CoachCathy

Hey - My name is Cathy - preparing to go to my fifth summer at Camp Sea Gull, a sailing YMCA camp along the NC seaboard. We take care of >1000 campers/counselors at a time, it is really alot of fun - I recommend it to anyone - especially if you can take your children. I took my teenaged boys, and we were able to have quality time like we haven't seen in many years.

When a child comes in complaining of a tummy ache/head ache, immediately check temp and pulse - great indicators of heat exhaustion. Remember that the pulse will elevate faster than the temp, so it's a better indicator.

Camp nursing is great! I've worked at a YMCA camp for the past four years, and look forward to the summers every year. It's a great bridge for school nurses. I work at Camp Sea Gull. We have 800+ campers with 300+ staff. They staff 11-12 nurses and 3-4 docs at a time. We have 3 hours a day off, where we can enjoy the activities. I am able to bring my kids with me. What a deal. We handle a lot of general trauma - small (and some large) lacerations, occasional broken bones, lots of rashes. You'll see some anaphylaxis (kids exposed to new things), home sickness, and the occasional 'plague' as kids share their germs with others. It's fast-paced, but a lot of fun!

A better idea than to try to back track like your facility did is to "freeze" the chart after an unexpected death. We do that at our facility - we use a dummy nurses note for the charge nurse that was caring for the resident to chart on. At the end of the shift, she can review it to make sure that she has included everything. Then, she copies everything into the chart.

In addition to the activities listed above, we try to have a "major" activity each month. (Our activity department is wonderful) We have a "senior prom" in May, where the local single Marines escort our residents (wheelchairs and all) for dancing and food. We have gowns and suits donated by the local thrift stores. Local hair parlors come and do the hair and nails. Everyone has a blast. We do a candle light dinner for Valentines Day. Administrative staff dress up in black and white and serve the residents and their families. We have a tea for Mother's Day. We have had luaus, pig pickin's, beach days (complete with sand that was brought in) We had a Winter wonderland theme last December - we made snow men with diaper boxes painted white - had a snow man decorating contest. The residents had an indoor snow ball fight (with cotton balls). It was so much fun!

Rhona - you also have to remember that on night shift, most of the residents are asleep and may not need to be changed q2h. If the resident is dry, then only turning and repositioning is needed. Back care, oral care, combing hair, etc. is done on one round (usually the first or the last). The other two rounds, the residents are usually asleep and don't require them. When residents go bad, the nurses are there to step in. It's a busy time, no matter what shift you work. Organization is the key. take care

In our area, you can see staffing at 8-12 patients on days, 12-15 patients on evenings and 15-20 patients on nights. We strongly inform our staff to use the "lift alerts" to protect their backs. Alot of times on nights, the aides will do as much as they can with the resident, and then will "buddy up" with either another aide or the nurse to finish up. Be sure that you protect your back!!

I agree with the earlier post that you might have a meeting to help sort through some of the "issues". I would suggest (and this is from experience) that you make sure - if you have a meeting- that you be sure to separate the different levels of care-providers. By combining the CNAs (Is and IIs) and LPNs and RNs, the meetings inevitably end up trying to push the BS up to the next higher strata. I have found that starting at the "lowest" level - e.g. the CNA and moving up works - that way you are addressing the concerns of the people who really have the most contact with the patients first. Good Luck!

I TOTALLY understand about crazy family members. I, too, work in long-term care. Many nurses at the hospital turn up their noses at LTC nurses, but truly the stresses are of the same level, just a different category. There are SO many psycho-social issues to deal with - ineffective coping, frustration, guilt - and that's just with the families!! So many times (99 of 100), when a family member is expressing THAT much frustration, it usually has a basis in guilt. It is so easy to let the family members get the upperhand when they begin their tirade. If, in the back of your head, you think of them as feeling guilty, it helps to allow you to keep the upper hand. This, I am sure, would also apply to the hospital patients. Families that feel that they had been taking excellent care of Mama, and suddenly Mama ends up in the hospital, will feel all sorts of guilt and will blast out at whomever is convenient. Things to remind those crazy families is that you - as a nurse- do not order/prescribe/diagnose anything. Those would be things that the doctor (who gets paid much, much more) would be responsible to do. You, as a direct care nurse/charge nurse/ whatever, do not get paid enough to also act as a social worker/therapist. When a family member begins to spin out of control, I try to become more calm and talk even softer. I parrot back their concerns, and let them know I will alert the doctor/ nurse manager (if it is about staffing)/ dietary manager (if it is about food) etc. I don't try to discount their problem, and I don't try to run away from it. Moonshadeau- sounds like your family really needed to speak with the MD to have their questions addressed. I don't know how it is in your facility, but with confidentiality and all, we aren't allowed to discuss the patient's condition with just anyone. That's when we refer them back to the doctor. Concerned with the medication side effects? We'll let the doctor know. Want to know what the diagnoses are? You'll need to contact the doctor, as he has not made round - if you like, I'll leave a note that you'd like to speak with him when he comes in. Good luck, keep a strong spine, and have faith in your decisions/ assessments - don't let them displace THEIR guilt onto YOU!! :) Cargal - I am so sorry to hear about your Psyco-***** administrator. Administrators should back up their staff, at least to the families. What you did was certainly appropriate. At our facility - we chart by exception. You went to look for the causes and found nothing. In most cases, that would constitute normal - no need to chart. Sounds like you're a conscientious nurse - someone we need in LTC. I hope that you aren't completely disillusioned that you won't find a better, nicer place to work! We have a prior nurse as our administrator - she is tough, but fair!! Take care-

Wow, sounds like you had one heckuva night! What you may want to first see, when looking at the staffing, is were there call-outs, etc. Once in a while working with less-than-minimal staffing can happen. You know - some one calls in, has a sick child, etc. If they had four (or even five) CNAs scheduled, it takes the ratio down to 1:12, 1:15, which is really good (at least for around here). North Carolina doesn't look at exact staffing ratios, it looks at personnel-hours-per-patient - meaning how many hours a day does an employee of the facility actually provide care for the resident. Amazingly enough, for NC the requirement is only 2.1 hours/day. There are chaotic nights whereever you may go - was this an exception, or the rule. A code blue, patient de-sat-ing, seizures, someone calling in at the last minute - all can make things pretty crazy. There is simply no reasoning for the rudeness to the residents. I wouldn't ignore that - it will only get worse. You should report it (annonymously if you are uncomfortable) to the DON/ Administrator. Both of these individuals have a personal interest in curtailing verbal abuse - they could both be held personally responsible for the actions of their employees if someone were to sue. (This has actually happened, where the Adm. was jailed for the actions of a CNA). Side note to Nur20- At least in our state, we aren't 'tipped off', but we know when our window is open for inspection. Yes, we do try to tighten up during that window - focusing on the details, crossing the 't's and dotting the 'i's, but I don't think it is any more than hospitals do before JCAHO....

In our facility, the QI must be an RN with two years LTC experience. We have training within our corporation for QI, but most of it is OJT. UR is primarily handled by our Medical Records Dept, with the ADON/DON filling out the FL-2s. I have been doing QI in LTC for five years now, and I really enjoy it. I am at my second facility (I transferred to a sister facility). The facility I transferred to was rated sub-standard, with 20+ deficiencies per survey. We implemented a strong QA program and within six months, we had our first deficiency-free survey!! I like being able to see the problems and work out the solutions. Once this facility is completely on track, I'll probably transfer to another sister facility..... CJ