Todd SPN

Yes, I chart it. When I send a FAX I always ask "Any new orders?" Hopefully I'll get response of yes or no.

I have been in LTC for 3 years at 2 different facilities. From my observations and experience they are not good places to work and things seem to get worse, not better. I'm sure it has to do with money and facilities getting less, having to wait longer to get it and more paperwork and rules and regulations. Your questions and my experience: #1 I worked a double shift on Thanksgiving because there was no one to relieve me. Oh, management knew but chose to ignore it. All my emergency numbers--on call nurse, DON, ED where switched to voice mail that didn't get checked. You are usually on your own to find a replacement for a call-in. #2 Acuity changes with discharges and admits. Also what unit. Medicare can get tough and hectic eating up a large portion of time making it difficult to attend to your other duties. IVs, tube feedings, trachs, dressing changes, etc. BTW, the 24 res you will be taking care of, are you sure they just don't have low census now and the unit has room for 30 that you will have to take care of when it fills up? #3 I've found CNA coverage to vary from day to day. They are usually pretty stretched out and again, if there is a call in it may be up to you to find coverage. Also, when the facility has to start cutting expenses because of low census, the hard and usually overworked CNA is the first place they take the knife. Most facilities do not have a full staff of CNAs and will take any "body" if need be. These CNAs are not much help. #4 I got 2 days of orientation at my present job. You will know who to ask for help. Those that know anything will stand out. The rest that pretend to know things are obvious. #5 You and any LPNs will likely be doing the same work. If you are equating being the person to oversee a staff (LPN) or for that matter (CNA) you may be mistaken. You mention a med tech on one side. Maybe this means on another unit. You of course will oversee the CNAs, but if they are any good they will not have to be told what to do and will report any problems to you. You will come to appreciated a hard working, on the ball CNA as a gift from heaven. But as the RN you have the ultimate responsibility. This is a whole different situation than a hospital. #6 A ward clerk if you are lucky enough to have one. Ours died so they decided to save the $9.00 and hour and have the nurses do it instead of hiring another. Oh, we also have to answer the phone by the 3rd ring. (Not anything you asked, but when someone calls for a resident and we transfer the call, if the resident doesn't answer, the caller will call back and tell us there was no answer and they will try again later or request you go track them down!?) #7 That varies with each facility. The last one I worked at was terrible for supplies. Each cath res got one new bag a month. If it started leaking it was up to the nurse to figure out how to patch it. We had 2 sizes of 18 gauge needles that afixed to non luer lock syringes. The supplies were locked up at night and on weekends so if you needed say a diabetic syringe you went begging to another nurse. It didn't make sense and didn't have to. When you complained they looked at you like what's the problem? All is not lost if you take the job and don't like it. You can always go elsewhere.

" Being a good nurse is not always the same as being a good employee." Timothy, I love that quote. Ain't it the truth.

I know exactly what you are talking about and how you feel. Last evening was my last shift and will be starting at my new facility in a week. I was not the first to leave and it sounds like I won't be the last. Our new DON is a midwife with no LTC experience. If this new place does not work out, I think I will be done with LTC. I kind of like the McDonalds drive thru position. Take the order, take the money and move on. I was surprised at the number of residents who came up to me and said they were sorry to hear I was leaving. It was kind of heart wrenching. Despite what I was told by my higher-ups, I must have been doing something right. Good luck to your. Todd

Just from what you have written, I wonder if you are over thinking this. By this I mean delirium has more than one etiology and you should only have to address the one specific to the resident. You should be able to identify the etiology by the dx on the face sheet and the h&p. The RAP summary should be just that, a summary stating the cause. This summary shows the state you are aware of the disease and are addressing it. It sounds to me like you think your bosses are asking for an all encompassing report on delirium and I would question that. Why not write a RAP summary on the resident the state felt was lacking. For your bosses you could throw in the general definition followed by the etiology to this particular res. You might also consider purchasing "The Merck Manual" to help you out. Todd

Sequim Mt Vernon Port Townsend (looks gorgeous) Whidbey Island/Oak Harbor/Coupeville Sequim and Port Townsend means quite a drive for work. If concerned about schools, cross off PT. If in Sequim, you would most likely be commuting to Port Angeles for hospital work (actually, not that far, but still a commute). Given you want outdoor activities and men, pick Whidbey Island. Lots of scenery, hospital places to ride bikes and the Navy!

Put me in the column of those who went back to school so I could escape being an aide. It is hard demanding work and I will admit I can no longer physically do an 8 hour shift of this type of work. I don't think that means I can not be a nurse. If all the hospitals and SNFs require perfection in physically fit employees, then there would be a lot fewer nurses (and CNAs). If your facility is willing to fire you as a nurse because you can't or won't do 8 hours of CNA work then I think you have lost nothing. That is not the type of work place mentality that I personally would put up with. Fact is, it they scheduled me to work as a CNA without asking, I would be out the door. Todd

Daytonite, Thanks for the links. I will check them out after work. To the OP, we are seeing many more cases of MRSA at our facility. The problem I see is that it may be colonized, but it can and does become active again. How do you know when it becomes active? We have one res that is classified with colonized that gets UTIs a few times a year and the labs always show MRSA. Had another recently with respitory MRSA. Our infection control nurse said there was no need to gown up unless res was coughing and might get on our uniforms. We of course wear a mask. But what do you do with items she has touched like dinner trays and eating utensils? It seems that we are treating MRSA much more casually than when I had clinicals at the hospital. I have also seen where MRSA is mentioned on one page in a hundred. It does not give you a feeling of security. We have one nurse who can no longer work for us collecting L&I because of contacting MRSA at the facility. Two months ago an aide went to her doctor to have a wound looked at before her wedding and the culture came back MRSA. Your facility has a infection control nurse. I suggest you start asking questions there. Todd

Congrats!! It has been my experience that there are fewer nurses on this shift, so you won't find it slow. Also, it seems that most of our deaths occur on this shift. Seems like a lot of prn pain meds are dispensed and suppositories! Also IVs are run and tube feedings need to be hung. As for advice, don't forget to start your assessments with VS and if you have to call the MD, have the chart handy so you can answer the MDs questions. You will not be always talking with the primary so the on-call will not be familiar with the res and may have many questions. Before making the call you might want to know the res dx and read the nurse notes a few shifts back in case there is something there that might pertain to your current situation. Good luck and enjoy. Todd

I posted about a week ago about payscales. I have been limited to 3% annually. I found out that most of fellow students I graduated with have received COLAs. I also found out that my facility has had to change their payscale in order to attract new hires. But they did not bring up the wages of those that have been there. What this means to my situation is with 3 years experience, I am making $1.50 less than the new grads they are hiring. When I asked for a raise I was told how happy they are with my work, but we aren't going to give you any more money. I got myself a new job today with an increase in pay. I was miserable training new hires that were making more than me. Todd

Why even mention you are working where you are presently? Do they have to know? Todd

OMG. What a stupid person.

Not unless they go to medical school. However, I am for allowing any nurse who works LTC to prescribe prn Ativan! Todd

Two weeks ago the facility had a leadership class. One of the points was when you tell someone you will look into something give them a time frame. Well, when I told my supervisor I wanted a raise I was told I would have an answer in a week. It has been more than a week and it looks like the tactic is avoid the request and hope it goes away. LOL-SOS! Anyway, with new grads being hired at $1.50 per hour than I'm making I guess it is time to update the resume. Todd

Huh? I work at a NH and deal with this stuff everyday.

Exactly. So they allow you-with experience at their facility-to leave and then they have to replace you with a new hire at the higher rate of pay when they could have paid you the new scale and retained you. I don't get it.

I would like to know from you nurses that work LTC how your raises are figured. I have been working at the same facility for almost 3 years now. I was hired right after getting licensed. It has come to my attention that my facility now has a 2 tier pay scale. They had to do this to attract nurses to fill vacant positions. What it amounts to is I am on the old payscale and new hires are getting substantially more pay. I'm talking dollars, not change. They are not raising the pay of those who have been there before the new scale. I am limited to 3% per year raise. No cost of living has ever been given out. I guess I don't have to tell you I am more than a little PO'd. Nurses I graduated with who work other facilities have surpassed me in pay. I told one of my bosses I wanted a raise in pay. She laughed! I told her I wasn't kidding, that I was aware of the new payscale and want to be brought up to "speed." I could tell by the look on her face she wasn't happy I knew. She said she would get back with me. The facility is not exactly where I want to spend the rest of my life, but it is the closest to home and serves a purpose for now. But I am willing to leave to make my point (not that they would get it!). Anyway, I appreciate any info or thoughts you have to offer on the matter so I can negotiate. Todd

Hey kat, The Olympic Pennsulia is a beautiful spot, but can be boring for a person your age (generally). PA as the locals call it was known for the lumber industry which has taken a downturn. I have worked with nurses that grew up in that area and were glad to leave to the "big city." Getting to Seattle in the winter can at times be difficult. I know of times where the winds closed the bridge down. (They actually open up a section to allow water through so the waves don't beat on the structure.) There are times the ferry can't run because of extremely low tides. You can, of course, take the long way around through Bremerton. All of this sounds worse than it really is, but it does happen. If you like rain, you will love PA 3 out of the 4 seasons. Less than a year ago the hospital was advertising out of the area for nurses. IIRC, they also were attached somehow to a NH. Anyway, they were offering a sign-on bonus and maybe some assistance with moving expenses, but I'm not sure about that. Hope this helps some. Todd

I'm not sure Sequim has a hospital. About 10 years ago I had a sales route and Sequim was one of my stops. A guy who worked at the local grocery store put it this way: "The people who live here are either raisins or granola's." Meaning retired old people or hippies. The town attracts many retirees because of the weather. It is in "banana belt," it can be raining on either side of them and they will have sunshine. But sunshine does not mean hot weather. It is on the Sound and the water does make for cooler temps than inland. The sidewalks roll up early. Last time I was out that way 2 years ago, the highway had bypassed the town so I can't tell you about growth. It is a beautiful area, but I am a person who likes solitude and I'm not sure even I could stand it for an area to live in long term. You might want to see my response to the person who posted about Port Angeles. Todd

I just saw an article the other day stating Physical Therapy jobs were to be a hot commody in the coming years. Was listed as number 3. Might consider that? Todd

I'm so sorry this happened to you. Gaining confindence and becoming proficient at nursing is hard and takes time. There were many times when I first started that I felt totally inadequate and wondered why I didn't get fired. Lucky I guess. A month after getting my job in LTC the state came in for the yearly inspection. I recall one of the inspectors asking me a question that I should have known about a resident but didn't and she obviously was checking my knowledge. After saying, "I'm sorry, I didn't hear your question" I thought about what she had asked as she repeated it. Took an educated guess and checked it out after the inspector left. I was relieved when it turned out my answer was correct. I certainly hope you overcome this with your self-worth as a nurse intact. Todd

As an LPN, I would advise going directly to RN. Todd

Sounds like you have a lot on your plate with an upcoming move. If there is a possiblility of a move within a few months, do you really want to be learning the ins and outs of a new postion, or would you rather go with what you know?

"The RN supervisor over the weekend said that if I refuse to accept the aide assignment she would write me up for neglect and I would lose my job. I just don't want them to think I'm not a "team player"." Well, that's just great. There is your typical "team player" attitude in action. You are hired as a nurse and if you don't accept an aide postition you get fired. But worse they are going to charge you with neglect. I really don't think they can make it stick, but they may try anyway. I too went to school because I could no longer doing aide work. I don't mind helping out when necessary during a shift, but if I want to do it an entire shift, I will apply for an aide position. Personally, I would say no and let the chips fall where they may. Let them decide if they want to lose a good nurse they will be needing in a month or save face by carring out the stupid threat. If they do the latter, you are lucky to not be there anymore.

Believe me, at your age, if you have the chance to do the ADN program do it vs going LVN first then going on. BTW, I advise any age to do the ADN program if possible. I went into a LPN program at 50 and have been nursing for 2.5 years. I am now looking towards retirement and how much I can save, not how much I will have to spend going to school.