Cascadians

Thanks Joe! I know your email because you email my boss all the time Thanks for responding! I want to read your editorial and am very interested in hearing any updates you've gleaned regarding resistance from nurses r/t culture change. Actually, after reading Dr Bill Thomas' awesome book What Are Old People For and working in a variety of facility settings, one realizes the resistance is fear-based, and that fear is held by anybody who has a "power" position that feels threatened by the acknowledgment that CNAs are timewise and hands-on the closest members of the healthcare team to the residents. If people would just address their fears rationally, directly and openly they'd learn there really is nothing to fear; everybody can focus on best patient outcomes happily in their own role and have plenty to do! It's going to be an interesting journey ... Currently there are no official Green Houses yet in Oregon. Praying the snobs don't derail this most promising practical mode of enlightened elderhood

Well, we're going boldly where angels fear to tread Our CCRC is going to build 2 Green Houses stacked vertically with a radically gorgeous design. Leading edge innovation, thought and care. The snots are already having conniptions but don't quite get the concept yet. When they do it will be all-out war. But we have an amazing leader DHS who can pull this off. She's already gone to Tupelo and seen it all. Wonder why Joe Angelelli never responded to my posts about this? Is he not really interested in this fascinating subject after all?

It depends how skilled you are at technique. Some are Ms Tornado lickety spit and have the pt cleaned, lotioned, re-swathed and turned perfectly in 3 short minutes. Practice makes perfect! :icon_twisted:

zenoangel, I'd like to read your editorial but it's a paid-subscription read only so would you like to post it here?

A CCRC I work at is considering this. I heard Dr. Bill Thomas speak in person last week and it was very inspirational. I thought he nailed it! However, I can see huge, HUGE issues implementing this. There are definite entrenched turf wars already at work and putting the resident and direct care workers at the center of importance is going to have almost everybody up in a major snit. There is an ongoing snootiness problem at this posh CCRC and whoever attempts culture change is going to come up against massive resistance. The CNAs, relieved at finally hearing somebody acknowledge that they are indeed taking care of the patients, aren't going to embrace having 10 pts per 2 CNAs PLUS simultaneously being the cook, chef, housekeeper, laundress, janitor, maintenance personnel, etc. It's taking skilled, ALF, residential care, memory impaired care, and foster homes and rolling it all onto the CNA's back. Acknowledgement accompanied by a major duty dump isn't quite what most CNAs are seeking. I think it would work better as an all-round shift in respect, realizing that all workers are contributing essential benefits to the patient. I don't see it as a power shift but I know that where I work, the whole concept of the Green Houses will elicit a horrendous screaming marathon from all corners. Yikes.

The Dr needs to respect and LISTEN to the RN. One explanation is all it should take. The CNA, RN, Dr and pts are all at risk here. If I were the RN I would resign with a polite note and write that I would be willing to come back after the new RN was thoroughly oriented to the job and had assumed RN duties. I would never ever allow myself to be in a professionally compromised situation. Part of the education every health provider receives is to know when one's scope is threatened and to protect oneself and the pts and other staff. If it means leaving, so be it. I have found myself in this position many times and do in fact leave if TPTB won't listen. Every caregiver needs to realize that s/he is his own business -- the business of his life and career, and the only way to survive is to put one's business first with honor. Nobody will protect you but you!

We made up our own form and pass it off to the next shift. Everything documented. Learned how to write really small :chuckle Getting report isn't always easy. We want to know what has changed, what precautions are necessary, which family members to watch out for, which pts are pulling their IVs, crawling out of bed, escaping the floor, etc Especially which pt's family members are lunatics and how to curtail their antics ... or if there's a mentally ill pt, how well has their behavior been documented ... CYA kinda stuff ...

At our current SNF they hired a pre-audit consultant who said we had to be more diligent about the female chin whiskers

Fantastic! Cheers!! At our hospital, for the 3 JCAHO Hells days, all the pts (for confidentiality reasons) were listed on the board by first name only. Nobody had a clue who anybody was. Considering that each shift was ordered endless "musical beds" and a pt was never where you left them, this added to abundant confusion. Of course everybody on the floor was double or triple William, Mary, Johnathan, Patricia, and Thomas. The minute they left the building the board was erased and reverted ... management solved this by remodeling and putting the board way back in the staff room not easily visible :chuckle

trying again ... poster published in newspaper ... cracking up the entire nursing staff! and the patients ...

image code not working for hunk poster

[ Fair Use: For Educational / Research / Discussion Purposes Only ] http://www.oregoncenterfornursing.org/about/ocnnews/heyfellas.html November 14, 2002 - The Oregonian, by Wendy Y. Lawton Hey, fellas: Operation tries to get guys into nursing The headline reads like a tough-guy taunt: "Are you man enough . . . to be a nurse?" Underneath the banner stand nine macho men -- Harley rider, black belt, combat medic -- who ply the profession of Florence Nightingale. They are, literally, the new poster boys for Oregon nursing. The campaign, unveiled Wednesday in Portland, takes aim at nursing's sissified stereotype. The goal: attract more men to a field starved for recruits. A Northwest Health Foundation report released last year found that one in five Oregon nursing jobs will go unfilled by 2010. By 2020, nearly half will go empty -- just when aging baby boomers will need more medical care. That's why the Oregon Center for Nursing, a nonprofit dedicated to solving the shortage, wants to get the guys early. Next week, the organization is shipping the poster to every middle and high school in the state. "We need to appeal to the jock freshman or sophomore in high school," said Deborah Burton, the center's executive director. "They need to know that nursing is perfectly compatible with being a stereotypical male." Nursing, however, has had a hard time shaking its girlie image. Poster boy Walter Moore Jr., a Kaiser Permanente intensive-care nurse and former Navy Seal, remembers his first visit to the nursing department at a North Carolina community college more than 20 years ago. Dressed in a camouflage T-shirt, cowboy boots and baseball cap, Moore told the secretary he wanted to sign up for classes. "No, no, no," he recalled her saying. "You must be looking for the welding department." Even today, when Boy Scouts earn nursing merit badges, the field doesn't always sit well with the Steve McQueen set. When University of Portland student Bill Maddalena announced he was pursuing a nursing career, his father replied: "You'll make a great paramedic." "Nursing is highly feminized," said Gene Tranbarger, president of the American Assembly for Men in Nursing. "People think about a white woman in a white cap. They think saint or madonna. And that's difficult for a 9-year-old boy to identify with." Statistics bear this out. In Oregon, 11 percent of licensed registered nurses are men. Nationally, 5 percent are men. With a national shortage looming, guys are being wooed to fill the ranks. Health-products maker Johnson & Johnson, for example, prominently features men in its $20 million recruitment effort. But only Oregon, Burton said, has created a campaign focused solely on guys. And it's testosterone heavy. Portland-area nurses on the poster are posed in scrubs or suits or sporty gear. There's a rugby player, snowboarder, marathon runner, basketball power forward. Everyone's feet are firmly planted. Jaws are set. There isn't a single smile in the bunch. The bad-boy black-and-white image will soon spring up on billboards and may land on TriMet buses and MAX trains. The center also has rolled out a class for high school boys, dubbed "Men in Scrubs," through the Saturday Academy in the Portland area. Will the macho appeal work? Nurses said "yes" -- but that the job's versatility, challenge, fulfillment and travel must also be stressed. And there's the pay. The average Oregon nurse makes $25 an hour. "Show me the money," Moore said. "That works pretty well."

That sounds really good. Sensible. Think that one is worth printing, laminating, and carrying in pocket at all times.

lgflamini, it sounds like your family was able to provide the very best situation: Aging in place in familiar surroundings with hospice present and family members providing the intense 24/7 care. Hospice funding varies but usually seniors get this service at no cost. Some Hospice programs pick up the medications and DME costs too, along with RN home visits, bath aides, pastoral, MSW, and 4 hrs/week volunteer respite visits, and some other services available. But homecare hospice is not funded to provide actual custodial care or 24/7. And the hospice programs we work with have changed some of the meds they're able to cover. Best to sit down with an experienced RN MSW where you live who is familiar with all the programs available and all the regulations for your state. Best wishes with a very difficult time and decision. A well-prepared well-cared natural death after a life well-lived is an amazing and beautiful spiritual experience.

24/7 is considered custodial care and is not covered by normal insurance, very tragic. The government is not likely to ever change this as it would totally drain public funds. End-of-life-care is labor-intensive. Very difficult and draining. The Parkinson's pt we have now was recently moved from home --> continuing care community private apartment; 6 days later to ICF/SNF for falls. He has stopped eating and drinking. A friend of his visited and told us that several months ago, he had said that when his disease became too much for him and his family to handle, he would stop eating and drinking. The pt and family are concerned about money, but having just sold their home, they do have money for end-of-life care. The latest we heard last night was that his family didn't know what to do and he was about to be admitted to the hospital. We are praying his family gets good counseling and repects their father's wishes. This man is an amazing multi-talented person who accomplished great things in his life and held very high positions of public responsibility. His dignity must be respected. There is usally a MSW or discharge planner RN at facilities / hospitals who does not charge for counseling, coordinating and advice, and arranging care at various levels. Always a good idea to receive their services and get all the help possible. This is a very sensitive time of life for all involved and it is very important to listen to and communicate lovingly with the patient. Even demented patients have a sense of what is happening to them and whether or not they want to stay on the planet or go Home.

What we have found with hospice pts even in ICFs/SNFs is that staffing is too short to provide adequate 1:1 care for the dying. We see the best results in ALFs or ICF/SNF with a family-hired private caregiver following RN instructions. Yes, it does cost money, but using a private caregiver is much less expensive than going Agency, and after all it IS the end of the pt's life. Worth it. A MSW or case manager will probably know of several good private caregivers. For 30 years we have run our own tiny 24/7 biz, and the care we as 2 caregivers per 1 pt in hospice homecare are able to provide is far superior than the 1 aide in SNF per 15 pts (with 1 RN per 30 pts) who simply does not have time. We also work as a team in an ALF/SNF setting with approximately 11 pts on our wing, and there is no way even then we can provide good enough care for the dying, ie gentle turns/cleaning q2h, mouth care, suctioning, medication monitoring, anxiety monitoring, comforting presence, etc. Working in a hospital with 24 acute pts per wing is even dicier logistically. It was hard to watch so many dying pts (oncology) without being able to adequately care for them. Just not enough time and too many other pt needs simultaneous demanding. Anybody who has done 24/7 for a variety of dying pts knows how much work is involved and how exhausting it can be. In our ALF/SNF we usually have several pts dying, since they don't come there until their health is in quite dramatic decline.

Discuss this with your father. If he no longer can accomplish his wishes through his body and no longer wants to try to stay on this planet, and wants to go home to the Lord, talk to his doctor about putting him on hospice and letting him stay where he is with a 24/7 private caregiver. It doesn't sound like it would be for a long time. We've got a Parkinson's pt in an ICF who is about to face this same decision ...

Oh boy. The foistering of life-and-death responsibility on the inexperienced keeps increasing. It's one thing to shadow an RN and be taught and return-demonstrate tasks, but quite another to be handling care on a complex patient in an ICU, with different patients often. If the student nurse does not fear this, it is simply because s/he has not yet experienced the horror of making a mistake, or having a crisis with no help around, or having a family taking "lawsuit notes" while watching every move, or suddenly finding oneself short-staffed and having to take 2 or 3 or more patients on, way over one's head, left swimming against a raging current circled by sharks.

How about a rolling cart in the interim? We used to use the tray-passing carts to chart on the roll, stuffed with all those supplies you don't wanna run your feet off for anymore. Among all the other hats we had to wear, we were expected to be a mobile instantaneous pyxis. A cart would be a low-tech band-aid while you're assembling your hi-tech solution :)

Homecare is a whole 'nother critter :) "Live-In" usually means the caregiver can get a night's sleep. Otherwise how would s/he have the stamina to keep caring for the patient? This month is our 30th anni for our own biz -- just us 2, 24/7 homecare. Always work together as a team so we can spell each other and thus one of us is always fresh on-duty for the patient. Lots of hospice cases. Family does not have to juggle different CGs coming and going :) We no longer call our services Live-In, however, because by the time a family calls us, the patient needs assistance at night. Either monitoring because of confusion, or medication reminding, or CBGs, or help to the bathroom because of fall risks, or turning q2û, or skin integrity maintenance, or reassurance for anxiety, or trach suctioning, etc. We call it Work-In! And that's 24-hr care, more expensive than "Live-In." After all, time is valuable, and one cannot actually sleep; only rest with senses alert for breathing changes, bells, sounds of pt trying to get up without notifying caregiver, etc. Assisted Living, we have found, is not optimally appropriate for those patients with mobility, continence, or confusion issues, because their units have closed doors and they need to be able to ring for help -- and many of them no longer understand the safety need to alert their caregivers. In any case, for homecare, be sure to get the Dr to order a homecare RN to oversee the patient and caregiving!

We worked on a "medical hilltop," night shift, where not only did they float us without warning, sometimes in the middle of a shift, but through 5 different hospitals! with zero orientation on any other floor! Turns out it had something to do with new hospital Medicare reimbursement regulations, and the fact that our "home" floor manager was able to shift the cost to another unit and therefore her bottom line looked better. We were told we should enjoy it, that it would add to our skillsets, etc. It was terrifying. That, and other abuses, contributed to intolerably unsafe working conditions, so we quit. IOHO those Agency nurses who are capable of working with anything anywhere are superheroes and have nerves of steel. Floating is all about COST ISSUES for the suits, and is not nursing-oriented. It is stressful for healthcare personnel and dangerous to the patients.

When we first started posting here we used that little lab flask bubbling one that comes with the vB software, but then we used the Squirrels, hasn't changed ... doubt you're crazy, just squinting :roll Speaking of image morphing, we did a lot of eyeball adjusting before we realized what NurseDennie's avatar was! LOL! These little pics are a blast! Something we really enjoy :)

There's 2 of us, so 2 ThanksGiving Squirrels, scanned from a greeting card Unfortunately had to shrink it to get it to fit as avatar! We're sorta old-fashioned like that, and are Preppers, ready for earthquakes in the Cascadia Subduction Zone, Doomer-type stuff, so the pic is apropo, heeheeheheheheheheh, plus an old joke We tried the lab jacket but have to wear short sleeve scrubs with 3 pockets and an apron to work fast enough and have enough handy for these poor ole tired feet n legs ...

16 Pockets in Apron http://www.scrubmed.com/fund.asp

Slapping? Punching, pinching, hitting, poking, stabbing, you name it, been there. A calm firm statement that such behavior is not appropriate and cannot be allowed, immediately followed by: If pt is ambulatory, a gait belt works wonders very temporarily slipped over arms at trunk and pt gently marched to nursing station for observation while incident report, charting and documentation quickly done. The Dr notified, a psych nurse will talk to pt, a conference convened, meds possibly tweaked, and patient will learn in no uncertain terms that type of behavior is not allowed and will not help them in any way. Workplace violence is rampant and must be curtailed or it will escalate. A patient who gets away with assault will do it again and do it to other patients too. It must be stopped. As much compassion as we have for Alz and dementia pts, we will not ever work in a Dementia Unit again. We salute those who are still able to take the risks.