Pat2012

I would just like to add one to the list: "No.... the comfort cart, is not for YOU to snack on, it's for the family of the DYING resident!"

i have been very annoyed with interruptions during med pass, and I've started a paper sheet communication, for people to WRITE IT DOWN, because I'm sick and tired of "so-and-so needs butt cream".

I agree with bluegeegoo. You need to set boundaries, or you will be doing a lot of extra work that your CNAs should and can do. If it's not something that will take less than a minute or so to do, I will say that I can't get that for them right now, but I will put their call light on, so the CNA is aware that you need something. Also, have you tried crushing those meds ahead of time? Or doing that hard room first? I vary it on my hall, I have 24 residents. Sometimes doing someone who requires more time, is better for me, because then I can whip through the other quicker med passes. Depends on the day. I work 3-11.

I have worked now at my facility for almost a year. In general, I enjoy where I work and I love my residents. However, in the past 3-4 weeks, it has been absolute Hell, because many of my patients are crashing and require a lot of time and care. To add to this, my hall has 6 accu checks that I have to do, and multiple behaviors. Normally when I come home from work I'm okay. I may feel stressed or frustrated at times, but nothing major. Two nights ago, I went home and I just sobbed. I think I am mentally exhausted because of the residents who are dying and because whenever this happens, behaviors go through the roof. Luckily, I have a very understanding and supportive supervisor. She said that if I ever needed a break, she could float me for 2 weeks or so, just to have a change of environment. She said my hall is not only the worst right now, but the hardest. I am considering, but I'd like other opinions. I like routine, but I do tend to get bored after a while, so I was thinking, maybe it would be good to do some floating for a while, keep things new and fresh. I know it can be tricky when you don't know residents routines or preferences, but I've been on other floors before, and the stress was MUCH less than my hall. I'm thinking of giving my supervisor an answer on monday....

On a daily basis myself and my CNAS deal with an ALZ pt who is verbally and physically abusive. She will not let my CNAs near her to change her brief or do HS care, she has slapped people, spit in people's faces, and raises her fists if you try to help. She also cusses you out every time. Now, she is literally taking the pills out of her mouth and throwing them. I've tried putting the pills in applesauce, pudding, hand delivering them into her mouth, and crushing them, and nothing works. My CNAs are getting frustrated because they have to deal with this nightly and then get accused of not doing good care, even when they have re-approached her several times, it doesn't matter. I feel that they should not have to risk getting beat up, just to change a brief. I have expressed my concerns with my supervisor, but she says you just have to re-approach her, and "that's the way she is and has always been." I feel this is an unfair response and doesn't help my team at all. I wanted to send her to geripsych, but my supervisor won't go along with it.... so what I am to do? What would YOU do?

First of all, I'd ask for more than 2hrs of orientation.... I mean, if they did that at the place I work at, I'd be headed straight out the door...... My typical day: I have 25 realitively independent residents, and the hardest hall in the whole building. I come in, get a report sheet, worksheet for CNAs, look to see who needs MOM, count narcs in my cart, and then get report. After that, (assuming there isn't a crisis right at shift change), I prepare my cart: I get pudding, applesauce, ensure, juice, and ice water. I use my med Mar tabs and pull them out for the 5pm med pass and I pull out a red tab for diabetics. I also make sure my CNAs have needed vitals by dinner time. After that, I quickly get my treatments ready and check the tx book. Mostly for me, these are creams, powders, occasional dressing change, maybe an ear irrigation. You memorize them pretty quickly. Then I head down my hall way: I find all my diabetics first, because they need thier insulin before dinner and sometimes they are hard to find, I also find the people who need breathing treatments (we do this ourselves). I aim to be done by 6 but I usually don't get done until 6:15 or 6:30, because I have a lot of eye drops. Then I take a 30 min lunch break. After break, I will try to do some charting so that I don't have to stay after so long to get it done. Then I prepare evening med pass. I get fresh water, re-tab my med mar, and I will pull both the med cart and the treatment cart down the hall. I will also make sure that I have snacks for my diabetics. At night it varies how I do it. Sometimes I go for the people who go to be early because they are hard to wake up. I know certain people want their pills at a specific time and you learn the routines so you know who you need to go see first. Med pass on a rare good day, I'll get done by 10:15, however sometimes I don't finish until 11pm. Then I go back to nurses station, clear off cart, make sure med mar and tx book is signed, try to get everything the midnight shift nurse needs. When the midnight shift arrives, we count narcs together, I pass over the keys, and we do report. Then, I go through the list of who I need to chart on. I have yet to get out of there by midnight. There is a shift for you! I also have 3 CNAs for my hall.

Yesterday, a resident told me "this cold water is really good." I gave her a smug look and said "I made it myself." Both of us: "bahahaha!" What moment have you had recently that gave you a good laugh? :)

No. But I was careful before I even went to nursing school. I did a lot of volunteer work in the health field and I did work as a home care aide and took a cna course, because I wanted to make sure. I also was very careful which job I picked. I don't do 12 hours, I do afternoons so I can sleep in, and I have very supportive supervisors.

Be prepared to understand that there is text book nursing, and real life nursing. Understand that you will never make everyone happy or be able to be on everyones own little schedule. Expect to be interupted all of the time, and that just when you think your day is actually going good, something will go wrong. Understand, that since you are new most of the CNAs will not trust you and can make or break your hall. And most of all, realize that while you had plenty of time to talk to patients in clinicals, you will be lucky if you get in a "hi" as you pass meds, and that if you don't keep it short and sweet, you will never leave. Sorry to sound either cynical or negative, but I am new to LTC too, and I wish someone would have mentally prepared me better.

I think I was given 13, but I am asking for more, because I feel uncomfortable taking the floor by myself

I am wondering if any of you get wrist pain from the repetitive movements that you do, when working with the med cart? Such as opening the OTC bottles, wripping the pill packages, pouring? I have noticed my wrist and hand will hurt either after work, or the next morning, and it will feel like it's swelling a little, and sometimes falls asleep too. If you do get this, how do you prevent such things?

I tend to vent alot. I also try to remind myself it's just a med pass, and the world will not end if I don't get the night time med pass done exactly on time..... sometimes I have to take deep breaths when I get interupted for something that really can either wait or is unnecessary........

I am a brand new RN, this is my first really nursing job, and my first ever full time job. I have got the dinner med pass down pretty good. Assuming there aren't any major crisis, I can get it done within' the time frame... The evening med pass, however, is giving me a terrible time. I am wondering how you would do things for the evening med pass with this situation: 25 patients, 4 insulins, 4-5 treatments, pharmacy comes anywhere between 8:15 and 10, and around 9pm the supervisor comes for report. I am feeling very frustrated and think other nurses must think I'm totally stupid for not getting done at 10pm. On a good day I might get done at 10:30pm, but many times it's 11--- and that's only because I have another nurse with me on the hall. I have tried doing treatments first and last, insulins first and last, people who go to bed early first, breathing treatments first..... I don't know what else to do......

I work afternoon shift. I get 25 patients to pass meds on, do breathing treatments, and wound/skin treatments. I also have people who need to be monitored because they're on a monitoring list for infection/fall/etc. I have 3 CNAs on my hall I supervise. We call dr's, patient's families, and do minor assessments on select people who are being watched. Keep in mind that there is real nursing, and there is nursing school nursing. The transition is a gross reality of what you really have to do to possibley get your work done on time.

I work afternoons on a longterm care unit. One of the residents has absolutely no impulse control what-so-ever, and purposely will interupt you when she knows you are the most busy. What she does is ask for PRNs, which she doesn't need but asks for anyways, such as tums, tylenol, cough syrup, and eyedrops. If you don't give her immediate attention she gets loud and mouthy, and complains that you never address her needs (which is grossly untrue). This disruptive behavior, in my opinion, needs to be addressed because it increases the risk the of a nurse making a med error because she is always asking when you're passing meds--especially insulin. Also, she is somebody that doesn't need to be on a priority list because she is capable of doing multiple things herself and doesn't not have nearly the needs that some of the much older residents do. Many nurses feel this is a control issue for her, that she asks when you are busy to throw control on you. I feel this needs to stop and would like input from more experienced nurses on how to deal with this issue. Thank you in advance.