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downsouthlaff

downsouthlaff LPN

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downsouthlaff has 9 years experience as a LPN and specializes in Nursing Home.

Licensed Practical Nurse. Male Nurse. Currently work in the Nursing Home/Long Term care enviroment as a day shift charge nurse

downsouthlaff's Latest Activity

  1. downsouthlaff

    New DON

    Hi, let me just start off by saying welcome to LTC. Although I am an LPN and have never been a DON, I have been working in LTC for 11 years. I’ve been an Asst. in the Activity Department, a CNA, then a floor nurse (LPN), an MDS coordinator, and a Assistant Director of Nursing as an LPN. It sounds as if your facility is in dire need of staff and getting rid of them will be more detrimental than beneficial. What I have seen work, instead of cracking the whip, employee rewards. Get your current staff to want to work for you. Show them that you will appreciate the good work they do. Examples, all nurses that complete all routine charting we’ll be placed in a drawing for an extra paid day off, or a 50$ restaurant gift card. For the CNAs maybe a turn reward program. Place a ticket in the resident room that could be daily prize for the CNA 20$ gas card, a free pizza. It will not solve all of your problems but I gurantee employee rewards will increase production. As far as you not having a lot of LTC experience, find your tenured LPN or RN floor nurses that are held in high regard and listen to them. Make them your number 1 advisors. These nurses know the refs and the rules of LTC inside and out, don’t dismiss them because your the RN, LTC is a different animal and no degree or amount of acute care experience will prepare you. Good luck
  2. downsouthlaff

    How to deal with workplace Drama/Gossip?

    I’m a Work in an LTC facility and you don’t imagine the drama between staff members even in this kind of setting. People are just so entertained by other people’s lives and nothing is gonna change that. When I was a newbie fresh out of LPN school I trained with another LPN who was held in high regard as the best nurse at the particular LTC facility, she was so commited to her job and residents. She had been employed their for 15 years. I asked her what was the secret to her longevity she said staying out the gossip. For the few days I followed her and trained with her, I noticed her responses to gossip when it was told to her. She would reply in a friendly way with “I’m gonna keep my comments to myself,” or “Some people go through a lot, we should pray for them,”. And the gossip would need their.
  3. downsouthlaff

    New grad, 52 residents, anxiety through the roof

    OK first breathe ! This is what you need to do and what helped me tremendously as a new nurse in LTC. One, realize that LTC is very hard. Until you have the advantage of knowing the routine to a T. And it’s still challenging. Next make a check list of every task that you’re responsible for (Medicare charting, weekly room charting, ABX progress notes, chart checking, pharmacy reorder, Glucometer control) make copies of this, check them off as you complete them. Also, make a binder of your facilities step by step processes like sending to ER, a new admission, entering new orders and refer to it each time the situation arises. Just remember the basic nursing practice rules when it comes to nurses notes and when to do them. 1. your facility policy for notes (skilled, Part B, weekly, ABX) 2. Anytime a resident leaves and returns 3. Anytime a NP/PA/MD rounds and or gives new orders by telephone or anytime you notify. 4. any change in condition and prudent action you took (PIE) 5. refusals of care best of luck
  4. downsouthlaff

    NCLEX LPN

    Congratulations and welcome to nursing. NCLEX PN is a nerve wracking test. It really makes you put your critical thinking cap on. The PVT used to be spot on, now we know it’s lost some credibility
  5. downsouthlaff

    Weekend Staffing

    The best for our facility when we had this problem was 12 hour rotations. It worked well for our nursing home. 6a-6p and 6p-6a nurses rotate between working a M,T,F,S,Sone week and then only working Weds, thurs the next giving them every other Fri sat sun off. It has worked wonders for satisfaction of floor nurses at our facility and requires less staff
  6. downsouthlaff

    Do Dept head meetings violate patient privacy ?

    I agree entirely. One of my pet peeves as a CNA for a couple years also. We were told that they can only know the type of precautions pertinent to the disease, but not the disease itself. I also think they should have a right to know, especially before an Activity Director or Social Worker would know but hey I just follow the rules
  7. downsouthlaff

    Active RN license working as an LPN

  8. downsouthlaff

    Active RN license working as an LPN

    I think that you have completely lost me here and do not understand what point I am trying to make here. Yes the RN maintains responsibility for the nursing process. I understand that and I’m not arguing that point with you. But do you know how LTC facilities are set up ?? Do you know the style of nursing that these facilities use? Do you know the level of care that is provided in these facilities? You can sit here and argue with me about all the technicalities until heck freezes over it won’t change the fact that most LTCs use staff nurses interchangeably be it RN or LPN. The technicalities are met. And the law is not being broken. For example in a scenario type situation, “The RN floor nurse is working at an LTC facility, during her Med pass she noted that a patient is hypoxic. She performs an assessment and diagnosis the patient with impaired gas exchange, she applies PRN 02 per standing order, she plans to monitor the patient and notify the NP on call. The NP gives new orders to send the resident to ER for eval, she carries out the order,” An LPN who is passing meds in a LTC facility notes this same scenario, resident hypoxic. The LPN places the resident on 02, and determines the need for immediate intervention, and reports the findings to the on call NP. The NP gives an order to send to the ED and the LPN carries out, the technicality has been met, and the outcome for the patient is the same. And the law of nursing was not violated. The technicalities and word play are very easy to get around and I’m not saying that’s a good thing just saying it’s the facts. And I don’t need to go back to gey my RN to have professional accountability. I may not be responsible for the entire nursing process but you best believe that I am independently accountable for Mr actions and decision making to my board of practical nursing.
  9. downsouthlaff

    LPN to social worker?

    This is not uncommon, despite what other posters have said here you are more than qualified. Surprisingly, state regs for nursing home (Social Service Directors) are very loose. Especially if the facility is under 100 beds. Lay people or CNAs can be trained for the role. As far as the psycho social assessments you are more so gathering the data with an assessment tool. Sock, blue, bed LOL. SSDs are also typically responsible for nursing home payments by the resident, referring residents to different programs, handling resident finances. Bringing grievances to the appropriate department. This position does not require a degrees social worker and most facilities don’t hire them. Yes a usually a CNA or another lay person if the facility is small. Your more than qualified. Our SSD is a CNA
  10. downsouthlaff

    LPN role on a medical surgical unit?

    It entirely depends on the hospital. I’ve seen small med surg hospitals use LPNs as primary nurses for about 6 or 7 stable patients who the only time the Charge RN was called was when a push was needed. The lpn assessed, rounded with the doctor, supervised the CNAs, and basically handled all of the patients primary nursing care and was the patients go to primary nurse. I’ve seen larger hospitals use LPNs as techs, po meds only, blood glucoses, and worked more as an assistant to all of the RNs on the floor. It just depends.
  11. downsouthlaff

    Active RN license working as an LPN

    Hanabanna, you also say that only an RN can assess, analyze, and interpret, and formulate a nursing diagnosis, but your statement is inaccurate. While in every state the RN must coordinate and review the process, some states do allow LPNs to assess, diagnose, and implement nursing care as long as the RN co signs and maintains responsibility. So saying that they cannot is just not accurate.
  12. downsouthlaff

    Active RN license working as an LPN

    Hanabannana, first of all you should know that every state the LVN/LPN is giving a different level of responsibility. In some states LPNs can push IV meds, hang blood, perform assessments in others they can simply gather data. The ANA does not make the rules for state scope of practice. My BON does allow LPNs to peform an assessment for injuries, and then use clinical judgement to determine who to notify. Don’t like that ? Take it up with the state BONs who Allow it. There is no such thing as LPN work. Administering meds, assessing patients, documenting nurses notes is RN work as well. I’m going to go out on a limb here and say that’s it’s perfectly legal for an RN to follow a care plan set forth by another RN. Unless it specifies as closed account written that she can only work to an LPN job description and cannot carry out RN tasks, then the OP has nothing to worry about. A competent RN should be able to carry out tasks of an LTC staff nurse without worrying about legal trouble
  13. downsouthlaff

    Active RN license working as an LPN

    Passing medications is patient care. LTCs hire LPNs and RNs interchangeably all the time. In LTC the plan of care is typically established and the LPN or RN floor nurse implements the care plan. Pass meds, consult MD as needed, Note skin problems wounds etc. I really don’t see how an RN is putting his or her license in jeopardy working in an LTC nurse position being that everything that’s In an LPN scope an RN can legally do.
  14. downsouthlaff

    Active RN license working as an LPN

    If you have an RN license and your working as a staff nurse in LTC, your working as an RN not an LPN. Passing meds and doing routine floor nurse duties is not just an LPN thing in LTC. And no even if your the only RN present, if it’s not understood that your the supervisor you will not be held liable for the other LPNs doing the same job as you. That’s what the DON or supervisor is for. LPNs can work under supervision of the DON/RN or APRN by telephone consultation it doesn’t have to be direct supervision. So if your job is floor nurse, and to only take care of residents under your assignment then no your not responsible as long as the LPN is caring for his her patients within his or her scope and reporting to an established supervisor (DON, NP, MD). In LTC typically there’s rarely any kind of occurrence that an LPN can’t handle within their own scope in Mr experience.
  15. I’ve been an LPN at the same long term care facility since graduating nursing school in 2014. The facility recently hired a new grad RN to supervise and do wound care on weekends. As a new grad RN she always seemed very intrigued that LPNs have so much autonomy in long term care, and that there are so few RNs on staff. Well on her previous weekend shift one of the charge nurses (LPN) who is also fairly new as a nurse, made a medication error and gave a resident in A bed the meds for B bed. She self reported and the situation was handled accordingly. In our monthly staff nurse meeting this RN went on and on about how she’s afraid of losing her license over this and that working with so few RNs on staff she didn’t feel safe being responsible for so many CNAs and LPNs. I then spoke up on the issue and voiced my opinion on the matter, that I didn’t think that she could be held responsible, and that it was my understating that the LPN is licensed and expected to be competent in (p.o.) med administration and will be held accountable for his or her actions, as long as she (the RN) who is responsible for the entity of the nursing process takes the proper action after the med error is made. She then took a tone like she was very offended. My question is, can the RN be held accountable for things that LPNs have been uniformly deemed competent to perform by licensure ? My understanding has been that LPNs accountable for there own actions and wrong doing within their scope, but RNs maintain responsibility for the care plans and the nursing process but not individual actions of the Licensed Practical Nurse as long as it’s something within the LPN’s scope. Just curious. Thanks for the input
  16. downsouthlaff

    Tips from experience LTC nurses

    Hi, I am an LTC charge nurse with 8 years experience. I have been a staff nurse most of this time aside from a short stent as MDS coordinating in LTC. LTC Nursing is different. It’s remote. Your biggest nursing skill used in LTC is clinical judgement in my opinion. Med pass, and Medicare and routine Facilty becomes repetitive. Entering physicians orders, etc. but your judgement will be crucial. You won’t have access to fancy monitors or medical equipment. Just text book judgment regarding issues before you notify the MD. You’ll do great. I love LTC