kstec

30 residents is a lot. Where I work the limit for true LTC residents is 25, that is with no medicare charting at all. We have a wound care nurse, but we still have to do dressing on PM's. There is a lot of falls (incident reports), lots of behaviors (Alzheimers and dementia) and a lot and I mean a lot of meds to give. Most are probably not necessary but you obviously still have to give them. I do work with some 50 + year old nurses but along with the younger than 50, we are darn tired at the end of the shift. It's like working in an adult daycare except your residents act like new walking 1 year olds (falling) and have behaviors like 2 year olds. When I get done working that unit I'm emotionally, physically and mentally drained. I do make great money, but I work for every penny of it and then some. I worked in a family practice office and the work is like night and day, along with the pay. I would definitely shadow, especially because not all LTC facilities are created equal. Understaffing, poor quality of care, lazy coworkers, etc. If the facility is promdominately medicaid, definitely beware. I told you the above all from my personal experiences.

Is the area your in just wanting a year experience for LPN's, or for RN's also?

I was given phenergan IM in my deltoid during a surgery by the nurse anesthetist (sp). No I did not have any nausea post surgery, but my arm hurt for 3 weeks post-op. I actually asked the surgeon at my follow up appt. if the darn needle had broken off in my arm because it hurt so bad for so long. Eventually the pain did go away, but I am here to say "Do not give phenergan IM in the deltoid." My common practice in family practice re: injection amount is 1cc can be given in the deltoid except for infants and children older than 5 or 6 years old, they are given in the VL. Any injection more than 3cc is to be seperated into two syringes.

I was the original poster of this and I have come to find out that certain types of disciplinary action are taken according to the residents cognitive ability. Have you ever heard of that? Both of the residents that I was cussed at in front what you would consider dementia residents but not so far gone that they don't know what cussing is. This event happened over a month ago and since then I've worked appx. 6 shifts to avoid working with her. I'm prn and fortunately I have that choice. Finally, today since I really do want to work I contacted administration to see if I'm overreacting re: this situation or should I let it go. My heart and gut tell me that this is not something to let go. If I wasn't still feeling that this was unacceptable from the get go I would of probably let it go by now. I just think that no matter whether you're demented, with it, or in a coma you have standards of behavior that you (healthcare professionals) need to abide by and when that is thrown to the way side than I guess it becomes a free for all and the the ones with the biggest b_lls stay and the rest of us leave with our tails tucked wishing that being a patient advocate was supposed to be a good thing. It's sad to think that I'm sitting her day in and day out due to the fact that I won't work with her and she has stated she will not work with me. I refuse to work with her in that it is walking into an uncomfortable situation. What if I asked her to do something? Her actions from a month ago could be her nice way of being unprofessional. I don't condone that behavior and I refuse to work with it. I did fill out three applications today. I know that the grass isn't always greener on the other side, but because administration did not back the fact that this was grounds for termination and back me in what I felt was appropriate discipline, I feel that it could happen again with little or no repercussion (sp). I think that she has been there a long time and due to this she has probably done many of things that have been ignored and with that comes more courage to be disrespectful and do what you want when you want because nothing is going to happen. Sorry so long... Any further input would be greatly appreciated.

The reason that I'm fearful is that she is known to be a CNA you don't mess with and is already walking on thin ice due to her attitude. When she was brought into my bosses office all she could do was demand to speak to me face to face and I guess her state of mind was so irrational that my boss said absolutely not. That is why I'm fearful. She's seems like someone who doesn't play by the rules which in turn makes me fearful of her setting me up at work, being a bully or whatever else. It is mutual that we do not work together per my bosses okay. But how sad, when the whole thing was over me asking her one to many times if she had so and so, and that if she did please let me know so I can come help her with the HS care and do my tx. whether it be a cream, oint, powder or dressing change. It's a lot easier doing it that way than asking her to go back to each room after she's done with them when we could of "killed two birds with one stone". But she took it as I was rushing her and riding her all night, which was not the case. I did not tell her to do anything. I asked her to tell me when and I would come in the room then. I even said if she wanted to she could turn on the light and I would come with my medications (oints, creams, drssgs, etc). Does that sound like I needed to be cussed at in front of two residents?

We as floor nurses are not allowed to write up anyone. If we had that type of authority, I would of sent her home that night. She is still employed there and her story is the same as mine, except due to her being so mad at me when written up she was allowed to go home the day of the supposed write up. Yes, I'm fearful she will retaliate, but I don't want to have to look for another job at this moment. I figure I'll just play it out and if something happens physically, 911 will be my new best friend and administration will be sorry they just didn't terminate her from the get go. Back to the original thread: She did this in front of two dementia patients, but my facility also has a rehab facility with perfectly coherent patients like you and I. What if she would of done it and had the patient go to administration? She got lucky on her part that the residents can't verify what she said. Well thanks for all the input. I'm glad that the majority of you agree with what I think should of happened. I guess with the nursing shortage all the way around it takes a lot to be fired d/t having noone to replace them.

If a CNA cusses at you (the nurse) in front of two residents, do you think that is ground for immediate termination? I think so, but instead I have to continue to work with this CNA. Not that I'm trying to save face but I didn't do anything wrong to deserve the cussing and the CNA just misunderstood something somewhere along our shift. She admitted to the DON that she did this and wanted to confront me in the DON's office, which she (DON )did not allow d/t the CNA being irrate when confronted from management. I refuse to work with her and she says she refuses to work with me. I do have to say I'm probably one of the most easy going, eager to help nurse that anyone including CNA's could possibly work with. I worked as a CNA and I know the hard work they do so I'm always willing to help if time allows. What would you guys do? Am I wrong to think this is ground for immediate termination and am I wrong to be in fear of retaliation, because this CNA was beyond ticked off when she got into trouble. Any advice? Oh and by the way I apologized numerous times to the CNA for her misunderstanding me and causing her to cuss at me. I do not like confrontation, so I tried to smooth it over, even though me reporting kind of made my apology null and void. Help, I'm worried she may do something, what I don't know......

Could someone give me a website re: nursing care re: checking for placement, how much residual, how much H2O to flush with between meds, how much to flush with before and after meds. This information only needs to pertain to the nursing protocol of peg tubes only. Any information would be greatly appreciated. State coming in for routine review and our facility has no written policy for me to review. Thanks in advance.....

State is coming in for our routine survey and we were told to make sure that we know everything about peg tubes re: checking for placement and residual. If I remember correctly you put in 30 cc of air and listen. As far as checking residual its over 100cc that is bad,correct. Always put back in residual, correct? How much do you flush with prior to administer meds? I've read several different amounts, I do 30cc. We are allowed to give all meds together unless contraindicated. If anyone can give me a website with any information that would be wonderful. We do not have a standard policy re: peg tubes. I want to be prepared. I know there is the school way and then the real way and some ways in between. Any information would be greatly appreciated. Some of these questions may make me sound like an idiot, but actually I'm not, I'm just wanting some clarification. Thanks in advance.....

You will find that a mass majority of nurses suffer from depression and anxiety. It's not just a nursing thing but a societal thing. Through my own personal experiences and work experiences, I've found that the "normal" people are the minority and a then there is the rest of us. If this is a personal issue with you, you'll do fine as long as you take care of yourself, just like a diabetic would have to. It's a disease and has to be treated as so.

I'm guessing you worked LTC. If so, if anyone wanted to find a reason for any nurse to get canned they could. When you take care of way to many patients you learn to cut "safe" corners. If LTC nurses did it by the book, noone would get their am meds until noon and their noon meds till mid after noon, etc. We as LTC nurse do our best and bless the rest because I've come to terms with I'm am only one person and if someone can show me how to do it by the book in an 8-10 hour shift with 25-30 residents, 1-2 admissions, discharges, sending people out to ER, triaging the residents who are ill, wound care, tubefeeding, medicare charting, accucheck, administering insulin with complete accuracy, writing up fall reports, neuro checks when they hit their head, infection control reports for all the residents on antibiotics, doing blood draws, collecting urine and of course helping to bathe and toilet d/t shortage of CNA's, than please do.......That's why I'm going back to school to get my RN, hoping that the grass is greener when the options are broader.

Long Term Care, a.k.a: nursing home

Long Term Care, aka: nursing home

In two out of the last 3 facilities I've worked at we shared a cart. I thought it was pretty much common practice since you always work short in LTC. Where I'm at now we have 4 med carts but usually only have 3 nurses so there are 2 nurses getting into one cart throughout the shift. LTC is one of those places where a good show is put on for state but the reality is much different. Sad but true.

Supervisors are added into the daily staffing? How can that be when they don't provide patient care? So in that case my facility we are over staffed everyday, due to having to many chiefs and not enough indians. Interesting......

I've recently decided to go back and get my RN. Why, because I've been told one to many times that I can't do this or that as a LPN. I want to do this and that. I'm going back in January and the thought of it nauseates(sp) me. It's a love/hate relationship with school. I hate the commitment, but love the rewards. So no I'm not content with my LPN level. I want more. At first I was content, but two years into being a LPN, I'm not. Our scope of practice is narrowing by the year and I have to always ask an RN to help with situations that I'm not allowed to do. I know that I will always have to ask for help or information to continue learning, but to do it for more is very depressing to me. I just hope I'm up to the challenge of school again. I'm scared and excited. If you don't mind being limited in your job, then being a LPN is great, but if you want a broader job description with more tasks that you can perform, RN is the way to go.

Are there a lot of jobs available for LPN's in your area? If not, that could be the problem. A little advise from when I was in your shoes. Kill'em with your charm. Come across as confident, but not to confident. Convince then that you are worthy of the position. Somehow let them know that no you don't know everything and you don't have any experience but that you would be an excellent choice due to you being eager to learn and eager to take care of patients. Smile, be confident, because you know that you are confident in wanting to be a nurse. I wish you the best and don't get discouraged. Analyse your prior interviews and tweek them each time until someone is willing to give you a chance. Noone comes out of nursing school knowing everything, and even the most seasoned nurses are still learning.

Welcome to LTC. It's all about the money and you either figure it out or get out. You learn to do your best with what you have. There are days, I know that I've just about went against everything that state would tag us for. When the states came up with the proper techniques for everything, they must of been in a facility that was fully staffed, because reality is much different. My thoughts are, if someone else can do it better with the poor staffing, then do it. I work with some lazy CNA's, who leave the nurse to pick up the slack. Toileting, changing and repositioning is time comsuming along with the rest of my job. But I can't look a frail old person in the eyes and decline them the right of being clean and comfortable. I do my best everyday that I work and pray that I don't hurt anyone. It's scary as heck, but what are my choices. This is my third LTC facility and one may be better in other ways then the others, but all in all, it's about staffing to the the bare minimum. I know that I'm a good nurse, my residents love me and I thoroughly enjoy taking care of them. I wish LTC would run how I would like them to, but that's not going to happen. I figure my options are to do my best and know that I made a small difference or quit nursing all together. Because of the LTC experiences that I've had, I'm going back in Jan to get my RN. I atleast will have more options, and maybe find a job that will not leavie me thinking everyday, what did I possibly do wrong, if anything. It's a heavy weight to carry everyday.

I don't know all the legalities in a hospital, but in our LTC facility we can talk about code status and quality of life at anytime. We don't need a MD to tell us what the patient and family have options to do. Some patients come in for rehab (medicare) and because of existing conditions besides the broken hip, knee replacement, etc, they end up getting real ill. Some are informed that they can go home and make the most of their time left. I always inform my patients of any information that I know is factual and give them any information they made need to make informed decisions. I don't know how many times when I worked family practice and internal med that the patient would say " I don't understand what he meant." I would then put the patient back in the room and tell the MD the patient has more questions or that they don't understand what you meant. Patients and their families have the right to be in control of their care and tx. I guess if your heart is in the right place when you are being a patient advocate, I don't know how you can go wrong. We as nurses are the middleman between the MD and patient and of course we may upset MD's sometimes, but when your patient is terminal, they won't get over it with the little time they have left, the MD will. Without us nurses most patients would be clueless as to their disease, their tx., and their options.

From what I understand as of this year all IV's are off limits to LPN's. We used to be able to be certified, but that is now null and void. The LPN's at my facility are no longer able to start IV's or hang any premade iv's. The scope is getting smaller and smaller and more confusing. I work in a LTC facility and am aloud to do admissions, discharges and assessments. I just took on a prn position doing homecare and I'm not allowed to do admissions. Why is that? Maybe I'm only competent in a nursing home? Heck, I don't know. That's exactly why I'm going back to school this Jan. I've heard one to many times, you're an LPN, you can't do that. I don't want to go back right now, but my sciences will expire soon and I sure in the heck don't want to take them all over again. So back to school I go.....

From what I gather, the scope of practice has been narrowed over the years for the LPN's, which contributes to the phasing out. How can we as LPN's ban together and get our scope of practice broadened back to where it used to be. Here in Illinois they just took our IV certifications away from us. I think the states assume that by narrowing our scope that we will go back and get our RN. But in realty, the LPN's who have been nurses for a long time and the ones of us who can't afford to, just aren't going to do it, or we're just going to quit nursing all togethers. Don't the states realize that by narrowing our scope and making us a burden on the RN's even though we have our own license to protect that they are only contributing to the nursing shortage. I've contacted the BON and got nowhere. Even they say if you don't like the scope of practice, go back to school. I wonder what legislators I would have to contact and what the process would be like to get some positive changes for the LPN's. It sad to think that years ago we were an assest, now to some facilities the BON has made us a burden. It would be interestng if all LPN's quit, what would the healthcare field be like then. I guess those places could replace LPN's with the imaginary RN's that there aren't enough of. Just a thought....... I, of course, don't want to be able to do everthing that RN's do, that's why I'm not a RN, but I want to be able to work to my (once was) full capacity.

I think it depends on where you live. My area kicked LPN's to the curb a while ago. Your choices were either get your RN or get fired. I know when I was in LPN school we especially focused on geriatrics, which is predominately where LPN's are. I used to think or was convinced to think by especially this web site that LPN's were pretty useless and were only ltc material, and that RN's were hospital material. Well the longer I've been a nurse, I've found out that is incorrect. In the ltc facility that I work in half of our staff are RN's, which in most ltc facilities is just unheard of. That I know of we have 4 RN, BSN's, and 1 RN, MSN going for her doctorate. I of course asked why aren't you guys in the hospitals and they proceeded to tell me that working in a hospital does not make a nurse and working in ltc doesn't make you any less of a nurse. The only place that I can't work as a LPN is the hospital. I can work in clinics, hospice, homecare, ltc, insurance companies and rehabilitation facilities. I'm sure there is more, but I can't think of them right now. So no LPN's are not a dying breed. If you don't like what areas of employment that are available to you, then go back for your RN. But if you like being a LPN with our options, don't let anyone discourage you. When I save a residents life when they are a full code, they do not care whether I'm a LPN or RN and in reality it really doesn't matter. My theory is if everyone obtained their RN, BSN and up, who would be left to take care of the patients, not all of them are going to stay at the bedside where the burnout rate is atronomical (sp). We all have a place in healthcare and all contribute something. When the baby boomers hit retirement, it'll be to bad if all LPN's are banished. Who's going to take care of them? Not us LPN, because were underqualified, NOT......

ibuprofen / oxycodone - oral [color=#006599]pronunciation: (eye-byou-pro-fen/ox carefully consider the potential benefits and risks of combunox and other treatment options before deciding to use combunox. use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see warnings). after observing the response to initial therapy with combunox, the dose and frequency should be adjusted to suit an individual patient's needs." for the management of acute moderate to severe pain, the recommended dose of combunox is one tablet given orally. dosage should not exceed 4 tablets in a 24-hour period and should not exceed 7 days.

I'm just curious as to how many jobs you had after graduating school before you found your fit and was it because nursing was not what you thought it would be? I graduated LPN school 2 yrs and 1 month ago. I've worked Family Practice and Internal Med, Hospice, and have been to 3 different LTC facilities. I know LPN are more limited in there options, at least her in Illinois, but have any of you experienced this, or am I just not meant for nursing? I don't get fired, I quit, professionally of course, because of numerous reasons. In the clinic I worked prn for 18 months, I quit because the pay was a joke. My first ltc facility couldn't keep an Administrator or DON if it's life depended on it (to wishy washy for me), the next ltc facility put me on a unit with 30-32 residents (almost all assist and incontinent) with 2 CNA's, Hospice didn't have enough work to keep me working, and last but not least my present job. I'm still there but don't know for how long. It's ltc but pretty high tech. They actually have computerized charting. There nurse/CNA ratio is almost tolerable when we are full staffed, but the cliches (sp) are unreal. This place needs the help, but they don't work together as a team. They have way to many chiefs and not enough Indians, if you know what I mean. I know I'll never find that eutopic job, but why is it that I worked at my last job as a registered pharmacy technician for 15 years? Any advice or input? I guess I invisioned nursing as patient care, not way to much paperwork, not taking orders from other floor nurses, not being afraid to ask a CNA for any type of help, and actually being able to give the type of care that when you go home you feel good about. In ltc care I've found out that administration won't stir up any trouble with the employees that are worthless, just because somebody is better than nobody. Oh and for the ones that say if I went back and got my RN I wouldn't have to work ltc, thats not even the point. I work side by side with numerous RN,BSN's, and even a RN, MSN who's working on her doctorate, they work there because they want to, not because they have too. My first job in high school was as an Activity Aide in a ltc facility. Geriatrics is where I fit, but not with all the b/s that goes along with it. I love the patient care of nursing but the other stuff is for the birds. Any kind replies will be openly excepted, any negatives, I don't want to hear.

I'm a LPN, but from what I've heard and gathered from talking to RN ASN, vs. RN, BSN is that ultimately you both take the same state boards, but a lot of the testing is on assessments and what to do first. Well, I gather that you get a lot more time in the RN, ASN because the BSN is prepping them for management so they have a lot more class time. I could be wrong, but I even talked to RN, BSN's when I was doing my LPN clinicals and they all said they couldn't believe how hands on we were already. 8 weeks after starting school we were doing clinical along with classroom. It continued until the end of school. In the RN, ASN program at the same school they were on the floors after 8 weeks until the end of graduation, 2 years later. Everyone can correct me if I'm wrong, but this is what I've either observed or learned. The one thing you definitely want to know is that if your long term goal is management, go the BSN route. I know a lot of RN, BSN who are on the floor, but most are my bosses.