the_alchemist

Hi all! I just want to know how other facilities conduct their weight variance meetings: who attends the meetings, how often, how long it takes on average, and follow up procedure. Our building has been through changes for the past 3 years and nothing has been well-established in terms of this. To make it more complicated, now come EHR. We just started using PointClickCare and using the weights feature, it spits out all triggers that would not otherwise be triggered using our "not-so-old-school" spreadsheet, which calculates for 5lbs/5%x30days, 7.5%x90days, and 10%x180 days (btw, is this guideline the same throughout US? or is it by State?) For those using PointClickCare, does your weight feature calculate and trigger for 5lb variance? This doesn't in our facility. Any tips how you use yours? Thanks in advance!

Thank you for your replies. We do not have Medicare residents. I am told that my job is "simplified" because of that. We have 98 beds and I am the only MDS personnel. And since I am the only person to do the job, I only do things related to MDS: care conferences, treatment meetings, updating care plans and assessments, submit MDSs, and whatever I need to do to accomplish my work. I am trying to make a spreadsheet and I am just figuring out what other things might need to be included there. I also want to keep track of admissions/discharges/transfers. Also, for someone who is just starting in this field, would you recommend using the printed MDS first and then input to the computer? Or will directly entering answers in the computer be less complicated? Just a thought, I could help save trees, just wondering if it will be helpful to a newbie.

I am a new MDS coordinator. No MDS experience at all, but like everybody else would say, my personality fits right in, and of course, i'll learn along the way. My first week of orientation dealt mostly with the basics. 3 days of practice on the computer and I'm starting to "create" a system that might work for me. But then of course, the MDS office literally looks like a mess right now, and I kinda have this picture of a more clutter-free desk as soon as I officially start owning the little room. Simply put, it'd like to get some ideas how to be more organized, efficient, less stressed-out (we all wish, if not stress-free!), and of course stay on top of our schedules. Any input is greatly appreciated. Thanks in advance!

I have a potential Health Care Coordinator position waiting for me at a Sunrise Senior Living community. I am currently a SNF supervisor. While I like what I'm doing right now, I dont think there is room for growth because of poor management and the fact that my efforts are not acknowledged, worse, if I do something out of the ordinary, the DON steals my show and pretends that it was her accomplishment. Also, talk about power tripping there, I was given a very minimal increase given my outstanding job (based on other employees, resident and family comments). This new position is offering just a little bit more that what I'm making right now but I am very excited about the challenge and a great chance to advance in the ladder. Yes, I may be ambitious but I know I can do it. I am just afraid that I regret leaving my current job (I am able to use my Clinical skills and my team is great). I can potentially be a DON at another SNF in a few years if I decide to stay. I'm not sure if my goal of being a DON is still possible if I stay in assisted living. What will assisted living bring to an ambitious nurse's future? I'd like to know your inputs. Thanks in advance.

I went for an interview last week and they wanted me to start 1st week of May. That same day, I was asked if I was ready to provide a urine sample. I wasn't ready due to the fact that I had to go to the bathroom just before I went in for the interview and didnt drink anything since (interview lasted for about an hour). Over the weekend i've had terrible migraine, eye pain, nasal congestion and flu-like symptoms and the doctor recommended Excedrine, Mucinex, Sudafed. I used to take Aleve. This week I'm supposed to come back for the drug screen and other pre-employment exams. While I've taken only one dose of each since i realized thay could give false positive results, will it still be a good idea to take the test this week? or to wait another week until the drugs are out of my system? I'm not sure what to do right now but im excited about the position and they want me to start soon. Please advise.. thanks!

Going back to this case, let me write down more info about this patient pre-fall he was non-ambulatory with 1-person assistance with transfers he had a fall 6 days before, in the fall, he fell on his rear end, pelvic x-ray done without any fracture he has history of cerebral bleed he was taking ASA 81 mg PO daily

There's no official report yet on cause of death, but the MD who saw him at the hospital said 'they found a lot of blood in the head"

they weren't. There was another RN who asked if 911 was called, and she asked before she saw the patient. After seeing the patient, she agreed that the patient was not in an emergent situation and advised about the importance of documentation, which the attending nurse did well.

The patient stayed in the hospital for about 16 hrs before he died. The DON and MD understood that pt was in no acute distress and not in an emergency situation, given the pt's condition before he left as witnessed by the EMTs and as documented. Unfortunately, the other nurses are the one questioning WHY not sent 911? A company consultant was also aware of the situation, the same consultant who questioned another nurse a couple of years ago why a patient who fall with no injuries but c/o headache was sent 911, thus wasting the governments money. It is not normally written in our facility whether or not for emergent transport, however that sound like a very good way of saving our butts. Our facility has fairly good protocol. we do xrays, ct scan, or what have your after EVERY fall and the doctors agree with the protocol. if a doctor doesnt agree after we explain the need to, we document and monitor the patient.

he expired about 17hrs after the fall. MD order was to send to ER for further evaluation. No change of condition the whole time pt was in the building. EMTs arrived about an hour after the fall, and exited the building 20 mins later. Like i said, they exited the LTC facility with patient still alert, with GCS of 14, A&Ox1 same as baseline. Now the nurse is being questioned why 911 wasn't called.

to follow up on this thread, unfortunately this patient died. he was sent to the hospital an hour after the fall. he left the LTC facility still alert, with GCS of 14, A&Ox1 same as baseline. What are your fall protocols in your workplace as far as calling 911 vs non-emergent ambulance?

thanks for your responses... btw, it happened in a LTC facility. given the above assessments, would you call 911? Or would it still be a prudent action to call the Doctor, get an ambulance and send the pt to ER?

Please share your response on this scenario: Demented geriatric patient fell on concrete floor from wheelchair, sustained a laceration near the corner of the eye and bleeding was controlled. c/o pain in injured area. He is able to mention his name when asked. He is disoriented to time and place, same as baseline. He moves his hands as he has been known to do. Vital signs stable.Neuroassessment done. Pupils round and equal, able to follow objects. No distortion in the face. No fluids coming out of facial openings. Able to move extremities when instructed to do so. Grasps hands when asked to do so, equal. No episode of unconsciousness, no seizure, no sign of distress.

thank you for your responses... like u said, it couldve been the tourniquet. the pt was really skinny and dehydrated. in fairness to the nurse, she did apply direct pressure. guess it was just the way it was. and i agree, let's not forget that we were once new nurses. and even with an already admirable amt of experience, we still learn new things along the way. :)

I was orienting with a nurse who was to start IV hydration to one patient. After preparing everything, I came closer to her to observe the insertion. When she hit the vein, there was blood return, i thought to myself wow that was pretty easy! as soon as she started flushing it though, there was a bulge. The patient did not complain of pain or anything. The nurse said it needed to be reinserted. She pulled it out, applied pressure and covered with a piece of gauze. I watched her opened the second needle (which was at the table right next to her), and as soon as we turned to the patient's hand, it was bleeding under her skin and it was fast! she got a tourniquet above the site, apparently to prevent further spreading. my question is, why did it bleed under her skin? that was a huge hematoma (like the size of my hand and the patient was skinny).. what could have been done to prevent it? any comments?

I got back to work after my leave. I had to see for myself what went wrong here. I have a couple of things I need to point out. 1. The medication was ordered last week of August. It was NEVER carried out. No 24 hr check was done. When I querried on this one, the Supervisor said that "the NOC charge nurse who worked that night is no longer is us." Apparently, that nurse has been terminated for another reason. 2. We get new MARs starting on the 11th of each month. Recaps are done before then, at least 2-3 days before. I have never done recaps myself, but I know that they double/triple check the new physicians orders and countercheck with the old MAR. did they catch it? NO. 3. Unfortunately, I came on the 2nd day since the new MAR has been out. There was a first signature before mine. It was initialed. I'm not sure if it was a "mistake" that I was too honest to acknowledge that "I might have accidentally initialled the MAR, but I keep notes to prove that there was no supply for this medication at that time, and so does the Pharmacy." The first person who initialed went on saying that he "clarified with the doctor." my question is when? why hasn't it been changed so it was already updated the next day? 4. I was written up for this, and I did acknowledge because the note written there was "signed the MAR even if the medication was unavailable." And it is just ME (and I was told the other nurse too) that was written up for this. 5. This was caught during the survey, and apparently the patient's Na level became abnormal. Does it have something to do with the medication "being given?"When did this happen? There are a few other things which I will write as I go no, but for now, I would like to hear comments from you. Thanks a lot!

Thanks for all your replies, i really appreciate it. I didn't mind if some of the responses sounded a bit harsh, I needed that to keep myself in check one more time. this is the real world and I know I can't get things my way. Tomorrow will be my first day at work, and surely I will keep in mind all your advice. I'll do my very best not to miss (or i'll lose my job!) a day i'm scheduled to work not only because I don't want a bad reputation, but more importantly, I want to train myself to be more dependable and more of a mature professional. Once, again, thank you.... wish me luck!

Thanks for your post, and yes this is my first 'real' job. I did not mean to sound so 'whiny' but yes, I admit that I have issues that need to be resolved. Healthwise, I do not take chances coming to work if I know I can endanger someone else, a patient, a co-employee or a visitor. My only mistake probably is that I didn't ask for a doctor's note only because i didn't require hospitalization. Will calls to advice nurse be enough to present as an excuse from work? Other than being sick as an excuse, the main reason why I asked for a 'time-off' has something do with with a family incident that jeopardized my safety and I openly told them about it. I have proofs for this in case they will ask me of that. But anyway, I totally agree that I must indeed be thankful that they took me back. I only makes me think why my attendance problem has only come to their attention when I told them about it. I havent been keeping track of my absences, but shouldn't they have found out about it themselves and gave me a warning beforehand? Should I regret that I even mentioned it to them? That's my only point.

Thanks for your informative post. I mentioned about the lunch break because that's what's been going on, although I don't complain and chase my way to be compensated for that. I know that it's what the law says, however, a lot of times, especially when I was working PMs, there was nobody else who could cover the floor for me other than the nurse in the other station who also has her tasks to do. As for the charting, I only get so start charting when I'm done with the meds, and that is about an hour before the shift ends. i have at least 18-20 nurses notes to write (it varies) plus my 24 hr report,, and while I do that i cannot shut the telephone off nor ignore my residents when they come to see me. Sometimes when really unfortunate, something comes up toward the end of the shift and it is necessary that I attend to it. Many things can happen in such a small amount of time which keep my from finishing my last task on time. This does not happen all the time, but it happens quite often. I work in California. I myself didn't get that, but the DON personally told me that I had to do it because the LVN doesn't want to do it because she's not certified to do it. I explained that I have a lot of things going on in my side and I needed to prioritize. I suggested that maybe she could attend to it herself for the meantime (I felt really bad for having done that but I didn't know what else to do) and I'll get there as soon as I could. In the end, the treatment nurse who just arrived was asked to cover my floor, and so I went ahead to speak with the MD and get things running. While I was doing what I was asked to do, I was told that a patient of mine fell off his wheelchair. I felt even worse. This time record I need to keep an eye on. I've worked in two other companies and got to sign time sheets. I wonder if this company is cutting down on paper costs, but I still believe that we get our hours in check. (One time I agreed to work extra because I needed money, come pay day it wasn't reflected on my paycheck.)

Honestly, your post sounds full of excuses. Yes, it does sound so and I truly believe that I needed time to sort things out. I'd rather keep this private, but since I'd like to hear your advice, I did ask for a"time off" with the excuse of a "family emergency" -- truth is, there had been a police intervention on this matter and I was advised to find myself a safe place to stay and a means to come to work on time, and I couldn't do that if I was at work. It was a very difficult situation for me and I didn't expect any sympathy. Just pure consideration. You were sincerely concerned about yourself. If you were sincerely concerned about work, you wouldn't repeatedly left down your employer and coworkers with unscheduled absences. I knew that my decision could lead to these consequences. It was in good faith that I spoke to my boss and told him that I will be back as soon as I sort things out. I told him about my situation. I asked if there's any paperworks I need to take care of before I leave, he asked me to just call him when I am ready to work (and I did). I said that I was concerned about "them" because I thought it might help by letting them know that I'll be gone so they could fix the schedule, and not fix it only when I call off. I truly understand that it is not easy to look for someone to work for me on the spot. And they were able to do that as soon as they learned about my decision. And i dis specifically tell them when i am coming back. I am currently working 56hrs/2weeks. alchemist, i hate to be the one to break this to you, but you are expendable. my goodness, you could be the DON him/herself, but if your attendance is erratic, it is a terminable offense. I totally understand this comment. I can't agree more. And I appreciate that they "took me back" but also thinking... what if I didn't tell them that I was concerned about my absences, would they even notice? I felt like I put myself on the line by doing that.

First I would like to tell you that NO OVER TIME, really means NO OVER TIME. Got it. It happens that this is being talked about every so often in the facility. I would do so freely if a supervisor tells me that I can get OT. It also happens that our Nursing Coordinator said "Don't every work for the company without getting paid for what you're doing." Just want to know my rights, not insisting on something that cannot be. "I bet she has never worked as a nurse"... you choosed totally wrong the words.... probably because you are frustated.... NEVER BUT NEVER to use these words with no one... I just told myself that out of frustration. However, at one point she did say that, so I remembered it and wrote it here. "They always tell me that I am doing a great job, and they have even asked me if I am up for some leadership roles (which I really want), just goes to show that I am on the right track. "....... now I really don't understand where is your problem..is a contradiction here.... I am as confused as you are with this matter. The company big bosses even talked to me about this, asked what else I want to do, what my plans are. I was even asked what time I want to come in to work because apparently they would like someone to do something and that I am a very good candidate. I must say I've made expectations because of this.... (until they hired a fresh RN, getting her first job at the facility as a supervisor). I started to question my ability, but still I got praises from them and the residents and their families and truly believe that I was getting even better at what I do. DON is not there to help you passing meds or doing charting I totally agree, absolutely. There's this one isolated case i could not forget. There's NO supervisor on the floor, the patient who needs the TPN is not on my station (the charge nurse in that station is not certified to administer TPNs), I'm having a number of "urgent" matters I need to take care of in my station, the treatment nurse has just arrived and while I was attending to the TPN patient on the other side a patient of mine fell! It sounds bad but that was a really crazy day. (Oh, and I was thinking maybe I could get OT for that but I didn't, because another nurse was called to help me and finished passing the meds that I failed to give when I was called in the other station.) "We do not get a chance to check our time record, but when paycheck comes the hours are perfectly tallied. We don't get OT pay unless we show written evidence that it was 'authorized' by the DON or supervisor. Wrong incriminatory statement here...if you really belive in it, find a lawyer....personally I am very carefully to work with anyone with this attitude..I am so sorry I mentioned this with all honesty. I clock out ONLY when I'm done with everything. To guesstimate, that would count to at least 3 hrs per pay period. If I do get to clock out for lunch and clock in late by a minute or so, a quarter of my time would be deducted. But yes, I never got to see a time sheet. If any corrections, everything would be verbal. How many residents you take care on they told you when you was hired and you said YES????? I was told that "there are 30++ patients in one station, but during the day, there's a treatment nurse, a supervisor, a DON, a DSD and Department Heads who can help." As a first-time nurse I had no idea how much 30 residents translate in terms of workload and I needed a job to start with. Turns out, each of those people expected to "help" also have their own work to do. (and I forgot to say that the administrator told us "the DON and the DSD who are RNs may be asked to help with nursing tasks and may cover the station when needed.") ZUZI, thanks for your post. I need to hear the 'real deal' and I realized that I shouldn't be taking things emotionally or overreacting in any way. However, even if I convince myself that I am happy with what I do and I like the people I work with, I still believe that there's something not so right about the place I am working and that I might need to take myself somewhere else. I am a pretty quiet person in the workplace and really serious about my job, but I guess I also need to check for myself what might be getting me 'stuck' in the future.

I'm not sure if it happens elsewhere, but during my orientation, I was told by the staff that the company barely gives OT pay to employees. Our unit can house 39 residents at one time, 38 the most I got so far, 32 on average. After passing meds, you get phone calls in between, PRN from residents, all with different kinds of personalities, families that needed to hear from you, 5 CNAs to help in the AM, 3 on evening shift and 2 for NOCs. And when you're done, do charting of 18-20 patient average (lucky if you get less than 18). I barely even have time to go to lunch since when I worked PMs, there would only be 2 licensed staff (myself and the staff on the other station), and on AM shift, the workload is just too much and the supervisor often goes to meetings so nobody can actually cover for me. That has been going on for 8 months. The first time I ever requested for OT was when I had 37 residents, and the Administrator asked me why I am requesting OT pay I said "high census, more workload" and she rolled her eyes, embarassed me in front of a new employee, chuckled and answered "Of course i know what high census means!" So i enumerated all the instances I could use to justify my OT "request." I bet she has never worked as a nurse, and while I want to give quality care to all of my patients, I feel the need to be compensated for what I do. I don't think I am being inefficient. I make sure I never waste a second. I barely even talk to other employees unless truly necessary for the job, only because I believe that it would use up my time little by little and will eventually make me end up late. They always tell me that I am doing a great job, and they have even asked me if I am up for some leadership roles (which I really want), just goes to show that I am on the right track. Now I have several concerns on this. 1. At what instances can we actually be paid OT? 2. If I don't punch out for lunch (because I didnt have a chance to go on break), it gets automatically 'edited' to show that I did take a break, and so I dont get paid extra 30 minutes for that. 3. It is only when I'm done with med pass that I get a chance to do my charting. Would that qualify for OT or not? 4. Because I am the only RN on the floor at any given shift (the DON does not help), I would be asked to give IV meds, hang IV fluids and TPNs to residents on the other side. I do it openly because I know they depend on me and I never complained about that. Just got me to think now if I can use that as a reason to 'request' OT or if it is actually legal 5. We do not get a chance to check our time record, but when paycheck comes the hours are perfectly tallied. We don't get OT pay unless we show written evidence that it was 'authorized' by the DON or supervisor 6. During in-service we are asked to sign an attendance sheet, and i didn't know that I was supposed to sign an OT request for each and every in-service meeting I attended to. (doesn't the attendance sheet that purpose?) and last but not the least, #7: how many residents can a charge nurse legally have in a skilled nursing facility setting?

Hi all! This is a little bit of an update for my previous thread: https://allnurses.com/general-nursing...ed-435666.html So i finally went to the facility to get things started once again. Like I have said, i asked for a leave for at least 2 weeks, and then called to let them know that i am ready to work again. Things were not written in black and white when I left so i am not sure if that was "official." I just spoke to the administrator (as advised by the company President who knows my story as well), told him the reason why i needed a "break" and he did say OK with no other questions asked. I had been a diligent worker, though I agree we make mistakes once in a while, unfortunately one of them was caught and a huge issue revolved around it. Honestly, I do believe from the bottom of my heart that for the mere 6 months that I have worked there, I have done a lot better than the rest who had been there longer. This is not to brag, but I know who I am and my superiors tell me so... that i do have the potential of becoming a DON one day, that a lot of my patients rave so much about me, and that I obviously do a lot more than the rest, a lot of times not even getting paid for staying late, a lot of times not even getting a chance to have a break. I've had personal issues of my own, but as soon as I clock in I make sure that everything that don't belong to work I leave behind. I don't think about my problems to work. I step in the door with a cheerful smile, an alert mind, a fit body and a strong heart. Though nursing is not my first love, I still give it my best shot all the time. However, there are instances when I couldn't make it to work. It's either I don't feel like I am fit to work (sick, worried to death) or I don't have the means to get myself to the facility which is 28 miles from home (another story). Nobody gave me a heads up that I might need to keep an eye of my attendance (there would be times when I ask another nurse to switch sched with me, and they agree with supervisor's and DON's approval). It was only when I spoke to the administrator that I said that I'd like to take a leave because I am going through a lot and would not want to mess up the schedule and that I do not want to call in sick anymore. I was sincerely concerned about them. Anyway, long story short, I called and I was asked to meet with the administrator, the DON and the supervisor. I was told that 1 more call off and I'd be terminated. (Though I know this was coming, I was never given a verbal warning prior to this. Does this serve the verbal warning now?) That was so cold! Anyway, i told them I would do better with my attendance. But still, i am now left with that kind of fear, and as much as id like to start fresh, i have that kind of feeling that just one miss and i'd totally regret that i went back. please help!

u better do... i tried to do all the "clean-up" for everything i could see before i went on leave, and still there's a lot more they could find from way back (they found the error in the September MAR).

when i finished my BSN i told myself i wont apply for a position in a SNF/LTC/nursing home and sort. but i received my license at a very bad timing, when hospital jobs are on freeze and if any, they need at least 1 yr experience.... so i told myself, i needed to start somewhere and will take the first decent job offer. and so i did. anyway, the stress level is so high in our facility. in as much as i'd like to give my 110% to every patient, i can only do so much to pass meds to at least 30 patients, some of which really demanding, receive calls from the pharmacy and call MDs when needed, plus families interrupting and everything else in between. trust me, i could barely sit down for a break and it makes me skip lunch which i never get paid for! most pts i had was 38 in 1 day, and sure it was killing me literally! if only i had a choice, i'd quit.. but i don't have any choice right now. so anyway, i was able to speak with the staff who had written down the 10mg order. the original order was 10mg which appeared as 50mg to whoever wrote it in the MAR initially and hasnt been caught during the recap! and yes, my fault too, i relied on the med label and the fact that Lexapro is commonly given in 5, 10 and 20mg for the dosage... *sigh, wonder what's in store for me on my first day back at work..