Latest Comments by JBMmom

JBMmom, RN 7,522 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: 396 (37% Liked) Likes: 497

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  • 1
    imhorsemackerel likes this.

    You're setting a really high bar for yourself, give yourself credit for what you have done so early in your career. You sound like you're doing your best, and you're getting your feet under you. You've already been recognized for some of your caring ways, but working days on a busy floor is going to limit some of the time you have for "extras". I work nights and find that I have some time available to spend with patients that could use some extra support, because the pace of the floor is different at night. Don't be disheartened, you're going to find a way to do what's important to you, and until you can fit it in try not to beat yourself up. You can't be everything to every patient, but you're doing your best.

  • 1
    pebblebeach likes this.

    I'm glad you found success in your program and much of your material seems valuable to others. I would caution you, however, throughout your career to avoid the sweeping generalizations such as the one made in your pet peeves section. While you may have been annoyed with the students that were CNAs before nursing school, your pet peeve is more of a highlight of an attitude that may get you into trouble in the future. There are certain things you just need to let go. If someone needs to feel a little more confident by sharing that they have past experience, how does that really affect you? I found during nursing school that I wished I had CNA experience because in many cases they were just more comfortable in the patients' personal space. They are often more efficient at some aspects of care, and those are valuable skills even at bedside nursing level. Try to find the learning experiences you can from everyone around you, even if it's learning what you don't want to do.

  • 2
    Sour Lemon and brownbook like this.

    Good luck in the supervisor role, you're obviously motivated to do a good job and that will take you far. I've been told that my coworkers like it when I'm supervising, so here are a few tips from me. Be fair and firm, as long as you don't play favorites and you show that you're doing what's best for your employees and residents, little bumps along the way will work out. NEVER get sucked into the gossip game, even if you have a relationship where you become closer with some coworkers than others, you need to stay out of that stuff entirely. And always be willing to help. Every employee in the building knows that I will never ask them to do something I'm not willing to do myself. Enjoy your new position, there might be some challenges, but it will be worth it!

  • 0

    That's what I thought at first, but we were specifically told that organizational sheets should no longer be used. All of handoff report should be in front of the computer, completely uniform among staff. I think they're making too big a deal about that point, it doesn't sound so far like anyone else works without a single piece of paper.

  • 2

    An unbiased opinion based on the tone of your post is that you should not pursue something you dislike before you've even really started. But as Sour Lemon pointed out, talking with people that know you better will probably be helpful, and support from family and friends is important when evaluating life decisions.

  • 0

    I was just wondering about how others have transitioned to not using paper, if anyone has. I'm not concerned about the cost of two sheets of paper, nor do I really think I will be fired for using them. Thanks for any tips.

  • 0

    Our facility recent changed EHRs, and we're being told that soon we will not be allowed to have any papers for our patients. The previous system provided multiple sheets per patient with the orders printed out, and I found it very cumbersome to navigate. I have my own sheet and I can cover my 7-8 patients on 2 pieces of paper. The EHR has a report page that we are told we will reference during bedside report, but to me that is very difficult to synthesize into an informative report. And I use my paper as a checklist throughout the shift, to remind myself when I've checked patient #1's IV flushed, and cleared the pump volume for patient #4, done my education and care plan on everyone, etc. Are there other med-surg nurses out there that have gone totally paperless? Any tips on how to do it? I really think that some of us are just list/checkbox people and to demand that we not use them, just to save 2 pieces of paper, seems like focusing on the wrong aspects of our job. Ensuring that I'm able to do my job thoroughly and safely, even if I need some paper, doesn't seem that awful to me. I'm not resistant to change for the sake of being resistant, and I'm definitely willing to give it a shot, I could just use to tips. (Or others with experience that it did or didn't work out). Thanks!

  • 3

    I agree that getting the most useful information at report and prioritizing based on that will be key. I come in for third shift, so it's slightly different because some of my patients are (theoretically) sleeping. If you have a complete handoff report, you shouldn't need to do much research, if any, before seeing your patients. I am personally not as concerned with what a note/lab/computer charting says, as I am with putting my eyes, ears and stethoscope on the patient. I would estimate that report is usually done between 11:30 and 11:40pm. By 12:30am, I've usually seen everyone, in order of most critical to least, and I've done my safety check- name and date of birth compared with bracelet, checked what's hooked up to the patient- IV, O2, Foley, etc., and asked if they are having any pain. It doesn't always work out that way because if patient's number 2, 3 and 4 all need pain meds, now we're past 1am before I've seen the others.

    Use your available resources. If you're lucky enough to take report on all your patients from one nurse, ask them- based on this assignment, how would your prioritize my next steps? Everyone was a student at one point, and everyone was a new nurse. There's no problem with asking a question to help you learn the best approach and any nurse should be willing to spend a minute to go over the assignment quickly for prioritizing. After you've seen everyone, then you read the notes, labs, etc. If you see a sodium level of 126, you might be very concerned, but if you've been in and spoken with your patient and there no complaints of weakness, fatigue, headache, muscle cramps, etc- that's might not be out of the person's baseline. Also, many people will share with you important information like "my sodium always runs low because I drink a lot of water", during an initial conversation.

    It will all come with time, don't worry too much, you sound like you're very much on the right track. And meds will come with time, you'll start seeing some of them over and over and will not need as much work there. Good luck!

  • 2
    Here.I.Stand and Everline like this.

    I always tell my kids that boredom is a reflection of the person, not the situation. You can find something to keep you challenged in just about any setting. (except maybe, as my kids have pointed out, working in a factory putting the toothpaste cap on tubes- but even then, someone has to do it). I think you need to find the area of specialty that you would enjoy and you'll automatically find a way to grow and learn in it. You've had some really smart people answer you here and look where they are- ICU, midwife, floor nurses, etc. There's no smart nurse specialty. Smart people are everywhere, and they're smart in part because they've learned what will make them happy and play to their strengths. The great thing about nursing is those opportunities are out there- hope you find yours.

  • 0

    You may have trouble finding a new position with your limited experience, I hope that you can find a way through to get more experience and build your skill set. Documentation is a key skill that you're going to need in any environment and many nurses struggle with it, ask for help from a nurse you work with if you can. There are many valuable skills to be gained in a long-term care facility. After caring for 20-40 patients in a shift, moving into acute care with 6-8 patients doesn't seem as daunting. Yes, the acuity is higher, but you've learned time management and that transfers anywhere. Focused assessments are key in long-term care, not everyone is having their vital signs recorded every shift, not everyone can communicate effectively, nurses have to learn to rely on their aides and also take action based on their observations if patients have a change in conditions. It's quite possible that your management is picking on you, or that you need to improve, or a little of both. Try to relax, everyone was new at some point, and there are lots of nurses out there that have been around a while, so it can be done. But if you're so anxious that you make it worse you're dooming yourself to failure. Before your shift, take a deep breath, put a smile on your face, tell yourself it's going to be a good shift, and you'll find that more and more often it will be. Good luck.

  • 1
    mymomisanurse likes this.

    I completed MSN in administration and leadership this past spring. During my preceptorship phase of my program I realized that I do not want a position in management, so I am also applying to go back for my FNP post master's certificate. I did not realize that patient care is completely removed from the jobs of the nurses that work in management, and what I really want to do it provide care for patients. I am not cut out for bedside care long-term, juggling the patient loads that mean I spend most of my time running just to keep up and feeling like I'm not really making a longer-term impact in their care has lead me to believe that FNP is the position I'm looking for. Not that the patient loads are necessarily lighter in those positions, but I know that in my long-term care facility, I like the role our nurse practitioner has in coming in to care for the patients on both a regular and emergent basis. I think that's what I'm working towards, I hope to be accepted into a program that starts in January, and it's either two or two and a half years. Good luck to you!

  • 19

    I'm a "cranky old ___" whisperer. Give me an assignment with a curmudgeon or two any time. Usually by the end of the shift we'll be getting along just fine. And if they still don't like me, God bless them anyway. I'll provide the best care I can and listen if they need. I never would have guessed in school the crazy old people would be my niche. Gotta love 'em.

  • 1
    brownbook likes this.

    You're going to be fine, you obviously care about learning and doing what's best for the patients. It's too bad the CNA took the opportunity to make you feel badly about being inexperienced rather than help you gain experience and confidence. In nursing school there were so many skills being introduced that you couldn't possibly retain every detail, they'll come back to you when you're practicing regularly. Or you'll learn some new ones that you didn't have in school. Don't get discouraged, find some positive people that you can use as resources and just keep your head up.

  • 3

    Clearly you are a very conscientious person and I'm sorry you're dealing with a difficult situation. I would recommend you meet with your manager and ask that in the future if someone asks that you be removed from their care team, your manager or charge nurse follows up with that patient to get more detailed information about the issue. Once you have specific feedback about whatever the issue might be, you will know what you can work on to make improvements. Try not to take it to heart too much, you obviously have had many happy patients as well. Good luck.

  • 0

    In my long term care facility, we've had many people make statements about dying, and some really did. One gentleman we had was a real prankster who was always joking around. He had no acute anything going on. Out and walking in the hall just before midnight he told my coworker, his assigned nurse, that he wouldn't need his medicine that night because he was headed to his room to die. They both laughed, and he went to bed. She got to his room about 12:15am and sure enough he was gone. Not the first time he had threatened it, but we were all shocked he followed through. That's how it want to go someday, walking around one minute, gone the next.


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