Nurses That Never Worked In A Hospital...

1 hour ago, Daisy4RN said:

I had this idea from being a Candy Striper (white and pink/red striped uniform and everything!) when I was about 14yo. The nurses all wore white and the hospital was always clean, under control, patients were all nice etc.

Those were the days, my friend!

On 5/3/2021 at 8:17 AM, Runsoncoffee99 said:

I think hospitals  are magical because you can learn everything there. 

One thing I learned with my first not-hospital job was that I had a helluva lot to learn about nursing outside of hospitals, LOL. 
Nursing school teaches very basic nursing to non-nurses, in largely hospital settings ; many, understandably, get hired in hospitals (perhaps for years) and think that’s mostly all there is, hospital nursing. 

I worked in the hospitals in the ICU/ER, LTACH, and SNF.  I didn't work in a SNF until I had already been a nurse for 8 years in the hospital.  The misconception that hospital nurses are "smarter" or "better nurses" than nurses who work LTC is a misconception.  Your assessment skills have to be on point to work LTC.  Why?  Because you have zero resources.  There is no telemetry, no on-site lab, no EKG machine, no CT scanner, it can take an entire shift to have an x-ray performed and get the report faxed to you (if they fax it all), no pharmacy, and the doctor only visits the facility once a week.  If you call the doctor because something is "wrong" they are going to expect you to be able to explain what you think is wrong, and whether it's mild enough to be treated in the facility or if it requires a trip to the ER.  Which gets even more interesting if it's a skilled patient who is there for rehab instead of a LTC resident.  All of the x-rays, lab work, medications, that the skilled patient needs during their stay, the facility pays for out of their own pocket.  So you need to make doubly sure with these patients you aren't just calling the doctor and getting things ordered for the hell of it.  Not unless you want to be called into the DON's office regularly.  If send a skilled patient to the ER, and that patient doesn't get admitted to the hospital, the LTC facility has to pay out of pocket for the ER visit.  So you have to really know your patients and what exactly constitutes and emergency.  Your assessment skills have to be superb.  You pick up on small things.  8 years in the hospital and it took working at a SNF to realize that you should always check for a UTI if one of them starts vomiting repeatedly.  Working in a SNF made me a better nurse.  

If your patient is having altered mental status and you freak out and call the doctor and tell the doctor the patient is having a stroke, so the doctor tells you to send the patient to the ER, and the ER send them back to the facility with a diagnosis of "UTI" and a script for macrobid, you're going to be in "deep doo-doo".  Because the facility just paid $20,000 out of their pocket to treat a UTI.  

Any time you think that as a hospital nurse you are taking care of a different type of patient than an LTC nurse remind yourself where the LTC patients go when they get sick.  You are taking care of them too, just not in the same ratio.

1 hour ago, Daisy4RN said:

(But, something ugly this way comes)

"By the pricking of my thumbs." -MacBeth

And we've all had to deal with pricks.

1 hour ago, Hannahbanana said:

One thing I learned with my first not-hospital job was that I had a helluva lot to learn about nursing outside of hospitals

After a year of dealing with an array of patients in HH, I once said that I had learned more in one year of HH nursing than I had learned in 10 years of hospital nursing.

Albeit, only two of those ten years were hospital medical nursing...