cindyjean

it is spring here in illinois, and with it come many memories of a happy childhood and later memories as well...as i look out into my yard and see flowers emerging. . as the first peonies poke their heads from the ground ,i think of my grandma wellman and her hopes for these peonies she planted on the wellman homestead, over 125 years ago. and as i see the cottage roses that once bloomed under my grandma schultz's window on her farm, i remember mom speaking of this many years, as hers also would bloom early summer under her kitchen window. and even dandelions in the yard...what a precious time it will be teaching my grandsons how to blow the seedings from their dried up flowers, even though i know that means more dandelions in the yard...all the more for making chains from their stems! and the wild violets that have transplanted from moms house to mine...reminds me of the story mom told of how they got started in her yard...my brother howard, now deceased, brought a plant home for mothers day...only to years later divide and take over her entire back field...the most beautiful site every spring when they would bloom...she always said...howie was coming back to visit when those violets would bloom!..(.as he will in my yard as well) i remember picking lilacs for school dances, iris and poppies on memorial day and taking them to veterans and family graves at the cemetary , and teaching my nieces and children how to make garden fairies from hollyhock flowers as we sat along the old fencerow my grandfather put in in the 1800's ... each flower or weed...has a special time to bloom a new memory for me. what a gift my mom gave me with sharing her plants...they can help so much with healing when you lose loved ones ..like a rebirth of life's memories in my mind..there is something about having flowers from my moms yard that comforts me ..and will each year as they all bring such special memories with them. wishing you each a wonderful memory this spring..times can be really rough...but there is something god gives us to heal...and i think it is called spring. cindy

I was wondering just how far a charge nurse can allow this to go? I have a patient with severe dementia that has slugged three of our aids pretty well...one had xrays done but thankfully no serious injury..I asked the DON why this client wasn't in an alzheimers unit...why are we putting our staff at risk..as we certainly are not qualified in caring for this gentleman..I was told it was because he was a well known man of town that everyone loved.that we would be ordering drugs to give hiom that may help...well they haven'ty yet..another CNA got hit last night...and the S.A.F.E.S.T. approach is definitly not working with this client...he believe we are she -devils and he is out to destroy us! My concern is where do we stand legally in protecting our staff and safety of other clients? what are you told where you work? any administrators out there that can offer any suggestions?

I know what you are feeling. My first job was in 1969 in Texas...I was given one week orientation and then placed in charge 3-11 of a 60 bed pediatric unit. I was terrified..as back then there was no PCIU and all accidents etc..came to our floor for care...including ventilators. I actually learned on the job from the doctors i worked with..they were patient and very helpful as instructors. I stayed for two years but dreaded what would come in each time I went to work as we were located centrally to three other states and got all trauma victims in to our unit if they were kids....a nightmare I will never forget. After two years, I really felt confident though and was able to handle this so much easier...those first weeks..just remembering all the 40 pediatricians names was an ordeal for me! when I left ( husband transferred in the military, I took with me what would be the best resume one could ever have...yes...those first couple years are so very hard...but you need them if you want to be a great nurse...consider it a learning opportunity..an internship..and soak in all you can..If after 1 year you don't like it then,,,then move on. that is my best advice..stick with it...none of us like that first year..you are not alone.

I still laugh at this one...( a patient with restless leg syndrome) a student wrote "sleeps with jerks" ha ha ha!!!!! also saw charted on notes one time years ago... " HWB ( hot water bottle) turned on low." ....

I guess what I was trying to state is...that where I now work, I can utilize all I have learned over the past 30 years. I have always liked "problem solving" and finding solutions for the residents best care ...would rather be out on the wings than behind a desk. ...so now I can be...that is except when monthly summaries come around and other paper work starts to bog me down. Surely there is a better way to help the nurse stay out on the floor with the patients where she can continue to find solutions and give good care, esp in the more complicated cases. at one facility ( ventilator assisted clients) we used pocket computers (radix) at the bedside for a lot of the charting..and it was very useful to us.

Due to the fact that patients get moved to new rooms( and errors are made in getting everything moved) , & plus they are not always in their rooms...we use nothing to indicate code status that is visible in the patient room ..or on the outside fo a chart. we have an * by their name on the daily report sheet we use in report each shift and any change in code status is reported as well.On the very front of the chart is the orange sheet that states their code status and also living will, POA etc... also on the top of each med cart of each unit, is a list of names with the *. we only have 9 people that are full codes out of 70.

I found that I have gained skills in LTC. At the hospital( where i worked 25 years) , we had a respiratory dept...at the home..I am the resp therapist at night doing as many as 15 treatments at times ( and there is much to know about this ), I am the physical therapist, continuing with gait training with RW , as patients ambulate to the BR at night.. and following up on PT recommendations. No where else but LLC does one have so much responsibility in assessments..and for the doctor to rely so much on your astute observations. In a hospital, the doctor and others watch the same patients day and night..but in LLC it is you alone and your CNAs until the next shift comes in...and it can happen in 8 hours. I am gaining skills in documentation I never had to have in the hospital setting to such a great degree. Nor do you see such attention given to skin assessments in the hospital for short term stays....which is obvious when the client reaches us.and there is so much more to add...no specialized units...you see it all in LTC and it is a very special person to learn the ways of communication...so add speech therapist and swollow evauation on top of that. ..lets see...how many hearuing aids have I changed batteries on, cleaned and put ionto a patients ears? yes..you are all skillful nurses!

this is good advice and i will adda little more if you don't mind.. 1)make sure your diabetics get their hs snacks ..also make sure am and pm insulin is given on time and they get their meal right away as well..many times kitchen helpers get busy and don't get the diabetics meals to them quick enough. 2)trust your instincts if you think some ones going bad they are . listen to your cna's that have been there caring for that patient for a while...they know what is abnormal behavior from his normal behavior..if something seems different it probably is a sign... for example..mrs. b suddenly confused during the night and bed wetting....ends up a full blown uti at times...or worse, a subarachnoid hemmorhage. 3) if they are not a dnr and are going bad get them out of there quickly our local ambulance service comes within 5 minutes of a call to them...trick is..how fast can you photocopy the needed documents, call the family and doctor..if in 5 minutes...you are doing super! ha! 4)learn from your cnas they do more 1:1 with the residents and they notice changes quickly yes...very true! cna's really are helpful and love being included on things you are watching the patient for as well. i share a special report with my cnas after i get my report..it is a good one on one time with them as they share their cna report with me as well. and the patient benefits. 5)pace your self find some thing about a resident that will put them in your memory and so that wont be just that little old lady with grey hair and glasses(that describes most of them) i found this to be true as well. mr b, a navy pilot...mrs g a 3rd grade school teacher..or mother of 5 ...it works! good luck i love working at ltc facility and i adore my residents,only problemis sometimes i get my heart broke cause i meet them so late in lifebut all in all its worth it.... :nurse: isn't that the truth though...such wonderful people with such amazing stories to share with you. it seems that by the time they come to the home they have "shut down" their wanting to tell you these things and i find it rewarding when i can get a client to start talking about their life with me. problem is...time...so i go visit them on a day off and get to know them better. believe me...it is really time well spent. do you all realize i cared for a man that once was a player for the chicago cubs? a teacher that taught school in a one room school house to 8 grade leves at once? and a man that fought in the normandy invasion (as described in saving private ryan) and a nurse that worked on a hospital ship during viet nam war? and a man that went to grade school with ronald reagan? wow..what stories they all had to share! but i enjoy each of the residents..all are special whether they talk or not...there is always some kind of communication going on.

Our DON said she got in trouble by the state for scheduling herself as part of the staff once at another home..she is not to be working on the floor in place of another nurse that should have been there. she is great about helping with the orders and pitching in but pretty much sticks to her responsibilities...which is a good thing too...she has many!

Yes..always . Unfortunately, ours is a 6 page form even an investigative officer would groan out load about..but it is an absolute necessity to be done.. No matter how long it takes nor how small the incident is. As a busy nurse I just cringe if a CNA comes to tell me about a small skin tear the patient got brushing against a door..or a patient strikes out at someone and so forth..all incidents have to be reported..some immediately to our state within 24 hours, for example a hip fracture

Yes..our home uses the mobility alarms, tag alarms and wanderguard alarms. ( they signal if patient going out the front door. ) they do work well though and we find ourseves out in the parking lot quit a bit each week going after someone! as far as staffing, I am the night nurse for 70 residents on three wings.( both long term care and a Mediare wing) I have three very good CNA's, one on each wing full time. I never worked so hard anywhere in 35 years as I do at this job. Charting has been the big challenge for me...over the years I can see this has becocme a main issue for nursing homes...and I have been their worst night mare , as i love being out with my patients and not behind th desk charting! but I am getting there and they tell me my nurses notes tell a good story of what I do for them...it is all the other data we have to chart about, other than in our notes that bogs my mind! If I did everything I was suppose to do in charting, i wouldn't even get to see and assess the residents. another big change i see in nursing homes...they are very high level care anymore...with patients coming back from hospitals with feeding pumps, IV's, nebulizer treatments..and so forth...I had 15 neb treatments one moring to start...and as you know, there is more involved in giving a neb treatment than turning it on..you do breath sounds, saO2's and how they are assessment wise after the treatment ..then to document it. Yes, it is a big job..but a wonderful place to work..these are such speical people I care for. .