fluffwad

It's usually the families that won't allow the DNR. Too many think it = "leave them in a corner to die". I spend A LOT of time correcting misconceptions about this.

Ditto to all of what Angie said + the realiztion that we are not responsible for the function of the universe or almighty enough to make sure everything goes right. Everything happens for a reason, even the bad stuff; and it doesn't happen according to our plans. God is in control.....we justneed to step back.

In LTC, it's not unusual for the folks to go in batches......esp. when the seasonal viruses start coming thru, but also at the change of seasons. We just lost 9 this month (10% of census).......all different reasons. The weakest ones just don't seem to have the energy to live thru winter again. "thinning the herd"

potential or actual alteration in psychosocial function / status related to [whatever is making her delirious] resulting in impaired social interaction / mood changes / impaired emotional control you might also want to care plan delirium / resulting in impaired ability to make decisions/ perform activities of daily living/ recognize or express needs / impaired safety awareness Just because she's not unhappy now, doesn't mean she won't stay that way......

At my facility, the MDS nurses have no on-call, no weekends, no holidays.

How did insurance changes effect CRRNs? I've had my CRRN since about '97, but I have to say I rarely ever meet any other CRRNs. I absolutely agree that you should get the core curriculum from ARN. The test was like taking boards all over again.

It's a pharmacy that can make special preparations themselves...not just sell prepackaged medications, we have one here that makes a topically applied cream with Ativan in it. (They don't manufacture the drugs) I think these used to be a lot more common in the 40s - 50s maybe ( I could be wrong) but I don't think they've ever been very common.

I agree that the pendulum has swung rather far in the other direction.....but I was doing LTC when half the patients were zorked on Haldol, people used restraints on anything that moved and tied the patients to the rails in the hallways. Sounds like the folks above you don't really understand the regs, they're just running scared with no understanding. But them regs are there because idiots did stuff that wasn't right and people got hurt....( gee, we never had any problems with patients smoking in bed before officer......) Also sounds like someone needs to talk to the families about what they can / cannot realisitically expect. Let's face it, no one learns about this stuff ahead of time, and some famlies never get realistic. But life ain't fair, the patients aren't there because they're easy deal with ( they'd be home if they had no problems) and the challenge is to cope creatively with the pile of lemons you've got to work with that day. I also think that there's going to be a culture change in the next couple of decades, I just don't see the baby boomers putting up with life in the nursing home....and I don't see Medicare / medicaid staying solvent or paying for a lot of the stuff they're still willing to pay for now.

I've been at it 7 years. At least 4 months is right, maybe a year before you get the sense of the finer points of the thing. Get yourself sent to training / seminars / etc. Subscribe to AANAC, take their courses. Learn and stay up to date with all the new developments you see at AANAC, sign up for their discussion group. Be proactive...don't just wait for corporate to teach you stuff.

if that's a phrase that the nurse managers used i would just move on before things get ugly.

My typical day is lots of assessments, lots of meetings, keeping an eye on all kinds of stuff. Ever done the MDS before? OCD is a plus here, being well organized is a must. check out aanac.org

Sounds like you need a change of pace / scenery / co-workers. Consider a different unit or facility. Some companies just have a 'mentality' that runs thru the whole place, sometimes just in certain parts of it.

Don't say anything to her now. It's not your place, and it would just create problems. If they don't keep her and she brings the subject up afterwards, be supportive.

MDS coordinator....although, sometimes I miss having a weekday off........it's tough to get appointments on the weekends or after work.

Almost every nurse I know came out of boards with brains fried and thinking they've blown it...... besides, you get another chance ( or 2). Test anxiety is not unusual.......besides you just put a ton of time and money into getting thru......things will look better after you've had a good nights sleep. Cheers!