ssmandile

I don't get it, the apparent self-loathing that occurs in LTC, it seems everyone wants to be somewhere else, don't get me wrong I think upward mobility is great and I think everyone should seize opportunities when it present itself, but it seems that people need to put a qualifier on the end of I am going to school, like to get out of long term care. Long term care is just a different nursing venue, like assisted living, home health or hospice. I have always thought of it as a specialty are, one that requires an understanding of geriatrics,med-surg, principles of rehab, psych, community health care. I don't see it as a negative at all, LTC needs bright new nurses to bring a new perspective to practice. Am I the only one out there that feels this way?

Congrats, on taking the job, how do you like it so far?

I agree with another post that sliding scale insulin is becoming a thing of the past, we do baseline blood sugars on our new diabetic admits, just to get an idea of where they are, and then usually DC the sliding scale altogether especially if they are not getting ac and HS blood sugars, what is the point and order HgbA1C's and the Docs will adjust daily insulin dosages. We have been getting really good results in blood sugar control for most of our residents, there are still a few that require more tweaking. As far as nurses documenting properly, and leaving holes on the MAR, if anyone has some ideas I would like to know as well, we have tried all the pre-printed sheets for insulins, made up our own, thinking it was a forms problem, but you know if they don't put pen to paper, there will be holes in documentation. Our facility will be switching to an EMR system over the next year, I am hopeful.

Just a suggestion, our building started using a kardex/careplan originally for the CNA's but it never got looked at, so we started having the day shift and evening shift select 2 kardexes (one for each shift) per day and take that into report, we also have the CNA's sit in on shift to shift reports and the kardex is updated at that time if anything has changed. it has worked well so far and over the course of one month the entire 50 bed floor will be updated, then we just start over again the next month. This was started just on our LTC units not our sub-acute unit where changes occur faster and more than once in a day, we are still trying to work out something specific to address the needs in that area. But it works well in LTC areas, and the CNA's really like it and are more involved. Lets face it they are with the patients the majority of the time and are often the last people to include in discussions regarding patients and interventions that are effective, they have a wealth of information and lots of suggestions.

I just signed up the chat boards and I read your post, how did your lawyers meeting go, any recourse for you with that employer? Your experience did not surprise me, but like the others said they usually wait until after survey not during to let DON's and administrators go, so it sounds like maybe something else was going on. I have been in nursing admin in LTC just a little while but recognize that personal dynamics between players is a big part of LTC management and I have to admit that that is what will make me move on, I can see that coming now. I have always maintained that the quickest way out of a building was to go into management, and I still feel the same way, unfortunately the turnover rate is so detrimental to a building. I was a state surveyor for a while and generally the buildings that did well were those that had a stable admin staff, everything else seemed to just flow from that cohesiveness. I am sorry that you had such a negative experience, all are not like that, but always with management there is the possibility that the game will change and you will no longer fit into the new game plan. Move on, learn from the experience.

Great advice, I wish I had signed on to this board much earlier, I identify with bzyadon regarding being new to the position and just being thrown in, yikes, I found myself in that very same position 9 months ago and just now feel that I am getting comfortable with what is required of me. I love your systems idea, I have tried to steer the rest of nursing admin toward picking systems and reviewing them but right now we are just putting out fires and given our DON is also new to her position perhaps we will all grow together at the same time.

Thank you for posting this, I have worked in long term care for over 20 years, and have been on the receiving end of some very hurtful comments regarding the "quality" of care and nursing knowledge and practice, especially from ER nurses. LTC is a specialty area that is much aligned, unfortunately some of what goes on in the industry perpetuates this, but I really dislike the notion that because a nurse works in long term care their skills are poor, or they just couldn't cut it in acute care. This is so wrong, long term care is community based nursing care more than anything else and has some very unique challenges and rewards you won't find in other nursing venues, especially in acute care.

I am new to this site but I have to agree with your statement that the focus of each year depends on the facility and their past history, I was a surveyor for a while and I can tell you the focus for each facility is determined more on the past five years of history of deficiencies and trends, you would be surprised that facilities continue to make the same mistakes over and over again, and the QI/QM reports. As far as the glucometer cleaning documentation, there is no federal requirement per se ,other than maintaining professional standards of practice, infection control and such however ,they will probably want to look at your facility policy and procedure or the manufacturers recommendation for cleaning and would expect that your nurses clean the machine properly between patients while be observed during a med-pass. That is really it, pretty simple, don't give them more information than they ask for period, make them do their own investigations based on what they know, if they need more they will ask.

For long term care this is pretty much average, but it an be alot at times especially when you are new to the long term care environment, but what is nice about long term care even in sub-acute is you have time to get to know the patients for a longer length of time and this helps you to be able to manage your time easier. It sounds like your facility is giving you a good orientation, so let them know if you are feeling over-whelmed, most places will extend orientation to keep good nurses on staff. Congratulations on your position.