wifeandmomoftwo 2,705 Views
Joined Sep 19, '09.
Posts: 99 (16% Liked)
Have confidence in yourself! I lacked self-confidence as a student and a new nurse and that lack of confidence held me back personally and professionally.
It took me many years go grow some backbone and learn to stand up for myself. Now I choose my battles and sometimes I let things go, but I'm no longer a pushover. I would have been much happier in my career and in life had I figured this out earlier.
just priotitise is all:
1st assess all your patients. wiat, hold on, meds need passed. they sent out an email saying the "window" for passing meds was being reduced.
1st, pass your meds. [gasp] i forgot, in the last employee meeting, they said all orders should be taken off the chart and put into action withni 30min. of being written, and there are five charts on the nurse server with new orders on them.
1st, initiate new orders case manager want's to know why tom abdpain isn't discharged yet. what!!? we need to have a meeting about this.
1st, attend meeting with unit manger and social service/case management to discuss tx/discarge planning. as soon as the meeting is over, miss. ineedattention want's tea (cause breakfast comes in 15min. and that is too long to wait), and we are supposed to be customer service oriented now right?
1st, attend to pt. needs (hopefully at the same time assess them, and maybe get those orders done, its been 45min. now) tom abdpain has his call light on. go to answer it, "can i help you?". answer is, of course, "i want dilaudid right now :flmngmd:". and "pain" is now considered one of the vitals right along with hr and bp now, right? alrighty then mr. sunshinecomesouttamybuttwhenipoop, i'll get it for you right away.
1st, attend to pain issues, then other pt. needs charge nurse can't help but point out to you the "window" for passing am meds is 5min. away from being over, but oh......sorry, can't help you do anything so you can pass meds, and you will get written up if any meds are late.
1st, pass meds then attend to pain issues, then other pt. needs then..............
ah, to heck with it. n/m.
Hey all! I just got word that I passed my LVN state boards today, and Ive always wanted to join this site, but told myself not until passing my boards! Anyway, Just wanted to say hi to my FELLOW NURSES!!
Ive learned alot from seasoned nurses on here, and other threads, and I cant wait to see where this career takes me! I eventually plan on going on to RN, its just not the right time in my life to continue school!
So I just wanted to say hey to you all! Hope you all have had a good weekend!
I hate to sound like an in your face, opinionated, New Yorker. But if she came to an urgent care center, needing/wanting, medical attention, she can take what she gets, in terms of a medical provider, or she can go home and live with her pain/discomfort.
I have had enough of individuals coming to this country, with widely different customs/ideas, etc, and then, when their needs cannot be met for obvious reasons, we are somehow supposed to bend over backwards, to figure out a way to accomodate them.
I am waiting for someone to tell these people ,"when in Rome, do as the Romans do".
JMHO and my NY $0.02.
Lindarn, RN, BSN, CCRN
Somewhere in the PACNW
I think this article illustrated a common problem: healthcare providers who aren't at the bedside and haven't practiced in years running to the ground current practitioners.
Let's face it, until more practitioners who don't work at the bedside get rid of their Gucci clothes, put on a pair of scrubs and come out of their ivory towers, nursing practice will remain fragemented and disjointed. Those who have NO IDEA what the trenches currently entail are making policy and honestly doing a poor job in formulating that policy! Real nurses don't come in and make idiot demands that make staff cringe and wish they don't have to deal with those people!
Congratulations on your new job! I have worked in LTC for 25 yrs. I love it. I worked in LTC for awhile, then worked in a hospital for awhile. Then I went back to LTC because I really missed it. Most of the residents in LTC are elderly. My soft spot is with the elderly. You are asking for suggestions.
What to do: Be kind and courtious to everyone in the facility. It sounds like a no brainer, but after a few weeks or months there will be times that won't be easy.
The PSW's, front line workers, health care aides, whatever they are called in your facility are your eyes and ears. If they tell you that Mrs. XY has a bruise on her shoulder, check it out. That too sounds like a no brainer. One of our biggest problems where I work is when RN's and RPN's don't follow something up. Write it down somewhere if your are too busy at the time. If you can't get to it make sure you pass it along to the next shift. If you do assess the resident, document it.
When I ask the PSW's to do something, I thank them afterwards. We had a RN who always said thank you when I did something for her. It made me feel good. So I do likewise. I also thank the PSW's at the end of the shift. I learned that from another nurse as well. If you treat the PSW's with respect chances are good that they will respect you too. So many times I hear PSW's state that this RN or that RPN looks down on them. That won't be said of you, will it?!!
Learn from your mistakes. We all make them. I continue to make plenty. Admit them and carry on. Hard, hard to do sometimes. This is so true with med errors. In our facility we have a special form just for med errors. That means I am not the only one who makes them!
Try to be punctual. Avoid calling in sick unless absolutely necessary. Accept call-ins whenever you can.
If someone reports you to management, document everything about the situation that you can remember: date, time, who was there etc. I find it helped me to keep the documentation and also the meeting with management as objective as possible. It is tempting to be defensive. Try not to be. Sometimes I have said to management (especially if I had been involved with staff conflict)"There are 3 sides to every story: the other person's side, my side and what really happened." Right then I demonstrate that I realize management probablly hears some doozy stories from both sides.
Smile! Even when it is hard. Sometimes it will be very hard.
What not to do:
Avoid small gossip as much as you can. In the long run it could really pay off.
If a co-worker gives you a hard time try not to take it personally. Some of the staff that have worked at these facilities can be downright rude. If they lambaste you, no doubt you are not the first and you won't be the last.
I know this is very long winded and wordy. I hope that it does help you a little.
Great luck to you. Keep us all posted on how you are doing.
Keep the faith life will punish her enough. It is her child that I feel sorry for.
"I can tell you're a Christian, arent you???" It's hard to beat THAT one (and YES I am!)...
Hi. Don't know that I have much to add to this topic and I do agree that there is a crisis in LTC, but it is not new. I started as a CNA in 1994, LPN by 1986 - worked all shifts - several years each, unit manager, staff development and currently an RN MDS co. These ratios have always been horrible. I was only 19 years old when I became an LPN and remember thinking that someone must have lost their mind to have me.. a 19 year old kid... in charge of 2 CNA's and 50 residents on 11-7 shift. My mother didn't think I could even take care of myself at that time[EVIL][/EVIL]. Unfortunately it really all goes back to the reimbursement level of our healthcare system, ie: medicare/medicaide. We are forced to take sicker and sicker residents that require very expensive medications and treatments and often we don't get fully reimbursed (thru the medicare PPS system). In my specific state, the state government spends more MEDICAID dollars per day on it's prisioners than it does on LTC reimbursement. Now that's pitiful! Also in my state, it is required that all LTC posts their daily staffing pattern in public view.. is it like this for all states? This only includes direct care staff, no managment nursing counted in this.
Also, in case some of you weren't aware, you can go to www.medicare.gov then find nursing home compare. From there you can find staffing ratios for all your local LTC and compare yourself with them... You can even compare to state and national averages.
And last but not least.. yes, nursing managment is often noted to be scrambling when state comes in and doing "things" they don't do everyday. This always got to me too, but now I do see the other side. It is really no different than any of you saying you can't always empty all the bedpans, do bedchanges and things like that because then you couldn't get your own job done. We all have a job to do and if we are doing someone else's job - than ours isn't getting done. We have many regulatory and coorporate obligations that we are required to meet (or else we won't have a job!). When state shows up, we have to refocus and prioritize too tho, just as you do when a resident falls and fractures hip right in the middle of medication pass and the med pass goes to the back burner for awhile. Really, I love the residents and wish I had more time for direct care... but direct care = late MDS's, which = no payment for the facility, which = very mad bosses, which = overtime (back to mad bosses), which = time away from my family, which = mad family... and now no one likes me . Sorry, I'll help when I see it's H_ll day, but otherwise I can't.
Ok, guess I best be done now - didn't know I would get so carried away, sorry.
Buy fax machine, if you don't have one. Put resume on one page. Brief cover letter.
Print list of LTC providers, these are online, determine which are 15 minutes from home, then 30 minutes from home, then 45 minutes from home and an hour from home.
Use Google to figure out how many miles each place is from home.
Call each facility and ask for the name of the Don and thier fax number.
Week one do the closest, weeek two, the next closest, and so on.
This is a way to carefully cover all options.
LTC facilities respond really well to faxes.
Address each cover letter directly to each DON, most won't read through a two page resume.
How do I know this?
Jan 2010 became licensed as LPN.
Was working by March, 5 weeks later loking for work again, in May started my current job.
I'm in west Tn, accepted a job 45 minutes away in the next state.
This worked for me in my situation, as I am new to nursing and it's rough to get in the door with no experience.
Wishing you good success.
If you have the drive, ambition, motivation, fortitude and smarts, go for the RN. You do yourself nothing but a disservice by selling yourself short with the LPN program. Furthermore, it will take you longer and cost you a lot more money (both in tuition and lost wages - because you could be working sooner as an RN) if you do two degrees. Why do that? The only reason to do the LPN program is if you are one of those people that need a lot of extra help, nurturing, coaxing and coddling along the way. If you have the desire, can set goals and do what it takes to attain them, the RN program is the right one, without question.
And one more reason is that the RN is only the first step. You need a BSN and probably Masters to really go somewhere in nursing. If you add an LPN into that mix, it will take you even longer.
Nurses are being replaced by medical assistants, LPNs, LVNs, and techs. While critical thinking is being practiced, most of the time it's not really necessary. Nursing, realistically, is still task oriented and charting. The nurses that I've had the priviledge to shadow are not using critical thinking. What is critical thinking anyhow? The ability to know that when you're patient has a SaO2 of 50% is in trouble? That's not critical thinking in my book.
Without more clinical time the nursing "programs" are wasting time, energy and money.
She looks a lot younger than she is. All her make-up is on but she is not at all flashy, she just takes care of herself, for herself. On the phone chatting away happily she sounds like she's on a business call with a dear friend.
She see me enter the room and her eyebrows shoot up in delighted surprise and she holds up a finger in that "just a minute" attitude. She winds up her phone call and greets me warmly.
Her smile is dazzling and she holds out her hand for me to shake as she introduces herself, she makes me feel as if I'm an important dignitary at a dinner party. Her hand is warm and her handshake firm. This patient may be one of the sunniest people I have ever met.
She is dying of cancer.
On closer inspection her illness becomes apparent. Her lungs sound wet and raspy. She coughs nearly uncontrollably when she laughs. Ascites takes up the middle portion of her body and she deftly teaches me how to drain the excess fluid that builds inside her peritoneal cavity and is slowly and surely 'drowning' her.
"Pancreatic cancer" she whispers conspiratorially as if someone may overhear and think badly of her. They may think she is sick or worse, dying; which she is.
"That would be the worst thing" she confides; "for people to pity me".
She doesn't want pity, she wants to live now the way she always has; with gusto, with bravery and with her friends all around.
This patient wants to die in the same fashion in which she lived her life, having fun and enjoying humanity. She is interested in me and my journey the way a favorite aunt might be and she is as happy and excited for the news of my graduation on January 7th 2010 as I am. "How wonderful for you!" she claps her hands together and her eyes sparkle like a young girl seeing her birthday cake covered in candles.
"I will be thinking of you on that day!" she promises, and I believe her.
Her pulse is weak, thready, the sclera of her carefully lined eyes slightly jaundiced. I touch her abdomen and it ripples with unseen liquid under the skin. Her back is dry and flaking. She would appreciate a back rub and as I massage her she relates her last few incredible months.
"I had no idea, no pain. I was working and traveling and meeting with colleges just four months ago".
She shakes her head incredulously and glances back questioningly over her shrugged shoulder at me to see if I have an answer, can I maybe explain this incredible news. I cannot.
My patient is a college graduation planner. Can you imagine the energy, the stamina and the intellectual input such a job requires?
She travels up and down the east coast January to June, visiting colleges and planning with students and staff the details of their most important day. She arranges the speakers, the programs, the invitations, the huge tents and thousands of chairs and then she leaves them to their celebration and moves on to the next.
This amazing woman plans celebrations every year for thousands of young adults on the precipice of their lives. "And now", she tells me tiredly, (for her voice is getting weaker, she has drained her fifteen minutes of energy telling me her tale) "now I must make some plans for myself." Again she shrugs and smiles and asks me to fix her pillow and cover her feet.
"Let me rest sweetie, give me thirty minutes would you?" I turn off the lights and quietly pull the door shut as I leave her room deep in thought.
A few weeks later I hear from a classmate that 'my' patient has passed away. Before she died she planned one last celebration. From her hospital bed she arranged a good-bye party. Not a funeral, not a pity-party complete with dirges; but a time for her friends and family to come and have a few drinks together; a time for reminiscing and celebrating life. This to me was a calling to live life to the fullest every day. We hear this dictum often, but what does it really mean? Who really does it? We complain about the weather, about the traffic, homework, bills, our kids, our parents, and our myriad other obligations. We're so tired. We hate our jobs; do not want to do our chores, the shopping, or the wash. When we do this, we complain about life itself. How dare we!
A woman dying of inoperable cancer can love and laugh and look to the future. She had not one complaint. Not one bad thing to say about anyone or any thing. Every day when I wake up I think of my most memorable patient and promise myself that I will try to make myself more like her. I have to. She just might be watching me, especially on January 7th.
Nice. Another misperception of HIPAA. Inanimate objects can NOT violate HIPAA. People do. Tell your coworker that he is full of crap. There may be "literature" of how PEOPLE violated HIPAA by using smartphones and technology, but that's not the machines fault.
Is it too much to ask? I mean seriously!! How much time have you WASTED running around your unit looking for a (working!) vitals signs machine each week. Does management not get it? Not to mention the infection issues dragging a machine from room to room using the same blood pressure cuffs etc.
Anyways... Not only do I think there should be a dedicated unit for each room, but (and I'm going out on a limb here folks..so get ready to catch me!) I think they should be built into the darn beds..or at least attachable to the beds (Can I get an Amen!)
I know. I know. I'm dreaming. It's too much to ask. Go ahead. Hit me with all the negativity and "reality" you care to. But a nurse has gotta have a dream!!
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