Mrs. M.

I will be posting a position for a subacute manager soon. Salary will be $90,00-98,000 DOE.

The 5 Star Rating system went into effect today. It starts with your annual survey results, then adds and subracts stars based on your QM data and your staffing. I am also very frustrated with the pressure ulcer information. Our Transitional Care unit specializes in wound care, so we admit many patients with pressure ulcers which we heal very successfully. Unfortunately, it shows up as a bad mark on our facility, because there is no differentiation between "admitted with" and "acquired in facility"

Utilization Review, perhaps?

Bed rails can be very dangerous. The CMS (CDPH) data shows that there were 46 deaths last year related to people basically hanging themselves on their bed rails. Care planning is the key. If the resident uses the rail for mobility or requests that the top rails be left up you are good to go, as long as it's documented.

You need to get the list of approved abbreviations from your hospital. I have struggled with eliminating many of the old standard abbreviations from my routine, but I've had to change because it is a patient safety issue. Better to learn this correctly now than to have to re-learn later.

I sent a CNA home just last week because she was wearing artificial nails. I gave her a copy of the policy, explained why we had such a policy, and told her not to come back until they had been removed. She came back the next day with the nails gone, and not another word was said.

That sounds about right. We run 8:1 on day shift and 12:1 at night (24 beds). Our unit is somewhat unique in that we do have a lot of wounds that come from other hospitals and SNFs (as secondary diagnoses), and we have a dedicated treatment nurse for that purpose on days.

Central California - we start our new RN grads at $34.00/hr.

Congratulations on your new position! At our facility, the TCU is very much like the med/surg units that many of us use to work on. The acuity can be quite high, and the diagnoses are all over the board. It's a great unit to start with, because the length of stay is a little longer so you can learn more from your patients. You will most certainly see diabetes, heart disease, chronic infections, etc. You are likely to have people admitted with significant pressure ulcers, and people who have been non-compliant with their care at home resulting in re-hospitalization.

Our Subacute and Transitional Care units are departments within a hospital system, and we have a career ladder just like the rest of the hospital departments. RNs put together a portfolio of their accomplishments which include any PI studies they have participated in, research, Unit Based Councils, policies they have written or helped write, etc. It doesn't carry over from year to year - the nurses have to reapply each year to show their continued involvement in projects which advance the professional practice of nursing. It's a ton of work, but the rewards (including financial incentives) are worth it.

the immediate answer is you need to have someone else do it or do it yourself. don't let the patient suffer for someone else's poor work ethic. then, as a don, i would expect you to document the situation carefully so that i could go to the cna and get a convincing explanation or proceed with corrective action. there is nothing more frustrating to a director than having a gut feeling that someone isn't doing their job and not being able to get anybody to document what they know.

If you are going to leave anyway, that's all the more reason to go to the DNS. Your co-workers will appreciate you, and the DNS needs to know that she has an ineffective manager. The manager is putting the facility at risk.

Four months ago we began q 2 hour rounds for the 3 P's - Pain, Potty and Position. Both our fall rate and restraint use have decreased significantly. We are also have very few issues with skin integrity.

We have a chaplain who comes through to visit, of course. This resident chooses not to engage in discussions about spirituality. Our Activity Coordinator spends a lot of time with him. He likes trivia games - he's quite intelligent. He watches other movies in addition to the Mediaographic movies. He is learning Spanish using Rosetta Stone software. We have a facility pet that visits him, and some of our staff enjoy going in to talk with him. He is actually more content with his life than a lot of able-bodied people that I know. The only problem is with a few staff members who have major issues with the Mediaography. Even though I've made it clear that they don't have to be involved in putting the films on for him, it bothers them that it is allowed at our facility. Their most recent argument is that if an emergency were to occur in his room they would be exposed to the Mediaography. He has never expressed any interest in child Mediaography. He likes women. A lot.

Exactly. They will be looking for how you have handled things in the past rather than how you would handle a situation in the future. My advice is to think of several situations from you past where you handled very challenging situations with doctors, co-workers, and patients, and reflect on how you handled the situations. This will help you to be able to come up with your example more quickly.