dukesgal

Hi, all! I've been a nurse for two years and have experience in LTC, rehab, hospice, and most recently am working private duty home health. I really love my current position, but there are no benefits and I know that in order to achieve my long term goal (MSN for the Nurse Educator track), I need a solid med/surg background. I am currently a few months away from earning my BSN, and I am hopeful to be able to teach clinicals for a bit until I can start on my MSN. While I was working LTC, and even rehab I had between 20-30 patients to pass meds and do dressing changes, treatments, etc. I know I can time manage to care for 5-6 patients on a med/surg unit. The hospital I am interviewing at is a small facility, with no ICU or maternity wards. I know a little stress and anxiety are healthy and ensure that I will be safe and utilize my critical thinking skills, but I am a little concerned that I haven't done med/surg since nursing school. I currently care for a vent dependent quad in his home, and while he is my only patient, I oversee all aspects of his care. I am confident in my abilities and the hospital is offering at least a month of orientation, and more if I feel I need more time to transition safely, but there is always that OMG! panic moment in the back of my mind! ;-PDoes anyone have any words of advice for those of you that have successfully transitioned from LTC to a medical- surgical unit? Any nursing brains or aids to help me organize my pts would also be very much appreciated!

Hi all, I am currently about to finish up my BSN through University of Phoenix. I am looking to get my MS in Nursing Education once I receive the BSN. I have been happy with my experience there, but the cost is pretty spendy. I have heard good things about WGU and how it is less expensive the more quickly you can get the coursework finished. What are the clinical requirements for the MSN? Any opinions on how knowledgeable advisors are? Some of the academic advisors at UOP didn't seem like they knew much about the RN-BSN and that was kind of frustrating, initially. Thanks for any advice or words of wisdom! -dukesgal

Hey there! I have been attending UOPX online since last March. I have five more classes to finish my BSN, so will be done early next year as long as I don't take any breaks between now and then. I really like it, for everything except the price The academic advisors I have had didn't seem to know a lot about the nursing requirements/program, so that has been frustrating, but I have a really great advisor now who will go digging around for answers if she doesn't know. The clinicals are all something you can do in the community or online utilizing the "Neighborhood" basically, little stories about individuals and families which detail their health issues. For one of the classes we had to follow a family and obtain a history on them, but once we met with them a few times, it was really easy to do. I work full time so was worried about the clinical component, but it has not been so bad. The worst part is getting stuck in learning teams where some members are uncooperative, that's happened once so far...::knocks on wood:: Anyway, any other info I can give you, I would...just let me know if you have more specific questions. I hear Western Governor's Univesity is a good online program as well, and the cost is lower, especially since the cost is based on how quickly you can get through the material. I am thinking about doing my MS in Nursing Education thru there instead of UOP, based on the cost, anyway. At UOP you can just go through classes w/ no breaks, or you can take a break here and there. I took two and a half months off last winter after my grandma was ill and passed away and then a week off to go on vacation this spring, but now I am just plugging away trying to get done w/ it. :-) Good luck! -dukesgal

So I have been working for about a year now, at first I loved my job. But knowing what I know now, I think my bliss was ignorance in disguise. I have found out about major med errors being swept under the rug by admin, several nurses who all of the staff suspect are using illegal drugs, admin won't random drug test due to them not being against recreational drug use (so when does recreational drug use, such as on days off begin to blur the line into taking a hit just before work?) Not to mention, my schedule is constantly changing. I have just returned to school for my BSN, my employer is less than supportive of this decision and it is hard to schedule times to meet with my classmates for group projects or simply develop a routine for studying when my schedule is in constant flux. As you can imagine, I am beyond disgusted and frustrated. My common sense is telling me to run, not walk, out of there! But reality tells me I need to pay the bills. However, I finally have another job lined up and should get official word within the next few days. I know they will ask me when I hand in my resignation letter why I am leaving, and will probably be told why it is a bad idea to leave. So do I just leave peacefully and try to keep things on good terms (as I may work with one or more of these people in the future). Or do I tell them some of the issues I have to clear the air and get it off my chest?

So all I know as new or recent grads, everything we were taught in theory and lab is still relatively fresh in our minds. I know we are still learning how to adapt to the real world of nursing vs. school and the perfect NCLEX staffed facilities of our textbooks. But I've come across a few practices that have rubbed me the wrong way. 1. Giving narcotics to help clients sleep/keept them quiet. Granted, I work in a skilled nursing facility and we have many patients who cannot verbally express pain, we must rely on non-verbal cues that our patients are experiencing pain. However, I have had older night shift nurses insist that I give a client narcotic pain medication so they will sleep. In fact, clients have even come up to me and requested "a Vicodin, so I can sleep. Nurse X says they help." Upon further questioning and some education that the purpose of narcotic pain medication is to relieve pain, not for use as a sleep aid, the client did complain of pain. At this point I gave the medication as I wasn't going to withhold pain medication. 2. Another new nurse was getting her supplies together to d/c an indwelling foley cath. The charge nurse on duty was there to assist, but when the new nurse came back to the room with a syringe, the charge nurse cut the catheter, pulled it out (without properly deflating the balloon) and a moderate amount of blood followed. The client is non-ambulatory and is cognitively impaired. I wasn't aware this was ever recognized as an acceptable way to remove a catheter and we certainly never learned this way in nursing school. When one of the supervisors was informed about these incidents, we were told that "this was the way we were taught" (many years ago) and "you haven't worked night shift, you don't know how many people can't sleep at night" I know this is wrong, and I am beginning to think I am not comfortable working at a facility where this kind of behavior by nurses is condoned. What would you do?

Hi there! My name is Tessa, I graduated from RN school in June 2010, passed my NCLEX in July and am currently working at an LTC/Rehab facility. I have been working there for the past 6 months so I am not really a "new grad" anymore, but still in my first year. I will admit it was really tough at first but I have gotten the hang of it and can finish my med pass and tx with time to spare. It required a lot of accomodation to the time management I had developed in nursing school, but I really do enjoy my job and the residents I care for. I don't plan to be in LTC forever, but I am getting experience all the way from acute care to hospice patients. I know God gave me this opportunity for a reason, and I feel like I have made a difference, no matter how small, in some of the clients and families I have cared for. All the hell I went through in nursing school is finally feeling like it was worth it!

That is truly unfortunate. I am still a new grad, have been working in LTC about 2 months now. I have had to adapt my time management from nursing school (most of my clinicals were acute care, 4 patients) to LTC/SNF and let me tell you it is one of the most difficult things I have ever done. I pass meds, do dressing changes and tx and most days I am lucky to get a lunch, let alone a break. My assessment skills have progressed so much...residents can go bad in LTC quickly and I am learning to trust my instincts when it comes to something even slightly abnormal. I feel like I could do med surg/critical care w/ my eyes closed...5 patients (down from the 30 I currently care for) would be a dream come true! God bless us LTC nurses. Some days I am ready to throw in the towel, but just last week a family member was leaving and came up to me and said "Thank you so much for what you do, I want you to know we appreciate everything you do to care for our loved ones" and those rare moments are the times that I realize I am making a difference...

I am feeling the same way. There are days that I really like it, really feel like I am making a difference to my patients and while I am always rushed, feel like I really accomplished something at the end of my shift. I will have a few good days, and then horribly depressing days that make me not want to go back. Some days, I can barely make it to the bathroom or out the door without bursting into tears. I have a really great supervisor who is very supportive, and she has really gone out of her way to help me adapt. I almost gave the wrong med to the wrong patient the other day...even though I caught myself, I felt awful. I am so rushed and there are so many distractions and the most important thing is being safe and keeping my patients safe. I am aware I am very critical of myself, and I know I need to cut myself a little slack but it is hard when there are so many ups and downs! I do like the residents and most of the aides I work with are very understanding that I have a bazillion things to do (meds and treatments, although most days getting to treatments is but a pipe dream) and are there to help me out, but there are usually only 2-3 of them for 30 patients, so it is often not enough. I feel like I am getting amazing support from the DNS and admin, however, I feel like the other nurses I work with are often frustrated with me if I don't get to my treatments (I have only been doing this a month) I know it will come in time and I will get there, but I feel bad passing off things to the next shift. I am constantly running with meds, prn requests and answering call lights when aides are tied up and a patient is in danger of falling, etc. I don't want to look like a job hopper, and I am applying for jobs wherever I can...not sure what to say in interviews as to why I am looking for another position. I often don't feel safe and I worry about making mistakes all the time. I come home and I am a huge cranky pants to my boyfriend, who wants me to quit just because he sees how unhappy I am and how much I dread going to work. But I know I am getting good experience, and I want to give this a fair shake. My goal right now is to keep applying and to at least give it til the end of September, possibly longer even if there is a glimmer of hope that I am catching on. I have had almost 2 days off, and I go back tomorrow for another 2 days...already dreading it though

When my grandpa was in the hospital from complications of pneumonia, he suddenly took a turn for the worse and lost consciousness. On that last day, we knew he would not recover, but our family opted to make him as comfortable as possible. I still remember holding onto his his hand as the nurse administered that last dose of morphine and his respirations slowly decreased. He died about 20 minutes later. I don't believe it hastened his death, I just believe it was his time to go. He was comfortable and it was peaceful for our familiy to be there for him and not see him in agony. I think that particular experience has made me a better nurse and advocate for my patients to get effective pain relief.

I have been working for a few weeks now. There are most certainly good days, bad days and VERY BAD days. I have been working in the rehab portion of our facility for the past week or so and I am really liking that. It is like a mini med surg, except for I am caring for all 15-20 of the patients. I have gotten to know the residents and some of their families and some days when things go well, I stay organized and nothing terrible happens, I stay on track and get things done on time. I am starting to familiarize myself with the residents dressing changes, and bring dressing supplies or creams into the room with their meds or tube feedings so I can group cares, this saves time and allows me to move onto the next item on the never ending "to do" list. I know it will take time, but I have to be patient with myself and give myself time to adapt and acclimate to this environment...one that nursing school most certainly did not directly prepare me for! However, using the critical thinking, assessment and prioritization skills I learned and practiced in nursing school are all applicable in their own way and I am thrilled to be able to use them. It is still weird/amazing to me that I am the nurse, now! No more student nurse...I am truly running the show! Of course I am relying on seasoned nurses in my facility still, as they know the residents baseline, and what is grossly abnormal...so I am very thankful when I have a supportive charge nurse and aides I can count on to be there...

I also am a new grad working in a SNF and I make a list of all my residents meds, scheduled times, PM and HS meds and then note any oddball times a resident has a med scheduled so I don't miss them. I have a little cheat sheet I use and highlight any of those med times. I am still learning too, but I try to go over the MAR with a fine tooth comb at the end of every med pass to be sure I got everything.

I know, it is difficult. I have days where I feel like I didn't accomplish anything and I can't wrap my brain around how these nurses I work with have done this for two years and how they are so efficient. I know I will get there some day, and there are days where there is no personal satisfaction. When residents are yelling at me for pain meds, telling me how to do my job, what orders the doctor should be prescribing, etc. However, it is when residents and their family members share their life stories with me or put their blind trust in me to care for them - are the days that getting up at 4 am and working two hours past my shift are truly worth it. I know that my entire career will not be spent in LTC, but I know that the experience I am gaining now is invaluable. Best of luck to you. My advice, hang in there. Talk to your supervisor, ask for pointers, always be safe and be patient with yourself.

A charge is a formal accusation used by the court system. It simply means they have evidence that suggests you may be guilty of a crime. A conviction is what is entered once you have been found GUILTY - either by pleading guilty or being found guilty by a judge or jury. If you are charged but then enter into a diversion agreement or not enough evidence is presented to secure a conviction, the charge may be dismissed. For all intents and purposes, it goes away. If you have a charge dismissed somewhere in your background, you should have no problems.

I started at a rehab/LTC facility a few weeks ago. There are 3 different halls, usually with about 30 residents each. I got 7 days of orientation, a few on each hall since I will be floating. I had my first two days on my own last weekend, and thankfully have had 3 days off to recover. I have several patients with G-tubes, often have pts receiving IV antibiotics. I know I am new and slower, trying to be sure I am giving the right med at the right time, etc. I have gotten lunches most days, but have yet to have a break or so much as sit down for five minutes. I haven't been able to get all my treatments done, just meds, BS, insulins, feedings and IV's hung. I know I will get there in time but it has been extremely difficult and emotionally draining. Like one of the other posters said, when you are able to talk with your patients and their families and get to know them, and know they trust and appreciate you is when it is truly rewarding. Obviously there is not much time for socializing. The long term care hall is a bit easier because (sadly) there are not many families there to see the residents, so I am not being distracted with questions from the family. I know I will just have to give it some time, and try not to feel so frustrated that I am not able to get everything done. I feel guilty passing drsg changes off to the nurse who is relieving me, but this is (hopefully) just temporary until I have a routine down. It is hard when you have 30ish residents and only 2-3 aides. We have both LPNs and RNs working in our facility, but they are pretty much one in the same. Both can be med nurses, but of course only RNs can be charge. Staffing is not ideal, but it is much better than the LTC facility I did clinicals in. Some days I feel completely incompetent, like I accomplished nothing and nothing went right, I know it will get better...eventually. I also know that I will move onto another area of nursing at some point, but for now, the residents deserve me to be the best and safest nurse I can be. I know the experience will help me in whichever specialty I end up in.

I guess I sort of have a success story. About a year prior to beginning nursing school, I shoplifted some clothing items. It was a terrible error in judgement on my part, totally stupid thing to do. I was given a summons, but never had to go to the jail for processing, mugshot, fingerprints, etc. I went to my first court appearance to enter a plea, was told I made too much money to qualify for a court appointed attorney. I was given a chance to speak with the prosecutor, explained the situation, was polite and remorseful and she asked if I had ever been in trouble with the law before - never had and never will again! She told me that pending a check of my criminal history, I could be eligible for diversion. I came back to my next court date and was presented with all the paperwork that would place me in the diversion program for one year. I paid $50 each month to pay off my restitution and court costs, had to attend a Theft Awareness class and most importantly, stay out of trouble for the next 12 months. I was very up front with my diversion counselor about my intentions for nursing school. She told me she had seen other people kept out of nursing school as the pending charge may show up on a background check until it is dismissed. This alll occured in July. The following April I applied to several nursing schools. I received an acceptance letter to one of them. Before truly feeling like I could celebrate my acceptance, I met with the school's DON. I was very honest and open with her, told her this was an error in judgement I had made and now I simply had too much on the line to have a lapse in judgement of this magnitude. She said as long as it was not a conviction I would be OK. In August/ early Sept after fulfilling all the requirements of my diversion agreement, the charge was dismissed. Shortly after that, as I began nursing school my school processed my background check, no red flags to them. When I sent in my application to the state to sit for my NCLEX, of course I had to check the box that stated "have you ever entered a deferred prosecution plea, etc" I had to get certified copies of my court documents, wrote a letter explaining how I had realized the error of my ways, took responsiblity for my poor judgment and how I had grown and how dear nursing was to my heart. I had an impeccable academic record in both clinical and theory and I had proven myself to my instructors and the DON, so she wrote a letter of recommendation that I included w/ the application. I sent it in a few months prior to graduation and prayed. I received my authorization to test and passed my NCLEX within a month of graduation. I was offered a job right around this time, and passed all their background checks and while I will never forget the shame I brought upon myself, I can truly say that I knew no matter what - nothing was going to stand in the way of my dream of being a nurse. I think that your past will affect you as much as you let it. The key to moving onward and upward is accepting responsibility for your actions and proving your ability to be a strong student and a safe, caring and compassionate nurse. I hope my story can help others avoid the mistakes I made - this was a shameful and stressful string of events that only I brought on myself. I would never wish this for anyone. But I would also hope that I can give a ray of hope to others who do find themselves in the same situation. Best of luck to all you future nurses. :)