So many ways to mess up!

ms_orion · Jan 19, 2011

It ain't NEVER going to end... if you do one thing well .. you will get reamed for doing another thing poorly -- and the thing that you did well -- you will get no credit for that. LTC... sucks! Not because of the patients, but because of the lack of staffing and the certain amount of people that work in the environment that really are there to get a paycheck for showing up. It's my opinion (I know, everyone has one)..but, to survive in this environment a person HAS got to have a certain amount of 'I Don't Give a Damn' in them, otherwise... eventually a person who doesnt have that...will lose confidence in themselves, in others and begin to lose their own minds. I am at that line right now. You wrapped an emergence bleed in the dining room? OMG! ***! Ya know? Be real! I would pat you on the back for taking care of it. You cut a sandwich without wearing gloves? Did you wash your hands first? Your hands were probably cleaner than the gloves anyway....who is doing all the reprimanding? Techs? Nurse busy-bodies that sit on their ass and gossip watching what YOU do instead of lending a hand. Relax...be the kind of nurse that you want to be.

Remember what you have learned. Continue to learn. DO NOT LET THEM BURN YOU OUT!

INLPN93 · Jan 19, 2011

Get out a report sheet, to use as your own at the beginning of your shift.

Make notes in report, write down the IV's, txs and pertinent charting.

Take this paper with you the whole shift.

Making notes, vitals, and blood sugars.

When the shift is over, use to give report and transfer the info onto the facility report sheet.

If you see right in front of you in writing, you will not forget it.

I have done LTC for 18 years, and have been at my job now for 2.

I know the res. and what's expected but that little sheet has saved my forgetful, scatter brain on many occasions.

nurseygrrl, LPN · Jan 19, 2011

Sometimes others forget that we are HUMAN. I wonder if the people that are reaming you out could do better? Probably not. I know just how you feel. As nurses we have to prioritize and write things down, but that doesn't work all the time. Think of it this way, if you had 10 patients would you be making these little errors? No. Management expects us to do the impossible. Just do your best and remember to keep things in perspective. You're not alone!!!

mentalhealthRN · Jan 19, 2011

LTC with that kind of staffing/numbers is a huge set up for failure and that is why I will never do it. Its stressful and unsafe. You can't expect any nurse to do quality, thourough work when you give her 20 + patients. And not easy patients......ones with 30 meds and 4 treatments........that is just the most insane thing I have ever seen and I refuse to put my license on the line for it.

Forever Sunshine, ASN, RN · Jan 19, 2011

3-11 gets the biggest beating out of all 3 shifts in LTC and I could write an encyclopedia to back that up if anyone tries to say its not.

And what were you supposed to do for the emergency bleed? Magically cauterize it? I would have done the same. Well first apply pressure than wrap it until we call the MD.

LPNs in my facility aren't responsible for IVs when we do have them. Yes we are educated on them, but the RN is responsible for assessment, care, and documentation of everything that has to do with the IV. The only advice I have for you there is when you are recieving report, maybe you could write next to the residents name, *IV*, and circle it or highlight it.

CNAs in my facility aren't usually a problem. Start out I had some issues that I realized were with myself being in charge of them, turns out I needed to make myself stronger and say, "This is what it is.. and this is what we are going to do". When it comes to helping them.. you have to draw the line somewhere.

I put on gloves if I have to touch a residents food. Not to cut something. Our facility's rule of thumb is if your hands come in contact with the food itself.. put gloves on. I don't disagree with it. (I'm very OCD about hands or other food items touching my food so I just apply the same thing with my residents, and another thing that gets my goat is when CNAs mix food. I hate mixed food)

There should be a contact precaution sign outside the door with PPE in a cart nearby for rooms with contact precaution.

namazonian · Jan 20, 2011

Amen to your statement Ms_Orion!!!

Popwhizbangz, LPN · Jan 20, 2011

To be honest - I was in the same boat, got out early, went into Geriatric Psych (Dementia) inpatient early on, and it was much better for me. Never looked back. I'm glad for the residents in LTC that the facilities find staff, but LTC is SO SO SO underfunded, understaffed and fiscally distressed on average, and the blame in health care tends to fall on the line staff, fairly or not, its just quite convenient for management, regulators and funding sources. Do the best you can, sorry I could offer nothing better. :coollook:

Also - Do your best, learn from experience, build your effective work routines based on that experience, and remember - stress and worry about mistakes can become a distraction that, ironically, can further contribute to mistakes....

NamasteNurse, BSN, RN · Jan 20, 2011

wow, thanks so much! you all really made me feel better. I will try and develop a thicker skin and take notes!

CoffeeRTC, BSN, RN · Jan 20, 2011

That isn't bad staffing for the 3-11. How many CNAs do you have?

I agree...get thinker skin. Some of those are minor errors and some can lead to more (Iv issue)

Organization is key and always remember the ABCs when prioritizing. Look back on those issues and think what you could have done differently.

The wound issue...Maybe it should have been done right there and then remove the resident OR in the amt of time you went to get supplies,could you have taken the resident to the supplies? (I wasn't there, cant guess on this one)

IVs....always get into a practice of cheking them first and frequently. Even when you do this you will still have problems with this. I had a lol infiltrate last week. It was on her hand and running at 75 cc. Even checking on it every hour, (well, the last check was at 1.5 hr and don't you know it blew) things can happen.

Leaning on the bed...really? I hope you don't get written up for this one. You can try and try to avoid residents with infections, but in LTC, you wouldn't have a job. Was it gross drainage you were leaning on?

Cutting a sandwich with gloves on? Really? I bet you were helping during a meal pass..did you wash your hands recently? Do they expect you to glove with every try you pass? Unless the state was watching.....

The CNAs are another issue...that will come with time.

Don't worry...we've all been there and even being a seasoned LTC nurse..I know I'm not perfect.

Forever Sunshine, ASN, RN · Jan 20, 2011

The wound issue...Maybe it should have been done right there and then remove the resident OR in the amt of time you went to get supplies,could you have taken the resident to the supplies? (I wasn't there, cant guess on this one)

This is what I would have done..

I would have left the resident right there in the dining room. its easier to clean a puddle of blood in one spot than to clean a trail of blood) Or if they were near a door... quick take them out. Have a CNA apply pressure with a clean napkin(have to improvise.. we are in the dining room here.. not the operating room) while I went to the treatment cart (can't have CNA do that as the supplies are locked and we can't give our keys to anyone) to get something to wrap up the leg. ..Then take them out of the dining room and take vitals.. call MD and take it from there.

NamasteNurse, BSN, RN · Jan 21, 2011

Thanks Michelle,

I think I've calmed down the last day or so. It seemed like one mistake led into another. I'd drive to work wondering what might go wrong and Murphy's law kicked in. With all the snow we've had lately, everyone seems to be on edge and short staffed.

To answer your questions, the bed I leaned on was because I was giving a bolus feed and the resident was pulling away, so I was leaning way over to reach his tube with the syringe in it with one hand and with my elbow keep him from ripping my other hand with the cup away or tearing out his tube.

The IV thing really haunted me because there was just no excuse and when the supervisor said "I'm giving you a verbal warning. I'm just so surprised at you", my eyes filled with tears. I'm waaayyyy too sensitive!

As to the sandwich cutting, yes I was helping with tray pass in the dining room. I had washed my hands, but if actually touch food we're supposed to wear gloves.

Thanks for the ABC's reminder. That's what I mean about forgetting the basics. Most days I'm happy when no one falls!

Thanks again! All of this talking about it really helps.