starting LTC and have a couple questions

JB2007, ASN, RN · Jan 14, 2011

They should have a P&P manual and I would not start working until they showed it to me. That is to cover your butt when something goes wrong you can show them where you was following their P&P. Otherwise they can throw it back on you and state that the problem was not theirs but yours because you was not following their P&P. That pt load sounds pretty normal. Meds that I would brush up on are your diabetic meds and your BP meds. Everyone seems to be a diabetic and have HTN now a days.

Good luck with everything!

Forever Sunshine, ASN, RN · Jan 14, 2011

I have about 25-30 residents. Even when I have to wear the charge nurse shoes.

We do have a policy and procedures manual and did they tell you flat out we have no policy and procedures manual?

Brush up on the med administration(as it takes forever), documentation up the gazoo, GTube care, wound care, inserting foleys, fingersticks,. As for the meds, coumadin(and pt/inr values), b/p meds, narcotics, antibiotics, laxatives, insulin.

oldfaithful · Jan 14, 2011

thanks so much. I was actually told that they don't have a P&P at all. i was kind of horrified and didn't know if that was normal.

Forever Sunshine, ASN, RN · Jan 14, 2011

thanks so much. I was actually told that they don't have a P&P at all. i was kind of horrified and didn't know if that was normal.

That is not normal. As much as that is just 3 big books stuffed to the brim that sits up on a shelf sometimes. It can be a lifesaver when you are by yourself and stuck in a cookie about what to do.

JB2007, ASN, RN · Jan 14, 2011

thanks so much. I was actually told that they don't have a P&P at all. i was kind of horrified and didn't know if that was normal.

No that is not normal and I would not work for a place that does not have one. Just my:twocents:.

locolorenzo22, BSN, RN · Jan 14, 2011

protect yourself. Legally, YOU are then responsible if you screw something up. The facility can go.."oh, that is not how our P&P mentions how to do this task..." and totally make up a binder to protect themselves. Anything can be done quickly to protect a business.

Forever Sunshine, ASN, RN · Jan 14, 2011

protect yourself. Legally, YOU are then responsible if you screw something up. The facility can go.."oh, that is not how our P&P mentions how to do this task..." and totally make up a binder to protect themselves. Anything can be done quickly to protect a business.

Thats also what I'm thinking of.

Suppose you do something one way that you thought was reasonable. And they come to you and say you weren't following our new policy on that.

Example- you take a med order for every 6 hours. And you put 12am, 6am, 12pm and 6pm. But their policy and procedures book that magically appeared states that the times for meds every 6 hours must be 10am, 4pm, 10pm, and 4am.

oldfaithful · Jan 14, 2011

Yeah, i'm on the same page. Not really comfortable with the lack of a p&p. Thanks everybody

debRN0417 · Jan 14, 2011

They have to have a PP. They cannot be certified under Medicare/Medicaid without one. Also ask them what Manual they follow for standards of practice.

dblpn · Jan 14, 2011

I'm going to be starting at a LTC facility next month, but have a few questions: 1) what is your typical patient load -they told me i would have 35-45 patients (one nurse doing assessments and the other doing meds) 2) does your facility have a P&P manual - this one doesn't and i find that concerning 3) what are some skills and meds that i should brush up on? - been out of nursing for 5 YEARS!. thanks everybody!!!

I would definately brush up on med admin. especially when it comes to g-tubes. state, if they ever come to your facility, is really big on this. they watch you like a hawk. like another poster said, know your HTN meds and diabetic meds. almost all of our residents are on one or the other, or both.

As for the P&P, they should have one and know where it is. this is YOUR license. Ask plenty of questions if you have to. remember there are no dumb questions when it comes to nursing. Good luck.

NamasteNurse, BSN, RN · Jan 24, 2011

xanax, ativan and other psych meds, coumadin, (know your norms) senna, miralax, colace, insulins, pain meds, synthroid, morphine, lopressor and other BP meds. suppositories, lots of creams esp for yeast type infections (lotrimin). nebulizer tx, (duoneb), just to name a few. I know other posters will name more.