jonamb

Spontaneous fractures, unfortunately, do occur. We had a LOL once who was just walking down the hall, went to the floor for no apparent reason, and BAM...broken femur. And she had been a good walker...steady, good posture...it was the craziest thing. On the other hand, staff do need to be careful with care giving on fragile residents. Way back when, when I was a CNA, I was trying to put a pull-over sweatshirt on a res. I had to reach through the sleeve to pull her arm through, and when I did, her arm jerked, I lost my grip, and somehow my arm flew back and smacked her right in the face . She ended up with a HUGE black eye. Needless to say, there was an investigation and it was found to be an accident, but I still felt awful. Sometimes it's almost impossible to dress/undress people who are contracted, resistive, etc. Who's idea is it anyway to buy these residents pull over tops and snug-fitting clothing? Anyway, I'm rambling...back to the subject. Yes, it is possible for injuries to "just happen". And sadly, it is common for "nothing" to be done, since sometimes the residents condition does not make repair possible. The most we can do is try to keep them comfortable.

Definitely sounds like verbal abuse. Just because the res. was showing no s/s of SOB does not mean she did not feel like she was SOB. How many times have we seen res. c/o something while showing no symptoms (think pain -- I've seen people say they are having pain rated at 10 while smiling and laughing -- who are we to judge?)? The nurse could have done a few simple things that may have helped, like elevating the HOB, repositioning, or just talking with the res. Sometimes just doing something simple and saying, "Let's try this...I think it might help" is all it takes. I think that nurse was out of line. Just my opinion.

Where I work, we also just have a rolling cart with a lock box and sign out sheet for narcs. A waste must be witnessed by someone with a license. It doesn't seem like good company policy to allow a waste to be witnessed by someone not familiar with the drugs. For your own protection, I would seek out another nurse to witness for you. You might want to ask your DON or someone else to clarify this policy for you.

In the LTC where I work, the max dose of acetaminophen was decreased from 4000mg/day to 2500mg/day several years ago. We need to get an order from the doc if the pt. requires more (sometimes they will write for a max of 3000mg, sometimes 4000mg). Most often, we are able to get a different pain med all together. Have they considered Fentanyl transdermal patches? Some elderly pts. cannot tolerate, but others do very well with them.

Sorry, I just reread your original post, and realized the order says she can have one or two Vicodin every four hours, meaning that she can have up to 1000mg acet. In this case, she could technically receive Vicodin and Tylenol within four hours of each other, as long as you didn't go over the 1000mg. However, giving her that much in that short of a period of time would mean she would have to wait longer between doses so as not to exceed the daily limit. My advice, talk to the doctor. Apparently, she is not receiving adequate pain relief.

I would take the order to mean that she can have up to 650mg acetaminophen q4 hrs, whether it be Tylenol or Vicodin. Therefore, if she had Vicodin, I don't believe she would be able to have Tylenol for another four hours, and vice versa. However, if she is consistently requiring more than the recommended daily dose of acetaminophen, maybe the doctor needs to prescribe something different for pain, as this doesn't seem to be effective for her. If for some reason the doc can't or won't do that, sometimes they will raise the max daily dose to 4000mg (depending on the pt. and her medical condition). You need to be careful not to go over the max prescribed dose -- you could be opening yourself up for trouble. I would discuss this pts. pain management with the doctor -- there are many other options for pain relief meds. Good luck!

I'm an LPN, not an RN, but I do know that where I live in Michigan nursing homes do pay more than hospitals. RNs that I've spoken to have told me that starting wages in our three nearest hospitals average about $17-$18/ hr. and it's close to if not more than $20/hr. in most nursing homes. As an LPN, I am currently making $22/hr. (with shift differential and insurance waiver -- I believe base pay is about $17.50/hr for experienced LPNs). I've been fortunate, for the nursing home that I work in is one of the top-ranked in the state. Patient care and living conditions are excellent there. As far as your license being at risk, in the thirteen years that I've worked in this facility, I've only known of one case where a nurse's license was in jeopardy, and that was due to neglect on the nurse's part. However, where you choose to work should not be based on pay alone. If you're not sure where you want to work, check out different types of facilities and see which suits you. Keep in mind that nursing homes are basically designed for long-term care of patients (that's why we call them "residents") and hospitals are geared toward acute care. Remember, you won't be happy with more money if you don't enjoy what you do. Whatever you decide, good luck to you.

Someone was passing this around work the other day and it made me smile... Stephanie was so happy. She was young, healthy, successful, and she was about to wed the man of her dreams. She was happily planning the wedding she had always fantasized about. Everything was falling into place perfectly. Nothing could get her down, not even her parent's recent nasty divorce. Just two weeks before the wedding, she was visiting with her mother when mom showed her the dress that she had bought to wear to Steph's wedding. The dress made her mother look twenty years younger and just radiant. Both were excited for the upcoming event. The next day, Stephanie was at her father's house, when his new, younger, beautiful wife modeled the dress that she had bought for the wedding. To her horror, Stephanie realized it was the same dress that her mother had bought, and her new step-mother looked ravishing in it. She told her step-mother the situation and begged her to wear a different dress. "After all," Stephanie told her, "you have so many beautiful clothes already that look great on you." But her step-mother refused, saying, "This dress makes me look fabulous. I'll be the envy of everyone there." Heartbroken, Stephanie went to her mother and told her about the dresses. Her mother told her not to worry. She would just buy a different dress to wear to the wedding. She said, "Sweetie, this is your day. It's only a dress." That weekend, Stephanie and her mother went shopping for a new outfit for mom to wear to the wedding. After her mother found a nice, albeit less fabulous dress to wear, they decided to go out to lunch together. As they were chatting over their entrees, Stephanie told her mother, "Thank you for being so great about all of this. But where is the other dress? I thought you were going to return it. There are no other special occassions coming up where you'll be able to wear such a fabulous dress." Her mother replied, "Oh, Darling, but there is. I'm going to wear it to the rehearsal dinner." :wink2:

One of the residents at the LTC where I work told us this joke the other night.... Why don't witches have babies? Because warlocks have hollow-weenies. :thankya: I know, I know, cheesey. But I have to tell you a little bit about this res... He's been depressed and pretty much has kept to himself since being admitted a couple of months ago. He's polite and compliant, but he's obviously wanting to be anywhere else. Anyway, he rarely initiates any conversation. So, imagine our surprise when he walked to the nurse's station in the middle of the night and said, "Since it's almost Halloween, I was wondering why..." It caught us so off guard that at that moment, that lame joke was the funniest thing we had ever heard. He then said good night and went back to his room. Just wanted to share.

Have you tried turning the pt. on her side with her knees bent (imagine the position her legs would be in if she were sitting in a chair)? A veteran nurse taught me this, and sometimes it makes things easier to see. I work in LTC, and the landmarks are often very hard to find on elderly women. Quite often, I could not find the "flower" and would have sworn I was cathing the lady parts, only to be pleasantly surprised to find I was indeed in the right place. And don't worry, I'm sure we have all tried to cath a privy parts or a lady parts. I had to smile when I read about the "flower". That's what I always referred to it as (I've gotten some strange looks from co-workers, but that is what it looks like). I, too, have never seen the "wink". I thought I was really missing something -- glad to know I'm not the only one. Everyone had good advice! I'm going to keep in mind the one about the bedpan. Always glad to learn something helpful!

These posts made me think of my mother-in-law. She had some good ones.... 1) For teething pain, give the baby a chicken bone to chew on. She did this with my son once and I about freaked! She apparently wasn't the only one who did this, though. I was telling some co-workers about it (because I could not believe she had done that) and several of the older ladies said that they had done that with their kids! 2) Another cure for teething pain -- whiskey. Give the baby enough, and he feels better and goes to sleep . I also had an aunt who would crush aspirin and put it in her baby's bottle to "help them sleep". 3) Mother-in-law also believed that pouring rubbing alcohol into your childs ear would cure an ear infection. But, if by some off chance that didn't work, you could take a lit cigarette and stick the filtered end into the kid's ear. The cigarette would "draw out" the infection. No health risk there. 4) My husband still believes that rubbing alcohol is the absolute cure-all. Whatever ails you, rub alcohol on it, pour alcohol into it, whatever. Except for an abscessed tooth -- then you pop the abscess with a needle and swish and spit with peroxide . Wonder where he got these ideas? You know, I'm sure my M.I.L. meant well, but.......YIKES!

Thought this was interesting, so I just wanted to relate my experience with soy based formula. Both of my babies were formula-fed. My first baby did just fine with regular formula. The second one, however, had a terrible time with it. The biggest problem she had was constipation. I can still see this little two-week old baby trying to poop what looked like adult turds (hard and formed). They were huge, caused rectal bleeding, hard as a rock. I can remember holding her up over a potty as an infant, hoping gravity would work. I can also remember one time when she was laying on her back trying to pass one, and I was flexing her knees up to her tummy, and every time she would yell, it would poke out, but as soon as she took a breath, it would go back in. I ended up just grabbing it and pulling it out:stone. Anyway, as you can imagine, this was very scary. I took her to her doctor well before her 6-wk. check, and there was nothing physically wrong with her. She (doctor) suggested trying soy-based formula. It worked wonders. My baby finally started pooping baby poop (and I considered this a good thing? ). She never had another problem. As far as the allegations of soy formula causing problems later in life, I can tell you that both of my kids are normal and healthy. My "soy baby" is a pre-teen, and as far as I can tell, seems to be developing at the same rate as her peers. No sociopathic tendencies. And if she turns out to be homosexual, so be it. Soy the origin of sexual orientation:uhoh3:? Anyway, too much information on my part -- sorry. Just wanted to share my experience.

In our facility, we have a variety of dressings to choose from. Most nurses opt for transparent dressings (Tegaderm, Bioclusive) that can be changed every 3-5 days for skin tears. I have found that these dressings are usually good for small tears on people who have fairly good skin. However, most of our residents have very fragile skin, and often the transparent dressings will make the tear worse or cause another tear when they are removed. Personally, I prefer to use vaseline gauze wrapped in Kerlix. It needs to be changed at least daily, but the gauze will not stick to the wound and the healing time seems to be faster. Also, geri-gloves (sleeves) and long-sleeved shirts can be very helpful in deterring "pickers". And I have to agree with wocnnurse: antibiotic ointments usually aren't necessary. Most wounds will heal fine without them if they are kept clean. We only use ATB ointment if there is definitely an infection present. With the problem of over-use of ATB's in this country, why use ointment unless it is clearly needed? Just my opinion.

I know what you're going through, and I'm sorry to say, these two CNAs that you are talking about are not going to change. And I'm assuming going to your supervisor won't help either, since they are both long-termers and obviously have been getting away with being ugly for years. The best thing that you can do is just keep plugging away and doing your best. I can bet that in time, they will leave you alone. If not, ignore their nasty comments and kill them with kindness. Be professional, thank them if and when they do help, and know that you are doing your job to the best of your ability. Stick with it, and you will get faster, you will get to know the residents, and life will get easier. Just be glad that you don't have to go home with these two nasty people (pity their families). Just some advice for your back, please use the lifts. If a resident is a two-person transfer, don't even attempt it. I know the lifts take more time and can be a general pain in the a**, but trust me, in 10 years your back will thank you for it. When I first started out, I was young and strong and didn't have time to use the lifts. Now my back is very angry with me. Back problems usually just don't happen, they come from wear and tear and abuse that you don't even know is happening at the time. And one more thought on "the nasties" -- have you ever confronted one of them on their comments? Sometimes that's all it takes. They are just bullies, and are probably insecure themselves, as most bullies are. You don't need to be rude or harsh (after all, you don't want to be them), just be firm and confident and keep your sentences simple and to the point (so they will understand). When they learn they can't intimidate you, they will leave you alone. I know their comments and attitudes hurt, but just keep in mind that it's not personal. It's just their way of welcoming new people. By the way, I was wondering if these people also complain about working short staffed? Where I work, there are a couple of CNAs who gripe almost every day about "being short again", but these are the same ones who are nasty to new people. Go figure.

In our facility, all baths are sceduled on 7-3 and 3-11. 11-7 will occasionally do a bath if the resident has been refusing on other shifts, if they (resident) is awake and agreeable at the time, and if there is time (and of course the occasional "too messy for a bed bath"). What other shifts seem to not realize is that 11-7 has much less staffing than the other shifts. Granted, there are no meals, appointments, activities, etc., but they have 3-4 times as many residents to care for. And contrary to popular belief, the residents do not sleep all night. Our dementia unit is especially active at night. Another thing that concerns me -- how do two CNAs get 30 residents up and dressed in just two hours? How can they possibly be giving proper AM care to that many residents in that short of time? On our dementia unit, (40 residents) about half of them are total care, requiring mechanical lifts to get out of bed, incontinent, combative, etc. We get the majority of them out of bed before day shift arrives, but some of them are just in a robe and slippers until after breakfast. Total AM care is done for the "quick" ones, but some of these people take a while to wash and dress. My other concern is this: how long are the non-ambulatory residents sitting in their wheelchairs waiting for breakfast? Does 7-3 shift come on and immediately start toileting and repositioning the residents that have already been up for several hours before serving breakfast? This just seems like skin breakdown and pressure ulcers waiting to happen. Maybe I'm misunderstanding what you mean by "up and dressed". If not, my heart goes out to you guys for having to run yourselves ragged every morning. What do you do when something unexpected happens that requires extra time? It sounds to me like they need to get more help on your unit if they're expecting you to do all of these things. Good luck to you. P.S. I know what you mean by not being able to help out like you would like to. I also work 11-7 and have 2 units to cover with med pass, dressing changes, prn meds, and all the other things that go bump in the night. Good thing we were born with super-human powers.

I've worked in LTC for a long time, most of those years on 11-7 shift. I don't have any good, scary ghost stories, just some creepy experiences. There is one unit in our facility that is notorious for "shadow" sightings. Many people, including myself, have seen figures in our peripheral vision. It's usually when we are in the nurse's station charting. You see someone walk by, but when you look up, no one is there. This has happened to many different people on numerous occasions. We joke about it, and often ask new people if they have met the "ghost" on that unit. We also have residents who complain from time to time about children coming into their rooms and making noise in the halls in the middle of the night. One morning, we had 5 or 6 different residents in different rooms ask if "that little boy" was still there. There have also been times when a resident will refer to "the girl behind you", but when you turn to look, there is no one there. We also have had episodes of call lights in empty rooms coming on, doors slamming shut, and just a general uneasy feeling in certain rooms. It probably doesn't help that many of us have learned to do many tasks without turning on the bright lights (as to not disturb sleeping residents) and things are always scarier by the light of night lights. I also have a couple of stories that have a definite creep factor, but are also comforting in a way. The first one involves my mother-in-law, who was in ICU and dying. She had been unresponsive for some time. Shortly before her hospitalization, she had been talking a lot about her childhood, which had been very hard. When she about 6 or 7 years old, she was walking with her mother when her mother got hit by a bus and died in front of her. After that, her father became abusive to her and her sisters in the worst way. Anyway, here she was, lying in a hospital bed, at death's door. All of a sudden, she opened her eyes and was fixated on the ceiling. She smiled, held up her arms (like a child does when they want to be picked up), closed her eyes again, and died. We like to think that it was her mother, coming to get her. Another time was on my wedding day. My brother had been killed just seven months before in a car accident (he was 19). Anyway, my mother said as she was driving to the church, she was thinking about how she wished that my brother could be there. All of a sudden, the smell of roses filled the car. She said it was so strong, that it was almost overpowering. Then as quickly as it had come, the smell was gone. Maybe he was there, after all. I know this thread has been going on for a long time, but please keep them coming. I love this kind of thing.

I agree that you have to be empathetic, kind, and patient and treat ALL of your residents with dignity and respect, but this can be a very difficult thing sometimes. From experience, I can honestly say that LTC workers are as close to saints as you can get. Some residents just make it sooooo difficult to be good. I will never forget the sweet little old lady who would "dig herself out" and smear bm everywhere (all over the bed, bedding, wall, her self, her hair -- EVERYWHERE). One night, she had done this for the third time, and the CNA caring for her asked her, "WHY do you do this?" The woman's reply -- "Shut up. It's your job to clean up my sh*t":devil: . The resident obviously had some dementia, but she was "with it" enough to come up with that reply. Very frustrating:smackingf .

I have a brother who was born with severe Down's Syndrome. I can honestly tell you that I cannot imagine life without him. He is the most loving, kind, considerate person that I know. His smile really does light up a room. He does not have a mean bone in his body. My children love him as well. And having been around other people with Down's Syndrome (ranging from mild to profound cases) I can tell you that this is true for every person with DS that I have met. He is mentally 3 years old and always will be (he is almost 40 now). So while he may have childish needs, he also has the innocence and wonder of a small child that I think more adults should have. My mother had a copy of a poem that she found about 20 years ago that I think says it all. It gave me a lump in my throat 20 years ago, and it still does today. I found a copy of it on a web site. Please take a look at it and give a copy to your sister. She may feel overwhelmed and may even be grieving in a way right now, but assure her that this child will definitely give her more joy than she has ever known. God bless you, your sister, and this new life. Go to http://www.our-kids.org/Archives/Heavens_special_child.html

love it!!! as a well-endowed woman who fears the "m-word", all i can say is thank you, thank you, thank you! you made my day.

My employer offered a scholarship in exchange for three years of work as well and I took advantage of it. They also offered as part of their agreement to pay me for 40 hrs/wk plus keeping my benefits and seniority. I had to work the days that I was not in school, but I usually got one day a week off. The hours that I spent in school, doing homework, and going to work was always more than 40 hours if I added them up, but it was still a pretty good deal. For me, it was the only way to go, as I wanted to go to school, but I also needed that full-time paycheck. Working full time and going to school at the same time was not an option for me as I also have a family and other commitments, and let's face it, I need to sleep sometime. It was still rough at times, but I'm glad I did it. I've had people I work with tell me they would never do it because they don't want to be "owned" by our company for three years. But for me, it sort of gave me a feeling of job security, and after all, three years is really not that long. Also, the administrative staff was very helpful and interested in how I was doing after I got my license (hey, they paid for it). The only down side that I can think of is that if some other opportunity were to come along in the next three years, you might have to pass it up to fulfill your obligation. Also, if for some unforeseen reason you had to relocate or leave your job d/t illness, family matters, etc., this might be a problem. Otherwise, like I said, I think it's a great idea. You might also want to keep in mind that the homework in nursing school is HEAVY (at least it was in the one I went to), and if you have kids to care for or other responsibilities, you really need to be good at time management. And one last piece of advice -- read your contract carefully!! You need to know exactly what they are offering and what they are expecting of you. You will probably have to maintain a certain GPA (which may be different than what the school of nursing requires). Also, what are the penalties if you should need to leave your job before the three years is over? Are you still liable to repay if they terminate you? Are you guaranteed a certain number of hours per week? Are you guaranteed a certain shift or a certain department? Are there any guarantees at all? And you might what to do a little research and make sure that this a place that you are going to want to work at for three years. Like I said, for me, this was a golden opportunity. Hopefully it is for you, too. Good luck with whatever you decide to do!

I can remember being in the hospital after the birth of my second child. At this point I had been a CNA for a year or so, and I wanted to be a "good patient". I can remember changing my own bedding when there was blood on it, emptying the "hats" in the toilet and telling the staff what my urinary output was, etc. Several years later, I was in the hospital for a week with pancreatitis, hepatitis, and an eventual lap-chole. I again wanted to be the "good patient" and did a lot of the same things as before. I thought that I was being helpful, and the staff never said anything negative to me, but now I think that if I had a patient being that "helpful" it would drive me insane. Also, the only hospital nursing I have done was in clinicals in nursing school, and I've never had a doctor for a patient. I've always worked in LTC. I have, however, had numerous retired nurses as residents. I don't know what it is, but they seem to make some of the worst residents. The few that we have had that were not demented in any way were actually very nice, but for some reason the ones with dementia are terrible. We always cringe when we hear that a new admit has some form of dementia and "by the way, she used to be nurse". Like I said, I don't know what it is -- just an observation.

now, even when family has complaints, one of my first questions is "when was your last bm and what was it like - hard, soft, colour? :rotfl: that is too funny. i do the same thing when one of my kids says that they don't feel good. "do you need to poop?" a good poop cures many ailments. this is usually the response that i get- :uhoh3:

I realize this is a little in replying, and that you have probably figured things out already, but I just felt a need to answer. I have worked in the same LTC for 12 years. 10.5 yrs as a CNA, and the last 1.5 yrs as an LPN (charge nurse). The thing that bothered me the most was the use of the word "handled". People do not need to be handled. Just treat everyone with the same respect and courtesy that you expect to be treated with. And don't be afraid to "get your hands dirty". It is as much your responsibility as the CNAs to make sure the residents are well cared for. One of the worst things you can do is spend 10 minutes looking for a CNA to tell him/her that so-and-so needs the bedpan My mother and my best friend work in the same facility that I do on the same shift (they are both CNAs). There are times when I am their supervisor. They know what they're jobs are and they know that I have a job to do, and we just treat each other respectfully. If I need them to do something, I ask them and they do it (and vice versa). I will admit that when I first got my license I was worried about how well things would go between myself and many of the CNAs that I worked with for years. Just remember, they know that you are in charge and they don't need constant reminders of that. I get along great with everyone that I work with. We talk, laugh, joke, hang out on break together when we get lucky enough to get to break at the same time. But I also know that when push comes to shove, I can count on them and they can count on me. Sorry this is so long, but I feel better for saying this. I've worked with nurses who think they are superior because they went to nursing school and they drove me absolutely crazy. What I have noticed is that the ones who carry an attitude usually do not last long. There will always be the CNA or other staff member who will try to bully you or make life difficult (okay, maybe that one needs to be reminded of who's in charge :chuckle ), but that is going to be true no matter where you work or what position you hold. Just remain professional and know that you are capable of making the right decisions and ultimately responsible for what occurs while you are there. Good luck and I hope you enjoy your new experience as much as I have!