misstrinad

I have worked in LTC doing 8s for 7yrs, we don't do 12s here. I like doing 8s because my entire day isn't shot, I can still run an errand after work and get home when my daughter does and cook dinner and have time to do things in the evening. I also only have .6 bid so it's easy for me to pick up OT. I do about 2 double shifts (16 hrs) a pay period and my OT pay starts as soon as I've been on the clock for 8 hrs. So if I need to stay late to chart or meet with the supervisor I get paid OT wages. If I worked this .6 as 12 HR shifts I would have to pick another 12 HR straight time shift to hit 80 hrs for the pay period, and then pick up more to get any OT pay. I'd rather do 2 16 hrs shifts and 4 8s and get the OT pay. Having a low bid also makes it easier to get time off for all the camping I do in the summer.

I'm sorry, but having had an AC IV multiple times I would definitely classify 72 hrs of an AC IV as a 'little discomfort' and not worth even thinking about compared to the issues that brought the hospital stay on. If the biggest issue a patient has is their IV site then they probably aren't sick enough to be in the hospital. Yeah, it's a pain in the butt, but that doesn't trump the fact that medically speaking everytime a new IV is started there is an increased risk, health risk trumps mild discomfort. Everytime.

You did the right thing. Honestly I would report the facility for threatening you, although that becomes a he said she said unless others have lodged the same complaint. Other facilities I'm sure will be aware of the shoddy reputation , just explain during your interview when it comes up. Any facility that doesn't understand why you didn't accept that unsafe assignment isn't a facility you want to work for anyways.

When I was a cna And started at 6am I used to use a before school program that opened at 530 and was able to drop my daughter off And just barely make it to work. Is there any way you can drop them off at school at 615 and make it to work on time? Or is there a friend, grandparent , sitter, daycare you can drop the kids off at and they can take the bus from there? Otherwise finding a sitter to come to your house in the morning is your best bet...good job for a college student wanting to make some extra cash before going to class. As for the rest of your question......Starting so early is sticky...when I started my first nursing job I started at 7am....luckily my daughter got picked up by the bus at 640 so I had just enough time to make it there. As a single parent I work day shifts....but depend on my family to help me when I get mandated for doubles or need some OT . I would like to switch to the hospital but would have to work swing shifts and wouldn't have a set schedule plus would have to start earlier (and I'm not interested in working in a clinic)....Instead I'm staying at a LTC facility for crappy pay because it is 5 minutes from my daughters school, 12 minutes from home, I work straight day shifts, my schedule is set in stone for am unlimited amount of time, And I don't start until 7am. Until my daughter is older this is what works for us. Facilities have different start times....maybe you need to look into working else where if the other options don't work out.

At my facility on nocs there is 32-50 pts on each unit and only 1 nurse and 2 CNAs and no supervisor or manager of any sort. The noc nurses Handle it just fine. That said, if you walk into work and suddenly they attempt to double your pt load and you aren't comfortable with that then I feel you have the right to refuse the additional pts. I had situation a few months ago were I got floated to an unfamiliar unit and was told that 2 hrs into the shift I would be required to take on an extra 12 pts due to there not being a nurse to cover the other med cart and I refused. It was literally an impossible task to even finish all the meds due during the shift due to my lack of familiarity with the unit. Best of luck and I hope you are looking at other facilities.

We use them at my ltc facility. I have used them on many pts during end of life care and can't say I've ever seen sores. I do alternate them with plain swabs with mouthwash diluted in water and we have a mouth moisturizer paste I use a lot of as well in those situations. I will mention it to my infection control nurse and manager. If you can find the study it would be greatly appreciated.

It sounds like no one there is interested in listening to your concerns and there is little you can prove. I would honestly start interviewing at other facilities and feel them out about advancement opportunities. It's always nice to work your way from the bottom up in one facility but perhaps you could move straight into management at a different facility. Good luck, it sounds like a very frustrating situation.

Oh, get to know who the Coumadin patients are so you can make sure new orders on INR day are followed up on. I don't know about other facilities but we do our INRs in house on a portable then fax to Coumadin clinic then they fax us back with new orders and sometimes they come in late and if the nurse working isn't watching for it and gets it faxed to the pharmacy right away we don't get the new dosage delivered until after 8pm or not at all.

This is an amazing answer, I don't have much I could add to it. As a nurse in ltc I depend on my house sup for anything that happens that I am not sure how to handle. Get to know your nurses. When I was new I was calling the sup all the time with questions that now seem silly. Now my sups know I can handle most anything and they are able to spend more time helping on other units. When you come on shift and make rounds to each unit check for orders that need to be 2nd checked or processed because I frequently see orders written at the end of shift and I don't have time to process them and the on coming nurse can't deal with it immediately. Make rounds a couple times a shift and check in with each nurse in each unit, staff will feel like you are really there to support them if they see you a couple times a shift, even if they don't need you. The most frequent comment I see about some sups is nurses complaining they never see them all shift. Good luck, it's a hard job and you will wear many different hats.

Great post! I loved it.

There's good and bad aspects of working in ltc. I have worked in ltc w alzheimer's patients for over 5 years now (1.5 as a nurse the rest as a cna) I love it but one day want to make the move to the hospital for more experience and better pay. You work your butt off in ltc and the time management skills you learn are amazing. It's great patient care experience and in my area ltc facilities provide a set schedule that doesn't change, unlike our hospitals where your schedule changes every 2 weeks. If you continue to look down on ltc you won't be happy doing it. But perhaps the experience will bring a new respect for the work done by ltc nurses. There are very few things in life more special than taking care of the eldest most fragile population of patients.

Too funny! Just remember not to use real names

When I was a student The hospital I did all my clinical rotations at did bed side report, however a large portion of report was conducted in the hallway right outside the room in hushed tones. We poked our heads in so the pt could be informed of shift change and meet their new nurse and ivs and such could be checked on, but the rest of the info was passed on outside of pt ear shot. I liked the system, however we frequently had to pause and wait for visitors, pts, and non medical staff to finishing passing by so they did not over hear.

I am a nurse that used to be a cna in ltc and I never order my aides around. And I help them as much as I can. I can't stand it when other nurses order aides around that are clearly doing their best and working hard. You need to go to the manager. And next time you tell her "its going to be 5 min before I can get there I am busy with pt x, unless you want to come take over in here for me I have to finish with this pt first and then I'll be right there" If this continues its time to look at switching to a different shift, unit, or facility. Good luck, and use this nurse as the example in the back of your head as the type of nurse you DON'T want to be. It does get easier, in a few more months you will have gained a lot of experience that will help make day to day tasks easier.

I would check into some training seminars either on the web or conference style to assist you. Make sure you get adequate training, including learning the jobs of anyone under you that you have not already performed (at my facility each unit has an rn manager). It's nice to hear your facility is promoting from within and also someone that has worked their way up. Make sure you feel ready for the position. I was pushed to apply for supervisor and manager positions but having only Been a nurse for about a year and a half I refused because I feel I don't have enough experience. Best of luck!

Out of my 30 dementia pts I currently have 1 that could quality to be a&ox3 and several a&ox2. Most only to themselves, and the rest to none. I don't chart it on most of my pts, because like you mentioned there is no need to. However on a fall f/u (the example I used) I do, if we were doing Neuro checks (in that case they either hit their head or it was unwittnessed ) I feel the need to check and document a&o status. Hope that helps clarify how I chart with dementia pts.

Scheduled meds should all be on their own sheets, then prn meds, then tx. I like all the diabetic orders on their own sheets put in the front but I've found other units prefer to leave their diabetic orders hidden in the back. On my unit we hand write the diabetic sheets so that we have space to legibly write bg numbers. We used to do an additional flow sheet because the bg numbers were being crammed into one little box and no one could read that, and if a Dr wanted to see the bg over a month period then you had to sit and rewrite everything or the flow sheet would end up with tons of blanks so we converted over to putting it right on the Mar.

do my best to include my CNAs under me in my plans.... Like giving supps or mom I ask them "when will be a good time for you before breakfast? I need to make sure you will be available to assist the pt to the br as I will be dealing with xyz " when I request they do something specific I include my reasoning "i need you to get pt x oob for breakfast this morning because I need to have a chance to monitor his response & vs before therapy comes at 830" I've found that going beyond just telling the more experienced staff under me what to do has helped Make sure that you are acting as a team player as well, try to get to know your staff, bring some treats in once or twice a week for them. In other words try to bond. And make sure you compliment good work, but make sure it is sincere and deserved or they will be able to sniff out that you are purposely dropping compliments. If your discipline policy allows for it perhaps you can pull them into a verbal coaching meeting with you and your immediate supervisor before doing an actual write up. Help them to see you mean business and your supervisor is backing you. If that's not possible or if it was more than a minor issue then you will have to suck it up and do that write up. You don't want to be seen as a pushover but you also don't want them to fall into the 'its us against her' mentality.

I would mention to the manager just incase other nurses need a reminder on what A&Ox3 means, especially if you are seeing that written for pts you are pretty sure are not. What I started I asked a couple managers to look over my charting to see if I was documenting the way I should. With Ltc I chart only when there is an issue/change/follow up needed. Keep it simple but cover all your bases. An example on a fall follow up might look like: Resident A&Ox1. VSS WNL, Neuro checks WNL and completed. denies pain, no s/s discomfort/distress. ROM WNL. Ambulating independently c FWW s issue, steady gait. Up for breakfast in DR, ate 100% 360cc. Refused lunch, snack offered at 1400 declined x3. Incontinent x2 this shift, check and change q2h implemented. With dementia pts I find it important to not only write denied pain, but that I don't see any symptoms of pain because frequently they can't verbalize pain correctly or if not at all then of course you can't write 'denied pain'. Document reapproaches and alternatives that were attempted. If a res if having behaviors our np s and drs like to see more than "restless despite multiple interventions " they want Me to document all the interventions I used...toileting/position change, food/fluids, ambulation, music, massage, prn meds, 1:1 time, etc. They also dont care to see "anxious" without more description ex: pacing halls for 4 hrs, unable to sit to eat during meal time, looking for husband and unable to distract/comfort/redirect. Hope that helps, each facility will be slightly different.

Death of a pt is never easy. You did the right thing did all that you could, some nurses wouldn't have caught such difficulty swallowing right away. I agree that sobbing with the family is not the professional way to act. Letting a tear or two slip by is one thing but otherwise the family needs you to be their rock during their time of grief. I don't have trouble with the deaths of my residents except when the family gathers Me in for a hug and cries on my shoulder. It takes everything I have at that point to hold back the tears And be strong for them.

In northern mn I've never heard the term walkie talkie until I saw it on this site. We just say independent. We do use terms like feeder or total.

I also love that I have a set 2 week block schedule 7am-330pm. It just repeats itself. So I know months a head of time exactly what my schedule is so I can plan around my family. They can't change my schedule or take it from me unless I give it up, of heaven forbid get fired. There's days I have to stay and work overtime of course. It happens. There is always extra shifts I can pick up for extra money. Needed extra cash to pay for my daughter's summer day care program so I picked up a couple extra shifts and I had it.

I work With dementia pts in ltc and I love it. It's always crazy and they drive me nuts but we get a chance to get so close to our residents and their families and I get to be there (most of the time) from admission to death. The thank you s from the families make the craziness worth it. I love making sure a resident passes away comfortably. I love the rare moments of clarity they have. I love that even though they can't remember the name of their children they know me by face and seek me out when they need assistance. I love catching little things that make a difference in their quality of life. I love tucking them into bed with their baby dolls next to them and having them reach for a hug and while telling me they love me. I love working as a team. I love having drs and np s respect my opinion.

Have you tried pudding? We use snack packs at my ltc and most of my pts will only take it in chocolate. Sometimes I try giving them the whole cup as a 'snack' with the meds crushed in it if they won't accept my hand delivered spoonful. Are you using juice or water for the Miralax? Experiment with different types as Apple or grape may go down better than orange for her. Same for pudding. I had one pt that would only take her meds crushed in butterscotch pudding. I have another dementia pt who I have to take her meds and lay them out on a tissue in a line and point to each one. If I try to spoon them to her or put them in her hand it doesn't work. I've had others where I had to put them in their hand then I could spoon them one by one from their hand to their mouth. Trying to get an idea if how her bg runs may be a bit trickier. Is it possible to catch her in the morning or evening when she Is sleepy and more willing? Can she hold a Lancet and let you guide her to poke herself? Can you non verbally indicate for her to pick a finger and would she be able to understand that? Just some thoughts. Keep experimenting. Wouldn't hurt to look up some phases in Russian and jot them down on a piece of paper to carry with you.

This year was my 2nd year having my med administration watched and it's really not as bad as I thought it would be, it was the same lady both years and she was actually quite pleasant during the process. First thing to do now and at least once a week when you work is go through every single thing in your cart and check for expired meds and open/expiration dates on every bottle. Make sure your insulins have their 28 day date on them. They will very likely request to go through the med cart and also do a random narc count check. Make sure you check 3 times every med, I usually verbalize under my breath so the surveyor can tell I'm doing it. Hold the card up to the screen as you do so. I pulled the meds, checking as I went, then went through my pile again checking as I went, then the last time after each one was checked I popped it out. I know with paper mars we can not actually put our initials until the med has Been administered so I put a line for each one as I go so I know I popped it out. Also with paper mars we have to sign out all the narcs a 2nd time in the narc books and when I work my home unit where I almost know the pass by heart I have a bad habit of signing all my narcs out near the end of my shift, this really should be done as you go. Standard things like don't touch the pills with your fingers at all, wear gloves for bg, injections, and eye drops. Make sure to wait the appropriate amount of time between multiple drops in one eye. I hop to and get my difficult pts meds done asap when I get there so I don't have to fret about being watched while I deal with my most difficult administrations (i work with dementia pts)....I usually have until 730-8 until the surveyors are on the floor. Just take a deep breath and don't rush and you will be okay.