Latest Comments by AngelRN27

Latest Comments by AngelRN27

AngelRN27 (1,223 Views)

Joined Aug 11, '12. Posts: 139 (29% Liked) Likes: 62

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  • 0

    I don't know that your practicum site/area plays a huge role in the direction of your career, IMO. I was lucky enough to get my first choice as my practicum site, which was PICU at our local, nationally renowned children's hospital. I loved it & learned tons, but it really had no bearing on where I worked thereafter.

    While I applied for jobs as a new grad, not ONE prospective employer ever asked me about my practicum site, though it was listed on my Resume at that time. I even applied at the same children's hospital that hosted me for practicum (where I was well-liked and had plenty of contacts) but I consistently got the "unfortunately, we aren't currently hiring new grads" spiel.

    My first job ended up being at a LTC/SNF which was rewarding, but not quite what I was looking for. I moved on to LTAC (see the LTACH threads-- this is comparable to ICU/Tele/ICU Step-down in larger hospitals-- except with ridiculous ratios!) and have been there for 2 years now...

    My point in all this is that, although you may have a clear picture of where you *eventually* want to be, there are plenty of paths that lead to the same destination. Not only that, but as sure as you may be now, many times nurses change their minds after being exposed to a certain area of nursing that perhaps they didn't even know existed...

    As a new grad, you really can't be picky. Just do great wherever you go and things will pop up for you! Also, take your time to gain valuable experience once you do get to critical care. In my experience, bedside expertise really makes a huge difference for our ARNPs and CRNAs... there is a world of difference between them, and those that sort of went straight into advanced practice.

    Good luck and have fun!

  • 0

    Our facility has a q4hr oral care policy (also shared between RN/RT when possible) but our policy for rotation of the ETT is qshift and PRN as someone mentioned above. We also use the Hollister holder as another poster mentioned. My facility hasn't had any ETT related breakdown for over a year, per administration, so I guess this policy/technology works. Generally, the tube "belongs" to the RT's, but depending on the pt load, the shift, what's going on-- RN's can rotate the ETT if need-be. Our RT's are big on teaching, so the majority of our RN's feel very comfortable with tubes. You should never go all-in if you don't feel safe or are unsure at all of the best practice. I prefer to have someone in the room with me (another RN or grab any RT) when moving the ETT, just in case...

  • 0

    Hmmm... not sure exactly what your preceptor meant, but in the clinical example you presented, everything sounds right. The interventions you mentioned (administering bicarb/initiating bicarb drip + increasing RR on vent) seem standard to me, especially for that pH. I would have to agree with FlyingScot's response.... but in this case we have more control because the pt is already on a vent...

    It all depends on the pt and the context.

  • 0

    I'm not sure that there is any one thing I could tell you to "review" to help... one of the biggest things you may need to get used to that we don't really work with much in LTC is lab values. You will get used to what is emergent and what is "okay," but you need to be aware of signs and symptoms associated with certain electrolyte imbalances or other abnormal labs. You also want to know what the usual treatment is. Apart from that (like most of nursing) you will do your learning on the job. It always helps to have a good foundation from nursing school, but that depends on a lot of factors, not just you as a student nurse. Plus, you can't really do that over LOL.

  • 1
    junebugjones37 likes this.

    Good Morning! I currently work night shift at a LTACH and I also started my career in LTC/SNF. Very big change, but if you're a quick study, critical thinker, a doer, and enjoy somewhat of a fast pace, you will do just fine. It helps immensely if you love to investigate and learn while on the job.

    While it is true that the night shift is a little "less busy" than days, that is really only true in regards to MD correspondence and (as the last poster mentioned) the absence of administration on the floor. Not that there is anything to cover up, but anyone will tell you that just the pressure of having admin. around sort of makes the shift more tense, so I appreciate not seeing them much LOL.

    The last poster also mentioned that one of the challenges on night shift is the lack of help and/or resources. Working nights in LTACH you have to be very creative and resourceful in solving problems as you will not have many people around to solve problems for you. Also, I'm not sure if this is just at my facility (although I've noticed this in a regular ICU as well) but most of the codes tend to be on nights. We also get more admissions on the night shift, believe it or not (that one is backed by national statistics, btw LOL).

    Anyway, make sure you learn all you can, investigate where necessary, ask questions, and you'll do well!

  • 0

    You definitely should not regret your decision to call a rapid response. In this situation, you were acting as pt advocate and perhaps saved the pt from a respiratory arrest or at the very least some respiratory distress. I do agree, however, that the medications should have been staggered somewhat. I know that the pt requested pain meds + ativan but seeing as they both depress respirations, I would have started with pain coverage then given anxiolytics afterwards. Either way, you did the right thing and it's all a lesson learned.

  • 1
    PierceTheVeil likes this.

    Some things you become accustomed to, others you don't. Some people can't deal with smells, others shy away from seeing sputum/respiratory secretions... it all depends.

    And I disagree that wearing a mask is offensive. It's part of PPE. I highly doubt that anyone would question your use of it, and if they did, PPE can easily be explained away...

  • 0

    Quote from HeartsOpenWide
    I started out in a specialty unit ((LDRP). I graduated with honors, sigma theta tau, took extra clinical courses through an additional collage, took a beginning midwifery course separate from my nursing courses, and became a certified doula during nursing school. There are your average students and your above average students. Some new grads do great in specialty units while others do better starting in med/surg. To make a blanket statement that new grads should not start out in specialty units is saying all new grads are equal; (I don't know how to say this without being rude) but that simply is not true.
    To be fair, graduating with honors and taking extra clinical courses/certification courses also does not indicate anything about your ability to function clinically in any setting. My nursing class had many stellar *academic* students that just weren't confident or adept when it came to performing skills or thinking on their toes in the clinical setting. It seems as though you are somewhat "blanketting" the topic as well...

    Clarification: I do agree with your point that not all students or new grads are the same; I also started in ICU Step Down and did just fine. Classmates of mine started in TICU and also did well. I disagreed with your argument as to why this is true, however.

  • 0

    Quote from KaLynRN
    ^I consider that pretty reasonable salary! Especially the differential. I wish I had the option of a LTACH attached to a hospital with an ICU to feed off of. I am in Illinois and I searched on "Care Look Up" and only found independent facilities, they didn't list it as "with a hospital." Also they are only found in the north/Chicago area.
    To be clear, my facility is free standing and private. We are not attached to a hospital. To be honest, I didn't even know such a thing existed. We have our own ICU in-house.

  • 0

    Quote from kissmyasn
    Thanks!! LTC is where my heart is, but all I hear is "You really need to start in a hospital to get that experience." Did you find you did fine after starting in LTC? I agree you will learn a lot in a hospital, but I've already learned so much at the SNF/rehab where I am now... Plus, all that stuff you're learning in the hospital, those resources just aren't going to be available most of the time if a similar situation arises in LTC (from what I've seen, anyway).
    I found my bearings quite quickly in LTC, but to be honest I'm a fast learner and love to work in a fast paced and/or hectic environment; people (nurses without LTC backgrounds, in particular) don't realize how stressful and busy LTC can be. Leaving your shift late is commonplace. It is a great environment to hone prioritizing and time management skills, however I will say that there are things you simply don't see or do in LTC that didn't satisfy my need to learn and advance. If you know your stuff and have the initiative to investigate a little further than most, you will do very well by your patients. LTC is also one of the specialties in nursing where intuition plays a huge role, because you tend to know your residents so well. Anyway, stay thirsty for knowledge, never compromise the level of care you provide because of desensitizing or complacency, and you will do great!

  • 0

    Quote from kissmyasn
    I will be relocating November 1 to Jacksonville from Montgomery, AL due to my boyfriend's job... I'm a new(ish) ADN nurse hoping to work in an LTC facility... I only have a couple months experience so far, but hopefully that will be enough to get me a job in Jacksonville. We will see soon enough!!
    I don't think you'll have a problem finding work in LTC at all. They usually hire RN's for supervisory positions here, actually. I'm not sure what the culture is in AL, but here in FL LTC is heavily saturated with LPN's working the "floor" or direct patient care, and RN's in administration. I worked LTC for a year immediately after graduating with my ADN down here in Miami, and I became a supervisor 4 months after working there, LOL

  • 0

    Quote from KaLynRN
    Why? What is the difference in salary, if you don't mind me asking? IE in my local, the hospitals pay $22-23/hour. I think this is kind of low, and I live in what is considered a rural community but we have the major state university in town.
    To give you an idea, our local "big" hospitals pay in that spectrum, $23-24/hour. This facility starts at a little over $25/hour, depending on experience and whether or not you are hired exclusively for ICU or not. Also, most hospitals in my area pay ~ $3 night shift differential. My facility pays $5, plus a little more for weekends.

  • 0

    Quote from sbostonRN
    I work in LTAC right now. I do think they like to hire experienced nurses but (at least at the one I work at) they can't really compete with the salaries acute care hospitals offer. Also, when you hire a new grad, you can shape them to follow policies exactly as they're written. By hiring a more experienced nurse, you sometimes inherit some of the bad habits they've developed over the years. Most of the nurses I work with (non supervisory) have less than 5 years experience. There are a few that have more, but generally people go there to work for a few years, then move on to acute care, home health or case management.
    In my area it is quite the opposite. My LTACH pays 1-2 dollars more per hour than starting pay at our local hospitals, all of which are large, well-known systems. The night shift differential here is also higher. Also different: the nurses working at my facility mostly have over 10 years of experience, many are closer to 20. Only a few of us (I'd say <25%) are new nurses or in the first 5 years of our careers.

  • 1
    KaLynRN likes this.

    Quote from KaLynRN
    I'm confused on how LTACH hire. Do they tend to hire New Grads? Do they want previous acute care experience?

    I have read on allnurses that people go from LTC to LTAC .... which is great, but if it is this acute, I would think LTACH prefer acute care experience. Also, if you have LTACH experience, then I would think you would be a good fit for ICU in a STACH. It seems like it should go both ways.....but does it in the real world?

    I'm bascially trying to see how these hospitals hire and what qualifications they are looking for. Also interested in hearing career tracks....LTACH to ICU?

    Thanks everyone
    Everyone's career path is different, and one person's success in moving from one area to another doesn't always indicate that this is the way it "usually goes." I worked in LTC/SNF for a year immediately upon graduation, and now I work at a LTACH with an ICU. Many of my coworkers also work per diem in an ICU at a STACH. One of my nursing school peers actually told me about this LTACH, and she was able to move on to a NICU at a reputable children's hospital in our area. She only remains in the LTACH as a per diem nurse.

    As far as what they're looking for, I believe it is true that they are much more willing to hire new grads than a "traditional" or STACH ICU because they are much more willing to train and also don't seem to have the same influx of applicants as, let's say, your local community hospital. They do prefer those with ICU experience and BSN's, though. I plan on applying to local STACH ICU's once I finish my BSN. Until then, I will stay here in LTAC and try to move on over into our ICU (at my facility, only a handful or so of our nurses permanently or semi-permanently populate the ICU, everyone else is on the floor). You learn TONS in LTAC.

  • 1
    Esme12 likes this.

    Quote from Esme12
    It depends on the LTAC. If your LTAC and you work the ICU you could transition to the ICU in an acute care hospital. However...be prepared to sell your experience for most HR/hospitals have NO CLUE what and LTAC is and what they do.

    I was a supervisor for a LTAC and they had an ICU. They have vented patients with PA lines and drips....post CABG patients very acute!

    LTAC's are must more inclined to hire new grads as they are willing to train.

    What is STACH?
    STACH = Short Term Acute Care Hospital. What most people just refer to as a hospital, LOL but it differentiates it from a LTACH, for example.


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