nurse62

I work in a long term facility as well and note the same type of conditions you describe. I think you did the correct thing, for this environment is very toxic. Years ago when I first became a CNA (now I am an LPN) my assignment would always consist of 14-16 residents. I worked at this facility for one year, and missed one day of work thru out that year. They paid me $6.25 an hour. I heard about agency work thru the grapevine, and tried it out. I went to work my first day, my assignment consisited of 6 patients and this was in a LTC facility as well, and my hourly wage was $13.50. Needless to say, I quit the other facility that day,and worked agency for over 4 years. I respect agency staffing facilities for they make sure their facililty is staffed accordingly regardless the cost. So my advise to you is to apply at several agencies and get the pay you deserve, but most of all, give the care you know the residents deserve.

We have a patient the doctor is tapering the effexor. The poor lady is a complete basket case. She was on 225 mg daily, and reduced to 150 mg. She has increased trembling so as it is difficult for her to even feed herself, she has had several paranoid, panic attacks, even threatened to kill her husband the other night. Simply awful. The doctor decreased the dose due to a slight increase trembling, but now her trembling has increased three fold. She is also on sinement for her parkinsons. I wonder if the doctor should of been more concerned with the sinement verses the effexor??? What do you think?

The nurse should of been able to attend her own son's memorial service. The facility, knowing her son had just passed, should of never placed her on the schedule. And as far as her yelling at the patient, well she said she was sorry to the patient and the patient seems to of accepted the apology. I would leave it alone. If this isn't her normal behavior, why added more stress to her life.

Update on benadryl: So I go to work yesterday.......guess what the res benadryl still is not in. I investigate.....fact is.........the pharmacy did send the med the day after I ordered..........however......the nurse on the unit when the pharm tote was delivered never took her med out of the tote........thus.... the med was sent back to the pharmacy. GREAT!!!!!!!! I report to the DON....she's fit to be tied over it..........I report to the NP...........which says to report to the unit manager.......which was done prior to the DON reporting. Now, we have well over 16 days without the med.

Complete the behavior log and quote her in the nurses notes. Social Services should get involved with her abuse to staff members and family needs to be informed of her behavior as well. And remember to smile :kiss

Yes, the main reason for holes on the MAR is due to being interrupted, which many times can't be helped, at the time. However, before turning over the med cart to another nurse, nurses should always look back thru their days work to make sure they didn't miss signing. It only takes a few minutes, and saves the next nurse a lot of unnecessary worry and work. Just the other day one of the residents c/o not sleeping as well as usually does thus feeling lousy. After I assessed the res I went to the MAR to see if res had anything to assist sleep. I noted scheduled Benadryl at HS but also noted over the last seven days in which the nurses intitials were circled, "med not available". The resident's med come from our in house pharmacy, thus I called them. Due to medicare regulations, the med was ordered too soon, thus they could not send until the next day, or we pay for the med. I advised the DON, which instructed me to pass on in report for the night nurse to take it from the EDK. (By the way I work day shift.) Easy enough to pull from the EDK, two minutes at top. My total time, with assessment, phone calls, speaking with the DON, took at least 15 minutes. Time consuming to say the least, and so dang simple to avoid.

A few months ago, the DON came out to the unit and addressed the QMA to write several orders. Never addressed the nurses on the floor, only the QMA. Of corse, the QMA had to address the nurses to sign the orders, which by the way, the nurses ended up having to rewrite......the nurses were pretty offended by this. Would you be?

Prior to becoming an LPN, I had my EMT-B license. After several months on the back of an ambulance, I hired into a hospital in the ER. My stay at this hospital was short for they expected me to work well beyond my scope of practise. There were several EMT Basics already employeed in the ER and they were comfortable with doing this and encouraged me to just follow suit, if I remeber correctly it was said "either swim or sink". Sorry, I just was not comfortable, so I bowed our gracefully. If I can't legally sign I did something, then I don't do it.

Wait until the doctor says, "Well, why are you doing sats, the patient is hospice?" The last times I worked with this patient she was sitting along bedside feeding herself and doing well, so why wouldn't I do sats when I walked in and found her totally lethargic. And once I requested Roxanol sublinqual for hospice patient very near death and the doctor stated, "no, that will only expedite the process" So go figure.

Mine did the same thing, I fretted for 48 hours. Pat yourself on the back, for YOU PASSED!

I as well have been put in the same position many times. I am known as a "strict, bosy" nurse. It doesn't bother me, for I know what I need to say and do to get the aides to preform. Lately, I only have to give them a disapproving look to get them up and working. It doesn't bother me what they may say behind my back, for they know what job they have been hired in to do. They snarl, at times respond with inappropriate comments, but they do what I ask, for they know I will check to make sure it's done. If I come across an aide that just "doesn't get it", I counsel her first, then if that doesn't help, I write it up and let the DON handle it. Post the DON speaking with the employee she or he still doesn't "get it", and if she or he still continues with inadequate care or comments, I'll write them up for each incident. I am a busy nurse. I work the floor right along with my aides. If help is needed lifting, or any type of ADL care, they know they can always ask me for help. I worked as an aide for years prior to becoming a nurse, so I can do the "grunt" work with no problem and I don't mind doing it. I don't spend unwarranted time behind the desk, and I don't allow them to do it either.

I have always worked in LTC facilities. When I was nursing school, I new I would stay in geriactrics....for it was always my goal to be a nurse for the elderly. I have interviewed at several hospitals, and I would of took at least a $5.00 an hour cut in pay if I would of accepted. I only work three days a week and bring home a very good pay check. There are many things that need "fixed".......in LTC. Staffing being the number one issue. If LTC had the nurse per patient ratio that a hospital has, LTC wouldn't have the problems they have now.

The way I deal with death, depends very much on the situation, but always in the end, I pray.

My neice has RSV, diagnosed 11/27/03. She is 11 months old. I pray for your Jacob as well.

We have an on going problem with one of our physicians at our LTC facility. such as this. One night, I had him paged within 15 minutes of the resident change of condition. Took him four hours in which to return the call, in which I had paged him two more times, a total of three. When he finally returned my call, I began to give him report of the change, and within the first two sentences he started firing off orders at me. I was absolutely furious at him and interupted him by saying " Doctor, I don't mean any disrespect, however, please allow me to complete my report to you, for I have started at the beginning of the patients change of condition, and it has been four hours and the resident has changed significantly within those four hours!" I wanted him to get the full picture, ya know. Once I was done, he gave me a different set of orders (naturally) then he started with. Then he actually apologizes, but then adds......"but I am in Chicago on a conference." I couldn't hold back.....thus I said "well, you may be in Chicago on a conference, but you are also ON CALL!" I thought I was in deep water with him after that, however he has treated me with a bit more respect since then....