Latest Comments by JBMmom

JBMmom, RN 7,027 Views

Joined Jun 24, '09 - from 'CT'. JBMmom is a Nurse. She has '4' year(s) of experience and specializes in 'Long term care; med-surg'. Posts: 375 (35% Liked) Likes: 449

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  • 0

    I recently started a med-surg position with a few weeks orientation on days before starting my contracted nights position. I got up to a full six patient assignment on days and felt like all I could do was keep my head above water and address the immediate needs as they came up. Barely had a chance to look at H&P, reports, labs, tests, etc. and when it came time for shift report I really didn't feel like I knew them all that well. Switching to nights I feel like I might be able to be the nurse that I want to be. We've got six-seven patients on nights and so far I've averaged two that really sleep all night, and the rest have had something I need to address. I haven't quite learned how to manage my sleep, but as far as the job portion, it's great. I can't sit down or I'll fall asleep, so I station myself somewhere near my block of rooms and I can spend my time learning. I have time to read through most of the surgeries, tests and labs that were done. I look through all the med lists and learn the ones that are new for me. And most importantly to me, I've had uninterrupted time when a patient needed me to be there. I held the hand of my 80+ year old dementia patient who kept trying to climb out of bed. She settled down and talked, animated and nonsensical until she finally fell into a more restful sleep. My 40ish alcoholic patient that just needed someone to listen as he talked about what drinking had done to him and his family and how he really hoped that this time he would be able to stop, knowing how close he had come to death. The older gentleman with concerns about not only his health, but how his wife's health seemed to be failing a bit, but she refused to admit it and he wasn't sure how to best help. Having a chance to make that connection with people is what I wanted out of nursing. Sure, I'm sure I'll have some boring nights, but fortunately I enjoy cleaning cabinets and studying, so I can easily keep productive. I know most other shifts think we don't do anything, and I'm okay with that, as long as I know when I go home, I've done my best for my patients. So, if you're considering night shift and don't know if it's for you, maybe my experience will help!

  • 3

    I'm so sorry to read this. When I first came to LTC, I searched through threads looking for your posts to learn from you. You sounded like my dream boss!! I would have considered commuting from CT to work for you- assuming you're in eastern Mass. Anyway, the state of LTC in general can be super depressing and I'm so sorry that this recent opportunity didn't work out. Your health is absolutely way more important, I hope you can find a place that will recognize and appreciate your considerable talent and knowledge. If not, the quilting world will gain a great asset! Good luck.

  • 7

    I've worked in long-term care for years, and I have walked out the door with a clear conscience every night- even the night I had a patient tell me she hoped that on my way home I had a fiery crash and died. In any patient setting, we're dealing with people that are ill to some extent. Pain/ disease/ dementia/ environment change, all of these things affect the patients and their ability to process. Does it excuse bad behavior? No. And there are some people that are just jerks in life. I think you're acting in a professional manner and that's the best you can do. I know that in all of my communication I am confident that whether it occurred between just me and the patient, or someone else was watching/listening (because you never know when they are), I would speak in exactly the same manner. You can't get through to everyone, you can't fix everything, and sometimes you have to just let it go. Good luck.

  • 1
    cleback likes this.

    Wish I had a magic answer for you, I hope that something works out for both of you soon. My only suggestion would be to reach out to any contacts you might have to see if you can get a foot in the door for other positions. I know a number of nurses that have had similar problems finding jobs, even with experience, while others are able to find them through contacts. Good luck!

  • 1
    FolksBtrippin likes this.

    I had a positive test almost 30 years ago after being a candy striper in a local hospital. I also got a year of INH therapy while I was in college because I was living in the dorms where communicable diseases could be a problem. Over the years I've had to have a couple chest x-rays, for nursing school and a new job, but other than that I've never had anything happen. Don't worry, get the information you can from your doctor, and take care of yourself. Good luck.

  • 0

    I can only imagine how she must be struggling to deal with the aftermath of this awful event. My thoughts and prayers go out to her and her loved ones.

  • 4
    Marshall1, abbnurse, Orca, and 1 other like this.

    I came into nursing as a second career. I never felt particularly called to it, the education I had for my first career made nursing or teaching the easiest second careers for me to consider. Nursing seemed to have a wider range of opportunities, so I picked that. I finished nursing school five years ago, and I really like being a nurse. I don't feel like I'm a better person than others for being a nurse, so I don't project that and no one has initiated any sort of conversation to that effect. I'm a person doing my job just like they're people doing theirs. Just because my job revolves around providing care to others doesn't mean it's better. I wouldn't be interested in being a civil engineer, but we need them otherwise our bridges will fall down. Other people aren't interested in providing care for people, I do that because it's what I'm trained to do. If you don't think it's for you clinically, that's one thing. But I wouldn't dismiss a career based on what someone else might or might not think.

  • 2
    TriciaJ and ceneil76 like this.

    I'm sorry that this happened to you. I would find myself in exactly the same boat if I was unlucky. At my facility, wounds are measured once a week. Dressing changes come up as a treatment order, and there is little to no documentation available to you about the wound itself. I think our wound care nurse may have a file in her office with information on her weekly rounds, but other than that there's nothing to look at. I would have done exactly the same as you and probably not given it another thought. Especially for skin tears, we just write the treatment order that we get and pass is along to the next shift verbally. Unless it's something really awful or unusual we'll just get "skin tear", and go about our work. Good luck!

  • 0

    Thank you for your input, I'm hoping that my boss will agree that a few more shifts would be reasonable to get me up to speed. Switching to nights would give me a better feel for what will be expected, and get me some experience. I hope they agree to give me a little more time. Thank you.

  • 0

    I have worked part time in long term care for about four and a half years, the past two as a supervisor, not on floor shifts. I recently lost my full time job of 17 years (not in nursing) and I applied for a med-surg position at the local hospital on third shift. I decided to apply to third shift because I thought it would give me a better chance to transition without things like lab results, consult results, providers on the floor, and the hustle and bustle of days. I figured I could get the rhythm of assessments, meds and treatments with potentially fewer interruptions.

    In orientation I found out that I would be trained on day shifts before my third shift position started. I have faltered a little. Admittedly I was focused on med times- because that's the key nursing endpoint in LTC- and my speed with charting was behind. I would complete the assessments early in the shift, but I was trying to chart all together when I had a quiet moment, so it looked like I didn't assess my patient until 1pm or so. On my 10th shift I was given an action plan with targets for charting and told we would reconvene in two weeks to review. I have had five shifts since then, and four have gone reasonably well. One did not, and I'm not chocking it all up to excuses, but I was on a new floor, didn't get my assignment and report until almost 8am and I had two patient with Q3 pain meds that needed 30 minute pain/vitals reassessments. I fell behind again that day and was told that I missed some things I should have followed up on, and I agreed that it was not a great day.

    My last shift, though, I had three discharges, one admission and one patient throughout. I had all my assessments in by 9:30 and by 10:30 two discharges were gone with education and care plans complete. I felt like a rock star and thought I had finally turned the corner. My coordinator said it was a great day and she would let my boss know. Then last night I got a voicemail message that I'll be meeting my boss in HR on Monday. I checked my schedule for next week and it's been deleted. So my assumption is that after 15 shifts they've decided I'm just not going to work out. I know in my heart that I can do this, and be an asset to the organization. My patients seemed to really like me, but I think I spent a little too much time talking when I should have been real time charting. The reassessments I was told I missed were blood pressures. Two people not had their lisinopril lately (one held for surgery, the other noncompliant) and their bps were running in the 150-160/90-100 range. This had been consistent for the past couple days. I was finally able to give the lisinopril- doses they had taken in the past, and I was told that I didn't reassess an hour later and that was wrong. I thought lisinopril would not reach peak effectiveness for about 6 hours, why would I reassess in an hour? I also admit I spent most of the day running around trying to fund supplies and do small task things so maybe I looked disorganized- but I did admit that readily. I obviously can't give the whole story, and I'm not even sure I know the whole story.

    I'm not going to the meeting on the defensive or coming across as negative. I would, however, like them to consider the investment they made in my orientation and 15 shifts thus far, and consider giving me 3-6 more shifts. Would it be unreasonable to suggest that? I spent the other night redesigning myself a new sheet for keeping track of things, I've been going in 45 minutes early to get my assignment and take down all the information I can before my shifts starts. I'm really committed to this and I've had a successful career in the past. I was also wondering whether asking for a few night shifts would be appropriate? I've had 5 patients on days, and the census lately has been giving nurses 4-6 patients on nights, so I think I could do it. Any thoughts? I'd appreciate any feedback, even if it's that I'm just not going to make it. Thank you.

  • 0

    Does your LTC facility provide CPR certification classes for staff nurses or are your required to do that on your own time? I just found out that our facility has been providing Heartsaver CPR to staff nurses, that is the certification intended for non-healthcare professionals that need just basic CPR- like teachers, daycare providers, etc. I don't want to cause a problem and make my co-workers responsible for finding their own certification classes at the expense of their own time and money, but I don't think it's good to have nurses in the facility with less than BLS level skills and training. Just wondering what other facilities require and/or provide.

  • 0

    Just wondering how other facilities schedule holidays.We get a list in October, you sign your name and then number Christmas, Thanksgiving and New Years in preference of what you would want to have off. Then at the beginning of November the schedule magically appears and you may or may not have your first preference off, even if other people with a lower preference for that particular holiday have it off instead. It appears to be entirely at the whim of the scheduler and manager. I had Christmas my first two years, this year I got Thanksgiving- but I was bumped to a different position. I've heard other people complaining that they have all three holidays and others got none. I realize no one approach can make everyone happy, but this random (by admission of the scheduler) just seems dumb. How do you do holiday rotations?

  • 0

    First, wow you're in a tough spot. That workload sounds like it would be overwhelming to anyone and your staffing sounds like something that would make it difficult to provide adequate care. I hope you can find something else soon. To answer your question, I know a number of nurses that transferred from my LTC facility into acute care positions. You are not a fake and a failure. You are doing your best with a very challenging first job out of school. When you have an interview for an acute care position, highlight the skills you have developed like time management, communication with patients, staff, families, assessments in a wide demographics range from psych to skilled nursing. Anyone hiring someone from LTC is going to understand that the skill set is slightly different in acute care, but it doesn't mean you won't be qualified. You're gaining valuable experience, just focus on what you bring to a new position. Good luck where you're at and with finding something else, because where you are sounds like a nightmare.

  • 1
    mltruglio likes this.

    We switched from paper MAR to eMAR within the last year and a half. It's coming up to the dreaded state inspection window and some nurses are getting slammed for signing off meds out of the hour before/after window. In some cases it's becaused a single resident's meds are ordered for 4p, 5p, 6p, etc. and we're trying to get all that straightened out so meds are grouped together and residents are getting them at the same time based on room assignments. And in some cases there are emergencies that require attention and get nurses sidetracked. I know that I have seen a small sign on med carts in another facility alerting residents/family that nurse is doing med pass and to ensure safety questions should be directed to other staff. Anyone else seen these? Anyone have other ideas? I'm just thankful that I'm rarely on a med pass anymore, I'm slow.

  • 2
    NurseEmmy and heron like this.

    In our LTC facility we have a resident known to get combative and spit during care. The POA objected to a surgical mask because he said it would be too restrictive, and his accusation was that we would leave it on for prolonged periods of time. So there is a care plan in place that a towel may be draped over resident's mouth in instances when he is combative or spitting.