KrisV27

First of all, be sure to check J5a, conditions/diseases make resident patterns unstable. I always make a note in the chart describing that the resident has been reviewed for a significant change-- "Resident reviewed for significant change. ADL patterns continue to fluctuate during the week/day between independent and extensive asst. due to (behavioral issues, etc.) Discussed with interdisciplinary team. No noted signs of trends indicating improvement or decline."

I am looking for a "Teachable Moment" form or something similar to use with staff as an alternative to a write-up or verbal warning. Something that allows the CNA's, nurses to evaluate on their own what their mistake was and what they can do to prevent the problem in the future. Write-ups tend to make the staff feel like they are being attacked, and something like this could be used frequently as a teaching tool. We have many brand new staff members that may have honestly never been told about the protocols and it may be unfair to "write them up" when they simply didn't know. Does anyone use anything similar or know where I can find a form for this?

Give her the phone and tell her to call away.... For the nurse to have this arranged, don't you need a dr. order? If he says, no, chart it, and that's all of your responsibility. right?

I know a patient who gets thalidamide. And of course, it's to be crushed. Perhaps the nurses can babysit each others' "flipper babies".

Where I work, we have many nurses and aides (mostly men) from other countries, mostly in Africa. I find that the families of the residents and the residents that are cognitively intact are the worst when it comes to racism. As it is impossible to assign workloads according to certain clients' "racial needs", I find I must be firm with them. I tell them, "you are hateful, we will not tolerate this in this building, if you don't like it then go to another nursing home." This might sound unprofessional or very straight-forward, but it certainly shuts everyone up. "When they say I don't want that (man, black, etc) in here", tell them "too bad!"

No. I went there. They have on of the best nursing programs around. There were recently granted a 10 year accreditation (which means they are really good) and it is hard to get. It is one of the hardest schools. They expect a LOT from you. Most hospitals love to hire PNC students (that's what i hear anyway). They also have a pretty high NCLEX pass rate.

Yes. I'm glad someone agrees with me. I work in a nursing home with many combative/behavioral residents. Being almost illegally understaffed, it is almost impossible to get to the alarms on time. Not to mention, EVERYONE has one, whether they need it or not. We have to look in every room just to figure out whose alarm it is. We have had 5 falls just this week (an 85 bed facility). Since the beginning of the year we have had spinal fractures, broken wrists/arms, and blood-splattered on the floor head injuries from falls. For God's sake, if we are going to have confused elderly people living in understaffed, poor quality nursing homes, lets do them a favor and tie them up! At least they will be safe. Oh, did I mention that I work in a "Deficiency-Free State Survey" nursing home?

CNA's are not allowed to touch the pumps where I work. They will be fired and the nurse will be fired for asking the CNA to do this. It is not in their scope of practice. I don't turn off the pumps during care. The order says 45 degrees at all times, that means at all times. It is possible to turn and change residents while they are sitting up. It's a pain, but it can be done. I don't allow them to be rolled down, I've seen residents start aspirating when this was done. Just because the pump is off doesn't mean there isn't 300cc of residual in their stomach waiting to be aspirated on.

It is not necessary to use alcohol pads if the hands have just been washed. But that's not always practical. Most facilities require you to use an alcohol pad since, especially in LTC, you never know where your patients hands have been. As long as you wait for it to dry the results will be accurate. I would go to your supervisor or someone who might care and express your concern. You are probably not the only one who has concerns about this woman. But yes, be careful, this broad seems like she has a few screws loose, putting a bent needle in someone and all. She might try to get you fired.

No, I am very serious. The people I work with are idiots. Could be just Indiana. You can be caring all you want, but if you can't even read... The NCLEX ought have a spelling test or something. If my coworkers passed the test, probably anyone could.

I am an (nursing home) ASN nurse and believe NO ONE should be allowed to touch a pill without at least a BSN. I work with LPN's and ASN's. None of them can even spell. My DON had to ask a doc what rhonchi was because she was reading my charting and hadn't a clue. Odor is always spelled "ODER" and "legs real swolled up" is a common term for 3+ pitting edema to both lower extremities. Personally I refuse to let most nurses come close enough to me to check my pulse. It is because of the lack of educational requirements that nurses have such a bad name. MOST nurses are just room temperature IQ, used-to-live-in-a-dumpster, got-five-kids nitwits who went to a tech school for 10 months and are now hovering over you looking for a vein (or bone) to stick an IV in. SCARY! Another suggestion I have is making the NCLEX harder. If you have to study for the NCLEX, you probably shouldn't be walking around with that needle in your hand. And put away the stethoscope if you don't even know what you're looking for. Don't get me wrong, I myself am totally incompetent. Unfortunately, many nurses are even worse.

I have a resident with the same problem. After we had placement verified, we figured it might be from too much air from frequent placement checks. Sucking the air back up after giving an air bolus seems to work. And we always wrap paper tape around the adapter so its almost impossible to end up with a mess.

An RN should NEVER take a job that pays lower than $15. That would be ridiculous, no matter what state you live. Average RN, new grad, $16 for LTC, $18 for hospital. Plus a shift diff. if applicable.

I have discovered that though you may put your initials and "med not available", when the monthly MAR sheets go down to Medical Records, they write ME (mistaken entry) and "med found" and are pretty good at forging your initials and signature. This is because not giving a med is NOT acceptable. If they leave that "med not available" on the MAR the nursing home will get cited. Try calling Walgreen's or another 24 hr local pharmacy to deliver the med. If nothing is possible, you must try to call the physician and have him order an OK to hold the med.

At times, LTC is very rewarding to me. I am not frustrated for myself, but for all of the residents that must suffer because I only have two hands. I love working with the residents, but it is disheartening that I can't give them the time they really need.