From LTACH to Med Surg

[dadweeb]

Hello all, I need some advice.

I have been reading posts on this web site for several years, there is almost always someone with a similar story where I can draw comfort/advice from. I have worked in an LTACH for three years and was searching for a hospital position. I was fortunate enough to get a position on a Med Surg floor. Administration has been very generous with the orientation period, I have been with a preceptor for over 6 weeks now. I believe they are giving me one more week. There are some good days, but most days I leave feeling inadequate and close to tears. I know I am a good nurse, but I am overwhelmed with 6 patients, constant discharges and admissions, one PCA on the floor most days which leave us to do the vitals and sugars. The phone provided by the hospital never stops ringing for patients wanting to go to the bathroom, wanting PRN meds, water/food, beeping IV machines, telemetry calls, family wants to discuss plan of care...and list goes on and on. Meanwhile, we have to chart in real time (almost impossible!). Labs need to be evaluated, doctors mention orders which they never enter into the computer so they are called for telephone orders, and the docs expect the nurses to read all of their notes. Since I am fairly new, I don't recognize the docs when they come in and end up calling them after they leave (pisses them off to no end!). Please tell me it gets better...I struggle every day with time management and providing good care to my patients. How long does it take to get "used to" the pace? Do you ever get used to it? Even the seasoned nurses verbalize how anxious they are the night before their shift!

[workinmomRN2012, BSN]

I actually think that since you came from LTC that you probably have a better handle on time management than most new RN's. I worked in a SNF doing sub acute rehab and that is what I found when I transitioned to a Med/surg floor. I set up my cheat sheet that best suits me to have everything at my finger tips. I have found that the day shift is much more challenging as far as more to do because that is when all the lab results are coming back and a lot of new orders are put in., dressing changes are usually done during the day too.oh well too bad if the docs get mad at you, they will get over it! Good luck :)

[KatieMI, BSN, MSN, RN]

Are you from LTC or LTACH?

Where I am, LTACH normal ratio is 4 to 5:1 and, while we do not usually get more than one discharge and one admission per shift, all these 4 patients may be vented to begin with and way sicker than anyone in med/surg. Many of my colleagues do PRN med/surg and describe it as equally or less busy, just of somewhat different kind.

[VANurse2010]

Hello all, I need some advice.

I have been reading posts on this web site for several years, there is almost always someone with a similar story where I can draw comfort/advice from. I have worked in an LTACH for three years and was searching for a hospital position. I was fortunate enough to get a position on a Med Surg floor. Administration has been very generous with the orientation period, I have been with a preceptor for over 6 weeks now. I believe they are giving me one more week. There are some good days, but most days I leave feeling inadequate and close to tears. I know I am a good nurse, but I am overwhelmed with 6 patients, constant discharges and admissions, one PCA on the floor most days which leave us to do the vitals and sugars. The phone provided by the hospital never stops ringing for patients wanting to go to the bathroom, wanting PRN meds, water/food, beeping IV machines, telemetry calls, family wants to discuss plan of care...and list goes on and on. Meanwhile, we have to chart in real time (almost impossible!). Labs need to be evaluated, doctors mention orders which they never enter into the computer so they are called for telephone orders, and the docs expect the nurses to read all of their notes. Since I am fairly new, I don't recognize the docs when they come in and end up calling them after they leave (pisses them off to no end!). Please tell me it gets better...I struggle every day with time management and providing good care to my patients. How long does it take to get "used to" the pace? Do you ever get used to it? Even the seasoned nurses verbalize how anxious they are the night before their shift!

You work at a poorly staffed facility if you are a floor nurse and don't have adequate CNA coverage to at least get your vitals and blood sugars. It's not you - or at least not totally. There is also no excuse for your having to put in telephone orders routinely in 2015.

Most hospital websites have physician lists - often with pictures - of the doctors. You may have to be proactive about introducing yourself. Doctors are also less likely to be buttfaces if you have a more "personal" relationship with them.

Being a floor nurse sucks. I much prefer the units. Given your experience with LTACH and potentially ventilators, maybe you should try ICU instead.

[TheCommuter, BSN, RN]

I actually think that since you came from LTC that you probably have a better handle on time management than most new RN's.

OP did not come from LTC; instead, (s)he came from LTACH (long term acute care hospital). LTACHs have much lower nurse/patient ratios than LTC.

In addition, the care at an LTACH is far more acute (ventilators, nephrostomy tubes, in-house dialysis, critical care units, pulmonary units, etc) since they receive the sickest hospital patients who have been discharged because they aren't progressing.

[VANurse2010]

OP did not come from LTC; instead, (s)he came from LTACH (long term acute care hospital). LTACHs have much lower nurse/patient ratios than LTC.

In addition, the care at an LTACH is far more acute (ventilators, nephrostomy tubes, in-house dialysis, critical care units, pulmonary units, etc) since they receive the sickest hospital patients who have been discharged because they aren't progressing.

I think some of this depends on the type of LTACH. In my hospital system, for example, the LTACH will not take ventilators that are simply "failure to wean." In fact, the patient has to be on