rapkeygurl

Hi all, I am a certified nurse assistant instructor in New Mexico, Actually I have been teaching for several years in Texas. Any information on the new mexico training differences would be greatly appreciated. I start my new class of 25 students on Monday and we really want this to go well. I have not been given a lot of direction from my program manager well we both are use to the Natcep program in Texas. I will probably just call the NM nurse aide registry tomorrow for more assistance. I love teaching!!! NO more MDS stuff lol HURRAY!!

A “significant change” is a decline or improvement in a resident’s status that: 1. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, is not “self-limiting” 2. Impacts more than one area of the resident’s health status; and 3. Requires interdisciplinary review and/or revision of the care plan. That comes straight from Chapter 2 RAI manual. Plus I am sure the resident would have grief issues possibly causing depression r/t the loss of the limb. I agree a sig change I would do also.

Wow you sound just like me. My back is killing me from the last 3 night of working 35 residents, One nurse aide and I might have been there by myself. We have had state in our building all week again for a follow up visit. I am going to drive 4 hours for an interview tomorrow Wish me luck!!! I am no spring chick either I am a MDS nurse but seem to get pulled to the floor lately while the change of condition, medicare mds's are piling up cause noone will do your work they are too busy taking endless smoke breaks. I get a note on my desk this morning when I was leaving the shift said, sorry I only got one order put in the computer. We have end of month paperwork to get completed can I scream now???? Not to mention I have drawn I believe the whole months worth of labs in the last 3 nights because noone else seems to think INR's are important?? Hm with 2 back from hospital with PE's and I dont even get good money NOR INSURANCE!!!! Past burn out..... If I dont get one of the 2 jobs I am interviewing for I think McDonalds is looking good lol at least they give there employees insurance.

Sue, I feel for you in my small town in the last 5 years they have ran off every new DON that comes in. Really good ones too. I dont think they will run off the current one He frankly has cahunas to put it bluntly. When he came in I was relieved because he has already gotten rid of one LPN that was terribly lazy and full of problems along with an attitude to boot. I use to be the 6-2 day charge nurse. now after 4 years of being department head. I dont have many friends in the nursing department either except the few other department heads. Which I dont see so much because they are having to cover nights a lot. Believe me they look to see any mistake you make and call you out on the carpet for it. I used to try to have orders done for them charts ready on new admissions. My hours where cut so these folks are going to have to get with the real world soon. Plus MDS taking 90% of my time just finding the documentation I need that usually is not there. I use to get peeved at the people that would hound me about the monthly summaries and stuff when all I wanted to do was just get my meds passed and treatments completed. I dont know but I guess I have developed a thicker skin. It was very hard for me to have to write up a coworker that was a good personal friend. that is why I really work hard on not developing close relationships with coworkers like I did at first. that has been different for me because when I was at the hospital after a night shift we would all go out for breakfast after A LONG NIGHT but I was only 19 then. Until I had to start doing some counseling forms - I called them coaching forms , I was not respected either. At times I dont feel I get the respect I deserve either but realize that is only due to administrator and BOM favorites who have tied the hands of nurses way to many times in this facility and thus the turnover. I am not too far behind them put in 20 applications in the city last week and am hopeful for a positive change in the near future. I have lasted 5 years most that have left tell me I am a gluton for punishment lol. Keep your head up and dont let them see you upset that will help a lot. Stay cool as a cucumber and yell and scream when you get home. I just took a long walk that is my stress reliever and glad it was warm enough to do it so I did not revert to the cookie jar!!!

Sue, I feel for you in my small town in the last 5 years they have ran off every new DON that comes in. Really good ones too. I dont think they will run off the current one He frankly has cahunas to put it bluntly. When he came in I was relieved because he has already gotten rid of one LPN that was terribly lazy and full of problems. I use to be the 6-2 day charge nurse. now after 4 years of being department head. I dont have many friends in the nursing department either except the few other department heads. Which I dont see so much because they are having to cover nights a lot. Believe me they look to see any mistake you make and call you out on the carpet for it. I used to try to have orders done for them charts ready on new admissions. My hours where cut so these folks are going to have to get with the real world soon. Plus MDS taking 90% of my time just finding the documentation I need that usually is not there. I use to get peeved at the people that would hound me about the monthly summaries and stuff when all I wanted to do was just get my meds passed and treatments completed. I dont know but I guess I have developed a thicker skin. It was very hard for me to have to right up a coworker that was a good personal friend. that is why I really work hard on not developing close relationships with coworkers like I did at first. that has been different for me because when I was at the hospital after a night shift we would all go out for breakfast after A

I did complain to the CEO and the second time I tried to meet with them they where in the office but "in a meeting" But that was one bad apple but it left a horrible taste in my mouth and I will not soon forget it. If I would not have been laying there getting embedded staples removed I would have gotten up and probably would have been in trouble. They will say that to the wrong person oneday or better yet "nurse big-mouth" will get dementia and I will say come on over to the dog pound lol

I was in the hospital ER to have some staples removed after my c-section, and low and behold the er room next to mine was one of our residents, a very confused man with alzheimers and they had him restrained, and I overheard 2 staff one nurse -- said I cant wait until they send him back to the dog pound. I was so sad by that whole thing. I have totally lost respect for this nurse. What is even sadder is almost everytime we send a resident to the hospital, they demand we leave a staff member to "watch" them. but it is not the whole staff over there, because I have been there several times with the baby and they are so great, so yes does seem to mean they feel the elderly dont matter much. I guess since I work for the dog pound I am a real B#####!

Oh gosh sweety, you sound so like me, I was pregnant and ADON and then the DON quit while I was 7 months pregnant and she was also our RN consultant, so I had noone to turn to in nursing but agency RN's we had a couple that were helpful but not knowing our policies etc.. was horrible. To make a long story short, I got so ill during my pregnancy, had a seizure r/t the high blood pressure and finally I went to the doctor and he said your NOT going back there period until you have this baby. The last whole month I was laying on my side they were calling me almost daily and I had been telling them soon I will be having this baby dont you think we need to get someone else trained to do MDS, admission, discharge, tiles blah, blah, noone listened. So I had my sweet little Jules, who is now 2, downs syndrome little angel. For the whole first year was in and out of hospitals, for his surgeries, and all that stress can really make a difference in a pregnancy. At the end of my pregnancy and my husband did not have insurance thru his work so I had to get on medicaid and I was so upset by having no insurance etc.. But that was just a God thing for me because with all the surgeries and stuff I would have never made it. Now I am back to work with no insurance for myself etc.. because I am only working parttime and I have over 22,000 dollars in debt to our local hospital due to my sons and my own health. I promise you dont want to go there. I only work a couple of days a week now back working on my RN thru online program. So oneday I will not have to deal with chips, medicaid and all the forms to fill out and how people treat you at the doctors office because "your a nurse and your children are on chips?" But the health of my child is all I care about now not being a slave to a facility that could care less if your laying on the floor with a 2 year old beside you crying and your husband comes in finding you laying there and having to rush me almost 2 hours to the city to a good hospital that can deal with high risk pregnancies. After I had my son-emergency c-section, they were calling me begging me to come find some papers because state was in the facility. Now currently I dont think the admin or DON would treat me this way if this happened again thank God, but the cooperate dowgs would still get the wipe out lol. Just think about this a good counselor I work with told me after all this happened, God first, family, career. Good luck to you and your little baby!!!

we have a similar policy due to our recent ij involving not notifying md's of change of condition. Ours is to call the md first then the DON, but also if there is a change we are to let the DON know the entire details of the events leading up to the change if we are aware, etc. In our facility our big problem is communication. We have state due back in for follow up from ij anyday and seems like noone is too concerned but me, the ADON and DON. (we have a new one YEAH!!) anyway we also got hit on pain- so I did a whole hall of pain evals and left a few with all the residents names for the night crew and evening crew to do. They did not do a single one!!!!! I swear I am sick of being the only nurse that listens to the DON. I believe they feel that doing fall risks assessments braden scales, aims forms or any type of assessment other than the initial one is not there responsiblity. so aggravating. I dont know if I should spend my only day off today going in doing the rest of the pain assessments or just let us get in trouble again. We just had a web bases training on pain all direct care staff was to attend some did not even show up and I hope the DON sticks to his guns that the ones that did not come dont have a job.We have had 2 brand new nurses come in wanting jobs I am all for an overhall of a couple of people that caused this whole situation in the first place.

YOU WILL GET BETTER, I felt the same as you almost 20 years ago at 19, but you really have a great ratio of nurses and CNA's which is not the norm were I am at we have 40 plus with 2 on and a restorative aide who usually is gone on transports which I think is dumb and not doing restorative, (this is why our rug rates are poor) anyway, What I do with new grads or did when I was ADON, was to make that little cheat sheet we call it a brain has a list of accuchecks, who needs o2 sats, a spot for i/o's and bm's (to check at the beginning of the shift so you know who needs a laxative) foley caths to record outputs and any special tx, appts etc. One section for incidents/transfers. I recommend making rounds 15 minutes before your shift before even report, or do walking rounds with offgoing nurse. You want to make rounds on the hour the nurse aides are not going to make sure they are looked at pretty much hourly and to see if they are clean, good body alignment for bedfast residents. Make a list after you have made your first round of what docs you need to contact and for what if you need to report a skin tear, fall, elevated bp/abnormal lab etc.. etc.. make your assignments early and let your nurse aides know what you expect of them like giving you a list of bms or outputs, or having people in the dining room by meal times, passing snacks we use a nurse aide assigment sheet to say who passes hall trays and takes meal intakes that day, and who goes on transports. Having all your ducks in a row early helps but takes time to get this down. It did me but I got to where I really did not want to stay 2 or 3 hours late so I learned to get things done when I could so I could be in the dining room monitoring meals and assist and aide if they needed it to prevent injury. Make a list also of familys to call to go to transports if they can which helps you and the facility if they go sit at appts if you have that luxury so you dont have to get a nurse aide off the floor. when you make assignments make break assignments and not let all of them go at one time. ( I made that mistake before) vital signs I usually did my own sometimes let the med aide get them if in a rush. also on your little charge nurse sheet you might jot down who is on abt's q 72 hour charting etc... MOnthly summaries to do etc. I made a Job duties list for our GVN's for each shift which helped them out a bunch you might ask someone if they have a list like that. or Job discription. You will get better, I remember the day I had to look up every stinking med and my med pass took me almost until 11 at first but got better with time. When I have to work the floor since I dont do it all the time I have to stay over a couple of hours to get documentation done. So your doing great !!

yeah I am still confused, we had reported 5 incidents with injury and one of them there was no incident report and we really did not know how the fx happened. So we went into extended survey and with that lost the NATCEP training class in a very rural community this will sink us not having enough nurse aide. I am still bummed about it but we do have a new DON that seems very knowledgable. Plus the Don had lost half the paperwork on one of the incidents. It was a real mess. I really hope it all works out in the end.

We use Obra-EZ which is from MDI achieve out of Dallas, when you call them they say Quick Care but it is not? When we first had this system we were in dos, we had to change over all data from dos to winobra, that was crap and we had no training with the system until 6 months after we were using it. Then I realized how much stuff I had to change. I have not seen our company send us to any new training for over 3 years and lots of staff have come and go, I have tried to teach a few but I am not a computer techy person but I do pretty well so my coworkers say, There are a lot of different types out there. I have no clue if when the 3.0 comes about they will just send up and upgrade or give us any training??? the Joys of LTC!!!

you should check out mds forum and there is a section about survey stuff we just had a doozy lost our natcep program due to quality of care issues surveys. I have been seriously bummed, but I am going to hang tough-- got new DON today hopefully we can get somewhere due to his knowledge and background. I am going to keep a positive attitude and keep trudging on.

the worst part of the whole thing is that we lost the nurse aide program that of course I teach.. so I feel personally punished. I called the nurse aide creditialing office in our state they say I know it is not FAIR but.... you can not teach the class for 2 years. We can have the nurse aide class but has to be someone has never taught it --- this makes me feel like I did something wrong. I have only had less than a handful of students fall the thing in the last few years. sure I can spend more time with MDS stuff and careplans. When I get back to work I am going to call them back and see if I can teach at the nursing home in the next town I have already put in my application. If they tell me that is ok I will of course be glad but be confused at the same time. so I can teach at another home but not in the current one?? that will not make sence . I will let you know what they say.

One of the things I did not see was rounds, before I take on an assignment as a charge nurse I go look at everyone, make sure they are all there. then get report then get typically if working 10-6am get all needed vitals and o2 sats, change any peg tube tubing out, and make assignments for the nurse aides they usually round 12-2-4-6 I am rounding 11-1-5 to check behind them if someone is wet etc.. or that they dont check on ( this is if your working agency and dont know your CNA's) we do get blood work at our facility around 5am then spin down the labs per policy. have them ready to pick up in am. We give morning 6am meds that can not be given with food like prilosec, thyroids, hhn tx if ordered. You might be responsible to fill out monthly summary forms, or weekly assessments but for the most part important thing to remember if something usual happens fill out incident report, call md and family. Remember CYA!!! Try it out, I was a hospital nurse for years and came over to LTC and I have loved it worked nights for a long time now doing MDS's -- brush up on your assessments skills if you are working nights because everything is on you.

Yes I was fired only once in my nursing career and I still cant see that I did anything wrong, and I am not one that can not admit my mistakes however, I feel the reason they got rid of me is that the girl that was there before me had just completed RN school and they wanted her back. and she was back about a week after I was gone but I ended up getting a much better job better pay and no call so it worked out for my Good. I enjoyed that job even though the call was killer sometimes and lots of traveling. They said they could not get me for 1 whole hour. but I was a church and turned off my pager and I had called them before church and told them if this clients Temp went back up to call the doc and send to ER, It was group homes for mentally ill. We had medication aides working in each home. That I had trained well and they sent him via ambulance so I dont know what I did other than they could not call me but they followed my instructions. Yes I believe they did me a favor also. Better job/no call/ better benefits etc.. 90% of the time doing the right thing never goes wrong and I feel even though we have been brutaly honest to the state and have taken a horrible fall our the current facility I am at it will all work out in the long hall. I am looking for another job also because I dont feel I am effective as long as we keep a few nurses that never check on residents, never call the doctors, and never give pain meds when asked for. They just keep letting them ride by, I really feel if we would have terminated the ones that caused our recent IJ- the state would not have been so hard on us because I have been with this home for many years and know how this survey teams thinks. We had a similar situation where a change of condition was not reported for 8 hours with a fx hip situation involved, and after we terminated this person they did not site us. I tried to explain that but I feel the whole problem was the current DON was afraid to have to work the shift this nurse worked. I even had that covered for her but. they keep her and aides complain the whole IJ was related to it. so, hence this problem is going to continue. but enforcement has not made up there mind if they are going to report to board or not. So we will see what happens. I dont think I can work as MDS coordinator, and knowing they will not be cared for and that frankly I can not take. I like this nurse as a person she is sweet but flat refuses to chart or send one out when needed. Not sure if it is the paperwork she does not want to do, or just does not have assessment skills. We just did a huge inservice on assessment skills, with videos and handouts. So I dont know. I am on the look out for something else. Maybe will move also my husband is not happy in this little town anyway. The only good thing about it is my parents help with my kids and there really is not any other place is this small town. I just take it a day at a time. They might need me more hours since our DON turned in her notice but I can not do that job I am still in RN school, yet when I was ADON we went without a DON for almost 6 months while I was pregnant and it nearly killed me. So we will see. Our owner wanted us to get rid of this nurse and the RNC also, I let her go once before. When I was ADON, but we have a good staff of new nurses willing to learn well I will stop going on and on and know it will all work out in the end I am glad you found another job and I hope you will have much success and be happy doing it!!!

yeah that is why we got so badly tagged this time on falls because the old RNC put will do fall risk assessments by 24 hours after admission, q 3 months, q 48 hours after readmision and a post fall assessment that was 10 pages lol. and to do them correctly you have to get orthostat. bp's, well most just put 0 on that section and forget about it. I use to do them all when I was there 5+ days a week but now only 3 days well without the class I can be working on stuff more. and I have learned a lot about what they want to see on a careplan regarding pain. So I just have to look at it as that. I was told if I want the class back 'I" need to appeal -- I am clueness how that process works. Gosh I so wish to have some guidance and it makes me want to study harder because I want to be able to help others and know where to get the information from if I can not get it from higher up's . I did make some mistakes on the CP's, I can see and I see that I will have to daily communicate what is going on with the residents for the days I am not there because it sure as heck will not be in the charts. When I go back monday I plan on hitting the floors running, and talking to every resident I see about anything and everything but I know I am not super nurse and still unsure if I am up for this after this process.

OH gosh I just was up all night doing an inservice regarding changes of condition with will email it to you if you like

Yeah -- I am just bummed because I truly love teaching the nurse aides and when that light bulb turns on I feel very good. When they go on and get there nursing license I feel even better. When I have the residents tell me hon, you are sure putting out some nice girls to take care of me. I feel very competent in the Instructor role- in the MDS role I dont always feel as secure as I should and the Care Plan - I feel I do ok but am not an RN yet so somethings I still need to brush up on. I did apply for a teaching job near by so hopefully that will work out will have to drive some but should not be too bad. I am just considering al my options

well with the big fines I am sure my hours are gone with that. There is always something to do at the nursing home. I dont know about physically being a full time nurse aide lol that is the only thing readily available. I could stay busy 24 hours per day. Nurse aide proficiency audits, fall risks assessments, careplan updates, Nurse proficience audits and the list goes on and on. But they just hired a full time ADON because I could not do it anymore since I had my last son who has downs syndrome he really needs me and has lots of therapy appointments not to mention, dr appts. My husband my mom- just give in your notice. I am not a quiter and I did not even stop working while I was on chemo I did cut hours back but I want to stay in the game. But I also dont want to lose my license and sad to say as long as they keep a few extremely poor nurses this is only going to continue. I am only doing MDS stuff according to cooperate people and they think that is just point and click- actually had them say that. They get mad that nurses control the money so they have commented several times. Well I did not make that rule for RAI assessments dang this gets fustrating. I have a few days to think on where I go from here.

We do the same as Cape Code does in her facility but when there is a fall we do a post fall assessment after that. Update the Careplan, of course if it is a fall with injury requiring hospitalization our state has us call and tell on ourselve we just got a 15,000 fine for reporting ourselves lol. Any my beloved nurse aide class taking away. I am sad and disappointed but I did read we get to continue the current class going on. But our nurse aide turn over rate is bad and we are finally getting some good ones in there if this is stopped for 2 YEARS as they mandated --dang who is going to take care of our residents? I feel so bad because most that go to the local college take our class first and we utilize them for weekend work while they are in school hoping to retain them after they complete LVN training. I have been reading rules and regs half the night. Making Inservicing stuff for the DON on changes of condition -- which they hit us hard on that and Notification of Doctors. Folks you better beef up your pain careplans they go for the jugular on that one!! Yes I have also vamped up my resume and sent out some via job search engines. Those of you that pray do pray for our little small nonprofit facility. It is my home away from home most of the time.

gees we finally got our final POC back from state, they took our nurse aide class away?? for 2 years--- gosh this is upsetting I dont see how we can function without having nurse aides in the building. Very fustrating. I teach this class and so now that is extra days will be cut from me and They only allot so much time for MDS- which is stupid because that is where you get money but they just hired ADON and they use to have me doing it but I refuse to do both-- because my children need me and I am in school so they got someone else but she has not been trained to do MDS and I will not train someone again and just stay home and in a few months ahve to come back adn clean up the mess-- I see the writing on the wall need to get my Resume up to date!! Sad been there a long time now. We never had this type of severe fines and punishments in the past but seems like now we do. The DON says just keep on teaching the class like I have been of course I will until I am officially told to stop -- this is the dumbest thing I have ever seen b/c nurse aide training is what is needed -- I train exactly according to the state guidelines -- my stomach is just sick over this one.

very nice program --- it is probably expensive -- my facility cooperates believe this philosopy: Well we will just pay the fines when the state sends them instead of making sure we dont get them. dang it is fustrating!!! Got yelled at today for coding in the mds that a flu shot was not given well hello we did not have it-- I can not give what I dont have. and there is no comment section to say our pharmacy says we are out!!

hm that was funny indeed, -- maybe add that the oral sex nurse- is proficient in perineal care lol . The slower than christmas nurse-- you might add that she is willing to stay late to get the job done

Yeah, I gave our social worker the final draft, her mouth dropped to the floor lol. That will be great if we get web-based training and the no cost thing is a no brainer lol