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Nursing Home Consultant

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  1. ltcconsultant

    MDS training unavailable in Georgia

    Rena Shepard will be in Atlanta sometime in the middle of September doing the three day AANAC workshop.
  2. ltcconsultant

    How to choose CPNE site???

    I saw an informal ranking of the test sites somewhere (can't remember where), with Racine, Atlanta, and Syracuse being the top three. I passed in Atlanta at Grady. The two adult PCS were both ortho, and the peds was sickle cell anemia. In fact, I was told by someone I knew in the area that all the hospitals in Atlanta had made each of the peds units focus on a specialty, in order to improve utilization, and the Grady handled the sickle cell cases. I have heard that SRMC doesn't do peds, but I know nothing about Gwinnet. I would imagine, however, that the CPNE would be about the same no matter where you go. This is because the test is as objective as it can possibly be.
  3. ltcconsultant

    QIS survey

    May I suggest using the forms from the QIS in QAA committee? You can get quality assurance and survey prep done at the same time. The forms have the guidance to surveyors written on them so there is virtually no subjectivity. The ones you really want to use are the stage II critical elements, available here.
  4. ltcconsultant

    LPNs Supervising RNs

    This is what LPNs can't do that RNs can: 1. They cannot complete the planning of phase of the nursing process independently (ie, they can contribute to a care plan but not write it) 2. Generally, they cannot push IV meds (depends on the state) 3. They should not be responsible for an initial assessment 4. They are not able to make a nursing diagnosis 5. They are not able to evaluate nursing care 6. They should not do the initial patient teaching, although they may reinforce it. In short, they may only perform the implementation phase and selected components of the evaluation phase of the nursing process.
  5. ltcconsultant

    LPNs Supervising RNs

    It is a violation of the nurse practice act for a LPN to supervise the clinical work of a RN, however there is nothing to legally stop a LPN from supervising the administrative work of a RN. Whether or not you actually consider a LPN to be a 'real nurse' (ANA doesn't), they are nonetheless an extremely important component of the healthcare team. Perhaps you should look at whether or not the role of charge nurse at your facility is one of clinical leadership or of (more likely) administrative leadership.
  6. ltcconsultant

    mds certifications

    Go with AANAC. Both AANAC and NRAI require that you complete a course to get the certification, but only AANAC gives you a choice of doing them online. NRAI requires that you sit through their course, which is only offered a couple of times during the year. AANAC can be done anytime online. It is the more respected of the two, and I'm thinking it's also cheaper. As far as MDS 3.0 goes, you will still be working with MDS 2.0 for another fifteen months before 3.0 goes into effect. AANAC will have a 3.0 course available when the time comes. Also check out http://www.mdstraining.org, which is a free online MDS tutorial from CMS. Good luck.
  7. ltcconsultant

    Don't You Just Want to Scream?!?

    Why does she perceive the ADL cards to always be wrong? What is her rationale for not using the gait belt? Was help not available, or did she have a reason for choosing to work alone? There are four primary goals for misbehavior: Attention, power, revenge, and display of inadequacy. Of course, there are a few more goals in LTC: trying to get everything done in a timely manner, trying to meet demands from residents or supervisors that are perceived as unreasonable, etc. What was her underlying goal? Irregardless of what you do with her, I think it would be worthwhile to try to get into her head in order to prevent similar occurrences in the future. Without knowing all the circumstances, I would probably fire her. I might also consider keeping her part-time as a paid feeding aide or some other quasi-clinical position that doesn't put her in a position of endangering resident safety, but only if you are short staffed. If she really is a persistent danger to resident safety, however, she doesn't need to be there at all.
  8. ltcconsultant

    Pearls of wisdom needed

    "At that minute, I knew there was nowhere else a high school dropout could go and have that much power and influence...You see, we have the power to make an old person feel special, beautiful, worthwhile, needed, wanted, respected, revered, admired, and productive, but we also have the power to strip them of their every dignity. That power should come with a warning, and we should all be reminded of it everyday. None of us fully appreciate or comprehend the power of our own influence." -from "Everything I Learned in Life I Learned in Long Term Care" by Lori Porter
  9. ltcconsultant

    DSD Course in San Diego??

    The California Healthcare Facilities Association is having a DSD course in San Diego June 24 through the 26th. The flyer is at http://www.qchf.org/fliers/2008/DSD_Edu_Program5-08.pdf
  10. ltcconsultant

    pt rights & staffing

    The reg is tagged at F356, the essential text of which is posted right above you.
  11. ltcconsultant

    pt rights & staffing

    Under the medicare conditions of participation for nursing homes, at the beginning of each shift the census must be posted along with the number of RNs, LPNs, and CNAs working. It must be legible and posted in a conspicuous place. Any person, resident, family, or whoever else, has the right to get a copy of it upon demand.
  12. ltcconsultant

    need idea for program name

    Can those two things actually be packaged together?!? Tell me some more about the program so I have more to go on. How do these things sound? Empowerment Express Suggestion Service (or service suggestion) These are the only ones I can think of at the moment. In my experience, however, slogans tend to backfire especially if they are part of a quality improvement project.
  13. ltcconsultant

    BUBBLES in the syringe!!!

    Make sure the bubbles you get are air bubbles...I failed the injection lab the first time through because I had somehow drawn up air and the 'bubbles' in the syringe was what little of the med I had actually gotten!:trout:
  14. ltcconsultant

    CPNE Failure

    I finally passed the CPNE this past weekend at Grady in Atlanta and had a good ole time. Each PCS went smoothly and quickly, got out of implementation phase in 15 to 45 minutes for each one, and passed everything. I did have to repeat two of my labs because of brain farts.:brnfrt: For my IM injection, I drew up my first med, flicked out the bubbles, and gave it to the CE to verify. It turns out that I had somehow drawn up air and the bubbles I flicked out were actually pretend medication. And then for the IVMB, I calculated the drop rate wrong. Not thinking, I put down the dosage in place of the volume in the formula. I knew something wasn't right when I got a rate of 100 drops per minute but I just couldn't put my finger on it. When I repeated the labs the next day, I did just fine.
  15. ltcconsultant

    helpful literature for new position

    I think the AHIMA book is at just the right level for someone starting out. Another good book I forgot to mention is Chip Caldwell's Handbook of Managing Change in Health Care, although it may be overkill at this point in time. There is only one measly chapter about change, the rest of the book is about quality improvement techniques. I've got some handouts and things from conferences I can send you if you PM or email.