Maedele

We just finished survey on friday 11/13/09 but they wont exit till monday that is when we find out the results, it shall be interesting. This was a very different survey called QIS, I believe it is the same everywhere? They walked around with their lap tops, no status reports at the end of ea day. Not many questions about restorative programs. They did ask for bladder and bowel assessments but both residents they asked about are continent of both, one has a toileting schedule as part of fall prevention, she had falls r/t toileting needs. I did the initial incontinence monitoring for 7 days using the dot form to establish a voiding pattern, and the other resident did not a comprehensive assessment since she is able to use BR on her own or ask for help and is continent. They seemed to accept my answers after reading my quarterly restorative assessment notes. We recently changed to charting by exception, we have 8 codes for the RNA to use if resident is not doing program on scheduled days. If resident does program RNA does not chart. I really likes this much better, reduces time spent charting, Our Rehab dept is aware of our charting system and will let us know when it is important to document distance walked and minutes for programs to monitor progress otherwise we use the same charting for medicare residents. We have group programs which does help, but we run into the problem of having the residents ready at the time needed for the group, they either need to be toileted, or have been laid down, I send schedules of groups to ea unit nurse manager,give a copy to the charge nurse and post it for the NAC's and yet it continues to be a challenge. I'll write some more by the end of this week, thanks for keeping the thread going we really can learn a lot from each other, I believe that we all have strength that we can share and learn from.

It would be great if we could keep this thread going. Being a Restorative Nurse is rewarding and can be fun and at the same time very frustratin, my RNA's are constantly pulled to the units or asked to do other jobs which means that many days programs are not done for all residents sometimes we can only get to 25-30 out of 60+ programs per day. I have 3 RNA's ea has about 20-22 programs daily, we have PSFP for 3 meals, have to assist in the DR's, provide transfer training, look for equipment, and on it goes, all this in 7 hrs/day. We recently implemented charting by exception for the RNA's and I will summarize quarterly about resident's progress, how much residents participates or not, and so on. We rarely get coverage in our department when RNA is sick or on vacation. How is everyone else dealing with these issues.

In Washington state, it is requiired to do the 1st step within 3 days of hire, and the second step 7-21 days after the first step. If an employee has a documented negative 2 step or 1 step within last 12 months from a previous employer we are only required to do a one step on day of hire. Could this be the facility's policy?

I'am the restorative nurse at my facility and I make it my daily mission to enforce use of gait belt. It is a safety issue for the residents as well as the staff. Anytime an NAC walks with a resident even if only SBA they use gaitbelts , only if the care guide states that resident refuses gait belt is it OK not to use it.

Thank you for saying that, I so agree with you. It is not always easy dealing with difficult patients but often depends on how one responds to them. If I ever have be patient in a hospital I hope to have nurses with your inside assigned to me.

Thanks for the info, I've been having some issues with CNA's following the programs as it is easier for them to just do everything for the residents instead of taking the time to encourage them do things for themselves. Anyone else having the same issues? I will stick with it.

Hello, I'am a restorative nurse from WA-state and would like to know how you set up your restorative programs, I have 3 regular RNA's and 1 to fill in on days off. Each RNA has 22 restorative programs, this does not include any ADL restorative programs such as eating, dressing/grooming or toileting. Then NAC's are to do these programs. it's not easy to get NAC's to follow these programs, it's always the same, "we are too busy" yet it would be much easier for them just to follow the program and help the resident's to either improve or maintain their abilities. Anyone experiencing this sort of problem.or do you have a better/different set up. Any input is greatly appreciated. My RNA's too get pulled on the floor very frequentlyand I'am starting to put my foot down and say NO unless it is the least resort. It seem that many don't believe restorative is an important department, but I do get panic calls when residents fall or have skin break down. Funny how that works Thank you, Maedele

:balloons:CONGRATULATIONS :balloons: Best wishes and success in your career as a nurse. Maedele

I wonder how "these nurses" would feel if they were sick in a hospital and their nurse would "fake" assessments and therefore they might not get the medication or treatment they need or maybe even worse..DIE.. But I'am sure that thought never crosses their mind.

How many hours do you spend per admission on average? I'am curious as my DNS thinks we should be able to complete an admission mostly within 4 hours that includes head to toe assessment, and ALL the paperwork including contacting physican verifying orders and so on. Thanik you in advance for your reply Maedele2003

Hello and Happy New Year to eveyone;) I haven't read all of the responses, hopefully I wont repeat something what was posted before. My thought on pain management is "pain is what the patient says it is" period!!! as some of you also stated. There also is a difference between drug " addiction" and "physical dependency". When a person takes opiods / narcotics for pain management they will experience physical withdrawl once they stop taking their pain medication or if they wait to long before they take their next dose. This is a normal physical response. Most of the time the dosage prescribed is just enough to cover the pain, and there is nothing "left" over for a "high" for these patients. Nurses and Doctors often mistake a person crying or being withdrawn after stopping opiods/narcotics for signs of addiction, when in reality they are suffering from pain. A drug addicted patient will experience physical withdrawl also, but he/she is seeking drugs for a "high" and therefore also experiences psychological/mental withdrawl and often become aggressive and combative. ( I was told by a Doctor working at a Meth clinic) Pain management has and always will be one of the biggest challenges in the medical and nursing profession, that is why we need to advocate for our patients at all times without prejudice. Just my 2 cents worth

The only way we can protect ourselves is with documentation and in as much detail as possible. I document that I reported to the oncoming nurse and often state that nurse's name. It depends on the facility's policy whether you can use a name or not. The DON or facility administrator are often (not always) the last persons willing to support their nurses when things go "wrong", but they sure are willing to baste in compliments received about their nurses. Good luck and all the best to your friend.

The nurse should then report the employer to the state board that issues the license to the nursing home, and report it to the BON. However, if a nurse falsifies records whether told to do so or not, that nurse is still responsible for her own actions and can be held responsible and in some cases can have her license suspended

I am glad you were able to get another job and your new employer is not judgemental. Your "old" employer actually accused you of falsifying records. In most states the employer is obligated to notify the BON of a nurse's suspected misconduct and the BON will investigate. I don't know the rules in your state, but if you can you might want to check if there is a complaint against your license. Good luck with your new job.