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I love LTC and that is because you get to know the resident and the families. You can spot a change in that resident right away. Its the great thing about long term care you begin a relationship with the resident that is irreplaceable. The residents become your second family, yet when its time for them to go you only wish it happens fast and peacefully while you are by their families side. I had one resident that got pnemonia every 4 months, resident total care with feeding and ADLS and the family just wanted her to be comfortable, ABX and 02 nothing else tremendous done, this resident went on for years this way until about two months ago she got pnemonia again and it was too late for ABX O2 sats 75% on 5 liters of oxygen, family notified immediately. Family there at time of death along with half the staff and DON and administrator of facility. Very depressing sad situation, however very rewarding that family appreciated that not only did they lose a family member but the staff lost a family member as well. The family still comes in to see the staff every now and again and that makes me realize that the staff at our LTC facilty really made a difference in that families life and that residents life. I am glad and proud to work in LTC the pros surely outweigh the cons, even when it seems that everything ids going wrong. There are a lot more good days than bad.

Hang in there! As long as your facilty does not get taged with immediate jeopordy the facilty will not get closed down, the facility will have a certain time period to get things up to code per state standard there will be a lot of changes but hey sometimes change is good. It isn't the care that the state is questioning it is probably the charting. you know if it was not charted it didn't happen even though it was probably done. Documentation is the key, its just hard to remember to chart every small detail of everything you do in an 8 to 12 hour time period.

I have seen nurses ignore protocol in LTC alomost daily like for instance our protocol states if chemstrip is > 300 then you must recheck and notify MD if no parameters are set, also must recheck chemstrip after 30-60 minutes, I have seen no recheck in chemstrip and no MD notification no family contact etc, this is very frustrating and I feel that if it is okay for one nurse to get away with this than if I forget to recheck a residents chemstrip when everything gets chaotic then its ok and I should not feel guilty since I am checking them before thay go to bed anyways and making sure before I go home for the night that they are below 300 why do I feel guilty that I did not get a recheck in after an hour past the > 300 check when another nurse never even bothers to recheck residents chemstrip. Isn't this enough for the other nurse to lose their job for not following nursing protocol? Or doesent it matter as long as the DON likes you?

I know nothing of being a supervisor, I in fact am a new nurse a LPN in fact, I too get tired of the DON or ADON telling us nursing what we are not doing. However I would never tell my boss to just try and do my shift and get out on time. I know that she would never do it for one and but no that is really disrespectful. The DON at my LTC facility is not as expeirenced as most but none of the nurses would talk that way to her. I think that in your position you could have done something a little more drastic than sending this nurse out of your office. My opinion and I know it doesn;t amount to a hill of beans but sometimes you have to do something to let that staff know how aerious you can be.

My opinion of a new RN in LTC would be based on how the new RN conducts their behavior towards other staff members. A RN may be better qualified but to a LPN who has been at the job for 12 years may be more experienced. Don't crap on the staff that may be less qualified because they have more experience. A RN is only as good as they are trained and have learned from many qualified individuals like housekeeping, CNA's Med techs and LPN/LVN. I have worked with may new RN's as a CNA and I have learned that the RN's that take CNA's for granteed don't last in LTC. However the RN's that rely on the CNA 's and that are helpful and respect everyone turns out to be a great accet to the facility.

What does IMHO stand for?

I know exactly how you feel, I find that I leave things for the next day, you know things that can wait. Wound assessments for instance, if done on day shift I will still look at wound do dressing or whatever however I won't chart on it until the next day. Respiratory assessments are something that can not wait obviously I would chart on that. In my LTC facilty I look at 8-10 skin problems a night and only chart on 4-5. I found that doing rounds with the CNA's being the most helpful. In the beggining of my shift I put stars around things that need to be addressed right away or that shift. It helps. Our DON informed nursing that skin problems only need to be charted weekly. My goal is to chart on skin problems q 3 days even if another shift already charted on them.

I am thinking about a decline in food intake may being the cause of low blood sugar readings. Maybe resident doesn't need oral agent any longer due to healthier choices/decrease intake from norm. So that way when you update MD you have the whole picture. That type of thing.

I am a new nurse and sometimes I get frustrated because of another nurse that is not doing her job. This nurse has called an RN because of a low blood sugar like the RN would fix this problem. The policy where I work is to notify MD of blood sugars

I am a new nurse. So I am asking for a little advice. I work in LTC and recently a resident had a decrease in oral diabetic agent due to low chemstrip resdings. This resident only gets checked once daily three times a week. Should we be monitoring food intake and cheecking blood sugars more often due to change?