DG5

After you get to know your residents and their routines it becomes a whole lot easier. Some residents wait by the dining room before breakfast, some are in the lounge and some are always in their room. There are a few priorities first, like taking the blood sugars. Can night shift help by taking some of the early morning B/P's? How heavy are the medcarts? How are the meds packaged? We had a whole revision of the way we did meds when I was in LTC and they got lighter medcarts, and pharmacy changed the way the meds were packaged. Also, our MARS were changed to make it easier to identify residents. All these things take collaboration between nursing, pharmacy and management. I used to work at a lot of different sites and I soon could see which sites had their act together and which ones were disorganised all the time. If you want to stretch yourself, try working casual at other sites and you soon will see how streamlined your site could be.

Also ditto to never writing down that an order has been received telephonically when it clearly hasn't, I would also never accept an order over the telephone from a doctor or hospitalist that would say for eg: "Sepsis protocol" because as it has been pointed out in previous posts here, those kind of orders have a list of alternatives that the doc would cross off or tick as appropriate and who am I as a nurse to know which are appropriate or not? Usually, a telephonic order is taken either when a doctor calls it in, or when a nurse phones the doc to request one, and in that instance, it would be for more specific interventions until the protocol can be reviewed and signed by the physician personally.

For the elderly, there is no easy way, especially with polypharmacy and those that needs their meds crushed etc. It is better to be safe than feel pressurised with time. Can you speak to your superviser - it seems like it is a workload issue.

I don't quite agree with darkangel 05b's comments that a "lot of the older nurses seem to get lazy in their ways" - a rather sweeping comment.I don't think doing assessments thoroughly is related to the length of time you have been a nurse- it is related to the commitment one has to your nursing standards and this is something that is carried right through from the time you get out of nursing school to the time you retire as an RN.

Same thing happened to me and I had worked in Canada for a few years before coming back and re-entering nursing again. Its just the way the provincial contract is set out, but once you are in the system it is really nice to know that there is a Union backing you up. It doesn't take too long to see meaningful increases to your pay once you start working and find there are all sorts of things worked into our contracts to benefit you pay wise ie: statutory holiday pay, overtime pay, shift differentials, in charge pay etc. It would be worthwhile to read your contract and talk to as many nurses as you can about things you can do to make it work for you. Good luck!

Years ago a friend of mine said the doctor had diagnosed her 7 year old with "Minimal Brain Damage" but he was as bright as a button. I've later come to realise this old term was what is now called Attention Deficit Disorder- thank heavens they changed that one - always couldn't figure out why a small kid should be labelled like that.

Tddowney and Tachybrady have it right here - listen to this letter very carefully - it says that there WOULDN'T be a nursing shortage if nurses performed duties that were conducive to their pay. I think T. Ball is emphasizing the fact that nurses leave nursing because they don't get paid ENOUGH for the job that they do.This letter is meant to cause a stir, to make people think....I believe he is using IRONY to put his point across. Irony is saying the opposite of what one means, it implies a discrepancy between what something seems to be and what it actually is. If you read his letter carefully, he just may be on our side....

Haven't read all these posts but some of my memories are: 1. getting my hair measured by the "matron" to make sure it was so many inches above the collar 2. passing a "flatus" tube per rectum to relieve gas 3. keeping cabbage leaves in the fridge to relieve breast engorgement for nursing mothers 4. ng tubes for tube feeds 5. wearing starched uniforms, black stockings (in hot weather), nurses cap, and woollen cape in winter as part of the uniform. 6. Stainless steel bedpans 7. Doing a "back" round - rubbing every patient's backs and pressure areas twice a shift 8. Split shifts So much more, but can't remember all the details.

Use every minute you have with something useful to do or observe. When you get a patient up say, onto the commode in the am, use that time to make an assessment, make a bed, wash her face/neck/back/underarms, etc, place a pull-up pad or pad with refastenable tape on her before she stands up, as you do that, check her feet, slippers may be too tight, etc etc. I find that even though I may be a bit slower than someone else, I am always observing and doing an assessment of some sort which brings me out on top at the end of the day. Don't get discouraged! Its just practice and focusing on improving only on one thing at a time.

This is not a silly question. Its something most of us still battle through after years on the job. But we find ways of coping with things that come with the job we do. I try to focus on the patient all the time, and when I do that, I realise that they are a person just like me and you who need compassion and care. It kind of takes the thoughts off yourself and what you are thinking and experiencing and you focus on the real job at hand- caring for that patient. How do you think a mother takes care of her infant with a smelly diaper - the smells are totally secondary to the compassion and caring. Maybe just visualising that may help.

I think you feel in LTC that you have to hold everything up and it is easy to forget that there are other RNs and LPNs who are also there on the next shift/s to carry things through. Don't forget that you are part of a whole team. Good luck - it sounds like you are doing just fine!

There needs to be a family conference including the S/W and the doctor. The family will have a very hard time accepting this but they could be offered pro-active bereavement counselling through hospice. Sounds like the family need active intervention to help them deal with the feelings of guilt and future loss. And yes, I agree with the previous poster - the patient needs advocacy without personal judgmental attitudes from nursing.

Regardless if she perceived you to be unprofessional, it was unprofessional of her to say "unprofessional" in front of your students.

Yeah - a long time ago - someone got a gunshot wound in the shoulder/upper arm and was bleeding profusely from the brachial artery. I stuck my hand in there and the ambulance took 45 minutes to get there. Fortunately he survived but I was up to my elbows in blood, the whole front of his car was full of blood and I was 8 months pregnant. Only afterwards I had the ghastly realisation of all the consequences of going in there unprotected. Now at least I have gloves in the car but it has kinda scared me off from doing that again.

I always use the dorso gluteal. I was taught to find the superior iliac crest, go 5 cm diagonally from there into the dorso gluteal muscle and thats the mark. Is that still ok?

Does your facility have a union contract? If it doesn't I would get out and go and find a job that is under the provincial contract, not a private one. Under a provincial one there usually are remedies, especially for health and safety of your residents where the complaint is lodged with the union and goes right up to the authorities at the top. It sounds as if you don't have these avenues and so the previous OP had the best solution: MEDIA.

The thing that immediately comes to mind when you ask the question: What sets you in a direction you shouldn't take as a nurse is thinking that you are not part of a team, that you are having to carry the weight of everything on your own shoulders. Then you start to make decisions that are not really yours to make and that can step on a lot of toes.

yes, but sometimes the decision itself is not so cut and dry...work is the np courses as well as the job. the np course is working towards bettering her family...becoming the kind of nurse maybe she feels god wants her to be...the job needs a person like her...perhaps god wants her to be in that position at this point in time to serve his purposes in some awesome way. its not so cut and dry. which comes first? i think the op herself has figured it out when she said "but i really want to focus on my np stuff" that is her heart and soul and by doing what she really wants to do deep down, she will also serve god and her family (and herself) well.

Perhaps you need to give it a bit of a chance, as the previous poster stated, to bring the chaos into perspective. You wouldn't want to make a rash move right now when there is a window of opportunity for you to find clarity in the situation. I have been in a position for sometime where the facility was being run from the bottom up (staff motivating management to make the necessary changes) and it was VERY stressful doing that and trying to be a nurse at the same time, also running a busy family and taking a certification. Something gives! If you step down to charge nurse in a situation of chaos, you may find you have more to deal with as you have all the ideas and motiviation, but no real authority to make changes. I would make some clear and concise timelines and goals with each sphere of your life, sit down and look at all the possibilities. ie: Can you delegate? Can you trouble shoot issues with a colleague? Can systems be streamlined? Can you change the way you study to make most of your time? If you've looked at all the possibilities and still find it far too overwhelming, it certainly IS time to re-engineer your life. What we have to juggle in this time of our lives is incredible! Family - work - education - at some point there has got to be some clear direction. I find removing myself from all the clutter and chaos into a quiet place to pray in silence (like my car!) every day is so necessary to find the "Other" voice we miss so easily in this noisy life. It can be the still and small voice but it can make it all so clear.

I was doing my practicum in an orthopaedic ward and the nurse asked me to go downstairs to another ward and ask for a long weight. I went down there and the nurse said "I'll be right back with it" and she went off and I sat and sat for the longest time. Finally they had to tell me that it I had waited long enough and it was all a joke. I felt so foolish! :doh:

Yes, it would be nice to hear from the OP now so that we know she is okay.

At the highschool where my daughter is, a nurse only comes once or twice a week. My worry is that by the time the school staff try to figure things out, calling 911 may be too late. Its a really scary thought.

My pet peeve is giving meds crushed in applesauce and then leaving the resident to the bitter aftertaste without offering a glass of water to swish it all down. Its such a simple little act, and a perfect chance to give them their much needed fluids.

We have a duplicate form with all the info written up down the side ie: name of resident, Dr, facility and signature of person who processes order. Then we write the date, time and order and also put TO Dr. Blank/Joe Doe RN or VO for verbal order. We have a stamp which we stamp on the order with MAR,Pharmacy,Pull,Lab which gets ticked off as you do it.

Venting to a co-worker has its place but in this situation, it was a remark that was made without the nurse knowing the ramifications thereof. If the OP had been made aware FIRST of what had happened last year, and THEN the remark was made, perhaps it would have been taken in context. But without that bit of information, what on earth are you supposed to do with a comment like that?