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WittySarcasm BSN

Rehab Nurse

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  1. WittySarcasm

    How best to transfer to a pediatrics unit?

    I’m not sure if this is in the right area and sorry if I’m posting in the wrong area. But I’ve worked LTC and inpatient rehab for my entire nursing career. I’ve wanted to always work pediatrics but I’ve wondered about how is it best to try to get into the unit. I know just apply silly, but is there any certain path that would be best? I want to look good when I do apply even though I don’t have such experience. I’ve been on ortho and wound when I’ve had to float and I feel ok and safe and comfortable with it. But I know this is specialized and I was just wondering what others thought. Can I just jump towards there, or should I do another unit before moving on? Thanks.
  2. WittySarcasm

    Charting and learning

    I agree with others saying this place is setting you up for failure. If moving to another place is possible I’d suggest it. However if it isn’t or you want to try to tough it out here’s some suggestions. I’ve worked LTC and in the hospital and this is just what I have picked up. 1) Call the doctor for anything that makes you feel uneasy- change of condition, abnormal vitals, falls. Even if everything seems normal you can still call and be like ‘he just seems off.’ Many times elderly won’t show any symptoms for UTI except for just being ‘off’. An example- yesterday they ate everything and was active. Today they are just sleepy and barely eating. Or they were sharp as can be yesterday but now it takes repeating tasks 2-3 times before they get it. And don’t be scared to ask if you can get a UA if you suspect an UTI. If your facility has a communication board for the doctor this is extremely useful for non-emergent issues- the resident wants to talk to the doctor about their medications, can they get a supplement since they just aren’t eating enough. Also always listen to your CNAs if they say that the person seems different. They are the first to know and the first to see everything. 2) Verbal and telephone orders can be taken at any time, per your facility rules. Just remember to repeat the order and the spellings of medications you don’t know or may easily be confused. Always spell out the doctor's names. For example ‘That order is 250 mg of Cipro PO twice a day for an UTI.’ This way you have verification you heard it correctly. 3) For charting I always went basic unless something was off. And even now I still do, it helps me keep organized in my thoughts and making my notes look good. For example if you’re just charting they’re still alive and fine you can do a basic head to toe charting. ‘Resident lying in bed, watching tv (or whatever their activity currently is). Vitals WNL. Assessment done and WNL. Up to BR to void, ate meals well. (Or whatever you want to add to show their current active level). And then build on from there. If they have dressings include that into your note. ‘All dressings CDI, no signs/symptoms of infection noted. (If drainage seen chart about how much- half dollar sized drainage seen on dressing, dark brown in color- I was taught to not use words like moderate or scant because this could mean anything but to use about what size it is- dime, half a nickel, etc). If they have IVs chart that they’re in good condition, (IV site and dressing CDI. No s/s of infection. All ports flush well). If they’re on antibiotics chart that they’re tolerating that well. (Continues on Keflex for UTI. No adverse reactions noted. No s/s or complaints of urgency, burning or unable to void). Document all calls to the doctor. Even if they don’t lead to orders just so you can show you called if something happens later. If they have A/V fistulas chart that there’s a thrill/bruit. Also almost forgot- are they there for Medicare charting? If so that is just to include they are still getting treatments there (for example if they’re there for PT, OT then chart ‘Resident continues to receive PT and OT.’) it is it just antibiotics they’re getting chart they are still receiving them. New admit charting- be sure to chart any skin issues seen on new admits so your facility doesn’t get the ding for it. But at the same time chart any new skin issue you see and what you did for it. For example, ‘Resident’s coccyx and buttocks red. Blanchable, educated pt on turning when in bed and chair. Took resident’s brief off to allow skin to breath when in bed. Placed zinc cream (or whatever cream your facility uses for skin) on site. Note left to doctor about skin issue.’ 4) If a procedure is being done you don’t know and another nurse is doing it go watch. When I first started my career I didn’t know how to change Peg tubes. I watched a couple get changed and could do it without problems. Is there a wound nurse? Follow her when she does the rounds. Is it possible for you to come in on a day off and just shadow for a shift? I know this was insanely long, but charting is something I semi get.
  3. WittySarcasm

    Nursing and Depression

    I hope this is the right place to post this... I was diagnosed with depression when I was 16. Back then I was with a therapist that more or less just wanted to drug me with every drug out there but never talk about anything, or try to find a way to help me. When I complained that the meds made it impossible for me to function- more so then the depression- she refused to listen. Pretty much just kept going until I decided to stop. Through the years I just learned to trudge through the depression. However as time has gone on- eleven years later- I'm finding it harder to ignore the feelings. And I've noticed them getting worse. My question, no one knows I suffer from depression at work. Would it hurt my license to go to a therapist? Even if it meant meds or something? I just really don't wanna mess it up, though I do wanna get help. Thanks, and sorry for the stupid question.
  4. WittySarcasm

    wow-ltc is crazy!!!!

    I can say from experience that yes, the first few days/weeks will be hard for you. I was in the same boat, my first nursing job was nursing homes. It is hard at first, but as time goes on and as you learn the residents it will be easier. One thing for sure- cluster care! What I do is when I first get on the floor after count is I grab the med book and quickly flip through and write down times that meds/finger sticks/whatever is due. This helps me from flipping needlessly and allows me more time to get other stuff done in the middle of meds. Remember the golden rule an hour before and an hour later for meds. I say golden rule because I've learned it helps a lot. As for family I found step back, take a breath (especially at this point you want to scream) and discreetly look at a clock or your watch. Allow the family member to vent for a few mins- whatever you feel you have time- sometimes just letting them vent will help a lot. If not, then find a place where you can break into the conversation and tell them 'I understand how you feel, if I this had happened to my family member I would feel the same way. Let me talk to the aide and I will come back to you.' And of course remember to come back (eek it's bad when you don't come back). As for the broken equipment, I feel your pain there. On my unit almost everything is broken (which we all find to just joke about). I mean our hoyers have been known to freeze in mid-air, our vital machines usually have to be done 4-5 times to get a reading. And just today we found out our blanket warmer just kicked the bucket. But this is also common in LTC. I know it is hard and tiring at times. But I promise this is a rewarding job. Especially when you see your residents smile at you and you can talk to the family. As time goes on, and they get to know you, they will get to trust you and incidents with them venting will become shorter. Also they will get to the point where they will not question your answers, job or even you and they will trust you. I've gained several family members trust now. Good luck!
  5. WittySarcasm

    I am a new agency nurse

    I relate totally. When I was working for an agency I found that I was always given the harder jobs. The ones that others did not want. I worked in nursing homes, and I found that there were some nurses- especially when I went to the same repeat nursing home over and over- that would actually give me their residents and they would take the lighter loads. One nursing home left me with one entire hallway (25 residents), a second hallway (18 residents) and the entire downstairs- which was the lock down ward and then two more hallways (10 residents). At the same time they would look down at me, for being "agency." Some demanded to know why I could not make it at a hospital or real nursing home like them. I finally got to the point where I decided that, you know it's not about what they think of me. Sure they could overload me, give me the worse jobs and look down at me because I was there for the patients who were in need of me.
  6. WittySarcasm

    Hopefully helpful advice!

    I know there are several of these out there. But as I have just hit my year's experience (yay! No longer am I a new Grad nurse) I thought I would share what I have learned. Especially since I went the backwards way by being an agency nurse (they were the only ones that after almost two years of looking would take me with no experience). Therefore I had to self teach myself some of the stuff because I was never trained. And so I wanted to share what tricks I found to help make my job easier. 1) The first thing I learned is to always ask questions. When you are new- whether it be a new grad or new to the place- you won't know everything about the residents. What you may think is abnormal you will find to be normal. And vice versa. So the best way to learn is to ask questions. And don't just ask other nurses. Ask the aides too. Believe me they know so much medical stuff. It may not be in their scope of practice but they do know when to give breathing treatments or ivs or what is normal or abnormal for the resident. 2) After report, ask the other nurse for just a quick rundown on how each resident takes their meds. This will make it faster if you know if the person needs crushed meds. Or if Resident A only takes meds with crystal lite. It saves laps and lets you get the meds ready before you walk into that room. 3) Take a breath! You have gotten report and how they take their meds. Now before you freak and flutter through the med book like crack head trying to get their next hit, take a deep breath. And remember that the first hour of your shift the meds are most likely done. For example if you do the 3-11 shift, the 7-3 nurse has most likely done the meds, just like how you will do the 11pm meds before you leave. So for that first hour you are ok. Instead of running around take this time to figure out when you have meds to pass. Here's what I found that works for me, however everyone has a different way of doing it (some mark pages, others use sticky notes). What I do is on the report sheet I take a different color (like blue or something) and I write in the times that meds are due. I will stand there and take an extra 10-15 mins and write down any times that fall between 1500-2300 (including those times) in blue on my report sheet. Or if I don't have room, I will grab a scrap sheet and write the room numbers and then write the med times. This way you save yourself numerous trips. 4) Now this one may not be as wonderful as a tip but it will save you stress. Remember you have an hour before and an hour later for meds. So a 1700 med can be given between 1600 and 1800. So just because it's 6pm when you finish your 5pm meds, you are fine. 5) Along with the above one. Try to group some of your meds together. Working at a LTC you will get meds almost hourly. I've had residents that have meds at 4pm, 5pm and 6pm. Instead of making three trips, if it is not too much try to give the 4 and 6pm meds at 5pm. Experience says that it most likely will be one or two meds for each hour. This will help save you odd trips. There will still be an odd trip alone, for one pill at a odd time, but you will reduce it a lot. 6) When you have the time to- in a break or something (you can also do this when you do your med times)- do the same thing with your TARS that you did with your MARS. Most treatments are just the shift (7-3 or 3-11) however there are some that are timed. But even if it isn't timed, just write on the report sheet- treatment, in the same color as your med times. This will help you remember who needs treatments and keep you from frantically flipping through the book. 7) Charting is usually by exception. Meaning antibiotics or abnormal findings or mental problems or things like that. For antibiotics the most simple charting should be something along the lines of "Vitals for this shift are- (vitals). Resident on (antibiotic name) for (why they are on it). With no adverse reactions noted." As one of my bosses stated at orientation- When a resident is on an antibiotic I want to be able to look into the chart and read the vitals, what antibiotic and why, and if there was any adverse reactions from it." If you want to chart more, chart based off of the reason for the antibiotic. For example if it's a UTI- does the resident have burning? Is the urine clear? Does it have an odor? And as you get to know the resident- do they seem "off" mentally? Sometimes that's the only symptom. If the resident has a foley look at the bag to see if it looks ok. 8) For rounds, do a fast walk around before meds. Remember that first hour, so if you take 15 mins to write down MARS and TARS time on your report sheet. That gives you another 45 minutes to do a quick walk around. Just look in on your residents. Check and see if they are breathing or in any pain- bring your report sheet with you. The report sheet will give you the PRN time of pain or anxiety meds, give a time that they can have the next one. This way they know you have not forgotten them. Also this quick round will let you at least put a name to a face. Because really those pictures NEVER look like the resident! 9) You will not be as fast as the other nurses who have been there for years. At first you will be running either late or just barely on time. Don't worry, it's normal! I promise. There are still times I run late and have to stay behind and finish charting. These are just some things I have found to help me. They are in no way the exact way to do nursing. You may find your own way. But these are the ways I have found that are helpful. And remember to do as what you would want done on the cart! When you come onto a cart would you like it cleaned, stocked, and the meds for the first hour of your pass done? If so then do it back. Clean and stock your cart before you leave. And just grab the 11pm meds with your 10pm pass.
  7. WittySarcasm

    Agency LTC or Staff LTC

    I started out as an agency nurse for LTC mainly because there was NOTHING ELSE out there. After a year and half I went for the first thing that called me. And now I work at a LTC as a full time nurse. I can officially say try to work at a LTC, and not as agency. It will cause added stress. Especially when you have to self teach yourself everything. The first couple times I sat in my car and cried before and after a shift. There is no training. They will put you in the first nursing home that calls for a nurse. And when you get there "I'm a new grad" will not get you any easier times. They give you the job that you were needed for. However when I went to the LTC place I work at now I got training (because I was still a new grad). I learned how to pass meds (though by that time I had gotten a pretty good system going). I learned how to do everything. That's why I say to try that way first. I had to go the backwards way mainly because of the fact that after a year and half of looking I had to go with what would take me. That is the ONLY reason you should try what I did, otherwise it will cause added stress at first!
  8. Ah I forgot the most important one! Look if you really feel we are that incompetent that you have to tell me how to do my job then perhaps you should take your son home. Really. He is at the best he's going to get. Take him home. You call every hour wanting to know if he is ok, if we are doing our job right, if he is covered up. Why no we have decided it would be fun to leave him uncovered in the middle of winter. Fun isn't it! Oh and gee I wonder how I know that he's doing ok. I mean his bed is out in the hallway because you don't "want him to be alone." So gee I wonder why I would know when I'm staring at him... OH It's because I'm psychic!
  9. ~Look you are what....800 pounds. I do not think you are going to starve to death just because you missed your 3 pm snack (which is an orange). If you do start to starve your body has about 600 pounds of fat to survive on. ~Ok so you want the "good stuff" I get it. Sorry we don't do that here. And you think the pain meds we have for you are "nothing more then candy." But when I ask 'are you feeling ok' when your blood pressure plummets and your heart increases it is NOT the time to give me a lecture about how I am getting rich off of meds. I want to make sure you are going to survive me calling 911. ~You can stop calling me a ************ (because first of all I have never ****** your mother). I'm sorry we cannot live to your outrageous expectations. But I cannot magically make a doctor appear. I explained that non-emergencies will mean that the doctor will come tomorrow. And wanting an order to state that only males can shower you does not constitute as an emergency. Despite how much you think it is one. ~Ok. Stop screaming. Really. You make my ears bleed and make my pulse race. Especially screaming over stupid stuff. I told you before we are not your personal taxi service. You got feet, you got a wheelchair, you got hands. Get moving. ~....why do you think I want to touch the leg that you state is "weeping"? Really do I look like I wanna touch it with my bare hands?! ~It's not the dumping syndrome you say you have. It's that you are FREAKIN anorexic! Ok! You are. Let's just admit it. I know you are. The doctors know you are. The entire staff knows you are. You only are the only one who believes you aren't. ~Look get out of that damned bed. I'm tired of arguing with you. The doctor himself said that you need to get out of bed. ~STOP WITH THE STUPID COMPETITION ON WHO CAN BE THE MOST NEEDIEST. If you or your roommate turn this call light on one more time I will walk in with scissors and cut the stupid cord so you can no longer ring it. ~Alright. Again with the screaming. Why? Look I explained to you that people have scopes of practice. A resident that cannot breath is not the CNAs job. It's my job so shut up with the screaming on how no one cares for anyone. while we are at it, don't scream at me when I'm trying to calm someone down who's turning blue. Really it defeats the whole purpose.
  10. WittySarcasm

    to New Nurses (long, but, hopefully helpful)

    I totally agree with number 4. I've learned that the CNA's almost always pick up on someone "not acting right." And 9 times out of 10 they will be right and the resident will have either a UTI or something worse. They are always around them, and have learned what is normal. I started in the nursing home, as an agency nurse so really I had no teacher. And even after a year of working I must say this helps me.
  11. WittySarcasm

    How Many Residents Do You Care For On Your Unit?

    I'm a charge nurse on my unit. We can run at the most with 30 residents. That's with 2 med nurses and 5 aides. So it isn't too bad. Though I myself is in charge of 30 residents. That's the 3-11 shift in Arizona.
  12. So I've been a nursing home nurse for almost a year. First I started out as an agency nurse, however because I had no experience they put me in only nursing homes and hospice. Which it was awesome, there was a lot of crash course teaching myself on how to best do the med cart and how to do dressings. But I pulled through and I have found little things that help me greatly. And then after 6 months of working at several different nursing homes I scored a job at...wait for it....yup another nursing home. I've gotten good at passing meds, and I can easily pass meds for 15-25 residents and do dressings as needed, as well as help the aides answer lights and feed. However skills like IVs and foley caths are things I cannot do still. I am just shy of my year of nursing (one month away) and I am hoping to get into a hospital soon. So I guess my main fear is- am I going to be able to go to a hospital easily? I'm not talking about experience or anything like that- that will come when it comes. What I am worried with is that I am used to being in a nursing home- or hospice but there's no treating there- am I going to be able to make it to make it? I mean even with another year of experience, I really don't see how it will let me grow on skills that we just don't use. I am a charge nurse right now, but still it's at a nursing home where there is not tons of action (except for the behaviors since we are a behavioral nursing home) Since I have never gotten the training that most new grad nurses get when they get hired into a hospital I am worried. My friends talk about how hectic it is at the hospital, and it makes it feel like I'm missing out on a lot, that I am falling further behind each time. Should I- when I get a little more experience- see if my agency will put in a hospital so I can get a feel for it? Should I just give up on the hospital? Or what would be the best course of action for when I find it possible for me to get into there? Thanks!
  13. Ohh this is too fun! I have so much I would love to tell certain people. ~Look if you touch my butt one more time you will find yourself nothing more then mush on the ground. Same thing for trying to grab my boobs or hey anywhere on my body. ~Hey, if you don't wanna eat fine. But don't lecture me for 5 minutes for the kitchen not having what you want. You have 10 fingers and a cell phone. Call your family to do it. ~No. I am not going to take your laundry home to wash. I don't care if you hate how we do it here. ~Look answer the damn question. Are you in pain? Don't lecture to me how I- a nurse- gets rich from the meds I pass. Cuz I am so missing out right now on millions. ~Hey, you have the right to refuse meds. But don't toss the whole cup at my face.
  14. WittySarcasm

    Straight nights or day/nt rotation for new grad w/ kids

    I found that straight nights is easier then rotating because then your body can get used to it. Rotating you have to readjust your sleeping schedule every time, and it gets hard. But then again it depends on how you can take that type of changing!
  15. WittySarcasm

    Verbal Orders - MD to RN to RN without Chart

    I wouldn't feel safe doing that. Instead I say just grab a brand new physican order sheet (stamp or write the pt info- at least name) and just use that and put it in the chart when the chart reappears. I'd say of it happens again, offer to do something with the other patients for the nurse so that she can run and take care of the verbal order that she was given. Or even just hand the blank sheet to her and ask her to write it down quickly so you can follow a written order.