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b_m_prosepct 2,734 Views

Joined: Aug 24, '04; Posts: 54 (9% Liked) ; Likes: 6
Specialty: 20 year(s) of experience in Med-surg

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  • Jan 19 '14

    Anymore when I see a sign on bonus I assume that that is a company I wouldn't want to work for. If given the current market they cannot get to keep nurses, what is wrong in that facility. I see modist bonuses of $500-$2000 but all at paces I know very few people stay long enough to collect.

  • Jan 19 '14

    PERFECT example of management throwing the problem back on nursing.

    "can you tell me how you could get a lunch break? ( vomit)

    There is NO commitee, no process improvement ideas that will compensate for SHORT STAFFING!!

    Tell adminstration to bring in agency to obtain safe staffing levels.

  • Jan 19 '14

    7-8:1 on PCU would have me calling safe harbor. I would advise you to host an in service reminding your nurses of this option. Those ratios are unconscionable, which tells me the "normal" ratios are already dangerously high.

  • Jan 19 '14

    You're going to have burn out and unhappy nurses and med errors and unhappy patients when you have unsafe ratios like that. No amount of strategizing or team building activities is going to make that staffing seem acceptable.

  • Jan 19 '14

    7-8:1 on telemetry/PCU is NOT acceptable, let's get that out of the way right there. At the same, if that's really how it is, while you're looking for a new job I like the idea of making sure that all shifts are FULLY staffed with clerical and NAs. If this means getting PRN CNAs, so be it.

  • Sep 21 '10

    No one will ask about your disciplinary issues if they call for a reference. Don't beat yourself up. Everyone makes med errors. You (and the residents) were lucky no one was hurt and apparently it pointed out a huge flaw in the SYSTEM. We know the residents don't like to wear name bands....get PICTURES of all of them and keep them in the MAR. The surveyors will want to see them and if you are Joint Commission accredited, they will want to know you have 2 forms of id.

  • Sep 21 '10

    When someone calls for a job references we are only allowed to tell them the dates of employment and if we would or would not rehire them. If we would not rehire them I can not say why. That being said, I would never be allowed to tell another potential employer that an individual had made a med error.

    From a management point of view, we do a lot of 1:1 education (and we document this on an education form). We would do this type of documentation following a medication error. This allows us to "prove" to a surveyor in the future that we were aware of the error & we have taken steps to attempt to prevent this from recurring. If we didn't document this then months later, with a surveyor in front of me, I have nothing to prove that I didn't just ignore the issue. It's not meant necessarily as a punitive measure against the floor nurse. I'm just covering my tail.

    Now if that same nurse would continue to make similar recurring medication errors, we would progress towards disciplinary documentation and eventually get to the point of having to terminate employment. We have to. If I would let this person continue to work, despite education on how to perform the job then I would have a liability when they eventually hurt or kill someone.

    Go back and simply ask to review the previous documentation. Hopefully they are just trying to educate you as well.
    Good luck

  • Sep 20 '10

    It's DEFINATELY a good experience, if nothing else. In a nursing home you will learn how to do quite a bit.....your telephone orders, your appointments, admissions, discharges, med pass, narc counts, patint and family teaching, become familiar with hospice/palliative care, IVs, trachs (if your facility has them), different sorts of gtubes and types of feeding (bolus, continuous, etc, wound care, neb treatments, the works. Plus you will learn how to supervise staff (CNAs), and how to deal with all sorts of different patients and family members. It will help you empathize and it will help you know when to draw the line. Long term care is not for everyone in the long term run (definately not for me!) but I do not regret my 1 year at the nursing home. It taught me a lot of valuable lessons and has helped me become more confident as a nurse. Plus, it gives you a good base to put on your resume when you later on try applying at hospitals and other places of the sort. Go for it! If you can, try and have them put you on either a sub-acute or a medicare'll see a LOT more there! Good luck!

  • Sep 20 '10

    Finallydidit, if I could give you 100 kudos for this post, I would! LTC is full of dilenmas, and staff is often too short to do the right thing *every time*. Our facility is pretty good - we've got a well stocked pyxis, so getting meds isn't too hard. I'm a nut about reordering meds, and sometime the other nurses gripe about this, if the cart gets too full. BUT - if I don't do it, it often doesn't get done, and then is is a PITA to get the med from the backup (case in point - when I returned from my week of vacation, meds missing galore, including narcs).

    At then end of my shift, I'm happy to know that I did the best that I could do for my patients...and then for the facility and myself. If that means borrowing, I will do it, and then replace when the med is in, since that is the best thing for the patient. I am aware that it isn't right, but sometime you gotta go for the less "not right" and hope for the best. I applaud Asystole for working hard to fix the systemic problems so that she can always do the right thing, and hope to some day be in the same position to do so; until then, I make the best of what I am left to deal with .

    ETA: It occurs to me that we haven't really helped with OP with her question about what other landmines in LTC to I will try to do that:

    1. If it happened on your shift, deal with it. Skin tears are almost a fact of life in LTC. Do the incident report etc so that the next shift doesn't get stuck with it. I finally got tired of cleaning up from day shift's skin tears (apparent from finding dried blood on the skin and sheets at 1530) and mentioned it nicely to the sup, who told the day sup.

    2. NEVER NEVER NEVER attempt to cover up a fall; I've seen it happen, and those folks are no longer employed.

    3. There is a lot of pressure in our facility to cover up med errors...stupid me went along with this culture one time, and I got burned. Please learn from my mistake and don't do it.

    There must be more, and I would appreciate the education!


    Quote from Finallydidit
    Seriously! We are all LTC nurses, and we are all faced with legal /ethical delimas everyday, most of us go home after every shift questioning the decisions that we made, and hoping that when we go in for our next shift that we don't get called to the DONs office to be bi*ched out, or fired for something that we did or didn't do, or a choice that we made.
    Fact is LTC nursing is hard period, we are short staffed most times, we must cater to not only our Residents, but to their families, the administration, the pharmacies, hospitals, the Dr.s and whom ever else we may encounter, all while giving medications to 30+ residents in a 2-3 hour time frame and doing skin assessment, dealing with falls/behaviors and then set down and document every little thing that happened during the past 8 hours.

    You know thing will be missed, skipped, forgotten, and overlooked. We are not programmed robots, we are LTC nurses! We simply do the best that we can with the situation that presents itself to us.

    None of intentionally puts our license, job or Residents at risk! None of us intentionally tries to make our facility look bad!, None of us intentionally wants a Resident to miss a medication, or have a skin breakdown, a fall, or a low blood sugar. But they all happen all the time at every facility.

    All we can do is go in and pick up the peices that the previous shift leaves us, do what we can do in our 8 hours, and then present it to the oncoming shift to take over. LTC is a never ending circle, and even though we are not "Stepford Nurses", LTC could never function without us.

    So "HERES TO US" May all of our choices be the right ones!

  • Mar 4 '10

    Quote from b_m_prosepct
    I don't intend to call the facility back to followup. I did call back another nursing home to follow up the interview that I had about four weeks ago, and the DON said there is no current openings. That's too weird, if no opening, why calling me for an interview anyway. So I decide not to give follow up calls in interviews from now on.

    Nothing like not trying to market yourself.

    Passed your classes. Passed your boards.
    You think/feel jobs will just land in your lap because you're a nurse? NOT!

    Try these simple tips:

    After submitting your application AND resume. Do some research on facility, managers and directors.
    Helps to know the movers and shakers within an organization.

    If you should be grated an interview be sure to have intelligent nursing related questions for them. Sell yourself to them. Get their attention. You have about 2 min to make an impression before things get stale.
    Try thanking them for their time.

    Give them some time and space to weigh your credentials and then to call you back.
    Talk to a secretary. Find out the status on open positions.
    Send your interviewer a thank you card within a couple days.

    Show them that you're interested and sincere in your desire for employment without being a pest. One or two calls a week or so after an interview is plenty.

    You need to get aggressive with job seeking and sharpen your interview skills. You might try a councilor with the local government jobs office (unemployment). Most places have some good information on writing resumes and interviews. Its free....

    Better luck next time.