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vampiregirl BSN, RN


Content by vampiregirl

  1. vampiregirl

    Nursing School Won't Teach You These Things

    So true!!!
  2. vampiregirl

    Assisted Living - What EMAR software do YOU use???

    I work LTC, so my situation is a little different. We use Point, Click, Care. The software is very customizable, I'd directly contact point click care to see if their product would meet your facility's specific needs. Any interaction I've had with PCC has been positive.
  3. vampiregirl

    The Cons of Working in Long Term Care

    I'm somewhat amused - the facility I work at is currently identifying it's most pressing concerns and trying to figure out how to address them. I could have written the OP's list myself, except for shortage of supplies. I am so fortunate that we have a supply guy who stays of top of things. We usually only run into issues with new admits that have specific needs that we are unaware of until their admission. I appreciate this article, there are many issues/ concerns in LTC if you face reality. If we don't identify them, we can't begin to address them.
  4. vampiregirl

    A Nurse Who Gives Thanks on the Thanksgiving Holiday

    I so agree with the OP- holidays were my favorite days to work the floor. And there are so many things to be thankful about being a nurse:) Tomorrow I'm working a shift on the ambulance (my fun, part-time job) and I feel the same way about working holidays there. I wish everyone a happy Thanksgiving:)
  5. vampiregirl

    Anybody a SDC or aka jack/jill of all trades?

    It really does vary in regards to how often my days are long - depends on resident acuity, admission, staffing, staff illness/ exhaustion, inservices, orientation, etc. I also am in the rotation for meal manager and on-call nurse (weekends). When I work the floor typically it is part of a shift, but occasionally I have worked an entire shift. More often I provide support to the existing staff so I just work the floor to help things get caught up (change of condition, multiple acutely ill residents/ neb treatments etc). When I do inservices that nurses attend I schedule times convenient for all shifts. I had been doing 7am, 1pm, and 3pm to hit all the shifts, but have been trialling 1pm, 3pm and 9pm with success. New staff orientation days can also be long because in additional to conducting orientation I also have other things that I need to get accomplished. I also conduct CNA courses as needed so this typically is long days all week when they are in session. I am lucky though - I was working PRN at this facility the the SDC became available. I had the skills set/ certifications they needed so they sweetened the deal for me to take the job by agreeing to more flexible hours so I can work EMS shifts at my part time employer occasionally. SDC is really a neat job, I am always learning something new and I still get to interact with the residents.
  6. vampiregirl

    Anybody a SDC or aka jack/jill of all trades?

    I'm an SDC for a 180 bed facility. I frequently do admissions assessments. I also help with assessments/ care of residents with a change in condition. I've worked as a floor nurse and a CNA when needed. Actually this help me identify topics for inservices (both the presentation type and written educations/ reminders), and figure out what resources the nurses need to take the best care of their residents. I would be leery though of a salaried position. If you are a "jump in there" person like me, sometimes days are long. I try to adjust my schedule to minimize any overtime, but just yesterday instead of leaving as planned at 4pm - I finally escaped at 10p. Being the last day of my work week, there was no way to compensate for those hours.
  7. vampiregirl

    Does your DON want you to do skin checks on night shift?

    We also do just monthly weights, unless someone is being monitored for weight gain, weight loss, or CHF. As for vitals, we check monthly unless someone is on an anti-hypertensive or psychotropic med, then it goes to q week (orthostatics for psychotropic med use). New admits get vitals assessed q shift x 3 days so we have a working baseline. We also have a protocol for unwitnessed falls/ head injuries. Occasionally we also get a doctor's order to monitor more frequently, but this isn't really common and usually for a specified period of time.
  8. vampiregirl

    Does your DON want you to do skin checks on night shift?

    The facility I work at used to do routine skin checks on noc shift too. Now only post-incident skin checks (q shift x 3 days) are on noc shift, with just a few exceptions. The routine skin checks are scheduled for each resident's first shower of the week. So if the resident has requested an early morning shower, and we do have a couple whom this is care planned for, then this would be one of the exceptions. Not only does it interrupt the resident's sleep (and a roommate's sometimes too), but the lighting isn't the greatest either.
  9. vampiregirl

    Gerontology vs. Geriatrics

    Yeah! It's always encouraging when I hear people who want to work with geriatrics. I love the people I serve in the LTC where I work, but also know that the LTC population is getting younger and sicker. Understanding the changes that the body goes through during the aging process is very important as a nurse. I am a member of NGNA, they are a wonderful source of information/ resource.
  10. vampiregirl

    HIPAA and Advocate for competent patient

    I agree that sometimes a 3rd party advocate (especially with a nursing background) can be beneficial, but in the case of a 29 y/o alert/ oriented and competent patient should be initiated by the patient. I've run into this situation in geriatrics and unless the appropriate consents/ documentation are in place, I give the same response as the OP. It frustrates me when "complaints" by persons who are declined info take up time (nursing supervisor, physician, management etc). Especially when it is a person in the medical field (a nurse for example) who has knowledge of HIPAA.
  11. vampiregirl


    Providing peri care is within the scope of practice of a restorative aide or a CNA. If that aide can effectively communicate the information, I think it's a great idea. I know this topic can be a bit uncomfortable to discuss, but it is so important (and often not properly performed).
  12. vampiregirl

    uncooperative residents

    I've also encountered an increase in younger patients. I think unfortunately there is still a stigma attached to long term care care, and many misconceptions. I also agree with Viva, many of these resident's probably have mental health/ psych issues that may need addressed. And if they didn't come in with them, residents of LTC are certainly at risk for depression... As for some of the "behaviors", sometimes I find that it is embarrassment that causes the resistance (toileting, TAP, etc). Some of them respond well to being more involved in their careplans and helping develop their own schedules because it gives them more control over their lives (which truly they have so little of in a LTC). Others simply don't care - or just give up. I've also encountered the food issues that the OP mentioned, and that is one area that is driving me batty right now. These are the same people who need the nutrition they aren't getting from junk food. And the family members who provide the junk food are the same family members who are upset d/t their loved ones lack of progress in getting stronger or other medical issues r/t their food choices. Even more frustrating is when the family members and even the resident have the cognitive function to understand the rationale/ education when we try to explain the importance of nutrition. Sadly, I've had resident's tell me that is how they ate at home. When you try to help the resident figure out a plan to enjoy their favorite foods in moderation... I think person centered planning is a little step in the right direction towards dealing with many of these issues. That can be tricky though, trying to balance what the facility is really able to do (with the current staffing models). I think this topic is great for discussion. I know I'd love to hear some ideas and approaches that have worked for others:)
  13. Excellent article:) I too took (and passed) my CPNE at Mansfield. I'm sorry to hear that site closed, I had a very good experience there. I agree that some of the biggest factors for success include preparation and not listening to the naysayers. Out of 11 students in my CPNE group, I was only one who was there for the first time. I was overwhelmed by the negativity, but a call home to a friend helped me to reframe my thinking.
  14. vampiregirl

    Non-rebreather mask with a co2 retainer

    Not sure what setting the OP works in, I'm in LTC/SNF. The sats are just one piece to the puzzle. After completing a more complete assessment I would (quickly) consider my options and obtain/implement the appropriate orders. Things like level of consciousness, skin color, and the rest of vitals would be some biggest deciding factors. Some times cold fingers really affect the SpO2 readings. Positioning and if the resident is able to be instructed in diaphragmatic breathing are usually 2 of my initial interventions with low SpO2. Just because someone is a CO2 retainer does not rule out ever administering high flow O2 via non-breather in an emergent situation. Respiratory drive can be addressed a little later, but permanent damage due to hypoxia cannot be reversed.
  15. vampiregirl

    Nexium Capsule!

    There are also instructions to give via g-tube at the bottom of the drug monograph - you add the granules directly to the syringe, add 50 mL water, replace the plunger and shake upside down for 15 seconds. You have to use gentle syringe pressure to administer the suspension (I usually administer meds/ feeding/ flushes with gravity only). After it is administered, flush with more water. I had to get orders for additional water to administer this (50 mL for the mixing, extra to flush). I ran into this with an adult with a small diameter tube. Insurance wouldn't cover the suspension... grrrrr. When I first read the instructions, I thought that it wouldn't work. I was pleasantly surprised to find out I was wrong.
  16. vampiregirl

    What Baffles You?

    I had patient inform me that since he was in a nursing home, he didn't have do anything for himself anymore. I attempted to educate him on why I was encouraging him to do what he could himself -- use it or lose it. I so was not his favorite nurse for a while... I know. I know. I'm supposed to remember to put customer service before nursing care;)
  17. vampiregirl

    Barrier Cream on a Skin Tear?

    Check your state CNA scope of practice and facility policy... here in Indiana it does allow CNA's to apply barrier cream but only to intact skin.
  18. vampiregirl

    Ready to leave nursing for good

    Keep in mind also that changes (even for the better) take time to adapt to. Sometime it means reorganizing your routine to be more efficient. I too work a place that has undergone many changes recently. In the long term, I can see the benefits. As we are trying to implement them, it's been really challenging them at times. Coupled with your role, that puts a tremendous amount of pressure on you. Good luck!
  19. vampiregirl

    Study tips?

    Thankfully with all the advances in technology there are more ways than ever to "study" and so many different kinds of resources available. Most the textbooks have online sites available these days. I was never a "studier" when I was in school, but I did great when I was working on my nursing degree. Nothing substitutes for being prepared and making sure all the assigned reading material is completed, but as far as "studying" for tests and figuring out how the actually retain the assigned material there are so many options available.
  20. vampiregirl

    Is LTC really a kiss of death for new grads?

    I'm in total agreement w/ the OP re: skills in LTC. I don't think I've "lost" any skills, but I know I've gained a few... It's refreshing to hear someone with this outlook. I started my nursing career in LTC - by choice. It's hard work, but it's worth it (most days anyways:)
  21. vampiregirl

    keys for narcotics

    If I've counted, then I'm responsible. Therefore, I don't give my keys to anyone. If a supervisor needs in my narc drawer, I'll gladly unlock it for them and stand by while they do what they need to do - verify counts, check something etc. I've also heard of a supervisor asking for keys as a test - to see if a nurse would let someone else borrow the keys:)
  22. vampiregirl

    To those passing excelsior with consistent A's

    In addition to many of the above suggestions, I also used a NCLEX review book and studied the pertinent chapters prior to each exam. Having the NCLEX style questions as well as the rationale was very helpful for me. My background is also EMS. The biggest challenge for me was to comprehend some of the nursing theories/ thought processes. Once I got my head wrapped around those, studying for the exams got a little easier. Not to mention, I'm a very handy person to have around when there is an actual emergency at work (I work LTC) - some of my co-workers have had little exposure to emergency situations.
  23. vampiregirl

    Morphine Authorization

    Where I work, a narc requiring authorization is not administered w/o actually having the authorization. So, to answer your question, I would not have administered the med either. Our pharmacy provides a reason for the denial, and usually it's something that just requires something faxed or a call from the doc. If your patient was sleeping and not in obvious discomfort and you also had other med options, I would have just continued to monitor the patient as you did. If something had changed, you could always contact the doc. Just a thought, it will come back to the facility that meds were taken w/o authorization. This isn't something pharmacy takes lightly. Your boss may have been upset at the breach of protocol and not you personally. Everyone was counting on the authorization, you just were the unlucky person who received the denial.
  24. vampiregirl

    Emergency Medical Techician Basic - Help!!!!

    Many EMS services offer ride-a-long programs so that prospective students can see what EMS is like. If that is available in your area, it would be a great opportunity not only for you ride along but also to talk to other EMS personnel. As for the EMS skills themselves, they've come in handy at every job I've worked (CNA, phlebotomist, and nurse). Learning to stay calm in an emergency, size up a situation quickly and deal w/ unusual circumstances is invaluable.
  25. vampiregirl

    giving report to a SNF

    Gee, I'll bet that gave you a great impression of the LTC... The patient may have initially been assigned to one room and then reassigned, I know that's happened at our facility. Still, it's no excuse for what you went through to give report. I appreciate that you considered that maybe the nurse was just a little frazzled. I know sometimes my mouth gets ahead of my brain sometimes. Maybe she really meant to ask if that was normal for the patient. As for streamlining the process, I know I've taken report for another nurse on an incoming patient - especially if room assignments are not finalized yet. In this case though, I always get the name/ phone # for the person giving the report in case of questions. Or if giving report seems to be an ongoing issue, could report be faxed w/ contact info. Often times nurses on both sides of the transfer are busy...

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