TardisMom

I have taken phone calls at home form the state to clarify info for an investigation, since I work 11-7, and also have had the police visit me at home to ask about a resident that I had cared for, while doing an investigation ( nothing regarding me or the facility I worked for)

At my facility we tend to put orders in for residents who want palliative care as "Comfort measures only, do not hospitalize except for trauma, no IVs, no weights, no labs." If a person is just a DNR that simply means no CPR but they still go to the hospital if they reach a state where we cant treat in house.

Sadly I have seen this situation more frequently then I would want (which is never) and it is always sad when the situation becomes lose your foot or possibly lose your life. It is understandable that your resident would be grieving the possible loss of his foot, mobility, ect., and I think as the nurse you should try to be empathetic and listen to his feelings and let him work through his grief. As far not wanting to amputate, you will just have to respect his choices whatever they may be. Insofar as caring for yourself and having nightmares I would suggest trying to distance yourself emotionally from the situation, I am not by any means saying not to care about your patient, but don't bring it home with you. It will stress you out and wear you down if you let it. Do the very best job you can for your patient but decompress and leave it at the door when you clock out.

Ours is 1:20 on 7-3 and 1:30 on other shifts on the 60 bed units. On the 38 bed unit it is 1:38 all shifts. No desk nurse or anything like that.

Sometimes you just have to keep them safe and tune it out. I find that many times they can be redirected but sometimes no matter how hard you try you just get them more agitated by trying to play along. Always remember that it is not personal and they can't help it. It helps to keep you patient and sane when the screaming goes on for hours.

"G-tube was clogged again?"

Another bit of advice I would give is ask for help but don't let anyone bully you into not sending a patient you strongly feel needs to go out. There is a tendency in LTC/Rehab to push for treating in house if we can for many reasons and other staff can get downright aggressive about it. I had a DON at a facility try to bully me into putting a lady with a clearly fractured hip back into bed to wait for a mobile x-ray while she was screaming in agony. Guess who was being picked up by EMS within a few minutes?

Where I work we do have ID bands on the residents that will keep them on, they can however refuse to wear them if they wish. We also have photos on the EMAR from admission but on some residents the photos are a few years old or they refused to have one taken. It doesn't take long to learn the residents if you are on a unit frequently. Especially on LTC or memory care units, they don't change unless someone dies. It gets more complicated on the rehab unit with the constantly revolving door. Sometimes you just do the best you can and, yes, I have had to ask a CNA who knows the residents better than I do, and I have worked at facilities that don't have armbands on any of the residents. It is scary but just another challenge in this particular area of nursing.

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I don't attend meetings unless they are at 7am. I don't think it is reasonable to make a "mandatory" meeting at 3pm when that is in the middle of my sleeping time. When they ask the day nurses, many of whom think we "don't do anything at night", to come in at 3am I will come to meetings at 3pm. I usually have someone I trust from day shift take notes for me and give me the info.

We are very busy on nights at my facility, on night we are expected to: Do 12am and 6am medpass and accuchecks. All wound treatments on non alert and oriented residents. Clean and stock med and treatment carts and check for expired meds. Take deliveries from the pharmacy and process all return meds. Do 24 hr chart checks. Do accu-check quality control checks. Check and replace all the full sharps containers. Skin checks and weekly nurses notes on non-skilled residents. Skilled charting. Quarterly MDS assessments. Complete Admissions assessments and put in orders that weren't finished on 3-11. Start new 24 hour charting. Update the daily census for the unit. Make out appointment envelopes for the next day's appts. Clean the nurses station and med room and do the filing for the day. Do temp checks on fridges and check the crash cart. Help the CNA's do turns and lifts since we only have 3 for 60 residents. Change over all the ADLS and do monthly VS and charting on the first. At least one fall or skin incident a week as the residents tend to get confused more or have increased behaviors at night. Make out updated report (brain) sheets to reflect any changes on the unit. Fill out lab requisitions and call to arrange x-rays/diagnostics for the morning. Reorder narcotics that need new scripts. Replace all Tubefeed, IV, O2 tubing and materials. I am sure there is more but I can't think of it right now, point is, night shift does a lot of things you may not think of but they add up. I think all nurses, regardless of shift, work very hard.