ChainedChaosRN

I'm a DON in a 160 bed facility and I did away with monthly summaries. I too found them redundant and not helpful. The patient is reassessed quarterly or with significant change. I'd rather have a nurse doing a several daily quality nurses notes then taking the majority of daily charting time doing filler work.

Depends on the type of resident being cared for. Totally dependent with all ADL's will require more staffing, more independent less. Care levels and layout of a facility are big factors in ratios.

In our facility we keep a bag full of small bags on the double hamper (laundry and trash) tied to it. Laundry stocks the linen carts for each shift and unit: adding the briefs, some gloves and the small trash bags. We ask the CENA's to carry a couple of bags into the room with them. One for soiled linen the other for soiled briefs. Deposit it outside the door in the appropriate hamper. Simple enuff:) Even though we have this system down to make things convenient for brief and linen changing, I still will see staff putting linens on the floor. The usual response is "I forgot the bags." Well....take 5 steps and grab the dang bangs.

I believe each institution or corporation has their own policy regarding it. Our companies policy is that it is a facility document. You do not chart that an "incident report is completed" and it does not become part of the medical record. This is usually the standard. Make sure you check the policy and procedure on your incident reports. Despite companies having this policy....many nurses have in error continue to chart erroneously and place it in a medical record.

MissJKM...please do not be hesitant to work with the dementia resident. They are our mothers, fathers, grandmothers, grandfathers, aunts and uncles. You may encounter all types, slightly confused to very agitated and striking out. Some that just need minimal ass't with ADL's to those that can do nothing for themselves. The best advice I can give you is to treat them with dignity and respect. Even the most demented are able to recognize kindness and compassion. Always talk to them as an adult...sometimes you might need to just keep it simple. Touch is ever so important and a smile. The demented patient is "us" who have lost their way. Treat them as you would want to be treated and you will be a jewel in their eyes.

Thank you DisabledNurse, it probably comes from having a strong back ground in MDS myself. I'm a firm believer that the MDS nurses are the ones that drive and coordinate the residents care. They are the ones that know the residents history, current medical status and the chart from cover to cover because they are the very first ones putting the whole picture together and relaying it to us-the team to move that patient forward. They are much to valuable to the patient and the facility to be charge nurse for a day on a unit. I try to keep quite a few nurses on as a contingent basis for emergencies. I just love my team, if we can't get a PRN nurse in...my nurse managers will just pull together and cover a unit, and you never see them any happier than when they have a chance to do hours of good old patient care. They are an amazing bunch and if it wasn't for them I'm not sure I would stay there. That's why I keep telling everyone...keep looking, there are diamonds amidst the rhinestones. Dawn

Thank you DisabledNurse, it probably comes from having a strong back ground in MDS myself. I'm a firm believer that the MDS nurses are the ones that drive and coordinate the residents care. They are the ones that know the residents history, current medical status and the chart from cover to cover because they are the very first ones putting the whole picture together and relaying it to us-the team to move that patient forward. They are much to valuable to the patient and the facility to be charge nurse for a day on a unit. I try to keep quite a few nurses on as a contingent basis for emergencies. I just love my team, if we can't get a PRN nurse in...my nurse managers will just pull together and cover a unit, and you never see them any happier than when they have a chance to do hours of good old patient care. They are an amazing bunch and if it wasn't for them I'm not sure I would stay there. That's why I keep telling everyone...keep looking, there are diamonds amidst the rhinestones. Dawn

The thing about policies is that they usually develop to "assist" the employee in understanding what is right and wrong at a job situation, because people sometimes leave the common sense factor at home. This is a true story about a storage bin I rented when I first moved to Detroit and the owner handed me the policy sheet. Some of the policies: You may not live in your storage bin. You may not keep animals in your SB. You may not store dead bodies in your SB. You may not keep dead fish in your SB. The list went on and on I started laughing....and she said well, the list just keeps growing because some people just don't quite get it. She actually encounted these things! I agree policies can be stupid..but sleeping ON THE JOB is not right. Punched off the clock...sleeping off the unit....happy dreams to ya.

If you are on your break, punched out, off the unit...sleep away. I could care less. If you are on company time be awake or be fired. If you are not on the clock...what could anyone possibly say unless you over sleep. I love the post about "teamwork" covering for each other during sleeping....ummm..sounds more like "teamsleep" to me. Just a regular old slumber party.

I thought it was harder then h*ll. I had to take Chemistry I and BioChem I and II for my program. After a year and a half of Chem...it was no wonder I grayed early. If you have good retention you will do fine. I don't believe they require all of that now for the ADN program?

Here here traumaRUs....unprofessional and they all need fired. If you have to sleep at night....get a day job.

That is a tough question with alot of variables. Alot depends on how well you know the patient and how good of job you do. How many disciplines actually do the MDS. How many computer terminals are available...etc etc. I require my MDS people to do a quick chart audit for necessary items as they review the chart. A good MDS person will. If items are not in place, it could take a very long time. A MDS person is the care coordinator and needs to let the IDT know if something is missing. It's hard to look at the whole picture if items are not in place. (ie risk assessments, AIM's, guardianship etc.) the list goes on. A comprehensive assessment with RAP's of course takes longer - if the resident is high acuity it could take probably about 3 hours without interruptions and if the patient/family/staff cooperates. A good RAP is lengthy because it needs to tell the patients story...past present and future in conjunction with the plan of care. My advice to you is get your feet wet, do a comprehensive and a quarterly. It's hard to explain to someone that hasn't done it. Good luck, I think there will be some interesting responses on this thread.

We use alot of low bed with the bedside mats. A roll off of a low bed to a mat is considered a "fall". Any change in surfaces. That is not our policy...that is the current law, at least for LTC facilities. There are some great alarms out there right now. One that I wish I could remember the name has a laser beam at the head to the foot of the bed..at the side of course. If the patient touches the beam, the alarm sounds. (Such as one leg going over the side of the bed). TABS also makes an alarm that puts a mat under a resident if the weight is shifted a great deal, or when pressure is relieved it alarms. For the extremely agitated I will put a mattress or two on the floor. Thankfully that has been rare.

I'm a DON in a LTC facility. I went in one night and found 5 people sleeping including the supervisor. I fired all 5. The patients are paying people to take care of them...and there is always plenty to do. Unless sleeping is listed in the job description (what's the chances?), I see it as stealing and unethical, and those nurses are in the wrong profession. I love the crap people can come up with as to why they think sleeping is ok while you are being paid to work.

Hi Suzy, I have always had shaky hands, it seems to be a heriditary thing. It did make my patients nervous, and i would give the "heriditary speech"..it would ease their fears some. Would go on to put in an IV without problems. Over the years the skakiness has gotten worse, especially in the morning. It is much more difficult for me to insert an IV, so I usually defer it to someone else if possible. If not....I just do it. I also no longer thread needles :) Now my biggest concern is signing meds out on the MAR...those squares are getting smaller and smaller I swear. Don't let it become an obstable to you...in the overall scheme of things in nursing, starting IV's is a very small thing. Dawn

Hi Frazzled, My facility is 160 bed skilled. I have 2 MDS Coordinators, and I NEVER pull them. We usually run 30-35 skilled residents. They work 40 hour weeks and rarely work overtime. You didn't say how many skilled you had, but in all honesty, if I had 4 for 120 bed, I would pull. That's quite a bit for that sized facility unless you are running a sub-acute. I rarely attend care conferences either, only if there is a troubled family, or a resident with family issues that needs addressing. The interdisciplinary team attends care conferences which includes Unit Managers and the Rehab Coordinator if the resident is having any therapies. The CNA's have a ADL performance record to fill out each shift, which codes closely to the MDS which is also their flow sheet. Somewhat helpful. In the event of lack of documentation, of course we do staff interviews and explain away in the RAPS. We have daily PPS meetings where we discuss each skilled resident, then a Resident at Risk meeting follows where we discuss a Unit per day. My facility has 5. Every resident and their care/social issues are discussed at least weekly. This is also a great opportunity to continually educate the IDT about MDS coding. I do rely on the Coordinators to address any concerns they have to me if they feel one of the IDT is coding incorrectly. Then we openly discuss it the next day as to what the reasoning was for coding ...sometimes the Coordinators are wrong and the team member can back up why they coded a certain way. I'm not sure if any of this helps, but gives you a glimpse of another facility. Dawn

Hellllo Nurse...sorry we are full up, but if you come to MI come see me, you never know. I agree good ones are hard to find, but they are out there. Revamping the whole industry will never work as long as LTC is basically taking care of the poor. The majority of most facilities are Fed/State funded. What needs dismantled and started over is America and the way they view their elderly. There is a large percentage of Americans in nursing homes who can be home with their family...but the kiddies are just to busy to deal with Mom and Pop. Let the gov't do it...right? Which is everyone of us...the working stiffs. Nursing homes are no different than a household budget. If you don't follow your budget, you are eventually bankrupt. Ever been in a nursing home that has to close due to financial reasons? I have. It's a nightmare for the residents who call that place home, and for the staff. Long term care has been on a train to hell for years. Recent funding cut backs didn't help the situation, with more to come. I could go on and on here, but I won't. Please contact your gov't officials and let them know your experiences, the voice of the people can change things. Last but not least raise your family with a sense of respect and responsibility for the elderly. Someday it can and probably will be a decision the majority of us will be facing: nursing home vs living with a family member. Peace, Dawn

Thank you ACNORN for saying it with flair and a little fire :)

Can't see anything wrong with sleeping? Getting paid while you are sleeping? Does the terms embezzlement and negligence ring a bell? I'm sure there is not a thing wrong with sleeping if it is included in your job description. Can't imagine what the odds are that's ever going to happen. Sounds like too much staff on duty if there is time to sleep. Obviously I feel nurses who sleep should have action taken against their license. Dawn

A year ago, almost to the date, I paid a "surprise" visit at 3:30am to my LTC facility. I found 5 people sleeping, the first I found was the nursing supervisor sleeping at the nurses station. I had to shake her shoulder to wake her up. The CNS's I fired of course filed union grievances. Only one went to arbitration, she lost, the termination held and was valid. Amazes me how someone can sleep on the job and think they shouldn't be fired. Ignorance shows no boundaries. I continue to make random "surprise" visits. It's no longer an issue. Thank God for the patients. Dawn

HellllloNurse, sounds like you had the shift from hell. LTC is not all like that...thank God. My advice for anyone taking a job ANYWHERE...do some research. For LTC, check past surveys, check the new Quality Measures. There are troubled facilities, there will always be so. One bad LTC facility doesn't make them all bad, as does one bad nurse make us all bad. MDS is one of the best jobs in a LTC facility, for someone with experience, excellent assessment and communication skills (oral and written). As in any job, know what your strengths are....then look for the right job. A nurse with less than one year experience "might" be able to do the job, odds are against it. You will be setting yourself up for failure, mostly likely the residents and the facility. Any DON who would hire a new nurse for MDS really doesn't know what she's doing. Just my two cents...don't throw us all away, some of us are trying hard and making it in LTC. Dawn