cschuess

are there any websites that train in utilization review? just wondering how to go about getting into this field

When we used the vac we found that we had problems with the black foam and the new granulation sticking to it. Our rep advised us to use adaptic (vaseline impregnated gauze) between the black foam and our problem areas. She also told us that if this continued to be a problem to switch to the white foam. Never had problems after this!

Capecod and nightmare...these dedicated nurses...the "link nurses" and you, CapeCod the "wound queen" is this the primary role that you play in your facility? What are your other duties. I am having a really hard time doing what I do and running a 40 bed unit in under 55-60 hours a week on a salary that didn't increase at all when the extra duties were thrown my way. I love everything that I do at the facility but feel that I need to do NM or Skin but not both.

I am looking to see what other LTC organizations are doing...is one person dedicated to skin and incontinence or are the RN's on the individual units doing their own "thing." I ask this because I track all the pressure ulcers and other skin issues in the building--the ones that I am enlightened enough to know about! However, when the EQUIP data comes out there are people listed that I was never informed of...makes tracking rather hard. People are missing things on initial assessments making some areas look like they are facility acquired when in actuality they were prior to admission. It becomes very frustrating! Each quarter I have to explain why these happened. Also, as stated in the F-315 tag every resident is to be assessed and diagnosed for their type of incontinence (if they are). Are the RN's on individual floors doing all the assessments or is it better to have one dedicated person in the building? I figure if skin is being missed, reversible incontinence probably is also... I just can't do all of this and run a unit also...I want to know is what are other places doing?????

personally, i would use non-sting skin prep and completely cover the areas that keep opening. i would follow this with a little barrier cream after the skin prep dries. this will help to protect these areas...have pt re-assess for transfers. there is no way to keep a dressing on those areas and to try is only compromising the skin more by having dressings roll off the skin. try it...it's worked for me countless times. we also do this for superficial stage 2's and they heal in no time.

Research has shown that silver dressings are effective against MRSA. There is no need to treat systemically when the infection is in the wound. Systemic treatment with antibiotics takes its toll on the body in so many facets.Read the literature regarding silver dressings and you will find the documentation to support their use. Also, be sure to leave the dressing on the recommended period of time to obtain the full effect of the silver. Change the packing and secondary dressing as needed but maintain the silver on the wound bed. As for honey...no idea!

I really think that's a bad idea...all they need to do it look at the handwriting...and if that nurse doesn't sign off you will be looked at as a "careless nurse" who leaves unsigned notes in charts.

I won't chart unless I did the assessment. Some people feel that the charge nurse should do all the charting for the floor when they actually have a charge nurse but I am not comfortable with this unless it's a generalized note such as a medicare note summarizing that resident for the week. Imagine being pulled into court and having to state that you never assessed the person you charted on...wouldn't want it to be me!

Thank you, I just feel that LTC nurses don't give themselves enough credit for what they do!

i have worked in ltc for over 14 years and i love it (most days...but it's the job that gets to me not the ltc atmosphere). i started as an aide, became a lpn and then rn. once i got my rn i had a moment when i felt that i should go to a hospital, be a "real nurse" and deal with critical patients and iv's etc...most know how people respond when you say you work in a nursing home..."oh, that's nice" as if you aren't really even a nurse. but it's important to re-evaluate how important ltc nursing is. speak to some hospital nurses and find out what they do when a problem arises. they readily have departments available to turn to whether it be respiratory therapists for someone in respiratory distress or wocn when a pressure ulcer is found or a problem occurs with an ostomy. doctors in house to turn to when something goes wrong. but what do you have in a nursing home? yourself, other nurses and a supervisor and cna's. i am, by no means, knocking hospital nurses-they're wonderful! however, ltc nurses need to have more respect from everyone in the medical community for the job that they do! you have to be able to think critically when an emergency arises. you have to keep your assessment skills up to date and sharp. you definitely have to be able to multi-task. ltc is not just being a med nurse even if you feel that way sometimes. anyone can tell you that the residents that come to nursing homes today are much sicker and more critical than they have ever been in the past. the entire population in ltc has changed over the years. the advantage that ltc nurses have is that they are able to know their residents more than hospital nurses can due to the short stays in the hospital. this allows the ltc nurse to notice subtle changes in a person that might otherwise go unnoticed i.e. uti's, pneumonia, chf, etc... i could go on all day about how special nurses are in any job atmosphere but i really feel that ltc nurses need more credit for what they do. so when someone asks where you work you should answer them proudly because what you do is so very important in so many aspects! it really takes a special person to do what you do!

We had the same problem of the black foam adhering to the granulated tissue...the KCI rep told us to use ADAPTIC on the wound bed and then apply the foam...I don't know why people would say NOT to use anything under the foam when the KCI people explain that the vac can be used with adaptic (which worked wonderfully) or a silver dressing if you make holes in it prior to insertion to allow the suction. Also if you have a tunneling area or unable to visualize where you are putting the foam...such as some major undermining...you are better off using the white foam which is stronger and won't rip apart. Granted the white foam won't give you the fastest results but it is better than leaving some of the black foam residue which can be devastating to the wound.

Night shift in a long term care facility is far from quiet! Usually people are awake all night with needs. Staffing is lower so the nurse needs to pitch in and help the CNA's. You are responsible for all the 2nd checks of new doctor orders. You are responsible for ordering stock etc...Lots of paperwork!! Pretty fair amt of medications to pass too!! Not to mention the wear and tear on your body! You can sleep 8 hrs and still feel like your exhausted!

:balloons: Thank you! Some I had, some I hadn't. Good luck with the graduation! My oldest is 8, youngest 4...I know that it seems a long way off but I know how time flies!!

I am doing a research paper on pain management in pressure ulcers and am very sad to find little to address this issue. Does anyone know of where I can find information...systemic, topical, nonpharmacological control??

Don't consider Nurse Manager. It's great pay if you're lucky enough to be hourly (we were for maybe a year) but as salary it stinks. When you average in the hours, I sometimes feel that I make about the same as I did when I first started out as a LPN. The stress is incredibly high for not only are you responsible for your entire unit-->staff and patients, you are also responsible for another hundred things they feel like throwing your way...on call supervision, MDS, PRI's, subcommittees, filling in when the unit is low etc... My God, thinking about it depresses me about my job!! And as for school nurses...the pay stinks! If you are lucky enough to be a school nurse for middle school and higher you can expect to be extremely busy and frustrated. My friend is a school nurse...her days sound busier than an ER and working with MD's of the children is worse than that of a hospital.

I wish that this was something that I could attend!! Would love to get away from snowy central NY, however, as a mother of three little ones it isn't a doable task...anyone know of any course on-line? Thank you for the post and the information! It is most appreciated!!

I am very interested in getting my certification in wound care. I am a nurse manager in a LTC facility and am presently trying to gear our unit for a wound care wing. It would be nice to obtain the certification. I can't take a week away from home to attend a course. I need something that I can take independently.

thanks, will check it out!

Does anyone know of a reputable distance learn BSN course offered by anyone besides Excelsior College? I am finishing my AAS hopefully next week (Take the CPNE 23-25) and want to start on BSN requirements while I wait for my degree to be processed. I probably will stick with EC but want to know what others might have to share! Thanks! Cyndy

Do whatever you feel good about. If you feel any hesitation or apprehension about missing that day then chances are you better go!! You get so much out of clinical that you don't even realize...would be a shame to miss something that could happen that day that was very unexpected...my thought is Go to clinical, at least that would be my choice...:balloons: