rebel_red

a big YEAH THAT...........

Graveyard is quiet because the residents are asleep......giggle giggle....try they can't sleep, are trying to get oob without assist and falling unless they have a bed alarm, then 15 bed alarms are sounding at once, oh and the residents on pain meds who call q 1 hour....and the adorable lol who parks at the station to chat.....oh and those residents that were "stable" all day and throw a PE or go into active gi bleed or develop a wheeze you can hear down the hallway and the perpetual insomniac who sleeps all day has enough prn meds on board to knock out a rhino but rings q 15 minutes because they can't sleep...I could just go on and on.....not to mention all the "house stuff" you get to pick up cause no other shift has time...(not trying to start a shift war I work all shifts all days and each has its particular and sometimes peculiar challenges..) And as to it being the charge nurse's job to keep on everyone's butt to see they do their job.....nonsense, they are all adults....I am here for my residents not to play romper room/prison matron with the other employees. With the changing of CMS and a fresh inundation of redundant paperwork, that leaves one wondering "gee what is more important to admin....the paperwork or the patients?" I say to the OP run like the wind....I too have worked back to back weekend doubles and understand how tiring and frustrating they can be. Good luck.... Tres

Irregardless of if you work 2nds or not, the facility is dangerous. The residents are in perpetual jeopardy. Not only would I run for the nearest exit, I would have to advocate for madandated ratios....No way is everyone getting everything that is prescribed. I have only 30, and some nights when I work 3-11, I am still inhouse and charting until 1 or 2am, especially when someone "crumps". Yep I am the queen of send out for eval.....and heaven forfend one of the docs coming in....add a few more hours to take off orders.... Tres

2 of my classmates hit 205, they both passed :-) And more importantly they are both darn fine nurses... Be Well, Tres

Yep. My assignment is 20 subacute patients and 10 long term care. Out of the 20 subacute patients, at least 3-6 at any given time would still benefit from a med surg floor. Their medical stability is at times creative writing on part of the dc planner and the doc at worst extremely fragile. My long term care residents are for the most part stable. Yet require a different type of vigilance because their changes in medical condition can be barely perceptible unless you know them well. We have 2-5 admits and discharges on any given day in our sub acute unit. Fortunately the house sup, UM, DON and ADON jump in with the discharges and admits. We usually have a wound care nurse on 7-3, at least 3 days of the week. Our floor total is 40 subacute beds and 20 ltc. 7-3 mon-fri also has a unit clerk. We try to staff at least 8-10 aides on both 7-3, 3-11, but with call outs usually end up with 6 or 7. And if our 50 bed dementia unit is short, they pull our aides. 3-11 also has 2 nurses with the same split and a house supe. No wound care nurse or unit clerk. However we schedule the time consuming treatments for days when there usually is a wound care nurse. 11-7 ideally has 2 nurses and house sup, if census is under a certain # (no hard and fast rule usually around 46) One nurse takes the floor and the house supe has the house. If we have one nurse and census is higher the house supe takes an assignment. Anywhere from 3-5 aides on 11-7. I really do love my facility. I have no compunction about asking for help when I have several emergent issues at once...eg last weekend I was sending out one resident for gross hematuria (couldn't be handled in house), another resident in acute resp. distress, while I was on the phone another resident took a header and had a head lac, and while all of this was going on one of our aides gave herself a nasty cut on a piece of equipment......then there was a code....just a normal afternoon. So during my shift I pretty much resemble a hamster on speed. The great thing is we do work very well together as a team. Everyone does help everyone. And the doctors who admit to us are for the most part extremely reasonable and easy to work with. Though there is one, I will probably run over with my truck. And then back up and do it again, but hey every facility has one of those.... It does get crazy though.....but shhhh don't tell anyone I am a secret adrenaline junkie and thrive on this environment. And being a new nurse, I have learned so much from my co workers and seen more and done more here than I did on my clinical rotations in the hospital. And as to the safety of those we are entrusted with.....I feel my license is safe here. I once refused to do a procedure because we had no protocol. Called the doc and med director they were fine with this decision as was admin. Yeah we get crazy, cranky, grumpy and a whole lot of snarky at times, fortunately we all have a sick twisted sense of humor..... I have a strange schedule and work all shifts....so I see the benefits and disadvantages of each shift, I also work all different days of the week, including weekends.... Ok I shall cease to ramble. Be Well Tres who still does sometimes fantasize about a job as a walmart greeter when things are really hectic....

Ain't it the truth??? Sometimes I just wanna make stuff up...but I like my licence too much so I resist the urge...... Be Well Tres

Our facility is split between sub acute and ltc. My ltc residents are absolute dolls. My subacutes are another matter entirely. Sometimes I wanna take em on a little field trip or offer them a little pillow therapy. Call me when you need pain meds, or you feel a little "off" always happy to assess and medicate, but do not tell the aide "Only the nurse can help me." Then when I arrive in the room tell me "You need to change the channel on my tv." Because I will perceive that as a change in mental status ship your butt off to the hospital and have you labeled a DNR as in do not return to our facility.....OK so I really wouldn't but I really want to......who knows how much longer I can hold onto my tenuous grasp of reality in light of such inanity......And yeah I know the tv thing may be a bid for attention or emotional reassurance....still.... Tres who thinks if you can do it on your own you should.....

Hmmmm I admit I have the apparantly bad habit of saying "my aides". I also say "my supervisor", "my patients" and "my facility" and ya wanna know why??? Because the are all in some way "MY responsibility." I have the responsibility to listen to my aides, keep my supervisor informed of assessments and nursing interventions, to keep my patients medically stable and facilitate the healing process and contribute to my facility's mission. Why because it is my license. As to the other issue....I wonder about it myself because on overnights I often have the whole floor, sometimes without another nurse and as always rely on the assessment skills taught in school. I send alot of our folks out to the local hospital for eval based on my assessments.... However I do see nurses doing what I call "bagging it". Waiting for the next shift to do "it", whatever it is...This is so appalling. I am not super nurse, yet I wonder how can miss these declines in condition and not do an assessment and intervene??? Wish I had the answer... I sent 5 patients out last Saturday alone, all of whom were kept for various admit diagnosis. All of whom according to nurses notes had these conditions brewing for 3-5 days.... When you find the answer let me know and I'll pass it on to our DON and UM.... sigh Tres

I lived by these words printed on the handout by the testing site when my computer shut off at 85. "85 is the minimum number of questions needed to demonstrate proficiency." A year later and I still remember!! I passed and I am sure you did too! So Congratulations!!!!!! Tres

I went the looongg way...took a job as a CNA to insure I could provide basic care without issue....Did my LPN. For me it is fabulous because I make decent money and can set my own hours while finishing my RN. I hold a Bachelors in Social Work..but because of the time frame I have to do sciences over..sigh.....

Tech school in NJ. 3200 include books, uniforms, stethoscope, b/p cuff and our program director managed to also obtain goodies like Tabers, Davis's Drug Guide, Careplan books. I bought my own insurance, cheap and worth it imho through NSO and I still carry it. This year I understand the program cost is 3800.... Tres

New Grad, NJ : 17.25 base rate, weekend rate of 21.50....no shift diff...so guess who works all weekends.....yep me, but down at the very end of the Jersey Shore this is great pay....My friends in Drs offices are making 13$ and 15.50. BTMH from what I hear and Shore start LPN's around $15... But I love my facility (subacute/rehab/ltc) and know my license is safe there.

I deliberately planned to receive my NCLEX results on my 41st birthday. My gift to myself. Our LPN class ranged in age from 19-52. The year before my friend graduated and she is 60. Go do it!!!!! I love it...(though maybe you can't tell that from my other posts...giggle) Good Luck!! Tres

Never be afraid to ask for help. I had to do a procedure I had never done before. My RN supervisor hadn't either, so we looked for the P&P whoops none existed...Called our nursing educator, she didn't know either. Called our UM, our DON...everyone without exception didn't know. Called the patient's Dr. explained the situation and he said "I don't have a clue, feel free to reschedule the procedure for when we have everything in place." Valuable lesson. No one was nasty because I said "I don't know and I won't do this if I can't insure the patient's safety." Everyone was very supportive. My motto is my patient's safety insures my license's safety. Tres

You care because you care about your patients and want to insure continuity of care. We have the same person at our facility. She perceives herself to be the "super" nurse, knows everything about every patient better than any of us ever will, the only time she listens is when admin is speaking, because she is all about brown nosing. The rest of us treat her as a joke, and when the patient is in a potentially adventitious situation, we tell the UM. Because supernurse has no follow through.....and somehow manages to finish a 2 hour med pass in 45 minutes.... Ack. So glad I don't follow her. As to advice....I still give supernurse a full report, make sure everything goes on the 24 hour report sheet seen by our DON, UM and LPN supervisor.Myself or our house sup also verbally gives report to the UM and we make sure to include patients requiring follow up. It is the only way I know there will be follow up. I have tried discussing this with her to no avail, because she is so convinced she is just that much better than the rest of us. We just live with her little ego trips and make sure that our admin team is aware. Sucks, but with the nursing shortage she isn't going anywhere..... Tres

I also work all 3 shifts, and trust me I totally agree with LPN1112005, NOCs is not a quiet shift by any means. I run just as hard on NOCs as I do on 7-3 or 3-11. And with a hell of a lot less backup than I have on the other shifts....Not to mention all the "housekeeping" chores left to NOCs...eg chart checks for the entire floor, change the batteries on the hoyer, change the batteries on bed alarms, empty the med carts for cleaning, clean up the med carts and the tx cart, stock the crash cart and the tx cart order meds for the backup boxes and house stock, change out foleys and foley bags, do the PT/INRs, make sure wheelchairs are pulled for cleaning, 6am weights (which might I add the patients just lllloooooovvveee), and of course doing all the recaps for the month for the MARs change out, and of course the regular stuff assessments, charting, med pass, assigning CNA's, handling emergent situations. Oh and I almost forgot O2 tubing and neb tubing and H2O for concentrators gets changed on NOCs also.... I am so glad I have and continue to work all 3 shifts. And hope I never get sniffy about 1 shift Doing more and NOCs not doing anything except snozing...oh that just twists my panties..... Tres

My favorite: "My Mom needs (insert need here)." Me: "And your Mom is?" Them: Blank stare like I am the biggest idiot in the world for not having my patients geneological trees memorized. Or the nurses are interchangable theory. I know my patients, but your family member may not be mine, ergo I have no bloody idea. Sorry I am not omniscient. And no I cannot just medicate another nurse's patient with Vics from my narc drawer. "Mom needs...." Try using the call light, our aides are pretty responsive to those pretty little lights and ringing bells. Oh you want me to jump up and run to her side with a fresh cold glass of ice water. Oh and it should be a ratio of 1/3 ice 2/3rds water and the straw needs to be bent at exactly a 32 degree angle? Sure let me just hop right on that. "I'm not taking that pee pill, it makes me pee too much." Guess its working. "I'm telling my doctor you don't like me." Bet he hates you, cause I know he refused to follow you at this facility and only did so because our medical director ponied in. And yes threatening the nurse with bodily injury always assures top notch care. Not to mention my all time favorite, family telling me to medicate the patient with a "little extra" morphine, that they wouldn't mind ending his suffering......Umm last time I looked grim reaper was not in my job description. My oh my its been a long week.....

I think my favorite was a very independent elderly lady who was becoming unsteady with her gait and had several falls. So a bed alarm protocol was initiated. I was still an aide at the time and was making rounds. I peeked into her room and there she was stacking books on the bed alarm so it wouldn't go off. Took me awhile to stop laughing before I could go in the room and assist, then report it to our charge.

Wake em up in the middle of the night for skin checks???? This is insanity. We do ours on 7-3 or 3-11 when they are in the shower. And it is spread over the entire week, so there are only a few to do on a daily basis. Makes it mucho easy. Plus are aides are really great about reminding the nurses of skin checks and reporting any changes in skin condition they notice while giving care. Tres

My motto is "When in doubt, send em out." Our docs are really great that way, especially since we (the nurses) utilizing our critical thinking and assessment skills have been absolutely dead on 99% of the time. Only once did a doc get snarky with me. And I was hot anyhow because the resident was showing symptoms of a fresh TIA. Our ER which is normally top notch turned her around in 40 minutes. Heck they can't even get their labs in 40 minutes. If I a 41 y/o woman had presented with the same symptoms, I would have been in workup (based on past experience) for at least several hours. Still po'd about that. Anyhow I talked with the doc in question the next time he came in......lets just say all is fine now. Tres

Well, lets see, we had a meeting at which gratis lidocaine cream was passed out so we could apply to our posteriors prior to butt chewing...... Oh and there is a luncheon. Ptomaine will be served..... snark snark snark Tres

I agree with cheerfuldoer and maolin. I voluntarily work back to back 16's on the weekend and am requesting a transfer. Why? Because I couldn't sleep Friday night and no one I mean no one would replace me on my 3-11. I worked on no sleep. No one really cared, best offer go home and take a nap then come back. Yet another nurse gets a freakin hangnail and they find coverage. Going elsewhere if my shift request goes unheeded. Its not worth the damage to my body or my license. Nor is it worth it for you either. The 'baylor" pay isn't even worth it..... Be Well, Tres

Its obscene that this situation even exists. How much do you like this job?? Ok so I am a little hot headed today, but apologize for something that didn't even occur? Absolutely adore MarieLPN's idea. Hope you are feeling better. Wish the "profession" of nursing would support its professionals. Take Care, Tres

OK deep breath. I am so furious. She is not capable of "dealing with it" or she would have deep sixed this jerk of a husband years ago. It is not her responsibility to deal with it. IT IS HIS RESPONSIBILITY TO CONTROL HIS ANGER AND DRINKING. Since she is incapable of taking care of and or protecting herself, the responsibility falls to the nurse as advocate. I do not buy the powers that be explanation of "We are handling it." As her nurse you better d*mn well tell me how, or I will take steps of my own. Seems to me like the husband is being placated. And the rest of the family is in a life long habit of fear. Here in NJ that type of verbal abuse is considered battery. I would call your local women's shelter since they too have a responsibility for confidentiality and see what their on call counselor or attorney (we're lucky our shelter has an attorney) has to say about what steps can be taken. Adult protective services needs to be involved. Gee get the family to move her out of the facility......lets really screw with the victim instead of adressing the issue with the abuser......oh and gee that also works out real neat for the facility......What he isn't mobile and can't call her or go elsewhere to abuse her???? Lets just make sure its not our problem anymore...... Sorry this is so inarticulate, but I am just ready to spit...... Keep us posted..... Tres

BlackCat99, I have a question. When I work nightshift, on our subacute floor and on our LTC floor as well, it is one LPN and minimum 3 nurses aides and a house supervisor. This is with 60 residents on each floor. It seems to me if it is just yourself and 1 aide and what sounds like the whole floor on bed alarms, there is a much larger issue, regarding resident safety. I feel for you, I usually work subacute, where we have 2 bed alarms out of 60. Upstairs though is another matter. When I work upstairs the cacophony gets to me too. And we do take the very restless out into the dining room, feed the folks, toilet them etc, but our house sup is a doll and will do one on one with our restless folks so the aides can do rounds and I can do med pass. This works well. It sounds though like you don't have any "back up". Good Luck! Tres