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!!!!

In Indiana we can start and maintain IV's. I work in LTC and have started many IV's, some IV pushes, we hang TPN and handle PICC and midlines.

i work 7p-7a in ltc. a very hectic unit. something always going on. when i get there, first and foremost, top priority, is my mt. dew for the noc. i then get report and count narcotics. talk the my cna's that i will have for the noc and give them a quick report on who i need them to keep a "careful" eye on or anyone who is exhibiting "new" behaviors. i then start my med pass, which can take anywhere from 45 minutes to 2 hours depending on the mind set of the residents. then treatmets. i then continue to do medicare charting and "special" charting. at 11 pm i get report from the other nurse and then i have all 54 residents for the remainder of the noc. i then proceed to do glucometer readings, 24 hour reports, census sheets, skin assessments, return meds, order meds, file faxes, note the ones that have not yet been responded too. i also handle labs in the am, fax all results to md. about 3 am i continue, once again, on medicare charting and treatments (i'm working 2 shifts basically). i also set up my med book for my 5/6am meds/insulins/accuchecks/g-tubes. then when 5 am hits, watch out, accu checks, med pass, insulin, i&o's, morning staff coming in, i have to set up schedule/worksheets for morning cna's, everyone griping about what sheet they have. then at 7 am be ready to give report and count narcs again. it's hectic......but again, once you get into a routine, it's not bad. good luck!:rotfl:

i work on a unit that i personally am responsible for 26 patients in ltc. after 11p i am responsible for 54. the med passes, treatments, and tubes, on top of charting, v/s, census reports, skin assessments and 24 hour reports are quite overwhelming. i've been working this unit for almost a year now, i used to work 3-11 p, talk about chaotic. but, you will adjust, you will get your own routine, and once you get to the know the residents and their "quirks" it will all go smoothly. to sit and type to you all that i must get accomplished in a 12 hour shift seems impossible, but somehow, i get it all done every weekend. unless of course, there is a major catastrophe, then that is a completely different story. i have found when my cna's are on the ball and doing what they are suppose to be doing, my nights go a lot smoother. when they are acting up (which they do often) then my nights are not so smooth. good luck, take a deep breath and jump!!!!:)

I work LTC and I work what they call "weekend opt" Although, since I've inquired about this shift, I have found that most weekend opts work you 2-12's and get paid for 32. However, where I work, I have to work 2-12's and pick up an 8 hour shift. I do however get a higher rate of pay than when I was working during the week. I currently work Friday 11-7 and Sat/Sun 7p-7a. I like the hours because I get to be home all week with my kids.

I myself have encountered several CNA's who think they are in charge and run the floor. Going to the DON is not always effective. Keep documenting, keep a notebook with you and document everything, and keep writing her up. Unprofessional behavior has no place in LTC, or anywhere, but LTC seems to be overflowing with people wanting the money, but not working, or behaving badly and getting paid for it. Good CNA's are hard to find and I feel a lot of their inappropriate behavior is overlooked because help is hard to find (good help). Good Luck!!!!!

Finally, someone who really put it out there the way I feel!!! It's crazy. I have such a hard time being "responsible" for everything and anything the CNA's do. I love LTC, I don't want to leave it, but I'm not sure I have much choice. I really thought I could make a difference there. And to top off all that went down between myself and the CNA's now the DON and ADON have called a meeting with the 4 CNA's involved and the two nurses involved (one of them being me). It's scheduled for tomorrow. I'm hoping the DON backs us up and let's them know that we are the one's in charge and responsible. But I'm not sure that is going to happen. The ADON is already mad at me and the other nurse because we said we didn't feel like she backed us up, and truly she didn't. She allowed the CNA's (all of whom are supposed to be grown women) scream at us (the 2 nurses) and at her. You could NOT hear yourself think in there. And I decided that I was not stooping to their level. If a meeting could not be conducted in a mature, professional, and rational manner, then I didn't want to be a part of it. The only thing that truly was reinforced was that they were "good" CNA's. That's it. Nothing about you need to deal with these issues with the charge nurse and they are in charge, they are responsible for the unit, nothing. Our DON is a little more "vocal" and she has promised me this will go well and all will be fixed. She kept telling me not to "bail" on her and to give her a chance to fix this. But what was even more upsetting was that she told the other nurse who is involved that she is tired of these CNA's running off her good nurses........how is that even possible????? How can 4 CNA's be let to run amuck like this and no one say anything??? I just don't understand. As I said, I was a CNA before I was a nurse, and I would have never dreamed of speaking to any of my charge nurses the way these 4 spoke to us and the ADON. I'd like to say it's the age, but they are all in their mid 20's except one, who is 40+........I even had another nurse that works days tell me these CNA's are the reason she left weekend opt in the first place.......:angryfire I just don't get it I guess. But what it boils down too is that I really like my DON, she's been more than helpful and understanding with all my questions being a new nurse. She always tells me to call her if I need her, and I do, and she is soooo nice about it. I just hope she is going to do the right thing. I worked 3-11 Mon-Fri up until about 2 months ago, and I never had a problem. I loved working there, I loved my job!! No so now!!

funny this should be on the board, i just had a similar experience sunday, actually monday morning 2 am. i work ltc. i have a chf patient, who is up and down, one day you think, well this is it, the next day he's alert, oriented, requesting to take a shower. he's been back and forth to the er numerous times. code status: dnr. to me that does not mean do not treat as well. he's extremely hypoxic. family very supportive and concerned. of course, lung fields very congested, bp wnl, o2 sat room air 70%, o2 @ 2l/nc 90%. his 02sat dropped on me, filled up quick, frothy mouth, requesting to see his wife, hallucinations, telling me he was dying today. doc didn't return call, house doc called with order to send to er. he was never admitted his doc seen him monday in er sent him back with comfort measures only and not send him out again. we didn't have that order to begin with. that's what is unclear to me, yes i understand dnr and i understand comfort measures only.......but i don't feel it's made clear by the doc's what they want us to do. this doc wasn't mad or anything, but if he would have returned my call he could have told me, don't send him out, etc. he did come back with an end stage dx...........i'm just really confused about all that. i'm never sure exactly what to do. my don also told me to send him b/c staff has to notify her when any pt goes out to er.

we did that in our "lab" groups. no guy/gal thing, the guys were in one place, gals in another. we wore shorts and tank tops. i was really nervous about it and really dreading it, but it went really smoothly and was pretty painless!:) the only other thing we did to "each other" were ppd's. that to me was worse than the sponge bath by far!!! 30 inexperienced nursing students sticking each other with needles......ouch!

I agree 100%, give the two week notice with a proper letter of resignation. Do not burn bridges. It will eventually one day bite you in the butt. As for your dad, cut that loose, you don't need that. The day will come when you call him up, tell him you are a RN, you did it, on your own! THE best reward....:rotfl:

I read through a lot of the posts on nurses and smoking and I felt compelled to say this. Everyone makes it sound like because we're nurses that makes us "not human" or "superhuman". Yeah, we know it's bad for us, we know the consequences, etc, but so does everyone else in the world. Because we're nurses we're suppose to lead the perfect lives, set the perfect examples, eat only what's good for us, always be the ideal weight, I think NOT. Our job is to educate people. Example: Whether a nurse believes in or not believe in abortion must never voice her/his opinion, our job is to give information, education, information on both sides. It's not our decision to make nor our right to judge. Same with smoking. When someone comes in with lung ca, of course everyone's first question, do you smoke? So then what do you say, see, serves you right???? Come on. We're all human, we all make mistakes, and it's neither for "nurses" or anyone else to judge or decide. The nurses job is to state facts. That's it, opinions are not a part of it. And as far as the "break" issue. Everyone is entitled to their 10 or 15 minute break, and that allows each and every person, smoker or non smoker that amount of time OFF the floor, otherwise it's not considered a break!!! Also, when you are at work your the nurse, when your home, don't we all live "normal" lives just like every other joe blow? But I do know that in my facility more nurses smoke than not.......maybe it's the stress of the job, who knows? I didn't become a nurse to condemn others......only to try to help. What about caffeine? Nurses live on caffeine, yet, we know it's not good for us? 12 hour shifts are tough.....so do we condemn everyone for drinking caffeine too? It's a never ending battle..........