BeachMurse

You are the patient advocate. Do what a PRUDENT nurse would do. Nurse J is not a prudent nurse. When the **** hits the fan, who will ultimately be held responsible? Stand your ground and do what is right. As stated before, you are not there to make friends.

I also work 11-7. Our CNA's do an initial walkthrough with the previous shift. All residents must be in a satisfactory condition before our CNA's assume responsibility. Any deficiencies are corrected on the spot. After that walkthrough they usually collect required VS and then stock the linen carts. The next round is generally started before midnight and then Q 2hrs. The "final" round includes getting assigned residents up and assisting with ADL's, which can last until 0630 or so. The ratio is about 1:15. Our shift then finishes with a walkthrough with the oncoming shift. The walkthrough is great because it keeps the "blame game" in check and gives the nurses the ability to hold folks accountable when someone is slacking.

On our LTC unit we have a few who are 100+ and mostly the g'ma, g'pa type. Our skilled unit, on the other hand, does have a much lower average age. Most are 50's - 60's with hip/knee replacement or some sort of chronic illness. There are also quite a few that are younger who are ill from drug or alcohol abuse. This area is saturated with LTC/SNF facilities. I would be interested to see the age break down from all the facilities in this area combined.

Initially I was against working in LTC, but my tune quickly changed when I realized that without experience my options were limited. Here are a few thing's that I've discovered in my first year. 1. LTC is very rewarding. 2. My skills are far more advanced than most of my old classmates who haven't been in LTC. 3. I have a new finely tuned set of time management skills.

No matter which hall/unit you work on, get organized before you start your shift. I make a checklist on my report sheet to give me an overall picture of what needs to be done on my shift. I always have a standard format where I list labs that need to be drawn, BS checks, insulins, treatments and folks that I need to chart on and then I list all of the tasks that may be specific to that hall/unit. I add to the the list as needed and check off as I go. Learn about your CNA's. Good or bad knowing their habits will only benefit you. Have a quick 2 min meeting with them after you receive report to keep them in the loop and address any concerns they may have from their initial walk through. Use this time to let them know what YOU expect of them. Communication is key and you may be surprised at how much better folks work when they feel like a team member instead of just an employee. Always say thank you and be respectful. It drives me insane when a CNA brings an issue to a nurse and the nurse responds with a roll of the eyes and a snide comment. CNA's are your first line of care and can be your best ally. Being proficient at the med pass just comes with time. The unit/hall, patients and meds may change, but your overall technique, although interchangeable, can remain the same.