What eveyone should know before working in an assisted living facility.

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There is things that one should know before working in an assisted living facility. The first thing is that if they have more than 8 pts who are complete care who can not do anything on their own from baring weight to feeding themselves you need to take note of that. The reason why I say this is because most assisted living places do not have Hoyer lifts or machines that help assist with pt transfers and the simple reason behind this is that most of the residents there should be able to help out and are not suppose to be complete care. You are more at risk for injury if you have to lift someone who can not bare weight at all. No one should have to lift someone that is dead weight period for the safety of the resident and the caregiver. Just think about it most of the elderly have very fragile bones/ or they have arthritis which is very painful for them. Lifting someone with a two person transfer who can not help it all is horrible for the pt and the caregiver. One as the person performing the transfer it is hard on your back and other parts of your body. You could really injure yourself or the pt if they are dropped or if the transfer is to rough for them. Which is likely to happen if they are to heavy and are about the fall. In skilled they do not want you to lift anyone period that is why they have Hoyer lifts, and other lifts to help. So that is something to think about before taking a job working in an assisted living facility. Just remember that most of them are suppose to be able to do their own care, they are not to be complete transfers at all. Don't let the people who runs the place tell you anything else. In less they have a working Hoyer lift in the facility. I just wanted to share this because no one told me and I had to find out the hard way did not get paid anything and breaking my back it the sometime!

Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
I beg to differ on the nursing judgment comment. It's one thing to "assess" the patient (which is what an RN should do) versus "hold" a medication. Without clear guidelines as noted in the physicians' order, it would be like I've made my self a doctor. Not good when it comes to keeping ones license.

Judgment on the other hand, comes into play for things like an infiltrated IV and you stop the IV pump to assess and most likely replace the IV then you resume the medication. That is not holding a medication (the IV), it's simply remedying an issue so the medication can safely be administered.

I disagree.

If I have orders to give insulin, but my patient's accucheck shows a blood glucose of 60, I will use my nursing judgment to hold the insulin as it is NOT appropriate (read: safe) for my patient at that time. Ditto if I have orders to give a blood pressure med to a patient whose BP is 60/40 at the time.

However, I won't just hold the med and continue about my day's activities...I will call the doctor and advise him/her of the patient's change condition, and also request parameters to be added to the med orders for future incidents of this nature.

As a nurse, it is my duty to use my nursing judgment to provide appropriate care to my patients. I don't want to be a robot, just handing out pills willy-nilly just because they were ordered.

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I disagree.

If I have orders to give insulin, but my patient's accucheck shows a blood glucose of 60, I will use my nursing judgment to hold the insulin as it is NOT appropriate (read: safe) for my patient at that time. Ditto if I have orders to give a blood pressure med to a patient whose BP is 60/40 at the time.

However, I won't just hold the med and continue about my day's activities...I will call the doctor and advise him/her of the patient's change condition, and also request parameters to be added to the med orders for future incidents of this nature.

As a nurse, it is my duty to use my nursing judgment to provide appropriate care to my patients. I don't want to be a robot, just handing out pills willy-nilly just because they were ordered.

Both of your examples (insulin and BP meds) should be ordered with parameters. For example... if blood sugar is less than 150, no coverage is need. Hold the BP med if systolic pressure is less than 100.

But hey, it's your license... if you choose to make assumptions of a doctors order, feel free. When I see an unclear order, I have no hesitation in calling for clarification and/or additional parameters.

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Specializes in Cardiac.

I agree there should be clear parameters set for meds.. And I never try to play doctor.. I was merely pointing out that med techs have very limited training and medical knowledge. However, I do want to point out that just because parameters are given for a med doesn't mean you still don't have to use nursing judgement to decide whether or not to give it. If a K level is 7.8 are you gonna give k-dur even if there aren't set parameters? No. What if the order states hold lopressor if systolic bp is less than 100. B/p is 102/58, but you're also giving lasix and a pain medication. What would you hold? It's not always cut and dry. That's why critical thinking is such a huge focus in nursing school...

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Specializes in PACU, pre/postoperative, ortho.
The reason for this is because none of the staff giving medicine are capable of using nursing judgement because they are not nurses, or usually even CNAs. They want those written letters because they have no autonomy to make clinical decisions because they are not medically trained. We need doctors orders to give pts tums. Like seriously, couldn't even give something PRN for fever of they didn't have it ordered.. Another reason I left the RN position... I could not educate them on things like this to a point where they'd understand :/

But there is an RN on staff that is responsible for the med administration by the techs. She point blank told me that my mother with dementia would have to refuse for them to hold the coumadin, not her POA/family. I would understand if it had been the techs making the decision to continue it. She wanted a letter from the office each & every day. If it was a weekend, too bad. Office got busy & it wasn't done? Oh well.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Both of your examples (insulin and BP meds) should be ordered with parameters. For example... if blood sugar is less than 150, no coverage is need. Hold the BP med if systolic pressure is less than 100.

But hey, it's your license... if you choose to make assumptions of a doctors order, feel free. When I see an unclear order, I have no hesitation in calling for clarification and/or additional parameters.

Reading comprehension problems? :rolleyes: I clearly stated that I would be on the phone to GET parameters if I did withhold, or to otherwise notify the physician of a change in the patient's condition.

Because believe it or not, doctors/PAs/NPs ARE human and they can and do make mistakes, pharmacists/pharm tech are human and they can and do make mistakes, and patients are also human and they can and do have unforeseen changes in conditions.

So if I see ANY drug ordered for a patient that flat-out doesn't make sense for that patient's condition/situation, you can bet your sweet bippy that I'm going to hold the med UNTIL I CAN GET CONFIRMATION/CLARIFICATION FROM THE PRESCRIBER. I'm not going to "make assumptions" about their order -- I'm going to protect my patient and get clarification on the prescriber's order.

Honestly, I am downright terrified that you would just blindly give any medication, just because it was prescribed, rather than holding an unsafe med until you could get clarification.

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Specializes in Cardiac.
But there is an RN on staff that is responsible for the med administration by the techs. She point blank told me that my mother with dementia would have to refuse for them to hold the coumadin, not her POA/family. I would understand if it had been the techs making the decision to continue it. She wanted a letter from the office each & every day. If it was a weekend, too bad. Office got busy & it wasn't done? Oh well.

Now that is just STUPID!! I attempted the RN job for a while and honestly could not take the stress for the pay. The lady we had on Coumadin had a mole removed and her daughter told me the dermatologist wanted it held for a week prior to the procedure...I just put a sticky on the MAR for the days to hold and passed it along in report. We did not require orders for things like that.. To me it's almost common sense..

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I was under the impression assisted living the residents were independent for the most part?

The ALFs around here agree to allow that their residents stay with them, even if there's a decline in condition that would warrant moving them to a LTC facility. It's an attempt to comfort, maintain a sense of resident independence, oh, and make money.

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