Skyfel

I only got to work for 6 days in the LTC facility I was at because they fired me last Thu. when I told them I wasn't ready to come off orientation!! I was making 18hr but $2 more hourly on weekends, double time on Christmas Day they said and time and a half on like 5 other holidays...this is Central Indiana.

I am an LPN who graduated in March 2010 and I have been hired FOUR times since then for an LPN position and then FIRED from ALL four due to not having enough experience! The first job lasted 6 months in a doctor's office but they made me work in the front office and never allowed me to work in the back so I didn't get ANY Nursing experience there. The next job I worked at for only 4 weeks and they told me they wanted me off orientation but I wasn't feeling very comfortable yet so they fired me. The third job I got was a Case Manager phone only LPN job and I was only there 8 days and was still doing computer training when they fired me saying they wanted someone with more experience and I had NEVER yet once gotten to talk to any patients on the phone! This last one was the FIRST LTC Facility I had worked at and I told them (as I told ALL the other places too) that I was a NEW nurse with NO LPN experience. They fired me last Thursday after only being on orientation 6 days telling me my orientation was over and they wanted to put me on my own cart. I had gone to the DON after 4 days of shadowing a nurse (that is what is was...NO ONE had TIME to TRAIN...they are way too busy!!1) and I told the DON that I had TONS of questions and needed someone who was actually going to train me. DON said I could be with her the next day so that's what I did. But the ONLY thing the DON did with me was let me sit in on a meeting she had with an LPN manager going over the residents and who has lost weight etc. and changing their meals etc. She did NOTHING to help me with my orientation. I was put in computer training class FINALLY the very next day after already being on the floor with nurses for 5 days prior. No resident care occurred those two days and then BANG the very next day I get called into the DON office and told that my orientation was over and was I ready? I told her NO I really am NOT ready. I need more training. I told her I came to you on Monday asking for help and now I'm getting told my orientation is over? She told me the company cannot keep me on orientation any longer and that I needed to be on my own. I was floored. I have ZERO Nursing experience other than the 4 weeks I had at the hospital 9 months ago which was a lot different than a nursing home that I've never worked in before. DON told me to go home and she'd call me the next day (last Fri) to let me know if they will extend my orientation or not. Well, she never called me Fri and the day was almost over so I called her and she told me they have decided to "separate employment" so once again, I'm out of a job. I have two kids to support and I just got married one year ago and built a new house that we are very far behind on with the mortgage. I just don't know what to do. I don't know WHERE to go where I will get good TRAINING. Not just "follow me everywhere I go and see what I do and you better learn it quick" training. Does any LTC nurses have ANY good advice for me? They had me with 5 different nurses during the 6 days I was on the floor. The only thing I was starting to feel kind of comfortable doing was med pass. There were TONS of treatments to do like trach care and stuff that I've NEVER performed on a human before (just a mannequin in school), wound care that only a few times nurses let me do, there's all kinds of charting to do that I wasn't used to, assessments of the residents that I forget alot about since I last had clinicals in summer of 2009 and not since. I feel like a big, fat failure and that I need to get out of nursing completely. I just don't have the confidence to do it alone yet and I don't feel like I have enough knowledge. Please give any advice you can. I really appreciate it!!! Laura in Indiana

Thanks for replying. Well, you brought up many valid points. Here's what I know, the IV pump was set at "80" and what was running (my instructor said) was 63.8ml/hr of Vancomycin and the fluids made up the difference. When we arrived in his room at 0730, the night shift and day shift nurse was in there d/c'ing his hand IV because of the infiltration and just hooked everything back up using the ANC IV site that already existed. I never asked the nurse why he had two sites. It was only my 3rd Pediatric patient in my entire life and that nurse had been rude to me for the past 3 weeks so I tried to avoid her at all costs. His hand looked like that when they went to check on him at 0730, that's why they D/D'd it. So, what do you think happened then? My instructor and I didn't talk all that much about it except she was upset that the NOC nurse could not have done hourly IV checks on that boy or she should have noticed swelling was happening. The boy was complaining more when they D/C'd the IV than when they first went in there and saw it was infiltrated. I just don't understand how nurses can sit there and chart "unchanged assessment" while it's infiltrating. It's just ridiculous.

Thank you so much for replying. I will use this the next time I need it. I had to turn in that careplan already but what you said was VERY helpful and I love how you wrote about real life experiences also. I read your comments all the time on the board. Very helpful! Thank you so much!! OH, about the infiltration...yea, that hospital is supposed to do IV checks every single hour also. That's why my instructor was so upset about it. She said to me, "There is NO way the nurse was checking his hand every hour. She was just charting no change in the computer without looking at it." I can't believe that some nurses are so lazy and irresponsible. I don't like the nurse that was in charge of that boy either....I wouldn't want her taking care of my child, that's for sure. I hope she learned her lesson, but maybe not.

Thanks so much. Yea, I didn't use any breastfeeding diagnosis. I was saying that she's not breastfeeding so you guys knew that would not be an appropriate nursing diagnosis to use and wouldn't ask me if she was breastfeeding or trying to. However, she did say right when I was leaving that she wanted to try one more time to breastfeed but her family was trying to steer her away from it because she was going to go back to school, for one, secondly she had her DEPO shot the day before (one day after delivery) because she told the nurses and doctor that she was only going to bottle feed. See, I think they "jumped the gun" on that one (sort of) because she's only 13 and didn't have a lot of time to think about pros and cons of breastfeeding and discuss this with the nurses. Yea, she probably talked about it with her family for the past 9 months (if they knew for that long) but she hadn't really thought it over well. Her breasts were busting at the seems, so to speak, and the nipples were flat because the breasts were so full. I don't know how she ended up dealing with that whole situation. I really wanted to help her express some of the colostrum/milk and try to latch the baby on so she could at least "try" to breastfeed like she desired but I had to leave the unit with my instructor at that time. I'll think about her for the rest of my life, I'm sure. she's the same age as my oldest child and she was my first 13 year old and my youngest post partum mother I've ever cared for.

Does anyone have a good nursing diagnosis using r/t and also AEB for an IV infiltration? Nurse must not have checked patient most of the night because when I got there for my clinicals the 10 year old boy's hand was swollen and all his fluids had run into his tissues. RN d/c'd the IV and NEVER applied ANY compresses at all to his hand nor elevated his hand or arm. Maybe it's because they ended up using the same arm for his IV to restart again by using the Right ANC. For some reason he had two IV's started in his right extremity. One was in his hand and one was in his ANC. Only the hand was being used when I got there at 7am but they d/c'd it because it had really badly infiltrated. My instructor was livid when she found out about it. Not at me but at the nurse. I don't think she said anything to the nurse about it but she sure told me a few times. I don't know why warm compresses weren't applied to his hand or elevated. Any opinion? I'm not a nurse yet of course so still learning here. Also, any nursing diagnosis advice? I want to use his IV infiltration as his Priority Nursing Diagnosis only because by the time I got there he was feeling fine and was later discharged home. He was admitted for possible meningitis so they started him on Vanc right away (which also was infiltrated in his hand!!) along with the Dextrose 5% Sodium Chloride 0.9% that was running along with the Vanc. His CSF came back no bacteria and the doctors told him that he must have just gotten a virus and now he has recovered. He only had a fever of 99.1 when I left the unit and he hadn't vomited and no nausea for two days. He actually was doing really well even eating and drinking fine. So, am I right to use the IV infiltration as his priority diagnosis or what is anyone's opinion on this? Skyfel

Thanks for replying. I think you are my first reply I've ever had on the All Nurses boards. Thank you. I haven't gotten any feedback for that care plan yet but I hope I did well. Yea, she's 13 and it blows my mind. I have a 13 year old daughter who is 4 months older than this new mother. I can't imagine my daughter having a baby right now. They are in the same grade and go to the same school even but I didn't say anything to my daughter for patient confidentiality so no worries. I have a sister who got pregnant at 14 and now her son is the same age as my oldest (her and I were pregnant at the same time). So, my sister is 29 and her son is going to be 14 in a couple months. Crazy isn't it? She's happy though that she got her kids out of the way young. She's totally not statistical though cause she never had anymore children after she got pregnant with her baby at 14. I just hope this mom being only 13 is actually going to help her grandparents raise the baby and not neglect it and force other family members to raise the baby. Also, I hope she doesn't go back out and get pregnant again. Scary thought!

Thanks for that sample charting. I printed the whole thing out and am going to keep it with me at clinicals as examples. Thanks for posting!!!!

Can anyone please help me with my care plan I'm doing right now? It's due tonight. I am needing nursing diagnosis for my 13 year old patient who delivered a baby. I'm sure my priority diagnosis is something to do with how young and inexperienced she is. She was stable when I had her, no breathing problems, had the typical cramping pain and only scant bleeding so she's doing fine physically. She's also not breastfeeding so I really think her diagnosis will revolve around her lack of experience. She's also going right back to school while grandparents take care of the baby during school. Trying to figure out what to say exactly with the 3 parts including the R/T and AEB. I am thinking one diagnosis can be "Risk for impaired parenting r/t lack of knowledge and experience AEB patient is only 13 years of age". Can anyone tell me if that's wrong and needs tweaked? Any other diagnoses you can think of? I would greatly appreciate it!!! Skyfel

I understand "inbox". Is that your username for real? Interesting. Well, I can say that I feel stressed, overwhelmed, irritated, *****, snippy, sad, happy, and lash out at my kids on a daily basis. Pretty normal for me being full time in nursing school trying to pass but having issues right now. School is HARD HARD HARD and if you have kids, a job, a husband, housework to do, car payment and lots of bills, laundry piled up, house is a mess, cat driving you crazy, and homework getting behind and no time to study......I understand why someone like myself would feel the way you feel. Not sure if you have all that, half of that or even 1/4 of that but if you do...I totally understand. :)

I wish I knew. I have worked as an OB tech in OB for 9 solid years now and I also am a Full Time Nursing Student who is in OB/Peds clinicals right now. I talked to my OB patient today a lot and didn't even get a lunch break because we were talking so long. I was doing a TON of teaching for my 13 year old post partum mom and just got "caught up" in there talking to her and her mom for most of my shift today. I do the same thing at my job when we're going over nursing and not nursing topics. I don't know how to just walk away unless I have other nurses calling me out of the room or something. Someone usually literally has to drag me out when the patient is wanting to talk to me. I gotta get better at this once I have more than one patient but right now in clinicals, I only have one patient or mother/baby couplet at a time so I spend all my time with them. At my work though I have LOTS of patients to help with and have to make myself not spend too much time with people. All I can say is that if you really need out of there just say, "Well, is there anything else I can get for you before I go? I will check on you again soon (or state a time frame)." Maybe? What does everyone else say?