Oranges3420

I am confused as to the proper way to administer meds and water flushes via gt or ngt. Most nurses seem to flush them in the tubes with the syringe plunger - either due to time constraints or because the fluids/meds don't seem to go down the tube. Are we supposed to do all of this by gravity? Is a "water flush" supposed to actually be flushed/pushed in or done by gravity? Why wouldn't the med/flush go down? What happens if we flush meds/water with the plunger? And lastly: I was told in nursing school to flush each med separately but I was shown in orientation to just mix 'em all up and flush them in all at the same time. What is the RIGHT way to do this? I don't want to do my patients wrong!

Wow: great reply. Thanks for the response. I'm going to talk to my manager about it tomorrow! I think you're right: they are assigning her patients with way too much going on!

So, my hospital is starting to hire LVN's on the floor. Yesterday I needed to cover an LVN for the first time. She can't take orders, note orders or push IV meds. I was with her patient all night! Mama mia! What are the roles and responsibilities of LVNs? And what are my roles/responsibilties as the RN? What happens if she makes mistakes or doesn't let me know what's going on with her patient while I'm with my 4-5 other patients? I just need to understand. Thanks ya'all!

Does anyone know where there may be a class (online or otherwise) to take to find out how to chart and avoid lawsuits? I'm a relativetly new nurse and only 2 months on the med/surg floor and I'm trying to figure out what the right/wrong things to say are. i notice some rn's write very detailed notes. others, barely any. suggestions?

fyi... registered nurse (rn)vn-0610-1/3 $52,095-$132,279 department of veterans affairs/veterans health administration auburn closes 09/30/2010 (from usajobs.com - sign up for their emails so everytime something opens up in your area, you'll know...)

Hi guys: I graduated last year and have been working in SNF since January. I have spoken with many recruiters and only one told me that SNF was a bad idea. A lot of the recruiters are familiar with the job market right now for new RN grads and are sympathetic. I was told by a CHW recruiter that they would consider someone with 1 year SNF experience for the med/surg floor. Another smaller community hospital told me the same thing. And now I just got a job at a small hospital for med/surg. They told me in the interview that they were "delighted" that I went the SNF route: it's a great way to test your time management and organizational skills! Just don't get too comfortable. One of the LVN's at my facility, who used to work for Sutter, told me that the hospitals are more concerned with the nurses who have been in SNF for years: the hospitals feel these RNs are set in their ways and it will be harder to break their habits. Hope this helps. There is is hope out there... just be patient but diligent. Even after you get a SNF job, keep applying EVERYWHERE!!!!

I never thought I would say this but finding a job really was the hardest part of this whole nursing journey for me. I graduated in May '08 and didn't get a job until January '09 - and that was in a SNF! I only recently secured a job that starts next month at a hospital. It is tough out there. REALLY REALLY tough.

Is anyone familiar with the RN to BSN program at CSU East Bay? I am an RN who is going to be moving to the bay area in the future and am curious as to how flexible the program is. I am familiar with Sac State's program - it is about 85% online and the professors are, apparently, very flexible with their schedules. Any information regarding this would be greatly appreciated!!!

Social_nurse, It's not necessarily true: it really depends on the facility as to whether you are considered a "new grad" or not. I've talked w/MANY recruiters and it varies from hospital to hospital - even within the same organization. Don't give up hope. If you are going to try for a Dec/Jan program, try to find out info about it NOW. I mean, get the name of a recruiter and/or nurse manager and find a way to TALK to them! Even try volunteering there. Get your name known to secure an interview.

I spoke last week w/a CHW recruiter about a job posting for M/S that asked for 1 year experience or new grad from May-August '09 only. When I spoke w/him about it, he states he limited it to brand new grads because otherwise, he'll receive 500+ applications. It's a way for him to cut back on applications from all the not-so-new grads that are applying. He states that perhaps after a year's worth of SNF experience, CHW might consider an RN for M/S. I guess it depends on the facility, the recruiter, and the floor manager. He also added that when looking at applicants, he takes into account if you did clinicals at their facility, went to a local school, and if you have a local address. He was not as familiar w/my school which, apparently, makes a difference in his mind.

Hi Dmeneses, 1. I just walked into the SNF and pretty much was hired - they were desperate for an RN at the time (I was lucky). I already passed the NCLEX and don't think they would have hired me otherwise. 2. How many WEEKS training? ha ha ha!!!! I trained for 6 or 7 days and was on my own. Needless to say, I am ALWAYS asking questions of the other nurses. 3. I care for about 24-27 patients - but it varies week to week depending on the census. 4. I work 8 hour shifts but I'm rarely there for only 8 hours. I frequently stay over by 30 minutes to 2 hours. 5. When I'm there (pm shift), I am the only RN for the entire facility after 5pm. If the poop hits the fan, I am considered the "supervisor" (kind of a joke since I don't know ALOT of the procedures yet). The LVNs snicker about that part because some of them have been there for 7-10 years. Don't get me wrong, though. They are awesome nurses and help me out tremendously. I must be honest: I'm not the biggest fan of SNF but here's the deal: 1.it's a pay check, 2. it helps you develop communication skills w/patients, doctors, and families, 3. you become famililar with medications (lots and lots!), and 4. your time management and organizational skills will improve like crazy. If the hospital thing doesn't pan out - as it hasn't for many of us, don't be afraid of SNF. It still is a job and you are putting your license to use! If you like working with older adults, it's great too. They can be a total riot and make my day! Good luck!

DNiceRN, I also am working SNF and, from what I hear from various recruiters, SNF work "counts" as experience for certain facilities. ValleyCare in Pleasanton, for instance, will interview you after a year's worth of full-time SNF experience. They put you with a preceptor for a few weeks instead of the "newgrad program." Try them! Try Contra Costa Med Center too. Even if there are no openings, they keep your resume on file for something like 5 months...

i sincerely feel your pain. i also graduated in may '08 and after several months of not working, i broke down and went to a snf in my area. it's far from ideal but it's paying the bills. also, i'm getting exposure to admitting/discharging, talking with doctors and passing meds for 25-30 people. my mom (she's got a saying for everything) says "when at work, think met: money, experience, temporary." these three things keep me going back to snf. i also enrolled for the rn to bsn program at my local cal state university for the fall. i know these times are tough and it's hard to stay positive. but, the economy will eventually turn around. it's going to definitely take some time, though. get yourself a snf job, do volunteer work at a hospital, go back to school, get your acls, pals or whatever. take a cardiac monitoring class. there are things to do so you feel like your not just wasting time away. good luck everyone - we all most certainly need it!!!!!!

As a new RN grad that recently started at a SNF, I am hearing horror stories from the other nurses related to the State coming for a visit: that they come and follow you around, ask you why certain patients are taking certain drugs, ask why I am giving my 8am meds at 10:30am (because there's too many patients and not enough time!)What exactly does the State searching for when they are looking at an RN and her job? How can I stay "out of trouble?"

mama mia! where do you work? are you in Ca?

Thanks CapeCod. Do you think it makes a difference if a new grad works for a LTC chain of facilities vs a single, private one? Would they offer more training or support to staff?

Thanks!

You got it: I went to SNF because I was unable to get a job at a hospital. Since my husband works, the farthest I could probably move would be the bay area. And I know that it's even worse out there. Any suggestions would be helpful!

I am a new RN just starting my first job at a SNF in Sacramento. The patient load is about 22-27 patients. There's a desk nurse - sometimes - to help w/admissions or new orders but, for the most part, I am on my own w/all of this. The residents are all sub-acute on my wing. It is a MADHOUSE!!!! Is this patient load normal? I was on my own for the first time last week and didnt finish my 21:00 meds til 23:15 at night!!! (my shift is 2pm-11pm) Then I had to chart on 15 of the patients. I left very, very late. Does anyone have any tips/suggestions as to how to manage my time better? The nurses tell me they double up the meds - giving 1700 and 2100 meds at the same time - but I thought this wasn't kosher. I also don't seem to have time to actually ASSESS my patients! I don't know what' going on w/them or why they are there. Are there other facilities out there that may be better for a new grad? This seems impossible to do!

Does anyone have any ideas on some decent SNF places to start working as a new grad? I started just over a week ago at one facility and it is a NIGHTMARE!!! 22 patients who are subacute? I stayed over 2 1/2 hours yesterday just to finish my work. No break, no lunch (though, of course, the facility automatically deducts a 30 minute lunch). Meds are going out late (2000 meds are going out at 2200), everyone needs help or pain meds at the same time! And where did all the CNAs go??? Nursing school was stressful, but it wasn't THIS stressful! I'm also concerned that I could lose my license by providing such poor patient care simply because I don't have time to actually LOOK at all 22 patients! Any information, kind words, advice would be so helpful.

Be able to answer at least some basics so you are not fumbling on your words, such as: Tell me about yourself. Why did you become a nurse? What are your strengths? weaknesses? How do you handle stress? How would you handle a conflict w/a doctor/patient/coworker? If you went into a room and a pt wasnt breathing, what do you do? Also be prepared for case scenarios. Those are the zingers. Review basic disease process & meds for HTN, DMI/II, PE, MI, Stroke. Just some things I have been asked at interviews or former classmates of mine were asked... Oh, Good luck and don't forget to breathe.

A Sutter recruiter (in Sac) told me they just hired a couple of Dec '07 grads, so all hope is not lost! Sonora is hiring new grads - they have a ton of M/S positions I saw on their website and are encouraging new grads to apply. I can't go up there - toooooo far but someone else may!

I hear ya. I have applied to OODLES of positions from San Rafael to San Jose to Sacramento and beyond and there just ain't anyone hiring. All the new grad programs already started. Also, the places that are still hiring new grads are doing it on a case by case basis - it depends if the dept. is willing and has the capability to train a new grad. A recruiter of St. Mary's (CHW) in SF told me that their Bakersfield facility is hiring. I can't do that move due to family but maybe some of ya'all out there that just need your foot in the door can move there for a while...

Figures! Mine took two weeks too and my last name ends w/a G. Coincidence? I think not!

There was an article (few months back) in the SF Chronicle that said there is something like 65% more nurse graduates this year than prior years. The governator threw alot of money at nursing programs a few years ago and we are starting to see the impact of it: too many new grads, not enough new grad positions.