casi

This has been the trend in skilled nursing facilities. I think they are expecting nurses to job hop for raises.

Paging in LTC really should be kept to emergencies only. I really hate to hear paging at my work, we are a person's home.

I work in LTC so I have a lot of interactions with medics. I give them report, most times I'll stay through their initial assessment or collection of history so I can advocate for my patients, this isn't long at all. Then I'll ask "Is there anything else you need from me?" and go on my merry way. Is the social worker newer at their job? Sometimes social workers don't really understand the nursing assessment and process. She also may have no understood that you handed over all care. Also the patient was discharged at 11am. He was no longer a patient of the facility, so you really weren't his nurse anymore.

We rarely use MoM, it's not even on our house standing orders. Too many renal patients who you can screw up electrolytes on.

Have we seen anything new from this family recently?

We had one recently that when he found out his family was transporting him to LTC grabbed the steering wheel on the car.

At the beginning of the shift make sure your aides know what you expect. It's nice to have a quick report with the aides. "Mr. Smith had a suppository on nights, please let me know if he has results. I need weights on Mrs. Johnson, Mr. Jones, and Ms. Anderson before breakfast. Mr. Doe has been combative with cares, from report PM shift had a lot of luck talking to him about his daughter while doing cares which kept him calm. Oh and Ms. Thompson has Shingles, if you are pregnant or haven't had chickenpox or the Vaccine stay out of her room, otherwise gown and glove. If you need any help holler and I'll try to help." When and if you can help out. As a new grad you'll be running like a chicken with their head cut off, but if you can help a little it helps gain some respect in some instances.

Time to start making changes. Take your med cart and own it. Most places nights are responsible for cleaning the carts. Dig in and waste those loose pills. Reorder medications, call pharm and find out why the heck they aren't sending reordered meds. A lot of places I've worked aides to apply creams and powders. Doesn't take much more instruction than, "Put this powder on Mrs. B's groin." Check the facility policy and if you aren't comfortable with this do the treatments yourself. I personally like to do some of my creams and powders on occasion to see how a yeasty groin or alligator legs are coming along. When it comes to aides (non-TMAs) giving pills I've only done this a couple of times when I was right in the room with the patient, I've had difficult/demented patients who would only take their oxycodone/pudding cocktail from someone who wasn't me. Is this good or legal practice? No, but the patient needed their oxycodone, if it were another medication I may have held it, but some you just can't hold. What kind of morning medications are you seeing given at night? There are certain medications that need to be given x amount of time before specific medications or food. If it continues to be a big problem, talk to the primary (or see if days can) and see if you can get an order, "May give synthroid at 8am with AM medications." The biggest thing I can say is you're the nurse, take control of your residents and med cart.

Nope wouldn't happen in my facility. If a patient has VRE the only roommate they can be paired with is another patient that has VRE.

Lots of hugs in your direction. These types of patients are just heartbreaking. It sounds like you did everything right working with hospice and advocating for your patietn. I'd talk to your DNS about the potential of using IV or sub-q drips on patient's like this. I tend to get hospice or the MD to titrate morphine (or any narcs) up until unconscious. I think the highest dose I've seen was a TCU patient on Dilaudid IV drip at 1-2mg (I can't remember), Valium IV q3h, intrathecal dilaudid q3h. It was pretty insane. Before she started going unresponsive she was on Dilaudid 24mg PO q3h.

I'd be really tempted to write an anonymous letter to the media about the lack of resources. My LTC has more working defibrillators.

Rarely. I'll normally pick up a URI once a year and maybe once every other year a stomach bug. When I first started out in healthcare I picked these things up much more quickly, but that's chagned.

I honestly wish that lotion was just apart of AM and PM cares, especially in the winter months. I'm seeing a lot of excoriation to backs and legs from scratching.

I actually might suggest something like this. I may not say it so bluntly, but I'd point out that the use of MVI and other various vitamins frequently leads to GI upset and nausea. If they are worried about their loved ones intake or nutrition maybe they can bring in food from home or spend meal times with their loved ones.

As long as the pharmacy says it's crushable, crush away!

I worked at a facility that had a shower. Only time I know of that it got used was when a nursing assistant ended up with poop in her hair.

What are you seeing that you consider deplorable? Maybe we can give you a better view of what is going on. I've found that in most placed I've worked we've worked really hard to educate our families and resident's on EOL issues. For the most part most of the resident's I've worked with have had DNR/DNI orders and orders for no tube feeding and in some cases IVs. When you are at a LTC as a student ask about and look for patient POLSTs. Just because these people don't want CPR done, doesn't mean we don't treat them. Grandma can have a CVA or a MI and we are still going to send her to the hospital. Grandpa could come down with pneumonia and we are still going to give him antibiotics if his POLST states it's okay we maybe will have to do IM or IV antibiotics. If grandma or grandpa has something that it looks like they aren't going to recover from or will greatly impact their qaulity of life we'll be talking to the family about palliative and hospice care and changing orders to do not hospitalize.

CapeCodMermaid, I want to come and work with you. I love your management style.

This actually seems a little scary to me. I'm used to management leaving nurses to their own once they are "trained", but the lack of organization and the four days of training for a new nurse seem pretty scary.

I am so thankful that my current place of employment really pushes the idea of chronic urinary tract colonization and only treating symptomatic positive UA/UCs. Also not collecting UA/UCs just because Mrs. Jones fell, is more confused, or looked at a staff member funny. It's really a matter of educating staff and educating prescribers. I also think that we are working with a population that believes there is/wants a pill or a cure for everything. I can't tell you how many patients I've had who demand cough syrup or Imodium after I explain that their cough or their small amount of diarrhea is beneficial in what their body is fighting off. I think that healthcare workers as a whole get sick of arguing are afraid of bad customer service surveys so they become complacent and give patients what they want. AMDA: Publications - Caring for the Ages - October 2002

I've never seen or even heard natal cleft. I tend to use gluteal fold.

How is it safe to not have spare keys?

How much time do you find yourself spending on school work? I've got a toddler and work a 0.8 with 8 hour shifts. I went back to a traditional online school a couple of years ago and the format drove me crazy, I think this would be a better fit and it sounds like something that can go a bit faster. I'm just afraid I'll jump in, be over my head and then waste a lot of money in school.

If he wanted me to feed him, I'd feed him.

In this case I think an order stating 'okay to eat for comfort' and maybe a waiver signed saying he's going against STs recommendations, but then I'd feed the guy!