closely for signs that her pain is NOT being relieved. Thank you for your concern about your patient. I'm glad that you didn't just report her problem and forget it. Many would have. Her recovery may depend on what you observe and report about changes in her condition, so please continue to watch her closely, and handle very gently.
  14. tinkertoys

    shift to shift report/staff assignments

    At our Center, we use cassette recorders, too. Each nurse tapes for their relief, and the Team coordinators tape a comprehensive report for the nurse following them. The TC listens to that tape, and the individual reports, and so has a good idea of what is going on and what she needs to accomplish for her shift. CNT's get report from their charge nurse at the beginning of the shift. As for assignments, our patients are divided into set groups for patient care. Each CNT gets a worksheet daily with the list of pts for her group, which includes V/S , I&O, meal %, shower schedule, and any special needs/concerns each patient may have. They then can add day to day concerns during report. These worksheets are updated twice weekly, and have improved our continuity of care. We also have a set schedule for showers, straightening of drawers, cleaning IV and GT pumps,etc. so that the work is spread over the week and no one shift or work group gets "dumped on".
  15. tinkertoys

    DNR? Why not?

    I, too, have had many patients who I felt should have been DNR, but were not. however, that is not our decision to make. The decision to change code status is not an easy one. It is one thing to say what others should have done. It is another when we, ourselves are faced with the same decision. We cannot see into the hearts and minds of the families of these patients. We do not know the reason these precious souls are still with us. Our job is to give those patients the best care we can, keeping them as healthy, comfortable, and secure as possible, and to support and respect those who have entrusted us with their care. For example, we had a patient who had multiple cardiac and respiratory problems. Before coming to us, she had been resusitated multiple times, and had been on mechanical ventilation more than once. She was a full code, at her request, and with her family's support. during the nearly 3 years she was with us, we sent her out in near-code condition 12 times, and coded her once. Each time, she recovered, and returned "home" to us. Because of the care we gave to her, she and her family were able to share 3 years she would not have had, had she been a DNR. We will always have patients who will break our hearts, who we will grieve over because of their suffering and lack of quality of life, as we know it. But we continue to do our best to care for them, because we are nurses. That's what we do. That's who we are. If you are against the use of feeding tubes, etc to prolong life, make out a living will, and let your family know how you feel. Otherwise, one day, you may be the patient with the GT and IV's, simply because of a decision your loved ones cannot bring themselves to make.
  16. tinkertoys

    Ques. about presetting up of meds

    Our protocol is to give meds, THEN initial the MARs. I, personally, have a problem with that, in that it's easy to get side-tracked and forget to initial after leaving the pt. My personal preference is to gather my meds, make sure it's all right, then initial and give meds. If something is refused, etc, then I circle on the MAR and document details on the back. I find that there are fewer blanks that way, and I have the med in front of me when I initial so I can verify... not try to remember later. Saves time, too.