TBLPN

"Full Codes" are an issue in the LTC facility that I work in, unfortunately. I have more full codes, many more, than DNR. This facility that I work in is brand new, it's only been open a year. A lot of bugs to work out of the system, believe me. Its really nerve racking. I am the charge nurse on night shift. I have in the short year that we have been open have had 2 full codes...........unbelieveable. However, this facility is very naive about a lot of things, and it was "against HIPPA regulations" I was told to put 'dot's' or color code the name tags on the charts (seemed crazy to me since the patients name, doctor and room number was in full view for all to see) We have to look inside the chart, and hopefully medical records has done their job and put the DNR/FULL sticker in there, which more often than not they havent. So then I have to search under the advanced directives, and again, hope that it is there. The first full code I had at this facility, it's pretty interesting, I had the other nurse check the chart, no sticker/no advanced directive sheet signed. hmmm, bad day for me, I knew she was a code, but wanted the other nurse to check while I'm getting the crash cart, wanted to be SURE, come to find out, in the middle of the code, a CNA comes down to the room tells me my DON is on the phone and needs to talk to me, I (as politely as I could) told her to tell the DON I was a little busy, the CNA says NO she says stop coding her, the family signed the DNR paper yesterday, it's in the chart "somewhere"........hmmmmmmmmmm. This nurse, not the happy camper, to say the least. The paper had been signed, and was put in the back of the chart, no one except the DON and Administrator new it was there.......It is top priority for me now to KNOW who are my FULL CODES. I don't trust my management team with that anymore.

At our facility we draw the trough (usually) just prior to hanging the vanc. We draw the peak an hour after infusion. If it finishes at 7 am we draw at 8 am. We have a doc that specifies he wants the trough drawn one hour prior to infusion and one hour after. That makes it pretty simple.

Well in the county I work in there are a handful of doctors. I've worked at 3 facilities in this area............he has patients at all of them. Downfall of a small town. I don't want to relocate at this time, or be on the road for hours, I have small kids at home. Why does he have to be such a jerk?

I just did this this morning. The order was specific. Draw the trough one hour before running the Vanc and draw the Peak one hour after infused. At my facility lab doesn't draw from a Picc either. I'm an LPN and we do. I love it it's great.........

When I first started in nursing, I was terrified of starting IVs. I didn't even want to attempt it. If one came up, I'd have another nurse do it, until the dreaded night I'm on shift by myself (I work LTC) and the IV running infiltrated and it was a necessity that it be restarted. I took a deep breath, remembered all the steps, and swore to myself I wasn't gonna freak out. I hit it, no problem. From then on, any chance I get to start an IV I do it. And in LTC you may go months without having an IV, then you may go months and that's all you have, IVs coming out your ears, which is the situation I'm in now. I've started/restarted so many IVs this month. I love it. It's one of my favorite things to do now. You will get better. You have to practice, it's a must.

I work LTC and I have to deal with a doctor that just gives me fits, all the nurses for that matter. He's a foreign doctor, he's the medical director of our facility and he has the majority of our patients. He, in my opinion, has the "little man syndrome". Nothing we do is right. The latest as of yesterday....the nurses do not send proper faxes. He yells at us all the time when we have to call him, being foreign, once he's mad, you can't understand him, then he gets even madder when you ask him to repeat himself or clarify an order. I work 11-7 shift, and I better hope, if I'm calling him, that the person is either dead or on the verge of dying, otherwise, I'm gonna get it!!!! Blood sugars of 28 with call orders

We have had SO many falls at the facility I work at. Numerous head injuries while one resident has an active "slow bleed" from all the falls. We now have initiated for our "dementia" type patients in wheelchairs, self release belts with alarms, they are nice, have reduced falls considerably. The only draw back is if the CNA neglects to turn on the alarm!!!! They are not considered a restraint considering the resident can release them, while the alarm will sound notifying staff that resident is attempting to self transfer. Just a suggestion. I don't know if all facilities would allow this type of intervention. We were desperate for awhile!!!

I've worked several LTC facilities. I have never received more than 3 days orientation. I'm not agreeing with this by no means, but that has been my experience. But once you have worked LTC, and move to another LTC, it's all the same, just learning the faces and the residents quirks!

PICCs have become a popular item in the LTC facility I work at these days. One lady in particular, just had hers replaced, because it occluded, but she is also a retired nurse, confused, and thought she would help us out a bit, by pulling and tugging on it herself. She informed the staff that she was capable of caring for her own line............although, in the next few minutes she was wrapping her IV tubing around a plastic cup. You know, because it was the right thing to do. As far as PICCs just "falling" out in LTC setting, rarely the case. I will admit, the CNA issue in transferring and daily care plays havoc with a PICC. They don't know the meaning of the word "easy" putting on that sweater.............I also think that the lines aren't flushed properly when we aren't running anything............therefore, occlusion. I also work in a restraint free facility, and keeping some of these older folks from pulling and tugging is almost next to impossible.

I work in LTC and there has been much controversy lately on fecal impactions. Can nurses check for fecal impactions as a nursing measure without a MD order? I know we cannot remove without an order.

I work in LTC 7p-7a. I have this little lady, incredibly sweet and funny although pleasantly confused, early 90's. She doesn't sleep much, we've lost many personal alarms because she hates them and throws them away or hides them. The other night about 1 am, she came to the desk, out of bed by herself, no alarm in sight, and I know it was there, I checked myself, anyway tells me in a very matter of fact tone " I need a tampon!" I reply: "I'm sorry, what did you say?" Again: "I need a tampon", I asked what for, trying to hide the laughter and she replies "because every time I stand up I dribble, and I want a tampon to keep it from doing that, call my doctor NOW!!!!!!! OMG, it was so funny, yet she was serious, we battled this situation for about 3 days, then she went on to 'I want a small, white dog, not a big dog, a small one, a real one':rotfl:

I hate the hand sanitizer our facility offers, 1. It smells like skunk and 2. if you happen to get to much on your hands it like clumps up and looks really weird. But some of the sanitizers that I have bought 'out' isn't too bad. I ALWAYS wash my hands, no matter what, no matter how long it takes, I have the raw, chaffed skin, that sometimes cracks and bleeds to prove it! I don't want to bring ANYTHING home to my kids.

In the facility I work at, I am the charge nurse of my unit from 7p-7a. But I pass meds, chart, start IV's, g-tubes, treatments, answer call lights, take off orders, changeovers............you name it! Mostly handle squabbles between CNA's......love that part!!!:rotfl:

BIGGEST: "Oh, that's NOT my patient"!!!!!!!!!!!!! Drives me insane!!!!!!!!!!!:angryfire

I agree, Xenaderm is great, works well on excoriated areas, however, our facility went through a period where Xenaderm was the "cure all", drove me crazy, same deal with Ultec, which I hate, leave that sucker on 5-7 days on a small o/a and remove it and you'll find a necrotic area. I can't stand ultec. It doesn't sit well with me to let something "brew" for a weeks time and never see it!! Finally our wound nurse caught on and we rarely use ultec now!!!!