nursegoodguy

So you just got this job... Give yourself some time! You've got a lot of patients there also... my load is 30 max but have worked in facilities where I had 45 average and in another facility they'd work us short and sometimes would have over 50 to 60 patients! The more experience you get as an LTC LPN the easier it becomes to see when you are being taken avantage of. Okay so how do you organize your med pass... Well to begin with get report from off going nurse, count, give your techs report get your med pass started as soon as you possibly can! You'll figure out where everyone eats, how they want to take their meds etc as you gain experience. Try not to spend a lot of time chatting with them just get it done! Don't take short cuts with med pass, you'll make a mistake! Just do it the way you were taught and know that as you get more experience it will go smoother... takes a good couple of months to really feel comfortable and that's if they put you on a unit and leave you there!

Happy Birthday! Don't worry... You'll be okay!

Happy Birthday! Don't worry... You'll be okay!

I work in LTC and I know the way I run the unit when "i'm on duty" is a little different than the way the other nurses run it when they are on duty... I would say that vitals by midnight is a good idea that way the patient can get the most uninterupted sleep possible. Also it is good for the nurse to be able to get some of the charting out of the way and to know if anything is going on with a patient early in the shift! I prefer for any shift I'm working to get vitals as soon as possible because if something is going on I want to be able to get the patient the care they need as soon as possible! Maybe if you do talk to the CNA you could explain the rationale for early vitals and make it more of a learining experience as maybe they think it's more of a power trip for the nurse? I would say if the other nurse talked to you and asked you to intervene I would still probably encourage them to try to take care of it themselves if they could but if they had a hard time doing it then I'd probably talk to the CNA for the nurse. Just keep in mind that maybe the other nurse is telling you one thing but not telling the CNA the same thing? I am not a big advocate of Write-Up's! To me the only time to use it is if you have a really bad employee who needs not to be taking care of patients and you need a paper trail to get rid of them! I've been fortunate I guess because for the most part most of the CNA's I've worked with have done a pretty good job! I can count on one hand how many times I've had to write anyone up. It's not that I won't do a write-up but it's got to be something pretty severe to get me to that point and that is probably going to be working with a person who truly does not care about the patient and needs to be outta there! As I said I guess I am pretty fortunate because I work with many wonderful people who do care! I've found that a more effective way for me to work with the Nursing Assistants is to talk to them and work with them especially when there's a problem... We start out our day with a brief report of what's new then work together as much as possible the rest of the day. Things just seem to go better when we have a caring attitude for all the people we come in contact with regardless of if it's a patient, visitor or coworker and a good attitude can become contagious and make just for a better work place for us and better patient care! Try talking before writing...

I work in LTC and I know the way I run the unit when "i'm on duty" is a little different than the way the other nurses run it when they are on duty... I would say that vitals by midnight is a good idea that way the patient can get the most uninterupted sleep possible. Also it is good for the nurse to be able to get some of the charting out of the way and to know if anything is going on with a patient early in the shift! I prefer for any shift I'm working to get vitals as soon as possible because if something is going on I want to be able to get the patient the care they need as soon as possible! Maybe if you do talk to the CNA you could explain the rationale for early vitals and make it more of a learining experience as maybe they think it's more of a power trip for the nurse? I would say if the other nurse talked to you and asked you to intervene I would still probably encourage them to try to take care of it themselves if they could but if they had a hard time doing it then I'd probably talk to the CNA for the nurse. Just keep in mind that maybe the other nurse is telling you one thing but not telling the CNA the same thing? I am not a big advocate of Write-Up's! To me the only time to use it is if you have a really bad employee who needs not to be taking care of patients and you need a paper trail to get rid of them! I've been fortunate I guess because for the most part most of the CNA's I've worked with have done a pretty good job! I can count on one hand how many times I've had to write anyone up. It's not that I won't do a write-up but it's got to be something pretty severe to get me to that point and that is probably going to be working with a person who truly does not care about the patient and needs to be outta there! As I said I guess I am pretty fortunate because I work with many wonderful people who do care! I've found that a more effective way for me to work with the Nursing Assistants is to talk to them and work with them especially when there's a problem... We start out our day with a brief report of what's new then work together as much as possible the rest of the day. Things just seem to go better when we have a caring attitude for all the people we come in contact with regardless of if it's a patient, visitor or coworker and a good attitude can become contagious and make just for a better work place for us and better patient care! Try talking before writing...

Some of those specialty schools that teach tech programs really do take advantage of people and most of the time they will try to get grant money or student loans to pay for the training. To become certified a person just needs to be eligble for hire at a nursing home and they will train you and get you certified. Where I work there's no difference in pay regardless of how you got your certification whether it was on the job or in a specialty school. They really just want to make some bucks on you!

Never chart you'll notify the next shift to notify the doc! If you note a problem take the extra steps and assess it fully and call the doc yourself.

Okay first of all I must be in a mood today... I don't want to quote anyone but, why do some people still refer to the nurse as "she" and the patient as "he"? You know that's getting about as old as the history of white uniforms and it is really condescending! So... Just how many people who think white is so great have actually been told by their employer, "by the way the beginning of next month all the nurses MUST wear white or a lab coat over their scrubs! Thank you, Management" Do the nurses have a right to complain? Uhh I would say YES! (not that it will do any good but it's nice to be able to vent!) One nurse I work with makes all her uniforms. Her patients all Love the variety and they each had a favorite scrub top! This nurse has so many scrubs that she has made that she can wear a different one every day for probably a year, most hand made! She dry cleans all her uniforms and always looks the epitome of a caring professional regardless of if she has frogs, chile peppers, or John Deere tractors on her scrub top! (and yes I have my eye on that John Deere scrub top!) Incidentally I have never had a problem with a patient not being able to distinguish that I was the nurse regardless of what color I wore. Maybe it's because when I have a new patient I go and introduce myself to them and spend as much time as I have with them. My techs also introduce themselves. Everyone in my facility answers call lights. If it's something they need a nurse for they come and tell me and I go to the room and take care of it. Even if the patient "thought" the housekeeper was a nurse in scrubs the housekeeper is not going to bring them a pain pill, I am! Nurse-Pill, Shots, Tx's Housekeeper-Cleans the room (and does a heck of a job at it)! I have a lot of patients with mild dementia and they still know the difference! It's really not that difficult for them to figure out! Oh yeah I did mention before that I have to wear white or a lab coat right?

Usually a few of us other nurses take their name tag out back and burn it! They usually get fired not long afterwards... LOL Okay really has anyone tried talking to this person about their attitude? You always have to be above reproach when dealing with someone like this. I have worked with Nurses like this in the past and they've always pushed just as far as I would let them push... Yea I complained to admin but it didn't seem to go anywhere? I think the best way to deal with these people is to first try to talk to them about what is going on. You never know if they have some problem at home they are unknowingly bringing to work with them. You have to take the first step and it might be more helpful "if" there is another nurse who will talk to the offending nurse with you! You just have to have the right attitude when you do it and that is the attitude of concern and helpfulness otherwise they will get defensive and you'll have even bigger problems with that person! Anyway that's how I would handle it... or you can always bring matches and burn her name tag on the patio! LOL

I do apologize if I sounded condescending... I really didn't mean to. I know for myself I have a lot of people at work who almost on a daily basis have some medical thing with a child going on. I don't work with children so I usually am quick to tell them to go see the doctor! One girls baby had a fever and rash and one nurse was telling her to use hydrocortisone cream... I told her to take her kid to the doctor, it could be scarlet fever! I do apologize for imposing my overly cautious attitude. It's truly wonderful that you've taken an interest in these people and their child. After all we are all here to watch out for each other...

We have to wear white or if we wear anything else we have to have a lab coat on and CAN'T take it off until we are through with our shift! I don't really care what color I wear, if it's all white then it's a pretty easy choice of what I'll wear today! However, white is not the most practical color choice for all the reasons that have been previously mentioned and having to wear a lab coat is not practical either as you are running into an emergency situation or just "running" all day in a hot lab coat! I think the biggest reason the suits decide to make us wear white is that it "looks professional"... I'm sorry but I really have a hard time with people just wanting you to "look the part"! That's like saying, "just ACT like you know what you are doing"! It takes a whole heck of a lot more that a white uniform to make a good nurse! And YES I do think that if you come in contact with patients your facility should take care of the uniforms and the laundry! C'mon folks it's not like we're stocking shelves! We are coming in contact with a whole lot of bad stuff that we can take home to our loved ones! It would be perfect to have a locker room with showers and uniforms! So with all that said, I need to find white boxers with Big Red Hearts to wear under those white pants and for Valentines day! Not really! I'll get socks with hearts! LOL

If you google thickit you'll find online medical suppliers and what I saw was definitely not as expensive as what you quoted!

That poor baby! As you already know be careful when giving advice and encourage them to seek out a better health care provider who will explain what is going on and can give them medical advice they need. Aspiration is a life threatening condition. There has to be a problem causing the kid to aspirate. They need to take him to another pediatrition and if they aren't satisfied take him to another still til they find out what is wrong. Is there a childrens hospital where they are? Are there any organizations who will help with the cost of thickener for his fluids? If he's aspirating on thin liquids then he's got to have it thickened. When I was a kid we couldn't afford glasses and I think it was the lions club or shriners that bought my first pair of glasses. Maybe there is a group like that where your friends are? Be sure to mention with thickeners you can't just have a recipe that works in every type of fluid. Different fluids, consistencies, temperatures all thicken differently and sometimes they get thicker as they sit. You really have to go by the consistency as you mix. So you mentioned Speech Therapist, is he getting therapy? Do they know why the kid is aspirating? Are the parents trying to monitor "how" the kid is drinking? They need to monitor every sip he takes and if it were my kid I would monitor him, encourage him to take small sips and tuck his chin down then swallow. I hope they get this worked out for the poor baby... It's emotionally hard enough sometimes to work in geriatrics I Know I could never do pediatrics! A big Thank You to the Nurses who do!

Anyplace I worked that had a computer system meant you had to do all your hard copies plus extra stuff on the computer!

I'm just sort of venting here and curious as to if anyone can add to this list. Okay suppose it is an order for routine pain med: So there's your initial assessment A call to the doc The T.O. MAR with notation of pain med given and effectiveness on pain scale Pain Scale in chart Pharm Fax Nurses Note when med given and follow up note Pain Assessment Care Plan Call to Family to notify of new order If you have a change of condition form E Kit for med, counting the E kit documenting med taken Shift to Shift Report Then you are thinking "now I know I forgot to document it somewhere?" Oh yea the new MAR for the upcoming month! If it's an antibiotic there's even another form! So how many places do you have to chart a new order?

I work LTC... I made up a report sheet with everyone's name on it and included essential info such as who gets crushed meds, diabetics, thicken liquids... I don't really like going over everyone's names and saying this one's ok and that one's ok and so on... just tell me who's not ok! I keep my report sheet right on my cart so if I run into anything I can jot it down, including if I am missing a med and have to order it, any new orders, any illness, anyone out on pass... etc Probably it's a lot different in LTC where you expect most of your patients to be relatively stable...

Definitely I would complain that Whomever was deciding this was not being fair and would ask what sort of system they used to determine who got floated! No matter what my experience has always been that if they are short they will sacrifice whomever for coverage!

Why do I find these things when I have to start getting ready for work! Okay, just two minutes... Where I live/work the majority of people are either hispanic or native american. We have two black people in management positions, the admin is hispanic, don is white, another nurse in management is native american, a good ethnic mix I guess? All I know is that they all do a great job and I couldn't think of any better people to do what they are doing! Most of the workers are hispanic/native american. Many of the people have 'mixed' families! I've never seen any problem related to race... I take that back there was one time when we all had to get fingerprinted a few years back and there was no place for hispanic as a race... one of the girls who is hispanic said, "I'm not checking white, I'll check other, I hate whites!" I told her to go to a real city where more than two cultures are represented and she see just how 'white' she was! A nurse was moving back to NYC and needed volunteer drivers... this girl was one of them and when she came back she was telling me about meeting some guys from spain and when she told them she was spanish they laughed at her and said she was not spanish, she was a white girl! I explained that they were probably right off the boat and her family has been here for generations! I don't understand that prejudice? We're our ancestors not all from Europe? Because mine were Irish/Italian and hers were Spanish does it really make us all that different? What gives her the right to consider me 'white'? Maybe someone could help me answer this one... One other time I worked with a black man whom I got into this discussion with... First it had to do with him going to gay bars with his friends... unhuh... he said if a guy came on to him he'd hit him... I said, then stay out of gay bars and just think about it... I have girls come on to me at work... should I hit them too? Then it went into race... he said he believed that the races should be kept seperate... I asked what about Marti Luther King and his speech I have a dream... He said the new thought was not anything like his I have a dream speech and then went on to justify keeping the races seperate... I told him that eventurally there would be only one race, a nice blended race! He disagreed and I had to point out, just look around you at work! Would you have seen so many blended families even twenty years ago, a hundred years ago... I do believe that if this planet survives then we will be one race and I really do think it is a good thing! One less thing to fight about... Now can I get ready in 15 minutes?

I have never attended any patients funerals... I have been right there until the end for many of them and feel that something spiritual was happening as they took their last breath. No funeral could compare to it. I just don't know how I really feel about funerals in general? I don't think for myself I would want one...

Be sure all soiled linens etc are bagged in the room before they are taken through the hall. Keep all soiled linen carts emptied and off the hall. Fresh air is nice, (I have never worked in a facility that allowed windows open though r/t airconditioning) We have some very nice citrus smelling sprays and wow do they ever work! Have mattresses cleaned with a diluted bleach solution, or whatever your faciltiy uses, and turned weekly. The most important factor, make sure everyone is inserviced on how to keep odors down and carry through with it!

On second thought, I see a linen closet in someone's future...

Now there are other ways of living in NYC... I'll tell you how I did it for a year back in the 80's... Well I met this girl named Jackie. She invited me to join the religious cult that she was a member of and I thought, "Hey I'm open for a new experience..." (plus I really wanted to live in NYC) Well after 3 months at "camp" I was ready for the BIG CITY! I became a "fund raiser"... Yeah, yeah that was me trying to sell you flowers at the airport! So there I am, a little guy barely 120lbs, not even of age yet, in a white oxford shirt wearing a think black tie, hair neatly combed over, and very timid! (Just got through 3 months of cultcamp) Well it wasn't a very good day for flower sales, but I notice out of the corner of my eye this woman staring at me... She was a kind of an older red haired robust woman wearing those little pointy high heals and carying a "purse", (she sort of looked like the mama in throw mama from the train...) Well I thought maybe she wanted a flower so I go up to her and ask, "Excuse me ma'am, would you like a flower?" Well she looked at me with these beady eyes then stood straight up and started calling me, "Why you dirty rotten little, EDIT EDIT EDIT!" I started backing up as she was coming towards me and now she was swinging her purse in the air, round and round her voice getting louder and louder! She scared the heck outta me and I fell backwards over my flower bucket and she was still coming so I threw the flowers outta my hand, jumped up and ran for the exit just as fast as I could! I thought I was safe but as I turned around I see those little pointy high heals running right behind me still cussing and still swinging that purse in the air! Okay maybe the doctor thing is not such a bad idea afterall? I'm still trying to think of a 15 letter word! Seriously though, only you know what you think the right reasons are to get married... Just keep in mind, we never end up with the type of person we think we want to find when we are young... And that's not always a bad thing...

A drunk driver caused me to break 3 vertebrae two years ago and I still have back pain every minute of every day! My patients mean too much to me to risk their safety to some drunk! If it was that noticeable that you had to back up then you need to go find someone in administration and tell them to do something about it. If they let the person stay then I would write a complaint to them and I'd keep a copy for myself and I'd be looking for a new job ASAP... Let a few family members get wind of the drunk and complain to admin, then I bet they do something. You know if that aid hurts someone, administration will say they knew nothing and that you should've reported it to them... They will try to hang you just to save themselves.

You mean all of a sudden the doc wasn't going to uphold the t.o. to the pharmacy so he wasn't going to treat the patient? Somebody at that pharmacy must've talked to the doc? Sounds like your x has connections with the pharmacist and is really trying to &$%% with you! Get a lawyer, get a new doc and a new pharmacy! Plus apeal to the board. You have to make sure they know that this did not happen! If you say nothing then it's like an admission of guilt. Be prepared for the next thing from the X... You see it always helps to have mafia connections for these x situations:devil: Giuseppe

Sorry to sound like a mercenary but money talks! Hey I would love to be able to do good deeds just because I like helping people but the bottom line is where I work is what makes my house payment and it's always nice to have a little extra on your check. Give a weekend differential and if you do already then give a better one! You could try to find people who just want to work doubles on the weekends and then pay them for 40, but if one of them call in then you really have a problem! Try finding nurses who are willing to be on call and give them a bonus plus double time if they have to work. That will take a little pressure off you for a few weekends... No matter what you do people will still get sick or have sick kids or whatever... they will call in from time to time so you have to attempt to entice them to show up and have a back up plan to get someone else to cover... Try offering double time plus a bonus if a nurse covers a call in anytime from fri 3-11 thru sun 11-7. In, (actually several) facilities I worked in if a nurse called in, the remaining nurses had to split that nurses unit... well that facility couldn't keep anyone! If you have to split a unit then split the pay between the nurses running their hind ends off, that would have been spent on the nurse that should've showed up. I worked in a facility in a small town that had a problem with staffing and call in's too. What did we do? We started working 12 hour shifts and everyone loved it! 3 on 4 off! And we got our pay boosted to reflect the missing 4 hours a week. We had some nurses that "prefered" the weekend shift (for one reason or another.) We really didn't have that many call ins because if I missed a day, well that was about a 3rd of my pay for the week and not just a shift! There was no agency in the facility the entire time we worked our 12 hour shift schedule and we even and we even had nurses driving in because they wanted to work 12's and it wasn't offered in the bigger city about 45 minutes away. This went on for about 6 years until we got a new admin nurse who went to the administrator and said that we were too crabby during our 3rd 12 hour shift and the administrator didn't like the idea of 12 hour shifts anyway,(?) So they had a meeting where they had food catered in for us, (always know when they feed ya it ain't good) and they said that we were going back to 8 hour shifts and not only that but 4 on 2 off! They also said it was not open for discussion, they didn't want our input! Guess what happened... by the deadline date they lost about 5 of their nurses and more were on their way out the door! Call the agency! The Administrator was transfered and the DON couldn't take the pressure and ended up working the floor on night shift plus they got a new ADON. The sad part is just think about what happened to the quality of patient care... The new DON, (who use to work as SDC) said Wow what happened and how do we fix it! Back to 12 hour shifts they went and little by little it has gotten back to normal. One thing to keep in mind is that with 12's you do need more staff and you should offer a "good" diff for people working fri-sun & sat-mon. Have a meeting and ask them for solutions or bring up some of these ideas... Hopefully you have your administrators backing or you might as well move into the big city yourself! In a small town where you don't have a pool of nurses to draw from you better make it worth while for the nurses you do have! Don't threaten your nurses with, "if you call in we'll do this or that" because you need them! If you have to write someone up then get out the pen and just do it but you'll have a much better group if you work with them and try to make it a great place to work in! Think about how you can make it better for them and I'm willing to bet they will think about you too...