Getting eaten alive at an LTACH...

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    Started my new job at an LTACH Nov. 11th. I took the job because I wanted new challenges in my career, caring for vent pts and in general higher acuity pts, because I've been caring for more stable pts the last 2-3 years. The nurses draw their own labs here, do all their own VS and blood sugars.

    Even though I'm not a completely new nurse, I know my strong suits are not phlebotomy and starting IVs. I know it, but I'm still willing to try. (I used to be able to do it in nursing school, but I've lost the feel for it since then.)

    The bad part is my preceptor. I really like her as a person, and she's been a great preceptor overall. I lost dome time during my orientation due to illness, and now I'm really worried coming off orientation on Saturday that I'm not ready to handle the jump.

    I had to initiate a new IV this morning on a pt whose line was due to be changed. My preceptor had already given me hell the night before for being slow (I'd had 4 pts in training, and got bumped up to 6 that night). She was charge nurse last nite, and when I tried (and failed) to get a new IV started on my patient, she and the nurse who was precepting me for the night followed me into the pt's room and discussed my past IV start failures in front of the patient. They were laughing and joking about my incompetence (and giving me hell about it), but I know this pt will prob never let me stick him again.

    Making it worse, my preceptor is Filipino, as was the other nurse. We frequently have a lot of Filipino nurses on night shift, and they're always conversing in the other tongue. I know they mean well (and are always quick to help) but it comes at a high cost to my self-confidence as a nurse.

    Should I ask for more time on orientation? I hate to do it, because I feel like others will look down on me for being too "slow". (There's a big push to get the new orientees off on regular staffing because my facility was using agency nurses heavily until now.) I'm just scared to go off orientation, because there are a lot of precedural things I'm not clear on, and still feel pretty lost on the general workings of the hospital.

    Jus wondering which way I should go...
  2. 6 Comments so far...

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    If you feel you will be a danger ask for more orientation. I have to say that there will always be some things you will not know until you encounter them working as a Nurse. That's when you ask someone for help. LTACHs are tough places to work. You have ICU like patients sometimes on drips, vents, etc.
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    Although I've never worked, or even set foot, in an LTACH, I have heard they can be hard, hard places. Be sure to speak up. That's what the preceptors are there for.
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    Moved to Long Term Acute Care (LTAC/LTACH) for more response.
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    I'm pretty sure the regulation states staff must speak the language of the resident in any patient care area. If they are not speaking English, they need to be told.
    Secondly, to talk about your failures in front of a patient just isn't right and they need to be told.
    Ask for more orientation...safer for the patients...better for you...and in the long, run the facility will get a better employee.
    LTCNS and Here.I.Stand like this.
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    There is more to being a good nurse than starting IVs. I work in LTACH and most patients have PICCS/midlines for a reason. They are difficult to stick. The procedural things like starting IVs and blood draws- you will get with time. It took me a long time to finally get decent with starting IVs and I am decent at most. I was a mess with it in the beginning. Believe me you will be surrounded by a lot of nurses that are great at it and love doing it! Watch them do it and notice their technique. The LTACH population is challenging but please don't downgrade your nursing abilities because you can't start an IV or draw blood. There are greater things to stress about like picking up when a patient is about to crash and burn. I would put the phlebotomy/IV as a skill set that is needed but in the grander scheme of things it is not a top priority. I know on nights you have the majority of labs to do so if I were you I would follow a nurse that is good at it and watch her technique.
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    Thanks for the comments, everyone. I was extremely frustrated that day when I left work. Mad and frustrated at myself for not being more skilled, but also mad at myself for not speaking up (either in front of the pt or after to my co-worker/preceptor). I don't think THEY got it, but I would never denigrate another person's skills like that in front of someone else. And they were speaking English about me in front of an alert and fully-oriented patient. I felt about an inch tall after we left the room.

    Thankfully, there are others who are willing to help teach me. One of my nursing school classmates works there, and she's been very helpful with tips on where to find good spots on hard-to-stick patients. Another Filipino nurse was kind enough to come in the other nite (after I'd stuck a pt 3 times) and point out a decent vein and a good angle to stick at. I am learning and always receptive and ridiculously grateful for a good teacher, but I don't think anyone would respond well to being talked to like you're slack-brained or an idiot.


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