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Aem1215 has 16 years experience.

I Started out as a CNA in the facility I am now the DON of.

Aem1215's Latest Activity

  1. Aem1215

    Help...do I want to do this???

    I would be asking about the training you would be receiving first of all. I have spent my entire nursing career in LTC, and I am always glad to see someone interested in it, but sadly I have seen more than one acute care nurse go down in flames because the realities of LTC aren't what they were expecting. It's a good idea to learn what the floor nurses have to do because likely when there are call offs, you're filling in. I have worked every position in my center prior to taking the DON position. Feel free to PM me if you have questions!
  2. My facility does IV Lasix, IV Solumedrol, TPN, maintenance weight based Dobutamine infusions, and maintenance weight based milrinone drips. I know it seems scary, but really it's not as bad as you would think. We take LVADs and Life Vests too. We treat acute CHF episodes all the time. Usually, the person gets a foley temporarily to monitor output while on the IV Lasix. We monitor pulse ox, lung sounds and vital signs while acute. For TPN, I require that the hospital have the complete TPN orders to be by 11 am the day they are coming. They also have to supply me with the confirmation of PICC placement at the same time. We also write a prn order for D10 at the same rate as the TPN in case something happens that the TPN can't run. You have to keep it in house stock. We do labs twice weekly, and if the MD prefers, the pharmacy will adjust the TPN formula based on the lab results. For the Dobutamine and milrinone, we call the weight in to the pharmacy each day to get the daily infusion rate. When we started taking these things into the building, my pharmacy provided me with the drug protocols, so I would suggest talking to them when thinking of doing these things. I review each of these referrals carefully to ensure we can provide the care before they come in. Actually, the Life Vest is the thing that hangs me up the most when considering taking the referral. Life Vest does a good job of selling their product, and even though it says in their literature that the candidate should be alert and oriented and able to care for the vest independently, that is not always the case. I ended up with an extremely confused Life Vest resident once, was walking down the hall and heard the alarm that signals a shock and got to the room in the nick of time to stop the shock. The resident had the pads wrapped around his head. We use the Interact II and care paths.
  3. Aem1215

    New NP in LTC

    Mom nurse, take heart. If you brought this to the DON's attention, she may well have done something about it. My facility has a progressive discipline policy, and I imagine most do. The other thing is I am obligated to protect my staff's privacy as much as I am the residents. If you brought this to my attention, I would have disciplined the nurse, but I would not be discussing that with anyone but the employee and HR. If you continue to have issues, continue to bring it to the DON's attention. I would rather an NP or MD call me when they are having problems with stuff like this so I can address it than risk the safety of the residents.
  4. Aem1215

    Doesn't It Make You Want To Scream, part two

    Sadly, I have been in this EXACT situation! These ladies and gentlemen do not understand how lucky they are that I have such a good filter because they would be shocked and horrified if I said to them what I really thought sometimes. If it makes you feel any better, I had to schedule my entire nursing class for an entire day of classroom education to reeducate them on how to pass medications and when and how to wash their hands. These were things I got cited on during annual and the problems were so widespread, it was the only way to correct the issue.
  5. Aem1215

    LTC geri chairs

    We have a shower bed at our facility. I have wrapped the arms of the shower bed with bath blankets to protect skin during the shower. It's considerably less costly to purchase the shower bed than to ruin gerichairs and have to replace them.
  6. Aem1215

    I'm back!!

    When I first started to be a DON, for the first few months, I kept thinking that once I got all the fires put out, I would really be able to get some stuff done. At about three months in, as the DOH was walking into the building again for a complaint survey, It hit me that there was never not going to be a fire. Since then, I have learned to work my day to day duties around the problems.
  7. Aem1215

    I just need to vent to people who understand

    Hang in there! I'll bet new grads in hospitals working on their own for the time feel the same way. Speed comes with time. Its not even about taking shortcuts, but becoming comfortable in your position and confident in your clinical skills. Don't put alot of faith into what the other nurses say, my nurses love to tell new people about how people get fired at the drop of a hat, etc. in our building. Then they don't understand when the newbies leave! Someday I'll convince some of them scaring people is not the way to retain staff!
  8. Aem1215

    New Grad in SNF

    This is not just you, and this is not how LTC usually is. Please do those patients a favor and approach the DON about this guy!
  9. Aem1215

    First RN job at LTC.. Please I need help badly!

    2 days of orientation just isn't enough. My nurses get 10 days of orientation and more if they ask. Put in 2 weeks notice though if you quit, you'll be doing you professional self a favor.
  10. Aem1215

    Admissions...who decides?

    I sympathize with your nervousness! Neither of my admissions people are clinical. My company employs people who are positioned in our feeder hospitals, some are nurses, some aren't. What chaps me is on the rare occasion I do say no, its a national crisis!
  11. Aem1215

    Administering IV Lasix & Albumin

    For fluid overload and ascites, you need to treat the immediate need of fluid overload first, so IV Lasix first. Overload can cause respiratory difficulty, so Lasix is the quicker fix for that. Then the IV albumin. Albumin will help the ascites as long as the patient continues to recieve it on a regular basis. It will not fix respiratory insufficiency caused by fluid overload. Hope this helps!
  12. Aem1215

    Wound teams

    We have a wound team at my facility that consists of myself, my DCDs and the dietician. We round weekly and measure and document on the pressure ulcers. The floor nurses are responsible for the day to day dressing changes. Also, the floor nurses measure wound that are not pressure related the day before we do wound rounds, and we check that it is done during rounds. We also make treatment recommendations and obtain surgery consults if needed. I have worked where there is a wound nurse before, and have seem the same thing you are talking about happen. For whatever reason, the floor staff think because there is a wound nurse, they are not responsible for wound care.
  13. Aem1215

    does your facility have a defibrillator?

    We have an AED and a basic crash cart. I actually have used it many times now, but I have to tell you, AEDs shock when they detect v- tach or v- fib, thats it. It doesn't shock for asystole, it just tells you to continue CPR. Its nice because our rehab unit does have many younger residents, but the likelihood of it assisting a little old lady or gentleman is slim.
  14. Aem1215

    New Nurse, when to send a patient out.

    Don't sweat too much. You did the right thing or the resident wouldn't have been admitted to the hospital. Speaking from the point of view of a DNS who has been working for a long time in LTC, sometimes we can see things in hindsight that maybe could have been taken care of in house as opposed to the hospital. That doesn't mean you did anything wrong. Also, don't let a cranky doctor get to you too much. I had a doctor scream and swear at me on the phone once because I didn't call him and report a change in condition before a resident of his died. He ranted and screamed and berated me for a good twenty minutes before he told me to tell him everything that had happened since the previous nurse had called him with the initial change. So I told him about how I gave the resident morphine as ordered, called in his family, and the hospice nurse, who were at the resident's bedside when he passed. Response from the MD: " Oh, I forgot he was hospice." Click. Egos are common. Don't let it get you down.
  15. Aem1215

    How many residents is too many for one nurse?

  16. Aem1215

    How many residents is too many for one nurse?

    I am a DNS and I gotta tell you, I have worked every nursing position on every unit in my building on every shift before I took the position I am in now. Part of the problem here is we get a picture on pur head of how nursing should be, and this is not reality. Its not reality in the hospital either. First of all, we don' just decide willy nilly how much staff should be scheduled. There is a formula that we and the DOH use to figure out staffing vs. number of residents. Second, we do not get the same reimbursement as the hospitals! My advice for everyone is to learn about your specialty. If you. Worked in an ICU, you would educate yourself about the specialty of critical care nursing. LTC nursing is a specialty as well. It would be refreshing to see us learn and make an impact in our specialty by making ourselves as knowledgable as possible instead of dwelling on things that will never change.