LTCangel 6,862 Views
Joined: Nov 8, '05;
Posts: 85 (49% Liked)
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Oh, by the way I am now an RN,BSN.
I recently left a hospital setting after 14 years(Ortho/Joint Replacement/Med-Surg) and am now in LTC, the reasons are too many to go into right now but I will tell you that I have NOT lost any skills! LTC now accepts residents with multiple medical issues and I have done everything from starting IV's, running IV fluids, IV Atibiotics, PICC's, colostomies, wound vacs, complex wound care, respiratory therapy, straight caths, changing foleys or placing new ones, 24 hr urines, G-tubes, CHF pts, brittle diabetics, fresh post-ops who are there for rehab or for good, deaths, discharges, admissions, tranfers to hospitals, psych, of course Alzeimer's and dementia, urostomies, drawing labs, arranging appts and consults, passing meds on 24 to 46 residents, using my assessment and critical thinking skills, and the list goes on and on. The push now seems to be to keep the residents in the facility as much as possible and provide the care they need vs sending them out to the hospital. I began my career as an LPN in LTC 15 years ago and it is much different and more intense now than it was then. Yes you will probably make more money on the Psych ward but I am here to tell ya that you WILL NOT lose your skills in LTC/SNF. You will probably gain many and learn time management skills in which to accomplish all the needs of these residents. 15 years ago almost all of the residents were DNRs, not so much now. They are many times full codes or at least limited interventions. So it really is up to you bit do not worry about losing or not gaining skills in LTC. I was afraid I would get rusty, but on the contrary, I use my Nursing skills each shift I work! Just my humble opinion and experience.
The company I work for also wants us to ty and clock out no later than 7 minutes past our sceduled time. So did the hospital I worked for before this facility. It's management's way of trying to cut back on the bottom line. I am usually out on time or maybe a few minutes past their "golden limit", but occasionally things happen at the last minute that just can't be passed on to the next shift. For instance, the last shift I worked, I was passed a new admission that had come in just before shift change, around dinner time. I was not passing meds on that hall from 7-11 but I work night shift and at 11pm I pick up both halls. The nurse who was working that hall did absolutely nothing for the new admission, she is agency but has worked in the facility enough that she has done admissions and could have worked on it, but it was passed on to me. So at 1130 at night I am trying to finish his admission, do his Nursing assessment,and his skin assessment which turned out to be extensive d/t multiple skin issues. I also had to do my Midnight meds on both halls and all the other routine things that needed to be done. Well at 330 am this new patient falls out of bed! Thank God he didn't get hurt but I had another stack of paper work to do on top of his admission. We also have to do computer charting along with the paper charting. Well needless to say when dayshift arrived I was finished with all of my med pass and care that needed provided but had had no time to do any charting. So I sat right there til 825am until i was finished! Some things can be passed on and some things just can't. I am the only one who could chart the fall and the assessment, no one else could do that. If someone says anything to me about it, that will be my answer. give yourself time to get things down and realize that Management will always want you out as soon as possible, it's what headquarters is telling them. They don't want to pay out more if they don't have to. I have also seen Nurses who have been there way longer than me, have to stay a little while to finish things that just HAVE to be finished. I just passed my 90 days and I would like to think that my DON is more interested in things getting charted in a timely and correct manner than whether they have to pay me another 45 minutes. I am NOT one of those who is able to get my 9pm med pass done in an hour because I give ALL the meds that are ordered. Don't take that stupid advice about doing it the wrong way, form good habits and keep them and eventually things will fall into place and you will find yourself leaving on time most of the time. Unfortunately in Nursing, things happen unexpectantly and we don't always get to get up and just walk out. We have to see it through til the end. Good Luck and God Bless
Thank you dragonfly55 for your kind words, I really do appreciate it and it makes me feel good to know that there are kind people like you in the world. I actually just got a FB message from a former co worker at this facility who was just let go under almost exactly the same circunstances as I except she was offered the option to resign. It seems they are head hunting employees who file for FMLA for whatever reason and my heart hurts for her because I know how she is feeling. To NoStarsInMyEyes, please except some (((hugs))) from me and prayers that God will send something your way so that the world can experience your love of being a Nurse once again. I'm so sorry your husband doesn't understand. I've been lucky that mine does. When I was in LPN school, I had an instructor who told us on the first day that when we were finished with the class and graduated we would forever more think of ourselves as Nurses because it becomes who you are not just a job. Even those who are unable to work still think of themselves as a Nurse. It's just who we are. When someone or something tries to take that away, our spirit rises up and says NO! I am a Nurse! Yes I am glad that I have a job and I intend to grow where God has planted me. It's not what I had envisioned for myself at this stage of my life but that's life, right? So I will go to work tonight and do my best to take care of my residents to the best of my ability. I will be 42 next month so I have many more years ahead of me, and I am excited to see what God will do in my life. Good Luck and God Bless!!
Dear No Stars In My Eyes,
I too was fired from my hospital job of 14 years on 03/24/2011. That date is burned into my brain and I know I will never forget it. My termination was a culmination of write ups due to being late. I'm talking 1-5 minutes late not hours. You see, I have been battling Fibromyalgia for about 5 years now and getting sleep and getting up on time and to work became a job in itself. I am a very good nurse and had been on the same unit for 13 years and was considered an expert in my field (Orthopedics/Joint Replacement). I had a former Nurse Manager who was very empathetic of my issues tell me to file for FMLA so that when I felt particularly bad I could call in and not be penalized for it. Of course this does not cover being tardy. This facility did not have a grace period for clocking in. They had stopped that a few years prior. When I first started there we had an 8 minute window to clock in before being considered tardy. My NM was in the Army Reserves and got called to active duty and the powers that be put a woman in her place who had never managed a Nursing Unit before and when she took over it seemed as though she made it her mission in life to watch my every move.
If you would have looked at my employee file you would have seen an employee who had for 12 years never had a bad mark. No patient complaints, worked well with others, excellent nursing skills, excellent charge nurse, good at maintaining a calm atmosphere on the unit, got along well with her peers, worked extra when the unit needed help, etc. It wasn't until I went to dayshift (which seemed to correlate with my fibromyalgia diagnosis) that I began to have trouble with tardies and absences. I tried to work with my new NM. I went back to night shift and this really seemed to help. My tardies became less. But instead of working with me and giving me the benefit of the doubt, I was written up again, and again, and the next quarter I was suspended 5 days without pay. I told my coworkers to take a good look at me because she was going to fire me if it was the last thing she ever did. The next quarter came and I was terminated for having 5 tardies. You were only allowed 4 in a quarter. The 5th one was due to my driving to work during a thunderstorm and there were trees down and hail and slow drivers on the road. I called and told them I would be late and I was by 5 minutes. This was 2 days before the end of the quarter. It didn't matter to HER, I was terminated, although she did tell me she hated to do it and that I was a good nurse. The Hospital also denied me unemployment and on appeal sent 3 people in to fight me over it. I applied everywhere, looking for another job. The only place that called me back were Travel Agencies and a Nursing Home. I scheduled an interview with the Nursing Home and got the job. the DON listened to my whole story of woe and said she thought I had been picked on (ya think!). She herself admitted that she has Fibromyalgia so maybe that's why she could be empathetic. I took a 7$ and hr paycut and I have to pay for my insurance premiums but Bless God I had a job. I never thought I would be in LTC again, you see that's where I started as an LPN 15 years ago. But I had come full circle. I am now an RN,BSN and have been working on my Masters in Nursing Education because I hope to be a Nursing Instructor one day. 13 on Orthopedics has literally ruined my back. I just passed my 90 days at this facility and I must say it's not that bad. I have a very good schedule, I am learning to love my residents, and they seem happy to have me. I have come to look at it as a place to hide out and lick my wounds for they are deep. What happened to me left me deeply depressed, questioning myself as a Nurse, and wondering about my self worth. Yes, I am in mourning and I understand what you mean by that. When will I stop mourning? I have no clue. I feel I have been beaten up. I gave that place the best years of my life and ruined my health there and it was all for nothing. Just so some woman could prove herself to Administration. I will pray for you, as I too have had to lean on God to get me through this and I'm still not really healed. I don't know how long that will be.
I agree with Forever Sunshine, slow and steady is the name of the game until you get your routine down- esp those large 9 and 9 medpasses! I just made it through my first 90 days at a LTC facility after 14 years at a hospital. My first job was LTC so I kinda knew what to expect but I still consider myself to be "slow", but I am slowly picking up my pace. I'd rather be slow and accurate then speedy and sloppy. You will get a routine, you will learn your residents. They become kinda like your children because after a while you know them so well that you can pick up on little things that alert you that something is going on with them. Your CNAs can be your best friends or your worst enemies. Treat them well and they will always want to come to you when they notice something is off cuz you can't be everywhere all the time. Once you are able to get faster you will find you have time to give that extra TLC that the residents deserve and sometimes yearn for, especially the ones who don't have family or friends who visit often. Geriatrics is a special calling and those who come to love it are special people in my book! This world we live in now doesn't always appreciate our seniors the way they did in the past and we see so many who have been dropped off to just wait to die. I hate that. Other cultures cherish their elders, but many Americans don't. LTC today is a place where you can become very proficient in the skills you learned in Nursing School because we do a lot more in house than we used to such as IV therapy, and of course trachs, g-tubes, foleys, strait caths and the list goes on. Just try to relax and it will all come together and 6 months from now you will be giving advice to the newbies who will be in the shoes you are in now!
Take it, you need the experience and as you have read many Nurses can't find jobs. If you find something better and have to resign, so be it. There will be 40 other Nurses standing in line waiting to fill your position. Just my
You may also look at clinics, Nursing Homes, Home Health, Hospice, Psych Hospitals, etc. Try to get some experience anywhere even if it's part time or per diem. Don't give up and look at everything out there as an opportunity!
It's also important to compare current lab values with earlier ones so that you get a feel for the patient's baseline. I learned that not everyone is normal so it's important as someone else said to know what is a really big difference that may need called. Also lab values that have to do with medication such as Dilantin or Lamictal are important because if they are too low or too high then meds need to be adjusted, also PT/INRs for Coumadin levels.
Ruby, I believe some people are more open to seeing the "other side" and I thin you ARE one of them! Another great story, I bet you could write a whole book full and it would be great!
You are a good stroy teller Ruby!! Love it!:bowingpur
We do weekly body audits on all residents, use moisture barrier creams, and we have a Wound Care Nurse who checks all the pressure ulcers regullarly and reccomends the type and frequency of dressings needed for decubs. We also have a few residents with wound vacs and they go out to the WC Clinic twice weekly to have their wounds assessed and the wound vac changed. Of course the wound vac can also be changed PRN by us when needed. The CNAs are supposed to carry a small pad around with them and if they see any new skin issues they are supposed to document this and bring it to the nurse so it can then be looked at, measured and a treatment started. It is hard to get some of them to actually use this, they would rather call the nurse in to look. Personally, I don't care as long as they make me aware of an issue. Any new admit gets a complete skin audit with measurements and treatments applied according to our P&P. A consult is also sent to the wound Nurse so she can also look at the wounds and make changes or not. We use a lot of skin prep on red heels and other red places and it really works. Hope this helps. It really takes a team effort to make sure that the resident's skin is looking ok and that any skin issues are addressed and continue to be monitored for healing.
I work 7p-7a and I have 24 residents from 7-11 and then take over both halls at 11p and have about 46 residents. I start my 6am med pass at around 5 and usually do my FSs at 6( they are ordered at 630). Most of them do not have insulin ordered until day shift ot thay are on Lantus at hs. If they do have SSI I wait til as close to 7 as possible to give insulin, if it's borderline on the SS then I will pass it on to dayshift to give after breakfast which is usually around 730am. I have one VERY brittle diabetic that I check between 4-5 because if I wait til 630 she will almost def be 30-40 and still be awake talking and smiling at me. So I am always ready to give her OJ and maybe some food and needless to say I have so far never had to give her any coverage. I have been at this facility for 2 months. I do not prepour. But some meds such as Prilosec can be given early since it's a once a day med. I flag all of med 12a and 6a meds while I am doing my 9p med pass so I won't forget anyone. I have gotten faster as time goes on and you will too. But I will say 60 residents with 20 FS is too many for one person. Also as far as BPs, unless the med is ordered with parameters BPs don't usually get done because this is considered their home and i=unless they are having symptoms or other known problems, I don't check. All of our residents have a sceduled body audit with vital signs once a week, just as most of them only get blood work once a year unless they are a med that requires more frequent checks, such as seizure meds or coumadin. Good luck, and God bless, I know it is sooo frustrating at first. If you continue to feel unsafe and unsupported then look for another job. Just sayin'....Lisa
Our facility also uses blister pack doses that are delivered in a box for a months supply. All nurses on all shifts will pull the sticker off when the box is empty or almost empty. These stickers are put onto a pharmacy order sheet and faxed to the pharmacy. The pharmacy delivers meds about four times a day, including at around 11 pm and 5 am. Sometimes though if a med does not get delivered in a timely manner, pharmacy has to be called.. sometimes the fax didn't go through or if it's a new med it can be a matter of getting it precerted first. this happens most often with antibiotics such as Zyvoxx or the doc ordered Prilosec but the resident's insurance will only pay for Nexium. We have Unit Managers on each unit during the day and since I work night shift I will pass these issues to her and she will usually get it taken care of. but it's everone's responsibility to make sure that the meds are there for the patient. It may be ok to borrow one dose of a med from another resident but after that the meds that were ordered should have been delivered. The most trouble I have seen is when we get a new resident and it seems to take forever for their meds to get to the facility. Or it's a new order and it needs precerted, sometimes multible calls have to be made to pharmacy. I've also learned to look in the very bottom drawer of the cart before I order meds. sometimes they've already been ordered and that's where the new boxes are stored.
When I worked the floor(Orthopedics) we often had these type of orders for IV meds and pain pills. I always tried to alternate the IV with the po if the patient was having pain control issues(and they usually were). It meant me going in their room every 2 hours but it also meant a much happier patient and family. I did not want to see my patients in pain especially with fresh fractures or post-op or fresh joint replacements. Pain control was always the most important intervention involved. Meds along with proper positioning and ice were invaluable. Also if the patient knew I wasn't going to let them lay there and "suffer" we got along very nicely. A patient in pain who is at the mercy of a "pain Nazti" always makes me upset. There is no need for this especially if you have the meds ordered to give than just give it. Yes if I had an order written the way the OP stated then I would go ahead and give the rest of the dose within the 2 hour time frame and then start timing again from there. You will also build a good trust relationship with your patient. Of course, when in doubt call the doc and make them get rid of these range orderes that can be hard to interpret, and maybe order a PCA if the pt is requiring that much IV push meds. Our hospital was trying to get the docs to stop writing range orders like that for the very reason that they are open to interpretation in different ways. And of course, always monitor those O2 sats. Some pts can take a lot, others, it will build up and the pt can crump! Sat monitors are available on the med-surg floor ot at least they were on mine!
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