ladylikeRN

I agree, I have seen a lot of health professionals like myself cast judgment on others because of pain medication usage. I have no problem giving scheduled pain medications. I also have no problem with seeking an increase in dosage for a patient that is having no relief. It's all about being a patient advocate, not a person to cast judgment on others. Pain is a personal perception.

Well, since I work contingent at three LTC facilities, I work wherever they need me in that particular facility. On the other hand when I was full time staff at my previous work, they shifted me at times, although they lied in the interview and said that I would not likely be pulled. I was all over the place and out of sorts. Now, contingent work has really helped me adjust and it pays better for them to push me around, so to speak.

Well, no you are not the only one. I graduated May 2007 as a RN and have worked at the hospital doing cardiac step-down, cath lab, neurolgy at one place (changing floors). I thought that maybe I should step into med-surg and went to another hospital closer to my home and hated it even more, as it was a mixture of bariatrics and med-surg. The staff in the hospital setting seemed to clique to me and never helpled unless you were rude and mean like them, by talking down about patients. I ahted IVs and all the beeping, and inability to bond with patients,etc. Needless to say, after many sleepless nights, I have now left the hospital and have a newfound love for LTC. I worked at one LTC for three months, but the place did very unethical things (removing charting, lying, covering up mistakes) , so I left for contingent work and more pay per hour. Now, I work at 3 nursing homes contingent and also work agency doing flu shots and clinics. I love my life now. In nursing school I was never exposed to LTC and always heard such bad things about them. I have learned that every place is different and a good fit for me was more autonomy and more pay. I even make more than some nurses who graduated before me as I top over $30 an hour after shift differential. I feel with LTC, I actually have time to do TX's, skin care, and nursing....not "get em in and get em out." I am even considering home health care. I learned to get my feet wet and not be afraid to leave when my intuition told me it was not right. Many told me that it would look bad on the resume for not sticking it out for a year, but I tell those people, it does not pay to suffer! Keep searching!

You know, I agree that working midnights does take a toll on the body as a whole. I worked midnights during the time that I was a student nurse associate to try it out the shift because I am a night owl (staying up till 3 am) and worked contingent. However, I did a month of midnights 11pm to 7 am and will never do it again. I got very sick, vomiting and diarrhea from a patient because my immune system went down. I have never been sick while caring for patients, even till this day, my immune is high, despite the type of patients that I care for. On the other hand, my sleep cycle was off and I never felt rested on midnights. On the days that I was off, I slept in, then upon going back to work I felt did not feel rested and I broke out more and had bags under my eyes. I did that for 4 weeks and will never do midnights again. I now work afternoons as this is the best shift for me. I no longer have bags, and people always assume that I am much younger than my age of 27.

The place where I work usually only staffs one RN/LPN to about 35 residents at the most. When working with more nurses at a time, the ratio is usually 1: 15.

Actually, my sister is an attorney and I phoned as soon as I got home that day it happened. She has told me to make copies of everything from here on out, regarding nursing notes done my me. She has also advised me to rewrite a nursing note about the incident and copy the NM nursing note that she replaced in the chart. She has also told me to keep a log of events at this job until I leave.

I really care about my job and in fact the resident who is anox3 knows exactly what happened that day and the family know as well because I told them. I know that I was not at fault with this incident and was told by other staff not to complete an incident report anyhow. The incident report is not apart of the medical record anyway and has no bearing on legal matters. on the other hand, it looks as though I never charted anything at all in the chart, although the transfer sheet is in the chart. I have never witnessed anything like this before and I fear what could come in the future, I hate to have to leave my residents but I feel that my license could be potentially in danger here.

I had an incident the other day when a CENA was with a resident in LTC and stepped on the peg tubing, ultimately dislodging it from her body while getting her undressed to take a shower. To make a long story short, I was not on the same floor when this happened as the resident is obese and had to go upstairs in the nursing home to a more accommodating area for showers and bathing. After being contacted by the nurse on duty upstairs about the situation, she asked whether or not I wanted a foley catheter to be inserted for patency or for her to be transferred to the hospital. I opted with the transfer to the hospital and contacted the doc and he agreed. When the resident returned to the floor minutes later, I secured the site which had minimal bleeding with a sterile 4X4 gauze, and fully assessed and documented the actions that I took after the event, including vitals,the circumstances leading up to the event, etc. Well, the next day I did not work, but was told the following day by the midnight nurse to watch my back because our boss documented as is she was present the night when the PEG tube became dislodged. Problem is, the boss was not there and my progress notes of the events have disappeared and is no longer in the chart. The nurse who told me about this said that i report that she received about the resident after her return from the hospital was that the resident took the PEG tube out herself which was blatantly untrue. So that nurse then looked in the Chart as she knows that I document very concise and she found nothing but our manager's writing. The nurse then told me that the organization that I work for (only 3 months) are very big on telling nurses what to chart and when to chart in circumstances like these. However, my boss never even approached me about her taking my progress notes out of the chart and replacing them with her own as if she was there. My boss only received report over the phone from me as a standard rule for all transfers. I don't smell a lawsuit in this particular situation but who knows? Should I run from this job or just start keeping a log and copies of all of my nursing documentation?

I had an incident the other day when a CENA was with a resident in LTC and stepped on the peg tubing, ultimately dislodging it from her body while getting her undressed to take a shower. To make a long story short, I was not on the same floor when this happened as the resident is obese and had to go upstairs in the nursing home to a more accomodating area for showers and bathing. After being contacted by the nurse on duty upsatirs about the situation, she asked whether or not I wanted a foley catheter to be inserted for patency or for her to be transferred to the hospital. I opted with the transfer to the hospital and contacted the doc and he agreed. When the resident returned to the floor minutes later, I secured the site which had minimal bleeding with a stereile 4X4 gauze, and fully assessed and documented the actions that I took after the event, including vitals,the circumstances leading up to the event, etc. Well, the next day I did not work, but was told the following day by the midnight nurse to watch my back becuase our boss documented as is she was present the night when the PEG tube became dislodged. Problem is, the boss was not there and my progress notes of the events have disapeared and is no longer in the chart. The burse who told me about this said that i report that she recieved about the resident after her return from the hospital was that the resident took the PEG tube out herself which was blatantly untrue. So that nurse then looked in the Chart as she knows that I document very concise and she found nothing but our manager's writing. The nurse then told me that the organization that I work for (only 3 months) are very big on telling nurses what to chart and when to chart in circumstances like these. However, my boss never even approached me about her taking my progress notes out of the chart and replacing them with her own as if she was there. My boss only received report over the phone from me as a standard rule for all transfers. I don't smell a lawsuit in this particular situation but who knows? Should I run from this job or just start keeping a log and copies of all of my nursing documentation?

Today, upon coming in taking shift report with the preceptor, she rudely walked past me, spoke to another employee then blatantly ignored me. After report and finding out that she would get 8 pts and precept me because the agency nurse did not show up, she snapped again. I asked her "which pts will I get?" She then told me that I am getting two and I should know what I am doing because of last week orientation and that she was going to quiz me from A-Z on everything later and that I better know it. An hour later, I pulled my manager to the side and told her how I felt about everything. My manager understood and told me that she has heard about this type of behavior before regarding my preceptor as a nurse but not preceptor. She also told me that the preceptor was kinda forced into it because only she and 2 other nurses are bariatric certified nurses. She then told me to not take it personal and talk to her about how I feel if I am comfortable with that. Later, when our scheduled preceptor, orientee, nurse manager meeting was going on, the preceptor went in first and said that she would call me in when they have finished so that I would join. Well, they stayed in there for about an hour and a half and then it was time for me to leave so the nurse manager told me to give her report and that we would talk my next scheduled day because she had an interview. When I looked into my skills folder that my preceptor had wrote in I was furious. She put things like "support with documentation" as my only strength for last week. As for weaknesses, she put "slow learning unit without letting preceptor know, unable to discern abbreviations, no knowledge of supplies for skin tx, no initiative picking up linen, no responsibility, not following directions." I have only been on this unit working a week and a week orientation and I feel that I am picking things up good and even other co-workers tell me so. I cannot even believe that she could put this stuff down when I work my buns off everytime I go to work! I cannot even address these issues until when I come back to work. She even snared at me before I left and asked would I be there tomorrow even though she knows that I follow her schedule and that we would not be there. This is so frustrating! i think that she is upset becasue my boss granted me to only work PT 24 hrs a week orientation, not the 36 hrs that she does. However, I am a PT employee and work another job as well as have some exp as a RN.

I just recently started a second job as a RN on a bariatric unit ( I also work at a psych hospital). My preceptor has been a nurse for 30 years and is precepting both me and another orientee. However, she is very rude to me and talks down to me most of the day. I try not to get upset when she talks to me that way. for example, I asked her what suppiles did I need to d/c an ON-Q medication pump, just beneathe the skin ( my first time). She told me to get the supplies then when I d/c the pump, she proceeded to take me to the side outside of the pt's room and tell me that I sould have brought a bag to place all of the dirty materials in. If she wanted it that way, then I wander why she had not told me when I asked her what all to bring. I have been with her for 2 weeks now and 3 pts/family members even have picked up on her demeaning ways toward me. My pt today told me that she talks to me bad and that she is way harder on me than the other orientee who she precepted the last 4 hours of a 12 hr shift ( I work only 8). Another pt said that she should know how it is to be new somewhere. I am not blundering around, I get all of my work down in a timely fashion and provide good nursing care but this preceptor seems to get upset because I ask her about technical stuff due to me not being exposed to all procedures and equipment. Then on the other hand she pretends to be so nice to me. What should I do? Am I being eaten because I am young?

Thanks for your response, I think that I will follow my "gut" intuition and resign from this place because my intuition tells me that something is not right there. Also, they tell me that the afternoon is very busy but staffed with mostly new staff. The co-workers seem very standoffish and now I can see why other staff have ran away from working here. The staff here complains about the parents of the children as if it is some big deal. I worked peds but not psych, so I know that parents need that extra comfort level because it's their child for heaven's sake. I just have a more laid back, non-judgemental attitude and I don't fit here. I am also worried about my license because during the non-violent crisis intervention workshop, several moves were deemed grounds for firing staff. The guy just kept saying "if you do this, then you get fired". I have no clue if I will be able to defend myself while trying to calm an agitated patient in a way that does not appear to be mistreatment. I will try another child/adolescent psych facility. Wish me luck! Until then, I will continue working my telemetry unit until I find another child/adolescent psych unit to go contingent at.

Just to add to what others have said, the day in the life of an actual clinical....I would come prepared with a small notepad to write patient report on and their drugs. Have a drug guide, stethoscope, nurse scissors, measure tape (for wounds or anything else that needs to be measured), 2 black pens, and 2 small pocket books that I used throughout nursing clinical called RNNotes/MedsurgNotes by Ehren Meyers. Just be prepared for anything that that clinical instructor asks you for. Most times in clinical, the instructor wants you to do a care plan at some point, so a care plan book by Swearingen (All-in-One) would be nice, along with as sheet to write labs on. As far as your drug guide, be prepared to tell the instructor the indication, side effects, contraindications, and interactions for each drug..the good thing is that you can use the small notebook to write them down as many of the patients will be on the same drugs on a day-to-day basis. Just have a bag dedicated for your clinical because the last thing that you want is to do is appear unprepared in the instructor's eyes. Good luck!

Thanks, I am trying to see what will happen here as I try to stay positive. My intuition is telling me to be leary though. This unit has a lot of new staff and the staff here does not seem to be very interactive with newbies. Another new co-worker and I were viewing charts until we toured the unit with the manager and most of the staff there did not even say hi or anything. It's weird. The manager then toured the unit with myself and the other new RN and paid more attention to the 40 hour a week RN than me since I am contingent. The manager even told me well I will see you whenever (because I do not have my other facility's work schedule until next week). Wish me luck and prayers..if this place does not work out, then I will stay on the unit at my part-time job.

Thanks for both of your posts. The PCS (techs) are said to have about 8-10 pts each amongst the 45. The other issue that I have is that the PCS gives the discharge instructions to the parents, even outlining meds that the pt goes home on. To me, this is something that should not be delegated. Also, the PCS techs does the initial assessment of the pt. before pt is admitted on unit by checking for marks, cuts, and.or any previous harm to self or by abuse. That makes me uncomfortable also. I will give it a try as the hospital oreintation is still going on and I go on the floor tomorrow. I hope I like it. However, the place that does the drug screen for this hospital giggled when I came in because they told me that they hire people there left and right. My boss even told me beforehand that there is a high turnover of nurses there because they don't like the psychiatric setting.