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Trubie LPN

Registered User

Content by Trubie

  1. Hello all! New grad here.... on my first day of orientation at LTC. Ran across a situation where a patient was very agitated and combative, refused to get up for the day/get dressed/receive peri care (incontinent). She was also refusing meds. She had a PRN order for xanax, but she wouldnt take it. Of course the CNA's did not want to leave her sitting in messy briefs (she had a roommate, as well as skin breakdown issues). What should the nurse do in this situation? The nurse who precepted me handled it in a way that I felt very uncomfortable with. What would you do?
  2. Trubie

    Nursing Home Activities

    Most popular at our facility is bingo and trips to the Dollar Store. Everybody loves the Dollar Store, LOL!
  3. All I really want is that everybody who wants to pick up Granny for a home visit on the holidays, CALL AND TELL US, before showing up with no notice!! Since we have 55 residents on my hall, it is extremely disruptive when half of them need to be up/dressed/freshly bathed, with meds packaged to take home, at a moment notice. All I ask is that you tell me in advance, so the CNA's can plan their care and get Granny ready so when you pick her up, it will be smooth sailing!
  4. Trubie

    How far do you drive for work?

    remember, its never "just" a 12 hour shift (or rarely). I usually tack on 10 minutes before my shift and at least 20-40min after my shift for report and finishing paperwork. I work 4 minutes from the house, the commute is bliss!
  5. Trubie

    Danger to self? help!

    Thanks for all the thoughts everybody!! I was off all weekend (going back tomorrow to work 3 in a row), so I will try to give a HIPAA friendly update :) To address a few of the questions.... 1) since this was a readmit after a 2week hospital stay, all my orders were fresh from the hospital MD and included ZERO prn/neb tx/pain management. zilch. 2) the patient had gone downhill REALLY fast during the hospital stay... before her fall (and subsequent admission), she was mobile with w/c and able to toilet herself. Now very weak, unable to make large motor movements without assist, bed bound. 3) Pt also refusing food/drink except ensure (and I was able to get the benadryl crushed with pudding into her mouth and she swallowed). 4) family (Power of attorney) was at bedside, requesting intervention to help her rest. 5) NO hospice, only palliative Keep up the great conversation, I would love to hear more thoughts!
  6. Trubie

    Danger to self? help!

    I work long term care, and we recently had a patient return from the hospital on palliative care (family did not want to pay for hospice until medicaid kicked in... also would not pay/consider having a patient sitter to stay with the patient in her final days ) Anyway... when she came back, her lungs sounded horrible and she had an O2 sat of 88% on 4LPM by NC. MD aware, family wanted her in LTC, so we kept her. She would shift between 90-95% on 4LPM. Gradually, she began to wake up and was very agitated. She would repeatedly remove her NC and try to climb out of bed (bed low, floor mat). Called the MD and he ordered ativan. Problem was though, that we couldnt get it until about 7 hours later, because pharmacy only delivers 2x a day. Of course, borrowing was not acceptable in this scenario. I told the MD that we had haldol, phentergen and benadryl available if he wished to use those instead. Eventually, he decided to go with 1x dose 25mg benadryl... but he was irritated about doing so, since he "needed a reason to prescribe" and she wasnt sneezing. He kept asking me "is she a danger to herself or others?".... Which really made me think. Danger to others? Certainly not. Danger to herself? Possibly. By removing her NC and allowing her O2 to drop, she is unknowingly a danger to herself (since she was so confused with demenia, she was not aware of the consequences of her actions). Would you consider a dementia patient who removes life-sustaining O2 a "danger to self"?
  7. Here is my thoughts on 'helping'..... I really try to be a team player, and if a CNA ever specifically asks for help, I will do my best to assist them. HOWEVER, the helping does not go both ways. If I am spending a lot of time helping the CNA's, I will not get my nursing work done- and then who helps the nurse? The CNA is not qualified to do my job, so I get the short end of the stick. The majority of my 'helps' are answering the call bell of Mrs.ImSoNeedy when all the aids are in other rooms, helping answer call bells during resident's lunch, and giving a bedpan when a resident has to go NOW. Im not opposed to helping, I just need to make sure that my work gets done as well.
  8. I would stay in my city, and work L&D/PostPartum at the hospital 5 minutes from my house!
  9. At my facility, we have 2 med techs for our hall- and one of them is shared with another station, so she is frequently off the floor. When my residents complain of pain (which is ALWAYS 8-10/10!), I go to the med tech, locate the appropriate med in the MAR, have the med pulled and then I sign the MAR/narc count/PRN log and personally administer the med to the patient. It just drives me batty when I ask the med tech to give a PRN pain pill, and the med doesnt get passed until an hour later (because the med tech was busy with the scheduled meds)... so I do it myself!! So today I did this again and my med techs kinda laughed at me- and they said I was the only nurse who would self administer a PRN med!!! I couldnt tell if they were offended or thankful? I just explained I wanted it given in a timely manner and I knew they were busy.... Do you think Im intruding on their stomping grounds?? I dont want to offend anybody, but I want my patients to get their pain meds and quit ringing the call bell every 5 minutes until it gets there!
  10. Trubie

    how well did your clinicals prepare you?

    Some things I wish I had done in nursing school (and would have, if the opportunity was presented!): Taking care of a vent or a trach patient Starting more IVs (I got do about 5 in school, and I think I missed every single one) More hands on care of central/PICC lines Doing a full admission & discharge Receiving orders by phone and interpreting MD handwriting Hanging blood In school we did total patient care on 2 patients and spent A LOT of time doing care plans/mind mapping/pathophysiology flowcharts. I wish I had more hands on and less paperwork!
  11. Trubie

    What is the least amount you would work for as a RN?

    omg, no I would never work as a RN for $12!! They pay CNA's more than that around here!
  12. Trubie

    dealing with confused patients

    I work in LTC and have several confused/dementia patients. One of them is a sweet old lady who once in her bed, does not want to leave her bed for ANYTHING. Yesterday I came in to work and I guess the night shift CNA told her she had to get out of bed because we were having a "surprise party" for her! LOL, she got out of bed and was so surprised and happy to see all of her "guests"! She frequently requests to call her husband (who is deceased), so I tell her that her husband is with her son (living), and then I let her know that I will call her son and leave a message for the husband. This calms her down considerably. Another dementia patient was all in a tizzy because someone came into her room and "took pictures of her" (Chest xray technician). In cases like this, I am not sure what to do besides try to reorient and tell her that it was the xray people and the pictures were for her doctor?
  13. Trubie

    Need suggestions on BSL/CPR certificate!! Many thx

    9 hours will be MORE than adequate
  14. Trubie

    I cant read MD handwriting! Ack!

    Okay, I have heard this is one of those skills that you develop as you grow in your career.... but for the life for me, I cannot read physician handwriting!! To me, it all looks like random loops and lines... I cannot see letters or words! Often, I will ask a coworker to help me translate this mess, and they are guessing and grasping at straws as well. Of course, if nobody can figure it out, I will call to clarify, but the doc I work with gets ticked that I cannot read his handwriting:uhoh3:
  15. Trubie

    New Grad RN in LTC, what can I do?

    I am a new grad RN, and LTC is my first job. My job title is technically "RN Charge Nurse", but I try to avoid being in charge because of my inexperience! I am the only floor nurse RN with a regular patient load. We have a few other RN's in the building, including the DON (who is completely clueless in every way), a treatment nurse, and 2 weekend supervisors. I work closely with several LVN's who are floor nurses. We share the same duties. I believe I am paid more than them, but I am not sure how much. Eventually, when I have a little more experience, they will probably require me to work as fill-in weekend supervisor. At my facility, we do not have differential pay, so I get the same rate for every shift (including days/nights/weekends). Since your goal is LTC, you have some time before graduation to do some research and find a good facility. I stumbled upon my job after 5 months of searching for hospital jobs. Since I am new to the area, I had no ideas which facilities were good and which were terrible. I applied in person (no jobs listed on their website) and offered a position on the spot. Later, I found out that pretty much everybody who applies there gets hired on the spot- which can really come back to bite you in the butt if the person is a horrible nurse/CNA. Good luck to you!! I agree with the person who said that you really have to be on your best game in LTC.... I am constantly searching for basic supplies and the only communication link between the patient and the doctor. If the patient is basically stable, they may not see the doctor for a LONG time, so you better be alert for when they need more help!
  16. Trubie

    Apply for state nursing license BEFORE applying for jobs?

    After graduating, I moved to Texas. While job hunting in Texas, almost every application asked for license number and state. I never received a call on any application that I listed my former-state license on. On the other hand, I never received calls for any of the applications that had my new in-state license!!! I think as a new graduate, you are at a severe disadvantage either way. I eventually found a job working in LTC. I applied in person, they copied my paper license and offered me a job on the spot. Is there any way you can visit these states and apply in person to smaller less-known facilities?
  17. Trubie

    "Waiting on pharmacy?"

    I work LTC and I have encountered this a few times. We have med aides, and normally they just borrow from another patient. This creates problems though, because then you have to borrow back since the original patient is now short. And of course you cannot borrow narcotics! We do have an emergency drug box, with the major antibiotics and critical drugs. I dip into that usually once a shift (because of new antibiotic orders). If a drug is truly not available, and nobody else is taking that drug and there is no way to borrow. I call back the doctor and explain the situation (which almost always irritates the doc!). Then I chart "Med XYZ dose# ordered. Medication not available. Pharmacy contacted. MD aware. No new orders"
  18. Trubie

    I cant read MD handwriting! Ack!

    I wish!! I work in LTC, so usually this horrid handwritten notes are addendum's to the discharge paperwork from the hospital. Often, this means a change to the typed orders Plus, since I am not in the hospital with them, I do not know the contact info to reach them easily. My alternate problem is that the 2 doctors I work with daily both have very heavy accents and speak 100mph. One is worse than the other, and his stream of thought will change directions so quickly!! I usually end up asking him to clarify at least 3 times, I read back the order, and sometimes I am still not sure it is right!
  19. Trubie

    did a bad check ruin everything?

    Seriously?!?! A bad check!?! Wow! In my younger days (when I was under paid and loved to spend money), I bounced several checks and none of them have come back to haunt me.... except perhaps by lowering my credit score and of course those nasty overdraft fees. I am really sorry... try looking at other schools, there are certainly other options out there!
  20. Trubie

    I need help with charting!!!

    "no voiced complaints" "no apparent distress", vocalized "blah blah blah" and my favorite... faxed pharmacy, updated MAR, completed lab requisition, contacted family, family acknowledged, initial dose given. We paper chart too... my hand might fall off soon!
  21. Trubie

    Wrist watches...what are the pros and cons?

    Pro: I always know what time it is, I never have to look for a clock. I can easily do resp/pulse counts. Con: Infection risk?
  22. Trubie


    My 3yr old crawled in my bed in the middle of the night. In my dreams, I was actually asking the CNA to remove the patient from my bed and return her to her room!! LOL I also check blood sugars and give insulin in my dreams!
  23. Trubie

    why nurses cannot have a nail polish..?

    Im sure I interpreted this wrong... however last week, I actually worked with an agency nurse who was painting her nails at the nurse's station, WHILE on duty
  24. I recently accepted job in LTC as a new grad and I learned quickly that if you want supplies, you provide your own. The facility has one BP cuff for all 80 beds. The facility provides an old fashioned oral thermometer that takes about 3-4 minutes to give a reading... some of our residents have dementia and cannot remember to keep their mouth closed that long, let alone keep the darn thing under their tongue! I bring my own temporal thermometer, pulse ox and manual BP cuff. I keep them in my purse, so they are readily available when I need them- I dont want to search all over the building looking for the BP cuff that is locked in an unattended med cart! I also buy my own air freshener for work (after incontinent episodes in the hallways) and I have a huge stash of black pens. I feel like a personal supply closet!! But it is worth it to me to have the equipment I need, without going on a wild goose chase!
  25. Trubie

    12 Hour Shifts--A bad idea?

    I work 12's in LTC and I either have 25pts as a floor nurse, or 50pt as a desk nurse. I actually LOVE working 12s! The day goes by really fast (Because we are always super busy) and I feel like I live there, so I KNOW most of the residents. If a family member calls with a question, I can immediately tell them what is going on, because I see my patients every day and have excellent recall of their recent medical history. I suppose the only downside is the on my off days, I am absolutely exhausted. I sleep in until 9 (hubby gets up with the kids), take a nap in the afternoon with the kids (1-4) and still go to bed around 10! And my house is a mess because I am too tired to fold laundry or pick up toys. So professionally, it is really good. Personally, it can be a little rough.