LuVnLpN08

I love the geriatric population. I have been an LPn for 3 years now and i have worked in LTC since i graduated and i absolutley love it! I am starting school for my RN next week & everyone at my job keeps asking me where im going when i finish school & they look at me like im crazy when i say im staying at my current job. LTC is special and rewarding in its own way. Thoes who dont work LTC or have heard the bad things about LTC dont reconginize the skills it takes to work with the elderly population. i love my little old ladies and my little old men. I adore the dementia residents & i have found that i enjoy them more than the A&Ox3 residents- I enjoy their stories even when i know that they dont know what they are saying. They keep me laughing and smiling. I have excellent relationships with all my residents, they love me as much as i love them, the recognize it when im not there, i have excellent rapport with my residents families, i have great commmunication with the doctor, I know my residents better than i know my self sometimes....Its an amazing feeling to , have when you feel within yourself that you are a true assest to a company and to a person. LTC is stressful and sometimes makes you want to pull your hair out, but it is also super rewarding. I've found that i've mastered several skills while working, I've found that I have a creative side that i never knew i had, and i've found that I am able to handle stress better than i ever imagined i could. LTC is a lot more than just pushing pills as so many people think it is. After I finish school, as an RN I imagine that I will explore other feilds of nursing at some point, maybe just PRN....but i do know that i will always come back to LTC because I love it.....I love my family, all 110 of them (when our facility is full :) ) & when one is called home, I always fall in love with the next one who comes in....even the worst ones :)

Congrats! I will also be starting in Summer 2011 at GCC for lpn -rn :)

So to make a really long story semi short, We had a very sick person come to our SNF/LTC facility maybe a month or a month and a half ago...this person had a muscle disease that they have been battleing for many years now. Came to our facility from the hospital, and basically came to die. Family wanted this person to have 24/7 care which is exactlly what they got. Family was very involved with this person, was there almost around the clock-us nurses really didnt have to do much but give medicines and help turn this person and tend to small needs. Since I knew this person came just to die, I told myself not to get attached-so I stayed out of the room as much as possible, but kept close ties with the family. Well its funny because the more I tried not to get attached, the more I did. One day this person took the turn for the worst that we knew was comming....Family was at the bedside every single day, day in and day out...for a week straight this person held on without eating, and barley drinking. I dont know how, but this person must have been waiting on something or someone. It was during this time I got really attached. Was in the room almost every 30 minutes every day just checking and rechecking on this person, ensuring there was no pain. respositioning ect, tending to the family-ensuring that they were ok as well. One morning I came on shift and this persons resp. were down to like 8. The family actually wasnt present at the time. I called them ASAP and urged them to come in-they came right away. I was sure that was it. This person STILL held on for another 24 hours straight. The next morning I came to work and was met in the parking lot by this persons son. He jumped out of the car and runs to me and gives me a huge hug and says "I'm so glad your here, I wanted to say thank you so much, My dad just passed and because of you I got to be there for it. He was so comfortable he just took his last breath while we were holding his hand". This man whoes father had literally JUST passed, was smiling from ear to ear, thanking ME for doing such a "GREAT JOB" and really "taking the best care of his dad"-Brought tears to my eyes on account of his greatfulness. The family continually praised me and my team of CNA's who were constantly doing the best they could to ensure comfort for this person and family. This persons wife actually called the administator of my facility to praise us and give her thanks. I was truly touched. I went to the viewing this evening, and once again the familiy contiuned to praise me, and told everyone else " this was dad's nurse-he went so comfortably because of her", and "she was so wonderful to him, shes an amazing person" ect ect ect. It made me feel so good that a family appriciated me that much, and truly felt that I made a difference in their family memebers last days. It is at this time that I forget about all the drama, the gossip, the backstabbing, the politics, the "customer service" attitude, the rude doctors, and everything else that comes along with nursing, and I rememeber why I chose this profession. I am proud to be a nurse, and proud to know I made a difference in someone's life. And for that alone, I will forever be thankful :) :redbeathe

Thanks! I dont know why, but the pharmacy ALWAYS slips my mind. I guess its just not a habit for me. Perhaps I should make it a habit. I will certianly call them in the AM though just to clarify! And no, no orders for potassium supplements...I will be getting on that too. Thanks for your reply!

Hi All, if anyone could give me any input on this it would be greatly appriciated. Pt with CHF...excessive fluid build up, edema all over the body, has a foley in, usually OP between 250-400 each 8 hr shift. On admission orders for lasix 40mg Qday...found out quickly thats not enough. unit manager talked with MD, and he orderd Bumetanide 2.5mg po QD. I saw the order written after MD left building, as I was taking off order..I am unfamiliar with bumetanide. I know its a loop diuretic...same class as lasix right? Correct me if im wrong..? Both are potassium wasting diuretics i believe... i looked up some info in drug book and on internet...My question is MD did not order to d/c lasix. Can both diuretics be given at the same time? Im concerned about the risk for hypokalemia... The med was ordered friday evening, pharmacy should be sending medication late this evening and pt should get first dose by me at 9am tomorrow. I put a call in to MD today to ask about it, and did not recieve a call back. Am i being over cautious? Could anyone give me any insight....Thanks a bunch!

Thanks to all who relied. I am feeling a little better about the situation today. Heard that my pt is doing fairly well in hospital so that makes me a little happy! Some answers to the replies-No, there was no dx of PE when the pt return from hospital. That def would have red-flagged me to keep the lovenox. No CXR done in hospital either. Could have been for a multitude of reasons, who knows what they are! Not sure why facility didnt want to switch to a generic brand, and i certinaly didnt think of that. I think from the get go they were so concerned with the $$ that they just wanted it gone ASAP. Pt allergic to coumadin so that not an option. In regards the low o2..a mask was placed on pt and o2 bumped up, but was ineffective. the highest it would go was 84 and then drop right back. Also im a firm believer that simply "pushing o2" does not solve the problem. o2 sats drop due to an underlying cause generally, and if breathing tx are ineffective and whatever else MD may order are ineffective then i certianly dont want to just keep pushing o2. EMT's came in one time and said "oh you called for low o2 sats but my machine is reading 93%" This was AFTER the bagged pt and put o2 up to 15 liters-OF COURSE ITS GOING TO READ HIGH NOW!!. My co-workers, while most of them are very helpful and very educated-there are thoes few who act like "know it alls" and feel like the have to belittle thoes of us who may not know as much as they do, or they THINK they do. I cant stand it. I may not know everything, but I pride myself on the fact that I ALWAYS try to seek learning opportunities and I never am afraid to ask questions. To NurseL156-Yes, they called me at home, on my day off from work to ask me about this pt. I was very irritated I said to the person who called me "please look in the chart and you will see where I d/c'ed the order on such and such date". They then proceeded to say "when you come to work tomorrow i need you to page the MD and get it d/c'ed again". My response was-its 12:00 noon and there is a perfectlly capable nurse in the building right now who can page the MD and get this taken care of right now, if thats what neccessary, please dont call me on my day off unless its an emergency". So when i return to work, they tell me "oh we paged the MD like 5 or 6 times and he never called back". While that is belivable sometimes, i doubt it was this time. I get sooo frustrated because things like that happen all the time. And EVERYONE Talks to the MD, like the DON, the ADON, the unit manager, nurses who work on different halls...but like when the unit manger takes orders, she will only write the order and not sign it, and not take it off in the chart. Us floor nurses have to rec the order, send to pharm, note in chart, talk with family ect. And then half of the time weeks later, someone else will question the order and because i signed it, i have to take all responsiblity. It sucks and i have brough it to mgmt's attention thousands of times, that when nurse's write orders they need to SIGN THEM THEMSELVES so they can take the accountibility. Its helpful to have the unit manger to talk to the MD and rec orders, but its not helpful when the unit manager doesnt know the patients like us floor nurses do, and then all hell breaks loose when you question why they got an order for something...i guess thats why they hole that oh so important "title". Hmmmm...sorry for the mini vent. As for my post being a violation of HIPAA....maybe I should take it down????

Thanks so much for all the replys! this site is great to me in situations like this. My mind is so curious so i love to hear others opinions. and FYI-yes, this was a nursing home, and no on site pharmacy. when we send for STAT orders, pharm is required to have it in minimum of 2 hours, hardly ever works like that! We have an emergency box and a stat box, but no lovenox. As well i know i could have spoke with pharmacy but with pt going downhill quickly i guess my mind was elsewhere. As for calling MD- i did, i called him back almost immediatley..The hard part is, i didnt take the order, another nurse did. I actually didnt speak with the doctor at all until after pt went to ER. I was comming in for the shift, and i guess you could say walked right into this situation-night nurse really didnt know what she was doing, sadly. Its where we get into the rock and hard spot so to speak-other nurses such as unit managers, DON's ect rec'ing orders from MD and the staff/floor nurses taking orders off... its crazy!!! But anyways thanks again for all the replies, I think I will be posting more on this site

Ahhhhh, so I see my facility is not the only one where nurses think they can just change medications and medication doeses "because i know what im doing"......*shaking my head* and to MassED- i do have a drug book that i frequently reference, its my best friend Sometimes I think some nurses put on a front to make it seem like they know more than they actually do...and then when someone like myself questions them for a rationale, they don't know what to say....

We dont use lovenox too much in our facility-actually i think ive only used it one other time, and it too was 40mg. We typically use coumadin. However, this pt allergic to coumadin. I guess ordinarily I would have asked the pharmacy but I was so flustered with everything going on I didn't even think about it....just another opportunity for learning I guess and I will know for next time!!

Thanks for the response-The only reason I hesitated really is because both of the other nurses immediatley said "NO!" That sent up a red flag for me. They are "experienced and older nurses" and I am a young new nurse! and so it just flagged my attention. After the day I had today, I am REALLY re-evaluating myself and my education and learning that I need to start trusting MYSELF, as I know much more than I think I do. I would think if it was "dangerous" to give 2 injections that it would state that in the drug book, or something....

To go with my other post "feeling bad because i didnt go with my gut"...just a question-MD gave order for lovenox 80mg subq STAT...what we had in the facililty was lovenox 40mg....when I went to get it from the nurse who had it she said "NO, you cant give two lovenox injections at the same time!!" and another nurse agreed with her, she said "No, you NEVER do that". I said ok well i will have pharm stat it out then...later on when things calmed down i inquired about why you cant give two injections. i checked drug book and didnt see any indication that you shouldnt. my DON/ADON said they didnt see any reason why you shouldnt. I asked the nurse who said it, and she said "well its a personal thing, i just wouldnt-its my license on the line" and i said why do u say that? and she says i just wouldnt because of the drug itself and what its for... i said i dont see why you can't give 2 40mg injections one in each side of abdomen...she kept saying "as a nurse, i just wouldnt". So my question to the experienced nurses (unlike myself!) is....would you give 2 injections, and why or why not?? PS-pt ended up going to ER before the lovenox arrived, and MD was paged so I could claify to give 2 doeses or not, and page had no been returned by the time pt went to ER so it ended up not mattering in this situation by my mind is still inquiring....

Here is a situation that happened at work today-I would appriciate any feedback! Without going in too much detail, here is what happened... Have a pt whos been with us for approx 3 weeks (SNF)...came from Hospital, and was bedridden for aprrox 3 1/2 weeks while there,due to some medical dx and background pt thats not important-important fact is pt was bedridden for sig. amt of time. completley immobile. Anyways, pt get up OOB with PT at hospital for first time after 3 1/2 weeks-MD decides is ready for d/c shortly after...maybe 2-3 days later. pt having minimal amt of pt at time. Sent to our facility for rehab purposes, with goal of going home. Pt sent to our facility with orders for Lovenox 40mg sub q qday UNTIL pt ambulating. pt NOT ambulatory at time of comming to our facility...administrators ect were riding me about having lovenox d/c'd ASAP when pt started PT due to the cost of medicine..insurance would not pay for, facility to pay out of pocket. pt with us for 2 days and PT picks up-pt doing very well in rehab however i would not call it ambulatory. Unit manager gets on phone with MD after 2 days of PT and rec's order to d/c lovenox-MD states since pt is rec'ing PT should be fine. Ok, all is fine and dandy....I think 3 days later, asses pt, o2 sats 69% on 3LPM (COPDer), pt confused to the max, alert to self only, normally A&Ox3, flushes, inceased temp 101.5 ect....can't maintain sats, nebs ineffective blah blah, lungs diminished....MD say send to hospital...send pt out....... pt stays at hospital about 2 1/2 days and returns to our facility-at hospital some cardiac workup was done and labs ect. pt comes back to our facility, with lovenox ordered 40mg sub q qday...this time does not specifiy when to D/C. I rec phone call from admin on my day off saying "i thought u got this taken care of, pt comming back on lovenox again, please clear with MD tomorrow, pt doesnt need to be on it, is ambulatory" I say ok will look at re-admission papers tomorrow on return to work. I do some research while im at home, I am not too familiar with lovenox, dont frequently use it. So i read some stuff about how its to prevent blood clots in immobile pt's or after surgery ect...I read about how DVT's can lead to PE's and so on....the PE part really stands out to me, im thinking "pt must be coming back on it for a reason, perhaps MD is worried about PE". I return to wrok and read the re-admission papers, still thinking about the PE. Admin still riding me about d/cing med. Unit manager talks to MD, MD states "is pt moving around", unit manager says yes. MD says ok d/c it then pt doesnt need it. The whole time my gut is telling me "pt does need it, and should have been rec'ing it for the last several days" pt is not ambulatory in my mind, some PT to the arms and the legs doesnt count I dont think. pt gets from bed to WC but a lift is used-heavy pt. Anyways fast forward to today-I get to work 7am, another nurse is on phone with MD...same pt o2 sats drop again to 70's...cannot maintain, go through the same things as before...MD says "oh crap maybe pt has a PE she needs to go to hospital now". pt refuse to go to hospital, very upset blah blah blah, MD says ok well give pt lovenox 80mg sub q STAT and set appt for chest CTA and xray and pt needs to have that ASAP at hospital...I talk with pt and explain whats going on possible PE, importance of proceedures...pt says ok il go to hospital if you promise me that ill come back today...I say go to hospital and have tests and HOPE you will come back but cant promise....pt goes on to hospital...they call me a couple hours later say pt admitted, with dx PULMONARY EMBOLISM. I am upset with myself because number one, I am the pt advocate first and foremost. i KNEW pt needed to stay on lovenox, i KNEW pt not considered ambulatory. I know the MD gave the order but in all honesty because the MD is only in house 1 x a week, us nurses are the eyes and ears for him. I feel terrible like I should have stood my ground and said to admin and unit manager, NO pt needs to con't on lovenox for a while longer, or something along thoes lines. I feel like this could have been prevented. I have never felt this BAD before. I feel like my judgement was not of a good nurse. I had that gut feeling, the one you shouldnt ignore. Im not sure that the lovenox would have prevented the PE altogether but my gut is telling me the outcome probablly would have been much different had I been the pt's voice and gone with MY instinct, something I knew was RIGHT. Since when did we put money before patients saftey and needs? I am so frustrated with myself. Everyone says "well the MD gave the order, all you did was follow it through" but in reality the MD was only going by what WE had to tell him... Maybe I am over-reacting for being so upset???? Has anyone else been in a situation like this before? Thanks for letting me vent, I am just feeling crappy right now! Sorry its so long, and if there was too much info in there that anyone thinks could violote HIPAA, PLEASE let me know ASAP...this is my first time posting a scenerio like this.

A residents family memeber told me "putting mom in the nursing home was the best decision we ever made, and were so blessed that she has a nurse like you caring for her" family memeber also said "mom's never looked better i can tell what good care you all give her"....this made my day because i work in ltc and its extremly frustrating some days, but when family memebers recongize the care and dedication we give to the residents, it always makes me feel good and proud :)

Thanks to all who responded. Of course I understand that when I am on shift, I am responsible for my residents and all that happens! That is to be expected anywhere. I was just wondering about the whole title "charge nurse" because in all honesty it makes me feel uncomfortable to be called that. I am not a big fan of "titles" anyways-I want to just come to work and do my job and know for MYSELF and my residents that i did the best job I could-that is all that matters to me! I cant really explain it, I just dont like "leadership"-something I know comes along with nursing and I am working on that issue. And as someone else pointed out, "i dont think they expect you to be responsible for what happens when your off shift"-actually at my facility, they kind of do. They constantly approach me with questions about everything and every resident, wether the resident is on my hall or not, and wether i was working that shift or not. its frustrating because while i try my best to be aware of everything, i can not be responsible for what happens when im not there! I feel like that should be the unit managers job-to know all the residents and to f/u and be aware of what goes on with each shift, each day.... and the DON is always saying, "well your charge nurse 7-3 thats why we mainly come to you". but they dont hold the other shifts responsible for what happens (or in most cases what does NOT happen) when they are on shift...its very frustrating!! Anyways thanks for the respones. i hope i dont sound like im complaining too much because I absolutley love my job and am so greatful for it! I guess I like everyone else just get a little frustrated at times.

Hi All...This is my first time posting here-have been reading a long time, but never posted. Some background-Ive been a nurse ( LPN ) about a year and a half, working at the same facility, a SNF/LTC facility. Ive been working 7-3 shift since I started, floated halls for about 4 months and then got a permant assignment. My question is, what exactlly is a charge nurse? I mean we have basically 2 sides of the bulding with 2 nurses working each side..so there is four med carts all together. my hall generally has about 28-32 residents (it is heaviest). We have 1 unit manager for each side of the building, who are both LPNs. We have a DON and ADON, and a QA person who is an RN. The nurse who works behinde me on the 3-11 shift is also on my cart permanently, she is an LPN Latley, my DON and ADON have been referring to me as "charge nurse". For instance when we have issues with the CNA's, they say "your charge nurse so blah blah blah....." and I am looking for a second job, my ADON writes me a referral and puts "Charge Nurse" as my title. Today my DON called me charge nurse to one of the other nurses and I felt uncomfortable. I tell my DON "please don't call me that-just nurse is fine" and she says "but your the charge nurse here".... I am confused because I was always under the impression that the Unit Manager is the charge nurse. It makes me uncomfortable to be called charge nurse because then I feel like I am responsible for the whole hall and all that occurs...and I feel like I am the one who is responsible for everything that happens-ex when residents fall, or new orders are placed, appts are made ect...even when I am off, or something happens on another shift, it is constantly me that the DON/ADON ect are comming to and questioning. I dont mind following up with my residents-matter of fact i make sure i do just that, i like to know everything that goes on...but latley i am feeling overwhlemed, like I am getting more responsibility put on me that should actually be on the unit manager. Also the nurse who works on the same side as me is a full time 7-3 nurse on her cart and has been there 3 months longer than me....they dont refer to her as charge nurse. And what about the 3-11 nurse who is following behinde me? I guess I am just confused and wondering what the title actually means as far as "job responsibilites"..? Sorry for the long post-any thoughts welcome and greatly appriciated! :)