suzieqlpn

I work in a long term care facility. I am also on the contract negotiating committee for our local union. During negotiations the subject of staff was obviously discussed. I was informed by our administrator that the state of Michigan only requires that long term care facilities such as our have an RN on staff for 8 hours out of every 24. The 1:30 ratio for staff to patient is all licensed staff to patients. That means that when those counts are figured they are using ALL licensed staff in the building for each individual shift to current patient census. In our case we have 78 patients in the building and they are including the DON, ADON, Social Services Director (who is an RN), the MDS (an LPN) coordinator ,the afternoon shift supervisor who is an LPN who never works afternoon shift, 2 ward clerks (who are CNA) and 2 float/treatment nurses in our count but there are currently 1 nurse and 4 CNA to 35 patients on the day shift and afternoon shift. On the night shift there is 2 nurses and 5 CNA to 78 patients. I am one of those nurses on day shift. The only time you see those in management out on the floor helping with patient care is if the state inspectors are in the building. I spend 80% of my 12 hour shift passing meds, 10% helping the CNA with patient care, and 10% doing assessments and charting. I am lucky if I get a chance to take a break and go to the bathroom. Bottom line the patient to nurse ratios need to be realistic for the types of illnesses we are seeing in the 21st century. This isn't the 1950s.

There is an RN at the facility where I work who disagreed with me on a staffing decison. We had an employee call in for their shift and had to be replaced. Calls were made and a replacement was not found. Someone currently working would have to be mandated to stay over. Our facility is a union facility and I am a Union Steward; I am also an LPN. I was trying to explain to her that by not following the rules in the contract I would be forced to file a greivance to represent the employees effected. She looked at me and said "too bad". I was assigned to one wing in the facility and she the other. The wing I was assigned to put me in charge of the whole building for the weekend. I reminded her of this and in front of residents, employees and VISITORS to the building--"Jane Doe is staying and that is the end of all of this. That is why I have RN after my name and am not some stupid little LPN". I was furious. The difference in our job descriptions is only IV insertion and IV push meds. That is the only difference oh that and $12 an hour. Justice was served for the employee who was wronged with a grievance that gave them their lost wages and she got nothing for her behavior! I may be an LPN but I am an LPN who has 20 years as a CENA before I became an LPN. We are valuable members of any patient care team!

I attended St. Clair county Community College. They have a campus in the Pt. Huron and Bad Axe (the thumb) area. I attended the Bad Axe campus. Tough program but very good. Full time attendance only in Bad Axe. Can go part time in Pt. Huron. They have website---www.sc4.edu My class of 2005 started with 30 and finished with 27. All of us passed the board on the first shot. Excellent instructors.

Our facility uses the protective ointment from smith-nephew..the aides call it blue gel (it is a blue gel), epc(extra protective ointment--white creamy cream) on our incontinent patients. EPC for excoriations and blue gel for those that are incontinent but not excoriated. The problem with the EPC is that it is difficult to wash off with regular soap and water and the aides have a really hard time understanding---a little goes a long way. These two products work well at our facility. We also use their brand of peri-wash incontinent spray to wash them up after incontinent episodes to get the urine off the skin.

In the facility, where I work (LTC-skilled), the non-licensed personnel are inservice semi annually on these types of cases. If the resident has MRSA in an open wound, a water-proof dressing is always applied by licensed personnel before the bath is given and the non-licensed still use contact precautions

My lpn program required the purchase of a procedure manual for all sorts of things...catheters, enemas, injections, dressing changes, etc. It also included assessment. I just about wore the book out. It was very helpful. I also found that for an assessment it was helpful to write it out on scrap paper and read it back to yourself before it went into the chart. I always destroyed the scrap paper, of course. I was always proud of the fact that my instructors would send other to me when they needed help with charting.

i work in a nursing home and often we keep confused residents with us that are fall risks,....so we can keep an eye on them and prevent a fall. last week, i had a 96 year old female confused resident with me along on the med pass...she was moaning and i asked her what was wrong. she said she was in pain....her abdomen...so i started asking questions. she looked up at me with the most sincere and unconfused face and simply stated "i'm having my period and i can't hardly stand it. it is flowing so hard, i can feel it." i couldn't contain my giggles and had to turn my back. just then one of our permanent cnas on the hall asked her what was wrong. she gave her the same reply. the cna however, decided to play along and asked her "are you sure your aren't pregnant?". this resident just looked at her with the straightest face and said "you damn fool, didn't you hear me i said i have my period." neither of us could contain our giggles and had to play along with the "period" to keep the resident from becoming upset and agitated. gave all of us a good giggle on what was an extremely busy day.:chuckle

i totally know how you feel. graduated in Dec., boards in March. i started orientation in February but wasn't allowed to do anything till they could confirm my license. now i have been working on my own for a few months, and feel like they are head hunting. a few weeks ago, a senior nurse on previous shift gave me report at shift change. he stated that their was a problem with a patient's wound vac. in nursing school...we didn't come into contact with wound vacs..didn't even talk about them. he stated that their were no more supplies and if i (emphasize I) couldn't get it running and keep it running. that i would have to apply some type of dressing to the wound after removing the wound vac dressing...vaguely remember something about a wet to dry. I got the vac running and was able to keep it running until about 2 hours before my shift was over. i ended up shutting it off about 45 minutes before the end of my shift. gave report and asked the oncoming nurse what to do. she said to leave it and she would have our wound nurse take care of it when she came in (about 20 minutes later). yesterday, i was written up for the entire incident. the nurse who was having the problem with the vac in the first place told them that he told me what to do with it....but failed to tell them that the vac was off when i came on shift and the other nurse never notified the wound nurse until 2 hours after i gave report. she wrote me up because it took almost 1 hour to peel the wound vac dressing off the patient. like an idiot, i stood there with tears streaming down my face and took the blame for everyone else's negligence including my own. i decided right then and there...never again. the male nurse i work with is a hot shot who gets away with a lot of things he shouldn't and passes alot of stuff onto the new nurses and laughs when we don't do it right and get called on the carpet. i have written a detailed letter to the wound nurse detailing the events of that evening...i admitted my responsibility but also stated that it is important that he be held responsible for his actions as well and he was......i feel like i won a little battle but not the war cause now they are scrutinizing my every move and nursing action.....gonna have to fire me though....i am not giving up keep your chin up and talk to someone in management....my ally was the wound nurse's boss....our DON

When I worked as an aide, i took care of a very funny, gentle man, named Clayton. He always asked for money from his wife to give "his girls" a tip. He was quite alert upon admission but as time went on things changed. We were not allowed to accept gifts from patient's families or the patients without permission. As his memory declined,we came up with the idea to give him poker chips--as he had alzheimer's and thought the chips were money. Every day he would give each of his girls a few chips as a tip of gratitude. He died a short time later and we were all deeply saddened by the loss. Shortly after he died, we were all summoned to the conference room for a meeting. When we arrived, we were greeted by his widow. She presented all of "his girls" with a gift left to us in his will--a tip of $15.00 a piece. I still have the check..and the beautiful letter written to all of us in his own hand before he declined. I will treasure that gift for the rest of my career. Every time I get down about the day's events, I pull that out and remind myself that I can and do make a difference.

I was given a glass nursing hat with a poem from my girls, a nursing statue from my husband with a hand written note telling me how proud he was of me. My most treasured gift was a hand written note from my mother with a lady bug pin pinned to it. Someone once told her that to have a lady bug in your house or on your person will bring you good luck, prosperity, and positive thoughts. My father died when i was quite young. My mother worked very hard to teach me the value that if you want something bad enough, you have to work for it and when you achieve it be proud of yourself for it. (Happy Birthday, Mom :biggringi )

Our policy is to do the chemstrip at 6am, and then give coverage units of regular insulin on those patients.

i paid the money to find out because i took my nclex on a thursday and ABSOLUTLY couldn't wait to find out until Monday or Tuesday of the following week. I figured it was only $10. I mean I had already paid $250.

Teamwork is expressed at my facility strongly. I was a cna at my facility while in nursing school and before. I am always willing to help and the CENAs on my shift know it. There have however been times when i have always been unable to but I get on the overhead page and page someone to the room to help. A few weeks ago, I wrote up an aide who was sitting on a bed watching MTV on a resident's TV, gossiping on her phone, but told a new CENA to our facility she was too busy to help. She filed a union grievence but my write-up held, because the new CENA finally got fed up and did the transfer all by herself and it resulted in the resident getting a skin tear that required steri-strips. Talk about being ticked. :angryfire

just remember to breath. have confidence in your self. and think how bad do you really want it. it worked for me.........Good luck....praying for you