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Fearless_leader, ADN, RN 8,464 Views

Joined Apr 20, '12 - from 'FL'. Fearless_leader is a RN. Posts: 366 (44% Liked) Likes: 284

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  • Aug 10

    Losing weight may be challenging, not impossible. Start focusing on the possible, not the impossible.You have already identified that sugar is a culprit. Concentrate on the what you will get vs what you have to give up. Find healthy alternative to your Mountain Dew and Kool Aide before you totally give up sugar. If you need support, reach out as there are many people that can help you with your transition. Check to see what wellness services your company offers. You will find a ton of support if you look for it. Many companies now have a RD to help staff make healthy changes. I agree a good place to start would be with a trusted physician, especially one who specializes in prevention or lifestyle medicine.
    You will find once you eliminate sugar, you may have more energy since you aren't constantly navigating the sugar rollercoaster.
    Wishing you great success!

  • Jul 28

    It's great that you're studying rhythms, meds, etc. But when we start a new grad in orientation, we're not expecting them to actually KNOW anything. We are looking for evidence that you're teachable, that you're reliable and that you're scared. Why do we want new grads to be scared? The new grad who is scared of harming her patient is the one who will check with me before she does something stupid. That's the new grad I trust. As for documentation -- you'll want to document the way the facility tells you to document, not the way the book does. It's great to understand why you need to chart this way or that way, but as for the way you chart -- make sure you're doing it by your facility's protocols. Try to relax now; you'll be busy studying once you start your job and they've told you want they want you to study. Go see movies, have dinner with friends, lie out on the beach and read trashy novels. You'll be studying all through your orientation and beyond.

    Oh, and congratulations on your new job.

  • Jul 23

    Following. I received a job offer for a cardiac stepdown unit last week. I'm meeting with the manager again on Tuesday and have decided to accept the offer. I have a million questions as well.

    Personally, I'm going to compare different stethoscopes at a store. I very well may stick with my Classic III.

    I have Cardiovascular Care Made Incredibly Easy in my Amazon wish list. What do you think of it so far? I'm also rereading notes from ECG interpretation lectures.

    Good luck to you!

  • Jul 23

    Hi everyone!
    I am a new grad starting next month on a cardiovascular surgical unit. I wanted to pick your brains!
    *I currently have a littmann lightweight. Will this work for a cardiac floor, or should I buy a classic or a cardiology?
    *What education/resource material should I buy? I am already looking through cardiovascular care made incredibly easy.
    *Time management tips? Brain sheets?
    *What NOT to do as a new grad in general?
    My unit does 6 weeks of orientation on the floor, plus a basic dysrhythmia class. Thankfully I know some of the nurses there, so I feel like I will have a couple of support people.
    Thank you!

  • Jul 23

    In the appropriate situation:

    I'm sorry, we did everything we could.

    I'm sorry for your loss.

    Would you like me to call a family member for you?

    Would you like a glass of water, tissues, a seat, etc...

    Would you like me to call our social worker, our chaplain, etc...

    Give me few minutes to remove her tubes and clean her so you can spend some time with her. (Set up a chair nearby) It's ok to hold her hand.

    Be strong in knowing you followed her wishes...(for those torn about DNR or withdrawing life support)

    She's no longer suffering...(for chronic cases)

    Depending on how close you were to the family and your comfort level, you could offer a gentle touch to hand, arm, or shoulder, or even a hug.

    Sometimes it's appropriate to not say anything depending on your role in the situation.

    Working in the ICU, you will most likely encounter quite a bit of death and dying. As you gain more experience, you will figure out what to say as it all depends on the situation. I believe as as long as it's genuine and empathetic is all that matters.

  • Jul 18

    Maybe nursing school should require a weight lifting class.

  • Jul 17

    I got the position. I'll be working on the ortho unit after I graduate!

  • Jul 6

    I had a surgery there in Dec. and I heard the nurses talking about how they prefer new nurses. Not sure how accurate that was but they said they prefer new nurses so they can train them the way they like.

  • Jun 25

    I worked in Home Health for 18 years.....loved it in the beginning, for I was like everyone else: sick of hospital nursing and working weekends and holidays. But as the years passed, I grew weary of going into nasty houses, the increasing, mindless paperwork (Oasis was the icing on the cake) and having to trade in cars every three years. But there were good times, too. I once cared for a guy who had a complicated GSW to the abdomen. When it was suggested (by his insurance co's case manager) that he start doing his own wound care, he started acting out and was verbally abusive, etc. I wasn't exactly having the best of days myself, loaded down with 8 heavy visits over a 100-mile radius, and I got into his face and told him: "You are perfectly capable of participating in your care, and if you don't get rid of this s--t attitide, you're never going to get better". I left his house, not giving a damn if he reported me or not. But after that confrontation, his whole attitude changed...and he began to assist with his dressing changes. By the time my assignment had ended, I had grown very close to him and his wife...and they presented me with a "Precious Moments" Nurse figurine.

    And now, six years later, I have that figurine sitting atop my computer at work...and am constantly reminded of why I became a nurse to begin with. :wink2:

  • Apr 6

    Welcome to the world of long term care. You will never have time for a head to toe assessment of every resident you're responsible for. You'll do a focused assessment. If they are there for exacerbation of CHF or COPD you'd focus on the respiratory assessment. If they are there status post hip surgery, you would note the condition of the wound, the level of pain, anti-coagulant use and the like.
    You shouldn't borrow from one resident...it happens but it shouldn't. And there must be policies on PPE depending on the need for precautions.
    If you IM me your email I can send you a charting cheat sheet. I've used it in 5 facilities and have seen it in another.

  • Apr 1

    Not at work for a few days, but if you PM your email I will send a copy when I'm on next. General orientation includes a group meeting with GM, DOC and heads of all departments who brief on their roles and how they work with care staff, general communication priniciples, etc. Includes company mission statements and goals, employment benefits and requirements, expectations, policies on PTO, seniority etc. Ends with a tour of the building and meeting other members of staff of available.

  • Apr 1

    I currently work LTC/short term rehab. Time management skills are not be underestimated in this environment. I worked med surg prior to coming to LTC/short term rehab and I just thought I knew what time management skills were about. While there are some days when I don't manage to leave on time, those are usually the days when the you know what has hit the fan and I find myself dealing with a fall, an admit, a transfer to the ED, and family drama all at once. However, those days aren't every day, so I am usually able to survive on my own time management skills and some hard work.

    A few tips:

    - If you have a fall, go by your facility policies. At our facility, it sufficient to perform a neurological check, assess for any injuries, and then continue on with the med pass - incident reports, notifying family members, etc. can wait until later as long as the resident is okay. The same can be said of finding bruises, skin tears, etc. I will usually go ahead and apply the tx for a skin tear and then move on. I can fill out paperwork later, but the meds have to be passed in a timely manner. To help with the paperwork, I will usually write down any pertinent times and information.
    - If you have to send somebody out to the ED, call to give report to the ED, fill out your paperwork for EMS, then call EMS last. EMS can show up anywhere from 5-20 minutes from the time that you call them, depending on where they are and who takes the call. Unless it's an emergency, you want to make sure that you have your packet of paperwork complete to hand to them. (If it is an emergency, then do the very best that you can but understand that you may only be able to get the essentials down before they show up.)
    - Support from your coworkers and charge nurse is nice, but don't come to depend on it. I have had charge nurses who stayed several hours after to help clean up the mess from a shift from hell, and I've also had charge nurses who walked out the door at 11pm. The same can be said of coworkers. At some point you have to be able to stand on your own two feet, even if that means staying over to ensure the next shift doesn't inherit a nightmare.
    - Develop a routine for your shift. If I'm on the short term rehab unit, I usually do assessments during the 4pm med pass since it's usually pretty light. Then I do Medicare charting during dinner time, since there are usually no meds during that time. After the 8pm med pass & any tx, I chart PRNs and any changes or new information. If I'm on LTC, I chart as I go along because otherwise I will always be behind. On both units, I do my treatments after I've finished passing meds.
    - Assess any new orders at the beginning of your shift. If you're not sure if the nurse giving you report has taken care of them, ask. If you're still unsure, go ahead and fax them to pharmacy, notify the family, etc. Assume that it hasn't been taken care of until you have concrete proof that it has indeed been dealt with.
    - Document everything. Any refusals, skin assessments, family drama, abnormal VS, communication w/providers or what have you. Document what you know and what interventions or actions you took. CYA at all times.
    - Don't be afraid to contact a provider. Trust your instincts. If you think your full code resident is circling the drain (or that your DNR resident has had a change in condition and needs a change in care plan such as a hospice referral, or whatever it may be), don't wait for your supervisor or DON to climb on board. Advocate for your resident's well being, your reputation as a nurse, and your nursing license.

  • Apr 1

    Quote from abreerose
    I thought this was going to be the perfect environment for me to get experience but it did not work out and had to resign fory own well being
    Since you have already resigned, the following advice is for others who choose to embark on a career in the LTC/rehab setting.

    I worked in LTC/rehab for a number of years. In fact, it was one of my first jobs as a new grad. In the geographic area where I work, less than a week of orientation is the norm. This is true even if you are a new grad and it is your very first job. Managers in my city will roll their eyes if you dare ask for more orientation in LTC/rehab.

    Although there are notable exceptions, most LTC facilities do not have extensive funds for training and onboarding, so they want new hires on the floor ASAP. Personally, I never received more than four days of training in this setting, even as a new grad nurse.

    Time management is king. This may sound brusque, but it must be instilled in our awareness that LTC residents and their families are not our buddies. We certainly must be respectful, but there is no need to schmooze with the same resident or family for more than a few minutes. Pick up the pace, pass their meds, change any dressings, and rapidly start on the next resident. Do not permit any individual to monopolize your valuable time.

    A 'to-do' list kept me organized. Below you will find one of my old to-do lists with names changed due to HIPAA. I worked 16-hour weekend double shifts (6am to 10pm) on a LTC/rehab unit years ago and usually had about 15 residents. At the start of the shift I would look through the MARs and TARs and wrote down all tasks that needed to be done in my notebook to formulate my to-do list. As a result, I wouldn't forget to do anything.

    9-23-20XX
    DIABETICS, FINGER STICKS: Linda (BID), Nancy (AC & HS), Bob (AC & HS), Pixie (AC & HS), Rex (BID), Jessica (BID), Eve (AC & HS), Marcy (0600, 1200, 1800, 2400)

    NEBULIZERS: Marcy, Eve, Bob, Jessica, Pixie

    DRESSING CHANGES: Pixie, Bob, John, Jessica, Lorelei, Rosa, Merle

    IV THERAPY: Pixie (Vancomycin), Linda (Flagyl), Rex (ProcAlamine)

    COUMADIN: Linda, Rosa, John, Merle

    INJECTIONS: Linda (lovenox), Aurelia (arixtra), Rex (heparin), Bob (70/30 insulin), Eve (lantus), Marjorie (vitamin B12 shot)

    ANTIBIOTICS: Pixie (wound infection), Rosa (UTI), Rex (pneumonia)

    1200, 1300, 1400 meds: Marcy, Marjorie, Rosa, John, Merle, Nancy

    1600, 1700, 1800 meds: Rosa, John, Rex, Shelly

    REMINDERS: assessments due on Linda, Nancy, and Merle; restock the cart; fill all holes in the MAR; follow up on Aurelia's recent fall, fax all labs to Dr. Scott before I leave, order a CBC on Rex...

  • Mar 17

    Hello everyone on this thread I would just like to share my experience with the NCLEX and the different review products out there. First of all, TO GOD BE THE GLORY!! The product I heavily used was UWORLD, which I thought was essential to my success on the NCLEX. I was also taught the decision tree from a friend that took KAPLAN. I would have to say that the decision tree helped me to critically think the questions through with different strategies, and ultimately arrive at an answer that I felt comfortable with. My school also switched from Kaplan to ATI on my last semester of nursing school. My school provided the ATI live review, which I thought was okay. It wasn't the greatest but I did get informational packets and a pink RN-comprehensive book, which I skimmed over for the maternity and pediatric section.

    UWORLD, on the other hand, greatly helped me with content that I lacked. Some of the content in UWORLD was very foreign to me and the others were things that I learned in school but did not explore since my first couple semesters (fundamentals and medical-surgical I). The price of UWORLD is a bit steep for a broke nursing school graduate. What I bought was was the 30 day subscription that cost $79.99, which came with a Qbank of 1,959 questions and 2 sim assessment predictors. For the qbank, I did 75 questions daily and read most of the rationale on questions that I got wrong and felt very weak on. The UWORLD rationales are amazing! I highly suggest reading and understanding each and every one of the sentences in the rationales. UWORLD lines the steps to different procedures and signs and symptoms to different diseases very well. It helped me to gain better insight as to WHY I got the question wrong. The UWORLD select all that apply (SATA) questions were very tough but totally boosted my confidence. When I took the NCLEX and saw a SATA question with the options, I didn't stress out or feel the need to panic (hehe). I think the UWORLD SATA questions were a bit harder.

    The 2 sim assessments for UWORLD worked great for me
    Each assessment consist of 75 questions, which they advise you to treat like the real NCLEX, meaning NO skipping or going back to the previous question because you second guessed yourself. Oh, and it is a timed assessment (around 1 hour 30-40 minutes). The results at the end of the assessment were either "very high", "high", "borderline", or "low." The results only reflected those among the UWORLD users, because they were the only folks that took the assessments When taking the sim assessments, I highly recommend taking it seriously, which I mean keeping away from any and all distractions for about an hour and a half. Turn off your cell-phone, close unused tabs on your internet browser, and put on noise cancelling head phones or ear plugs. Really immerse yourself into the assessment and treat it like how you would taking the NCLEX. Afterwards, UWORLD will give you your result along with the rationales. Read those rationales and understand how and why you got that particular question right. I wrote down the information that I got wrong and really thought about why I answered it this way, and how I could better formulate a plan to get the correct answer, if I saw this on the NCLEX.

    I tested on March 9 for about 2 hours and 101 questions. I got SATAs after every 1-2 priority questions, 1 drag and drop, 1 math question, 1 recognizing an image, and 1 ekg with delegation to UAP and LVN/LPN. Did the PVT about 8-12 hours after taking the exam with the good pop up or "Our records indicate that you have recently scheduled this exam. Another registration cannot be made at this time." Searched all over the internet about accuracy of the PVT for about 2 days
    which I believe WORKS because I got my unofficial results this morning that said "Passed". I initially got down to my knees, broke down into tears, and prayed to God. I thanked God for his unwavering waves of blessings into my life.

    I shall be praying for all of the student nurses currently in the struggle, graduate nurses who will be taking the NCLEX for the first time, and those who will be taking the NCLEX after multiple attempts. God Bless Allnurses peeps!

  • Mar 17

    So I took my NCLEX 2pm today for about 2 hours. Shut off around 98. Had about 25 SATA, mostly pedia and maternal, 5-10 meds, 1 ECG, NO delegation which I was really hoping Id get a lot on. I really dont know how I feel RN. Im scared to do the PVT. I hope Florida BON post it tomorrow so I dont have to wait longer. ANXIETY IS KILLING MEEEE!


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