311ltc

Also notified the state. They are in violation of unsafe staffing by being understaffed.

I know a nurse who had restrictions placed on her license and she got a job in dialysis. Actually went back to dialysis after she was given a choice at another job after that, that she could resign or be fired.

Have a NIDD in personal care facility. Resident's family member doesn't understand or doesn't' want to understand that we can not make the resident eat only healthy foods, that if they want to eat cake, ice cream etc., that is their right and we can not withhold it from them. We offer and encourage healthy choices. Family member has gone as far as to have the physician write orders to have carb controlled diet. Has anyone else run into this problem with a family member? Any success getting it across to the family member that the resident has rights?

In the years I have been an LPN it become increasing apparent that the nursing profession must be one of the most abuse profession. Where else does a person have so much at stake, i.e. potential to lose license, etc., yet expected to do more and more with less. Don't make an error because it's unacceptable and can cost you everything you have worked for. I feel that nurses need to unite and demand better working conditions and protection. Unfortunately, I'm not the one to orgainze such an effort, I don't have the skills, dipolmacy, etc. Sad.

Shane505 - you pretty much hit the nail on the head in regards to LTC!

Thank you, rbytsdy. Your information was helpful.

The reason it was considered misdiagnosed was related to the fact that her hormone levels were being monitored and even though they weren't in the nl range an ectopic wasn't considered until after the third trip to the ER when the tube had ruptured.

Three years ago, a family member had a misdiagnosised ectopic pregnancy. The docs tried treating it pharmacologically, but it was too late and it failed. After being all night in the ER, docs decided surgery was needed. Were going to do laproscopically, but the tube had ruptured and there was too much blood. The doc did a typical C-section incision. Now here we are, family member is pregnant. Being told, my need C-section due to abd surgery. Uterus is intact. Why would a C-section be necessary since it was an abd incision and the uterus was not cut? Is there the possiblity that the abd incision could ruputre during labor and delivery? Thanks!

Thanks for all the input. Fortunately DON and administration support us in trying to modify this behavior. It really sucks up staff time when one person (has used the CB over 12 times in an 8 hr. shift) and takes away from time other resident's should have. Resident doesn't meet requirments for skilled cared. Come on the call bell isn't for every little things, esp when the person is capable.

About the only way the family is involved is to tell the reisdent to behave. They don't come too often and don't stay long. I think the behaviors had pushed them away. They use to take the resident out, but the resident refuses. Don't know if they would consider going to activies. Good suggestion. I'll have to get social services involved. Thanks for the input.

No, the resident's have call bells in their rooms also.

Thanks! We are keeping a log. Started out just keeping a count of the call bell. Now it has become reason, action, result.

Thanks! It's not an easy one!

"Looking for what others think is appropriate use of the call bell in ALF. I'm looking for a way to manage over use of the call bell. This is regarding an able body person who may or may not have memory issues. " I copied and pasted the start of my original post. This is Assisted Living. If the resident is lonely, unfortunately it is of their own choosing. When they are out by the nurses station it is the same behaviors as when they are in their room using the call bell. At the nurses station they use other residents to wait on them. Doesn't converse much with other residents' who may repeat their conversation. In the dinning room they are constantly tell the other table mates what they, their family and everyone else under the sun should be doing. It's not an easy situation. It's difficult on all the staff. Thanks!

Looking for what others think is appropriate use of the call bell in ALF. I'm looking for a way to manage over use of the call bell. This is regarding an able body person who may or may not have memory issues. The call bell can be activated as much as 12+ times in a shift. All non urgent/emergency issues. Try re-enforcing call bell is not for requesting a drink, pull my covers up, turn my tv up, down, off, on, what's for dinner, did I eat my dinner and repeated request for PRN (knowing that it is too soon, will tell you what previously said about when they had it and when they can have it again.) need to come to nurses station to request PRN (because this is a constant request). Yes pain med has been increased, has been to other doc's, has had multiple test, exams, etc. Pill seeking?? Attention seeking?? Is on psych meds, does see the psychologist when willing, but often refuses. Never applies any of the interventions suggested by psychologist. Where is the line drawn. Don't want to violate resident's rights... Thanks for any suggestions!

Amen to that (give them an inch...). The more you do, the more they take and your still expected to get in all done within the time constraints.

Just need to vent. It's my day off. Don't get me wrong I love my job, my choosen occupation, co-workers, residents, but most of us need and value our time off, away from the job, the call bells, the complaints, the stress. One of the reasons it pays to have caller ID and an answering machine. The telephone rings. It's my work. The reason for the call isn't an urgent matter, it is something that can wait until I'm on duty tomorrow. Did I pick up the phone? Nope. Will I call back today? Nope. Funny how you're expected to be available anytime. But the door doesn't open both ways. Can't begin to count the number of times I've left messages on voice mail at work when I'm on duty and never get a response. Oh well. Just one of those days when something is more irritating then at other times. Thanks for listening.

If a prn medication is ordered q 6 hrs, can it be given again after 5 hrs or does it need to be kept to 6 hrs? The reason I ask is because I had a nurse say you have the hour before and hour after to give meds. I thought that rule applied to scheduled meds, not prns. Thanks!

I'd like to see ratio changes in LTC/ALF also. We deal with people not objects. Just can't set them aside and finish with them later. It's hard to provide quaility care when you can have 30 to 40+ people to care for.

I have a resident who's family takes them out for the day on the weekend, but hasn't been taking her meds with them. I work 2nd shift so, I found out they doesn't have the meds when I come on. I spoke with the family member and said that the meds should go with the resident. I was told by the family member that they had been told they didn't need to take the meds with them, that the meds would be given when the resident returns. The resident doesn't usually return until 8-9pm. So they haven't had any of their 5pm meds, which included oral diabetic meds. Where does that leave me? It's my understanding that since it is so far past the ordered time that I can't give the meds. Can a med be given that late if it's only a once a day med? Is it a med error? Who's error? If I give the meds am I out of compliance, if I don't give the meds am I out of compliance? Is there any lead way for discretion in this situation? Is it a black and white issue or is a gray area? Thanks for any input.

How many of you need to review the new records and sign off on them? We need to squeeze this in along with the regular shift work.

Sure sounds like age discrimination. Who doesn't have days were they yawn alot. I think that would probably put alot of nurses out of work! I agree with gonzo 1 I would be talking to a lawyer.

ALF Assisted Living Facility. What is DTO? Delagate to others? How about MMC, FI1AA, PPHM, CUD?

It is understandable in this time of economic crisis, the push to elimate overtime, but where do you safely, ethically, morally, legally..... do this. I work second shift in ALF (with 30+ residents with a mixed population of AAO to moderated Alzheimer), there is no third shift nurse. Doctor comes in after 6PM leaving you with 11 orders to take off. Most of which involved some type of med change, none of them being critical, i.e. increase in slept medication. Your told to do only the orders that needed to be done immediately. Directly related to the avoid OT. I have a problem leaving things unfinished even if I was passing it on directly to the next shift nurse, but more so, especially since it would not be handed off directly to the next nurse. So I pushed myself to do it all, which isn't the best thing to do either. How would one decide which should be done and which could wait until the first shift nurse came in the next day. Protecting themself and the residents. Thanks!:)

Have a resident who is basically noncomplaint in all aspects. Knows it all and self diagnoses. We'll skip the mental issues the staff is in agreement about. Never comes to the Dinning Room (DR) on time. Will come in after meal time with others in tow wanting a meal for herself and them. No matter how many times you inform her it's time to go to DR, she does her own thing, ie makes a telephone call immediately after you remind her. It is a problem for the dietary staff. Basically college and high school students. DON says remind her and if she's not in the DR go ask her if she wants a tray bought to her room. Well, it might sound like a little thing to do, but the CNA is in the DR feeding and the nurse is doing the med pass. So walk down to her room from the DR, then if she wants the food on a tray, go back to the DR get the meal and then back down to the room. When she didn't show up to the dinning room by 6pm had the CNA put her meal on a tray and took it to her room. She refused to have the meal in her room and wanted in the DR. Met her in the hallway and said that dinner is served at 5:30PM, it is now 6:10pm and they are done serving and going to start clean up. She just doesn't care. I have left several messages for social services about this. The dietary staff is fustrated. Where can the line be drawn without violating residents' rights. One of the rights' listed in the facilities residents' rights is to be served in the DR at the designated hours. Any suggestions? Thanks and Merry Christmas!