StarNurse2006

Yes, we receive a month's worth of meds at a time, except for Medicare meds, which come in 14 day supplies and have to be reordered as needed. At any given time, only about 10% of my patients are on th 14 day cards. I cannot imagine having to reorder as needed for everyone...to much room for error, since there seems to be weeks where the pharmacy is SO SLOW in delivering!

I have done something similar...if the patient is their own responsible party, their request to go 911 trumps MD's refusal to give an order!

The facility I work in is currently on a "the resident has the right to fall" kick. State surveyors were very restraint-focused this year, so we are implementing a new fall-risk program. The staff as a whole is VERY resistant to it. However, I am pleasantly surprised to find that it is actually working out OK. I have only had one my residents fall, but better that she fell off the bed (trying to get up) as opposed to off the bed from another 12 inches up, going over the siderail. LOL The hardest part is getting used to seeing my residents in bed with both siderails down and stopping myself from running frantically into the room and pulling rails up!

Loves: My residents, of course. They are who keep me coming to work every day. The autonomy, as someone else mentioned. The busy pace. Hate: The people I work with who feel that you can walk into LTC, be lazy, and then pretend to know everything. Dealing with difficult families. Lack of communication between departments. Overall, I know this is where I belong, as an LVN. When I complete my RN, I'll run screaming! (And probably be back the next day to say hi to everyone! LOL)

Our facility has a pharmcy rep come in on the first of the month with all of the meds in large cardboard filing-type boxes. The rep checks against the MARs to make sure all the meds are there, and then the boxes get locked up in the med room... Until the third of the month, when each charge nurse changes out all the cycle cards for whatever med pass they are responsible for. (For example, I do all the 9AM and 2PM cards because I work 7-3. That way, the nurse who is responsible for those meds puts them away, in room order. PRNs/Narcs (even routine ones) are ordered/come in as we run out, and we receive 3 deliveries a day. It's not a perfect system, but it sounds a bit easier than some others have it!

I would also love to hear more from those who have taken the exam! I have been looking into this myself and bought the text recommended by NAPNES. The website stated that the exam was based off of this particular text. I bought the older addition for 88 cents on half.com! The name escapes me at the moment! At any rate, please share if you have taken the exam for the curious!

Sorry I wasn't more specific! I was referring to registry in a hospital setting. 33 patients in LTC is MUCH more hectic! I was rather bored with 6-8 patients. It made for a long day! :)

Every morning I have a quick meeting with the CNAs assigned to my residents. I give them any report pertinent to their assignments, confirm what showers they have assigned, let them know if a (combative, agitated, etc) resident has or will be medicated, tell them my expectations (vital signs in by 10 AM, let me know when you are leaving the floor, etc) and ask them if they have any issues they need assistance with. It takes less than 3 minutes, and it makes for a fantastic day. I believe it makes them feel that we are a team and they can come to me with issues, and it also makes them aware that I DO watch to make sure things are done correctly and that I appreciate them. If a CNA does not meet my expectations I set out, I counsel them, in person or with a written warning. That is usually sufficient to prevent a second occurance. We call these the morning "Come to Jesus meetings." LOL :rotfl:

I work in a LTC in Southern CA. We have a 99 bed facility, with 3 charge nurses each taking 33 beds (regardless of census, but it usually evens out) I work 7-3, so I have 3 CNAs, the other 2 nurses have 4 CNAs. Honestly, on a typical day it is not at all unmanagable. Yes, I'm busy, but I have the DON/ADON on weekdays as well as other department managers who are nurses, when the need for advice/assistance arises. We have a TX nurse 7 days a week as well. On the weekends, we have an RN supervisor. I started at this facility as a new grad, and after working some registry shifts with myself and an RN for 6-8 patients, I find I thrive on my busy LTC day!

I just want to clarify, I did not access any records. This incident occured on my day off, and now, with the suspension, I do not return to work until next week. When I told her I would look into it, it was my intention to ask the discharging nurse if she had any information, and follow up with my NM if necessary. I would not have access to her chart because she was discharged. Thank you everyone for all of your comments and advice. I appreciate it more than you could imagine. I have no intention of signing this write-up, and right now i am just trying to get myself together to go about refusing professionally and without jeopardizing my job.

She found about her visit because the daughter in law called the facility to ask what was going on with the labs. Apparently they either never notified her of a problem or gave her the run-around about it on discharge. I believe this was the reason for the harsh reaction towards me...my boss got caught letting the ball drop, or possibly in an outright lie.

I didn't give out any info such as lab results, I just told her I would look into it if she called me and reminded me. I felt that what I shared was general info, i.e., I don't know if it was completed, vs. specific info, such as actual results.

I really hope that you all can help me with your opinions/professional knowledge on this topic: I am a nurse in a LTC. I have been caring for a particular patient for the past year. During this time her family has been very involved and has had a hand in all of her care, decisions, finances, etc. She is her own responsible party, but I believe her son has POA. She has never had any problem with her son and daughter in law having a hand in her care, and has in fact, encouraged them to advocate for her. She was recently discharged to home. She is now living with her family down the street from me. As you can imagine, we have all developed a good relationship and so I thought nothing of her daughter stopping by yesterday to say hi and update me on how she is doing at home. She asked me about some labwork we had been waiting for, stating that the home health agency needed it and no one at the facility had updated her when she called. I told her that to the best of my knowledge there had been a snafu (an error on the part of the nurse/facility) and that she should perhaps either ask it to be repeated by home health or she could call me on my next day on and I would look into it. She thanked me, we chatted some more, and she left. I completely forgot about the encounter. I got a call from my boss last night, and she very rudely informed me that I had violated HIPAA. She told me not to come to work for the next 3 scheduled days and to come sign my write-up when I returned. I didn't say much on the phone because I was baffled. Here was a patient who was no longer our patient, and I gave information to the very same person that we gave all information to every day for the past year. I believe that she was upset because she got called out by the family for letting the ball drop on the labwork. Her tone and the way she spoke to me said "retaliation" rather than actual concern for the situation. I am not trying to give too much info here, but from this can someone please tell me if I was in the wrong? At this point, I have no intention of signing the write-up, but I fear for my job. All opinions are welcomed! Thanks!

Called the board again yesterday...they were on October 2! :)

YES! Because I also took mine October 4! I called the board today...they are still processing Sept. 29 results! Good luck to you...I no longer feel so alone! Keep us updated!