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MikeTheNurse ADN, RN

Rehabilitation / Long Term Care
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MikeTheNurse is a ADN, RN and specializes in Rehabilitation / Long Term Care.

MikeTheNurse's Latest Activity

  1. MikeTheNurse

    New RN: Let’s Talk About Staffing

    Before I go on, a disclaimer. As a novice nurse, it’s entirely possible and even likely that my problem lies in my own ability to manage time or tasks. I accept that, but I will also stand behind the effort and thought I put in to solving for those issues on a daily basis. I work as a Rehabilitative RN and am responsible for up to 15 patients per shift. I have found over the past 2 months of working here that the morning and afternoon med passes plus basic nursing skills (draining an abdominal Pleurx catheter, draining a Billie tube, changing colostomy bags, etc) take up the entire 8 hour shift, even when walking up and down the halls at full speed just shy of breaking into a sprint and when administering some medications earlier than scheduled when possible. That doesn’t include charting, which requires staying past the end of my shift to complete. That also doesn’t include admissions, which may add an extra 1.5-2+ hours of overtime to a shift. Finally, that doesn’t include weekly skin checks, which sometimes requires checking multiple patients on the same day and, to be done properly, requires time to be carved out of a day of doing med passes where barely enough time exists to begin with. I imagine some of you may be reading this and thinking “yeah, that’s nursing.” Some may even think “suck it up, if you can’t handle it, get out.” My concern is with the patients. If we have created a system where our patients have to compete with our own families for time (which is what overtime really means), our patients will eventually lose. Are we ok with this? Is this normal? If, for example, a facility can scrounge up the cash to make sure a nurse is present, why can it not scrounge up the cash to make sure enough nurses are present to provide patient care without being in a constant state of full-bore rushing around and having to stay hours late regularly to catch up? Is there an evidence based process for providing staffing based on patient care needs rather than census? If we push our nurses to do more than is possible, the ones who make a good faith effort to try are the ones you will lose to turnover. The ones who don’t do the work will be unaffected. How do we create a system that rewards nurses who make a good faith effort to care for their patients without making them trade between time with their family beyond their shift and providing adequate care to their patients and fulfilling their professional responsibilities? Does anyone have any positive experiences to share from their work places regarding this sort of thing?
  2. I’m a new nurse working in rehabilitation and I have a resident with Parkinson’s and dementia. The resident also has wounds and has lost all mobility except in their arms (barely). She takes her Parkinson’s medicine (Sinemet & Neupro patch) without issue, but consistently refuses all other meds (muscle relaxer, steroid, APAP, nerve pain med, and vitamins for supplementation and wound healing - a total of 8 pills every morning), stating that she takes too many pills (often arguing that we try to give her more than 8 at a time). She is not completely oriented to time/place, but she is always consistent regarding her medications. Her family has tried to pressure me to administer her medicine without being forth-rite about it. For example, administering the meds in pudding without mentioning that there are pills in the pudding. The family wasn’t pleased that myself and the other staff comply with her refusals. It seems wrong to ever be misleading to a patient or resident about the care that they are receiving and we know that our patients have a right to refuse. But what do you do when they potentially have altered mental status and their noncompliance puts their recovery in danger? (I’ve notified the provider already.) I’d be interested in hearing stories and advice from other nurses.
  3. Hi! I'm an inexperienced RN working in a Rehabilitation / Long Term Care setting. I'm looking for advice from experienced nurses because I haven't been working as a nurse for a long time, I graduated years ago, and I only briefly worked as a nurse around the time I graduated. I have already signed up for an RN refresher course and I'm trying to redevelop the skills I was taught in nursing school. Is there anything anyone would be willing to share that could help me to provide the best care to my patients? I am responsible for roughly 15 patients at a time. My responsibilities include medication administration, assessment of new admissions, and handling emergent issues / changes in condition. Although LPN's typically work in the role I currently fill, my lack of experience, the facility's strong desire to hire RN's, and a staffing shortage have placed me into this role. I find that the LPN's and Nurse Aide's are far more experienced and comfortable in their work than I am at this point, naturally, but everyone expects me to more capable because of those two letters: RN. And to think I spent years thinking no one thought my license was valuable because I'm an ADN and not a BSN! It turns out that in this setting, people think it means something even without that Bachelor's Degree. A true shock after my very unsuccessful job search after graduation. Anyway, any advice? (Besides "Don't work in Long Term Care" - I'm determined to give this job a minimum 6 months before I search for alternatives. I need experience and my old profession is being automated away so I can't go back to it.)