onyx77

Current regulations in my state do NOT allow for any type of e-kit in an AL facility. Period. Not even for those who have staff administer them. Residents who self-administer their meds take care of getting their own meds. Those that have staff administer receive their meds through the pharmacy the facility contracts with. The pharmacy bills the residents' insurance and the resident personally. AL facilities and regulations are very different than those of a SNF. I have worked both and am VERY familiar with both as I work in a facility that has the full continuum of care. SNF = e-kit/box, contingency. AL = no e-kit, contingency. Hope your pharmacy can do a quick STAT run.

Actually this is incorrect. A resident in an AL (and LTC if not on a med a stay) privately pays for their meds. If staff is administering meds they are more than likely coming bubble packed and labeled for that individual. A pharmacy will not send the med without first billing the resident's insurance. The resident is responsible for any copays or whatever their plan does not cover. They personally receive this bill. Thus, borrowing from another resident is fraud/ stealing. Another thing to add is that ALFs (not sure if its state specific or not) canNOT have an e-kit or contingency per regulations.

Once you pass the NCLEX you have your license. ADN and BSN take the same test. Getting your BSN doesn't change your license.

That is very unusual. There must be more to the story that they aren't telling you. Its not common for CNAs to know the payer source of residents. And a lot of times the nurses don't know that information either. Its really not needed (unless residents are on medicare A) to do the job. Payer source definitely doesn't change a CNAs work with a resident. If I were you, I wouldn't worry about. Just take care of them like everyone else.

Know your limitations. We all have at least one thing that "gets" us. Some of us have more. During my ER rotation in clinicals I quickly went from nursing student to patient when watching a hip reduction. I work in LTC and love it! I have seen many dislocated and broken hips. As well as other broken bones and have not had a problem. It is different when you are the one taking care of the person or the problem. Nursing gives us many different setting to work in. Choose one that best suits you and your limitations.

Having a CNA certification was required in my state for nursing. There were several people that just got their certification and never worked as a CNA that failed our first clinical because they were still working on developing their basic care skills while the rest of us were working on our Nursing Skills. So, YES, Take the CNA class! It will only benefit you!

Try your best to read the chapter before class. This way you are armed with questions when they are being discussed. Review the information discussed in class at home (or where ever) that same night. Reviewing it while still fresh makes it easier to remember. Notecards. LOTS and LOTS of notecard! You'll be learning as you write it down and you can review them as often as you need. They also fit nicely into purse or bag so you can review them ANYWHERE!

I work in a large CBRF as a unit coordinator and am really frustrated with the floor nurses' charting. Its not all of the nurses, but most of them. They just don't chart or don't want to chart on a sick resident longer than 24hrs. I just don't get it. Maybe its the SNF nurse in me but, If the resident is sick, they should be assessed and charted on. Example..... it will be written on the report board that so-n-so has sore red area under abd fold or cold s/s, but NOTHING in the chart. IF there is something charted it is very generic. Example... "scrape to resident's leg looks infected. Hospice updated." Ummmmm..... what happened to describing HOW it appears infected? It makes it really hard to come in and know what happened over the weekend or even over night. When I ask the worst offenders, their response is always "This is a CBRF NOT a SNF. We don't do that." So, my question(s) is this... For those that have more experience than I in CBRF/AL - is this really the norm for charting? How do you chart on your residents? Do you have set guidelines on what needs to be charted and what doesn't? I've actually had a couple nurses (very seasoned nurses) ask for this. I feel its common nursing knowledge. Do you chart on the progress of wounds on a regular basis or just initially? Do you chart names (other than the MD's) in the nurses notes? I know these sound like very silly questions, but this is truly what I am faced with. I was taught in nursing school that charting needed to be detailed. And if its not charted it's not done. I am actually to the point of asking my boss for a mandatory charting inservice.We can review and review these things in our nurses meeting, but they just don't get it! Any and all advice is GREATLY appreciated!

Are you sure this resident is actually staying for free and not on medicaid?

Oh... and if you start with something like "I'm really sorry to bother you, but I'm calling regarding your pt Mr. Icantstayoffthefloor....." They might not be so hard on you. I love the caller ID at work because I can tell where a MD is calling from. If its a Sunday morning and I see a local church on the caller ID, I will always apologize for bothering them at church. And sometimes we need to word things to make them think its really their idea! Don't worry.... You'll get the hang of it quickly!!!

My motto is "When in doubt- check it out! or call the MD." Definatley go with your facilities P&P for updating MDs with any COC's. Some only require faxes. If you're unsure, call the MD anyway. They may yell at you (literally) but at least you've done your part. But make sure you have a thorough assessment done before you call. The SBAR form that CapeCodMermaid mentioned is a wonderful tool! You can search it online and print it out for free.

To the OP..... It seriously sounds like you're suffering from burn out. I hope you get time off soon so you can take care of yourself as well. If we don't take care of ourselves, we can't take care of others. Our pt/residents DO sense the stress and frustrations that we all have when we get burnt out (and we've ALL been there at one time or another no matter what setting we work in) whether we feel we are hiding it well or not. Dementia pts pick up on this VERY well and they will act out because of it! I love working LTC and wouldn't change my setting! However, I understand you're frustrations all too well!!! Unfortunately with the economy all healthcare facilities, including both LTC and hospitals, are cutting back on staff. I left my last job because they not only were cutting back on staff, but were admitting the most acute pts and expecting us to do medicare assessments, change of condition assessments (there were many days that I had literally 15 full assessments), 2 admissions, a discharge or two, 6 different IVs, a tube feeding or two, 15 treatments/dressing changes, 2 med passes, new MD orders and taking care of the crashing resident, the fall, the low BGT, the new skin tear, etc all in 8hrs. I think you get my point. Its places like these that you need to do your best while your there and look for something new. One thing I encourage you to do is really concentrate on your assessments. You actually can gather a lot of info in a short amount of time. It is in LTC that you will really learn to hone into those assessment skills as you are literally the eyes and ears for the MD. It is YOUR assessment that gets the residents the care they need. There is no MD in house to come check out a resident when things start going wrong. I also find that in LTC you do learn a lot about many different disorders/illness. And you get to see the disease in progress. many times start to finish - You can learn A LOT from this. I wish the best of luck to you! I hope you find your niche. Don't count LTC completely out - there are good facilities out there!