Gizmo44

I think schools need to practice medical emergencies like they do fire drills and tornado drills. and now often active shooter drills. At least for the adults to know how operate. Sounds like you had utter chaos and your instincts kicked in meaning your focus was on the patient. This was more than skinning your knee on the playground and needing to go to the nurses office.

I have my first interview for my first RN position at a hospital this week and am getting nervous. I know to prepare in advance - research the facility, practice answering interview questions, have my own questions prepared, and come with extra resumes in hand. What is concerning me most (today) is what to wear. I have always worn a suit or dress slacks/blouse to interviews in the past but this is my first one as an RN. The other issue is the weather - they are predicting temps over 100 deg. I am trying to be practical by dressing for an interview and while taking into account the weather. Another issue is I am on a big budget having just finished school. If I have to buy anything it will be a new pair of shoes. With that said, I am considering wearing a dress (short-sleeved, tan, shirt-dress) and appropriate shoes (flats or low heel). Is this an OK outfit to wear? I know appearances are everything and I don't want to make a bad 1st impression but like I said I want to be practical, too. Any suggestions would be greatly appreciated.

I think you meant too many patients to a nurse, at least I hope that's what you meant...I'm sure that is it based on the rest of your post. I had a similar experience and couldn't deal with the risk it was putting on my license. I was a new nurse and I was "in charge", had 3 days orientation, and most of that was spent following the nurses around. Only one had an interest to observe my skills but we were so short staffed that day that we were lucky to get it all done. In the end I had to evaluate my own skills - no one really watched me do anything before I was set loose on the units. I figured they would want to "see" me do the basics to know for themselves that I could do them & did them to company/facility standards before I would be considered "Charge" nurse. I also observed long-term staff complain about the work load and lack of support. That alone should have sent me running for the door. Now these were nurses filled with compassion and struggled to do what was right for their residents but they worked at a high level of "overload" for so long that it led to burnout. Two come to mind here - one was very frustrated and the other was very bitter. Both had been at the facility for over 10 years and experienced a lot of changes - it wasn't the same place they started. I kept hearing, "State won't allow us to have another _________ on the floor that shift" - fill in the blank depending on the situation whether it was a CNA or QMA or nurse but I think it had more to do with the facility and/or company and their bottom line and reimbursements. They often said, "fill out your paperwork right and maybe you'll get another person." This also led me to believe that it all had to do with their profit margin rather than giving the staff what they need to give the care that the residents deserved, and paid for. As new nurse I thought, well show me some examples so I do the assessments right. I think there was confusion as to how a resident should be assessed or rated when it came to mobility, needs, or self care assessments, etc. which, perhaps, led to them being underrated resulting in an inaccurate picture of their needs and in less reimbursements. I also suspected that people just copied the same information that the person before them entered. Lets face it, people in hospitals are sicker, are discharged home sicker, or come to LTC facilities sicker than in the past. Sure advances in diagnostic, treatment, & medication has resulted in people living longer but that does NOT mean they are fully self-sufficient. LTC nurses & staff are expected to care for people with more complex needs than in the past and each one has more medications. Staffing models aren't keeping up with this need. It is definitely time for a change...

Noc4senuf, This sounds like a situation that I would love. Its overwhelming enough just starting a new job out of nursing school...anywhere for that matter. But to feel like you're just thrown into it, like I was, is another thing all together. In 3 shifts you're just getting your feet wet with the facility (finding the bathroom, learning how clock in, where is the back up stock kept, not to mention learning faces & names-of residents AND staff) I mentioned my experiences to RN friends of mine and they seemed shocked. One said, her unit required 4 months of full time orientation for new hires regardless of the shift they were hired for and more if they need it. You obviously really care for your staff and their development and it shows.

OMG - I feel as if someone is writing my memoir. Put "Gizmo44" as the poster and all would fit my experience. I went through the same thing only as a new grad LPN. I got my license in Aug.08 & started PRN in LTC. I asked if it was doable for a new nurse to do PRN and was told yes. I needed a job so I took it. Training was 3 days-1 day in each unit, I got 5 days because I asked for additional time since I would be floating. It was so unorganized - took over 3 weeks mind you to get my 5 days in. My title was Charge Nurse which I thought strange because I didn't feel as if I knew enough to be in charge of anything. I should have listened to my instincts when experienced nurses were complaining about the work load. I saw so many corners get cut I couldn't believe what I was seeing. Was told this is how it is in the real world. By the time I was on my own, it was almost 2 months before I got a shift. I had nearly 40 residents of all acuity levels, had j-tubes, treatments, blood sugars/insulins, supervised meal time-including recording nutrition/fluid intake, Supervised 2 CNAs in my unit, lucky if we had a 3rd that floated, had a killer med pass-most got them crushed or floated-felt like I was doing nothing but passing meds. We had a 2 hour window to pass to everyone and I hate to admit it but I couldn't do it in that time period. Not do it to policy & procedures - then I found out hardly anyone did. The person who trained me on this unit didn't crack open the med/treatment books. Said she had everyone's meds/treatments memorized. Charted on her med pass/treatments at the the end of her shift. I never had time to assess anyone for changes, have a conversation with anyone, I barely got the required assessments in as it was. Speaking of assessments, during a training shift, I as given a stack of assessment forms that needed filled out on some of my residents. I thought, I didn't assess anyone, I can't fill this out, I don't even know anyone's name. The response I got was sure you can you saw everyone today. I said to myself this is nuts but said outloud that I did not do any assessments, don't know the people or their condition, so I would not feel comfortable charting on them. Then, when I was at my lowest, wondering how can I do this, why is it like this, why am I so slow, I found out that it was common for people to clock out at the scheduled time and work off clock to finish their paperwork or charting. I was shocked at how wrong that was. For one thing, it puts you at risk if anything happens to you (slip/fall, etc) because Workman's comp will NOT cover anything that happens off the clock. But it was common practice among nurses because OT wasn't allowed. Now, I did not go into nursing thinking it would be easy, on the contrary. I wanted to work hard, be challenged, help people, and learn new things. I did not want to sit behind a desk staring at a computer all day anymore. I was bored & needed a change. Through my experience I decided to achieve this the best thing would be continue to get my RN to broaden my opportunities. But due to the economy, no one wants to hire new nurses whether LPN or RN. The more I learn about this subject the more I wonder about my decision - as a result I am also looking into other areas of healthcare like surgery tech or RT. I also do not believe there is really a nursing shortage. There is, however, a shortage of nurses wanting to work so short-staffed, putting themselves & health, their patients, and licenses on the line. I bet if they took a poll of everyone who ever held a nursing license, they would find enough people to satisfy the need. Also, if they polled the people with or without a current license to find out why they weren't working in the field I bet it would be somewhere a long the lines of working conditions. I, for one, will not accept the status quo so anyone who says suck it up & deal with it, is wrong. The thing we must remember is that residents in LTC are someone's mother/father or husband/wife or sister/brother. Would you want your's to be treated like this?

Taranator - I just finished 101 from Terre Haute. If you want, PM me your instructor's name and I can probably tell you exactly what to expect.

Thank you BlindMouse3, I figured since it was an 8-week course, it would be very intense. I already have the book and have started reading it based on what we covered the first time I took it. I also saved all my notes from the first time I took it. Then it was the same book, just different edition. I tend to do really well with on-line classes. I guess because I can work at my own pace to an extent - meaning I can work ahead because everything is laid out for you-you know what to expect. So often my face to face classes didn't do that. We knew there was an assignment coming up but didn't get the instructions until a couple weeks before it was due-really drove me nuts. That is depressing that there is an 80-90% fail rate though. Anyway that one of you could send me a copy your syllabus from A&P101? Send me a pm or attach to a post I guess would work too. I'd appreciate it. Thanks

Thanks Csab Sounds pretty doable and the format is similar to other online classes I've taken. Since I took it before (face-to-face) I just wasn't sure how the labs were done. We had Lab exams where you went around to stations and had to answer questions or identify a bone structure or muscle. Sounds like you get more out of the labs, since it appears you can get more practice with the simulations. So often we had to share the equipment or were pressed for time in class. I couldn't make it to open lab because of my schedule. I emailed a few teachers assigned to teach 101 this summer and 2 responded right away. One really kinda scared me about the work load & cost since it is a short class. She did say that all the online classes are the same and use the same book. The other one wasn't nearly as intense and made it sound like any other online class. I really need to get an A in this class but am not looking forward to spending my summer in class 2 nights a week for nearly 4 hrs each time again. Plus I may be working nights this summer too. Hoping that it will be more review either way since I already have my LPN.

I am retaking both A&P 1 & 2 to raise my points for the LPN to RN transition program since I didn't get in for this summer. I figured since I already took them as well as went through all the LPN courses (old curriculum) at Ivy Tech and passed boards it shouldn't be too bad for me and might just be review. I am registered for A&P 101 face to face this summer but am considering switching to on-line. I wondered how they did the lab portion though. The section I am looking at is not a hybrid class. I have taken other on-line courses (Eng, Psych, Comm-got As) and enjoyed them so it wouldn't be new to me. I understand what it entails. I would appreciate any input. Is one class easier on-line than the other? I thought A&P102 was much easier than 101 face to face but then 101 was one of the first classes I took when going back to school 4 years ago & took it in the Summer as well - I am a lot different student now. By the way, I took those classes before I was certain I would continue to get my RN so the grades weren't that important at the time (I got Bs). I plan to take A&P 102 and Chem 101 Fall 09 and am considering online then too. Any details & input would be greatly appreciated.

I took this class last Spring out of Fort Wayne. It was a 5 week class & the book we used was K.I.S.S. - Guide to Fitness. We walked a mile for each class and had to keep an exercise log along with heart rate & BP. We also went on field trips. One was to a health food store & another was to IPFW rec center. We did an individual paper - personal health plan and a group presentation - disease or health concern that we did on the last class day (so only 4 actual lecture mtgs). No tests but attendance was required.

I only meant that I want to get my RN to broaden my opportunities. LPNs aren't utilized in the areas I want to work (hospitals, surgery) and the only way I can get there is to get my RN. LPNs are pretty much only used in nursing homes and offices where I live anymore. If an LPN leaves a hospital they replace them with an RN or not at all.

When I posted before, I hadn't worked a shift outside of training because I was hired PRN. Well, I did this past weekend (11/22 & 23). My training experience was horrible, mind you, and I almost decided not to work there. I only trained on days, knowing that I potentially could work any shift. Training consisted of 3 days - but I asked for 1 more, got 2, because (I realistically thought) I didn't know when they would need me again. I finished training mid Oct. - so I had 1-1/2 months until I worked again. They've had some staffing changes so I they finally needed to use me. Anyway, weekend shifts are killer 12 hrs long. On days, North (32 beds) & South (38 beds) halls has 1 LPN charge, 3 CNAs, no QMAs & the Alzheimers unit has 1 LPN charge, & 2 CNAs. There is an RN supervisor maning the desk. I tried to do as much as I could on day 1 but ended up so frustrated with myself because I was slow, don't know the residents, and am a 1st time nurse so I needed lots of help which frustrated me even more. On day 2, we developed a system where I just did pills all day (2 killer med passes ) and my spvsr did everything else - BS, insulins, treatments, assessments, VS. We shared the charting at the end depending on what we did/saw. Day 2 it was much easier to keep track of where I was but I still don't know how I'll be able to fit it all in. They tell me I'll get faster with meds but not to expect to get it all done. To me that is not acceptible. Right now I am concentrating on learning the residents and speeding up my med pass and get a system in place to make multi-tasking easier. It drives me CRAZY that I have trouble keeping track of more than a couple things at a time. But I am so overwhelmed with volume of work that needs to be done. For the first time, I started second guessing my decision to be a nurse. All I hope is that once more baby boomers start needing full time care and families get involved, that they'll start screaming for a change because no one is listening to the nurses - IMHO.

This is how it is in Indiana too. I researched the issue after finishing training and being so frustrated I didn't want to return. I figured there had to be regulation somewhere saying what the max. was. But all I could find was nurse hours to resident and yes, they include everyone with a license whether they do direct care or not. The only exception in Indiana is they don't include the DON.

In Indiana they have nurse hours/resident but I think it is to compare facilities and not "regulation". I am not sure what it means as far as nurse to # residents though. I do know that it is the average for the whole day and can include anyone with a license (RN/LPN) but not the DON. Even the unit supervisor who sits at the desk, auditing charts, & doing new orders, etc is counted in that ratio. Where I work there are 3 halls - Alzhiemers hall has 1 LPN & 2 CNA/20 residents --> Days & evenings, director is there only on days. North hall has 1 LPN & 3 CNAs/32 residents; South has 1 LPN, 1 QMA & 3 CNAs/ 38 residents --> Days & evenings, plus a nurse supervisor that mans the desk. Nights has 1 LPN/2 CNAs in each hall and the LPNs share the Alzeimers unit for 42 or 48 residents --> no nurse supervisor. We have something like 1hr.24min. nurse hours per resident & we have 90 residents total. The facility I did my Geri clinicals was quite large. It had 4 halls, 2 were for skilled nursing, 1 was transitional, and 1 was LTC/ALC. We were assigned to the LTC/ALC hall which had 1 LPN & 2 CNAs/20 residents. I am not sure what the ratios were for the other 3 halls. They also had a Rehab center attached but it was pretty separate from the nursing home side.

I hope everything went well for your training. I am a brand new nurse starting PRN in LTC and thought I would add my 2 cents based on my training experience & the changes I would make. First of all, Michelle126 & StephanieS321 have great ideas. The one about carrying a notebook to jot down questions to go over later is one I wish I had. In my facility, we had 3 days of orienting/training - 1 in each hall before being out on your own. I asked for an extra day because 2 of my days were very chaotic - I was urged by two of the nurses that I followed to do it. Because of this I had 4 different nurses training me so I got 4 different ways of doing things. I believe being oriented in each hall is a good way to learn the facility but not a good way to know the residents. Therefore, an additional 1 or 2 days, at least, in the hall on the shift they will work is in order. As a new nurse, and working PRN, I would have loved to have twice the amount of training days at the very least, and a variety of shifts - all my days were Day shift, no evenings. Now I realize that you may not have control over the number of training shifts they get. As Michele said, take a minute to find out their experience level. Think of some things your residents have that she may not have seen in clinicals or might be nervous about. Two examples - 1. I did 1 foley cath in clinical with my instructor helping me. I have never done a straight cath. On one of my training days, there was a resident who gets straight cathed 3/day. I mentioned I never did one & would like to. When it came time to do it, the nurse brought me in with her but did the cath herself. She explained that some nurses have a CNA hold a flash light but I just do it - she's real easy. I thought to myself, I would have liked to experience that myself. 2. On the other hall, a resident had a suprapubic cath that needed changed. I have never seen one outside of my med/surg book and told the nurse that. She had me doing treatments and never got me when it was time to change the cath - even after I asked her too. Take the time to show the MAR and TAR - make sure they know what they're looking at. I had one clinical in a LTC facility (out of 6 total), and we passed meds only one day - the noon time pass so there was only 7 out of the 20 residents that got them plus we were paired up. I had more experience in hospitals using Pyxis & bar code scaners. Punching meds through cards is real awkward for me. Now, when the new nurse goes from following/shaddowing to doing, observe their technique & how they work with residents but don't keep interupting them. Wait until they are done with that resident or even med pass to make suggestions. On my extra day, the nurse would interrupt constantly when I was in the middle of something, sometimes I was just double checking the MAR to be sure I had the right med pulled & she would say whats wrong, what are you doing. Plus she kept saying, hurry up, speed it up, which only distracted me. The exception is if you see something that could cause harm, then yes, speak up. When you see things done right, speak up too. I never heard a good thing I did during training. I often felt like I was worthless and never should be a nurse. I kept reminding myself that I got great reviews in clinicals and all my teachers liked me so there must be something there. I heard more than once that "you'll come up with your own system". That is to vague. Now, it would be more helpfull to have "your" system explained to me with some options and maybe even a "don't ever do this" thrown in. Now, I know we are supposed to know right & wrong, know the nurse practice act by heart, etc. but during training it is so overwhelming and there is a lot to absorb so a reminder now and then would be nice. Starting on the floor with a limited number of residents - say 6-10 would be a great experience (after being oriented). Then gradually build up to a full load all while having a trainer available for questions or to help with those things that come up that you never prepare to train for because they don't happen that often or you need to see it in action in order to understand it (deaths, falls & all the paperwork, combative behaviors). Training should be more than 3 days period. Hospitals do more. An office where a friend of mine used to work heard her replacement had 6 months of training. When my mom was getting chemo, they were training a new CMA as chemo receptionist. She was with her trainer at least 2 months and she worked full time. It makes completely no sense to me why LTC generaly has only 3 days. You are usually in charge of more residents and CNAs. They are coming sicker from hospitals and from home with more complex problems too. Plus we have 2 hours for a med pass no matter how many residents you are assigned. In clinicals, the nurse on the hall we were assigned had 20 residents & where I work now we have, depending on the hall, 20, 38 or 32 residents. Makes no sense. Training could be catered to individual experience and there is nothing wrong with a new hire finishing early if they have previous experience. In my opinion it is better to have the training days budgeted and not need them than to need them and not do them because of $$ and risk someone leaving due to being overwhelmed and stressed. Then you have to start over - its a waste of money. Also, the saying - If you keep doing what you always did, you'll keep getting what you always got - works here. If a facility has high turnover, they should examine the training program. But enough of my soapbox. I hope this helps - anyone