psychgeribuff

At my facility the doctor can speak directly to the pharmacisit to gain the order for weekend/nights. Then they can give you the code to get into the e box or send the medication. I assume your pharmacy is the same way and they have not notified the nurses of this. It is unethical to allow a patient to suffer with pain.

I have worked with many dementia patients in ltc and psych. Another way to handle the situation in the future is to look at the patient state there name and say "please do not hurt me" once they let go or you are able to remove there hand gently walk away. This is called decreasing stimulation and I have found to be the best intervention in a violent situation with dementia.

♥♥♥♥♥♥-love this post, I believe we are on the same wave length Kevin. I think you would be the perfect Nurse for a geri-psych unit!!!!

Check devices to be in working order. Walker, bed, wheelchair.

I am not sure what is running through the tubing and where it is going- iv, gastric tube,?? If you look in our policy manual at work it will give you a set limit of time to change tubing. Every facility is different. Also last resort you could call up your pharmacist and ask what they recommend. Hope this helped!!

Awe I am sorry, I was trying to be cute not mean. I did not understand the post because of all the abbreviations. If you clarified some of them I would love to try and help!!!

I think my head just exploded with all the abbreviations.

I have liability insurance and have had it since I passed my exam 4 years ago. I appreciate all your input and I will take everything into account. The lawsuit has been made very public and I read about it in the paper it blames the ltc facility for death due to understaffing and undertrained staff. It is such a small communit word gets around even my son's violin teacher was not wanting to preform our annual christmas concert thier due to this.

The ltc facility that I am employed with has a lawsuit filed agianst them. I have worked for them for 3 years and this is the first lawsuit since I have been there. We have always done well with state, have won many awards, and have had a good reputation. How as staff nurses do you deal with this knowledge? The change in reputation in your community? The fear that you might get called in for deposition? And wondering if your managment will notify you about the lawsuit?

First off hugs because it is difficult to deal with patient that are combative/confused/ and med seeking behavior. What you are in need of is empathy, the ability to be in their shoes. And this is made so difficult with the time constraint put on you in ltc. I took a workshop a few years ago that placed me in the shoes of someone with cognitive dysfunction. Glasses I couldnt see well out of, corn in my shoes, head phones with distracting noise on it. Then I was sent to complete a task....it was impossible. Imagine being somewhere you dont recognize and have someone pull your pants down every two hours. So just take a deep breath and always remember that they are behaving this way because of a disease process. Mabe look into further education on geriatric care or dementia and goodluck with the rest of your career!!!

I have the same issue, and I have been at the same place for 2 1/2 years. I think it is how my brain works. The way I get what I need is ask another nurse to help me find it or the medical supply person that stocks the unit. And I always try to pay back the person that helps me.

Awe first off hugs to you, what a mean nurse!! I fill out the incident and ask for a statment after a fall if the cna saw the fall. I am also doing neuro exams (which include vitals) every 15 mins the first hour and every 30 mins the second hour ect. And so on for 48 hours for falls that are not wittnessed. It puzzles me why you are getting the vitals do the nurses go in nd check pupils/hand grips and such as often as you take vitals?

I believe that the MD ordered the fluids for the time it was wrote. So if I were the nurse the IV fluid would be running by 1215 all medications must be given within an hour of the order in my state including IV fluids. Now if I have difficulty gaining access I would notify the Doctor (I have had this happen). Ask what they want to do, usually we send them out if we cant gain access and the lab is critical. If I had been the nurse leaving I would have never dumped that in your lap. I would stay until I got the order complete. Sorry you had to deal with that. Next time let your doctor know though!!!!! That would cover your back.

Is the patient on sinemet or another antiparkinson medication? Mabe he is in pain bc his medication needs adjustment and at dinner/toward the evening his muscle ridgitiy is more significant.

The only thing I would have done differently would be to speak to the health care surrogate. Did they want him sent to the hospital? I personally think you did the right thing. His cancer wasnt diagnosed yet and you had the post form with limites interventions. In the end the MD made the decision you just gave him the facts. You will get the hang of it!

We are professionals and held to a different standard because our patients depend on us. In my opinion leaving without two weeks notice boarders on abandonment.

Yes I do explain the side effects of psychoactive drugs to my paitients and there health care sureogates. They then have the chance to choose thier route of care. I am curious beOne77. Have you ever worked psychiatric intensive care? With psychotic patients?

I work both positions as a prn RN. I love the wound care/restorative position!! It gives you the chance to critically think and your not a slave to that pill cart. As to the routine part it will come. You now have the oppportunity and time to make meaningdul changes. I hope you end up enjoying this new position!!

Well I believe the correct diagnosis is BOB. Bowl on the Brain. I am attempting to get this diagnosis into the next DSM. Lol. Goodluck with the poo!!

Thank you all for sharing!! This theory is how I try and practice. I also try and stress this to the new nurses I am able to orient. I use the example of passing medication and being in a hurry. Your patient needs to use the bathroom and there is no cna to do this task. Your thinking " O no I dont have enough time!!" But rememmber this basic need trumps the pills we throw at them. Put them on the toliet, meet these basic needs please!! They are the most important part of nursing. And enable our patient to start on the next hierarchy of needs. If we dont meet the basic ones our patients lose a lot more than there dignity!!!

I am curious to know how my fellow nurses prioritize patient care and needs. Does anyone ever think about Maslow's Hierarchy of needs? First tier is physiological: like breathing, eating, and excretion. 2nd is saftey: security of body, morality. 3rd tier includes love and belonging. 4th tier is esteem including respect. And last tier is self actualization. Do you follow these tiers and do you believe the patients you care for are getting these needs meet.

I tell them. Makes them more aware of the care they give. I dont want them taking short cuts with me or my kiddos.

I have to agree you sound like a wonderful DON and I would love to work for one such as you. My facility is the same were are the nurses? I can tell you I am staying home with my young children my husband has a wonderful job. But go to work about two days a month. Wish it were more often but my question is where are all the reliable child care workers. Welcome to rural west virginia.

I had two friends that worked LTC out of nursing school for one year and then both recieved full time positions in one of the best ICU's in our area. Experience is what managers are looking for. And not to be snippy but what do you mean "Loosing your skills" nursing school isn't where you obtain your nursing skills it is where you learn the basics. IE the reason why graduate nurses have trouble getting hired. My advice to you is to be proud of what you have done for the past year!, LTC is not easy!!! And follow your heart and apply to what you believe is your dream job!! Good Luck!!

Thank you all for posting your thoughts and opinions. During a monthly meeting I brought up this issue to my DON and medical director. The doctor agreed and said she had been thinking about eliminating medication due to new studies finding them not beneficial. Now at her quarterly meeting with pt she is eliminating medications that are not necessary. This is what I love about the health care field, you can see progress in the best interest of our patients!!