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squaw nurse

squaw nurse

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20+ years in nursing, love nursing and have thoroughly enjoyed the challenges of my career

squaw nurse's Latest Activity

  1. squaw nurse

    Pros & Cons of LTC physician standing orders

    We have always used standing orders at our facility and they have been wonderful. They were developed by the LTC nurses and the team of physicians in our community and are updated annually. However, the Louisiana State Board of Nursing recently issued a statement as follows: "it is not within the scope of practice of a registered nurse to initiate standing orders without contacting a physician for patient specific orders in accordance with the Law governing nursing...". The whole purpose of the standing orders is to enable the nurses to administer a Tylenol without having to contact the physician. Have any of you out there had similiar statements issued by your state boards? What alternatives have you used? Help! I feel like I'm in quicksand and need some answers. I just sent out the revised standing orders for 2002 for MD signatures. Not only will my nurses be livid, but the doctors are going to scream when I break the news we can no longer use standing orders. Please help if you have any suggestions.
  2. squaw nurse

    DNR? Why not?

    I don't know about other states but in Louisiana the major problem is lack of education about end of life issues and the DNR. Many people are familiar with advanced directives such as the famous "Living Will", and think this is all they will need. Instead of helping, the advanced directive issue has actually muddied the water for many of the elderly in my community. To deal with this problem, we have included in our admission packet a form called Request for DNR. The new resident or his responsible party initials whether they desire resuscitation or no resuscitative measures. The form describes in detail what measures will be taken or not. Once initialed, the form is sent to the physician for his signature and then becomes part of the permanent record. We include this in the care plan and then it is discussed again quarterly to assure this is what the resident and/or family desires. It is, of course revocable at any time. It has worked so well at our facility, (this was initiated approx a year ago), we now have about 80% of our residents with legal physician signed & documented DNR's. Of course, there still remain those who want everything done and we respect and support that decision. But at our facility, education of the resident and family has been the key.
  3. squaw nurse

    MRSA policy

    Never heard of this before Kimmyjc. It's not in our P&P.
  4. squaw nurse

    MDS/PPS nurses... a roll call

    I'm looking forward to the MDS Q&A's. I'll be sure to forward them on to my MDS nurse. We need all the help we can get in today's age.
  5. squaw nurse

    MDS/PPS nurses... a roll call

    I'm not an MDS nurse but am a DON and work closely with the MDS nurse at my facility. I am also very involved with the care planning process and would love to be involved in Q&A concerning the MDS process. We are not a Medicare facility so I have very limited knowledge about PPS. However, Louisiana is preparing to go to case mix this year which I understand is very similiar to the Medicare PPO.
  6. Sounds like she needs lots of love and reassurance. Was this patient previously abused? Can you tell us more about her age and history? Wish I were there to help. Sounds like a real challenge.
  7. squaw nurse

    Any LTC DONs out there??

    Spudflake, I have found that I receive the respect I demand. Not only does my administrator respect me, but he also values me, as I do him and every member of the health care team at our facility. LTC has gone through many changes during the last few years and yes it is hard work, but never in my nursing career have I felt so rewarded. I have to disagree with you concerning the end of life issues. We must all face end of life issues- some with Alzheimers, some with cancer, and still others with multisystem failure. I consider it a privilege to be able to serve and provide dignity to that special Alzheimer's patient, or to hold the hand of the terminal cancer patient. While most of our patients do not get better and return home, I find it most rewarding to be able to provide some degree of dignity to those who are no longer able to care for themselves. LTC nurses deal with those special issues such as incontinence and restraints with innovative methods all while preserving the dignity of our residents. Many of us have been able to completely eliminate restraints while decreasing falls and injuries at the same time. It takes an open mind, planning, and lots of patience. Thankyou for recognizing our hard work and the contribution we make to nursing. Though frustrating, I still love what I do and wouldn't trade places with any other nursing speciality. I've been there and tried several others and always return to LTC where I feel I can make a true contribution.
  8. squaw nurse

    Any LTC DONs out there??

    We also have had the problem with CNA's documentation on ADL flow sheets. When I searched the HCFA guidelines for direction on what had to be documented I was surprised to find there is no regulation stating the CNA must document. The only things I found to be required was nursing documentation, and of course you must have a written record of meal consumption and BM's. According to the regs, we must provide ADL's but it does not state routine care must be documented. So, to solve this problem we did away with CNA documentation. Instead we use a care sheet that describes in detail the care needed for the resident. Just to cover myself legally, I have the assigned CNA initial a sheet daily that states "I have reviewed the care plan and provided the assigned care." I'm not sure what the regulations require in your state, but it is legal in our state and pronto, no more problems with CNA documentation. This allows more time for providing care, saves time for the DON on reviewing the documentation and always fussing because the CNA has not documented. Another advantage is preventing the CNA (though most of my CNA's are great, every facility has one or two of these) sitting in the break room with the ADL book in her lap visiting with her friend and never getting around to charting. Hope this helps you guys. It has worked well at our facility. The state surveyors frowned on it at first, but could not provide me any regulatory basis for requiring it. Of course we do have task lists on which the CNA reports information to the charge nurse such as recording I&O, BM's, VS, etc, but this is not a part of the permanent record, and therefore reduces the risk of blanks on the ADL sheets which will get you in more hot water.
  9. squaw nurse

    MDS info sources

    Good luck with your new position! I'm sure you will enjoy the challenge. Ask your DON to let you train a few days with another MDS cordinator. Most are great people and willing to share their ideas. This could get you off on the right foot until you could schedule a workshop. By the time another seminar or workshop is offered in your area, you may be ready to throw in the towel.
  10. squaw nurse

    Input Needed for software

    I like the name "Interim Orders" also. But what in the world would you do with them?? Could they possibly be used as a phone order form with a signature line?
  11. squaw nurse

    nurse aides rules

    I am a DON who values all my staff- charge nurses as well as CNA's. I am very familiar some of the above situations. The facility where I work was once labeled as one of the facilities where CNA's rule. As a previous CNA I understood the philosophy of many charge nurses that CNA's are merely "butt wipers", and as a previous LPN I also understood how it felt to have my write-ups trashed by the DON. I was determined to make teamwork my priority. I started by purchasing a set of videos called "Nurses Aides Are OKAY", which help to build self-esteem and self-worth. I watched them with my nursing team (nurses aides and nurses watched them). My next step was a workshop on how to be a charge nurse for LPN's. They were taught the importance of the nursing assistant and ways of improving performance like talking to your staff the way you would like to be addressed. I even asked the most domineering LPN to teach the specific segments of the workshop. Though after 22 months we still have problems from time to time, all staff respect each other as human beings and caregivers, and all understand the chain-of-command. The LPN's realize I will not tolerate abuse of the nursing assistant any more than I will tolerate abuse of a resident; the nursing assistants realize they are a valuable member of the team with a valuable contribution. As a team they will not tolerate new persons who do not buy into the team concept. Though time consuming, it has overall been a success. My goal this next year is to work on dietary and housekeeping departments so that all function as a team for the good of our residents.
  12. squaw nurse

    Bowel Protocol

    We also had a problem in our facility with constipation/ fecal impactions. Part of the problem was inaccurate documentation by the CNA's and the nurses not taking time to review the daily documentation by the CNA's. To resolve the problem I changed the responsibility of documentation of BM's to the nurses. I just added a line to the MAR for BM's and as the nurse makes her last med pass of the shift, she asks the resident or CNA about BM's, documents this on the MAR and then administers the PRN laxative. Our standing protocal is for MOM & Cascara q3d if no BM, (unless the resident has another ordered routine laxative) and Fleets enema if no result from the laxative within 24 hours.
  13. squaw nurse

    Any LTC DONs out there??

    Hey Guys! I just found this site tonight and am so glad to see some communication between LTC DON's. I've been in LTC for 20+ years and have always felt the need for a way to communicate with other DON's to share information and ideas. I'm glad to see the number of new DON's- we need you with your fresh new ideas. Yes, it is frustrating many times, but always rewarding. As you leave work each day just think of the special contribution you have made to someone's life. I am DON at a 98 bed facility in a rural area of North Louisiana. Since reimbursement in Louisiana is nearly the lowest in the nation, we must constantly look for innovative and inexpensive ways to provide care. So I can really empathize with you Peter. After years of begging and screaming for needed supplies I found the solution. First I decide if the item is really a need or a luxury item. It it really is a need, I mention it once to the administrator. If I do not receive a response in a timely fashion, I then send the request in memo form (keeping a copy of course). Since I regularly communicate messages to my staff with memos, it does not appear I am acting in revenge, but rather as a reminder. Works most of the time. However, when it doesn't, I have the copy of the memo to refer to. Somehow things always get more attention when placed in writing. Hope to hear lots of ideas from you guys.