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