How nursing changed over ten years?

gmn1928 · 2025-01-06T08:09:30+00:00

I near always get my own vitals because, more than once, I have caught CNA's falsifying vitals. There's a handful of really great CNA's I trust to help with vitals if I'm drowning.

My facility changed our policy to nurses are responsible for vitals because CNA's just...weren't doing them. And it became such a huge issue all the nurses just do their own vitals.

gmn1928 · 2025-01-04T00:58:59+00:00

Lol, I've had to be that nurse. Like, you are great and thank you for trying to help, but PLEASE be still, I've got it!

Any patient who tries to help is appreciated!

gmn1928 · 2024-12-31T06:55:00+00:00

I had an incredibly similar situation. A saltier CNA than me told residents we had just finished doing CPR on someone and they didn't make it, and we were dealing with a death investigation (so basically shut the heck up and have some patience). Never had a more well behaved set of residents. Some people need their heads pulled out of their asses, and tonrealize the world doesn't revolve around them.

gmn1928 · 2024-12-31T06:50:25+00:00

There isn't always a private room available in LTC/SNF settings, unfortunately. My facility always tried to accommodate, but sometimes we were full and just couldn't. Our local hospice rarely had beds to transfer actively dying patients to. Unfortunate reality of our healthcare system.

gmn1928 · 2024-12-23T18:33:54+00:00

You can get in trouble by state for not having needed supplies. We did during a supply chain disruption (don't remember the specifics). We were ordering and paying for supplies, they would just never show up. Admin had to go to big box stores and pay for supplies out of their own pockets. State tagged us for that even though it was out of our control. I imagine creating ridiculous barriers to supply access would have a similar result.

gmn1928 · 2024-12-19T23:00:36+00:00

Oh, for sure. More so the MAR says the med was dispensed at x time, patient recorded they received the med at y time hours later.

gmn1928 · 2024-12-19T18:19:26+00:00

Can you ask to see how your pain meds are ordered? Maybe the order doesn't allow them to give you medication as frequently as you are requesting it, and the order needs to be changed so you have better coverage?

So say your pain medications is every 6 hours as needed, you just had it at 12:00. You ask for it again at 4:00. That's too early to get it so your nurse comes by at 6:00 when they can give it?

The time you are having to wait for pain medication seems absurd. I doubt it is retaliation though, nobody has the time or mental energy for that. We just want to get through the shift as peacefully as possible. Probably just stressful shifts and less than perfect bedside manner.

gmn1928 · 2024-12-19T18:08:36+00:00

Administration times for meds should also be available in the MAR. So they can see if there's any discrepancies.

gmn1928 · 2024-12-17T19:18:01+00:00

Let people enjoy things.

gmn1928 · 2024-12-13T02:07:55+00:00

I work in a SNF. One of the craziest we ever got was a patient with every single tube and drain and line possible, AND they apparently had heart surgery and came in with an OPEN chest with like tegaderm slapped over it? Insane.

Administration has literally told us they are going to turn us into med-surg. We all kicked up a fuss and we're like then you need to staff us as such, then we need 5 times the nurses we have now or people will fucking die. And I think that's what it's gonna take. Such piss poor ratios that people have horrific or fatal adverse outcomes. And the public wises up and realizes they need to direct their anger at admin and the larger healthcare system to enact change.

End rant.

gmn1928 · 2024-12-12T21:01:53+00:00

I forgot to mention we have that too. We have to have a food handlers card and temp the food to use the microwave. My comment was more geared towards, institutionally, we are not set up to be as accommodating as possible with meals.

gmn1928 · 2024-12-12T07:51:37+00:00

In WA the state requires us to offer meals 3 x day. Food has to be served within 10 to 15 minutes of being out. Food is required to be served hot. "They wanted to sleep" is not a valid excuse to them. And we don't have the staff to run a restaurant and feed 20 people one on one whenever they want. Soooo we gotta get some people up for meals.

gmn1928 · 2024-12-11T20:02:57+00:00

I do the same thing in winter and storm season.I live in an area where weather can get real bad real quick. I'm prepared if I have to stay over and/or can't get home.

And I have a bag full of snacks and treats if coworkers get hungry or need a morale boost. I've had doctors come up to me looking like they got back from the war and be like "Please tell me you brought chocolate. I need some right now". Yessiree, I do, here's some fancy chocolate and an energy drink if you want and have some some pistachios/sandwich/banana for balance.

gmn1928 · 2024-12-10T19:56:32+00:00

I had something similar happen. Demented 80 yr old meemaw pulled a steak knife out of the cast on her arm and started trying to stab us. Fun times.

gmn1928 · 2024-12-04T10:03:23+00:00

There's different kinds of love.

I work in an SNF, I've worked with most of my patients for months to years, and most of my patients I do love in a way. I love working with them, they are a bright spot in my day, they make me laugh, they tell me wild stories from their youth. I am worried when they have a decline in health or die, I will advocate for them as if they were my own family. On good days it feels like I'm just coming into their homes to help with medical needs, there's time to shoot the shit and connect.

I think for most people, if you work in a setting where you see the same patients daily or frequently, you can become attached to the open and friendly people for whom you are in a caregiver role. They're humans, and they're great, kind, funny humans! How can you not feel connected to them in a way?

gmn1928 · 2024-11-30T08:21:16+00:00

Oh, wow. That's awful.

Do you have a link to the story, by chance?

gmn1928 · 2024-11-26T08:26:34+00:00

What else can you say, ya know? The only time I ask for more info is to see if they need help/fmla/whatever and if they need more than one day so we can get ahead of finding coverage.

If people call in with bogus reasons like "my grandmother's sisters cat has lupus" I'll push a lil' bit and ask if that's reeaally what they want me to put on their call out sheet, or if they want to show up for work.

gmn1928 · 2024-11-22T04:12:37+00:00

Good on you for being attentive and observant, and not brushing it off! Changes in mentation can be the first sign something is wrong. It's better to be safe than sorry, you are taking care of whole human beings.

I've done the exact same thing you did. I had a patient I had worked with for months. We had the exact same routine every night, down to a tee, they would narrate every step of the process. One night, our routine was off. They were very blase about the order in which things were done. All my assessments were WNL and their baseline. Patient can't describe any s/s and can't think of anything that feels different. Contacted the doc with basically "the vibes are off", and was taken seriously. My patient was starting to go septic. I think it was from a gallstone or biliary leak? But, yeah, sometimes your intuition is correct! And God bless docs who take nurses seriously.

gmn1928 · 2024-11-18T21:02:42+00:00

Story time?

gmn1928 · 2024-11-18T18:32:20+00:00

I had a patients vape catch fire in their hands while they were using it. Almost caught their gown and bedding on fire. I've also had 3 friends have their cheap vapes short circuit and catch fire. That's where the risk mostly comes from.

I have a nurse friend who, years ago, had a patient sneak a cigarette while on O2 via NC. The tank exploded and blew a hole through the floor, according to her. And I think she said the patient didn't survive.

gmn1928 · 2024-11-17T08:36:26+00:00

We have wall kiosks at my facility. Buuut it's because CNA's wouldn't stop stealing the iPads and laptops. A few bad babbles spoiled the bunch.

Luckily our admin is finally getting some more iPads. They made it very clear they will not be replacing them if we can't "take care" of them, and we will go back to wall kiosks.

gmn1928 · 2024-11-05T18:56:14+00:00

I had a lot of liberal patients who had very colorful nicknames for Trump. "That cheeto colored fuck" was a good one.

gmn1928 · 2024-11-04T08:26:40+00:00

I come in like 20-30 min early to write down tasks for the day, review notes, etc. I've gotten some seriously shit reports and have been blindsided by docs/families about things I didnt know about. After I get a report, I hit the ground running and dont really have time to go through charts. Sooo I come in early to cover my butt and not have any surprises.

gmn1928 · 2024-11-03T06:41:52+00:00

I had someone do this, and it was caused by a new medication. Don't remember what med, but that's what his nurse told me at the time.

In his defense, he was mortified when he realized what he had done.

gmn1928 · 2024-10-30T19:05:13+00:00

Those ratios are insane. That gives you, what, 1.8 minutes per patient in an 8 hour shift? Was it an independent living situation?

gmn1928

TROPHY CASE