marthyellen

Sorry you do not like LTC. I personally love it. It is not the perfect work environment, but what is? Thing I love about nursing is that there is something for everyone. I hope you find the job for you. I asked my admin one day why he chose LTC and he said "At least it is never boring" If unrealistic families, yelling residents, primadonnas, and cranky staff bother you, then LTC is not for you. I hope you find your niche in nursing. Good Luck

Always chart objective not subjective information. If a resident is cursing write what was said. I hate to pick up a chart and read "inappropriate behavior." What does that mean? Moral values play into what someone thinks is inappropriate. Be specific.

I think three days orientation is ridiculous for a new grad.

I am in Texas which has the second lowest Medicaid rate in the US AND just had a 3% cut BUT we are taking higher acuity residents. BTW I had a 105 y/o full code. When we explained what would happen if we performed CPR, the daughter stated "she is strong she can handle it."

If you know psych nursing is not for you have every right to sat so within your first 90 days. There is no reason to feel bad about that. There are so many specialties in nursing even within LTC. You said you enjoyed rehab and the other LTC units. It is okay to know your limitations Also I would have concern about working a unit that has both dementia and true psych. There is a difference. Dementia behaviors are handled differently than true psych (major depression, schizophrenia, bipolar). These people should not be on the same unit. Dementia units should not have more that 20-25 residents on a unit. More residents means more simulation and more behaviors. Is there an opening on the other units? Good luck to you -- I hope you find the right fit.

Unless the self report is substantiated and sited they are not listed on the Department of Aging website only consumer complaints are.

In TX you must have a BS in any subject attend 15 hours in long term care administration and 1000 hour AIT program. In Colorado you must successfully completed an associate's degree or higher degree in a health care-related field and have a minimum of two years experience in administration in a nursing home or hospital. And Attend a AIT program. If you google LTC administrator for the state you are looking, you should be able to find the requirements. I have worked with administrators who were nurses and they seem to undermine the DON because they are nurses. "When I was a DON...." It is not worth the effort, when all of your decisions are second guessed. I would rather work with an administrator who admits he knows nothing about nursing.

The nurse in question needs to understand that EVERY nurse makes a med error at some point in her career. Any nurse who says they have never made a med error is either a liar or too stupid to know she made an error. You found the error and you reported the error. It is the DON's responsibility to investigate.

Why would he sign someone else's name and not his own?

Wow that is the problem. I have work with administrators like that and will never do it again.

Thank God I have a great administrator. Luckily my administrator agrees about alcoholics and alcohol related dementia. Not drinking for 30 days does not guarantee that someone does not have alcohol related dementia. They are VERY different from other dementias. The nurses and the CNAs can tell which residents have age related dementia or alz type dementia compared to the residents who have alcohol related dementia. Their behaviors are different. BTW when our census is low my admissions person tells corporate that I am refusing all of the admissions and that I don't give her an answer in a timely manner. And our census is runs between 85%- 95%. I tell her if she wants to admit them she needs to be willing to leave her office and try to take care of them. I have on an occasion admitted someone who she insisted we take and we the resident required one on one attention for behavior and attempting to leave, the unit manager took the resident to the admission office so the admissions person could watch her and entertain her.:)

He had no payer source which is why the hospital was willing to pay us to take him. I like when corp tell you that you should be the employer of choice. If you take residents like this you will NOT be the employer of choice. CNAs and staff do not want to care for 600 lbs or behavior problems or alcoholics.

I feel your pain. There are buildings that specialize in morbid obesity. You know it is trouble when the fax cover page says that the hospital will pay for the patient's stay at your facility. Stop reading and call them back and say "No, thank you" But admissions brings it to you so you can read it and say "Really? Hep C patient hospitalized for chest pain after snorting cocaine and shooting heroine which was diluted with "boiled" well water and drinking a 12 pack?" My 90 year old ladies are going to love him

Care Cards for CNAs can be placed inside the residents closet. One page with basic info like ADLs, food preferences, diet, etc. We also have a CNA 24 hour report they can fill out themselves and pass report to each other

I thought the same thing about "potty" I think rounding sheets hourly sounds like is a great idea. Unfortunately, there is no way possible to do it. They barely have time to the minimal documentation. CNA's and nurses became CNA's and nurses to care for people not to do paperwork. I know it is a necessary evil. I never add more documentation for documentation sake. What would be awesome is if we had the scan cards like they have in the movies so you just scan your card every time you walk in and put of a room. Then we would know where everyone is all the time and could track how often someone goes in and out of a room :)

Yea! for you. Good Luck. I hope you have great success with your new administrator.

I was toileting a resident one day, and as usually I was talking her through the process. While she was seating I changed the incontinence pad and explained what I was doing. I said "now you are going to stand up and I am going to pull up your pants" She replied "if you do that that thing will be next to my *****" I replied "yes ma'am it will"

Isn't that the truth. The Charge nurse has the last word if someone who is already clocked-in can leave. IMHO. If the supervisor is not going to take the aids section and provide the care to the residents then she had not authority to allow that aide to leave. If everyone called me before they called family members I would not have any peace and the nurses would not get any other work done. Family members are supposed to be made aware of every lab test, every new medication, every change in condition, every behavior. Seems like a lot of extra work for the nurse to call the doctor, and then ask permission before calling the family and then calling the family.

We had a life like doll for a dementia resident and she woke up in the middle of the night and wanted the nurse to call 911 because her baby was not breathing. And what ended up happening? Did they play along or tell the resident the baby is breathing fine? Luckily she had dementia so they took the baby and told her they were calling the doctor and were able to redirect her. She was not given her another doll. She could only have stuffed animals.

[WIKI][/WIKI]Actually we buy dolls that were created for use as "doll therapy" for our Alzheimer's patients, they feel and weigh and smell like the real thing, This really calms many of our patients (male and female). We dress them according to the seasons and this actually helps our patients know when it is winter and when it is summer. We had a life like doll for a dementia resident and she woke up in the middle of the night and wanted the nurse to call 911 because her baby was not breathing.

I had a resident who constantly said "nurse, nurse, nurse, nurse". One day I said " Madge what do you need?" without missing a beat she said " A million dollars." Five minutes later she returned to repeating "nurse" I did not ask her again

Both my unit managers are LVNs. One became a unit manager with only 2 years experience as an LVN. She had leadership skills from a previous job experience in another industry (she did not become a nurse until she was in her 50s) I would rather have an LVN with 2 years long term care experience than a RN with no experience in LTC.

To add to med pass advice: Read out loud to the surveyor what you are giving, including dosage, time, medication, resident name.

If you say no, be ready to look for another job. She is not asking you to anything beyond your license. I am sure that like most long term facilities that your employee handbook states that refusal of a reasonable assignment is grounds for immediate termination. I know I sound harsh but the reality is she has a building to run and she may want to replace your current position with an LVN and use an RN in the skilled unit.

I know corporate nurses like that. They come in swinging and screaming and acting like Hitler. Then in the next breath talks about treating people with respect. Do as I say not as I do. I wish some of them could be filmed so they could see how they really act. Fortunately, I do not have one of those right now. I like my current corporate nurse. She is respectful. She offers advice and I call her when I just need to hash things out.