ltcconsultant

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

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.

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.

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.

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.

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.

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.

"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

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

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

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.

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.

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:

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.

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.

Email or PM and I'll send you some stuff.

The book I recommend most often is Quality and Performance Improvement in Healthcare which is published by AHIMA. It is a very practical book on how to actually do QI. Another interesting book is Health Care Quality and Outcomes Management, which is in an enormous 2" thick binder and published by Aspen. Someone is selling used (although still in the shrinkwrap - practically new) copies on amazon for $25. This is geared towards hospitals, whereas the AHIMA book covers all types of healthcare facilities. I can make more recommendations if you can give me more detailed information about exactly what your job entails and what kind of information you want.

I've got some powerpoint slides on this. PM or email if you would like a copy.

With any sort of dementia, it is helpful to have some sort of routine. It works better if the person's usual routine (the one they followed at home) is continued on in some way after they are admitted to a nursing home.

I've never of heard of this before. It seems that requiring bedroom doors to be shut at all times could potentially be a violation of resident rights. I'm curious as to how your facility has done on its last life safety code inspection?

I actually addressed this in my blog back in 2007 The basic premise behind hourly rounding in the nursing home is that you check in on each resident about every hour (every two hours during nocs) and check on 3 things: Position, potty, and pain. You see if they need to be repositioned, you take them to the toilet or change them, if necessary, and you ask them if they are in pain. These 3 things are contributing factors to quite a few falls, and so if you check on these things frequently you thereby lessen the risk of a resident falling. Since there is a good chance that a good number of people aren't going to need anything when you check on them, this can actually be a more efficient way to accomplish dry rounds, by spreading it out, so to speak. You could take the lean approach and only use this for people who hog the call light or are at high risk for falls. I have worked with a facility to implement hourly rounding and it wasn't as bad as they initially thought. It really isn't as demanding on staff as one might imagine.

The thought of having to change a unit's culture is scary. I've got some good stuff on culture change via implementing resident centered care that you would probably find to be very helpful. Drop me an email and I'll send it to you. My gut instinct is that the CNAs may not have as hard of a time adjusting as you think. I imagine that they will relish the idea of being able to meet the resident's psychosocial needs as well as the physical ones. I agree with capecodmermaid that there needs to be boundaries set.

Just for clarification, it is possible to work in any state as a RN without holding a license in that state. The only catch is that the only employer you can have is the federal government, most likely the VA. Federal health care facilities require that you be licensed in any state, but not necessarily the one you are practicing in. This is probably what the dean meant in his/her letter, but it was unethical for them to not clarify it further.

AANAC's RAC-CT seems to be the more respected of the various MDS certifications out there. It also appears to provide the best value for the money since you have access to their website when you join. Joining + online certification with AANAC is about the same price as the two other major certification programs but I believe this is the only one you can do by self study.

CMS (the federal agency that runs Medicare and oversees all nursing home surveys in the country) have a book called the "State Operations Manual" that contain the minimum standards for each type of Medicare participating facility (hospital, home health, hospice, nursing home, dialysis center, etc.) and the protocols for doing the annual surveys. For each different set of minimum standards, each standard has a "tag" affiliated with it that serve as a kind of code. Nursing home minimum standards have F tags (ex. F309), whereas home health minimum standards have G tags (ex. G114). If a survey agency cites a facility for failing to comply with a minimum standard, they will list the F tag being violated. When someone in a nursing home talks about F tags, they are probably referring to the deficiencies they received on their last survey, which are issued by the state under the authority and guidelines of the federal government. The best source for learning about F tags is to review appendix PP (guidance to surveyors) of the CMS state operations manual. You can get it on the CMS web site or email me and I'll send you a copy.