Chel

I'd know the names of the little towns in Lawrence county...I'm in Ironton.

I'm from southern Ohio. I'm an lpn charge nurse in long term care. The plan is to get my rn and teach when getting up at 4am becomes too old.

Our lab draws are done twice a week, unless it's stat. The lab book is broke down by month, with a register for the name, test, date to be drawn, and which doc ordered it. The lab tech initials when the lab is drawn. Critical values are called to us as soon as the lab runs the test, and we page the doc. Non-critical results are usually faxed to us starting around four or five pm. I page the doctor for some labs (pt/inr, dig levels, anything that's really out of whack) and get new orders. I write on the faxed copy what the new order is, the date and time received, and my initials. The rest I fax to the offices and note the date and time on those as well. They get clipped together and passed to dayturn, so they can note the new orders when they call the doc the next day. The order is written on the copy, and it goes in a binder for "white labs". When the signed copies get bacl the midnight nurse highlights the test in the register and files it in the pt chart.

We have certified med techs at my facility. They do the po meds..except for schedule II narcs. The nurses do the med pass for the tubes. They make about 2.50 less than starting nurses. In Kentucky, they have to take a six week pharmacology course, and pass a certification test. Most of them are pretty good. If they have a question, they ask.

...don't forget about the increase (massive) in behaviors. Sundowner's....gotta love 'em.

Collins Career Center, Coal Grove. ...Soon to start an ADN program.

I love my job too, Dinkymouse. Or is it more of a love-hate relationship? I've been at my facility for almost two years now. I left twice, for a couple weeks each time, but came back. We are so understaffed right now (nurses and aides), but even working by myself with 60 pts, alarms going off, phone ringing off the hook, demanding patients and family members, addressing critical labs, taking off phone orders, documenting, documenting, documenting, documenting, med passes, flushes, breathing treatments, dressings, and doctors showing up...I love it. I can't believe someone could leave a pt on a bed pan long enough to cause the skin to peel. Oncoming shifts have a tendency to come up to me after my crew leaves and ask....who had this room...then proceed to tell me they left a dirty brief in the garbage, or OMG!!...didn't empty the trash, or didn't replace the trash can liner, etc. I couldn't begin to imagine what they'd say if they found someone still on a bedpan. I tend to ***** alot about my facility (along with every other nurse there), but after reading these posts I've come to the conclusion that I work in a top rate long term care facility. We just won a safety award for our state...Okay, then right after that had four staff injuries. We have the top skin care program of any facility in our corporation...we currently have two stage IV decubs out of a census of 100...and those were hospital generated. When we see red skin we get right on it. We have a weekly comittee that pictures any skin conditions, addresses them, and follows up on them. Last year we only had three minor deficiencies during survey. The staff development coordinator, DON, and administrator all have open door policies. If there is a problem with a staff member they look into it, or advise you to start documenting incidents to create a paper trail so that action may be taken. If there's a problem with staffing...this one doesn't want to work here or there, and threaten to leave if they don't get the area they want (and that happens from time to time), I have the authority to tell them to clock out and go home. The charge nurse has the final say in assignments...and administration will back any nurse that has to do that. Hmmm. I rambled again. Enough said.

You get six issues a year. It has some really helpful articles...especially for those of us who haven't been around all that long.

Mine doesn't...and probably never will. One of my clinical sites used computers for charting. Soooo much easier. Everything was right there. Last night one of the nurses had to find a couple of labs in a hurry r/t a panic level pt/inr we were getting stat labs on for a few days (doctor was on the phone). They were no where to be found. She was embarrassed in front of the doctor, and felt like a total idiot expecting things to be were they could be found. She never found the labs, but I have a habit of keeping a pad of nurses notes beside me. Everything that goes on gets written there, or when I have to jot down numbers, names, critical labs, etc...just so I remember to see to it. It was still in the shred drawer ~ lab values and all. If we had computers we wouldn't have had to waste 30 minutes looking for them. Hmmm ~ maybe I'll just put that in the suggestion box.

I forgot to mention ~ our low beds are ON the floor. I think we currently have four right now. Chel

Hi ya ~ Any change in elevation is considered an incident. I don't call the family or doctor though if it's late on something like that...unless there's an injury or skin tear. I just pass it on for dayshift to make the calls. Chel

Hmmm, I don't think our MDS coordinators know where the floor is. :rotfl: About the only time you see them is when they're on their way outside to take one of their (many) 20 min smoke breaks. Okay, okay, one did try to help me the other day..on orders from the Aministrator. I had three readmits, and one new admit, one actively dying, and was by myself with 60 residents (I have two cmt's to do the regular med passes), and was working a 16 hour shift. I appreciated the thought, but she was new, and had no idea what to do. I'd just as soon do it myself...but I found a kindly nurse to come in early to help. The DON doesn't work the floor either...but as far as DON's go, she's pretty cool. The other three administrative LPN's don't do floors either. Let's just say the regular staff nurses can have alot of overtime...mandatory, that is. Long term care is not boring to say the least. You learn amazing organizational skills....

Stuff and nonsense. I got my license in Ohio, and then got an endorsement for Kentucky. Fees vary by state. Chel

Yep ~ some things are ridiculous. I had a resident pull a hang nail that bled a little the other day. According to policy, it's an incident. That means filling out the form, calling the doc, and the family. Incident charting is done q shift for three days. Skilled charting is q shift until the resident is discharged from all therapy services, new admits are charted on q shift for seven days, re-admits for 5 days. Antibiotic charting is done q shift until they're off the antibiotic...and any other little changes in condition. Fun, fun, fun.

It's a little late to reply to this post, but what the hey ~ I'll chime in anyway. I'm at the southern tip of Ohio...and an LPN charge nurse in LTC.

On my shift (evenings) it's one nurse to 60 residents. I have one CMT, and four aides. On rare occasions it's TWO nurses...and it's wonderful. If I'm on the other side of the facility it's one nurse to forty residents, no CMT, and three aides....four once in a great while.

Welcome to long term care, Sue. You'll be surprised how attached you become to some of little old people. Don't be discouraged by that list. You'll find you know more than you think you do. You'll also find that it'll be a good three to six months before you're actually comfortable and confident in what you're doing....that's how it was for me, anyway. There's always someone there you can go to and ask questions...and of course you have this board. There's a lot of experience here. Brightest Blessings Chel

Mornin' all ~ I have a favorite little adage. "When in doubt, send them out". It hasn't failed me yet. Chel

Okay, I'll put my two cents in. I'm a charge nurse in LTC. Things are starting to change now, but for the past year I was the only nurse on my wing. That wing has 59 residents with various levels of acuity. I have one CMT who does the majority of the med pass. I do a med pass of my own at 4pm and 8pm to patients that have g-tubes, and for the meds that the CMT isn't allowed to pass...and a few pills in between that are time specific. I do several tube feeds, and a dozen flushes per 8hr shift. I have an average of 8 breathing treatments to be done twice a shift, and a number of treatments. There are all the flow sheets (treatment, behavior, pain, ADL's) and daily charting (new admits, readmits, antibiotic, skilled, incidents) along with anything that comes up during the shift. I round the the physicians when they come in, otherwise, when one of the four physicians we deal with calls back with orders from the problems that dayturn called in, I take those off. I do my glucoscans...I think I just have 10 of those now. And of course, there are the falls, the phone, the families, the visitors. Public relations is a big part of LTC. When I have the time I'll catch a call light. If I'm in the area I'll answer an emergency light or get an alarm that's going off. I also try to feed a patient when I can, but that's a rare occurance. I also have 10 primary care patients that I'm responsible for doing a weekly full assessment on, and keeping track of labs and ppd's. I'm not a "glorified aide". I have my own duties for which I am responsible, but I'm not above taking someone to the toilet or helping one of my four aides clean, change or transfer a patient. I've never been asked to work the floor as an aide. In those instances when we're that short staff, the CMT is pulled to the floor, and another nurse called in to help with the med pass. There are a couple of nurses who will volunteer to work the floor on occasion. Hmmm ~ must have been in a talky mood. I'll stop now. Chel

Hmmmm ~ I think I meant I counted the number of chapters (or was it pages?) and then divided them. I had to force myself to study that much every day.

Hi there~ I set my test date first thing (30 days after graduation). Otherwise, I knew I'd put it off, and off, and off... I divided up the chapters in my review book (saunders), and divided it. I didn't look at a thing the night before the test. It was a two hour drive to my test site and I had kid rock blasting the whole way. When I sat down in front of the computer I took a deep breath, said a little prayer, and did my best. Know your abc's, maselow's hierarchy, and the nursing process. You should do ok. Best of luck.

We have another name for 'on call' nurses. We call them It's on your side, you have to stay over and work it nurses.

Wow. Sounds like where I work. It's usually midnight or 1am before I get to leave. On a few occasions, if nothing happens, I get out by 11. Love that 'pass it on to the next shift' philosophy....I've tried it. It doesn't work. Best of luck to you.

OH, and I'd NEVER sign off on an order I didn't hear with my own ears. I learned that the hard way once. Never again.

Amazing how the scope of practice differs from state to state. I'm licensed in Ohio and Kentucky (work in Ky). In both states LPN's take orders, sign off on them, and carry them out. If someone falls, or we get an admission Lpn's do all the paperwork. The RN's are supposed to do a couple of the assessment sheets (rumor has it), but after 5pm, they're gone.