Furwillfly

I am an R.N. in LTC. have worked in LTC all my life it seems. Started out as CNA. LTC has bad rap and always will due to people's ignorance. Yes, it's hard work. Yes, the nurse/patient ratio is high. Yes, there are skills I haven't used in awhile. Some nurses think LTC nurses 'just pass meds'. That is not true. Its not about LTC......its about what do you really find rewarding in your nursing career. I LOVE my job in LTC. Yep, been in hospitals, and doctor's offices...etc. There are many skills I have that hospital nurses don't. But for the most part......it is peoples ignorance in that nursing homes are just a place to watch people die. your underpaid and overworked. I say every nurse should work in a nursing home as an aide and a nurse. I draw blood, do IV'S, iv pushes.......manage, delegate, call doctors, call families, etc. Oh......i could go on and on about what i do and why i love it. Good luck! You make up your own mind.

As previously mentioned, I know all about HIPPA. I also already said that perhaps she did try to check on him, or he refused to have her in his home. I will give her that one. However, if someone is gravely disabled and you are concerned, you get the courts involved if you can't call the kids. If I'm concerned about someone and my hands are tied to get family involved....I call APS. That is what they are there for. Even if she wouldve started steps with APS and gotten a court appointed guardian........I would have been happy. Even 'difficult' people need care. This is why they have mental hospitals. If you see a child is being neglected.....and you can't call family......you call CPS. The elderly are at risk. And people feel because they are older and have their rights they can care for themselves. Incapacitaion is just that. They are also the ones who fall through the cracks. Looks like HIPPA and the state didn't protect my father, just gave him the right to be gravely disabled.

Thank you for your insight. No, he doesn't believe he is schizophrenic. And the family isn't as much concerned about his schizophrenia, 3 of the 4 kids are nurses...we are a statistic from a dysfunctional home. So we know the illness. My sister and I are going to get guardianship of him with or without his consent. He evidently has reached the point of not taking care of himself.

I am not at all offended by what you're saying. I appreciated it. And you have a point, I don't know if they tried a home visit and he didn't allow them in. Quite possible, knowing my father. I also work in psych/geriatric in rural community, and if I'm concerned about an adult who can no longer care for self, despite how he/she wants to live; I have the legal responsibility to call APS. And check to see if perhaps they shouldn't have a guardian appointed by state. And you say "they have the right to live as they choose (within legal limits)" what are those legal limits? Shouldn't elder care make sure those "legal limits" were ok or not? We could have a wonderful debate :) about this. I do appreciate your time and insight! And you do have very valid points. I will step down my anger until I have the 'facts'. thank you!

Thank you for your insight! I don't know if he was asked if he wanted his family called, as I don't yet have priviledge to that information. Like I said I understand HIPPA, but they weren't making sure he was taking care of his needs. They couldn't have done a house visit.....we now have pictures. AWFUL! No hot water on, mold in the bedroom he was sleeping in, no furniture, refrigerator unplugged, no cooking utensils of any kind, and filthly, and he had been heating his home with propane tanks inside the house....(they knew about that one)_ So it goes further than them not calling us. It's more what the heck were they doing for him if they considered him 'at risk'.

My father was discharged from the hospital as 'gravely disabled' adult, whom had a psych consult while there, and i found out he had been diagnosed with schizophrenia prior to the admission; don't know when. He has always been a loner/hermit. He was a sick man who just had surgery on his neck, and was discharged with(as psych guy says) "no plan for follow-up treatment for neck or mental health care". Come to find out elder care services knows him very well ,they say, they knew he had children, but none of us knew he was in hospital, and/or gravely disabled. Or we would've stepped in. They didn't call us. And he's not enrolled in mental health services....why? And why were we not called? I know all about HIPPA, but when you have a gravely disabled, schizophrenic man don't you need to do what is best for them and see if their is family who wants to help? This mans health has now deteriorated severely as his growth on neck is now Cancer. He had gone into elder care office 6 years ago with a small growth to get help, and they did nothing. Isn't that wrong or is it just me?? Me and my sister are now going to get guardianship over him so that his health care and financial needs are being met. I really want to file complaint against this elder care woman, but I want to make sure there are others out there who think this was wrong. Now the elder care woman calls my sister to see what we have done for him, and is going to call in a month for a follow-up!!! That really ****** me off! Sorry. Please give me your opinion.

I need some nursing management advice please. I have worked at my facility for 5 years now. For the last two years now, the Administrator and DNS have worked the floor quite often as we are very rural and short staffed. I genuinely like the two very much. Problem....they have their favorite CNA'S. I don't mind this unless it gets in the way of how the facility functions, which it has and I'm being the good little nurse and keeping my mouth shut. I use to open my mouth but it has gotten me NOWHERE. My other CNA'S are very hurt and frustrated by this. I'm the charge nurse when my bosses think it nessacary to call me that. Other than that I'm just a glorified floor nurse. These two CNA'S get away with things like calling off for the most innane reasons, like ones husband and daughter had to go to town that day and they only have one vehicle, comes in early and leaves early without telling me, has told me I'm a brown noser. Has told the other CNA'S that nothing is my business. she has the other CNA'S come tell me stuff regarding the residents cause she chooses not to talk to me. I changed the dining room around to make it more feasable to feed residents properly, she changed it back. My boss told me I should ve asked my 'team leader', which she is, by my bosses choice. One time my boss changed the dining room to make it more feasible, on my days off and about a year later, and I said to her, "Did you ask your team leader and your charge nurse?" I laughed, but meant every word:confused:. Team leader does the schedule for the CNA'S. She also changes it anytime during the month to suit her needs. She has out and out not done something I've asked her to do for a resident. The other girl calls in all the time, works another shift so don't have much dealing with her. except her calling in sick and then being out on the town within an hour of calling in. She does this repeatedly. I tell my other boss and nothing happens. I could go on, but you get the idea. I've lost the charge in charge nurse. I dont know how to get it back. I feel undermined and disrespected. I am angry at myself for allowing it to go on, but I need my job. My CNA'S turn to me to change things, but I can't. I have tried outside of turning in my notice. So, I reward the CNA'S that are respectful, hard workers and don't call in al the time. I love my job and co-workers and don't want to leave. we do have an attendance policy but it doesnt get followed anymore. Any ideas?? Thank you!

I need some nursing management advice please. I have worked at my facility for 5 years now. For the last two years now, the Administrator and DNS have worked the floor quite often as we are very rural and short staffed. I genuinely like the two very much. Problem....they have their favorite CNA'S. I don't mind this unless it gets in the way of how the facility functions, which it has and I'm being the good little nurse and keeping my mouth shut. I use to open my mouth but it has gotten me NOWHERE. My other CNA'S are very hurt and frustrated by this. I'm the charge nurse when my bosses think it nessacary to call me that. Other than that I'm just a glorified floor nurse. These two CNA'S get away with things like calling off for the most innane reasons, like ones husband and daughter had to go to town that day and they only have one vehicle, comes in early and leaves early without telling me, has told me I'm a brown noser. Has told the other CNA'S that nothing is my business. she has the other CNA'S come tell me stuff regarding the residents cause she chooses not to talk to me. I changed the dining room around to make it more feasable to feed residents properly, she changed it back. My boss told me I should ve asked my 'team leader', which she is, by my bosses choice. One time my boss changed the dining room to make it more feasible, on my days off and about a year later, and I said to her, "Did you ask your team leader and your charge nurse?" I laughed, but meant every word:confused:. Team leader does the schedule for the CNA'S. She also changes it anytime during the month to suit her needs. She has out and out not done something I've asked her to do for a resident. The other girl calls in all the time, works another shift so don't have much dealing with her. except her calling in sick and then being out on the town within an hour of calling in. She does this repeatedly. I tell my other boss and nothing happens. I could go on, but you get the idea. I've lost the charge in charge nurse. I dont know how to get it back. I feel undermined and disrespected. I am angry at myself for allowing it to go on, but I need my job. My CNA'S turn to me to change things, but I can't. I have tried outside of turning in my notice. So, I reward the CNA'S that are respectful, hard workers and don't call in al the time. I love my job and co-workers and don't want to leave. we do have an attendance policy but it doesnt get followed anymore. Any ideas?? Thank you!

I don't know the r/r of ALF as Im in LTC facility. I do work with these kinds of residents and we do a few things. Being they are forgetful to use a walker we provide them with a Merri walker. It is a form of restraint, but typically in our state its ok if we have family permission and MD order; as long as you are providing the least restrictive method. If this gentleman was im my facility I would have to come up with something. Here is an aside however, I have a gentleman who worked on tractors etc he was always on the ground fixing things. He will put himself on the floor, not fall; so it is part of his careplan and he is checked on and provided plastic tools to do his 'work'. some thing to think about. ask family what this resident use to do for a living. We still find him on the floor, but never see him fall, so we do do frequent body assessments; just in case. Anyhow, think outside the box.:)

I was taught to do this as a standard practice.

I have to say how ASSININE! Ask the pharm. if you need an MD order to wipe their periarea with cleanser too! Sorry.... Get routine standing orders from your MD. Lip balm is part of cares...... Trust me, your MD will get tired of calls for orders of lip balm etc; he/she will give you standing orders. we even have standing orders for sunscreen....

Never stop asking 'why'. An increase in behavior could be a UTI, or pneumonia, or pain, etc. It may not just be a deterioration of their Alzheimers. Be creative with interventions. Your CNA'S are your eyes, ears and backbone; listen and respect them. Families can be difficult but become an important part of your work family.

We weigh weekly upon admit for 4 weeks, then 2x a month until the dietician and I go over the weights and mutually decide to change to monthly. I am in charge of the weights. What I do to make it easier is split all weights up between day and evening shift. I highlight the resident's name on the Bath list on a week to week basis if they need weighed that week. And noc shift weighs wheelchairs q 3 months. They go back to weekly/2x month if they loose weight per our protocol, or nutritional risk, or like you said any increase in a diuretic. I think you should come up with a plan that is reasonable and present it to your staff. Good Luck

It's hard isn't it. I've been there many times. Remember the good times with the resident. And know in your heart, you gave him the best of you that you could give, and blest his final days with the sharing of your heart and soul. God bless, will keep you in my prayers. I wish I could say it gets easier, but it doesn't, you just find a better way to be at peace with yourself. :redpinkhe

And some of the more cognitive residents enjoy responsibilities, like " you would be a big help to me if you would brush my dogs fur...or watch him/her for a few minutes in your room for me." it makes them feel important. Of course you need to know the resident and be able to trust they won't hurt the animal. that's a GREAT idea to help you name new puppy :)

We have a 10 year old 'facility cat', that was adopted when the resident passed away. We have one other cat that is a residents and we share taking care of it's responsibilities. And we have two dogs that are residents'. We are animal lovers at our place, and I'm highly allergic to cats (have 5 myself :)) I love them more than I mind allergy pills. Anyhow, to your question ...they only rules we have besides up to date shot records on file for state is the animals aren't allowed in eating areas when the residents are eating. That's pretty much it here in WA state.

Just an FYI, it could be his oral mucosa is dry. So it would just be a natural response to suck on something wet/moist. They make an oral moisturizer that one uses after oral care, to keep the tissue moist, I have found it wonderful! And can tell the residents like it.

I agree that residents need continuity and a nurse should be on a wing for a certain amount of time. One can get to know their residents well and are quicker to pick up signs of illness. However, the other side of the coin I can understand completely. We have 'wing wars' from a few nurses and it's honestly ridiculous! I'm charge and I go where ever I need to go as I also work the floor. It is something that also happens with my CNA's. One won't work any hall but 'their own'. I do think staying on a hall too long can burn one out sooner. And with the behaviors and difficult clientele we have more than one month would be awful. However I give any whinny person whatever side they want cause I don't want to hear about it, and don't want them to quit. = poor charge. But it is harder if you don't get the support you need from your bosses.

I live in WA and my guess is DAMale works in a hospital or something, because we can't use leather restraints where I work; so lets not stereotype. :) Talking about interventions of this gentleman, have we a behavioral intervention list? Have we attempted to see if he has a medical reason for his agitation? Like a UTI? Labs...thyroid...etc? If he is difficult to give meds to a short term order for Ativan cream, or perhaps Zyprexa IM, just to provide cares etc....what oral meds is he on? For inappropriate toileting a "Onesie" works wonderfully! I work with residents like this everyday where I work.....it's not easy; you gotta try everything to figure out what is wrong and what will work for him. I would keep calling his doctor until I got an decent order, he may get mad, but he would be 'on board' then. Our doctor doesn't like me very much, but I'm not there for him, I'm there for the resident.

I walk on my treadmill too. The question was: has anyone tracked calories burned during a shift at work.

I work in LTC. I have a pedometer, I average 4 miles per day with 650 calories burned during the 8 hour work day.

One nurse to 40 residents? That is insane! I think it differs state to state, but here in Washington I don't think there is a law on the alloted ratio. However, here if you don't feel you can't take care of 40 residents.......don't clock in. Don't accept the work load. That way they can't hold it against your license. I think it is awful of them to not have discussed the hours scheduled. I wouldn't work in that environment, not fair to you, your co-workers, most of all the residents.

That's too bad. We can't afford to not do a r/o UA or my staff have the potential risk of getting the c*** beat out of them, or worse another resident. In our eyes this is more important and cost effective than staff time loss or state having to come in for a resident to resident with injury and siting us for not treating or following through. And we got our MD to see it our way..LOL

We have standing orders for UA'S/Labs from our COS. We will usually dip it first, and do vitals before calling MD. Our MD doesn't usually do abo's for

I think hospice care is very different than treating chronic pain. I think if one is dying and a durgesic patch is cut.......fine. They probably need the dose delivered immediately, as they probably won't be there in 3 days anyhow. I'm not going to go back and forth with more experienced nurses here, we are all here to learn from each other, young and younger and old and older. We all know there is a reality and the 'right' way. But I do believe if one of my fellow nurses found me cutting a patch in half and putting on a patient with chronic pain, they would turn my *** in to state. That's my 2 cents.....