EdwardDunlap

Get to know your residents well. Get to know their family members well too. Especially those that visit often will save you lots of head aches. The better you know the family and resident the better off you will be. I have been in LTC for 28 years count count the times the family put their trust in me because of those little extras you do for Grandma or Grandpa. I have even been ask to be Pall Barer at several funerals over the years for different residents. I think it all comes down to treating them like you would want your Grandparents treated or you Mom or Dad

Rounds In our facility on the 10-6 shift are at 11-1-3-5. The 5am round is the heaviest due to all the get-ups that days wants up when they come on shift

My wife custom makes most of my tops. I have John Deere tractors, wildlife, and even holiday tops . I don't do scrub pants. I wear Dickies 874 originals exclusively they have about 10 colors in the catalog. That is all I have ever worn.

The standard on nights about the same everywhere I guess. It sure seemed easier in the past night shift way back was just keep them turned and dry. Then autoclave aseptos they were glass then with big rubber bulbs on top. I think we had like 6 meds. The old Doc didn't want his patients woke up at night for any reason. How times have changed. you could cook some great hotdogs in the autoclave. Anybody miss the old days

I would not say wasted just decided I was proud to be an LVN . And was happy doing what I do as an LVN. That was 27 years ago this month.

If you want it go for it . Just wasn't for me. Started once way back was in the second year of a two year program looked out the class room window one fine spring morning saw a couple crappie fishing boats go by on the way to the lake. Asked my self why are you here? Walked over to admin at break and dropped out went fishing never looked back been an LVN for 28 years now figure to work about 12 to 14 more years then see ya later fish all the time.

Wow how do you find the time? I have been on Nights for 8 years now and we are just as busy as the day and evening shift tell me please what I am doing wrong. Typical night in my facility with 75-82 residents split between 2 nurses. Come on shift at Ten take report. Count three med carts for your three halls. Make out your V/S list for the residents in follow up including your Medicare patients Last shift I had 8 on Medicare + 10 on medical follow-up (falls,antibiotics,readmits, new admits, etc, etc). Lets get around and see those 18 folks before it gets to late. Make your notes to chart from as you go along. You also have 3-4 patients on Bi-Pap that need assist with their head gear and all the humidifiers on the BI-Pap machine need distilled water.Your still on the first hall of 3 you have at least 3 people see you pass by and want prns for this or that if its a pain med all the back to the unit to that cart where all the pain meds are. add your pain meds to the to do list you are making you will need that later for the charting you have to do in triplicate on pain meds. The phone rings at the desk you wait on the 4th ring you make a run to get the phone. Good Morning Its a great day at Happy Acres. The required way to answer our phones my direction of the corporate gods in New Jersey are down south in Oklahoma but don't get caught answering the wrong way or hour head will be chopped off. Can speak to my mom one of the CNAS Or the other nurse on the other side of the building cant use the intercom at night so go get them. Now back to hall one and finish there. Start hall 2 if your lucky 30 to 45 mins same with hall 3. Back to the unit. I have the unit , locked /dementia unit with 13 of the sweetest little ladies in the world but they can get on a roll even on the night shift. By now its after midnight closer to 1 a.m.. Get ready to do all your required paper work . Book 1 The Pain Book enter all the prns you gave on the 3 halls on the pain sheet be sure those are signed for in the narcotic book and charted in the nurses notes in the chart told you it was in triplicate. Book 2 The Behavior Book one page for each Psych med or sleep aid each pt is on typically 90-100 pages to initial in 3-4 places. This book also contains the Resp sheets for HHNs, Bi-paps, O2 , and inhalers. The diabetic sheets are here as well make out the FSBS list for your finger sticks later 18 right now. The Day nurse will give the insulin after six closer to breakfast. Book 3 the treatment book for your 3 halls 40-45 pages to sign no real TXs but all things you initial for not covered in the other 3 books. Don't forget the MARS for three halls. Lunch break 30 min that you punch out for but keep working. if you stop and do nothing for 30 min you are 30 min behind the rest of the shift. Now there is those 18 charts to start on 8 are Medicare so start the new MCR for the next 24 hours don't forget your required shift entry on the back of each sheet. Its 4:30 now time for last big push before shift change. Set your pills for morning med pass yes i said pre set there is no other way to get done on time there are 30 people with 6 a.m. meds ( synthroid, protonix, pepcid, various ac meds)depending on the day of the week. Now if you have had no falls or mishaps requiring the 10 page incident report, no one to send out , or no admissions to finish from 2-10 shift you might get done. Is this typical of all places? How can I do all those extras you do.

I have now been in LTC 28 years and have seen lots of changes. The changes have not been for the best. When I first started we cared for the resident and not the patient. That was the difference I think. We knew each and every one as individuals. 28 years ago I started at a facility with about 80 residents. The 1st and 2nd shift was staffed with one nurse one medication aide (CMA) 4 nurses aides (CNA) the night shift ran with one nurse and 3 aides. Guess what we took care of business deficiency free always. The difference much less regulations. We had two physicians that cared made rounds frequently. These two guys lived in town and would come in the middle of the night if needed. They even came an pronounced when we lost one of our folks. The Docs ordered a med they got what was ordered no switching to this or that. We got our admissions in a timely manner not at 7 or 8 at night if the hospital sent someone it was before 2 p.m. or they waited till the next day. The pharmacy was local not a big corporate one. All our MARS done in house and not on the last day of the month either. The nurses all looked out for each other we helped shift to shift. As the older staff left and newer ones came the atmosphere changed. Its more me me me and less team work and looking out for each other and the resident. When I started the DON had been there 25 years and was an LVN she ran a tight ship. When the new RNs came when the state said LVNS cant be DONS any longer the team work was lost it seemed to be all about them most had no clue how to manage a home. It became more and more about paper work an less about the resident they became patients not residents. And yes we loved our residents then and now some become just like family. We feel a loss when we lose one.Some we will remember for ever. My first wife and I were married in the flower garden of the facility were we worked with all resident attendants. When I lost her to cancer many attended her funeral. We have forgotten that we are taking care of "America's Greatest Generation" to borrow a term. It scares me to hear folks say or I guess propose care based on cost. That older generation should get the best care no matter the cost.

I have been an LVN for 28 years there is not much in nursing that I have not done. I think the older a nurse/RN is the more they respect the role of the LVN/LPN. The younger nurses/RN some times don't have a clue when it comes to clinical skills. I still remember the RN that could not take an E cylinder a regulator and canula and make them work. Then there was the RN that Thought the oxygen cylinder was empty did not know you had to open the valve. Lets see I remember the BSN weekend supervisor whose calculator went dead and could not calculate a drip rate for an IV the old fashioned way on paper with the times tables and long division. I remember the Diploma Graduate RN that taught our LVN class always said "The LVN knows the how the RN knows the why." I have worked Long Term Care for 28 years now and am proud of my status as an LVN and have no desire what so ever to be a RN.