djewel

Hello, did your DON have also a charge nurse along with the ADON and MDS Cordinator? I know my DON is very busy, never said she sat on her behind??? I have been a DON and never had the privledge of having a ADON or MDS, I did it all, but it was not a SNF, it was a reg. LTC. I had no Professional lic. nurses on every shift, so I had to take call 24/7. My question is still this, was is normal in a small SNF, are they all different? Is it common to have 4 nurses on a day shift, while the other shifts suffer? I know everyone is very busy, no one just sits all day at this home, just curious to find out from others what thier homes have as far as staffing/Nurses, DON, ect. in a small SNF???? If anyone could comment, thank-you.

Thank-you. So how big is your facility and what is the day staffing for a SNF? I am curious on how other homes are ran. Does your DON delegate any of her responsibilites to other staff, like her MDS, or a charge nurse? I know for a fact that a nurse does'nt sit on her bottom at night, there is always plenty to do and more. Even in a small home I run all night doing Skilled assessments and meds ect. ect. I like working nights as it is better than the eve. shift, as I can't keep up when I do the eve. shifts. I have to do what does'nt get done on the eve. shift, but in all, it is better besides having to change my sleep schedule around, this is probably the most wearing on my body. Thank-you for you help.

So what is customary for staffing for a SNF in Mng? I have too, been on both sides of the fence. I am not saying that any one job is easy. I am just wanting to know what to expect from Mng.? Should the Don have an MDS plus 2 nurses on her shift? This seems alittle unrealistic to me unless this was a very large faciltiy. This is a very small facility, so I am just wanting to know again, what is customary in staffing? I was once a DON, plus did all the on call, MDS's, Care plans, med orders, had a charge nurse only and that was it. This was not a SNF, so I am not clear what is expected from a SNF? I took care of upper mng, plus dealth with families and residents on a daily 24/7 basis. I felt very overwelmed, but it was all done. I did not have nurses on the other shifts most of the time, this was very rare. The ADM and myself took care of everything. It is very hard as an eve. night nurse in a SNF to feel as I am doing it all, when I am not. I relize the day shift had their stuff to deal with also, but in reality it just does'nt seem quite fair to me that the day shift has all the help when the eve. and night nurse has little. ADM will cut the direct care and keep adding to every dept. for the day shift. It just does'nt add up to me. If anyone can assist me , please do, I am desperate. Thank-you so much!

I am wondering what the staffing should be for a LTC facility which is a SNF. This is a 50 bed SNF that has a DON, MDS, and two nurses and a DON assistant all whom work in the day shift. Is this customary? The last LCT facility I worked in had only a DON and Chg. nurse during the day shift, this was not skilled. The eve. shift has only one chg. nurse whom is overwhelmed with usually only 2-3 aides. The night shift has also one chg. nurse and 1-2 aides. I believe the day shift is over staffed while the eve. shift struggles. If anyone has any imput I would appreciate it. I work the eve. and night shift at this time and it is very difficult to get everything done. Usually the admits come on my eve. shift, and I am still responsible for the skilled nursing assessements. I also get labs late in the day, have to answer the phone, and deal with just about everything. Thank-you for any imput on this!

You cannot escape the sadness you feel when you loose a pt. I never said it was easy, it gets better, you learn to cope. You have got to understand dying is apart of living, and it always hurts no matter what. This may sound really corny, but we are all travelers on this earth, it is true, I believe. We all have our time. Another story of mine, is that I took care of a boy with CP for almost 7 years. I became close to him. But I never forgot I was his nurse and he would someday die. He lived so much longer than he was surpose to , he was 18 years old, the size of a nine year old. I grew close to his family as I did homecare. I was'nt as upset as I thought it would be, I guess is because I knew it would happen someday soon. I expected it, and knew he only had so much time on this earth. If we treated everyone like that, I think we might look at things differently. We might go that extra mile for someone, we might give an extra hug, we might spend more time, and give just alittle more. I miss him terribly, but I saw so much of it when I did hospice, I just know myself, I am only here for a short duration and so is everyone else, we just don't relize it too often. We can't spend our lives worrying about it, it's just the way God created us. When people die close to us, it takes alot of time to get through it, but if you can put something positive into something you think is negative, we all gain. I still see Bobby's mom, and she is still having such a hard time, if I could take all the hurt away, I would. I am definately designed to be a nurse, and get so frustrated with all the rules. I just gotta be me. My motto is this. "I can't do enough, so I want to do more". jewel"

Definately I would, no question. I started at $12 an hour 15 years ago. It was not about the money when I started, it was the fact it was in my heart to become a nurse. Yes, I too needed the money, but it was a small part of why I became a nurse. { it might have been less than $12/hr, but it was'nt more}. I live in a small community, and have to travel for work, so what I make now, is below what other nurses make. But there is nothing greater than what you recieve in life, if you are not happy with what you do. :kiss

I think it will get easier. I remember my first pt, that died. I was very emotional about it, I was crying so hard, my instructor told me not to be in the room with the pt. after the death. I still remember that day, it was very hard. I think I grew from that first time in seeing a pt. I cared for and now gone. She was getting ready to go home, and had turned for the worst. I have been a nurse for 15 years, and it is never easy, but you learn to cope, and being there for the family is so important. I worked for Hospice for awhile in my later years, and it seemed I was always around death. I would think of my own family making my trips to see my pt's. I think God allowed me to do this kind of work, because I have such a soft spot for the dying and I needed to experience this over and over, to make me into a caring nurse. It has gotten easier, but it will never be something I go through and not learn from. Life is a gift. Being a nurse, is so special. It will make you a better person. You learn to deal with it, and to be strong for the family, that needs you even if you think you did so little, the family will always be grateful to a caring nurse. After 15 years of dealing with the living and the dying, it is all apart of living. Death is not the end, it is the begining. It makes me feel like I was glad to be apart of the pt's life, during the time of need. It will get better, and it will make you stronger, and you will grow and learn in away that is needed in order to become a good nurse. Good Luck and God Bless.:smiletea:

I think it will get easier. I remember my first pt, that died. I was very emotional about it, I was crying so hard, my instructor told me not to be in the room with the pt. after the death. I still remember that day, it was very hard. I think I grew from that first time in seeing a pt. I cared for and now gone. She was getting ready to go home, and had turned for the worst. I have been a nurse for 15 years, and it is never easy, but you learn to cope, and being there for the family is so important. I worked for Hospice for awhile in my later years, and it seemed I was always around death. I would think of my own family making my trips to see my pt's. I think God allowed me to do this kind of work, because I have such a soft spot for the dying and I needed to experience this over and over, to make me into a caring nurse. It has gotten easier, but it will never be something I go through and not learn from. Life is a gift. Being a nurse, is so special. It will make you a better person. You learn to deal with it, and to be strong for the family, that needs you even if you think you did so little, the family will always be grateful to a caring nurse. After 15 years of dealing with the living and the dying, it is all apart of living. Death is not the end, it is the begining. It makes me feel like I was glad to be apart of the pt's life, during the time of need. It will get better, and it will make you stronger, and you will grow and learn in away that is needed in order to become a good nurse. Good Luck and God Bless.:smiletea:

Thank-you for your all of your imput.

Can't a living will or Advance Directive be the same as the DNR? I don't really understand why you have to have a DNR, if you have an AD or LW. I had been gone for several days, and the day nurse did not report that this pt. was actively dying. I called the nurse on the eve. before and she told me to go by the hospital transfer sheet that said, DNR. But the DON says we can't use that? This eve. nurse said the pt. was actively dying on her shift, but was a re-admit, so the hospital dismisses her actively dying. It just does'nt make since to me. Here I am an hour or so into my shift, finding her dying, and have minutes to an hour and 15 min, to call the DPOA which was unavailable, then the AD says to not use CPR, along with the sister that I got ahold of on the phone, she says, she has a living will, do not resusitate her, so with all of this info. I did not do CPR. So is this a law that you have to have the DNR in the chart, is it my responsiblity to get it, I was just thinking with everything aboard, I was doing the right thing. I though MD records was surpose to have everything ready for the nurse, to quicky assess whether to resusitate or not to resusitate, there were no clues from the MD records not even an updated face sheet for information, and then I am called into the Don's office to make out a statement, and later reviewed it was a disciplinary form, which is being appealed by myself right now. The other nurse calls the state and they tell her all we need is the AD? I am so confused. Thanks if you can help.

Also, how long does the Nursing home have to update the chart after a readmit? Nothing was redone in the chart, after this readmit 24 hrs after. Then I am the nurse comming on duty, working part-time not able to find anything in the chart only the AD and the DPOA, in which the DPOA was out of town and not available. Should'nt the NH have had everything in place. I had an hour and 15 min to work before this pt. passes away, trying to take care of 40 other pt.s also. Thanks so much!

Okay, this re-admit was done 24 hr. ago before my shift, and this nurse tells me that this lady was modeling upon return from the hospital. I could'nt find anything in the chart except the AD, and thats what I went by, with the other nurse telling me she was a DNR by transfer sheet of the hospital. The family, then tells me she has a living will, and do not resusitate. Was I still surpose to do CPR, knowing her family is telling me not to, and she has a living will not in the chart? Thanks for you help.

Hi, I was wondering if a pt. has an Advance Directive, and it does not conscent to CPR, then is'nt that all a nurse needs to have in the chart to not start CPR? I am being told by my DON that CPR should have been done on a pt. She did not have a DNR order, just the AD. I am told I should of sent her to the hospital or started CPR. The DPOA was out of town, and I could'nt locate him until after the death. He asked nothing about whether I did CPR, but the Medical Records is saying I should of done CPR since there was no DNR in the chart. I am so confused. This lady was a readmit the day before she died, and the hospital information also said she was a DNR, although we did not have that order. ALso, I called her sister and she told me not to do CPR. I am afraid to call the DPOA and ask him. What are the state regs on this, does anyone know for Kansas? Is my DON right, or is she denying the AD. This lady had COPD, and the family knew she was not expected to live very long. Can anyone help me on this, please. Thank-you!

I want to tell you to not give up. I too, had a bad experience in a hospital. I had a Nurse tell when in nursing school, that I would never make it as a nurse. I was one of the outstanding students in my class. I tried very hard and was very dedicated. I have found through my last 15 years of nursing, that their are alot of choices for nurses, not just the hospital routeen. You could work as a Home-health nurse, Case-manager, ect. there are so many options depending where you live. There are alot of caring Professional Nurses out there, there are also those that just do it for the money, and their attitudes, I don't know how they made it in nursing school. My instructors would of ate them alive, if they treated anyone so demeanful. Just don't give up, if you enjoy caring for your patients. Nursing needs more nurses, that really care. I still deal with those type of nurses, who want to be judgemental, you have to be non-judgemental to be a "Real Nurse". It takes self-preserverence, and having that self-confidence. I felt like it was my calling to be a nurse, that's the only reason I have'nt given up. Because it is very hard at times, and very pleasing other times. Don't let others destroy what you have worked so hard to achieve. Give it another shot, and you might have a different experience. I too, stay away from hospitals. Good luck!

Thank-you. Can you explain the MDS 3.0/ I have'nt done any skilled MDS yet. We call the Physician order sheet, the POS. What is the PPS? Thanks a bunch! Our facility is 48 beds.