beatrice1

Congratulations and good luck with your first Job! Honestly it is just as easy to make mistakes with computerized system, no matter what remember what you learned “5 checks” ?

Hmm, I guess I did assume that. Curious now to know if it is or not

How is this order set up in the Emar . If patient is on parameters, then entering the B/P in should alert you to any PRN orders. Maybe going forward this could be an opportunity to make orders more clear to avoid errors or near misses. You are probably not the only one that has missed this

Anyone have any advice on finding the appropriate Wound certification course. It is very confusing given the different organizations, certifications, prices and requirements... I am a RN with an Associates, I work in a LTC/SNF facility. Our 1 and only Wound care Certified Nurse left the facility and I was asked if I would like to work with the Wound MD who comes to our facility (Vohra wound MD) I took the Vohra wound certification course but it was very basic and not accredited. I would like more education if I am going to be working as "the wound Nurse" in my facility Although certification is not required in my facility, I would like to advance my knowledge base to go the job more effectively. I want to be Wound care certified. Any suggestions? I know I am limited due to not having a BSN Any advice will be helpful Thanks, Bea [email protected]

I work in a skilled nursing facility. I have been a nurse for 8 years and work on the skilled rehab floor. I have been working with the Vohra wound MD in our facility as his assistant. I took the wound certification course offered by Vohra wound care, however this is a very basic course and not accredited. Although it helped me get a better understanding of wound care, I feel like it wasn't enough to entitle me as the "wound nurse" in our facility. I think this may be a specialty I would like to explore but want to be more educated and don't know Where to start. What is the right path for me. I have a Associates Degree. So I know that limits me to some of the courses. Any suggestions as to where to start to see if this field is for me? Thanks , Bea

Occasionally in Long term care you have the family who Keeps their loved one on Full Code, even after patient is nearing their "End of life" Sometimes Patient has chronic illness or no quality of life but family members think they need to "do everything for their parent" My question (although may seem like a dumb question) If Patient passes away, and they are not found (say in the middle of the night) right away, they are Obviously deceased. Are you suppose to do CPR no matter what/when you find them? Is there ever a time you dont do CPR? What is the Ethical/responsible/ proceedural thing to do? Bea

Just wanted to hear other peoples opinions/thoughts or experience with online degrees. I am a RN with a Associates Degree and want to continue my education and get my bachelors degree. I am working full time 3-11. I am torn between returning to my state college or do online classes, as some of my co-workers are going this route. Are on line degrees accepted (respected) my most employers now? Do you feel you are getting a good nursing education this way? Is there anything I should look out for? Just any advice that will help me with this decision. Thanks for any input Bea

"My problem with your request is that you are looking for a chemical restraint. Think long and hard before doing that - or at east, don't post about it on a message board" @SuesquatchRN In My original post, I asked about Sleep Aids because the woman was already put on one at this point and I was questioning WHY Trazodone was used. I was questioning OUR MD's choice and wanted to know what other's peoples experience/opinion on this medication was. I am a fairly new nurse and still learning. I have only been in this facility and often ask how other facility deal with situations. I am NOT for sleep aids for the elderly, without trying all other interventions. Which is why I also asked "What are other sucessfull interventions you have used." I went into LTC because I don't think there are enough good Nurses that care about the elderly and thier care. But I LOVE it, and am proud to be a part of what ever time they have left and I believe they deserve the best of care til the very end. If anyone else has any advice that would help, I appreciate it. Bea

Thanks for the answers so far, I am surprised to learn that Trazodone is used more than I thought. The issue isn't just the wandering, in fact I don't mind the fact that she is up and walkig around, cause he is safe and not a fall risk, However, she gets awfully loud at this time (11pm-12am) she is wandering in and out of rooms waking sleeping residents up lookin for Mario, and she is upset that she cannot find him. I want to find a way to redirect and put her at ease.

Could you all give me some examples of Sleep aids you use at your facility to help your resident's rest/sleep when all other interventions do not work. ex. We have a Portuguese speaking dementia resident who sundowns and starts to wander in out of other residents rooms "looking for her husband" when there is no Portuguese speaking CNA on, she is very difficult to redirect. We have tried many non-pharmacologic interventions that are not working. she wanders around sometimes till 12am-1am, waking up the other residents and getting them upset. The House MD at our place seems to have a liken to Trazodone. This is what he ordered for her. (which isn't working) Isn't Trazodone an antidepressant? maybe drowsiness a side effect but not what it should be used for. I would love some input from experienced Nurses who work with Dementia patients. What are some successful interventions you have used. And Is there a safe sleeping aid for elderly as a last resort? Thank you, Bea

@JBMommy I loved your post! You stated exactly how I also feel. I too started as a new Grad in LTC. Although I always loved working with the eldely I felt as though I should be working in the hospital for "more experience, learn more skills...ect) However, I have learned so much this past year working in LTC. We are not just a "Nursing Home" We are admitting more and more skilled residents, rehabs patients from hosp, younger elderly rehab patients,ect. I have learned that LTC is more challenging and you really have to know your stuff. The Doctor may be a phone call a way, but I am the one doing the assessment and what I find and report to him is what he bases his orders on. I also had to learn to know what to suggest to him exactly what I wanted from him, so you have to know your stuff. I love getting to know "my residents" and thier families and making there day a better one. I believe these people derserve the best care and deserve a caring Nurse watching over them. There really is alot of opportunity in LTC, especially if you want to make a difference. Thanks for the positive post Bea

@JeanMarie Thank you for sharing your personal experience with your Dad. It was very insightful and also reminded me how to consider the change in routine/place can make them appear to be disoriented or disoriented more than usual, and more conversation may be needed.

How do you all check orientation in the elderly in LTC. Most of them are oriented to self, but what is the best way to check time and place. Do we really expect them to know the date, even the month when every day to them is the same routine. and how about place? Do you know where you are? What are the questions you ask? Bea

I am a new nurse working in LTC. I carry alot of resource books books with me to work... Lab tests, drug book, nursing proceedures...ect. Can someone tell me a great Nursing resource book that includes everything so I don't have to carry so many books. or another words.... What is the one Book or Nursing resource that you cannot do without??? Or Nursing App? My facility is not computerized yet so I don't have that resourse at hand But I do have a smart phone, so any app recommendation will be appreciatedT Thanks, Bea

This is my first job as a charge Nurse in a LTC facility. I float between two different units and work with with alot of differnct CNA's. I would like to give them all a little something as a holiday gift. Can you all give me some ideas as to what you give your girls for holiday gifts to say thank you for all you do? I probably have a bout 10 different girls to buy for. Thanks for any ideas Bea

I was always interested in Nursing, and after being involved with Hospice because my mother was dying of cancer at the age of 46, I knew I wanted to be a hospice nurse and make a difference like her nurses did for us. I went back to school at the age of 45 and got my nursing degree, one year ago. I landed a job in a nursing home, which I love because I also think the elderly deserve the best care and nurses that want to make a difference. The only problem is there isn't alot of learning, trainning and the opportunity for more education when you work in LTC. Those of you in Hospice Nursing, please tell me how I can transition in the Hospice field. What do I need to do to transition. what skills do I need, what classess or trainning can I do? Any advice would be appreciatede. thanks, Bea

Ok, a resident in our LTC facility is diagnosed with VRE in the hospital. She has a colostomy. I take the order from the doctor, Bacitracin 10 days... reculture rectal swab x3...ect. I hang up from the doctor. Then it dawns on me.... rectal swab? she has a colostomy? I am a new nurse so wasn't sure about this... I ask my fellow vetran nurses and get all kinds of answers.... "hmmm, I'm not sure", "yes, you do a rectal swab, the bacteria is still carried in the rectum" "No, you swab the stoma, you have to test stool" What is the correct proceedure? I would have called the lab and asked but it was after hours. she does not have to be restested till after completion of anbx, but I want to know the correct answer! Bea

Help, I am a new nurse, work in LTC and just started administering I.V. meds. We don't have many residents on I.V. medication so there isn't alot of opportunity to get familiar with this. I seem to always end up with air in the I.V. set after priming the line. What am I doing wrong? I remember in Nursing school being told to invert the ports but this doesn't seem to help, I have tried priming it really slow but still sometimes get air bubbles. I was told your not suppose to aspirate the air out anymore. Any advice? Bea

I am a new Nurse in LTC. I have a question about your bowel regimen. If our residents have not had a bowel movement by the 3rd day they get 30ml of MOM. I was doing meds on this day and a resident that was due for MOM had a high Magnesium level that day. ( I only know cause I reported the labs to the doc that day. ( cant remember what her problems were, but doc just ordered repeat labs) Should she have had the MOM this day? Another situation, a resident with kidney problems gets 40Meq of potassium everyday. He only gets lab workup 1x week. I am not comfortable giving potassium without knowing his most recent level. What do you all do in this situation? What are some of the things I should be looking for in situations like this? Bea

I am a new nurse working in LTC 3-11. I was surprised to see how "short and sweet" report given to oncoming nurse usually is. I know personally, because I am new I like to know a little something about each patient before I start so I know what has been going on and what to expect from them. Some Nurses don't even want to hear report they say " don't worry I 'll just read it" (shift report). Being a new Nurse I am asking the advice of you experienced nurses... what is the most important information you would like to hear from my report when you come on to the 11-7 shift? and what do you suggest is the most important info I need to ask for my report if not given to me? Just want to hear what others think is most important info to start the shift. Thanks for the info Bea

I am a new Nurse who started working in a LTC facility who sometimes uses agency Nurses. I give you all so much credit for being able to be so flexible and confident to go into different settings at a moments notice! I get so nervous going to a different wing than I am accustomed to. My question to you experienced Nurses is, What are the most important pieces of information that you get from report or Patients chart that you feel you need to know before your shift. I would like to know for myself and to help give a good report to oncoming agency Nurses. Thanks for the advice. Bea

I am a new grad working in LTC, never had any experience before this job. I feel as though in school they really don't spend enough time with physical assessment. I am having a hard time understanding heart sounds and to know what to look for. Most all elderly people have abnormal heart sounds, but I don't know exactly what to look for. I want to learn more about this and want to be more proficient. Does anyone have any ideas the best way for me to learn more. What do I listen for when they have heart failure, as a diagnosis, when should I be concerned? When do I contact the doctor? Most of the abnormal sounds I hear are their "normal" sounds I wish I could follow a Cardiac Nurse around and have her explain the different sounds she is hearing, is this possible??? any advice would be helpful Bea

I guess I should be more specific, I am talking about materials on things like dehydration...ect. Why I&O's are important...ect Bea

I am a brand new RN working in LTC which I LOVE. I have a pretty good repoire with most of the CNAs. Most of them are good workers but some just seem to do the job to get it done. Especially when it comes to filling out the I&Os and BM list..ect. I would like to "teach" why this information is very important to us nurses as to how our residents condition is changing or imporving...ect. Do any of you have any ideas as to how to give this information in a appropriate way. I don't think they get enough teaching here and that is why they are so task oriented. Any suggestions to a new nurse Bea

Thank you for your comments, this is all new information to me seeing I am such a" newbie" but I plan on reading up as much as I can and becomming educated seeing so many patients seem to be becoming dialysis patients