PooterPT

our ratios are pretty good. 1 nurse & 1 aide for 12 pts with a charge nurse & unit secreary & a float nurse - this is for day and evening shifts. Night shift does not have a float, unit secretary, and the charge usually has to take a team.

I am the PPS case manager. I do all the FIMs training at our facility. UDS has gone to great lengths to put out all kinds of things from the tree to verbal dialogue to rate FIMs. However, I have a simplified cheat sheet that seems to be very helpful and it has helped to bring our scores into alignment. We all need to be certified. Some basic info I ask our RNs to tuck into their head that has proven very helpful: 1. 2=1 (if it takes 2 helpers the score is 1) 2. If you touch the pt the score will be 4 or less 3. If you do 50% score 3 4. Tabs monitor = 1 5. Verbal cue or supervise = 5 or less after that I go over the cheat sheet and we do several case studies. We just finished a certification class. All scores were >90%

The 75% rule certainly does make things tense at times. I am PPS nurse at rehab hospital and these new regs keep me hopping. Our census has been up and down at times as we try to stay above the 60% mark. We are hoping they will extend the time where we can do 60% rather than 75%. As we get used to the new criteria we will become more adept at looking for patients who fit the CMS and also at the comorbidities that help to make them fit.

Mulan, I am a Healthsouth RN. It is a good place to work. The have good benefits, a nice clinical ladder program, good resourse people. With that said I need to tell you what I feel is a draw back. Often there is a lack of cohesiveness between the disciplines. More often than not at our facility, nursing is at the bottom of the food chain.

I became a nurse because I was sure I could be more caring and do a beter job than the Hospice nurse who cared for my dying mother. I was an elementary school teacher living in Canada, when my mother became very ill. She and my Dad retired to the Eastern Shore. No one seemed to know what was wrong with her. She grew tired of being told it was all in her head, it was her nerves, etc. Long story short - she had undiagnosed colon cancer. By the time it was diagnosed it had spread and her prognosis was not good. We moved to the US so I could help care for her. Eventually Mother was placed in Hospice care. Her nurse held her and my dad emotionally hostage. I tried to convince my husband to let me go back to school but he thought I was out of my mind (since I loved teaching). Since he wouldn't consent, I took a CNA course and started working in a nursing home. I worked full time and went to nursing school. First I became an LPN. Then after having a bilateral mastectomy, I returned to school for my RN. I love nursing. I especially love my patients and take very seriously their need for an advocate.

It is not unusual for ICUCCU to be a difficult area to fit into. They are a pretty "tight" group. I don't think they intentionally "eat their young" but I know it sure feels that way. Be patient and you will earn the right and respect to be there. Been there done that. I know its not fun to be on the outside looking in. You can do it and you will be glad you did. Ask yourself, "How bad do I want it" Then don't let them drive you off.

Mslucky, Rehab nursing can be very challenging. While it is very different from Home Care, it adds new depth and dimension to you base of knowledge. It does have its frustration. Sometimes it seems as if nursing is at the bottom of the food chain and therapy at the top. However, it is such a blessing to see the rehab process in action.

Teresa, There are so many opportunities and options in nursing Cae out there. Don't settle for something you are not happy or fulfilled with. Check out the options available in your area. I am certain there are many. Go on line. There are endless possibilities out there. I know you will find your niche. Don't be afraid to try other forms of nursing like Home care, Hospice care, Same day surgery, etc.

Taylor, One thing that I found helpful when I got overwhelmed was this: On the first day of class one of the instructors told us it would be tough, we'd have to put our life on hold, etc. Then she said, "Let me ask you a question, how badly do you want it?" Every time I felt discouraged I'd ask myself "How badly do you want it"? This usually helped me get back on track. that and a good cry.

Wilbeth, Next time read question, then decide what you feel is right answer. The select the multiple choice most like your answer. When you read all the choices first you begin to think of too many "what ifs". The choices often cause confusion. Trust yourself. Keep on keeping on.

Crystal, I too am expected to be on call 24/7 every 4th week without compensation. I agree with you that there should be some type of compensation. I also can take off time during the week but like you said there never is time to do so. We are paid every two weeks. I rarely put in less than 45 hrs a week. Yet when I took off last Friday it was educted from my PTO. I am certain that salaried positions are only beneficial for the powers that be. When I was at a Hospice inpatient unit I worked anywhere from 50 to 65 hours a week because of being on call without an monitary gain. Again it was a salaried position. You could always work more than 40 hours but never less.