LPNfurever

Are RN's/LPN's allowed to delegate application of swab caps to CNA/RT ? I was under the impression that only IV certified nurses (ma's if trained) could touch an IV.

Hi All, Do your facilities have protocols for extravasation(non chemo)? If so what are they for antibiotics, iron(venofer/feraheme) and others such as Demerol/morphine? Other than stopping the infusion, elevation and a compress(warm/cold/compression) I wondered if there was anything else. Thanks!

One would think that higher staff to pt ratios would increase a facilities revenue, ie: better care = satisfied customers, satisfied customers = more customers, more customers = more $$$$$!!!!??? I take care of 23 pt; 8 of them are BS, 5 of them are creams, 2 of them are dressing changes, 6 of them are head to toe assessments and alert charting, not to mention charting on anyone else who has change in condition or behavior and then there is calling the docs, checking the fax for labs and processing orders... The aids are burned out, the nurses are frustrated and management is relentless in the need to eliminate overtime. I will skip my lunch(even though i still sign out for one) for the sake of getting things done. Im ready to pull my hair out!!!

M'am I have a problem when I watch you (the non-compliant diabetic with 350+ BS) stuff your face full of jelly doughnuts, hot chocolate and God only knows what else and then ***** about how slow the van-driver is when taking your overweight rear to wound-care or hyperbarics to resolve the diabetic foot ulcer on your good leg, because you had the other one amputated. You are the reason healthcare costs are sky high; because you live an unhealthy life and then expect Uncle Sam to pick up the tab and when he does, you dont do anything to better yourself or get well, and then you ***** some more when the motorized wheelchair (on the govt's dime) craps the bed and you actually have to propel yourself to and from meals!

I really think it would help out immensely if the night nurses could do blood AM blood sugars and if the aids got up several of the totals on the hall. All night shift ever seems to do when its mentioned is act put out about having something else to do. I would bet my life that they dont have as much as I have to do on days, granted i understand things get busy on all shifts and there are exceptions to the rule, but pleeeeaaase have my pitcher full of ice water and the cart stocked. Ugh......

We get in trouble if we dont take a 30 minute lunch and if we stay late! I usually work my lunch and just write it in...

I work at a LTC facility and it is so very frustrating; the day starts at 6am and ends at 2:30pm. I take care of 23 patients and for those 23 pt I have 2 aids that are expected to get those people up, shaved, face washed, dressed, changed and teeth brushed in two hours. Night shift gets up one person because by 6am she is crawling out of bed. I am expected to be in the dining room to help feed at 8:00am, never mind the hellish med pass I am trying to get done so I am in "compliance". I also have BS, skin checks, dressing changes (we dont have a Tx/wound nurse), PRN meds, creams and Tx to administer. Needless to say I am usually late getting to the dining room and the aids are busting their butts to get everyone up.I do what I can to help my aids; laying people down, getting them up, toileting, shaving...etc. I brought it to managements attention that if we had an additional aid from 6-10 that would help us get people up, ready, in the dining room and fed, and laid back down after breakfast. They told me that we are "overstaffed"; apparently state minimum requirements are acceptable. We have patients that dont get turned ( I try to keep up with it), skin is breaking down and cares are not getting done. I am ready to rip my hair out and say what is wrong with you people!!! Cant you see that if we spent an extra $30 a day on an extra aid it would save HUNDREDS of dollars on wound care????? Not to mention our reputation would actually get better and people would want to come live here....(((((headdesk)))) Is it just me or do other nursing homes run like this? With a skeleton crew and saving a few pennies at the expense of good care? Does anyone have any ideas about how to run a nursing home not only efficiently but so that people are well taken care of? I have also been offered a job at a hospital but its a huge paycut and I will be barely scraping by financially, but I will have my sanity...

Dont do it! In the facility I work in we need a Dr. order for milk of magnesia. Call them and get a telephone order so then all they have to do is sign it. You will lose your license if something goes wrong. Believe me the doc will not put his license at stake for you and neither should you. From one new grad to another, DO NOT trust anyone!

One other thing is that I am a new grad LPN, and at this LTC facility we do not have an official Tx or wound care nurse. Also the manager for my hall is also a new grad. Its very frustrating. Do I need a doctors order for dressings and wound care? I am being told what to do by an RN, however, I dont remember seeing anything in the chart from the physicians.

Does the skin cancer progressively cause the wound to get worse? The dressing is scheduled to be changed Q 3 days and PRN; although it needs changing usually every other day due to the drainage. Would a wound culture be appropriate in this instance?

It is a high calling!! Im a new grad and I love long term care...my med/surg nursing friends go on and on about so and so who OD and had to be kept in restraints, or how whats her name has some rare bone disorder (they maybe have 5 pt) then when I tell them about my crazy (apparently boring) day (with 20+ pt) they roll their eyes. The fact is that nursing home work is a completely different animal and just as demanding if not more demanding then med/surg. :)

I have a pt with skin cancer who picked off one of the lesions on her hand. It started out as a scabbed over sore about 2 cm in diameter. It keeps getting worse despite PRN dressing changes. It is now approx 5 cm in diameter, and .5 cm deep, has a foul odor to it and when I change the dressing its completely saturated with serosanguinous drainage. The wound care I was instructed to do was cleanse the area with NS wipes, then to use a skin prep pad over any area that would have adhesive on it, then to cut a piece of COPA foam to the size of the wound, place that in the wound, then use a COPA foam island dressing on top of that. The I am to wrap the whole dressing with coban( resident picks constantly) to secure it in place. Is this appropriate wc? I also began to skip the island dressing as the adhesive seems to irritate her skin and just double the COPA foam, wrap with kerlex and then use coban. I think the kerlex helps the coban not get too tight and adds an extra absorbant layer. Any help would be appreciated. Thanks!

One of my pleasantly confused elderly patients had DC'd her foley catheter one evening on her way to the bathroom; just ripped the sucker right out. Fortunately she had no ill effects of doing so. When I came on the next morning she was sitting in a completely saturated bed and was dumbfounded about it. "Why am I sitting in a wet bed?" I explained that she didnt have a catheter anymore and told her that when she needed to use the toilet from now on to urinate. She looked at as serious as could be and said "Well I want that decaptiator put back in". LOL i about died. Later that afternoon PT was walking her and she asked me again "I want my decapitator!" The PT lady and I stifled laughs and managed to keep a straight face. I almost for got this one....Another confused lady was in her wheelchair asking for her baby. Now this woman rarely talks, so I get her "baby" which is a life like doll that makes noises and blinks its eyes. I was going to put some cream under her breasts and started to lift up her shirt and she says "Oh, honey Im not going to feed it." LOLOL.

I work at a LTC facility and have roughly 21 pt to care for. I graduated 6 months ago and am still learning the ropes myself. The other day I had four students with me!!! Anyone else have this happen to them?

I work at a snf and have on average 18-24 pt. I have found that if I can start getting my 1130 BS at 1115 and just get them all out of the way it runs much smoother. I also dont like giving insulin and checking BS in the dining room. I know state doesnt approve of giving meds in the DR but in the real world there isnt a realistic way around it. I have about 6 skilled assessments to do as well as any alert charting and change in condition. If I start getting flustered I make a list of things according to priority. One evening I got an admit 5 mintues before dinner started and I was in the middle of my 1700 med pass. I did a quick assessment on the pt, admission vitals and got him a meal tray. Other than that the night shift RN had to do the admission paperwork. She wasnt too happy, but hey I got the med pass done......