ChineseRN

Our hospital policy is no blood draw from the peripheral line that is receiving heparin drip. If the pt has an A/V shunt or mastectomy on the other arm, then we cannot use either arm. Then, the MD would have to draw coags from the leg. Nurses are not allowed to draw anywhere but the arms.

Hi, I was in somewhat a similar situation as you 5 months ago. It took me half a year of hardwork searching, basically flaunting my resume and cover letter to all the hospitals in NY. After harassing the nurse recruiters through phone/email/fax, and getting the same answers, I started looking for nursing home jobs/LTC. I was so grateful when one decided to hire me. I would say orientation was also bearable, trying to absorb every little detail possible, which is impossible. Med pass scares the hell out of me because sometimes the residents would make a long line and I feel my stomach turning trying to get vitals, contraindications, etc. Getting the whole picture on a pt is so hard. I really disliked the paperwork because I felt the system was so outdated and I have been trained to chart everything on the computer. :typing One thing I did enjoy was calling the doctors for abnormal lab results, because after awhile you can kind of predict what new orders there would be. When the doctors do come for their monthly/weekly renewals, they are very friendly and some really don't mind answering my questions. I felt really left out at times, because everyone had so much time to socialize. Not that I care about socializing and making friends during work, but I also felt like a chicken trying to do everything I aimed to do within my shift. I also felt so pressured to delegate to the CNA's. It got a little better over time. OK ENOUGH RAMBLING: The result of my LTC experience, I didn't quit until I made sure I had another job. I went on 2 interviews during my orientation, and when I was certain I had a job in the hospital, I gave them 3 weeks notice. I thanked them a million times for hiring me during the hard economic times. Surprisingly, most of the people there were so supportive. They encouraged me to go to the hospital to learn more. What I'm trying to say is, don't lose your heart for wanting to be a good nurse. If you don't feel that LTC is giving you great experience, you should start looking elsewhere. Your facility sounds like you can gain a lot of experience, and learning from the elderly is a gem. :heartbeat My preceptor, whom I call my "mother," told me one of the smartest nurses is a nursing home nurse and I agree. There is so much involved. Whereever you end up, I feel that you will be a great nurse because you care. Hang in there. Whatever path you choose to take, as long as you keep learning, you will be a great nurse. P.S. I made a master sheet during orientation. I made my preceptor check off some things for me. On the master sheet, I had the pt's names, and columns of "crush med, PEG tube, Fingerstick, Other" I just check off whatever my pt has, and during med pass, I can refer to the sheet, and it really helps. GOOD LUCK! :w00t:

I used to hate I & O's. But someone showed me their way of doing it smoothly. Whenever hanging a bag of lets say, vanco, immediately hanging the bag, I go to my Intake and output flowsheet and record, 250mL/Vancomycin. Doing right after hanging something will prevent a headache towards the end of the shift, trying to remember who receive IV med and how much. For my patients on continuing IV fluids, I do them toward the end of my shift right before giving report. (100cc X12, etc) Usually my PCA's do I&O for urine/stool output, and I make sure to tell them who is on strict I&O when I give them report. However, my pca'S automatically do it. If I am in the room, and I happen to empty a urinal or foley, whoever empties it, records it. PCA pumps are hospital policy to be cleared every 4 hours and we pass on a PCA pump flowsheet during report that lasts 24 hours. It is up to the night shift to renew the flowsheet during their shift. I follow the rule of at least 30cc/hr. Here is where I rely on my PCA's as well. If my patient is an elderly or have CRI, I sometimes say, please watch out to see if she is giving at least 30cc/hr by the end of their shift. :yelclap: Good PCA's have reported to me that our patient have urinated less, and I report it immediately to the doctor. Urine output less than 30cc is very easy to overlook and may be critical. It is very hard to find time to do a simply check during our shift. So pray for great PCA's and urine output!!! :redpinkhe Good luck!

I started in LTC just for a month. The only computerized charting we have is for the CNA's to record the number of assists used while transferring and bathing. The rest is PAPER CHARTING. :smackingf

Thank you all experienced nurses for all the great tips. I am a new grad and just started in a LTC facility. It is my second week and I am OVERWHELMED! usually we have an LPN to do all the med pass, but today there was a short of staff, and I was exposed the the RUSH!!!!! It is really scary. It's like trying to do a million things at once because while I'm am checking their blood sugar, my preceptor and I try to do treatments at the same time, and talk to the residents. OMG I cannot predict the future if I am left in charge of the floor without an LPN. I feel good on some days of orienting, and some days I don't feel as confident. I am 24 and have been told I look 18. That makes it harder for me to be "in charge." I may have did some slight engraving in my own head of how people will view me differently just because I am young. My preceptor is great. The place is great, but on some days, there are those experienced nurses who question me: Is this your first job? Why didn't you start in a hospital?, etc It just bothers me and makes me feel less confident. I just swallow my fear and try to answer them with a smile. I feel better when I read about other new grads in a LTC facility. I don't feel as alone. For now, all I can do is try to absorb anything and everything. There is so much documentation to do! But my biggest problem is CONFIDENCE! Ok, I'm babbling. BUT THANK YOU ALL FOR THIS POST. IT REALLY HELPS!!!! :thankya:

If not equal, male nurses sometimes receive more respect from what I've seen. Maybe its the size or maybe males are sometimes more firm, so the patients listen to what you have to say and do what you ask them to do. Even though female nurses have the same qualities, in certain areas, male nurses do have an advantage. So don't worry! :mnnnrsngrk:

My favorite one is Nursing Made Incredibly Easy. I also receive Nursing 2009 and AJN. They are both great as well.

This happened when I was a student: You know you are in for trouble when, you walk into a pt's room, you introduce yourself, and the pt takes one look at you, closes his eyes, and says, "I need to rest. Leave me alone." When administering meds, he would question the class of the drug, generic name, etc. As a student, I don't know of all the meds yet, so I whipped out my PDA and read of Davis's drug guide. He was satisfied for the moment. Later you find out he is a pharmacology professor. And he eloped in the afternoon. :smackingf Paperwork, paperwork, paperwork!

:yeah:Great video!