steff_rn1

We have 90 residents and work with two LPN's and usually 5 CNA's. No supervisor. I am surprised that some places have 1 nurse to 30 or less res. at noc.

At our LTC, we often call the medical director if we can not reach one of the doctors. If we can't get the doctor, we also send them if needed, and continue to try to contact the doctor. Never had any problems with calling the ambulance before the doctor is notified.

In the LTC where I work, our nursing ratios are typically 1 nurse to 30 residents on days, 1 to 45 on 2nd and 3rd shift. Of course, on weekends and when call offs occur, this may be less.

I agree with the above posters. Even in my current position as DON, I am able to make a difference in the lives of the residents we care for. Last month, I held a woman's hand as she passed away. Last night, I comforted and cared for a man who is ready to give up and die. His wife has been gone for five years, and he sees no reason to live. After going to his room a few times and talking and listening to him, he seemed much more content. Staffing is an issue anywhere in nursing. Yes, if you work in LTC, you will probably get stuck at work sometimes when you would rather be at home. As far as the CNA's go, I have found that if you let them know that you will lend a hand when needed and address their concerns, they are fairly easy to get along with. They usually go above and beyond if they know you share their desire to take care of the residents. Of course, this is not always true. In these cases, the facility needs to get rid of them. Family members, for the most part, want their family member to be taken care of. If the facility makes a mistake, it is best to address it and move on. I can not count the number of families who have been satisfied with the care that we have given. Overall, I truly enjoy working in LTC. I enjoy the daily interaction with the same residents and making a difference in their life. I enjoy knowing that the families are happy with the care that we give. And most of all, I am happy to care for people that were the bankers, teachers, farmers, housewives, supervisors, and nurses years ago. What a great feeling to give them the care and respect they deserve at the end of their lives!:) :) :) :) :) :) :)

My first suggestion would be to develop a resume that focuses on your skills that would be useful in these positions (assessment, supervision of staff, and knowledge of nursing standards and regulations). Send your resume to all of the LTC's in your area. You could also spread the word that you are interested in one of these positions. You also might consider applying for an RN supervisor job. Since turnover is common in nursing homes, it is possible to "move up the ladder". I started as a supervisor, and in less than two years moved to ADON and then DON. Good luck! Focus on selling your experience and networking.

The original post said that the patient was on Hospice, had advanced Alzheimer's disease, and was evaluated as unable to swallow safely. I have cared for patients like this, and many do reach a point where they are unable to eat and drink because they no longer have the strength, the cognition, or the desire to. In the dying process, the body requires less and less food and fluids because it is in the process of shutting down. I can imagine that if the resident had a "diet as tolerated" order, some staff would try to give them things they could not safely take it. When we care for Hospice patients, we follow their guidelines of patient comfort and working with the family to make decisions regarding their care. I see nothing wrong with NPO status when that time comes.

My husband works in a factory, building cabinets and store fixtures.

I attended a community college and got my ADN. I feel that I was very well prepared after I graduated from school. Graduates of our ADN program scored higher than the diploma programs in my area every year. I chose this program because of the cost and because I could do it part time. After graduation, I think the only thing that mattered to employers was that I was an RN! (and my previous experience in health care, probably). This may be different in another area, but in my experience, the important thing was that I passed boards and was an RN, not where I went to school.:)

Do you have a BM book and policy/ orders as to when laxatives are to be given? In our facility, a suppository is given on the 3rd day of no BM. It sounds to me that if she is not following the policy and MD orders, she should be reported and disciplined. Constipation can cause discomfort, behaviors, etc, but she should be using them right.

I am a DON, and would be happy to have you. I understand that some facilities only want full time help, but in our facility, having an RN PT on nights would be an asset. I have found that most of the RN's that apply have "skeletons in their closets", which their former employers warn me about (without giving specifics, of course). If an RN would apply and not have bad references, I would be happy to hire them PT. Good luck, and keep looking. You would be very valuable to someone.:) :) :)

I am a DON, and would be happy to have you. I understand that some facilities only want full time help, but in our facility, having an RN PT on nights would be an asset. I have found that most of the RN's that apply have "skeletons in their closets", which their former employers warn me about (without giving specifics, of course). If an RN would apply and not have bad references, I would be happy to hire them PT. Good luck, and keep looking. You would be very valuable to someone.:) :) :)

I have been out of school for 2 1/2 years, and have never actually used nursing care plans the way we learned to write them in school. I have, though, used the knowledge I gained from doing care plans to plan care for my patients. Goals and interventions are used to guide care. Rationales are not written in "the real world". I think care plans are used in school to develop critical thinking, which is a very important part of being a nurse. When you are working as a nurse, it will be important that you guide your care and decisions based on the ability to think (to yourself) why you are doing what is best for the patient. To me, this is the same as taking math, algebra, etc in high school. You do need it, although in a different way, in the real world.