carolbear

I am not going to tell you how good you have it. It will only serve to make you possibly feel more insecure. The beauty of LTC is that within a month or two, as long as you work the same shift with the same patients, the medications really don't change often. If a medication changes for a particular resident, since you are already taking the orders off, you will know if there is a change for your resident. After a month or two you will have memorized most of the medications your residents are taking. You will also know where to find medications in the cart, right away. However, you still need to observe the Rights of Medication Administration, but it will go very quickly for you, I promise. Same with treatments. You will become very familiar with the treatments and will be able to do most of them by memory, unless the order changed. Charting does not need to be a book on each patient. If the patient is not a Medicare patient, most LTC's only have you chart by exception or if the resident is on alert. Please don't be hard on yourself. It takes a while to know your resident, your resident's meds and their treatments. But when you got it down, YOU HAVE GOT IT DOWN, and maybe have some down time to spend with your residents. Hang in there, baby!

I understand how difficult this must be for you. I have been in LTC for several years and have been in LTC management for most of the time. Resident's have RIGHTS. Be it a nursing home or private care home(often referred to as Adult Family Home), and even Assisted Living. If your resident is a 'DNR', that specifies what you do 'if' you found the person without heart beat or breathing. DNR does not specify exactly what one is to do for someone who is refusing medical treatment. However, in the LTC facilities I have worked in, when we have a resident who is of the same mind-set as the patient you care for, we honor their wishes. Some things you need to chart in the resident's record or keep personal charting for protection for yourself are: Any Risk vs. Benefit of not complying with medical/nursing treatment, and make sure your resident understands there is a very real risk of dying by refusing medical treatment, chart that you have alerted the resident's MD and any family member or Durable Power of Attorney of the resident's wishes. If the home has a MSW, alert them, to. Please offer and chart offers of Hospice services to the resident. If you are concerned that your resident is suffering and will ultimately die, offer Hospice Services, or recommend your employer offer Hospice to the resident. If you still remain worried, call your local Long Term Care Ombudsman and speak with them annonymously. Alert them to what is going on and ask if they have any recommendations. Call your Board of Nursing and see what thoughts they have on your situation. Better to call everyone in the whole world, than making a HUGE mistake and having to pay the price. One last thought: I made my significant other, who is a nurse, also, promise to honor my wishes. My wishes are if I get a disease that causes dementia or Alzheimer's (or any other brain trauma/injury/brain disease), that my significant other will honor my wishes and allow me to die. Do not force me to live beyond what nature intended. Good luck!

Have you thought of a specialty you might want to go in? If you have thought about LTC as an area you might go into, then I probably can help you. I live in Seattle and have lived here for several years. Just drop me a line if you are interested. Good Luck

The docs I work with are almost always happy to write for pain meds to be given routinely. That way you can be assured the resident is getting something for pain, especially if they are demented. Just be careful about being the only one who passes PRN narcs. If you are the only nurse who cares enough, and I'm one of those too, to be concerned about pain in demented patients, speak with someone in management about what you are observing and what other nurses say to you. To be the only person who passes narcs prn on a unit, you could be placing yourself under the microscope for possible diversion. As a manager, if we have med problems with a nurse, or people are saying "Nurse So-and-So" is the only one who gives narcs, etc, management does look at the MAR's. Please protect yourself and the patients. Good job for what you are doing for these poor people, just get everyone on the same page.

Going from acute care to long term care is hard enough, but to go from acute care to AGENCY Long term care has to be a nightmare. I can tell you from having experience in both settings, that the bet option would be to just do full-time LTC care at one facility. The trick to passing meds quickly in LTC is knowing your patients. Unless your on a medicare unit where there is a lot of turnover, you will know your patients, what they take and when the orders change. That is the key to LTC medication pass. Good luck, I feel your pain!

In the Greater Seattle area we all make at least 20.00/hr with bennies, in LTC. I love it!

Oh my gawd. You need to move to the Northwest! At least we make 20.00 - 22.00/hr depending upon experience and only have 25 residents at the most. I would not survive in your facility and I have many years experience! Why don't you talk to your Union and tell them what dangerous conditions you work in? Good Luck:monkeydance:

St. Joseph's HANDS DOWN. Non-profit and the bennies are good. Only problem is if you come from the West or East Coast, the pay is much less than the W/E coast. It is also a Right-to-Work State. Good thing is that they do hire qualified LPN's if you are a LPN. If you are a RN they have a state of the art Trauma Team and also world leaders in Neurology. The best TBI and Spinal Cord Acute Rehabilitation Nursing.

Dear Mean Bird, Consider me a 'mean bird' also. I have worked with many a co-worker who behaves in similar manners. I refuse to be their doormat or excuse. If it were me in your shoes, I would speak softly and carry a big stick. The next time Mr. Unhappy says he wants a hospital job, I would give him the names of some local hospitals that are hiring and just say "I hear 'such and such' a hospital is hiring. You may want to go there. Have you applied?". You could say "Wow, if you hate it so much why do you stay?" When it comes down to treatments, if you have treatment records showing that your resident normally will allow male nurses to treat him, if I had a good relationship with the DON, I would make her aware that it has only been recently that the resident has requested this special arrangement. If this nurse is really this horrible, the DON is probably already aware of the issues but may need more documentation from the co-workers in order to do something about this person. If your own performance is up to standard, you do not need to worry about going to your DON with your concerns. Good Luck!

Hi there! Welcome "Home"! I am a LPN who works in Puget Sound. I found myself laid off from Correction Nursing. Unfortunately if you have Corrections Experience (jail) you can work in Snohomish County or Pierce County. Benefits are great but the hourly would be about what you have made in Kentucky, which is really hard to live with if you live in the big city. Nursing homes in King County pay about 18-20 dollars an hour depending on experience. Hospitals are about the same, but very competitive and depend on your experience. Clinics about 16-18 dollars an hour depending what County you work in. Agency work pays better and many offer benefits now. If you want to privately or even on this forum e-mail me and let me know what County, I may be able to give you a better idea. I was recently laid off and know the salary range in my County, depending on your specialty and years of experience. I suggest sending out resumes before you even arrive. Just let me know. Good Luck!!! CB

If you feel in your professional opinion that a decision about a patient's life has been made by the POA, was made strictly for the benefit of the family/POA, you should report this to the proper authorities, ie; the state you work in, the Ombudsman and try to involve Social Work. Like most people are encouraging, it would be worthwhile to ask him what he wants. Let him know the risks and benefits of what are being done in simple terms and see what he indicates. But if for any reason he is able to communicate that he wants to live, it is your responsibility to advocate for him. If he indicates he agrees with the plan of care, then you need to respect those wishes and be the very best support you can be. I wish you the best and its always good to see nurses advocating for their patients.

As a nurse who worked in the county jail of a big city, we NEVER used our last names, strictly for what you have described. If it were me, in your shoes, I would call the local city jail and also the prison and find out what their policy is regarding name badges for the nursing staff. I would also ask them for the rationale. That way you could present this to your supervisor. If you are represented by a Union, this is a time to alert the Union and file a grievance because your safety and that of your family are in jeopardy. Or, contact a lawyer that handles employment issues. Good luck.

I just started a new position as a Staff Development Nurse. Talking and working closely with the CNA's and Nurses, I have found a common thread to poor morale. It's the one patient on the unit who is not demented but has behavioral problems. We all know the one.....the one who puts on the call light 15 minutes after the CNA or Nurse has met all the resident's needs.....and continues this behavior, often with the resident yelling at the poor CNA who has eight other resident's she must attend to. This is also a survey nightmare. You have your DON's and Administrators telling you that you have to answer the call lights within three minutes. What a horrible nightmare. To top it off the resident has been assessed to death! Nothing physical, nothing environmental AND the resident refuses mental health!! It is just the way they have been all their life. How does one deal with this type of resident and their demanding family members? Can't force psych on the resident who refuses, nor can you make them see mental health? Does anyone out there have sucessful experience with this kind of patient?