dawnb70

Too many times to count!!! I thought it was just where I live! Recently we had a78 year old man in respiratory distress. The ambulance arrived to transport him to the ER, received another call and then proceeded to leave to answer that call. It took them a half an hour to return to transport our resident!!! Fortunately we had been able to keep him stable until they returned. Maybe they responded to the other call because it was someone younger...who knows! I wanted to turn them in, but didn't know where to turn!! :angryfire

I turned in a family member today to the Ombudsman for suspected elder abuse, and I'm not sure if I've done the right thing. There have been several occurences with this family and their mother. The first one I experienced was over a bill from the pharmacy for a multivitamin. The daughter was very upset over this bill for $3.00 for a 30 day supply. I told her we would begin using our stock supply and she wouldn't have to worry about it (normally we don't use our stock supply for the private pay residents). The next time I dealt with them the MD had recommended an annual EKG for the resident because she is on Mellaril. The family said absolutely not...it costs too much. We have had to get clothes for this res. from the Salvation Army because the family doesn't provide them and her clothes were literally falling apart. The final straw for me was when the resident fractured her foot, and the family only wants her to receive Tylenol (which we supply). She has been on Tylenol QID for years, so I know it has lost its effectiveness. The resident doesn't speak, but has been crying and moaning and showing obvious symptoms of pain. The Tylenol is not helping, and the family won't let me ask for something stronger. To me this is blatant abuse/neglect. I'm not sure what category it falls under. I've heard that there is a lot of money involved when this resident dies. Any opinions? Did I do the right thing?

I was the treatment nurse for a few months in the LTC facility that I work in. I was responsible for the weekly measurements of decubs. I also determined what treatment to use if a wound showed no improvement or deteriorated in 2 weeks. Also, I called the Dr. to obtain the new tx orders, get orders for Vit C and Zinc, a nutritional supplement, and Albumin/Prealbumin levels. There really is a lot to being a treatment nurse, I believe. We have a lot of paperwork involved with our wound care program, and have a weekly wound meeting. I didn't do any other treatments besides those with decubs., but I think a treatment nurse would be responsible for that also. There is so much involved, a lot of responsibility (especially if State comes in on a wound), and there are so many different treatments to choose from. Good luck to you if you decide to go into it! :)

I haven't been a nurse for that long (going on 4 yrs.), but I feel that I am using so much of what I learned in school. I change catheters, insert IVs, do blood draws, do trach. care, deal with G or NG tubes/feedings, do wound care for various stages or types of wounds, have residents with central lines or shunts for dialysis, do pacemaker checks, participate in codes, and the list goes on and on. I know there are a lot things that I haven't been exposed to, but I feel that I'm still learning to be a well-rounded nurse. I also feel that working in a LTC has helped me to do a quick and accurate body assessment. Plus, I have really learned a lot about medications. I feel completely safe when doing my med. pass. I have every one of my residents meds. memorized. That's the benefit of having basically the same routine day in and day out. If a family member asks what meds. a resident is on I can recite them off to them, plus give them a list of the side effects. Not to mention that we know our residents diagnoses by heart, and can remember when certain labs or tests were done. I don't think that LTC nurses get enough credit for what we do, and are capable of doing. I even had a nursing instructor tell our nursing class (when I was still in school) that we should never go into LTC because we would lose our nursing skills, and that most hospitals won't hire a nurse that has worked in LTC for too long. It's just unreal the perception that others have of us. I think we all deserve a pat on the back!

I was so happy to read this post. I thought I was the only one who felt this way. I've been an LPN for 4 years, and in LTC the whole time. I think I'm starting to get "burnout" big time. At least our CNAs can do the V/S for us, but the rest is on the nurses. And recently the powers that be decided that if an admission comes in right before change of shift the nurse that is getting ready to leave has to stay over until the admission is done. We are not supposed to leave anything for the next shift to do. Too many mistakes were being made when nurses would leave an admission for the next shift to finish. I love my job...but am seriously considering a career change. I hope everything works out for you. I definitely feel your pain.

We have a form for everything too. But my favorite (yeah right) is the new order and lab binders. Anytime we take a telephone order we are supposed to write the order in these binders. It's supposed to keep us from making mistakes, but it is just so much repetition. We give the DON a copy of the T.O. I would think that would be sufficient. I've never worked in a hospital setting, but isn't everything on the computer as far as documentation goes? I'm just praying that there will come a day when LTC facilities change to that.

Find a mentor. It really helped me, anyhow. And never be afraid that any question is stupid. I've been in LTC for 4 yrs. and I still ask for help if I'm uncertain of something. And like everyone else has said, make sure you've had enough orientation. Oh...and listen to your CNAs. They are your eyes and your ears. If they tell you that a resident is "just not acting right", then take it very seriously. And lastly, be careful of "burnout". It seems so common in LTC to me. We've lost quite a few awesome nurses because of it, anyhow. Best of luck to you!!!!!!!! :)

Nurse who don't restock supplies.....GRRRRRRRRR! I also hate clutter at my portion of the nurse's station, and it seems that people always use my part of the desk (I believe because it's the only clean part) and they don't put away charts or papers when they're done with them. Then there are the nurses who leave one line of blank nurse's notes or use the last line and don't put in a new blank page. Or someone uses the last copy of some form and doesn't make copies. I could go on and on. But then again maybe I'm just too particular. :smackingf

I currently have 33 residents to care for. I have been responsible for as many as 72 when I was the only night nurse in the building. It is possible, but you are not able to give the care your residents deserve. I'm curious about the laws of nurse to patient ratio. Sometimes I think they don't pertain to LTC facilities. I do know that it's based on the acuity of care. Most of the residents are going to be generally healthy, and you'll only see them during your med pass. Pitiful, but true. If you really like geriatric care, there are always LTC facilities hiring. And I'm sure you will be able to find one with a lower ratio of residents to nurses. Good luck!

I'm an LPN in a LTC facility...wasn't sure if you only wanted RNs to respond. The RNs and LPNs have equal responsibility in the facility that I work in. Many of the LPNs are IV certified/trained and are as competent as the RNs. I have never worked in any other setting, so I'm a little unsure of what other duties nurses have. We basically do all duties except the CNAs do the majority of hands-on patient care. I do occasional transfers, and many repositionings, but have only given 2 showers in the 3 1/2 years I've worked there. Most of the RNs that I work with have an associate degree. Of course we have continuing education in the form of "inservices", and occasional seminars to attend. There are daily obstacles to overcome, but I'm sure that's the case in any field of nursing. We deal with the families issues/complaints. We also call the doctors and pharmacy on a daily basis to obtain new orders or order prescription refills. Then there's the issues of the resident. So many are lonely or bored. Few families visit except for holidays and birthdays. The patients emotional well-being is as important to us as their physical well-being. I love my job, and it brings me joy everyday. Good luck on your research. I hope I was of some help to you, despite my rambling on! :)

I also applaud your bravery. Too many of us who work in LTC facilities are so used to being short-staffed, and overworked that we take it in stride. If more nurses would stand up for this issue maybe something would be done about it. You shouldn't get in trouble for what you did. I once had an awesome DON who would work the floor as a CNA if we were short, but she eventually got burnt out and went back to work at a hospital. Anyhow, bravo for what you did! :balloons:

I was mistaken...She's not on Cardizem. It's Dilt X-R (or Diltacor) I think, which I can't find in my drug book. She has no history of A.Fib, and does not normally have an irregular heart rate. I think I may have found part of the problem though. We recently put her on Risperdal, when Medicaid quit paying for Zyprexa. I think it may have interacted with her Sinemet, and could also be causing the insomnia. According to my drug book Risperdal is a Dopamine antagonist. Plus, it's contraindicated in the elderly with dementia. Now that Med-D has taken over I can get her off of the Risperdal and back on the Zyprexa. I'm hoping this will help. Thanks to everyone for their advice.:)

I'm trying to remember what meds. this pt. is on. She gets Sinemet, Effexor, Mirapex, Requip, Plavix, Diovan, Cardizem, Synthroid, and Lisinopril in the a.m. At lunch she gets the Effexor, Sinemet, Requip, and Mirapex. PT hooks up the pulse ox. while they're working with her (around 10 a.m.), and they reported to me that her pulse was dropping when she was doing her exercises. When she is at rest it shoots up into the 100s again. This pt. keeps begging me to do something for her. She says "I just don't feel good". Yesterday her heart rate was regular with an irregular beat every 4th beat. I reported it to the MD but he didn't order anything new. I asked if we could check her K+ because she has a history of hypo/hyperkalemia. He didn't order anything. We did a BMP last week and everything was WNL so maybe that's why. I've been racking my brain trying to figure out what is wrong with her. The other nurses say she's just attention-seeking or that it's psychosomatic. This pt. prior to her "just not feeling good" was ambulatory, active socially, and very cheerful....now she just lays in her bed most of the time. I'm so sure we're missing something, but I don't know what else there is to check for. HELP!!!!

Thank you for your help! I did a little research online and ran across an article from USA Today that stated that individuals whose heart rate drops during exertion are more likely to drop dead of a heart attack. I can't remember the details...I guess I just feel like I should be doing more for this resident. She's had generalized c/o malaise for several weeks, and we have been unsuccessfully trying to find the cause of it. I thought maybe I had found something with the dropping heart rate.

This resident had been getting dialysis 3x/wk for about 6 mos. He has a shunt in his left arm, and still has a SC central line. He has been on the diuretics for a week now and the edema has not improved any.

I am an LPN in a LTC facility. I have a resident whose resting heart rate is always >100, but after PT her heart rate is dropping into the 80s. What could be the cause of this? I've reported it to her doctor, but he doesn't seem concerned. I feel it warrants further testing. I need some advise please!

I work in a LTC facility and recently had a resident who was receiving dialysis three times a week have his treatment put on hold. We had done a 24 hr. urine on him and it had good results. Then he went to the hospital to have a test done to check his GFR function (I can't remember the name of the test) which also had good results. His dialysis has been on hold for a month. Is this a common occurence? Also, what should I watch for to determine if he's in need of dialysis again? We still have him on strict I&O (he has a fluid restriction of 1800cc/day, and has a foley). We do a monthly BMP on him. But in the past few days he has been having edema of his hands and I'm concerned. His primary doctor has put him on HCTZ and Lisinopril for this. Any advice would be greatly appreciated!

We use the Norton Scale at our facility. Those at high risk are care planned to address the issue. We also have a program called TAPS (Turn and Position & Sips-offer hydration)that is announced at odd hours over the intercom. For example, "Attention staff it is 9:00 o'clock, TAPS to the window". It seems to be working well. I haven't worked anywhere else, so I wonder if other facilities use similar programs? We also hand out barrier cream at the beginning of the shift, and the CNAs are reminded to "grease" everyone when TAPS is done. We have really cut back on our skin issues.

Just curious...I was wondering how many nurses are being educated about Terminal/Kennedy ulcers. We've had state in the building recently over a wound that was clearly a terminal ulcer, and now the family is sueing. How do you document when you are certain that that's what the wound is? And how do you prevent legal action in that type of situation?

We've had a lot of luck with the seat belt alarms for those known to attempt to transfer themseleves out of the w/c. They're not considered a restraint, and will only sound if the resident undoes the clasp.

I also have a problem with ER nurses in my area. Actually the local hospital in general gives us a lot of problems. I would love to find out why the nurses in the hospital seem to look down on nurses in long term care. Every time we send a resident to the hospital, and they have a decub., a nurse at the hospital will call State on us. But when the roles are reversed and we have a resident readmitted from the hospital with a new decub. we don't report them. I sent a resident to ER with edema of the right leg. The extremity was cool to touch, unable to palpate pulses, etc. The ER nurse called me after about an hour to let me know that they were sending the resident back because it was just "dependent edema" and it should resolve in a few hours. I was furious. They didn't even do a doppler/DVT study on him. So the next day I sent my resident to the ER again. The same nurse was working that day, and he was pretty upset with me. He treated me like I was a total idiot. At least they did do a Doppler on the resident.....and gee whiz it turned out he had a clot. The man died two days later. I totally respect what those ER nurses do....really....but I don't understand why they can't have the same respect for nurses who work in Long Term Care. (I shouldn't have generalized ER nurses. It's just the ones in my area that I have problems with.)

I'm not an Activity Director, but where I work we have a wonderful person running our activity program. She's had great success with Pet Therapy. The residents love it. Bingo is the most popular. We have it Mon, Wed, Fri, and Sat. Many of the residents also respond well to music therapy. We have students from the Cosmetology class come and do nails for all the women. They love it. I think having a full schedule and lots of variety really improves the resident's outlook. Best of luck to you!

I have a similar problem where I work. We have to notify the DON and the Administrator before we send someone out. Plus they want us to use the facility van to transport instead of an ambulance whenever possible. At one point I had to have the DON do her assessment of the resident before I was allowed to send them to ER. It's disgusting. Now when someone needs to go to the ER I just make the calls and send them. If anyone gives me any flak I just say either we'll lose this resident temporarily or permanently (if they die), and if they have a three day hospital stay the facility will get the Med-A money (I think it's around $10,000 a month). That always shuts them up! I think the anonymous call to State was a wonderful idea. It sounds like your DON needs a huge wakeup call!!!

I had one resident that would say his "boys" needed adjusted. It took me awhile to figure out that he was sitting on "his boys", and that couldn't be very comfortable! Another residen't kept yelling "my noodle's over my nubbin'" after I changed his catheter. He was uncircumcised, and I had failed to put the foreskin back. The poor man was in some discomfort while I tried to figure out what the problem was! I never made that mistake again!

Prefilled syringes? What are those?:rotfl: I work in a LTC facility, and everything is outdated. If we need an ice pack we fill a glove with ice cubes. We are owned by a corporation, and all that matters is money. If I try to get anyone to order new supplies all I hear is that there isn't enough money, or we have to stay in budget. Meanwhile we have scales from the 70's that don't give accurate weights. Does anyone else work in this kind of setting?