BHolliRNMS

I don't think you will be fined monetarily for late submissions. However, if it is a widespread ongoing problem, state surveyors can give you a tag on it during your survey. I would write the problem up and take it to QA committee with a plan of correction just in case a surveyor asked about it.

I think most boards of nursing will tell you that you can make a late entry on anything that you can factually remember without a doubt. I think anyone would have a difficult time convincing a bon they can remember a month ago. In MS the bon doesn't specify a time limit on late errors; they do stress factually remembering---without a doubt. Most companies include a time limit in their p/p. Ours is 5 days on resident condition but no later than end of shift for administration of a medication.

The DON clocking in and leaving is as illegal as any other employee. Federal regulations require nursing homes to have RN coverage at least 8 consecutive hours everyday. If the nursing home does not provide this coverage, they are not meeting federal regulations and will face penalties if caught. No, you can't work seven days a week. The company may have to pay an agency RN to work on the weekend until you can hire and train someone.

Track location of the infections per your facility floor plan. Could there be a px with hydration and/or incontinence care in a particular area? Track UTIs with catheters...is there a px with catheter care? Track organisms....which are widespread? Which are spread by contact? ex..mrsa and location of these Track which doctors are rx antibx...do they have a positive c/s or just order antibx If antibx ordered prior to c/s, notify MD if c/s show no growth to possible dc antibx. to help avoid overuse of antibx. sometimes extra fluid and cranberry juice or tablets can stop "burning" What s/s are being recorded as symptoms of UTI? Do certain residents have repeated utis? Do they need preventative maintenance antibx? This is a few things we have looked at thru our QI committee with UTIs. State surveyors usually want to see how you provided adequate hydration, toileting and care of catheters with utis. It's a good idea to watch cnas and nurses actually do catheter and perineal care regularly.

i work in a 120 bed ltc and we just dc'd our last restraint. It takes a lot of creativity to keep people safe. you have to learn what each individual likes. Ex...we have one lady who liked to read...she is very demented...but she will sit and "read" for hours. We also have modified a merrywalker to enable another resident with paresis to be able to unlatch it if needed. Getting residents active is important. We started out focusing on one resident at a time...made a c/plan to decrease the amt. of time spent in the wc by transferring during meals, supervised group activities, during restorative exercise program, etc. before you know it, you are no longer using the wc. remember that wcs are suppose to be used only for locomotion...not for sitting.

I think it is great that you recognized the acute change in your patient. Usually a cna is the first person to notice a change in a LTC resident. However, taking the time to go get a pulse oximeter machine and "assess" the patient yourself BEFORE sending for a nurse is really out of your scope of practice. I would have wanted my cna to stay with the patient and turn on the call light to seek help.

in order to be a "skilled" patient under Med A, the patient must need care that requires the skill of a licensed nurse or therapist daily. Daily wound care, IV therapy, observation and assessment of many diseases, etc. The key to getting paid is in the documentation.

Not ALL crash carts in long term care are a joke. As a nurse, I feel it is my responsibility to check the crash cart at the beginning of the shift to be sure O2 etc is on it. Let's face it. People come to LTC to stay til they die. The families say to do a "full code" Do the families really expect the person to survive it? No. They just want to feel that something was done.

It sounds to me like it was already getting better under your leadership. I have been a don in two different facilities. The first year in each, I was at work more than I was at home. I have been at the place I am now for four years. It is a thankless job most days. But, those days when a resident wants to hug me out of the blue and tell me how they love me, where else can I go to work and get that kind of "pay?" I still work a lot of extra hours...was there til midnite last nite. I just made a committment to myself when I started, because I had sworn when I left my first DON position that I would NEVEr take that on again, lol, that I would stay one year. That gave me a goal. I will say that without a supportive administrator, you will always be limited in what you can accomplish and the moral of your staff. Maybe you could speak with someone above your administrator? If you are having doubts about your decision, maybe you should stick it out just one more month. Long term care RESIDENTS need nurses like you.

I don't believe in unnecessary charting or duplicate charting. I do think sometimes forms help nurses to document important information in a quick way. Our company doesn't require monthly summaries for instance. We do acute charting, MDS charting and incidental charting. Sometimes just getting the opinion of the nurses who actually use the forms helps to modify the form to fit the need instead of creating a new form. For instance, in my facility we want to do a better job of pain control and documentation of a pain assessment. So, we simply added a pain monitor to the MAR that only requires a number from 0-5, instead of a new form. Nurses need to work smarter, not harder. (one of my favorite sayings, don't know who said it originally, a nurse, I'm sure). I have had to review many charts this year for litigation and though we gave good care, great care, in fact, every chart could have better documentation to prove it. So, documentation is always and will always be a challenge.

I agree, it is necessary. I just think I would appeal the G tag on an alert and oriented resident who fell. She has rights to refuse restraints and alarms can be restraining. I get tired of everyone saying you have to have a new intervention with every fall, but don't restrain anyone. I have started careplanning "new intervention" as med reviews by rph for fall, sitting/standing bps and reporting to MD. My goodness, there are only so many gadgets you can use. Was everything on this resident on the plan of care? as her removing the alarms? I would fight this tag.

ask the lawyers.

we have a crash cart on each nursing wing. We only initiate CPR until the paramedics arrive and they take over. If you know CPR, you should be fine. Play out the scene in your mind a few times and prepare yourself. It will happen sooner or later. Just plan, example, can you instruct a cna to call the ambulance? Is there another nurse there who can call the doctor for you? And brush up on what you will want to chart.

on 11-7 we have 1 nurse to 60 residents. The 11-7 nurse is responsible for acute charting, supervision of cnas (3-4), PRN meds, emergencies, 6am FSBS, and 6am meds (mainly the tube feeders). I have worked it many times and it isn't bad.

what about behaviors related to pain? Are we treating behaviors related to dementia when residents are actually in pain?