agency Nurses, How do you do it??

If you are working in LTC make sure the Narc count is right.

I am a new Nurse who started working in a LTC facility who sometimes uses agency Nurses. I give you all so much credit for being able to be so flexible and confident to go into different settings at a moments notice! I get so nervous going to a different wing than I am accustomed to. My question to you experienced Nurses is, What are the most important pieces of information that you get from report or Patients chart that you feel you need to know before your shift. I would like to know for myself and to help give a good report to oncoming agency Nurses. Thanks for the advice.

Bea

I just quit an agency job because I could not deal with it. Yeah, the pay of $35 an hour was great ($10 more than a regular LTC care in my area), but after 10.5 hours with no break at all (I know it is the law, and of course, the agency totally offers it, I did not feel like I could take one!), giving morphine doses to a HOSPICE patient with tons of family in the room, having LTC residents say they should have been in bed 2 hours ago instead of waiting for their HS pills, and having to process a new admit (really? couldn't someone else have asked him the same questions? Does it have to be an RN? Some of it, yes, but not everything!) - I wasn't willing to risk my nursing license and my future nursing goals for working a temporary, part-time agency job in LTC. I am on my way to being a midwife (what I have always wanted!) and am not going to lose the opportunity to a stupid med error in LTC. But, while I was there, what I really wanted to know was how their took their meds (whole, with sauce, crushed in sauce, etc.), who needs accu checks before dinner and insulin, and what strange personality quirks to look out for (i.e.: who want their HS meds by 7pm, who gets a cocktail each evening and how to prepare it, and who will refuse everything no matter what I try?). Good luck to you. I think LTC, and especially agency work, is harder than ICU and hospital units!

In report, as agency new on the scene, I care to know a brief but relative history if there has been change of condition in patient.

Who is diabetic, and pills crush or whole. New admits, recent falls, isolation's for_________, any GT's, ABO's currently being administered for________.

its OK to hear "OK, no changes" if all is OK and none of above.

out of report...

where things are located ( med room, supplies, drug overflow, etc)

yes, always narc count on with nothing funny going on.

Added note: I guess its like, if you know how to drive and drive on freeways regularly, then travel to an different town on a different freeway...you can still get around with a general sense of how things are .... but its always good to know where the exit is. :-}

And thank you for your concern and questions...it really is about the patients well being...nurses that care are awesome!

Remember as a new nurse being so confused, writing down the report, and being uncertain as to what was the most important. For me, it took experience and learning to process the significance of everything. Understanding the disease process, risk factors, patient history, and so on. I wrote everything down. Every day I learn something new. I hope you have experienced nurses working with you that are teachers too. It is a given that when you are a new nurse, report goes somewhat slower.

Narc count, you bet ya. Just worked in a PACU unit with some problems. One nurse was fired while I was there. It was a contract job. I was toooo trusting too. Never assume anything. There are checks and balances for a reason. You never know who may have a secret problem and some people are good at hiding it or at least for a while.

Patient routine is a given in report, but remember anything that helps the next nurse coming on shift to know what to expect is important too. Because if it is not an expected situation, it should set off her alarms to look for a change. Remember the goals and what has been done and not done. We get to mechanical and things get passed on till discharge comes. Then the discharging nurse is stuck doing things that should have been done through out the patients stay in the hospital. Teaching is one of those things. Remember to get an order for home health if it applies too. I never send a patient home without it, if it is deamed necessary. In nursing school, I was not taught about the value of the home health agency and the flow of care. Ask lots of questions. Discharge planners and case managers are valueable resources for continuity of care.

If I like a hospital, I go there again and again and eventually I will know everything about the place. Nursing care is all the same, the charting and policies are what makes agency nursing tricky. If you are not afraid of learning thimgs as you go, then you should be fine.

I always kept my own little notebook of information on patients, notes, important stuff handy with me at all times. I worked in a LTC/sub acute facility where turnover of staff was all the time. consistency was my greatest peev. I couldnt handle things that werent followed up by the nurses/aides the next day. communication WAS SO BAD. And the Nurse Manager? NO WHERE TO BE FOUND? What was she doing. smoking, talking, laughing, in a patients room for an hour throwing the bull? well. I found to cover my own hide, I followed up and found it very helpful. Other nurse didnt follow my way of MY LITTLE NOTEBOOK, but they were guick to call me Super Nurse sarcastically because I get the work done.!!!! It bothered me for awhile but then I was happy with myself and covering my own backside.

I've been doing it for a while now and some times it's tougher. I recently decided to go get a regular part time job. A lot of it depends on where you work. In the same hospital, I got sent to this med/surg floor. I had two RRT's and the nurses barely helped. I had one pt going down with septic shock, low b/p and tachycardia. I asked for help and only nurse (my angel) came to my aide. The nurses seemed preoccupied like they didn't care. I didn't get upset because this is how healthcare can be sometimes. I thought about it and it seemed like they didn't care because I was agency. I was looking at them like if it wasn't here to help you, your patient load would be heavier. Besides, a pt is a pt. Could be your mom or anyone you love. Sad. I beg them to help me transport the pt up to ICU. Mind up, I'm agency and don't know how to work their crash cart. I needed the monitor off the crash cart to transport the pt going into septic shock. Needless to say, I was ignored. One nurse came to ask me a hour later if I still needed help. I could only look up to God and shake my head. These are the ppl taking care of sick ppl. Still not shocking. Then, I was floated to the ER. Complete 360. Nurses there, no matter how busy always take time out to show me things and where to find things. Ironic. I did not expect that. Still, I'm not shocked and appalled anymore. I'm looking forward to finding a regular part time job outside the walls of the hospital. I will stil continue to do my agency thing, but I love the fact that when I am completely ready to walk away from anything, my versatility will allow me to do anything. As a agency nurse I feel that the other nurses look at me with resentment, but I'm think yea, I only make few extra than what I would make and get no benefits. Is it worth it? Yes, if you don't need the benefits. If you do it might not.