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Fearless_leader, ADN, CNA, RN 7,745 Views

Joined Apr 20, '12 - from 'Broward County, Fl'. Fearless_leader is a RN. Posts: 357 (45% Liked) Likes: 283

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  • 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!

  • Mar 7

    Read the 35-page study guide. Good luck and share with us the good news ok?

  • Mar 7

    i always try 50 questions and i always got average score. never tried the self assessment yet. im scared im not gonna make it

  • Feb 11

    I've been in this cite so many times and I promised myself once I passed I will share my story. theres so many things i want to say so if you want to skip to how I did it/ study routine please find********

    Background: graduated may 2013 and to be honest I was an ok student, the school i went to as well I felt like didnt prepare me or guide me enough for the nclex, but my biggest mistake really is not taking my nclex earlier. When youve just finished school everything is still fresh in your mind so youll have more content information. Another big mistake is really not understanding nclex style questions. If i were to go back, i would have enrolled already or bought books for nclex review in my last semester of nursing.

    Anyways, I know what your thinking... I took the nclex 10times. YES IT IS ALOT! Im lucky that i live in a state where they allow you to take it as many time but in a span of 8 years i believe. First let me start off by saying i know its a lot of money, time wasted, and energy draining... BUT IF ITS YOUR DREAM ISNT IT WORTH IT IN THE END? there were countless times where i really questioned if this is really right for me...and it is. this is my dream and if i had failed again, I would have studied harder and wouldnt stop until i became an RN.

    This cite was very helpful throughout my journey, there were many helpful tips, and success stories, however this cite also brought me to tears many times. There are so many people that are so negative, saying things like "maybe nursing isnt for you" or "even if you passed already i still wouldnt want myself or any of my family members to be cared for by you since you failed so many times." I know people are going to say they are just being real or why give someone false hope. I understand where you are coming from, but truth is if nursing is really what you want you have every right to fight for it. Noone can stop you from achieving your dreams!

    There is so much negativity going on around us that is it really necessary to put someone down when they are already down? false hope is when there is absolutely no way for them, but if they still have the opportunity why not take it? can you imagine telling your child, your parent, your bestfriend, that even if they worked so hard and failed but still want to try again to just find something else to do? find a new dream? so many times Ive failed i've always looked at it as negative, but its a chance for me to rise up and become stronger. I think that was the hardest part in this journey, picking up the piece and trying again, because for those who dont know the feeling of giving it your all and in the end its still not enough, taking a chance to do it again takes so much out of you. its is not only mentally and physically draining, but very EMOTIONALLY draining as well.

    Everytime I saw that fail word in the quickresults, its was mindshattering heartbreak. It took me several weeks even to pick up any book and at times reading made me so sick or just even answering a question made me throw up. But I refuse to give up! AND YOU SHOULDNT AS WELL! i think the reason more people fail after the first time is because our confidence in ourselves really go down. IF WE DONT BELIVE IT HOW CAN WE BECOME IT? And for those who still have a negative outlook on multiple times nclex takers, think of it like a drivers license. your permit is graduating from your school but to be a safe nurse or in this case "safe driver" you need to pass the road test. Once you pass the road test the first time are you automatically the safest driver? there have been many people who got into accidents the next day after passing their road test. Same with nursing, passing the nclex the first time wont make you the safest nurse, it just makes you safer than the one who didnt pass yet. But being a nurse is not a race its a journey. what if when you were taking your road test, its was pouring so much rain or there were accidents on the road test site.

    Im not making excuses for failing but in life there are many parts in our lives that affect us and its not just going from one end of your destination to the next in a straight line, sometimes we have to stop for pedestrians walking, sometimes there are ambulances that we need to pull over to let them through, sometimes we run out of gas, but if you give it your all, even if you get a flat tire, or you engine dies out on you, and you get to your destination, applaud yourself because you deserve it.

    Also, for those who have said "I've tried it all", unless you have done EVERYTHING, READ EVERY BOOK, ANSWERED ALL THE QUESTIONS, TRIED ALL THE RESOURCES... YOU HAVENT DONE IT ALL. PUSH YOURSELF, THERE IS ALWAYS SOMETHING ELSE TO BE DONE! IF NURSING IS WHAT YOU WANT DO IT! DO IT! DO IIIITTTTT! DONT LET ANYONE TELL YOU MAYBE ITS NOT FOR YOU. Surround yourself with positivity, Law of attraction! I was blessed enough that i have my family, friends and a partner with their continued support. Dont be afraid to ask for help when you need it, dont let pride and embarassment get the best of you. i had 2 jobs and quit one because i want focused enough. to cover my other finances my parents and partner helped me so much, so if you have people who are willing to help take it!

    Another big change when I took it this time is Praying, I prayed that I would have a clear mind and open heart that no matter what I will still fight for this dream. God will not be taking the test for you so dont pray just to say let me pass. Do your work put in the effort and if you fail again dont give up. take it as soon as you can. you will have more knowledge than the previous test, you will be an inch, if not, a mile closer to your destination. Finally I really want to say is dont be afraid of failing, failing is not a sign of weakness, or the end. Not getting back up and quiting is when youve really failed.
    this time around i was not afraid of failing because I know as long as there is air in my lungs, a mind to critically think, and an opportunity to take it again, possibilities are endless.

    ************** ncelx 1st-3rd time i was taking it:
    studied ncsbn learning extention, kaplan qbank did not finish, previous notes from school
    didnt really focus, was not motivated after failing the 1st time

    Nlcex 4th-7th time took hurst live review but didnt finish online questions, purchase ncsbn again and still didnt complete
    had 2 jobs 6 days a week, nclex was not priority just taking it to see maybe i can pass

    Nclex 8th time- quit other job, read suanders, studied 6-8hs a day answered 50-100 questions a day. would read for endless hours but found out the hard way i wasnt retaining information. did not really apply critical thinking.

    nclex 9th time- thought this was it! purchased uworld finished i think 900 questions 53% average. Amazing resource detailed rationales but its just a qbank and feels like your taking the nclex with the style of the site.

    Jan 28 2017 10th time taking the nclex. I waited 3 months after test 9.
    enrolled in self passed kaplan. watched the videos multiple times, finished qtrainers except QT7.
    diagnostic- 62%
    QT1-56%
    QT2- 63%
    QT3- 50%
    QT4- 58%
    QT5-52%
    QT6-61%
    WHO DO YOU SEE FRIST 77%
    SAMPLE NCLEX 58%
    LESSON 7 75%
    i would do qbank questions 75 questions average 57-67%
    finished the rest of qbank for uworld
    did not read any specific books, rather i watched alot of youtube explanations and videos here are some of the channels:
    nrsng- also go to websites for free study guides
    nclex tudy guide
    registerednursern
    picmonicvideo
    tootrn, LLC
    anneliese garrison
    podcast library
    BEST OF ALL THEY ARE FREE!!!!!!

    also with the labvalues kaplan decision tree, maslows, infection control, nursing diagnosis and scope of practice, i printed them up and hung is next to my bed, atleast once a day i would ready every single one it took about 5 mins of my time every day but it really helped me remember the information.

    The biggest thing about this time around is I made this as my number one priority, and for the days i did not feel the strength to do questions, i watched alot of those youtube videos.

    Also my BIGGEST mistake in the past was not really using critical thinking, and what is the nclex ? CRITICAL THINKING QUESTIONS! Kaplan played a huge part because it really dissects the questions and how you should train your mind to think. I know most of you are thinking, why didnt i do kaplan first, well, when i was researching on which resources to use the had so many negative comments, and many people told me not to aswell because it didnt work for them. Everyone is different, you just have to see what works and what doesnt, and yes it is expensive but this is an investment for you.

    And now finally, after my long journey i can call myself an RN! and my journey is still not over, i will do my best to be the best nurse i can be! And for those who are still not accepting of multiple times nclex takers, and see them unfit, and still think they are unsafe, please ask your doctor how many times they have taken their mcat, or usmile or ask that restaurant how many time they passed their food test or your accountant how many time they took theirs or that taxi driver whos driving you around how many times they passed their road tests? the point is, it is just a test, it doesnt define who you are or who'll you become, its takes trail and error and expierences to mold the person you can be. GOODLUCK TO ALL FIRST TIME TEST TAKERS AND MOST OF ALL FOR THE PERSON WHO JUST FAILED, I BELIEVE IN YOU! TAKE A DAY TO BE SAD, BUT IF ITS YOUR DREAM DONT GIVE UP!
    also here are some people who've failed:

    Oprah Winfrey was publicly fired from her first television job as an anchor in Baltimore for getting "too emotionally invested in her stories."

    Steven Spielberg was rejected by the University of Southern California School of Cinematic Arts multiple times.

    Colonel Harland David Sanders was fired from dozens of jobs before founding a fried chicken empire. (KFC)

    Lady Gaga got dropped by her record label, Island Def Jam, after 3 months. Upon receiving the news, she "cried so hard she couldn't talk"


    ALSO if your curious here is a link of some nurses who have passed the nclex:
    1 Serial-Killing Nurses - Listverse
    +++ this link is just to show, its just not just about getting the license, its what you do after you get the license is what counts.

  • Feb 11

    Quote from shelbym01
    how do you the check the bon for your name?
    Well I'm from CA so I went on the Breeze website to search my name under "Look up License" and also verified by logging into my own Breeze account as well and it was labeled "Registered Nurse" with my application no longer being at pending.

  • Feb 11

    HI EVERYONE I WANTED TO SHARE MY GOOD NEWS, I GOT MY RESULTS THIS MORNING THAT I PASSED MY NCLEX. I have been reading all nurses forums since my first attempt/failure and this forum really helped me. I wanted to share my journey with you guys.

    FOR MY FIRST ATTEMPT, I did the full 265 questions and, when only took 1 break. I went to the bathroom and took a drink of water and came back. I literally studied 5 days a week and occasionally took Saturdays and Sundays off. For my first attempt I did the NSBCN course and uworld. Not to knock down those two resources, but I did not learn much from them mainly because I am a visual learner. So if you are someone who learns by reading and taking their own notes then those resources are for you.

    FOR MY 2ND ATTEMPT... I started studying 2 days i got my big fat FAILURE email from my nursing body. I don;t recommend that, I recommend to take at least a week to two weeks off to really recuperate, and take a break.Anyhow, I started using hurst, AWESOME RESOURCE if you feel you struggled on content, and then I bought the kaplan in class review which was extremely helpful because they help you with strategies. The nclex is 50% content, and 50% strategies!! so kaplan helped, and the inclass bootcamp comes with a qbank, which is A LOT HARDER than uworld in my opinion and harder than the nclex itself because it's quite wordy HOWEVER, uworld had the best rationales, kaplan had really short and crappy explanations.

    ANYhow I studied everyday, even on christmas and new years I studied at least 20 mins by doing small mock exams.

    So the day before the exam, hurst recommens u don't study, but I studied anyway, I only studied for 4 hours, and then called it a day, went for dinner with my boyfriend to enjoy myself. The morning of the exam, I woke up early, had some breakfast and packed a snack and my water. I drove to the testing place, blasing some hillsongs music to really pump myself up.

    I got there at an early time around 7:15 am and they let me go in right away, i was the only person inside the testing room. when I hit 75 questions I started to get defeated and asked for an early break. I went out, stretched, drank water, went to the washroom and looked in the mirror and told myself "you are passing today, and you are gonna burn all your nclex notes". As soon as I got back, I did a couple more questions, I stopped counting at 115, and a little over than the computer shut off. I smiled, because I knew I was kicking ass (although the questions were hard and rally didn't know for sure if I was even getting them right), I must have because I passed.

    I drove home, hugged my dog and my dad and then binged watched netflix. Then bam, this morning I got my results and BAM I passed.

    I felt so lonely during this journey and honestly its such a heart breaking experience to fail and I understand anyone who is struggling with this. SO please email me if you guys need any support. I love you all nurses!! I am still very much against this exam, but I am glad I passed and it is over. GOD BLESS YOU ALL! KEEP FIGHTING THE GOOD FIGHT!

  • Dec 22 '16

    Thank you so much everyone, everyones response has been overwhelmingly kind!! I will keep everyone posted! 12 more days!

  • Dec 9 '16
  • Dec 6 '16

    Quote from Anoetos
    all i did was take the Kaplan course and did all the testbank questions. Averaged about 60%, passed NCLEX on 75 questions in about 45 minutes.

    II didn't "study" anything. There's nothing on the test that you haven't seen or heard if you were paying attention in school.

    It's a MINIMUM competency exam.
    This. This this this. I don't understand the draw of studying for months. What's on the test that you didn't already learn in nursing school? In my opinion, pick ONE review book/class, take some practice tests, and take the real exam ASAP. My degree was stamped on May 30th, and I tested on June 14th. I read the Saunders book on the beach for two or three days, took a few practice tests on the included CD and felt comfortable. I feel like, if you're studying for weeks and months, you're just getting farther away from when you actually learned the material and are more likely to do poorly. Obviously, your mileage may vary.

  • Nov 16 '16

    Quote from OrganizedChaos
    But why do it at all? None of what you said justifies it. I would rather wait 2 days to make 100% sure I passed rather than do a trick & then still be stressed. But to each their own.
    I agree with you 100%. I waited the 48 hours and didn't bother with PVT. I knew I'd never be able to trust it either way. Was it a long wait? Yes. But I lived

    I had 2 classmates take NCLEX on the same day. One finished in 170 questions and the other in 78. Both did PVT the same day. One got the "good" pop up (170 questions) and the other got the "bad" (79 questions). Both of them failed the exam. I don't put much stock in PVT. It doesn't relieve any anxiety because you'll sit there and doubt it's true. Either you'll be devastated with the "bad" pop-up or not feel secure with the "good" one. It's just not worth it, even if you use an invalid card.

    OP: Wait 48 hours and pay the $7.95 to know 100% for sure that you passed. It's the best $7.95 you'll ever spend when you find out you passed. Stop torturing yourself with PVT.


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