baygrl11

Totally agree. In the beginning of my career as a licensed nurse I used to focus on what the CNA missed or forgot to tell me. Now that I've seen what a difficult job it is I am thankful for the times they found something and informed me...and I forgive the little things more.

It was not my intent to call nurses of LTC's or anybody who works in a LTC a joke. LTC nurses are hard working and commendable. I am frustrated with the fact that workers in LTC's are held to impossible standards. Bottom line I feel like if the government truly cares for the elderly/residents in LTC's then there should be better staff to patient ratios. It just makes me angry that they expect so much, and know that a "show" is put on for them during survey. Why? My facility always knows when survey is coming, within a 2 week window...shouldn't it be more random so facilities will always be in "survey mode"? So yes, wording of my title was bad. Sorry...love and respect to all who work in LTC's, we all deserve it!

Oh wow, I love that!

Exactly! Set to impossible standards that are really only "enforced" once a year when it's survey time.

Don't state surveyors know that med nurses (and other nurses for that matter) cannot possibly do everything the job entails? That it is impossible for one nurse to pass meds to 25+ plus patients within the 2 hour window "by the book"? That the facility basically puts on a show once a year when they arrive? I especially feel for CNA's. Its bad enough to be on the bottom of the totem pole, so to speak, as far as pay and "status". Its such a difficult job, especially when there are so many patients to care of in an 8 hour period. What makes the department of health think its okay or feasible for one nurse to care for so many patients? It almost makes me sick...it really takes a special and strong person to work in LTC's for many years. Okay...rant over!

I work for a facility who absolutely will NOT give raises to ANYBODY. It is a for-profit company that I believe does very well. I believe I am an asset to the company. I am reliable, work well under pressure, rarely call in sick. I try to be a good leader who puts patients first and makes sure they are safe and happy. This company recently helped pay for extra education/certifications (which was 100% for the company and not MY benefit) and I would feel kinda bad for leaving after they paid for this extra education for me. However, I have not had a raise in years and don't foresee one in the near future. My wage is fair, but I know I can make more money somewhere else especially with my new education/certificaion. Just wanted some input on what others think.

YES I got my license 5 years ago and I felt like I learned 95% of my skills and knowledge on the job. I felt like nursing school prepared me for taking NCLEX, but not for working as an LVN. It took me probably 1 1/2 years and 2 jobs as a med nurse until I felt like I was proficient as an LVN. The sad thing is I felt like I had to make so many mistakes, and that is how I truly learned how to do things. Good luck girl, hang in there, you're not alone! :)

I am hoping I can be non-specific and say "medical issue".... and you're right about being able to trust my managers. I do for the most part, but you never know. I guess I just want a job to come back to, regardless of who knows about my issues. I want them to know I can still be trustworthy and a good employee, and hopefully if I end up taking the leave I will come back a better person AND a better nurse!

My doc told me I would be able to get disability pay while undergoing the CBT program, so I am pretty sure I have to tell them I am sick in order to get paid

Hi everyone, I have worked at my facility for 4 years. I believe I have built a strong relationship with my employers (I love my job, have excellent attendance, only written up once for a minor etc). To make a very long story short, I have bipolar disorder/anxiety that has been under control for years, with medication. Very recently I have relapsed into a severe depression. Work has been a source of "stress relief" for me for quite some time, but my psychiatrist thinks it is only a matter of time before I experience a major breakdown. She is recommending I take time off work (about 6 weeks) to undergo a cognitive behavior therapy program. I love where I work, and I have no idea how to bring this up to my administrator. Nobody knows about my illness. I keep my personal matters to myself, and rarely socialize with my coworkers just to keep things professional. My personal life has deteriorated badly, and I believe my quality of life will improve if I go through this therapy program. My psychiatrist told me I can take the time off under california FMLA (she will provide necessary medical documentation, but it will be coming from a psychiatrist.) I have looked through the employee handbook, and it looks like I can take time off with medical documentation. I guess my question is should I take the time off? I don't even know how to bring this up to my administrator! Nobody at work knows what I am going through. I don't want rumors to start, and for word to get out about my "condition." My other option is to have my medications increased, and to continue to work....its just that my body is so tired of these meds. I think I am ready to really do intensive therapy. Just not sure I can take the time off, or if I will even have a job to return to. ((sigh)) Any thoughts/opinions on how I should approach this? Thanks guys

Would it be strange or inappropriate to keep in touch with a patient after discharge? Really because of a close patient-nurse relationship that developed and NOT anything personal or romantic. I guess just to check in on this patient's health issues in the future, and maybe an occasional "hello hope all is well". Any thoughts?

$26/hr California

I work with a staff of CNA's who are mostly helpful and work as a team. However there is one CNA who is very sarcastic, rude, and her comments are often times unnecessary. I have friends who work in the front office (not nursing) who also sees this rudeness. I have not asked other nurses about it, because I don't want to seem like I am badmouthing this girl BUT I'm pretty sure a lot of them feel the same way. Its just that nobody says anything. Its getting increasingly difficult to work with this girl. She doesn't like being told what to do...I mean, she does it but there's always a sarcastic comment coming out of her mouth. She seems to say just enough to get away with it. What should I do?

All you wound care nurses out there--what is your favorite tip/trick/tool that you use daily? A wound care nurse at my facility has one of those head lamps glued to her head, and I covered for her one day and used her little gadget. It was really helpful in seeing the wounds better because the lighting is horrible where we work. Anyhow, I was wondering what YOUR favorite wound care "thing" is.

Suppose a facility has several incidents of suspected abuse, major med errors which kept a patient sedated unnecessarily for weeks, and other things acknowledged by management, but unreported by administration. How does one go about reporting to the health department? If you could provide a phone number I would appreciate it thank you

Thanks for the reply and for the "I understand." I too used to love going in to work, and now I take two motrins before the start of my shift!!! Despite all that, let's be happy we have jobs we're good at. I'll try to think positive thoughts. I hope things get better for you too!

I love my job. I really do. I was a supervisor and decided to go back to direct patient care, on the floor. I feel like I am very good at my job. I am always on time and I rarely miss work. I am reliable and I think I have good critical thinking skills. I am very comfortable being on the floor. We all know that nursing (pretty much no matter what "specialty") is stressful. Although I like my job and feel like I am good at it, I have become very irritable and bitter at my coworkers, my supervisors, and upper management. I find myself finding other nurses' mistakes and finishing tasks (mostly paperwork) that they should've completed. Instead of taking initiative and dealing with changes in condition etc they wait for me to do new orders. I am very vocal about the problems I've been experiencing, but instead of getting help I feel as though I am being labeled a "*****" which I am far from it! No matter who I complain to, nothing changes. My supervisors understand, but I receive no support from them. They always act like they have better things to do...and maybe they do! I feel like I am frustrated and irritable at the staff for this and sooo many more things. I am not getting any help from anyone. I am literally carrying this facility on my shoulders with NO support, NO help. My phone rings at all hours of the day, including my days off, and it is always work related. I feel like it isn't rocket science and they need to figure things out without relying on me so much. I like my job a lot and I like my position at work. I also like my schedule very much. HOWEVER I don't expect things to get better. I am pretty sure I won't get a very good pay raise at my upcoming review. So.....when is it time for me to move on? I am well aware that the grass is not always greener, but I am thinking this current situation is unhealthy for me. Any advice or words of encouragement will be appreciated :)

First job hired at 19.00/hr. 4 years later, different facility $25.50/hr

I have been a licensed nurse for a decade and have worked in about 5 LTC's and one LTAC. Of all the DONs I must say my current one is by far the laziest and most useless. She is never on the floor, never knows what's going on with any admission/patient. She comes in at exactly 9:00am and leaves at exactly 5:00pm, taking 2 hour lunches. She is Asian and ONLY hires Asian nurses, most of whom she has some kind of personal relationship with (family, friend, etc). most of our patients are Hispanic/Spanish speaking only and NONE of her new hires speak Spanish. Only about 1-2 nurses per shift speak Spanish fluently. Our ADON and our DSD are the exact same. They have no idea what is happening on the floor, never answer call lights. As a result all the CNA's are lazy, whine all the time, take breaks whenever they want to. The licensed nurses are either too busy to care or are too nice. I don't want to quit. I just want more structure. We have an awesome facility, that can be so much better, if we had supervisors that actually supervised, favored people less, we're consistent with management style.

First of all, "study" and know the proper way to dispense medications, remind yourself to do identification checks, necessary vitals prior to medication administration, etc. I kept this sheet on my cart in the weeks before state came, and "studied" daily. When state shows up, I did the difficult patients first--GT's, people with eye drops, etc. As soon as I received report and counted narcotics I was on the floor and started right away with rounds, etc...get as many things out of the way so you can focus on med pass and not making any mistakes. . I saved the "easy" patients for last--the ones that were very compliant and took medications orally. Remember to wash your hands before and after contact with patients. Do the ID checks. Check the medications against MAR, the route of administration, all the "checks" for med pass. Ask your resident if they are in pain. If you have to practice with a coworker! Role play! Hope this helps a little, I'm sure there's a lot I missed but that's what I can think of for now :)

I am experiencing an increase of facility acquired pressure ulcers at my LTC. (mostly stage 2's and a couple stage 3's) I am the only wound nurse Monday-Friday. It is a 100-bed facility with full census at the moment. We have a lot of confused and immobile patients who I suspect are not being turned/changed as often as they should be. Does anyone have any ideas on what I can do to ensure they are receiving the proper care? I feel like nobody cares about pressure ulcers in my facility but me. I can't blame one person, its a team effort. Tomorrow I plan on signing briefs of the high-risk/confused patients at the beginning of my shift and noting which way the patient was turned when I see them, then rechecking throughout the day. I do not know what else I could do, if you have any suggestions on what I could do to 1) make sure patients are being turned/repositioned/briefs changed 2) How I can prevent future pressure ulcers, please let me know. I feel like I am one person and I cannot "police" a 100-bed facility to make sure briefs are being changed! Thanks so much!

I am experiencing an increase of facility acquired pressure ulcers at my LTC. (mostly stage 2's and a couple stage 3's) I am the only wound nurse Monday-Friday. It is a 100-bed facility with full census at the moment. We have a lot of confused and immobile patients who I suspect are not being turned/changed as often as they should be. Does anyone have any ideas on what I can do to ensure they are receiving the proper care? I feel like nobody cares about pressure ulcers in my facility but me. I can't blame one person, its a team effort. Tomorrow I plan on signing briefs of the high-risk/confused patients at the beginning of my shift and noting which way the patient was turned when I see them, then rechecking throughout the day. I do not know what else I could do, if you have any suggestions on what I could do to 1) make sure patients are being turned/repositioned/briefs changed 2) How I can prevent future pressure ulcers, please let me know. I feel like I am one person and I cannot "police" a 100-bed facility to make sure briefs are being changed! Thanks so much!

1) When do I do a pre albumin level on a wound patient (upon admission, after wound won't heal???) Also how often should I do it after the initial one? 2) When should I do wound cultures? Do I need to do wound cultures on new patients with wounds, even though the wound does not seem infected? Should I do wound cultures on new pressure ulcers (stage 2 and above)...also when/how often after the initial culture should I repeat the culture? Thanks guys :)

I am a charge nurse at an LTC. There is a med nurse at my ward that I can prove skips multiple patients on med pass. Its not obvious but can be proven if investigated. Nobody wants to narc her out to the director of nursing. Is this something that should be reported to state?