debbiemig

Where I work, we have a nurse who works every Sunday. She's 82 yo. Hard of hearing and more energy than I have. She " goes by the book" on everything. She is a pleasure and has no problem asking for help. She's been with us for about 20 yrs.

Of course it's for real! The times have changed for the better thankfully! I've been in long term for many years and I've watched how the restraint situation has changed. I remember years ago( going back into the 60's ) when as a nurses aide, we used to toilet our residents on our dementia unit every morning. We tied them with restraints to the toilet and put an overbed table in front of them and they ate their breakfast there on the toilet! We really thought this was a good thing! I was in high school at the time and did as I was told. I remember also one morning hearing a screeching sound coming from down the hallway. I went to investigate and found one of our little old ladies with a posey restraint around her neck pulling the bed toward the bathroom. Her face was beet red and once we released her, she had a red welt around her neck. She didn't stop for a second once released, she continued on toward the toilet where she had a huge BM. Didn't even mess herself! So thankfully, the restraint, dignity and saftey issues are better now. This facility was at the time private pay and no medicare residents. So there were no state inspections like now.

I was at a LTF the other day visiting a friend. I knew several of the nurses there including the ADON. She asked me if I wanted to work perdiem. They pay 23.50 perdium. That is Putnam County, New York. I work in Westchester County and make more. The reimbursment rate for Medicare is very different between the 2 counties.Don't know about what the RNs make.

I believe it is a Federal Law not to restrain residents. We did this in our 300 bed facility several years ago. What a uprising we had, staff and family members. What we had to do was be more creative in fall prevention! We have low beds on most of the units. We have floor mats. We have electric beds with half side rails. At one point the State objected to the half siderails. I always felt that they were an assistive devise ( especially since I'm getting older and find getting up at night sometimes requires a little boost!). We do have velcro belt restraints. As long as they can open them, they aren't considered restraints!We have chair and bed alarms. I would suggest not to purchase the alarms that attach with a string. I would suggest the under the seat or under the mattress alarms. They are much more effective. The ones with the strings go off with a high pitch noise that sometimes sounds like someones cell phone, the string allows them to be already on the way to the floor when it sounds! So basically it's calling you to help someone off the floor! Then we have an increased activity program. They work until about 8 pm. So by the time the residents go to bed, they are tired and sleep! It has been a big trasition, but overall it has been a very good thing!

I can remember as a very young teen in the early 60's having surgery for an inquinal hernia repair and spent a week in the hospital. I was out of bed 2 days after and walked with my nose to the floor the entire time I was in the hospital. My youngest daughter had the same surgery in the same hospital in '78, they " glued" her together and sent her home the same day! I remember disinfecting rectal tubes and sterilizing equipt. in the autoclave. No disposable needles. Metal bedpans ( we used them as planters in my facility for a long time after the disposable came out). I remember going to our DON to get permission to wear white uniform pants in the 70's. That had to be OK'ed by the administrator! My cap was always off to one side of my head because I was always climbing under beds to connect bed restraints! Ah the memories! I also remember prepouring meds in a med room with a cigarette hanging out of my mouth! Wow, that was a short walk back in time!

We haven't done HDC in about 15yrs where I am. I'm so glad, I think it was cruel. Give me an IV anytime!

zippy, i'm from ny. up until about 18 mos ago, i was able to do everything an rn did in long term. i have been with this facility for over 30 yrs. i have been inservice coordinator, i helped open a rehab unit, i admitted residents, doing the assessments. wound assessments,ran units when we had no care coordinator, sometimes for monthes at a time. i supervise cnas and have earned the respect of other nurses, drs., physical therapists,residents and family members. i love my job. suddenly, lpns can no longer do assessments, can not work without an rn on the unit with her. when a resident is discharged from the rehab unit, i can no longer sign the discharge forms. which all really sounds petty, but it really burst my balloon. i feel less valued as a nurse, a good nurse! when i come on my unit, my residents greet me with comments like " thank god your here today, your'e the only one that knows what's going on around here" the cnas say the same thing. i have cut my days down to 3 days a week now, so that all those above issues really don't bother me so much anymore.i still love my job, i just don't feel valued by administration. my families and residents and peers all value me, that's what counts! the worse part about no longer being able to do many things is, administration never had a meeting with the lpns to explain any of the new rules, the just sent word that it wasn't allowed any more. so, i imagine, mass. day will be coming for lpns .

2 weeks ago we had our state survey! There were about 10 survey people, several were being trained. We did'nt have one citation in regard to med errors or untimely med administration. Could it be that the state is well aware of this problem and just don't include timeliness in the survey?I don't know!Any survey nurses out there that can enlighten us?

I remember one year, the facility I have worked at for years, gave us all carnations on the day shift,(the flowers were distributed about 11am) then we were asked to leave them for the next shift!!!!!!!!!!!!!!!!! How about that! They really love and respect their nurses! Debbie

Thanks for your inpt. The DON is very well aware of the problem, she was my supervisor a few years back. The facility didn't mandate the rule of 1 hr before the scheduled time and 1 hr after. this is a state mandate. Many of the states rules are very unrealistic as most of you know.I have been reading your replys and I see many great suggestions. I thank you all. I did a double shift last eve. and saw how few meds the residents get in the evening. I am thinking of possibly adding some to that shift. Also, we start our eye drops on the 11-7 shift at 6am. The resident is lying down, making it easier on both the res and nurse. I also add things like Lovenox injections to 6am, for the same reason. I do thank all of you for your ideas and experiences. Debbie:)

I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives. The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?

I would like to know if any of you have a problem getting your meds out in a timely manner. I have a rehab unit of 39 residents. They ALL have many meds. Most of them need to be premedicated for pain before going to Physical Therapy. My shift begins at 7am. The residents get breakfast at 8am. Physical Therapy begins right after breakfast. They are picked up from the dining room for the most part. We are not allowed to give meds in the dining room. Not even allowed to bring it to them if they are finished and are just chatting. We aren't allowed to interupt their" dining experience". ( I think the experience is ruined when the meal arrives. The food is terrible!). Now I've only had an hour from the time I arrived to get most of the meds out. It takes me until almost 11am if I'm not interuppted, which is rare. We are allowed an hour before the prescribed time and an hour after in order to get the meds out in a timely manner. Now, by 11 am, some of them are getting their 9 am meds. Then they may have meds due at 1 pm. that's 2 hrs until they may recieve them! My meds at noon are much less. If anyone has this problem, and they know what can be done to solve it, I would be ever so grateful. I've spoken to the DON, the administrator, the inservice director. They all agree that it's a problem, but don't have any solutions. The state is expected any day now and I am not going to be compliant.What do I do?

Thanks for clarifying for me. One concern I have at the ECF where I work is that there is a PA who takes call for a few of the Drs. The answering service is instructed to refer to him as" Dr. S........". When he calls the facility and speaks to a nurse, he says " this is Dan S.......". I know he isn't a Dr! I feel that the particular group of Drs are misrepresenting him as a Dr. I have seen on nurses notes where they have spoken to Dr. S and written a telephone order from Dr. S. What are your thoughts?

Who has a more in depth education? A Nurse Practitioner or a Pysicians Assist.? I know both write scripts and both work under an MD.

Last December my hubbies dad fell off of a ladder in the garage and onto his head.He was airlifted to the trauma center where he was placed on life support. EEG showed no activity( there was brain matter at the scene). He had very clear advance directives drawn up by a lawyer a few years prior.After a week, the family was brought together to discuss taking him off the support. My husband and his brother were against it. My sister in law and I tried to make them understand that he went to all the trouble and expence to make his wants known." He really did you a favor and took the desicion away from you, HE made the desicion already!"The grand daughters finally convinced them to let him go. So even with very specific advanced directives there is still an issue. I told my daughter that SHE was in charge if anything like that happens to me. NOT my husband. He'd keep me alive forever no matter what! My desire to be creamated is also an issue with him, but that's another story!