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  1. ShadowNurse

    What advice to give your fellow LVN students??

    Probably my best advice is: Don't let your classmates decide how your program is going to go. You may get along with everyone or you may not mesh so well, but there will be anxiety. Some people don't handle anxiety and pressure very well. Take a deep breath, focus on you and your study habits, and don't take in their anxieties too. I don't get test anxiety as a rule, but everyone having a meltdown on every day of our exams would make my heart race. If you know you are a person who gets very anxious, take some major steps to keep it under control. Medication, therapy, breathing exercises, whatever you need. Because you cannot go around transferring your anxiety to patients.
  2. ShadowNurse

    Pain management in nursing

    Yes, pain control is a top priority. Pain interferes with rest, causes anxiety, and drives patients to stress-related behaviors. In the hospital I had worked at, we had a tiered pain med system where we gave narcotics for a reported pain level of 5+ and non-narcotics for 4 or less. I had a patient who was on chronic pain medication request an NSAID although his pain was a 7, but that was his call and I made sure he undersrood that there was no need to tough it out if he didn't want to. In home care pediatrics, I do a lot more non-pharmacological interventions for pain (though there are always PRN orders for Tylenol/Ibuprofen). This is often because my kids are non-verbal and already on so many other heavy medications. Heat, cold, change of position, distraction, holding/cuddling, massage, music can all help too. I had one infant with an anoxic brain injury that could be instantly soothed from minor pain by swinging her rhythmically side to side. I agree with the other commentors as well. Screw up your courage and report. I saw neglect in my nursing school days too, and it's never okay. Many nurses think that students can't or won't call them out, but we can and we should.
  3. ShadowNurse

    Safe Patient-Nurse Ratio

    I just left a job at a Kindred LTAC. One of the issues I had was struggling to keep up with the workload. It was entirely normal for me to have 5 patients who were all total care. All needed to be turned q2h, some needed vital signs q4h (due to being on telemetry), at least one in restraints. It was normal to have 2-3 trached and/or ventilated patients in my load as well. At some points, I could have 6 patients. Again, all quite heavy. We had CNAs some days, other days we were primary, but since we only had one CNA for the entire floor of 12 patients it didn't feel like it made a difference; I still took all of my own vital signs and other nurses frequently had to help me turn or change linen (and I helped them). The other nurses I spoke to said that they cried frequently their first six months, and none of them were new grads. Is 5-6:1 a safe or normal ratio for LTAC? My patients just seemed so ill and the expectation on the nurses so high. I worried every shift that I just didn't have time to be as thorough as I needed to be with my people. The nurses orienting me were always telling me to go faster, yet be more thorough. I could not do both.