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!

When I graduated (1983) you could get a job as a graduate nurse until you got the boards results.......boards were only done twice a year back then and the wait for the results was long. Now, you cannot work as a GN or GPN.....at least in my state. My facility will interview new grads, but until you've got the license.....

I've had symptoms since I was a kid......but it didnt become a problem until i was 40. Water just spreads the acid around more. Find a GI specialist / get a second opinion from some other doc..... I find it difficult to believe a doc would actually say that: erosive esophagitis can be fatal. Consider other things like lifestyle, emotional things, other medical conditions, habits.....etc. Stay away from OJ, pop, fried foods, acidy foods, spicy foods, alcohol. Don't eat before going to bed. Elevate the head of your bed. Lose weight if you need to. Anger / anxiety makes it worse....do what you have to do to chill out. I take the OTC Zantac twice a day when it flares up.

what year did you graduate? 1983 what was your first job out of nursing school? nursing home skilled unit how long did you stay there? 3 yrs why did you leave? better pay elsewhere, wanted other experience did you have adequate orientation to your new job? no was there a nursing residency program available? no if there was a nursing residency program, how long was it?

After being married for 27 years, we're 2 sides of the same coin. When they meet him, my co-workers tend to say things like "OMG there are 2 of you"

Working for an agency as a new grad is a mistake. You will be expected to hit the floor running and will not be given any support....you need to get a couple years experience in a steady job first.

It means keeping them comfortable, not to neglect them until they die but it also means not getting too aggressive with interventions or trying to prolong their life. Without any kind of info on the patient, I can't be specific but it seems to me that increasing the O2 thru the nasal cannula and getting some MSO4 if they're in distress might be more comfortable for the patient than using a venti-mask (which makes some folks anxious / claustrophobic).

Managing Anger, A Handbook of Proven Techniques http://nursingeducationofamerica.org/course_list/all.htm

One of my co-workers got her RN here in Ohio thru Excelsior.

How are you submitting your MDS info to the state? W use Accumax to fill out the MDS / write care plans / submit data to the state. Our aides input data on ADL's , weights, intake, etc. into a computerized system called Care Tracker. Care Tracker has its pros & cons like any other system, but the aides can't just copy what the one before them wrote and it saves the MDS nurses a lot of time in data collecting. Care Tracker can be web based (meaning the data and programming are on outside servers , not computers in your facility....not good if the internet connection goes down).

how about- "observe for side effects that might cause resident to fall" or "observe for adverse drug reactions / changes in cognition / ADL performance" You could add sx r/t GI bleed ( tarry stools,etc) or allergic reactions........depending on the kind of drugs being used. CNAs are not trained for adverse drug reactions (that is the nurses job) but a good aide will see a lot of things anyway. Keep it simple ....The care plan is NOT the PDR, nor is it a substitute for the MAR or policy and procedure manual. I don't list specific drugs....just classifications ( ex. admin. antianxiety agents as ordered. monitor for adverse reactions that might lead to falls). Specifics will hang you.