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Todd SPN

Todd SPN

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  1. Todd SPN

    "No New Orders Received" ..... ?

    Yes, I chart it. When I send a FAX I always ask "Any new orders?" Hopefully I'll get response of yes or no.
  2. Todd SPN

    LTC Nurses I need some advice Please

    I have been in LTC for 3 years at 2 different facilities. From my observations and experience they are not good places to work and things seem to get worse, not better. I'm sure it has to do with money and facilities getting less, having to wait longer to get it and more paperwork and rules and regulations. Your questions and my experience: #1 I worked a double shift on Thanksgiving because there was no one to relieve me. Oh, management knew but chose to ignore it. All my emergency numbers--on call nurse, DON, ED where switched to voice mail that didn't get checked. You are usually on your own to find a replacement for a call-in. #2 Acuity changes with discharges and admits. Also what unit. Medicare can get tough and hectic eating up a large portion of time making it difficult to attend to your other duties. IVs, tube feedings, trachs, dressing changes, etc. BTW, the 24 res you will be taking care of, are you sure they just don't have low census now and the unit has room for 30 that you will have to take care of when it fills up? #3 I've found CNA coverage to vary from day to day. They are usually pretty stretched out and again, if there is a call in it may be up to you to find coverage. Also, when the facility has to start cutting expenses because of low census, the hard and usually overworked CNA is the first place they take the knife. Most facilities do not have a full staff of CNAs and will take any "body" if need be. These CNAs are not much help. #4 I got 2 days of orientation at my present job. You will know who to ask for help. Those that know anything will stand out. The rest that pretend to know things are obvious. #5 You and any LPNs will likely be doing the same work. If you are equating being the person to oversee a staff (LPN) or for that matter (CNA) you may be mistaken. You mention a med tech on one side. Maybe this means on another unit. You of course will oversee the CNAs, but if they are any good they will not have to be told what to do and will report any problems to you. You will come to appreciated a hard working, on the ball CNA as a gift from heaven. But as the RN you have the ultimate responsibility. This is a whole different situation than a hospital. #6 A ward clerk if you are lucky enough to have one. Ours died so they decided to save the $9.00 and hour and have the nurses do it instead of hiring another. Oh, we also have to answer the phone by the 3rd ring. (Not anything you asked, but when someone calls for a resident and we transfer the call, if the resident doesn't answer, the caller will call back and tell us there was no answer and they will try again later or request you go track them down!?) #7 That varies with each facility. The last one I worked at was terrible for supplies. Each cath res got one new bag a month. If it started leaking it was up to the nurse to figure out how to patch it. We had 2 sizes of 18 gauge needles that afixed to non luer lock syringes. The supplies were locked up at night and on weekends so if you needed say a diabetic syringe you went begging to another nurse. It didn't make sense and didn't have to. When you complained they looked at you like what's the problem? All is not lost if you take the job and don't like it. You can always go elsewhere.
  3. Todd SPN

    Turning in my resignation Monday

    " Being a good nurse is not always the same as being a good employee." Timothy, I love that quote. Ain't it the truth.
  4. Todd SPN

    Turning in my resignation Monday

    I know exactly what you are talking about and how you feel. Last evening was my last shift and will be starting at my new facility in a week. I was not the first to leave and it sounds like I won't be the last. Our new DON is a midwife with no LTC experience. If this new place does not work out, I think I will be done with LTC. I kind of like the McDonalds drive thru position. Take the order, take the money and move on. I was surprised at the number of residents who came up to me and said they were sorry to hear I was leaving. It was kind of heart wrenching. Despite what I was told by my higher-ups, I must have been doing something right. Good luck to your. Todd
  5. Todd SPN

    care plan meetings in LTC

    Just from what you have written, I wonder if you are over thinking this. By this I mean delirium has more than one etiology and you should only have to address the one specific to the resident. You should be able to identify the etiology by the dx on the face sheet and the h&p. The RAP summary should be just that, a summary stating the cause. This summary shows the state you are aware of the disease and are addressing it. It sounds to me like you think your bosses are asking for an all encompassing report on delirium and I would question that. Why not write a RAP summary on the resident the state felt was lacking. For your bosses you could throw in the general definition followed by the etiology to this particular res. You might also consider purchasing "The Merck Manual" to help you out. Todd
  6. Todd SPN

    Puget Sound RNs I want to hear what it's like...

    Sequim Mt Vernon Port Townsend (looks gorgeous) Whidbey Island/Oak Harbor/Coupeville Sequim and Port Townsend means quite a drive for work. If concerned about schools, cross off PT. If in Sequim, you would most likely be commuting to Port Angeles for hospital work (actually, not that far, but still a commute). Given you want outdoor activities and men, pick Whidbey Island. Lots of scenery, hospital places to ride bikes and the Navy!
  7. Todd SPN

    New to WA..need $alary info for LVN/LPN

    The kind of nursing you are applying for makes a difference. LTC, MD office? Todd
  8. Todd SPN

    Think I could get fired for this.....

    Put me in the column of those who went back to school so I could escape being an aide. It is hard demanding work and I will admit I can no longer physically do an 8 hour shift of this type of work. I don't think that means I can not be a nurse. If all the hospitals and SNFs require perfection in physically fit employees, then there would be a lot fewer nurses (and CNAs). If your facility is willing to fire you as a nurse because you can't or won't do 8 hours of CNA work then I think you have lost nothing. That is not the type of work place mentality that I personally would put up with. Fact is, it they scheduled me to work as a CNA without asking, I would be out the door. Todd
  9. Todd SPN

    MRSA help!

    Daytonite, Thanks for the links. I will check them out after work. To the OP, we are seeing many more cases of MRSA at our facility. The problem I see is that it may be colonized, but it can and does become active again. How do you know when it becomes active? We have one res that is classified with colonized that gets UTIs a few times a year and the labs always show MRSA. Had another recently with respitory MRSA. Our infection control nurse said there was no need to gown up unless res was coughing and might get on our uniforms. We of course wear a mask. But what do you do with items she has touched like dinner trays and eating utensils? It seems that we are treating MRSA much more casually than when I had clinicals at the hospital. I have also seen where MRSA is mentioned on one page in a hundred. It does not give you a feeling of security. We have one nurse who can no longer work for us collecting L&I because of contacting MRSA at the facility. Two months ago an aide went to her doctor to have a wound looked at before her wedding and the culture came back MRSA. Your facility has a infection control nurse. I suggest you start asking questions there. Todd
  10. Todd SPN

    New LPN grad in LTC

    Congrats!! It has been my experience that there are fewer nurses on this shift, so you won't find it slow. Also, it seems that most of our deaths occur on this shift. Seems like a lot of prn pain meds are dispensed and suppositories! Also IVs are run and tube feedings need to be hung. As for advice, don't forget to start your assessments with VS and if you have to call the MD, have the chart handy so you can answer the MDs questions. You will not be always talking with the primary so the on-call will not be familiar with the res and may have many questions. Before making the call you might want to know the res dx and read the nurse notes a few shifts back in case there is something there that might pertain to your current situation. Good luck and enjoy. Todd
  11. Todd SPN

    Common raise amounts?

    I posted about a week ago about payscales. I have been limited to 3% annually. I found out that most of fellow students I graduated with have received COLAs. I also found out that my facility has had to change their payscale in order to attract new hires. But they did not bring up the wages of those that have been there. What this means to my situation is with 3 years experience, I am making $1.50 less than the new grads they are hiring. When I asked for a raise I was told how happy they are with my work, but we aren't going to give you any more money. I got myself a new job today with an increase in pay. I was miserable training new hires that were making more than me. Todd
  12. Todd SPN

    Switch jobs so soon??

    Why even mention you are working where you are presently? Do they have to know? Todd
  13. Todd SPN

    What would you do if you worked with a racist?

    OMG. What a stupid person.
  14. Todd SPN

    Just a quick opinion question....

    Not unless they go to medical school. However, I am for allowing any nurse who works LTC to prescribe prn Ativan! Todd
  15. Todd SPN

    LPN pay in LTC

    Two weeks ago the facility had a leadership class. One of the points was when you tell someone you will look into something give them a time frame. Well, when I told my supervisor I wanted a raise I was told I would have an answer in a week. It has been more than a week and it looks like the tactic is avoid the request and hope it goes away. LOL-SOS! Anyway, with new grads being hired at $1.50 per hour than I'm making I guess it is time to update the resume. Todd
  16. Todd SPN

    Any LPN's with first job in Homecare?

    Huh? I work at a NH and deal with this stuff everyday.