ctm985

Breathe!!!!! You will get through this. Nobody starts in long term care with it all figured out. Time Management is key. Day shift is wonderful for new(er) nurses because of the resources available-management, more staff. However, you also have all the added benefits to accomodate-appointments, visitors, doctors rounds, phone calls, etc. Is it a usual practice at your facility to 'float' new nurses? I have never been a fan of flip flopping. Not only do you need the consistency of learning the land, but your residents value consistency. They appreciate having someone they know taking care of them. Are your co-workers just as swamped as you? Talk with them, ask for help. Believe it or not, they have been in your shoes. Remember there are 24 hours in a day, and it is OK to leave something un-done. If you have a few minutes before your a.m. med pass flip through the MAR. Flag those things that catch your eye as potential trouble. Try to address multiple things in one phone call or fax to the MD. Keep a small notepad on your cart. During your med pass, jot down those items needing clarification and keep going (if possible). Make notes/use a report sheet to keep track of key points to include in your documentation. You are thorough, and you have the compassion that is needed in long term care. Two qualities needed greatly. All the rest will fall into place.

1 nurse : 20 residents!!! Usually between 3-4 CNA's.

I would like some advice on how to utilize an "extra" nurse on night shift. Our facility has 12 hour shifts and I work 7p-7a. We have 3 nurses occasionally, with 2 med carts. As of now, the 3rd nurse is a float, helping with finger sticks and the minimal dressing changes assigned to our shift. Any ideas would be greatly appreciated. :bowingpur

If I'm remembering correctly, once the board issues your "seating card", eligibility letter to sit for the NCLEX-PN, that is also your date that you may start working as a GPN in the state of FL. Her employer has a copy of that document. Valid for 6 months from the date of that letter...or if you fail.

Our management team believes that a flowsheet that focuses on rounds, meal %, floating heels, skin checks, oral care...will be enough for our medicare patients. I tried to show some guidelines that I have re: proper documentation and the response I got was as if I hadn't said a word. I know the guidelines, I was just asking. Thanks though:typing

Your employer should pull her if it has been over 6 months since she started her GPN status. That is the time frame you are allowed to work. Why are they allowing her to continue to work? When did she gain her GPN status with the BON? That is different than her graduation date.

I am an LPN who has questions regarding the substance of medicare charting. Isn't it required to chart by diagnoses? If they are there for a respiratory issue, then you document respiratory findings, etc. I have always had to chart on surgical incisions, assist with ADL, lung sounds, etc. until my current facility. I tried to mention this and was told that generic flowsheets generated by our MDS program would cover all required doc, but the flowsheets do not address any individual problems. Any advice?

It is definitely illegal to alter hours, whether its your doing or management. My advice is to follow your chain of command. First speak with her, and see if it gets resolved. If not, you need to go above her. I don't recommend going above her first unless you have issues with her. That may come back to bite you. You should be paid for all time worked. If you do not receive a lunch break, you need to be compensated for that. I understand the economic issues at present, but you are putting your time in, and deserve to be paid. Also, try to take a look at your time management. See if you are able to multi-task on some things to enable you to get out on time. Being able to show your making improvement may be helpful.

I don't want to sound rude or upset anyone, but she is an acute care nurse. Most of the nurses I work with are from acute care...so what does that say about their 'acute care mentality'? My point is that in their hospital, the lab would report to the MD, the pharmacy would get clarification from the MD. In my experience in LTC, all of those things fall on our shoulders. We don't have all of those luxuries in our facility. The aides were mad when they found out that they had to empty garbage out of patients rooms. These employees were not given proper orientation as to what it takes to succeed in LTC. And that falls on management!

I need to vent on some things that are bothering me. My RN supervisor recently used the phrase "well, thats the nursing home mentality". It took all I had not to snap back at her, as I have been in long term care since 1994. I started as a CNA and am currently an LPN with goals to return for my RN within the year. My current facility is new. It is under hospital authority. Over half of the staff, including management, is from the acute setting. This line of health care is new to them and I completely understand that. I work nights, however I am THE rare breed in my facility. I have found everything from orders not completed, DNR's not followed up on, and missed treatments. I have done the monthly changeover paperwork for the past three months. I have tried to help the CNA's by devising a bath schedule, made a list for required vital signs rather than making them get vitals on all patients, helped weed out unnecessary documentation, mentioned ideas to cut costs...What is the definition of "nursing home mentality"? My co-workers have questioned how I can stay busy all night, asked me if I take speed before I come to work, and reassured me the DON isn't gonna pop in during my shift ("just sit down"). But these are the same co-workers that come to me for my paperwork every day. One of the day shift nurses mentioned that I should be on days. My response was "but then who would do all of this at night?":banghead: Other departments make comments like, "I know you didn't work this past week-end because the O2 tubing wasn't changed". But no one informs the other nurses that it needs to be changed. I told some people the other night that my back hurts...from everybody walking on me! Maybe I'm asking for it, maybe I'm doing too much, but that IS my nursing home mentality!

You are a great addition to the LTC nursing team! It takes a special person to work in an "extended" care facility. I started my career in '94 as a CNA, and got my LPN license in '04. I can't think of anywhere else I'd rather work.

Reason For Leaving = Difference in Professional Opinion

I am new to the state of Georgia. I also hold an LPN license in FL, and am familiar with the scope there. I'm finding that the board of nursing in Ga gives vague information, i.e. doesn't specify our position for IV's. Your employer should have a policy/protocol re: your duties. They can be stricter than the state board, but never less.