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  1. VeronicaWileyRN

    Quality Assurance/Audit Tools or Forms for LTC or ALF

    Check Brigs for any forms. They will also have state regulations and forms to go with this. I don't know what state you are in, but in NC the AL the med techs pass the medications and do the documentation. They do not know what they are doing. You may need to do some inservicing and monitoring their work closely.
  2. As a nurse I feel that it is important that staff work together. Nurses need to help nursing assistants and the nursing assistants need to help the nurses. The patients come first.
  3. VeronicaWileyRN

    missing narcs

    They should be looking at the nurse that signed the narcotic sheets in and look back at other narcotics that came in that same day to see if anything else is missing. I agree that I don't think they will do polygraph test because they are very expensive. You worry way to much, just take a deep breath and do what you where taught to do correctly then you will not have any problems.
  4. VeronicaWileyRN

    is nursing supposed to be sad?

    When I was in Nursing school, I was going through a divorce. It was not easy. I was depressed, but I had a strong support from my family. Your friend needs to continue to go to counseling and you need to be there when she wants to talk. She could have some underlying problems that you are not aware of and don't push it until she is ready to talk to you about it. I do agree encourage her to continue nursing school. When she is finished, it will be like a big weight is removed from her back and she will look back and laugh (I hope) I will pray for your friend.
  5. VeronicaWileyRN

    Am I being too sensitive?

    Many of the previous reply are what you need to do. Go talk to the person who supposedly talked negative about you. It could be that she didn't say anything or was talking about something else. If she checked you off on your orientation then why did they take you off of orientation. The people telling you what the not so nice person may be true not so nice people and are just trying to cause problems. Go talk to your unit manager and find out if she/he has issue with your work and sign up for every inservice that the hospital has.
  6. VeronicaWileyRN

    I had an 89 yr old patient curse out the doctor today.

    I have had patient cuss a doctor because he wanted to put them on an antidepressant. If she cussed at him because he was predicting her death in 4 months, she probably in her mind is going to fight death tooth and nail. As a younger person, she probably fought the world the same way. Most doctors have thicker skin than we know.
  7. VeronicaWileyRN

    Applying for night shift RN position

    I have worked some 11p to 7am. If you are working 7pm to 7am, there is some difference. 7pm you come in and start a med pass. Check 8pm blood sugars. at 11pm do another med pass. If you have tubefeeders you will need to address them and give them the flushes. At the last place the 3rd shift had to check the temperatures on all the refrigerators and document the information. 3rd shift also had to check the blood sugar machines. 3rd shift also had to check all the orders for the day to make sure they are posted correctly. Between 4am and 5am you will need to start your last med pass and check your morning blood sugars. Some facilities could also have you do Nursing Summarys. Good Luck
  8. VeronicaWileyRN

    ADON misleading title? Rant from DON

    I will tell you as a DON that has been fired a couple of times it makes it hard to find a job down the road. I do suggest you look for another position, because it sounds like the problems are just going to get worse. I would suggest that if you are going to stay get some friends there at the facility. Make friends with some CNAs and nurses. Use them to funnel you information. GOOD LUCK
  9. VeronicaWileyRN

    Turned in my Resignation

    The facility you worked for obviously doesn't understand that the MDS can make or break a facility. MDS must be done timely inorder to get the appropriate funds. The MDS must have appropriate documentation of where all the information came from so the facility will not lose money. I will say that the MDS's from the summer cause that the facility to get a default rate which is usually around $100. The facility will always have problems keeping a nurse doing MDS if the MDS nurse has to take call. The MDS nurse is all ready under stress and doesn't need call stress to. We used to call our On Call Week, "Hell Week." They should make ALL the nurses take some call time. I did that and the people that called out alot eventually got worked out.
  10. VeronicaWileyRN

    as DON/ADON ....do you help or hinder your staff?

    I have worked as a DON for over 20 years. I have helped the CNAs, passed meds, pulled 3rd shift because there was no one else. I have helped with admissions and discharges. The DON job description is long and complex. Most staff have no idea what the DON is responsible to do. The administrator should be chided because he/her aren't looking at the problems or they live in their office. If the facility is part of a corporation, I suggest you contact the corporate people. They may help or not. If not I suggest you look for another position, but remember if you move to another facility things could be just as bad or worse.
  11. VeronicaWileyRN

    ADON misleading title? Rant from DON

    The assistant DON title in the facilities I have worked in never does the MDS unless the MDS nurse is out sick or on vacation and the MDS nurse also does the care plans that allows for continunity. The PCC nurse (Patient Care Coordinatoor) should be taking up the slack. I also agree if your facility is with a corporation, you need to talk with the corporate nurse. You need to talk with the administrator with the ADON and the PCC. You need to have everyones job description and you may even need to do a time study for the things you do. It sounds time consuming, but in the end it will proof a point. If your administrator does not support you, you may need to be looking for another job. My question is why didn't the present ADON take the DON job, was it even offered to her? Good Luck. You have 61 patients, I did it all, but I had good staff that supported me and helped me when I needed help.
  12. VeronicaWileyRN

    new RN needs advice

    What is the difference between a per diem nurse and a staff nurse? This sounds like a big problem. I would suggest that you talk with whoever is in charge of staffing. Find out if you are going to be assigned a specific schedule and a specific hall? If you are being assigned a specific schedule and hall, then when the per diem nurse asks you what you are going to work tell her/him. If they have problems with it, they need to talk with the staffing person. There could be things going on that you and the per diem nurse may not know about, i.e. staffing changes=increases or decreases, someone could be changing position a per diem nurse may be changing to the Assistant DON position or doing MDS. There are so many things that happen in LTC. After staffing and you get no good results talk to the DON. Good Luck. Not all nursing homes have the same feelings or culture.
  13. VeronicaWileyRN

    serious question, need reply: policy on rape

    At one facility I worked, we did accidently admit a resident that was listed as sex offender. We did have a very explicit plan of what we did if we admitted a patient that was at risk for assualting any other patients. To begin with that patient would have an employee assigned to him/her 24 hours a day for 2 weeks. That patient would be careplanned for the risk and if no episodes occured the resident could be changed from constant supervision to 15 minute checks... over time the patient could be decreased on his/her supervision depending on their behavior. We got stuck with this patient only because of an over zeolous admission coordinator who conviently forgot to tell the administrator and the DON until the patient shows up and the transport person announces the situation on Friday evening at 5:00pm. It was a mess. I did hear that after I left that facility that particular patient had been decreased on his time for monitoring. He was found hitting another resident and he had to go back on 24 hour montoring. I belief that facility had to find other placement for that patient. Always beware of Admission Coordinators they have quotas and are under constant threat of termination if they can't produce. Sometimes they bring in patients that are not appropriate.
  14. VeronicaWileyRN

    Can you really change a bad LTC?

    I have worked as a DON in several places. I worked in one facility where the administrator started having the beginning symptoms of dementia. I worked with another administrator that totally had no clue what was happening. If it didn't happen on the computer screen too bad. I found that I had to follow the employee hand book closely. To terminate someone even the Staff Development person, you need to document what she/he is doing, or not doing. You need to document the information on all your trouble makers. Write them up by using your Handbook. In the state I work in you don't have to have a good reason to fire someone. You need to set down with the administrator several times a day. Make him see that you two are a team, keep him always in the loop and support him when he needs it. It is hard at the top. If he is new, like never done this before assist him. If he is the type person who knows it all, then go to him and ask for assistance. Start with something small. Good luck.
  15. VeronicaWileyRN

    Patient refusing meds, combative

    Without knowing if this patient has a diagnosis of Alz, dementia or other mental health diagnosis, it depends if you have to hide the medication. If you have a patient with dementia, then you may have to hide their medication, but if you have a patient with mental health diagnosis, you need to do some investigating. Why are they really upset? Do they have a UTI? Do they want to get up latter in the morning, etc? I had a patient who was alert, but he didn't want anyone to come clean him up on third shift. He just wanted to be left alone. We tried alot of ways to get him to let us clean him up and sometimes he would corporate and other times NO. You just have to keep working with the patient and family.