jacesmom2

I am writing a new Emergency Preparedness Plan for our Adult Day facility due to our current policy being non-compliant after our recent survey. Can you give me suggestions how to maintain the proper identification of each client to ensure that care coincides with the client's needs. Are they referring to care plans or a client photo book? I guess I'm stumped since I'm new at writing policies. Any suggestions are appreciated!!! Thank You! Jacesmom2

I am a Director at an Adult Daycare and have a staff member who has had several performance issues. The most recent complaint is from a family member who informed me that this particular employee has been asking her mother many personal financial questions. She asks several times how much money she receives each month from social security, Medicaid, etc.. and asks how much her daughter receives from a pension. Also she makes make inappropriate statements such as "it must be nice your daughter has enough money to quit her job and stay home with you." This family member is outraged because she is a very private person and her mother is not. She will disclose any information this employee asks. I confronted this employee and she denied it. However, due to the number of other complaints I have a difficult time believing her. My boss refuses to terminate her employment and I am becoming very frustrated beyond belief. What would you do in this situation? I need advice!! Thanks in advance!

Can anyone give me a website that lists Scheduled II Narcotics that need to be double locked and counted? Could you tell me if the following are categorized as Narcotics? 1. Propo-N/APAP 2. Diazepam 3. Lorazepam Thank you for all your help!

I am the Director at an Adult Daycare and just hired a CNA 2 months ago. She is having difficulties catching on and just doesn't seem to have any common sense whatsoever. For instance, I have trained her several times how to transfer an 80 pound girl (using 2-assist) and she almost dropped the Client today! Then when she passes meds she will actually interrupt the Client and bring the pills into the restroom while they are on the toilet. She even forgot a Client in the restroom and told them not to say anything. I could go on and on...but I just don't see her improving no matter how much training I give her. The other aides are refusing to transfer with her since they are hurting their backs and carrying all the weight. But I don't think it's fair she is not performing her job duties. Should I give her 30 days to improve her skills or put her on a probation period? I'm getting very discouraged! Thanks for all your advice, jacesmom

One of my tasks as an LPN at my facility is to oversee the medication aides at an Adult Daycare which is at an off site location from mine. Once a month (go figure) I'm required to visit their center to make sure they are passing medications correctly. Well, the State was at their facility doing their inspection and they questioned the med aides giving PRN meds without a nurse on site. They said my license was on the line and that I need to create a policy and a competency test over PRN meds. Does your facility have such a thing? If not, do you have any advice as to what I should include in this policy or competency test? I'm not so sure I like the idea of having this responsibility... Thanks for all your help! jacesmom2:o

I have a new order to increase a medication to 4 times p/day instead of 3 times p/day. Do I need to D/C the original order and then add a new order in the MAR? Please help I'm having a brain "fart!" Thank You!

I am a nurse at an Adult Daycare and we had a Client fall while in our care and break his hip. The family specifically said he is independent while ambulating with his cane but he became unsteady while standing and fell. The aide was within 15ft from him and unable to prevent this fall. Well, now the grandson wants to see the incident report. I am so worried that he is planning on suing our facility. I feel so horrible and have apologized several times. Should I be worried and can he sue us for negligence?

Yes, the adults and children are in separate parts of the building so the children do not even know we get candy. But the childcare staff wants the same rules on the adult side which I don't agree with. At lunch time, the 3 staff eat with 20 Clients in the same room. Since lunch is our busiest time of the day (toileting, fixing lunch, cleaning kitchen, tube-feeding, meds) the staff is required to eat with them. All staff is part-time so they don't get more than 30 minutes to eat their lunch elsewhere. I just think it's difficult to have 2 Directors in 1 facility with two different leadership styles; authoritarian and democratic. She's more strict and I'm more laid back and her staff see that. It's really not about the candy or the fact I let my staff eat with the Clients. I just want to know if I should change my rules to make them happy or stand up for my staff and explain we're two different programs. Thanks!

I work at an Adult Daycare at an Intergenerational Center as the Director/Nurse. There is continuous conflict with the Childcare side since there is a different Director who has different rules than I do. The teachers are constantly comparing their side to ours and I am getting frustrated. But i want an outside opinion because maybe I'm just being defensive. One of the things they argue over is the fact that the Adults can have candy but the Children can't. I allow candy to be used as bingo prizes since they enjoy it and it's cheap. But now the teachers are angry because they think it's unfair to the children. I say the adults should have their choice and enjoy their candy. What do you think? Am I being selfish or are they? Next thing they complain about is I allow my staff to eat their lunch with the Clients since our busiest time is the lunch hour (10:30-2:00). They get 1 hour breaks but my staff doesn't. Sometimes they bring their own lunch and the teachers think it's cruel we eat in front of them. However, they put their food in containers so the adults can't see. Again, am I wrong or are they? I am just getting tired of them comparing our side to theirs and I think I'm taking it too personal. It's very difficult having 2 directors with different leadership styles and rules. Please give me your opinion! THANKS!

I am a new nurse at an Adult Daycare and I want to hang a bulletin board in our center with pictures of our clients and list their names (first names only), age, where they were born, number of children, hobbies, prior work history, etc.. But is this against HIPAA? I didn't want to get in trouble with the State on this one. Any advice is greatly appreciated! jacesmom2

I've been a nurse at an Adult daycare for 3 months and Upper Management wants me to terminate a client because he no longer fits our admission criteria. He's got Parkinson's and he's unable to stand at all. Most days it takes 2-3 max assist to lift him (he's 190lbs and 6'2) and our criteria says 1 assist only. Also, we're feeding him which is out of our range of care, too. I have a meeting with his spouse and I'm terrified because I've never had a position where I had this type of authority. What is the easiest way to break the news to her without sounding harsh and uncaring? Thanks! Jacesmom2

Thank You so much for your words of advice! You don't know how much that means to me to have encouragement from a much more experience nurse than I. I definitely will try your technique tomorrow. I never thought of using hemostats to help getting the ties through. Have a Great Week!! Jacesmom2

I'm a new nurse working in home-health and I have 2 pediatric patients who have trachs. Each day I have to do trach cares which involves changing trach ties. What is the easiest way to change (velcro) trach ties on a child who won't sit still. Is it ok to change them while sitting watching tv? Or will the trach fall out easily? I'm very frustrated since it's difficult to hold the trach while getting the ties adjusted correctly. And it doesn't help when one girl has hair down her back and is unable to hold her head still! Please help me master this skill!! Thank You!! Jacesmom2

This is my first year as a nurse and I have been working at a pediatric clinic for the past 9 months and I'm extremely "bored" with my job! Each day is the same; I greet patients, get vitals and find out what is wrong with the child. Besides giving an immunization shot, inserting a cath, or removing a cast I am not utilizing a lot of my nursing skills. So, just last week I got a job working at an agency, Interim Healthcare, where I can use some of my nursing skills. Well, I'm scared to death because I have little to none experience working with vents, trachs and working at a LTC facility. They pay an extra $7 p/hr than the pediatric clinic, but Interim says the pay is so great because these places expect you to have experience and they're taking in consideration my experience at the pediatric clinic. (What experience?) Am I way in over my head? Is working at a LTC really difficult to learn? Please help!!!! Thanks! Jacesmom

I just started working at a Pediatric clinic and I need some help with figuring out an infants weight gain/loss per day. I've had a few nurses try to explain it to me but I am a sucker at math and I need a formula in order for it to make sense. OK, say an infant is 3.363kg at birth, discharge weight is 2.777, and two days later at the clinic it is 3.045kg. How do you figure the weight gain/loss per day in grams? I was taught to take the decimal out (to make it grams) and subtract 3363 from 3045 which equals 318, then you divide by how many days from birth date, so by 2 days. The answer I am getting is 159 grams. I think that sounds way too high! What am I doing wrong? I feel so embarrassed to keep asking to explain it over again. Please help this math idiot!!!! Thank you!!!! Tiffany