LTC_LPN

Perhaps I'm missing something here....I work at nights in a nursing home, but we NEVER have an RN on duty during the night shift. Only a couple of LPN's and a handfull of cna's. And we are a "medicare skilled" facility....certified for medicare and medicaid. Are they supposed to have an RN on the nights, too? If so, I'd hate to be the one to tell them!

We have an ER box which is kept locked - when anything is taken out, the ER box is replaced. No narcs are in the ER Box. The only narcs we have are whatever meds the md's have prescribed for individual residents, and these are kept in the appropriate med cart's narcotic lock boxes. These are counted q shift by oncoming/outgoing nurses. We don't keep any narcs "on hand" to be counted. We don't lock up Ultram or other routine meds...thank goodness. Otherwise, we'd be counting all day!

As a night nurse in LTC, I am paid $15.50 per hour, and I work in Arkansas. The dayshift nurses at this facility are paid $12.50 per hour. My problem is that I've been an LPN for 15 years, and yet the other night nurse, a new grad LPN, makes $15.00 per hour. We have no insurance or other benifits, except we are paid holiday pay and get 2 weeks paid vacation every year.

How in the world would someone get that info off the DOH website? I just checked at the arkansas state department of health website, and there aren't any links that show nurses names, etc. Or at least, not that I could find!

I am paid hourly, as an LPN, and I frequently work very much overtime. However, if the overtime pay is taken away I will not work overtime anymore because I don't believe that is a fair issue. We don't have "mandatory" overtime. If someone calls in for work, we have a "call list" of nurses who are paid salary and it is part of their job description to be "on call". This is already included in their salaries. It is not my responsibility to stay and cover the next shift....especially after I have already worked my 8 hours for the day and do not get paid for overtime. The nurse on call is responsible for coming in to cover the shift, or for finding a replacement if she doesn't want to work it herself. It's sad that many facilities are implementing new payroll plans and are putting ALL the nurses on salary so they can take away all the overtime pay. If our facility does that, I will not be employed there.

I would definitely speak with social services about this situation. Even if a doctor writes the order for "comfort care only" - like they do when someone is gravely ill or failing, I would think that chest pain would be uncomfortable and should be treated. Evidently it's causing the resident distress? Does she have nitro SL? I'd try that if ordered, but if no effect, would send to ER. You always have to cover yourself and be responsible for your actions, so be ready. Then again, you never know.....if she had chest pains and you did nothing but let her stay in bed and she died of a heart attack, the family could always come back and say "why didn't you send her to the hospital?!?!" or "You did nothing to help her!" I've seen this happen before....the family will tell you one thing, then if something happens they "had a change of heart" or would file suit due against the home. But you're right for leaving the job...if the facility has no better structure than that, I'd leave too. I think the DON turnover rate would have been a red flag. However, you can always put in an anonymous call to the ombudsman for the nursing home with your concerns for the patient....they can step in and try to help do what's right, according to the patient/resident's rights!

At our nursing home, according to the law, we have to comply with the resident's rights. If they want to take a bath at 4:00 am, then we'll give them one. But I'm not about to wake a sleeping resident to ask them if they want to take a bath at that time! On our 11-7 shift, we have a "shower/bath list" of specific residents that are to be bathed/showered on our shift. These usually begin at 5:30 or 6:00 am. Of course, we do have quite a few "early risers", those who get up normally around 4:30 or 5:00 am, without any prompting. These people we usually bathe early, per their request, so they are ready for the day ahead. Each shift has a bath list, with residents who prefer to be bathed at those times. We respect the resident's rights: if they don't want to get up, we don't make them. If they don't want to shower/bathe, again...we can't make them, but we do encourage them, and chart well when they refuse. I myself have worked 11-7 for a couple of years now, and I still can't understand why night nurses get the "lazy nurse" rap. Just please consider for one moment that all nurses are not alike! I have never slept on the job, never ignored my call lights, and I appreciate and help my cna's. It's sad that the rest of us "good nurses" get the bad rep like some of the others......:angryfire

If my state board of nursing knew you were sleeping at the nurses station, you'ld be out of a job....and out of a license. I don't know what alternate universe you work in, but I work 11-7 shift, and I have never had a night where there's no work to do/everyone is in bed/everyone had their restoril/etc. Apparently where I work, we have a little higher regard for our residents: they are allowed to get up in the middle of the night, not forced to lie in bed tho they can't sleep. They aren't drugged just so they will stay in bed for the shift...we try to keep our residents FROM medicinal restraints. There are plenty of meds to be passed...I myself have 22 tube feeders in my area, for example. I have about that same number of residents that get meds at midnight, and that's not mentioning the peg treatments, decub dressings, skin assessments, various bolus feedings, etc. that go on throughout the night shift. Pardon my english, but my butt is lucky if I can find a straight hour in which I am able to sit down and chart. I have approx. 24 medicare charts to do, right now there are 15 on the hotrack, and about 14 on abx which also have to be charted on. Then add in all the alzheimers residents who are constantly up and down all freaking night....lost in their own worlds. And let's don't forget the 3 CNA's who are on duty. Add in all the call lights going off, especially when the cna's are doing their rounds every 2 hours and need me to help answer lights, as well as what I'm trying to do at the time. We have an open door policy, too....we have family members that actually stay with the resident on our medicare hall, so yes, we DO have to deal with family members at all hours of the night. Then shall we talk about the 15 accu checks, plus insulins each am, plus all the various meds and creams and treatments that are to be done first thing in the morning??? Right know in my facility, I work with approx. 50+ residents on my unit as the ONLY nurse with 3 aids. No med nurse, no tx nurse. Sound like fun? I noted you said you "worked" the night shift for so many years are you still on the night shift?Night nurses shouldn't have to "bite" anything. Obviously some people already have their mouths full enough. I think it's a shame that you feel this way. If all I had to think about at work was flirting or surfing the net...or not doing my job.....I would have chosen a different career. Some people actually care about the people they take care of, you know.

Funny story....and totally true: when I was 7 months pregnant, I had my hair highlighted at the beauty shop. I did sit outside in fresh air a bit while the goo was on my head. Strangely tho, when my daughter was born 2 months later, she had the prettiest "natural" highlights in her hair! She had a head FULL of dark, dark brown hair with very blonde streaks! And I have the baby pictures to prove it. I know there's no possible way it's related....but it's strange!

Our facility has about 110 beds, and we are practically full right now. Our staffing is this: 7-3 shift: 4 lpns, 1 tx lpn, 12 cna's, 2 rehab cna's, rn(mds) lpn (mcare coord) don, adon, rn supervisor 3-11 shift: 4 lpns, (sometimes only 2 or 3) 6-8 cna's 11-7 shift: 2 lpns, 6 cna's Even with all this staffing, dayshift runs ragged...what with all the family, doctors, etc. calling/visiting + visitors, too. Then add in the "call-ins" on all shifts, it's rough. we have 2 main nursing stations, and on the night shift, sometimes 2 nurses will split the 11-7 shift for one station....1 stays until 3 am and 1 comes in at 5 am. Not much fun for the other nurse left in that lone supervisory position for that small time period. I always wonder what will happen when the are catastrophes at opposite ends of the building!

Where I work, we don't have an RN on the 11-7 shift, although I wish we did. We have approx. 110 residents, 6 cna's, and 2 lpn's....although quite frequently one of the lpns is left alone for a few hours each night. Usually one lpn stays and passes the midnights, then another comes in around 5 to pass the 6 am meds. Thank goodness for the great aides I work with during the night. Trust me, sometimes those night shifts are non-stop chaos!

:angryfire :angryfire :angryfire what??? not a "nurses job" to answer a call light?!?! what alternate universe does this idiot don work in????? i'd hate to have to work with any nurse who has the audacity to stand beneath 7 call lights and not lift a foot to see if help is needed. pardon my language, but in my book that nurse is nothing but a lazy assed b***h. when you work in a nursing home, regardless of what your job title is, every single resident in that facility is "your resident". nurses should answer a call light if there is no one else already headed to the room to see what's wrong. anyone can answer a call light....you never know if someone is in the floor and injured, or if they just need their tv turned down. then again, i'm the type of nurse that always lends the cna's a hand...whether it's turning a resident or if they need help with feeding. if someone tells me mrs. so-and-so needs some tylenol, i'm up and going to get it for her right then...not an hour later. and i frequently joke with my cna's and tell them that if i ever do hesitate to give care/give meds/help in any way to promptly whack me upside the head if needed. i'm there to help my residents, regardless of what they need......i'm not there to take 2 hours to pass meds or sit at the desk and file my nails, as i've seen others do. i'm proud of the lpn title behind my name, and i try my best to uphold that title proudly. and trust me, my cna's....and i call them "mine" because they always help me as i help them...they are always glad to see me coming down the hall. when i've been off work for a few days, all i hear is "god, we're glad you're back!!!" now that, ladies, keeps a smile on my face and puts a lift in my step....and walks me right on to that next call light with a smile.:balloons: :balloons:

My sentiments, exactly!! At our facility, residents who are like this - with extreme behaviors - can and will end up with a 30 day discharge because of their behaviors. So...in 30 days, they are discharged from the facility. And in most cases, will not be re-admitted to our nursing home. I must say our staff does very well in listening to the cna's and nurses, and behaviors are charted q shift and as they happen.

It's no longer a "last resort" because I've worked with the same nurses at the same nursing home now almost 2 years...and we've been inserviced and inserviced on this subject repeatedly. Yet amazingly, we still have the same problems. Notes left in the med room about flushing tubes, notes left on the pumps as reminders. Some people are just plain lazy...and they don't care. But since we're so short staffed, our dept. heads are happy to have the nurses we do have.:angryfire

It's bad news anytime a resident is combative with the staff and someone ends up getting hurt. As charge nurse, I've told my staff that if this should happen, to notify the nurse immediately. Last time, I had a CNA struck twice in the face with a closed fist by a resident who is a/o x 3. I called the local police and had a report filed. An I&A was done, and the CNA was sent to the emergency room to be checked out. Of course the resident wasn't arrested, but the report went into his file/chart. And the incident was thoroughly charted in his chart. Without the proper documentation, it's very hard to do anything about abusive residents in the nursing home. And if it's a trend, you can't do anything unless you've got the charting to back you up. Our facility does not mandate that the cna continue to work with a resident if they have had a combative issue with them - we transfer them to another area of the facility if they wish. However, once some of these residents "get their bluff" in on a staff member, that's it. I once had a little bitty lady smack me square across the face, but I was right back passing her meds the next morning. She couldn't believe I even came back into her room. (many residents in nursing homes are alert and oriented x 3.) There's a big difference in being struck by someone with dementia who doesn't know what they're doing and being struck by someone who INTENDS to strike you. And would strike you again, given half a chance.