JellyBean1

I am an RN in BC and as far as I know you only need to prove your graduate RN status to become registered. The universities now provide a BSN for graduation.

You're right doing VS in LTC is not routine, particularly if they are Palliative. We usually monitor the temp only and give Tylenol per standing order. We are beginning an educational campaign specific to this however there remains a few nurses who will do as they want only. Even if there is a Drs order as a nurse you are able to do your own assessment and choose not to give a drug!!! Personal opinion on what is in our facility...it is an additional walk down the hall to the patients room, if the option is there to give a Tylenol or not.......they choose not to because they can. Sad as that is. How do we get around that one.

We are faced with this issue alot in our LTC. Even a doctors order for Tylenol four times a day is disregarded because it's thought the patient doesn't show any signs of pain. So some say anyway. She is frail with huge ulcers to the bone. At least it would make turning and washing more tolerable. I don't get why people won't even give Tylenol. Isn't this the very least we can do to at ease her journey?????

I was always taught that maintaining a sterile environment and a closed drainage system is crucial in catheter care. If a resident switches between a leg bag and reg. drainage bag in the day it is routine at our facility that the larger drainage bag is washed and rinsed with vinegar or......any other cleanser available in the service room. This goes against everything I've ever been taught. The bag is taken to a service room and stays there through the day to drain. What about the sterility of the system, back flow of unrinsed cleansers? It's not sterile anymore. You'd think with the stronger bacteria around these days that this would be frowned upon. Maybe I"m old fashioned but to me this is something best not tampered with. Can anyone offer thoughts on this?

I need some advice. Would you consider things like fleet enemas and ear syringing necessary in Palliative Care? I ask because we have alot of new grads. One of our ladies has been Palliative Care for a couple months, she is extremely weak, barely eats or drinks, is awake and talking. She had a sore ear and now has the oil/syringing. Plus has been given supps/enemas as she is not going to the bathroom. I have a hard time with this. Just wondering how others feel.

Sorry for the confusion. It is 4-8mg. in a subcutaneous butterfly. This person is palliative care. :imbar

Yes we are giving Ativan through a butterfly needle so it's SC or IV prescribed. I do believe it is 10-20 mg.

I'd like to prepare myself for this young mans death. I know it will be unbearable for him, his family and myself to watch as he fights for his last breaths of air. Anyone with some ideas on what I can do for him both physically and emotionally to help him through. He will be a fighter till the end.

Okay I'm new to all this and I need someone to give me the straight explanation on a couple issues. 1: Ativan po dose compared to Ativan SC dose. ( like 0.5mg po and 4-8 mg. SC) Both routes ordered. How to explain to the family why there is such a difference in dose between po and SC. Sounds like the patient is really getting a huge dose increase when SC is used. 2: Nebulizers: Combivent vs. Ventolin nebs.and puffer. Pt. can take a ventolin puffer but can't tolerate the Ventolin neb, barely tolerates Comibivent. Why is that?

I've had it. I started nursing later in life. I'm in my forties now and find I just can't do it. I thought I could but find I'm not comfortable with the amount of self doubt I have. I am a LTC nurse which I love. Recently started in a home where I work alone and no one else around to ask questions of. It's lonely and scary. Things eat me up. I'm scared of making the "fatal mistake". I'd like to leave my job and just carry on with the rest of the day instead of beating myself up. What's happened. Can anyone share some insight. I'd like to start anew but not sure which way to turn. Give me the biggest rock to crawl under please.

Well I'm in Canada and in my province the move is to drastically reduce the RN positions and have only LPN's. It is happening at many facilities now. Legally there should be 1 RN in the building for consult and the rest could be LPN. Seems if they can find a way to get rid of the 1 RN they will do that too. QUOTE=surfnbeagle]:) Hi I am an RN and work as a staff nurse in a SNF in FL. Has anybody heard that facilities are looking to hire LPNs and not RNs for staff positions?

It is too bad you couldn't keep taking shifts at both places. I know for me, I only have worked LTC. I only did acute for a few months and now it's been 8 years. It will be next to impossible for me to return to acute unless I have a few months perceptorship. I may pick things up quickly again but it would be the confidence level I would need. There are just alot of things you don't really do anymore in LTC and the focus is quite different. Many times we are not totally there to cure but more to provide comfort and quality. But if it's ultimately the type of nursing you want you will find satisfaction. QUOTE=nadia562002]I recently resigned my position in a hospital and now considering a job in LTC. I have one year of experience on a step down tele floor. I am wondering if taking a job in LTC would be to my disadvantage. WIll this decision arbitrarily make it harder to return to the hospital in the future?

I felt the same when I first started in LTC. I got 3 shifts each one in different areas. Basically gave me a full overview of my facility but nothing too specific. It is daunting at first but remember to ask LOTS of questions. I think most places would (or should) say if you are still unsure ask for another orentation day. It's in there benefit as well as yours especially since you have just graduated. I know look after anywhere from 25-75 residents depending on the shift. You will soon feel more comfortable. Just don't do anything you have questions about. Everyone starts somewhere. I for one am still trying to feel confident about lots and I've been at this for 10 years. Hope that helps you.

Wow lots of replies. Thanks. Actually the man was in long term care and not a transfer. He was walking and likely lost his balance and fell backward. No bruises or trauma immediately noted. He was more or less fine for the first night then the next day took a turn for the worst. Thought maybe he had thrown a clot from the hip fracture. Thought game over and seemed like he was dying then. He did bounce back but then starting to throw up dark blood. Soon after died. He had some sort of lung condition I believe from working in the past with asbestos or silica. No autopsy.

Had an elderly man who lost his balance and fell backwards. Xray showed a crack in back of hip. Went downhill after a couple of days, vomiting blood and then died. I believe he had some lung disease, silica or asbestos. How would a fall have triggered this?????