BoopetteRN

I also think hiding meds in food is illegial. They can be put in applesauce or ice cream. As long as it is documented and after 3 missed doeses the doctor is notified there should not be any problem. Sometimes it is very difficult to get residents to take their meds, dfferent approaches sometimes work, but there are those that just will not take their meds not matter what, as long as Dr, family and it is care planned it should be ok.

:nurse:I am so sorry that your experience has not been a good one. You do spend much time passing meds in LTC, but the more experience you have the better it gets. You become familiar with each resident, their meds, and the unit you work on. As you pass your meds you begin to notice more, and it seems to fit. Don't get frustrated, just give it time, I went through the same thing when I first started, we all do to some degree. Each facitlity is different, but LTC is a wonderful place to be.

I could not imagine going through what you have been through. I have worked in the same place since I was 18, it is large, 304 licensed beds-4 neighborhoods. Each is different and each has its problems, but not taking off patches, giving medications or doing treatments is unacceptable. I have noted one thing over the years, teamwork is not what it used to be, everyone does not pitch in to help like in the past. Jobs are not as plentify as before, so if you feel that you need to go somewhere else get another job first, but have an exit interview and tell them what is going on and why you are leaving, perhaps that will help change things so the residents get the care they need.

The worst CNA story I have is our facility partnered with the housing authority to provide jobs for CNAs they had trained. There were 17 of them, we gave them intensive orientation and worked really hard to help them succeed. It has been 2 years since then and we have 1 left, most were unprofessional, loud, did not follow directions, were unsafe, and most fired themselves by being no call no show. I have a wonderful group of CNAs that have come to the plate when things have gotten tough. We had a fire in our laundry a few months ago and the county decided it would be cheaper to outsource the laundry, all the laundry people were laid off and we got a new service from the outside. We have had so many problems with personal laundry, the CNAs without being told are doing laundry for the residents who are compaining, I was so proud that they took this upon themselves. It shows that they really care and want it to be a home for them

We ask when they are admitted for a funeral home, and then upon death, check to ensure no changes have been made before we call for pick up

I have my MSN?ED, I graduated in 2006 and became the in-service director in the facility I have worked in since I was 18, I am now the DON. Is it needed, no, but it has helped me. I am an educator and that helps alot when dealing with staff issues and preventing problems

CNAs can not in Illinois

40 hours what is that, right now I am covering for nights because I did not have a supervisor. By the time you put out all the fires in a large facility, there is no time to get ready for QA&A reports or anything else. It would be nice, and I do have people I can depend on to help but 40 hours just is not realistic

I was an LPN for 17 years and then went back for my RN. I still feel the same, there are more LPNs that I would want to take care of me or my family then RNs. Many times it is the experience that makes the nurse, the bedside manner, and how they deal with those difficult residents and families. The other thing is how the nurse uses her education, and what he or she does when their out of school, nursing is ever changing and so the nurse has to be active in learning and trying new things--the old ways may not be the best, example, culture change.

We are a non-smoking facility and one of the questions on the assessment is are you a smoker, it they are, the application is denied immediately. Upon enterence to the facility a form is signed that the resident will not smoke and will be asked to leave if such action occurs. As for the nurse she should be aware of the policy for the facility and be held accountable.

At times CNAs can make the job stressful. I have always found that telling them upfront that they are my eyes and ears for resident care is important, and that I would never ask them to do anything I could not or would not do myself, but, I have got my job to do. In an emergency, helping is ok, but being told to do it by a CNA is something else. Most CNAs see nurses sitting at the station doing nothing, not realizing that the work we do is important, again that goes to show the a little knowledge can be dangerous. The other thing I have always done is give them expectations of what I expect from them and menor and coach them if there are problems. Best wishes to you, hope all goes better

The surveyor said that the nurse failed to do an assessment, and I agree, the resident was transfered to the hopital, and had another CVA and passed. Looking at it from the nurse's standpoint, this resident had frequent emesises and dx that supported that. She was aphasic and a hemi due to previous CVA, she was difficult to regulate coumadin--she would have a critical INR with the slightest change. The DON came to me yesterday about the plan of correction and kind of dumped it in my lap, which is ok, but she was very scarcastic. How are you going to fix this so it won't happen again. What constitutes a change of condition and when do you call the family and dr, it is subjective and every resident is different, the first emesis and every single one after--next we will be calling for pooping. I feel that if the nurse had done at least a full set of vitals, and did a head to toe assessment for that first emesis, we would not be sitting in this kettle of fish.

In Illinois we do not have med aides, but that is totally wrong. I hope that something will be done with her. Does your facility have progressive discipline or is it union. I ask because my facility is union and at times that presents a problem when trying to discipline the CNAs. Nurses and management are not in the union. We do not always have a union rep working on PMs and NOCs so giving disciplines on that shift can be tricky at times, because if the staff member wants a rep, we have to supply one.

Keep your dream, I am sure you would do well as a DON. Remember each facility is different. I have been lucky to work full time in the county nursing home, where we have no corporate bosses. The downfall to that is when there is a problem and you have to work out the solution, there is no one but you to make the ultimate decision--you can work with the administrator and the unit coordinators, but ultimately you are left holding the bag. I think that is why I am so worried about appling for the position, and now I have my interview at 2:30 tomorrow. This week we had a hot line call from an incident that happened a year and a half ago. The resident since has passed away and we had to think, just given a scenerio from the surveyor who she was here to investigate. We received 2 tags from her visit( no reporting condition change to family, doctor, and assessment). The resident had an emesis and the nurse did not call the family or doctor immediately, the next shift nurse called and had her sent for an evaluation 4 hours later because she continued to vomit. The first nurse only had that the resident had an emesis and her temp--no other vitals, no abdominal assessment--nothing! The surveyor told me that if only the first nurse had done and charted the assessment and a full set of vitals we would not have these tags. This incident really has me concerned--everyone in LTC knows that if you didn't chart it it did not happen! So now because of poor assessment and charting we are in trouble. If I get the DONs position, I want to have a meeting with the nurses and tell them they are going to be held accountable, it is only fair--taxpayers will now have to pay the fine--the nurse who did not assess, call, or chart is scott free, the DON is doing nothing, not even talking to her--I have to do the education because that is my current job but that is fine, I am just upset she is not going to be held accountable am I looking at this the wrong way? Would that put me in the same category as the DONs who house clean?

I do work from home sometimes, usually doing powerpoints for some inservice. I do it on my home computer and then email it to my work computer. I am on salery so it would not matter if I did at home or a work I guess. The only difference is I can do it in my pjs if I desire

We are licensed for 304 but only currently have 232 residents--one hall closed down on one neighborhood and one hall converted for Hospice made into private rooms but currently no one there (these halls were emptied about 6 years ago due to staffing issues). I have applied for the DON position here and I do not know if I am ready or not. I have worked here since 1972 have been a CNA, LPN, House Supervisior on PMs and Nocs and currently the inservice director. The only problem I see is she is leaving on the 11th of December and that does not leave very much time to train anyone for the position. I have my interview on Thursday. I know she tracks the decubs, incidents, and falls for QA. We do not have an ADON but there are 4 unit coordinators-1 for each neighborhood who run them. She hires the nurses, CNAs are hired by someone else. She give disciplines out that are written by the teamleaders and coordinators. She writes the plans of correction when the state finds something wrong. She is a mentor to staff and listens to both professional and personal problems. She does alot--I just do not know everything she does

We have a flow sheet that follows the care plan, med changes, wt changes, behaviors, transfers, ADLs ect. Everyone usually is behind in their charting. One of our neighborhoods has had the night shift do the charting which I am not sure is such a great idea. If the nurse has a question and she wants to speak to direct care staff that might become an issuse--in fact, she did not know that our operator keeps a log up front for residents who have behaviors and try to elop, I do not see how that can be effective charting.

I have been at the same facility since 1972. The DON, ADON, lasted a year after the administer retired in 1978. Then we had a parade it seemed of administers, DONs and ADONs. In 1995 we got a new female administer who really got along with staff well, the DON retired, so one of the unit coordinators who had been a DON in another facility years back applied and became our new DON. They worked well together and I can not say that I remember any of the house cleaning mentioned. Our administer left last year and was replaced by her assistant. Our DON is leaving next month. I have applied for her job and have my interview on Thursday. I know our staff, our strengths and weaknesses. I have been the inservice director for 3 years and before that a supervisior and floor nurse. I hope that if I get the position I will be able to make a difference in a facility I love and for staff who just need a little direction at time.

I am the in-service director and infection control person for a 304 bed facility and the job seems to never end, but it is rewarding. Monthly I have in-services with the CNAs reminding them of isolation procedures, how to use the lift, behavior documentation, handwashing, bathing, other topics that I feel need review from what I see when I am walking down the halls. I was a floor nurse in this facility for almost 30 years so I know what kind of stuff goes on. A couple of months ago I did one on Infection control and I covered everything from MRSA to head lice. We have a supervisor's clip board and 24 hr report is on there, I look for any infections, wounds, and things I need to address with staff. When someone is placed on isolation, I recieve a sheet telling who what and where so I can ensure everything is being done correctly. Toward the end of the year I have mandatory in-services with the cnas about residents care, reminding them what is expected, and that good care needs to be delivered every day, not just when surveryors are in the building. Most of my in-services are on powerpoint and last anywhere from 20 to 30 minutes. These are on top of the mandatory in-services we have to have. Another thing that helps is I have a CNA training program where I monitor all new CNAs for their first 90 days. This is done by having trainer meeting every week where we as a group discuss how new staff are doing and how we can help them succeed, that has been a jem. It also keeps me informed of practices that go on that should not so they can be resolved in a more timely manner. There are times that I can not be here all 3 shifts to inservice everyone so I leave memos at the desks and ask them to call me if there are any questions or concerns. I have an open door policy which I feel helps alot, CNAs come in and talk to me about issues so they can be resolved

It is not a bath tub, it actually looks like a vacum, water is sprayed out and sucked up at the same time with any debris on the skin. It also has a urine collection feature where you get the proper attachment and when the resident feels the urge to urinate, they urinate and then you push a button on the attachment and water is sprayed and vacumed up. My problem with it is 1. it feels cold-the water is warm, but the air being sucked in feels cold. 2 Why would you bath someone with the same machine you use for urine collection. 3. To clean it between residents the attachment used, the water receptacle, and the vacum tube have to be soaked for 30 minutes in 50 X diluted clorine bleach. 4. It takes 15 minutes to warm the water up before you start. 5. It is loud, just like your vacum at home. I am just trying to find out if anyone else has used these products. All 10 units, which cost over $3,000 a piece are sitting in the classroom. I do not feel comfortable trying them on residents until I hear someone else has tried them. The day the DON and I did try them ourselves we were not impressed. They were donated by a family member who I guess is a company rep.

Our facility also has a problem with staffing, however we do get new grads who actually stay. We are one of the sites they use on their clinicals which I think helps alot. They get to know the facility, staff, and how we do things. By being a clinical site, we have had many new grads. The other thing our facility has is a "grow your own" program. All staff get an educational reinbursment of $350 a year, they can take any classes they want. After they have been accepted into a nursing program, the facility pays for their tutition for the nursing program, however, they have to sign an aggreement they will work here for three years after they graduate. So far we have only had 1 quite after and she had to pay the county back. Now that does not count for nurses who are LPNs going to RNs, only CNAs to nurse. It has been a really good program for us.

Our facility just got donated 10 Body Vac in bed bathing systems. It is kinda of like a vacum cleaner if you ask me. You fill the tank with warm water, it has a temperature gauge on it and will give an error message if it is too hot. Room temperature takes about 15 minutes to warm the water. It has a place to put the soap/shampoo in. You also have to use defoming solution in the tank. The DON and I tried 2 different models, they donated 10 of these to our facility--brand new. Both the DON and I thought that the bath felt cold, the water was warm, but the sution causes the air to feel cool. If this system works it would be great for residents who are bedbound. I was wondering if anyone out there has used the Body Vac system. Currently all 10 are in the classroom, the saleman is going to provide the DVD that goes with them--maybe we are doing something wrong, but we followed the directions word for word. If any one out there has used this system I would like some imput about it, at this point we have 10 units collecting dust because if I was the one getting a cold bath, I would surely complain.

I don't think that it has made me bitter, I do get angry with the younger nurses who won't answer a call light or take a resident to the bathroom. I always say I will do what ever it takes to get through the shift, I never ask the CNAs to do anything I wouldn't or couldn't do myself. There are days I wonder why some of our staff stay if they are so unhappy, but then a resident does something to remind them why they still do what they do.

I am the in-service director at a large nursing home, when full we have 304 beds, it is really like 4 different nursing homes. I have all the new nurses and CNAs for 2 days than they go to the floor. I shutter when the nurses go for orientation on the floor. We have been working with agency nurses for quite a while and the thought that an agency nurse would train a new grad nurse just makes me sick. The last nurse we hired had the same problem, and I was unaware of it becuase I do not know the schudules. After 2 days the nurse came to talke to me, I was so upset, I actually worked double shifts to make sure she had the proper orientation. The med cart is an important part of our job, but also the paperwork is sometimes overwhelming. Having it explained in detailed and putting a rhyme to the reason it has to be done helps the new nurse understand the importance of it. The other thing that is difficult is supervising the CNAs, making sure they are doing what they are suppose to do. PMs is one of the worst shifts to work when you are a new grad and have to get used to doing a med pass, answer the phone, interact with visitors, and resident tend to feelo worse at night. Residents tend to fall more on pms because they all want to go to bed at the same time and you have to intervene and find out why they fell and come up with solutions to prevent it from happening again. At first you are overwhelmed, but as time goes on, you will be comfortable with the route, or should I say the shift, because one thing for sure, long term care nursing is neve boring, residents come up with some pretty interesting situation. I wish you the best of luck

I agree that your mom should be moved out of there. There should be a hotline number posted for public health in the facility. I would call that number and they will investigate that complaint. The facility would be in more trouble if they took any adverse actions toward your mom. Nursing homes like that are what give the ones that work hard to make residents happy and well taken care of bad names. I have worked in my facility for almost 37 years, and I have never seen a bruise like you described from putting in a foley.