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That is actually a great trick, it avoids the need to remove a resident's shoes and pants in order to change a soiled pull-up. Assuming your mom is changed frequently enough that her pants don't need to be changed it is quite efficient. The other thought I had is, why not get your mom nighties to wear? That would avoid the dignity issue of her being only half covered. Pants are much more difficult to change in bed and often dementia patients get upset with staff waking and changing them. Also if you want them to get a good nights sleep the less time the resident is disrupted for changing the more likely they'll fall back asleep. If you haven't been speaking to the director of nursing go to her with your concerns, then the administrator, then if still not satisfied go to the regional director. Give them a chance to fix things first.

In some states it is required to be reported; in my state we have to report incidents in which our investigation shows that staff could be guilty of neglect, which includes failure to follow the careplan. When we report the incident we also tell the state of our plan of correction-in this case your writeup would be part of the plan- and often the state accepts that plan without coming out to investigate and that is the end of it. If I were you I would find out how to make sure you are always transferring residents correctly, and if the state does come out and investigate be honest about the fact that you did not know you were doing anything wrong. In my experience it is very unlikely that any action would be placed against you by a surveyor; they are much more likely to cite the facility for failure to train you adequately if they do come out and investigate.

Actually Florida does have LTC staffing laws; I did some research last year for a paper I wrote in my class and found several articles about it. Try this link for an article abstract: Florida's efforts to improve quality of nursing home care through nurse staffing standards, regulation, and Medicaid reimbursement. - PubMed - NCBI

Don't take this the wrong way-I do think the SNF you were at sounds like it has some real problems. But I don't understand why you were just putting concerns on a supervisory report and expecting others to take care of them? Why not contact the Dr. yourself if you have a resident concern? Also, with heel ulcers when the skin is intact it is common not to debride them; often they start as an intact blister and if you do betadine to dry it out it will eventually heal if circulation is sufficient. If circulation is not OK there is probably nothing you can do other than amputation to get to where the wound can heal. Infection is more likely to set into an opened wound than a closed heel blister.

I have one but I think I don't post enough to send private messages-if you can message me with your email I'll send it to you.

Try looking at it this way-she is covering that one day a week that you and one of your full time coworkers have off, so that you can work only 3 12 hour shifts a week with no mandatory overtime. Learn to plan ahead and ask off early and let your family and friends know that they need to plan ahead too so you can make it to important events. Do favors for your coworkers when they need time off and you can help them out, and they will return in kind. Don't be the one pouting and complaining that they can't get time off; if you and your cronies are sitting around complaining about other nurses it's no wonder you're short staffed. No one wants to work in that environment! I could never afford to stay home with my children but if I had 4 under 5 I sure would have until they got older. Trust me, there's nothing lazy about a mom staying home to take care of that many little kids. She's working alot more hours than you are.

Try looking at it this way-she is covering that one day a week that you and one of your full time coworkers have off, so that you can work only 3 12 hour shifts a week with no mandatory overtime. Learn to plan ahead and ask off early and let your family and friends know that they need to plan ahead too so you can make it to important events. Do favors for your coworkers when they need time off and you can help them out, and they will return in kind. Don't be the one pouting and complaining that they can't get time off; if you and your cronies are sitting around complaining about other nurses it's no wonder you're short staffed. No one wants to work with a bunch of whiners! I could never afford to stay home with my children but if I had 4 under 5 I sure would have until they got older. Trust me, there's nothing lazy about a mom staying home to take care of that many little kids. She's working alot more hours than you are.

No, I do not think that workload is reasonable. A C.N.A. might have 10-15 patients to care for (with the help of a float C.N.A. assisting with baths or lifts) but for a nurse to have all the med responsibilities, orders, phone calls, etc. along with all the ADL cares I don't think is safe.

How big is your nursing home? Ratio of ICF to Skilled? Are there different roles you could transition your "good, slow" nurses to? I have one RN who residents complained about constantly when she started as a charge nurse (waking residents up for HS meds because she just couldn't get it done...) She is now our Restorative nurse and does great in that role. Still a little slow with charting but it doesn't hurt in that role...

Alzheimers patients with extremely aggressive behaviors pose difficulties even for facilities with dedicated Alzheimers units. 1. They pose a risk to other Alzheimers patients some of whom may be much more frail than your grandfather. Keeping him from injuring others is the nursing home's responsibility and can be very challenging. 2. Aggressive patients pose a risk to the staff who are responsible for insuring all of his needs are taken care of even though he may be physically and verbally abusing them as they try to help him. 3. Surveyors hold us responsible for declines and poor hygiene, weight loss, etc. even though these patients may be constantly refusing care and abusing staff. As a DON in LTC I have had staff members quit because of patients who have been especially abusive to them. The DON calling your mom is likely grasping at straws for ways to deal with the behaviors so she doesn't lose her staff or get a bunch of state survey tags related to the behaviors that are going on. Alzheimers units are great for the typical wanderer, but don't really do alot to help the physically aggressive behaviors. There is a push to get rid of the psychotropics for dementia but in these types of behaviors they are likely needed. A transfer to geripsych unit to manage medications should be done if he doesn't have a psychiatrist managing his meds. Sometimes the only way to help facilities manage these types of behaviors is to sedate the patient; but it needs to be done by a professional in this area not just the primary Dr. Transfer to another Alzheimers unit might be helpful if the staff are more experienced or lower staff: patient ratio. Not taking meds can be a big problem, have they tried liquid meds or compounds? When I was DON at facility with Alz unit we did alot of med compounding into lotions that the nurses could just massage onto the skin. Not all meds can be compounded but I know we used several antipsychotics, antianxiety, and pain meds. You just have to find a pharmacy with the technology to do it and if we have it in Iowa I bet it can be done in NY....

You need to report her to the DON NOT the state. If you are concerned the DON may not investigate tell your administrator as well. The state will investigate the whole facility not just the nurse;and it could well take months before they get around to it. You owe it to the administration to tell them so they can investigate and fix the problem. As a mandatory reporter you must report this ASAP; if it is true the nurse is guilty of neglect. BTW---if you report to administration and they do not do anything about it in a timely manner (3 days to investigate in my state) and you are sure there is not another explanation-that is when you should report to the state.

I think nurses who are parents just need to be flexible and proactive. Planning family events and holiday celebrations is key! We often celebrate Christmas the weekend before or after depending on my work schedule. Once in a while I do miss an extended family event but that's the price of the job. I don't have to work many holidays anymore but when I was in the regular every other holiday rotation I made sure to be flexible. I would trade with corkers so that they would do the same if something really important to me like a child's Christmas program was on my day to work. I have rarely had to miss anything like that, because I would plan ahead and trade favors to make sure of it.

Before you suggest any med changes to the family or Dr, be sure to discuss it with your DON. A few of the med suggestions here would not be allowed in our nursing home. There is a huge push against antipsychotics in dementia residents and surveyors are looking for it. Not saying it's never allowed for hallucinations, severe behaviors such as physical aggression, etc. but if one of my nurses suggested a Dr. order Seroquel for insomnia I would hit the roof. First thing I would check is if she has any pain symptoms. She might not be able to tell you but why not try some Tylenol at bedtime or when she awakens and see if it helps? Pain is woefully undertreated in our dementia residents. Then-after ensuring all behavior interventions are exhausted--- I would try the antidepressants, we use Remeron rather than Trazadone and it works for some people. Depression is also undertreated in the elderly. It requires monitoring like other psychotropics but it is indicated for use in many nursing home patients. Another med we have been using recently is Namenda as it has been shown to help with alzheimers behaviors as well as slowing down progression of memory loss. Stay away from prescription sleep meds and benzodiazepines. They cause falls and are habit forming. If she is causing severe issues on your shift, especially if a lot of other residents are complaining, write up each episode and leave messages for your DON social worker and Administrator to follow up on. They should then find her an Alzheimers unit where she can wander when she wants and sleep when she wants in a safe environment.

You might expect to see that kind of ratio on overnight shift, but not during the day when you are passing meds and completing treatments, charting and noting orders for that many patients. 20-25 patients to 1 nurse on day shift is common, but we also have MDS coordinator, QA nurse, and Rehab nurses who we call on to "pitch in" and help when acuity level is high. The workload can vary a lot in LTC if you have a fall, sick residents,..