sandy123

I work on a busy medsurg-oncology floor on midnights and am wondering how other hospitals deal with the accuity related to demented, detoxing, and confused patients. On my floor midnights generally has 6 or 7 patients to start and generally get atleast one if not 2 admits nightly. Our patients range from chemo to ETOH detox to pneumonia to you name it. Over the last 4 months, we have been transitioning to a staffing by accuity model which focuses on a Braden scale score and "nurse input" regarding how heavy the patient is. Factors such as wound care, tubes in and out, telemetry, etc are left to the nurse to add in. We on midnights are having a hard time getting the management to recognize how big of a factor sundowners, agitation, dementia, detoxing behaviors, etc increase a patient's accuity rating. They tend to minimize the patient who is climbing out of bed from the minute you come on or screaming at the top of their lungs. Does your facility get how much this impacts a patient load and adjust accuity accordingly or is it like this everywhere?

I would totally try to get with a good preceptor if the opportunity is there. I am in 4th week of my preceptorship and had the same nurse for first 3 1/2 weeks. She was awesome. She went out for surgery of her own on Wed so last couple of days I had a different preceptor who talked to other staff too much and yesterday was hell. I know if my first preceptor had been with me, she would have been more helpful and the day would have gone better. I left feeling deflated for the first time in my orientation, but when I got home realized I made it through a really rough day with minimal assistance, so once on my own I think I'll be fine because the nurses on my shift really work well as a team. Orientation is the opportunity to work out the kinks so anything you can do to make it smoother, I say it is worth it. Might be uncomfortable with the other person, but if you explain it tactfully that the other nurses style fits you better, hopefully she/he will understand and respect you for standing up for yourself. Good luck!

Today I had my first bad day and just need to vent and hopefully get some support from my fellow new grads. I am 4 weeks into orientation on a heavy med surg/oncology floor. I am orienting on days but go to nights this weekend. Til today I have had good to okay days with a couple of great days. Today totally sucked canal water!!! First I had a preceptor who is nice but talks alot to other people. Three times when I came up to her for questions, I literally had to wait a couple of minutes while she finished her personal stories...I didn't have the time but waited patiently rather than be rude. Then had a large guy with a HUGE wound (total abdomen, thigh, buttocks involved) that took literally an hour and half to do dressing change with 4 of us in room whole time. This man had PCA, IV ABT X4, the dressing change from hell, TPN, et all.... I never got a lunch and then 25 minutes before I to leave, an admit. That would have been ok but his doc was a total jerk. Guy comes in from chemo yesterday with dehydration, n/v, diarrhea....anyway long story short, his stool looked really mucousy and smelled like c diff so I asked for a rule out and was treated like a complete idiot by the oncologist...His diarrhea was from chemo, but if I felt like it I could get a rule out. Our protocol at the hospital is if suspected, isolate and rule out. The doc made me feel an inch tall and was really a jerk...but i still sent the sample and if it is cdiff i will bring it up :) Anyway...today left me totally drained and needed to vent. Thanks for reading/listening.

Thanks all. It is soooo hard mostly because we can not afford for one of us to move out so we are still in each other's face. He tells me it is him he is giving up on not me, but can't give me a chance to make up for some of our problems. My mom died last November and I have been having problems dealing with that and feeling alone. I guess he felt like I pushed him away and that our relationship went from being fun to being work. All relationships are work, I think he is going thru something on his own. I have resolved to hope for the best until he serves me with divorce papers, until that day there is a chance. He says no but I can hope. I still love him. But, my study group is really being great to help me thru and I will finish school come hell or high water. It is just going to be the hardest thing I have ever done and I just hope I can keep the faith and keep it together!

I'm an LPN still in school working towards my RN. WIll finish in May 08. My husband suddenly announced he wants a divorce. We have both been under so much stress but I had no idea he was so unhappy. Neither of use can financially afford to move out and he says he wants to help me finish school...he says he owes me that. I don't know how I am going to handle all of this with my last semester of school. Anyone been there? Any advice? I work 3 days a week LTC and go to school full time so we will be able to avoid each other. I want a chance to work it out, but he says it would only be delaying the inevitable. I am so confused. :o:o:o

I also have had the RN neg attitude. If I get attitude, I kill em with kindness...most of time they are just trying to get a reaction as it makes them feel better about themselves somehow. When you don't give them the reaction they are expecting, they really don't know what to do!!! I just got my LPN license even though am going for RN with school starting in 2 weeks again. I am doing it for the experience. I am working LTC and already have done some hands on things at work that I only saw or did in lab portion during school (not to real human). It is also giving me opportunity to practice my skills especially assessment. Nursing at any level is about caring for your patient!

worked my first night "in charge" of everything with the training nurse just shadowing me. most residents were still in bed or room when 0600 med pass started so my fears of who is who were lessened as I got another night of faces to names . most of the nightowls were quiet. all in all was good night. Only one potential problem when I almost went into the wrong room with med. 2 helens right next door to each other and their pictures look so similar they could pass for sisters! luckily my shadow questioned me and now i have an identifying method for the helens....one is a walker other has a w/chair. should suffice until I recongize them on sight. Have one more night of orientation and then am on my own. Have the same shadow my last night so have weekend off and then am pumped to come back and feel ready to go solo.

just finished my 1st year and found exercise and diet were critical for me and when I ate right and walked the dog I felt better, studied better, and slept better when I slept (which was usually about 6 hr per night). I agree that too much caffeine and cramming doesn't work. Organize so you can study during down time by taking book, notes, or flashcards with you everywhere so if stuck in traffic or waiting for something you can be productive. make time for fun too! Good luck to you!

Hi, recent grad LPN...first job in LTC working at 144 bed facility, nights. Usually 2 nurses (they'd love 3 but can't get people), 7-8 CNA's, 4 units 2 CNAs each. I'm on day 5 of 8 shift orientation and it seems OK so far. I was CNA for 2 yr before nursing school so familiar with the LTC gig. The nurses orienting me are OK but have alot of bad habits that I hope not to catch. I think I will be OK. My biggest concern to be honest is learning the residents. They are in bed when I get there, most look nothing like the pictures in their chart and I am worried about giving wrong med to someone. Any suggestions? thanks:idea: