Bird2

It is very important in LTC to know the paperwork and procedures. I wish our facility had a process that you are describing. Once you have the paperwork down then you should start with med passes, assessments and treatments. Good luck to you.

We got tagged for the same scenario. You should not sign out until the meds are given. I see many nurses place a dot in the box as they pop them out just as a reminder that they did place the med in the cup.

We are a smoke free facility and all residents are told prior to admission. If they are alert, oriented, can sign themselves out, and take themselves out then they can smoke. Staff can not assist them with getting out, lighting the cigarette, etc. If they can not abide in a safe manner we step in and stop the activity. Usually we end up paying for the patch.

I also just attended an inservice on c. diff and quite truthfully it shook me a bit. My first thought was the big push we have all done on hand hygiene/alcohol hand sanitizer. Did we inadvertently spread the spores? I was very proud of myself for using that gel and praised all employees that I saw using it properly. Any thoughts or am I over thinking in my very tired state?

In the ADN program that I completed the Capstone was the last week of school. We chose an area of nursing that we were interested in and then found a preceptor that agreed to work with us in that area. We then worked side by side with that one nurse for a 40 hour week to "see" what that field was like. If they worked midnights then we did also. If they wore professional clothes so did we. The Nursing instructor was available by phone if we needed her. We updated the instructor via e-mail every day. It was the finale of our program. Some of the areas that students worked were Hospice, Wound Care, ICU, Management, ER, etc.. It was the best part of the entire program.

We do daily charting on Medicare. Hall A is done by dayshift, Hall B by PM's. They rotate halls every week. Vitals are done daily. Every shift does charting plus vitals if the pt is on an antibiotic, had an incident, etc. With the daily Medicare charting we get more details than if the nurses are trying to chart on 26 residents every shift.

It would depend on your facilities policy but we initial then circle our initials. Then on the back of the MAR chart "med got given d/t pt being out of facility" or meds sent with pt. Then we chart in the nurses notes what time they left, the condition they left in, why the meds or treatment s were not completed, if they received education on the meds that they would be taking per self and what time they returned.

The worst that can happen is they will put you on a do not rehire list. Basically you got do what you got to do. I would not risk not getting the new job.

Barrier cream is a great idea. It will protect the area from further breadown. If the drainage is excessive you could try a thin layer of a zinc based protective barrier. I am so sorry that your husband and you are going through this ordeal. Has any nutritional areas been addressed and does he have a pressure relieving mattress and cushion?

Your co-workers are misinformed. They are different organisms and you won't find the info documented because it is not possible. Also, good for you for not believing everything that you are told. I am a firm believer in researching the topic myself or speakng to an expert. Do you think they were pulling your leg or did they actually believe what they told you?

Just like Suebird I have only worked LTC. First as a LPN and now as a RN. I knew deep down that Hospital nursing was not right for me. I love LTC. It is very rewarding. I did not allow myself to become stagnant. My priorty was learning the skills needed and learning the regs. Good luck to you.

I would be upfront with any facility that you are applying. It cost a great deal of money to train a new nurse and a lot of time. The LTC I work gives new grads a minimum of 3 weeks of training and then they need months of working with a strong nurse that can answer questions as they arise and guide the new grad. I have heard that many LTC's give much less orientaion and may be willing to hire you. If you feel comfortable taking a job with less training they may give you a chance. Good luck to you.

I always float heels even if they have an alternating mattress.

Your recourse if calling the Department of Public Health. If your are concerned about someone finding out that you called then tell no one. Not even your best friend. You do not have to give your name but help the DPH out by giving them specifics such as dates of when food and other supplies ran out, give names of managers that were given the notifications. I do not think that reporting your workplace in this situation if being nasty, you are just being a patient advocate. If you stress the seriousness of the situation they will arrive quicker to assess and remedy the situation. Places like this give all LTC's a bad name. Good luck to you. You are a caring person that can make a difference in the LTC world.

Literally ran out of food??? Call the Department of Public Health! The facility should have gone out and bought paper towels, food etc while they waited for the supplies. If I have read your post correctly all of your residents have been placed in a potentially dangerous situation.

The facility is responsible for meeting the residents needs if the family won't. I believe that the family can not dictate the care. For example if this resident had a pressure ulcer and the family would not pay for the dressings the facility would get cited for improper nursing care if they did not provide the care and put interventions in place. The MD and care planning team should be deciding what is best and of course getting the families input and keeping them informed You may have to supply the meds etc then attempt to go after the family for the financial costs. Keep us posted I am curious which way this situation will go for this resident and your facility. Anyone else out there with any insight???

If I were you I would get the ok from the D.O.N, Social Services, and the family. I clear plan should be in place to protect you, the pt, and your facility. All interventions need to be clearly documented.

Another problem with not making an incident is that the resident could have still been injured. Years ago I had a resident roll out of a low bed onto a mat and they fractured their wrist. Or ecchymotic areas could pop up a few days later leaving staff scrambling to do an abuse investigation.

Nice way to explain that. I omitted that part but I usually think of length and width as looking at a clock. I like your way better. Thanks.

I would not refer to the ulcer as a pressure ulcer. It does not sound as though pressure caused the area. The hardware probably caused the area. I would read all of the documentation from staff and the MD's to get the correct info on this area. I would be interested in hearing what everyone else thinks.

Good morning Boynurse07. You should measure in centimeters. Measure length first at the longest section then width at the widest section then depth at the deepest section. To measure depth gently insert a cotton swab and were your fingers meet the edge of the wound measure that area on the cotton swab. If depth can't be measured but the wound is open then mark it as

How about insensitive, unprofessional, and down right ignorant. Not to mention a Hippa problem. That nurse needs some training on end of life care.

I actually work with a manager that tells staff to come in because they are short staffing us. When I am the one on call I refuse to tell a staff member that they can not call off. Makes me unpopular with this other manager but Oh Well ! I also take care of the Infection Control and will not risk the residents and other staff members health. Yes I have had call offs claiming illness only to find out they were at a party but how can we live with ourselves if that employee was truly ill.

Medicare.gov/nursing home compare is approx 6 months behind but you can still view the most previous and last 4-5 years worth of surveys. I woud do a walk through tour before asking for a tour from the facility. Just walk in like you are a visitor. That way you can see if it is clean, has odors, if the residents are happy and well groomed. Once you have the quality indicators from the web site then you can ask them specific questions for example if the site shows a high number of pressure ulcers. They may have a lot of admits with ulcers because they are good at healing them or they just may have a poor skin program. Good luck.

Just do a search on YAHOO for AHCPR guidelines. I received mine at no cost from our wound care supply vendor. Although I believe they are under 20.00. Someone in you facility may have them sitting on a shelf and not even know what the book is.