Old Gal

I am currently enrolled in Athabasca University's post RN-BN degree course. Go to www.athabascau.com for more information.

Hi, The health region in which I work defines 3 levels of care, number 1 being comfort measures only to number 3 being the most intensive care level where resuscitation (CPR) and other measures are to be given. Families and the residents (if they are competent) decide on the care levels upon admission to our Long Term care facility. We are located in a wing of a hospital, but do not have our own crash cart, etc. I honestly have gotten several different answers both from management and other RN's about what they would actually DO in the event of either an unwitnessed or witnessed collapse of a resident. Yes, we can start CPR, but often are on our own way down the long hall and if we ring for help we would be waiting a long time on this busy unit as call bells are rarely answered immediately due to staffing levels, etc. Another answer I was given is to load the resident on a stretcher and get them over to emergency, which would take much longer than 4-6 minutes by the time you find help to load them on a stretcher, that is after locating the stretcher, etc. How do other nurses on similar units deal with this situation? I am a returning nurse after 16 years away and am finding this the most stressful thing to deal with, in the anticipation of such an event. Like the old saying goes, Wal-Mart greeting is looking mighty good. I hate to give up nursing after all the work I went to in refreshing my RN., but staffing levels, policies that are not backed up with practical instruction, miscommunication, etc. are driving me crazy. (My fire orientation consisted of the maintenance man pointing out the exits to me as I finished a bleary-eyed night shift, this on the instruction of my manager!) Any thing you can say to cheer me up would be most welcome! Thanks in advance.

Hi Pam, I work in Long Term care too and we have several residents who also like ringing that call bell. Most often, the reason they are constantly ringing the bell is not the reason they tell you (needing help with dressing, etc.) but rather a general frustration with their situation. I find just sitting down with them at a quiet time when they are NOT ringing and talking to them, acknowledging their complaints and fears, and using a calm quiet voice can be helpful. Talking with them about their past, their family, etc. goes a long way in helping them realize we really do care. Including them in planning their care is also very helpful, for instance we had one gentleman who was obsessed with his bowel routine. By sitting down and going over the best form of treatment with him and trying to use his input, the use of the call bell decreased dramatically as he felt he had some control over the situation. I realize this can be very tricky to do as far as the use of your time goes if your unit is as busy as ours, however sometimes it can prevent that chaos that results with the constant bell ringing. It sounds like you and the staff are trying all avenues, and I agree that a Mental Health consult is a great idea so that this person has someone to vent his/her frustrations onto. Our mental health specialist is very helpful, often recommending a change in meds, etc. I don't mean to sound "Polly-Anna-ish" but sometimes the simple things really do help. A sense of humour is great too when used with ethics and respect for the person in mind. Also, I have used honesty and told people that would they please mind waiting if their need was not urgent, as I was busy helping a sick lady down the hall or busy handing out meds. Sometimes that is a reality check for them as they realize they are not the only ones residing there. I go into their room to tell them that and they seem to respond positively. Is your resident bored? Is there something the family could bring in to keep them more occupied such as puzzles, etc.? Hope I have helped. You sound like a caring nurse who is an asset to your unit.

Hi There, I originally took my RN years ago, graduating in 1976. There were grandmothers over 50 in my class; and they were wonderful students and did well. After working off and on between children, etc. I then had a 16 year hiatus from nursing. I just recently completed the refresher course and am now moving on to my BN through Athabasca. You can do it! While doing my clinical for the refresher in a long term care facility; I worked with a newly graduated over 50 LPN who was learning to do the daytime meds for 60 residents. It was tough the first couple of days but by the third day she was doing great. Let's cheer each other on! Good luck.