RubyDeeRN

I totally agree with you about the charting in the home, I find I get a lot more accomplished if I chart while I'm there. But I'm still learning how to do SOC's and I've never been very good at multitasking. I need to learn to listen with one ear and chart at the same time. I tend to get lonely older people who are so happy to have someone to sit and listen to them (which I do love to do) that every time I ask them a medical question, it turns into a long rambling story, and my computer always logs me out because I'm trying not to be rude while they're talking to me, lol. And then I leave and at best I have contact info, vitals, PMH, and other pertinent assessment info scribbled onto my notepad in pen and ink (because at the time it's faster just to write it down), and I go home and transcribe for hours. I know I'll get faster at charting the more I do it, but it's hard to see the light at the end of the OASIS tunnel right now.

I see that the last comment was posted July 2018, but I'd like to keep this thread alive, for any nurses out there considering home health. I just started a home health job, and my company is excellent. I love everything about the job... minus the charting. I've done private duty home health before, and I thought that the multiple pages of narrative we were required to do was a lot, but visiting nursing is above and beyond all that. If it weren't for OASIS charting, I would absolutely love this job. OASIS is my nemesis, but I am determined to master it, because, as I said, I love everything else about my job. I love being able to make my own schedule, I love that my company is growing, I love that no matter what time of day or night I can text a question to someone else on the team, and they will answer. I love meeting new people in their homes, on their turf, and I love visiting people who know me because I'm "the visiting nurse." I get to sit down with them, ask them questions, play with their dog or cat, and figure out what's really going on with them. My last job was in a hospital, and while I got to know many "frequent flyers," this is so different. My main job as a visiting nurse is education, with some skilled care here and there, like wound care or infusions, but mainly education so people can manage on their own. Some people desire that education, and other people expect the skilled nurse to act as a home health aide and housekeeper. You can see their faces fall when it's explained what skilled nursing really is. Most people, though, are happy just to have a nurse come to see them 2 times a week and take their vitals, monitor their weight and blood sugar, and give them advice on diets, medications, how to avoid ER visits, etc. I do really love my job. I'm just trying to get along with OASIS - it's like that one coworker you know you need to get along with, but just can't find it within yourself to like.

Sorry if this reply is too late to be of help; I hope not. I went through nursing school twice, once for my LPN, and then again for my RN. I have to say YES to the study groups, but only in addition to your solo studying, not in place of it. Study on your own, but use those study groups to challenge what you think you've learned. Those people you're in school with are just as smart as you, and in some cases, some of them are a hell of a lot smarter than you...or at least that's how it was for me. A lot of the people I studied with had notes from lectures I'd attended, but somehow missed certain points...even though I am a meticulous note taker. I was SO glad I attended those study groups, introvert that I am.

Nurses are always in the middle. We always take the brunt of the physicians' wrath whenever a patient has a question we ourselves cannot legally answer, even if we already know what the answer will be. Among our thousands of other duties, it's also our job to relay those inane questions to the doc. I hate to say that, but it is. We are the go-between. I still have yet to understand just WHY we, as nurses, are forced to be in this position, but we are. I have called countless doctors asking questions such as yours, all along knowing what the answer would be, and I too felt really stupid. But sometimes we have no choice. If it makes it any better, I've found that "asking for an order clarification" helps a lot. Like, "My patient states she normally gets X amount of whatever medication; I'd like clarification on that order." I apologize if someone else already said the same thing here...I think we've all dealt with this.

I feel your pain. I graduated in December of 2010, and as an LPN, most of the jobs out there for me are in long term care. I'm on my third job in a little over a year. At first I thought that I just wasn't a good fit for those places, but now I realize that basically, and sadly, most long term care places are like this. I have roughly 30 patients as well, with 3 CNAs. I bust my butt every shift trying to get all my work done in time, because, as we were all told just a few days ago, we are allowed absolutely NO overtime. And I'm not allowed to work through my lunch - it's mandatory that we clock out for thirty minutes every shift. So if I want to work through lunch, which would help at least a little in getting me out the door in time, I have to do it for free. As I said, I'm on my third job since graduating a year and four months ago. I left my last job because our paychecks were constantly being delayed due to various reasons, and I thought a better run facility would be better overall. But although at that last place I had more patients - 40, with 2 CNAs, on nightshift - I'm already contemplating going back because my workload wasn't quite so heavy. Well, it was heavy, just not this bad. Sorry - I know nothing I'm saying is helping you. I'm just commiserating. When people say, "Our healthcare system is in crisis," it's heard so often it almost sounds cliche. But it's not. It's true. And it sadly, it all boils down to money. Not enough money means not enough staffing, and not enough good equipment or supplies, which leads to not enough quality care for patients. And we, as nurses, get caught in the middle, as always. We want to care for our patients, and we try, so very hard. But when you're working for free at the end of your shift because you were forced to clock out before you could get all of your work done, with a thousand things still left undone because there weren't enough people on staff to do them, and you're facing a write up for something stupid (like forgetting to do a Braden assessment last night because you had another patient who went into respiratory failure and by the time you got done shipping them off to the ER you were already on the overtime you're not allowed to have), AND they've cut your benefits, AND they're threatening to cut your hours, AND raises have been on hold for over a year now already...it's a wonder anyone works in long term care in the first place. Okay, so my commiserating turned into a rant. I'm done now. Good luck...but I do have to say, if you still love being a nurse, just not the job you have, take the time to explore other nursing options. There's a lot of specialties out there. Some may take more schooling, but if you're thinking about going back to school anyway...like I said, good luck with whatever you decide!

I work in longterm care (geriatric/psych) so it's a bit different, but so far what I hate to hear when I first walk in (that I've heard at least ten times in my five months at this job so far, as part time night shift nurse - I fill in for the full time nurse; we're the only nurses here at night, and only ever 1 at a time in my 40 bed facility) is: We have a new admit with no psych meds ordered, and he's been off the wall all evening. The doctor's on vacation. Good luck! We have a resident who has been trying to climb out of bed all evening although he/she can't walk AND is on hospice AND the Ativan isn't working AND he/she isn't allowed another one for another four hours, AND he's still a full code for some bizarre reason even though he weighs 90 lbs and CPR would kill him anyway, so good luck! Thank GOD you're here! Tonight was crazy. Oh, by the way, you had a call off, so you only have two aides, but one of them is leaving early because she came in early due to our shift also having a call off. Oh, by the way, resident A is actively dying. Oh, and he's a full code. I really want to know why hospice patients are still full codes sometimes??

This thread was last commented on almost two years ago, but I feel the need to add to it for anyone else out there reading... LTC may seem to be "the bottom of the barrel" as far as nursing specialties, but as far as experience, there's no where else will you care for patients with such a full spectrum of health issues. Yes, most of the patients are nearing the end of life, sadly, but the majority come along with a whole range of diseases and conditions that they have dealt with for far longer than the time they've been in LTC. Advanced age just tends to makes these things more chronic - not excitingly acute as in most hospital situations - yet it also makes the patient more fragile, which complicates the care involved. From cardiac issues to chronic renal failure to COPD to uncontrolled diabetes to wound patients with MRSA to multiple sclerosis to Huntington's to Parkinson's to schizophrenia to bipolar disorder to Alzheimer's....*takes a deep breath* I've seen all that, and I didn't even finish the list. And I've only been working as a nurse for five months now. I graduated just last December. I expect to see a lot more in the years to come in this field. I know the OP has probably found their answer and moved on, but like I said, this post is for anyone else out there wondering if LTC is really "that bad." No, it's not bad at all. It's hard work, sometimes exhausting and extremely frustrating, but not "bad." You get to know your patients in a way you can never do in an acute care situation, and they come to realize, after time, that you are now part of their "family." The LTC facility where you work is actually their home. You get to leave; they don't. As far as going from LTC to psych, it honestly seems like a logical leap to me. Anyone who has worked in LTC has to deal with psych issues, at least from time to time. Even if, as a nurse, you work in an ideal LTC situation where no one has a past DX of dementia, schizophrenia, bipolar disorder, etc. (which is rare), still, most residents have at least a DX of depression and/or anxiety. Who wouldn't, after being displaced from their home and re-placed in LTC? And, as the nurse, you have to deal with these issues accordingly. Psych issues are huge with the geriatric population, and no wonder. No longer able to care for themselves, plucked out of the homes they've lived in for the last forty years, a lot of the time dealing with the fact that they've lost their spouse in the last few years, and placed in a LTC facility by well meaning family...of course LTC involves a lot of psych issues. A lot of my time, when I'm not passing meds, charting, or helping an aide toilet a resident, is spent holding hands and chatting with residents, even if they are completely demented and we're talking about the bridal shower they're planning on throwing for the sister who died 20 years ago. I'll step off my soapbox now. I just want to conclude, LTC could never be considered "bottom of the barrel" as far as nursing experience, and especially so if you want to move from LTC to psych. While I was in nursing school I did clinicals in four different hospitals, one hospital on different floors, so that's five different acute care experiences over the course of a year, yet I never saw the diversity of health issues there that I have working at my LTC facility for the last few months. And, for those of you who think it matters, yes, I'm "only" an LPN.

The test was interesting; scored a moderate in three areas, low in everything else. Thought I'd score high in obsessive behavior, though. Weird.

It sounds like your program is WAY different than mine; we started our clinicals in longterm care (where things aren't quite so hectic, medical-wise) and we're now in our final semester. Things just kind of built up for us. After longterm care we spent most of our rotations in hospitals, but we're back in longterm care right now, though we're going to finish out this semester in a hospital again. The prior posters gave such good advice about being in a hospital situation, that I don't know if I can help... My best advice is to plan on being prepared, and by that, I mean find the nurse RIGHT AWAY that gives report for your patient(s). The hardest part for me was finding what nurse to get report from. All hospitals have different ways of giving report; some do it by tape, where everyone sits around the recorder and listens to everything (which is easiest, but not very specific, since sometimes you still don't know who your nurse is after you've sat in the group and listened, and mostly psych hospitals do this, at least in my area); some also do it by tape, but nurse-specific, meaning your nurse might be coming onto her shift, grab the tape she needs to listen to, and go hide in a break room to listen all the while not knowing (or caring) that there's a student who also needs to listen to it; and some do it nurse-to-nurse, and trust me, if you aren't already shadowing the nurse who has your patients, the nurse going off-shift will NOT wait for you before they give report. Not to scare you, but student nurses are like the scum they accumulate on the bottoms of their nursing sneakers by the end of the day. Just something that tags along, but that they'll shake off at any chance they get. Like they were never students themselves. But I digress... I have to say, though, don't stress about hospital rotations. :) I liked them the most. Yes, it's acute care, but as long as you go in there with your head in the game (and you grow a thick skin) you'll be fine. Get your vitals on time, know how often you need to get them, know what your patient is in for, use your head regarding any abnormalities, and you'll be fine. You're a student, so no one (or hopefully no one) will expect you to know what to do when confronted with a strange situation. If all else fails, do what I do: open your eyes really wide and try to look scared. I'm in my last semester, and this tactic has never failed to rescue me :)

About the HACC uniforms, as far as I know, they're going to be white tops, maroon bottoms. I'm in the PN class right now and they had us vote (same with the RN class) about changing the bottoms from white to maroon. We all voted to change the colors, but unfortunately the uniforms won't change until next year. As far as how many to buy, from my own personal experience, start out with one or two. I'm entering my third semester and I still only have one uniform set. The material is thick and uncomfortable as hell, but it's extremely durable. I was afraid to buy more than one set at the beginning just because I was afraid of wasting the money if I didn't make it in the program. Now that I'm starting the 3rd semester I'm going to buy another top, because despite all the bleach I've used it's started to look a little gray. But that's just me. Other students in my class have three or four sets of uniforms...and then again, others have only one that are left over from when they attempted the program a few years ago. Good luck!