2LTCnurses

In PA. it is absolutely against state reg's to pre-set meds! We have had the state pop in several times early in the morning, and it would be a big deficiency for the facility and I'm sure disciplinary action for the employee. That is the reasoning behind the "one hour before and after" dosage times. The reasoning is that you are supposed to check the meds against the MAR immediately before giving them, and if you pre-pour you can't do that. Also, just as an aside, I was previously a Unit Manager and these rules are not just something "the powers that be" dreamed up to make ours lives harder........the state sets the reg's!

Just my 2 cents worth here..............if anyone is hearing a CNA or ANYONE "yell" at a resident, that is verbal abuse and if you are aware of it and do not report it, you could be charged with abuse also! I find that verbal abuse is so rampant and a lot of people don't realize when it happens. Aside from that, many times they do try to see how far a nurse can be pushed.......the only way to break this cycle is stand your ground. If they are going to administration and not coming to you, then they are breaking chain of command and this HAS to be addressed! YOU are their direct supervisor and push comes to shove, are responsible for anything you "let" happen on your shift. If you don't have support of management then you can't do your job correctly and IMO I would look elsewhere for a job that allows you to take responsibility and charge of your residents and staff.

Hi! It would be helpful to know what area of nursing you work in. There are so many different regs for different areas of nursing. In LTC where I work......we have an hour grace to get the meds out.....because your assignment can be anywhere from 20 - 40 residents......and many are on anywhere from 8 - 17 meds:eek: The state regs for LTC are so strict.......refusing to give a snack when asked for one, for example, if witnessed, would be considered "neglect".....seriously. Food trays must be passed within a certain time frame, and all people in a room must eat at the same time, so if one of them needs fed....someone has to stop and feed in that room (if you're short on CNA's the nurse must assist!) If you fall behind on a med pass on 40 residents, you are seriously in trouble for the rest of the day!! (Also during this pass you have to stop and suction trachs, hang feedings, change IV bags.......not a lot of takers for LTC these days!!) We are also not allowed to "pre-pour" which is a huge no no. At any time a state inspector or even a Pharmacy inspector can come in and unlock your cart and check it. They've been in several times shortly after 7am.......you just never know when it will be. As far as shortcuts.......heavy sigh......not many. I just go as fast as I SAFELY can......limit chit chat without being rude, promise to come back later.....etc. It makes you feel so bad to pull a little hand off you who is asking you to stay and talk because you don't have time:o It always makes me wonder when I'm on with someone who does a pass that takes me over an hour and they do it in 20 minutes.......then you find unopened med boxes that you stocked 2 days ago.....STILL unopened! They come back with a list of B/P's.....and there is only one cuff on the floor and I had it the entire time......heavy sigh.......the most common "shortcuts" are obvious to the trained eye....... ;)

I've had multiple stones over the last 25 years, the pain is unbelievable!! Almost worse though is the chronic pain associated with what I have 'Medullary Sponge Kidney" which means I am a repeat stone former. The chronic pain comes from the crystals collecting in the tubules. I have had a few good ER experiences, most horrible. In this area, it seems that even if you go in with a complete history....surgical scars...... your Urologists PHONE NUMBER......etc. they tend to think you're a drug addict looking for a fix. Last time I begged them to just CALL MY UROLOGIST and they wouldn't!!!!!!! Toradol is not effective on my pain personally.......they wouldn't believe me and tried to give it to me anyway......I was soooooo frustrated!!!! After a few hours of me throwing a hissy fit, they FINALLY called my Doc. and then came in and gave me the right meds. I have found very little compassion......if your arm is not half severed, they don't think it's an "emergency"!!

ANY teeth thing is GROSS! We have acouple of really yucky trach's right now on our floor in LTC......I can suction and go to lunch....no problem. The WORST is when they throw up and the teeth are FLOATING in the emesis basin!!!!!1 AHHHHHHHH!!!! When I worked Med Surg we had an admit come in with maggots in a filthy diabetic ulcer.......that gave me the creepy crawlies when I had to clean them out!!!!!!

Because of this problem, we solved it by our wound measurement sheets. Our wounds are measured on a weekly basis and our sheets have a column that states the actual stage (because you can't downstage a pressure ulcer) and another column that states "visualized stage" that week, which covers the reimbursement issue. It satisfies both issues.