momandstudent

Mary, so it sounds as if our current plan is the best for right now. We are actually going to start out with the focus on those coming out of therapies. We have our electronic documentation service where the aides will put enter the minutes and this will pull to the MDS. The binders have the residents' specific exercises listed. Thank you. @ DHawkinsrn: Good luck with your program and please keep me posted, if you would-what you have found to work and not.

Yes, thank you for the links. I have taken binders for each wing and given a section to each resident. In each section will be their therapy communication sheet which states the exercise/ambulation program. We have POC and the aides will be documenting the amount of minutes on there. From what I have been told, our restorative program is going to focus on those that have completed therapeutic services to maintain their functioning level. From what I have researched, anyone should and could benefit from a restorative program. This is where we are confused (or at least some of the confusion). Couldn't ALL of our residents benefit? Or is this just a financial thing? Couldn't we see a higher reimbursement for anybody that receives restorative services? Do you have your aides do any notes on the programs? I want to make this program as successful as I can but I also don't want to go overboard-I have a tendency to do that. @ DHawkinsrn: how are you starting your program?

We have an issue going on with our hydration pass at our LTC facility. It doesn't take a rocket scientist to figure it out but to get the nursing department and dietary department to work together is more like trying to give a cat a bath. Anyways, the dietary manager and I have been given the job of coming up with a game plan to make sure this works for the 2 departments and, most importantly, getting done. We used to have pitchers and fresh ice water was passed 2X/day. The residents were complaining about the heaviness of the pitchers and filling the pitchers was time consuming to the nursing department. We since have ordered 12 oz. glasses and the water pass it to be done 3x/day. The first pass is to be completed after breakfast, by the NARs. Now, they are still getting residents up at this time and residents are returning from breakfast. Need to be toileted, lay down, get ready for appointments, etc. So this pass is difficult and is not getting done. The next pass is at about 2:30pm. The NAR goes to each room and picks up the "dirty glass," then a dietary assistant fills all new glasses with fresh ice water and passes out to each resident at about 4:30. If residents want water in-between this time, we use disposable glasses. At HS, the dietary department refills with fresh ice-water. We cannot depend on the dietary department do to all 3 passes and I get the business of the NARs. But our residents have to have their water.....this should be an easy problem but looking at infection control, time management and ease..... How do any of you pass your fresh water throughout the day? Looking for suggestions....

My facility is starting a restorative nursing program and I will be the supervising RN. I am curious if anyone has any good information that they would be willing to share with me, such as: care plan ideas, templates to use, ideas to incorporate to ensure the program is being completed, etc. Has anyone used any restorative textbooks to get their program up and running? We do not have restorative aides-it will be our CNAs completing the work along with their other daily functions. Any input would be greatly appreciated as we (the other nurse managers and myself) are really in the dark.

Thank you for all the input. This pt. was moved to a private setting as soon as we "thought" it may be C-Diff. In our facility, we do not have the availability of moving pts. around easily. So far, while I have been in this position, we have at least been able to move those with C. diff to private rooms (even if they have to share a bathroom). This resident was treated with C. Diff from the beginning but has had multiple bouts. One time, the NP ordered a sample just a few days after she completed one of the treatment rounds. I strive for waiting at least 10 days after treatment to run another stool sample to decrease the chance of false-positives (which I think may have happened one of the times). She then also had a very bad UTI (of course she had recently completed her 2nd round of treatment for C. Diff) and of course-C. Diff AGAIN. This has been one of my major projects this week-to look at and develop a policy for commode use/emptying and disinfecting. We did some science experiments yesterday and came up with our plan and everyone appears happy with it. Now, the question was raised by the DON: What are we going to do when we all of our rooms are full (no available private rooms) and we have a resident, who resides in a semi-private room, gets C-Diff. So the research continues......Again, thank you for all of your input.

Hello, I need advice. I am the infection control nurse at a LTC facility. We have a pt. that we have moved to a private room months ago r/t c-diff. This private room does share a bathroom. Anyways, we do not have a policy (which I now to need to get completed and in place) for proper disinfection of the commode that the pt. with C-diff uses. So here is the problem: Pt. with C-diff uses the commode and pt. without uses the shared bathroom. The aides had asked me early in the game how to empty the commode. I looked at the whole picture and felt transporting the commode or even the covered commode bucket down the hall, to the utility room to be disposed and disinfected was possibly a huge risk to many other people: other pts, visitors and potentially staff. Oh, and we keep our clean commodes in our hopper room (not because we want to but that's the only space we have). So I told the aides to empty the commode in the bathroom and bleach down the toilet and sink and fixtures after doing so. And yes, I did think about the "toilet spray" effect. The other pt. who shares the bathroom has had no S/Sx of C-diff at all. The question, after months of completing it this way, has been raised. I have looked through APIC and all other infection control manuals, policies and web pages. There is nothing out there. I am now looking for flushable commode liners and am unable to locate anything. I need expert advice. I have looked at all possibilities and I know what we are practicing is possibly putting someone else at risk but if we were to take it through the hall, that would put more at risk. And the pt. who does not have C-diff will not use a commode-she insists on using the toilet in the shared bathroom. This posting is very poorly written and I'm sorry...long day, lots of brain activity and lack of sleep.

I am the occ. health/education/infection control nurse at a SNF and I am trying to come up with some material to help alleviate medication errors among our nurses. Right now, when an error is found, a form is filled out and the nurse and DON discuss what happened and what steps will be taken to prevent further mistakes. Many, many times, the nurses say, "Will pay closer attention or will take more time during the pass." Our DON is new and would like me to come up with some sort of "homework" for the nurse(s). She did give me a packet to go through this weekend which is about 60 pages of combined reading and essay questions. I have not thoroughly read it (it is the weekend ) but I was wondering if anyone else had any good ideas. I am going to post this in some other areas on the board but thought I would start here as it gets more traffic!!!! Thanks for any input.

My favorite: "Where's my call-light?" as she has it clenched in her hands.

I have just started orientation at a LTC facility earlier this week and I have some fears/questions that I would like any help with. First of all, the facility has 77 residents. I was hired for the night charge RN position. During the night, I will either have the wing with 53 residents or the one with 24. I will have 6 nights of orientation (3 on each side). I have started my daytime orientation which has 2 nurses caring for the 53 residents and 1 nurse with the 24. I get 2 day shifts per unit. So here lies the problem, what is the easiest and MOST effective way that you have found to memorize who is who in LTC and quickly? I have looked at the pictures that are in the MAR and they were taken when the resident was first admitted...we all know that could have been 1 year, 2 years or maybe more years ago. They have changed in looks. I am so scared that I will give the wrong meds to the wrong resident. I do feel comfortable on the unit with 24 residents so I am thinking I may discuss this with the DON (who is extremely nice) and ask her to allow me to work on that unit until I feel more comfortable with names/faces on the other unit. I know that I can ask my fellow teammates for help with identification but if there is any trick(s) that have worked for any of you, I would appreciate your help. Any other advice that you have for LTC will be greatly appreciated also :). Also, how are state surveyors with new employess (and new grads)? Are they extra hard on them because they can see that we are shaking in our boots? Apparently state has not been there yet and I am fearing they will come as soon as I am of orientation-just hoping that none of them are "night owls".

I have thought about the same thing but what the previous poster said is true. They see the RN and know that once you find that job, you will take it. Also, does your state allow you to practice under your license class? Another thing to consider. But, yes, I have also seen many LPN and MA positions advertised...I too have been looking since June 14. Two interviews and nothing. It is what it is and it does bite...hang in there with your head held high-easier for me to tell you to do that than do it myself

I cannot give you good information on what to study because I didn't study before I took boards. I did the ATI and that was pretty much it. I did do about 15 questions the day before but that was all. I was so burnt out and really just had the thought of, "If I pass, I pass. If I don't, at least I know how the test is and I can study from there." I know, I know...really bad thought process but I tried and tried to do more than open my books and stare blankly at the pages in front of me. I know one of my classmates used Saunders and she passed (she did the whole book). I am sorry I cannot help you more-GOOD LUCK!

Aahhh, the virtual ATI...brings back memories from just a mere 3-4 months ago. My school also utilized this program and all that I can tell you is..just do it and get it done. We were told by the school that it was a very beneficial program. In all honesty, I wished we didn't have to do it. I don't know if I was so burnt out after graduation from school in general or if the first assessment left a horrible taste in my mouth but I didn't like ATI. I struggled to complete the program but looking back, if I would have just bit the bullet, it would not have taken me almost a month to do. I can say that the questions for the assessments were very comparable to the NCLEX. They were hard but so was boards. I tried to utilize the study material offered through the program and quite frankly, it was of no help. I tried the study guides-no help. The power points were also worthless. I wish I could tell you differently, but I can't. The only thing that I found with ATI was that the questions were comparable to boards. I know that I really didn't help you and I am sorry about that...good luck!

I would like to take a minute and tell you, "Thank you for being such a caring and supportive husband!" Your wife is very lucky to have you. I can honestly say that if your support throughout her education was anything like it appears, you helped her immensely through a very rigorous and emotional time in both of your lives. It helps so much to have a supportive spouse that is always there to cheer you on. I know that I can never repay my husband for the support he gave me while I was in school... Now, CONGRATULATIONS to your wife and may the two of you continue to support one another throughout life. Both of you deserve a nice night out (or in) because I am pretty sure the dates were pretty far and few between there for awhile...

So, can any of you tell me what your credit scores have to be like for them to even think about accepting you for the process? We (husband and I) have had some "not-so-perfect-times" with our credit because of his line of work and getting laid off. Another friend of mine wanted to apply but she she just filed bankruptcy because her husband had been out of work for almost 2 years while she was in school. Thanks for any info...

Hope3, Thank you, thank you, thank you for this valuable piece of information. I am going to call the state tomorrow and see what they have to say. I have never heard of this before and I am willing to do anything right now! Again, thank you so much!