New Grad to TCU..

  1. Hi Everyone: I'm trying this here, because I had no bites on the rehab forum, so I'm hoping some of you may be able to help me.

    I am a new grad RN (May 2008), and have just accepted my first nursing position on a Transitional Care Unit. I am familiar with the facility, as I worked there 2 years ago as a nurses aide (on a different unit). I am very excited to start, but am now starting to get nervous about actually being a nurse! (Yikes)

    Any pointers on things I should study or review? Typical meds or dx's maybe? Should I go over stuff like htn, diabetes, CHF, ortho stuff? I just want to do the very best I can and feel like reviewing some stuff before orientation starts will take the edge off of my anxiety.

    Thanks!!

    Katie, RN
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    About NurseKatie08, MSN, RN

    Joined: Jun '07; Posts: 754; Likes: 557

    7 Comments

  3. by   Mrs. M.
    Congratulations on your new position! At our facility, the TCU is very much like the med/surg units that many of us use to work on. The acuity can be quite high, and the diagnoses are all over the board. It's a great unit to start with, because the length of stay is a little longer so you can learn more from your patients. You will most certainly see diabetes, heart disease, chronic infections, etc. You are likely to have people admitted with significant pressure ulcers, and people who have been non-compliant with their care at home resulting in re-hospitalization.
  4. by   Thornbird
    I've worked in TCU in MA. You will see a lot of post CABG, post joint replacements, post CVA, post trauma usually MVA's. You see a lot of people who are there for longer term IV therapy, like Vanco that can't get beds in SNF's. Always good to brush up on diabetes although that's not usually what they are admitted for, many patients will have it. You will see more PICC's, Central lines and implanted ports than in long term care. Probaby at least occasionally TPN. Also sometimes AIDS patients who are either recovering from an acute phase of their illness or are terminal and can't get onto a SNF or Hospice. It's a very mixed bag in TCU. It's agreat place to learn because they are better staffed than SNF's but not as fast paced as acute care. If you are working days pay attention to the therapists, you'd be surprised how much you can learn from them. I've worked TCU in small hospitals and it's not that different from the more skilled units in LTC. But, I've done it in Worcester and the above is what I've seen there. I would think Boston would be much the same. Good Luck.
  5. by   Thornbird
    I've not seen much of the pressure ulcer or non-compliance issues in TCU in Mass. There are generally enough SNF beds for them. SNF's in Mass do a lot more skilled level of care than in other states I have worked in. There are also many SNF's in Mass which cuts down the wait for beds. If there is a shortage of SNF beds then the hospital will shift those patients to TCU to make room for the higher acuity ones.
  6. by   NurseKatie08
    Quote from Thornbird
    I've worked in TCU in MA. You will see a lot of post CABG, post joint replacements, post CVA, post trauma usually MVA's. You see a lot of people who are there for longer term IV therapy, like Vanco that can't get beds in SNF's. Always good to brush up on diabetes although that's not usually what they are admitted for, many patients will have it. You will see more PICC's, Central lines and implanted ports than in long term care. Probaby at least occasionally TPN. Also sometimes AIDS patients who are either recovering from an acute phase of their illness or are terminal and can't get onto a SNF or Hospice. It's a very mixed bag in TCU. It's agreat place to learn because they are better staffed than SNF's but not as fast paced as acute care. If you are working days pay attention to the therapists, you'd be surprised how much you can learn from them. I've worked TCU in small hospitals and it's not that different from the more skilled units in LTC. But, I've done it in Worcester and the above is what I've seen there. I would think Boston would be much the same. Good Luck.

    Thanks to both of you. The facility I'll be working in is a SNF that also has this TCU attached, as well as an assisted living facility all on the same campus.

    I'll be working the evening shift. I would have liked days for the experience, but day positions on that unit are tough to come by.

    What type of nurse patient ratios did you guys see in your TCU?

    All of the things that you both mentioned are things I was thinking of reviewing, so good to know I'm on the right track. I know I'll feel like a deer in headlights when I start, but I figure spending a bit of time reviewing something can't hurt and may lessen the anxiety I'm feeling.

    Thanks for your responses!!
  7. by   Thornbird
    I've usually seen 10-12 to one. Some places work like med-surg where you have your assignment of ten patients with a CNA or PCT and others where a whole unit of 30-40 patients would be staffed with charge nurse, med nurse, treatment nurse or chrage nurse who does treatments and 2 med nurses depending on workload. A lot of TCU's and Rehab's have PT, OT and ST into the evening so you still may get to see them work.
  8. by   NurseKatie08
    Quote from Thornbird
    I've usually seen 10-12 to one. Some places work like med-surg where you have your assignment of ten patients with a CNA or PCT and others where a whole unit of 30-40 patients would be staffed with charge nurse, med nurse, treatment nurse or chrage nurse who does treatments and 2 med nurses depending on workload. A lot of TCU's and Rehab's have PT, OT and ST into the evening so you still may get to see them work.
    The DON said that it's 11:1 on this unit (when it's full), because it's 22 beds. They have plans to expand, and she plans on adding a third nurse working the floor in that case. Just wanted to see if 11:1 was typical, and how overwhelmed I should be about that, lol. I think it works like med/surg, the first way you described because I know I will also have CNAs to cover my pts with me.
  9. by   Mrs. M.
    Quote from NurseKatie08
    The DON said that it's 11:1 on this unit (when it's full), because it's 22 beds. They have plans to expand, and she plans on adding a third nurse working the floor in that case. Just wanted to see if 11:1 was typical, and how overwhelmed I should be about that, lol. I think it works like med/surg, the first way you described because I know I will also have CNAs to cover my pts with me.
    That sounds about right. We run 8:1 on day shift and 12:1 at night (24 beds). Our unit is somewhat unique in that we do have a lot of wounds that come from other hospitals and SNFs (as secondary diagnoses), and we have a dedicated treatment nurse for that purpose on days.

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