moving from LTC to medicine

Published Aug 12, 2012

120 Posts

Specializes in geriatrics.

I am not a new grad cuz i graduated in 2010, but i am a "new grad" to medicine.

I started in extended care, not that i chose LTC but LTC chose me. I worked 2 facilities including one special care unit and one peritoneal dialysis unit. I started in a private facility with a patient-nurse ratio 1 to 28 including orthopedic patients, and after 9.5 months I was fortunate enough to be hired by the facility of the largest hospital of the city. By then the patient-nurse raito was 1-17. I stayed there for a total of 8 months and I felt very comfortable. At the same time, I also used all my savings to pay off my student loans and credit card. I realized my nursing skills were disappearing, including assessments, hands on, and in depth analysis (criticle thinking). I decided to move on. I told myself, nursing should never be so comfortable. This is a high-stress profession in nature.

Again, fortunately I was hired by the medicine unit of this hospital as an internal transfer. The manager told me that I reminded her 32 years ago she was the same as me, knowledgeable, nervous, and looking for self-identity. Likes challenge but lack of confidence, looking for the "perfect" specialty but doesnt know where to go. She said she was glad that I was seeking for acute care, if I stayed in residential care a bit longer I probably would not have the same opportunity as today. So she offered me a full time job.

They offered me the maximum orientation, which was 3 days and 2 nights. What I brought to medicine was my team work skills and customer service. I practiced in residential care setting for 1.5 years I worked with LPN and PCA all the time, and I dealt with family complains all the time, including the ones that involved case managers. So I had a plan, I learn on site as days go by, I review my med/surg knowledge at home to refresh criticle thinking. I was nervous, but not overwhelmed.

After three days, I am trying to figure out my own way of assessments. 1) making my own set of head-to-assessment. If the pt is lying in bed, I wake them up, listen to lungs, heart, bowel sounds, check the brief, both radial pusles, capillary refills/edema, lower extremity edema/pedal pulses, check tubes/IVs. Then having the pt sat up and listen to the back lungs and check possible bruises on the back. I am aiming to get this set done within 5 minutes.

or 2) focus assessment related to the pt's current diagonises which would be 5 minutes as well, however, more thorough.

In terms of teamwork, I saw incompetent nurses, lousy nurses, fishy nurses, critical thinker, task oriented nurses and team-players within one week already. It is a big team! I am not surprised, I had complaint from the nurse who oriented me already. I didnt panic although I am suprised of what she said. I am just so used to those type of personality so I stay away from her. She was on this unit before I started, the problems were already existing in this world before I was born.

I have been on my own 3 days so far. I learnt a lot and I sweat a lot due to the physical work. Patient ratio is 1-5 during day and 1-6 at night. I lost 5 pounds. One 12-hour shift I changed 15 times briefs myself (all 6 patients are 1PA and all incontinent multiple times!). Any suggestions how to do that faster? In 3 days I had PICC, CVC, CBI, IVs, rebound hypoglycemia, death, dialysis f/u, blood transfusion *2, catheters d/t retension, elopement, aggression, family complaints, chest tubes, falls, post-op. I havent had a cry yet, maybe sooner or later I will. I passed out on the bus after night shift. When I wake up on the bus, all passengers were gone. The driver was quietly sweeping the floor. He didnt want to disturb me, I think he knew i was a nurse who just got off night. Another day I felt into sleep on the bus but was waken up by police officers who were checking bus fares =)