Summer69

What about the Federal Correctional facility in Texarkana. I have heard good things about it.

Update on Haldol. I recently went to a seminar on F329(unnecessary drugs). Hospice is allowed to give Haldol for endstage COPD. Could the Haldol somehow be connected to the pnuemothoax and some extremely bright MD:idea: thought is is similar to COPD ? Ya know old people are all the same.

Hi, Just wanted to say congratulations on your grad from Excelsior. I am working the program now. Dig in and start reading the RAI manual Look at MDS's already done(if the prior person was good). That will help with the logic part of figuring out why some one is a 3 and some one else is a 2. If you can not figure out the directions. Our state survey agency does training so I was able to go to that.

OH GOOD GRIEF!!! You are correct about care conferences. You have really stepped into a mess. Is it the administration who feels care conferences are not necessary or did things just get dropped? I did work one place where the DNS was the care plan coordinator( a small facility) and she had just dropped that part of the MDS process and everyone got into a rut so when new DNS started she had to basically start from scratch on care conferences. Good Luck

I have added pages in the ADL books that are drug category specific. (purple for antipsychotic, yellow for antidepressant etc). Side effects are generic and I add the specifiec medication and resident name and have put them in plastic protectors so they stay there till med is d'c.d. The page is also in the MAR book as we utilize CMAs. The care plan remains generic.

Glenwood Iowa has a facility similar to Woodward-Is is on the western part of the state about 30 miles from Omaha. Woodward is about 30 miles for DesMoines.

Go to Craigs list for housing-some reasonalble apartments are listed there. As for jobs-Bishop Drumm in Johnston is wonderful. Also there is the Madrid Home in Madrid Iowa about 20 miles for DM. Good benefits. You might want to try agency work until you see the lay of the land( good vs bad). I know there is Nurse finders in Des Moines. They are a national chain and do have a web sight for info

I have been a nurse for 36 years and was a NA for 3 years before that. Hve only done LTC. Yes I have been in the good and the bad. The bad places have made me a better nurse(more vocal about concerns and sticking up for Pt. rights). The good ones made me love my job. The ones with outstanding administration have guided me to where I am today in nursing mangement -who leads by example(answers call lights, does a med pass, walks folks who need help). LTC is not for everyone and it is not easy but when a patient's family tells you how much you mean to them by helping their loved one it is worth it.

Our pharmacy comes in quarterly and offers a CMA inservice. Since they are in our facility monthly they see what our errors are, what new meds we are using and what interactions(such as TF to be turned off 1 hour and 1 hour after Dilantin admin.) are occuring CMA'S enjoy this and are more receptive to this forum rather than me talking to them. Also we make it fun -have cookies or doughnuts and pharmasist always brings in pens, paper etc for the drug classifiacation she is going to talk about. In Oregon CMA's are required to have CEU's for med pass and this also helps meet that criteria. The pharmacy also provides supervised med pass if we ask for it.(which we usually do for new CMA's even tho they have passed their boards)

Smile, be polite, and do not answer more than they ask for!!!!(kind of like being questioned in a trial). Do not try to avoid them(as in sneak around and do dressing changes that they have asked to see) then they think you are hiding something and they really start looking!

roxanal, ativan-the hospice favorites. Don't forget the vitamins for wound healing. We are now adding vit d to the list.

Graduated in 1970. Have been in long term care the entire time. My goal is to become the PERFECT old lady. All kidding aside, I have never regretted not having hospital experience.

Some of my coworkers do not need help in the "look stupid" dept. They are doing a fine job all on their own!. One nurse told an MD that we did not offer special diets(diabetic in particular)!!!

I am not sure of the actually site but if you go to the Medicare web site you should be able to navigate thru that to get to the survey site. Please note thou surveys may be 6-8 months old.

Hi, I currenly live in Oregon but call Iowa home(kids still live there). I am doing the RUE plan LPN to RN. The text thru Rue (the $125/month payment) is not the real expense but rather the 220 (or more depending on test you need to take) from Excelsior. Plus all the other ADD ON stuff($900 to enroll in Excelsior for 1 year, $500 everyear after that that till you graduate etc. The people from RUE gave me a very good detailed accounting for costs I used that same info when I called the others-and they seemed upset that I was asking for amounts/reasons that RUE had given me. For $75 registration fee a "real" college admissions person reviews your transcripts so you know what you need to take(Excelsior). Class requirements are changing so check into things carefully!!!!!

Thanks to all of you.

Hi, We are preparing for survey so, of course, people from corporate have decided to decend upon us to "make us better" overnite! Well any was with our quaterly assessments we have to do a bowel and bladder evaluation(each one is seperate). One of the questions is "do they take Vit.C?' My question is how does this imact bladder contience? Corp. nurse had no idea (and it is their silly form)? Does any one know the answer? I would like to know the answer Monday AM when she shows up.

FYI Smoking Aprons are available thru Briggs or Direct Supply. Another "Hot" item regarding the smokers where I work is "Who supplies the lighters?" Families complain that they bring them in and then they just disappear. Staff complain that either 1. "I do not smoke so I refuse to buy a lighter" or 2. "Why does everyone come and get my lighter to take the smokers out to smoke" Of course there are the staff that refuse to take out the smokers because they do not smoke and do not feel they should be exposed to the weather and 2nd hand smoke. "It is against their rights" Is this a merry go round or not. Our smoking staff love to take out the smokers cuz then they get extra smoke breaks in.!!!!!

Wow!! I thought I was alone. New employees have different rules than our reliable ones(or at least they think so). Cell Phones, walking by call lights, dressing residents in PJ's during the day and heaven help me if I ask them to put in dentures or give a shower-the resident always says no according to them. Oh and I forgot extra break times!! I am lucky we utilize med aides and the one I work with most of the time is above exceptional and I sic her on them and she can tell it like it is and threatens them with me which works most of the time. I know it is not her job to supervise them but she knows they do not listen to any of the nurses.(I even took her out for dinner for nurses day as a thank you gift). Desperation for cargivers is the reason for keeping them but if I hear "we need to make sure they understand the rules before we do disiplinary action" one more time I will scream. My grandaughter works at McDonalds and she does not get by with stuff like this(cell phone use, breaks )[EVIL] [/EVIL]

My facility, also has new management. The previous one had just started understanding the nurses problem with the CNA/wanna be nurse and then left. This CNA listens to direction but then calmy tells family that she knows other ways to do things and proceeds to do them. Until management actually hears it there is no good answer.

Hi, I was iniated by fire so to speak. MDS coordinator for ICF residents (basic call me if you need help training) but well acquainted with the residents and MDS issues. Facility fired the Medicare/PPS nurse fdor possible "medicare fraud"(miscoding of the MDS-in a hurry and to many to do) nothing really resulted in overpayment) sooo I got promoted! 2 months later I was crazed and insane so got to go back to my sweet ICF people and I love my jo b again. did get training for the job after I had it 6 months but still read the Ria manual frequently. Looking for a QA position now regarding admissions/mds/careplans- my company has the need just need to keep promoting the job to the regional