Maddie86

I went on a foot care rampage when I first became a unit manager after seeing the most disgusting pair of feet in my life the first day on my new unit. I could not believe what I found. I ended up making a shower schedule and witnessed and assisted with each resident's shower the first 3 weeks I took over. My CNAs and nurses were exhausted by the last one, but you better believe they understand the importance of skin and foot care for these residents now! Now, on the floor, things are different. What I did when I worked the floor was take a wipe in between toes on each foot and behind the ear of random residents that were scheduled for a bath on my shift. I did that at the end of the shift to hold the CNAs accountable. If they know you are looking, they will do it the right way. EVERY resident should get some kind of lotion or moisturizer to their skin after their shower/bath/during ADL's daily and even more if needed depending on the resident. Also, I preach to my CNAs that "we are only as good a unit as our dirtiest feet". This is true. If your CNAs take care of your resident's skin, half your job is done. Nursing can take care of the rest. Think about it...if your CNAs keep them washed, lotioned and from getting discoloration or bruising or any type of skin damage, their job is done. That means that they are transferring properly, they are performing ADLs appropriately, etc. So...just ensure you do the quick, little things that make it clear to your staff that you are paying attention to what is going on! Meghann

In our center where I manage a unit in LTC, we got cited for an inappropriate intervention for a fall in our last survey. Our state is going after falls hard and heavily. We treat a fall like a crime scene, that is the key. We involve everyone in the response. When a resident is found on the floor, a "Code Star" is called to the location and dept heads and managers respond including the assigned nurse and CNA and any other CNAs that are available on that unit. We have a form the nurse fills out that answers important questions in order to get to the ROOT cause of the fall. For example, if a resident is found in the floor and unable to verbalize what he or she was doing that caused the fall, we take note of all surroundings and examine the resident to determine the need that was not met. The resident may be found to be soiled and there may be no other clue, so we begin a B&B assessment and start a toileting schedule. I've got the highest fall risk resident in our region on my unit and I have gone so far as to have customized furniture made for her by our maintenance dept. With all of the interventions we began since our new fall program began, we have decreased her falls from 34 in a year to 10 this past year. So, it all works...but it is a real culture change. CMS is heading towards a new world and it is difficult, even for me as a "new school" nurse to change my way of thinking to personalized care from a traditionally run unit that is set up to meet the needs of the staff. If you have any questions, feel free to get back to me! Meghann

Hey there! I've been a new UM for a little more than a year now. I have TONS of advice and experience for you. If you are interested, send me an email and I can share some systems that really, really helped my unit. We were nominated for most improved in patient care this year at our yearly conference after the changes that were made out of 130 centers in 11 states, if that tells you anything :) Meghann [email protected]

Hi there, I am a Unit Manager at a facility that was cited for a fall intervention for our last survey. I completely understand this issue. I have become our facility's "fall guru" in working on our correction plan, etc. If you have a resident that has no awareness and is completely unable to provide information for the 5 Whys, start thinking outside the box. Start a social history on him, get his family and social services and activities involved. He maybe worked 3rd shift or had a habit of getting up at a certain time of the night for a snack. Look at the last time he ate, last BM, etc. I train my nurses and CNAs to look at the site of the fall as a crime scene upon finding the resident. We all gather and go through our fall intervention huddle sheet and work together to come up with as much info as possible. Try a med reg review on him, see if there have been any changes lately. Also have your nurses monitor his sleeping pattern for a week or so to try to find a individualized, person-centered plan for his falls. Be certain that this is all on his careplans and documented in the nurses notes in a specific way, tying it all in. Hope this helps!

I am a Unit Manager at a LTC facility. I have worked with dementia in one way or another since the beginning on my nursing career 6 years ago. I'll tell you what I have learned works best for me. Keep it personal, speak softly as you can and make your voice as pleasant and as sweet as you can. Be sure you smile widely or look concerned, whatever suits the situation the best. Smiles go a long way. Your initial approach to a confused and/or a combative patient is key. Try to make eye contact with them and keep it, get their attention focused on you if you can and keep it there. Ask them questions about themselves: where did they grow up, what did they do for a living, where and how did they meet their husband or wife, etc. With a pleasantly confused patient, this works 95% of the time. You did well with the towel folding. Usually if you figure out what they did for a living, you can come up with some creative ideas related to that to keep them occupied. A lot of my older folks used to work at a cotton mill in my town. I have loads of clothes and sheets we bring out for them to get their hands on and they will fold alllll day long. If they did something with their hands, find something for them to do that will resemble that feeling in a tactile manner. Something familiar such as this almost always has a calming effect. I had a little woman who was a housewife. I would go into her room and put things out of place, unmake the bed, etc. She would go back in and clean everything up. Just some ideas, hope it helps!

Hi! I am an RN, BSN. I started out my career 5 years ago in a LTC/Rehab facility. I have some attention issues and the hospital setting just didn't compliment me. I have made a career of it and am now certified in geriatrics and was recently promoted to a unit/nurse manager. After working for so long as a evening/PM supervisor and moving into management, it has come very easily to me because I understand it from the ground up. That being said, I regret very much not trying a med-surg unit first. My husband is also working on his second bachelor's-in nursing. I am very insistent with him that he begin in a large, preferably teaching or state hospital with a tried and true new grad program. I struggled on the hospital floor bc of very little clinical experience and thus weak clinical skills coming out of school. Just some thoughts for you. Hope it helps!

I am a new nurse unit manager at a SNF in upstate SC. I started on my unit about 2 mos ago and so far, I believe we have made positive progress. I have putting together a pilot for my DON regarding a new system in nursing communication/documentation/alert charting/daily task organization, etc...Basically revamping the entire unit from top to bottom. I am searching for tried and true ways of alert documentation, how to mark a pt for alert charting, what they are alerted for, etc. My DON will not allow me to implement the "sticker inside the chart" system, which is what I have always been familiar with in the paper charting world. Are there any nurses out there with experience in reorganizing and/or implementing new systems on a unit? Help!! Any suggestions or ideas welcome!