wannabe2008

I live in California and have never seen anyone wear a cap. Not even students. All the students I have seen wear white uniforms but no caps or dresses.

Yikes! If those supplies are not already available in the cart and at the nurses station, it probably is not the facility to be working at. They spend the money on that, not you. Just make sure you know where they are even if it means making a list of everything MyHartSings4U mentioned and where they are located so you can go right to them when needed, On the other hand, the advice relating to everything else is right on! YES I know I am replying to an old post but I am posting this in the hopes that another new nurse might find it useful.

In LTC, it is normal to stay late to catch up on documentation but it is illegal for them to make you do it without pay. I would stay long enough to gather what you need to prove your case, find another job and on your way out the door call the state to report them and an attorney. I heard of someone that did that and the facility was fined and had to back pay based on the average amount of time everyone spent over the last two years. (it may have been two years maybe longer i don't remember)

Alcohol in LTC/SNF facilities is very common. Unlike acute hospitals, the facility is the resident's home. There is alot more freedom as to what they can do. Just ask the MD for an order for x amount of x-kind of alcohol and how often. Put it in the careplan. It is normal to keep it in the med room. I have mixed many a drink on the 3-11 shift for residents. I have seen alot of wine, scotch and beer stored in facilites. I think nurses have a tendency to forget the facility is the patient/resident's home while they are there. That is why you knock before entering "their" bedroom, ask if they want to take "their" meds, ask if they want to take "their" shower... and respect "their" right to decline (not "refuse" because that implies they are doing something wrong). I really felt weird the first time someone told me they wanted to have a beer. Another nurse explained by telling me "Hey, it's his home and his beer, why not? Just tell the MD."

I know this is a really old thread but I still want to say "You can not do a sterile procedure in a non-sterile environment". What you can do is varying imitations of it though. The room, your clothers, the bed and sheets, his clothes, his roommates... are not sterile. Read your facilities Policy and Procedure manual. The manual contains alot of good info on almost anything you will do in a SNF.

I forgot to add one point that is subjective in my opinion. The state lists the above ratios as minimums but then also says facilities have to have enough staff to provide quality care. They suggest that if a larger ratio of direct care staff is needed, the facility has to provide them. They don't really define what good care is though.

In California, there isn't a ratio of nurses to patients in long term care. Instead there is a ratio of "direct care staff to patient". AM is 5 to 1, pm is 8 to 1 and noc is 13 to one. The ratio includes nurses+c.n.a. to patient. One nurse with three CNA could be taking care of 32 on the pm shift. BUT! The ratio takes into consideration nurses in the building, not nurses on the floor. So if a nurse is working in an office of your facility(actually officially scheduled to be there) at the same time you are on the floor, that nurse affects the ratio so you could be assigned even more patients. An example is the MDS coordinator sitting in his/her office. He affects how many patients the nurses on the floor are assigned. I know this because I am an MDS coordinator as well as ADON in a SNF. Monday through Friday, they count me into the ratio even though I don't work on the floor. On weekends, the am superviser affects the ratio. Depending on the size of the facility, the DON can also be counted as direct care staff so that would affect your patient load. It is very interesting reading and I recommend any LTC nurse in California go online and read it. At least this is what I read at the California Health Department website yesterday.

huh? someone asks you for a nurse with another color of skin and they are endangering your staff? are you serious? yikes! i must say people do get pretty crazy when the subject of race comes up.

Uhm... That is not what I was asking for but thanks anyway. Those patients were being abusive not just verbalizing their desire for another color of nurse. By the way, just describing a situation involving a patient without identifying their name can be considered a HIPPA violation. Remember in school they told you not to discuss your work day in front of the general public? That is because someone might recognize the patient just from your desciption of the situation.

The state, federal nondiscrimination laws do not have anything to do with a patient having a preference for a certain color nurse.

I would love to know what hospital is refusing care just because someone is expressing their personal beliefs. That in it's self is illegal as heck. As long as the patient doesn't act on those beliefs in an illegal way, it is their right to say what they want. It is not illegal to verbalize racist views, in most situations. That is why the KKK and Black Panthers are still around(or variouse versions of them). Again, I would love to see some actual evidence of a patient being rejected care for being a racist.

I think those situations are a good time to politely explain that the nurse of their preference is not available and give them who you have. Tell them that if someone becomes available, they will be assigned to them. Treat them like you would any difficult patient. Ultimately, you call the shots and should not let any patient interrupt the routine on the floor or the care of others. Treat them as you would when women reject male nurses or men reject female nurses. Do your best to accomadate them then go about your business. If the patient refuses, treat it as another case of a patient rejecting care. Good documentation and lots of witnesses. Struggling with assigments is just part of the job. Seems like if it is not one thing it is another. I wish racist patients were the only problem I had. That would make work so much more pleasant. I would take a racist over some of the emotionaly/mentally ill family members/patients any day. Ultimately, it is their right to request whever they want. It is not illegal. Hospitals DO NOT refuse treatment over requests like that and I think we all know that if another nurse is not available, the racist doesn't get who they want.

Oh puleeease! I have had black patients request only black nurses, females reject me for being a male, white and black patients reject filipina nurses. I have seen patients reject nurses just because they didn't like them on a personal level. What is the big deal? Your job is not to convert someone's life long beliefs in a few hours... It is just as much their right to have their personal beliefs as it is yours. The last I heard, it is not illegal to be a racist of any color as long as you don't act on your beliefs in an illegal way. It is not illegal to reject a nurse for ANY reason. If we have the kind of nurse someone wants, we will accomadate the patient. If not, we tell them "Sorry, this is who you get" and politely explain no one else is available. In spite of what I read on this thread , I do not believe any facility in this country refuses care to a person because of their personal beliefs. That would result in one heck of a law suit. Rejecting a nurse of another color is not illegal. Some people need to get off their high horse and get a grip on reality.

You should do the same thing we do when a patient doesn't want a male nurse like myself. Respect their wishes. That is their right. I have lost count of how many "macho" Mexican guys don't want us male nurses aroung their wife even during birth(which i personaly find to be a pretty sick attitude) but it is their right and we should repect it. I often run across patients that don't want Filipina nurses and we just roll with it. My job is not to change anyone's beliefs. It is to provide care whether I like the person or not.

Ativan.