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Nurse Graduate 09/16/2010

CareteamRN70's Latest Activity

  1. CareteamRN70

    Help! Pre-employment nicotine test!

    Lol I'd be scr*wed either way. I quit smoking cigarettes but now use e-cigarettes which still have a healthy (pun) dose of nicotine. No tar, no 400+ other chemicals, but still nicotine. My facility went non-smoking on the grounds which is par for the course, but we had 1 resident that was grandfathered in as being allowed to still smoke since they had come to us long before the no-smoking rules came into effect. She used to get smoked 6x a day out on the edge of the property. Just this week they took that from her and slapped a patch on her which is driving her crazy (along with withdrawl). As for obesity, I am a very large guy. You've heard of functional alcoholics..well Im functionally fat. I don't even know what the chairs feel like in my facility because my @ss never gets to sit in them. Im on the floor humping along my entire shift, plus being regarded as my units spare hoyer lift. I even chart standing up. The day I get judged by my waistline vs my work output and attendance record for illness (normally 1 day in a 12 month period for flu, cold, or a planned MH day which I havent taken yet) is the day I hang up my exl scrubs, say my good byes to my favorite residents, and take up the mantle of grandpa extraordinaire.
  2. CareteamRN70

    I gave a back massage yesterday

    I give massages quite a bit, my unit has an unwriiten rule that we should try two nursing interventions for pain control before breaking out the narcs. I have seen pts who are mean and surly calm down if I sneak in a massage while doing tx's. I try to, whenever possible, not glove up when interacting with pts. I've held many hands and it amazes me how my relationship with a pt can change just because I came in and held their hand while listening to them verbalize a complaint, a fear, or even just a bit of dementia rambling. My only one request I get a lot that terrifies me are pts who request leg massages. I apply lotion to legs a lot, or do ROM or limited stretches for contactures...but many of my pts are susceptable to clots..recent surgery, DVT's, etc and it pains me to have to say no.
  3. CareteamRN70

    If YOU were the patient, would you feel comfortable...

    The previous post about using disposable cloths for wiping butts and peri care is nice..but unfortunately not sustainable. I work in LTC and we get one shipment a month or so of the disposable cloths and my aides grab as many as they can, some even stash them around the unit so they will have some for later shifts. But in the end (lol made a funny) we always run out and then its hand cloths for the nasty work...if our laundry has left enough for us in linen service..otherwise it's like being back in the marines...you get 3 squares of tp to wipe..well in my LTC you get 1 washcloth to clean up a huge hot mess that just erupted out of your c-diff pt. as for anything else at work...cups..toliets...mattreses..I'm not a germaphobe..figure im crawlin with about 95% of what my pts bring in...but I refuse to eat at work (first because I feel guilty if a pt see's me eating fast food or home cooked food while they are slurping down mech soft meat that looks like grey baby food- and 2nd because work doesnt leave me with much of an appetite until I get home). I am fortunate to be male and have great bowel control and can "stand" for the other...how some women can hover over a toilet I still think is a gymnastic feat i could never master. My kids still think I hate them some days because I come home and won't let them touch me until I strip outta the scrubs and shower...and it is an ultimate crime in my household for my kids to touch my workshoes...just one tale of what I walk thru, step in, and get splashed on them has traumatized them enough they wont go near any of my shoes
  4. CareteamRN70

    Do you ever feel like a licensed drug pusher?

    I try not to Judge. I work in LTC/Rehab and most of my pt's have been on pain meds a very LONG time. Most get set round the clock narcs at 4 and 6 hour intervals. They take in amounts that honestly would have me laying on the floor in a drooling coma (and I am not a small guy). The fact that some of these meds have no effect on them beyond allowing them to function at a relativley normal level tells me that they have been on these prescriptions so long that the sedation effects have been worn away. I end up most days worrying more about counting up how many grams of tylenol are imbibed then worrying about the strength of the narc that it coats. I've questioned orders on both ends of the spectrum..pts preparing for hospice on northing stronger then tylenol for pain that rates 8-10 and others that are short term rehab that get 15-60mg morphine everytime their back itches. About the best I can do is get those that need stronger pain meds new orders from the MD, and get the PRN stronger narcs set to scheduled times to lower abuse. On a side note I do try non-narc nursing interventions first...mostly because I get the strangest looks from my fellow nurses, it seems to annoy my pts that put on huge coughing fits to get their morphine/codeine syrup..until I reenter the room and then they are prefectly fine and asking if they can go out for a smoke, and once in a blue moon just talking with a pt to distract them from from some kinds of pain actually does work, or they were lonely and the only thing they could think of to get attention from the nurse is to ask for meds. -Big J
  5. CareteamRN70

    Drug seeking patients

    I feel for you and understand some of your frustrations. I have a pt with respiratory problems that puts on a grand show at the start of my shift. He likes to pile up his PRN narcs. First ten minutes he complains of cough and asks for his prn cough syrup with codeine. Ten minutes after that he complains of dyspnea and wants his prn sublingual morphine. Ten minutes after that he complains of back pain rated 10 and wants his oxycontin. I always have to check the MARS and previous nurse report closely because he tries to do the same thing about half an hour before my shift starts hoping, I guess, he can get dosed again before his 4-6 hour alloted dosage schedule (depending on narc). My solution, which doesnt apply to all pts by any means, was to point out to the MD that this happens every night at 12AM. She dc'd most of the prn narcs, changed them to set schedule dosage at 12AM, and lowered the strength of PRN pain narcs. I don't deny my pt had pain or breathing difficulty, but it is frustrating to watch him put on a huge show of pain and coughing, then 2 minutes after he gets his narcs he is smiling, feet up on the bedside table telling me now to go find him a soda and something to eat with absolutely no symptoms of pain at all. All I can do is educate the pt on his medicines, his dosage schedules, and try non-narcotic interventions as a first line attempt (and boy does he hate those). But I figure the MD knows their orders, I feel responsible enough to check and follow them or ask for clarification when needed, and bottom line the pt's pain is what he says it is and as long as I have educated him and tried non-narc attempts first I have done right. At the end of the night afterwall I am not an substance abuse nurse. Now, you want to really get me started..its not the drug seeking pts that get me..it's the pts that are undertreated for pain who won't ask for anything or even if they do the MD just won't prescribe anything stronger then tylenol.
  6. CareteamRN70

    how did they pass theyre boards??

    WoW..thats all I can say..I could mention the points brought up from earlier post about administering tx's and medication (O2) outside of your scope and the dangers and RISK "YOU" PUT THE PATIENT IN but that would be redundant. To be quite honest I am surprised and slightly remiss your nurse didn't A: Throw you off the unit B: Report you to the DON C: Report you to the state board for CNA's I've had cna's that have saved patients lives by pointing out symptoms that were leading to a bad outcome, and I have cna's that grab me everytime a pt passes wind thinking it's relevant. I still go and check it out just to make sure and CMA, but if a cna doesnt agree with my judgement they need to go over my head or even grab another nurse before they go practicing outside their scope and even meddle into "practicing" medicine w/o a license which in itself is not only morally wrong but is illegal with sever consequences.
  7. CareteamRN70

    Ever hear of "rollover charting"?

    It amazes me how I can go into work and when I get off in the AM I log into All Nurses and see a post that directly relates to my last worked shift. I had "one of those" nights. Everything was going well and then in the space of two hours 2 falls, an employee injury (which I completely botched by not knowing all the companies protocols). So I pushed off my charting, grabbed the fall packets and started making phone calls like a madman. My unit is currently 55 patients and at night its 1 RN, 1 QMA, and 2 CNA's. By the time I finished the packets, made all needed phone calls, finished all treatments i had put on hold to deal with falls, the continuing neuo checks etc it was an hour past clock out time. They have really started pushing the Nurses to clock out on time, with threats of write ups etc and I have been really proud of myself that in 3 weeks of working as a new nurse graduate that I could get my time down to no later then half an hour past. Today I left at a hour and half past and just did my hot charting and the charting on the 2 falls but still had 26 charts to chart in. I was burnt, I was tired, and I honestly didnt know if I could chart accurately at that point. My plan is to go in tonite for my shift and get report then pull all of my charts from today and late entry as much as I can. I in no way plan to make this a habit, to me this is just an emergency patch to still meet my charting obligations and I hope and pray I never have to even consider it again. I get torn on charting early in my shift (the "ya never know what can happen" aspect bothers me, but I guess I should consider it like an above poster does after assessments..if nothing happens that chart is done..if something happens start a new entry). Any other speed charting advice please comment on. Thnx
  8. CareteamRN70

    How Much Nursing School Debt Are You In?

    I hope no one on the boards thinks I was implying that I was equating not being eligible for grants or scholarships because I was not female, a minority, or belonged to another specialized class to somehow being an injustice or the main reason for myself having to pay cash for my degree. Nothing could be farther from the truth and I apologize if I gave that impression. The fact is the majority of the scholarships I saw, I was not elible, and yes some were because I was not the aforementioned female, minority, specialized class but the primary reason I was not eligible for many was I could not prove "need"...as I said, wife had a very good paying job and on paper we must have looked too comfortable. In reality we were scrapping by to feed our kids and pay for my school. Also the school I attended was very new to my city and was ineligible for many state student grants including nursing grants and federal grants. So again, I wish to state that I fully understand why they do have specialized grants for groups of people, and fully support such grants. Many of my fellow classmates were able to obtain some and I was always very happy for them. They used to joke with me that there should be a special minority grant for men who go into nursing (as I was the only male in a class of 30 women). But the fact is..I did pay..I graduated and have some debt but I and my family survived (very very frugaly) proving in fact that I would not have been able to prove "need" so I have no disdain for those that did benefit from grants I would not have been able to obtain.
  9. CareteamRN70

    LTC is making me hate nursing!!!

    Deja Vu...The OP's post matches one I made last week about not having enough time to do all I have to do in an 8hr shift. I can't say things have gotten better..in fact due to them cutting back on aides it has gotten worse as i find myself doing my work and covering patient needs that my two regular aides can't get too becuase they are busy with one or two other patients. I look after 54 patients divided among 3 halls on the 11p-7a shift. As for me answering call lights I have heard it sets a bad precedence...but a call light chime to me has a pavlovian effect (I was an aide for several years before I became an RN)...I can only listen (ignore) that sound for so long until I just rush up to the residents room to answer the call. The ONLY good thing I see from starting in LTC is "if" I ever switch jobs to a mid acuity floor with less then 20 patients I am gonna feel like I have died and went to heaven...cuz right now I sure do know what Hell can feel like...its an understaffed shift that has additional call offs, an admit, one or two discharges to the hospital, and the "fall" you can count on happening during your longest med pass.
  10. CareteamRN70

    How Much Nursing School Debt Are You In?

    Okay..consider me a worst case scenario. I went to a very expensive for profit school. My reasons are many but to narrow it down...no wait list...accelerated program...no prereqs (they were built into the core classes). I jumped in blind with no savings, no scholarships - ethnicly and by grace of a wife with a wonderful job that pays well I was not eligible for even a pell grant or anything else. My program was about $40k for a 2 yr ASN. I used student loans every quarter and those still did not cover the quarterly cost so paid the rest (about $700 a month) out of pocket. I graduated with $20k in student loans...a lot..but I see it as manageable. As I said consider me a worst case type. I am sure their are many cheaper schools out there and many people are eligible for various forms of student aid.
  11. CareteamRN70

    What colleges offer RN - BSN for graduates of ITT Tech?

    Hi, I went to one of those "for profit" colleges to get my ASN and I will be attending Western Governors University for their RN to BSN program. I have just enrolled and am waiting for them to get my transcripts to let me know how many credits will transfer but from talking to an admissions rep quite a few will, plus they only charge a little less then $4k a semester and if you bust butt you "can" get your BSN in one year (1.5 yrs is the norm) and its all online. Their BSN program is CCNE accredited as well..the school I just graduated from just recently got candidacy for NLN but is not fully accredited. Worth a look and cheaper then other online programs. http://www.wgu.edu/online_health_professions_degrees/bachelor_science_nursing Good Luck in which ever school you chose.
  12. CareteamRN70

    How long is the orientation period in the SNF/LTC?

    I just started as a new grad last month Nov 2010 and was told I would have 10 shifts to prepare me for taking over the night shift. I had 3 shifts on days, 2 shifts on evenings, and then on my first night shift orientation i was informed orientation was finished at the start of the shift and I was on my own. I was told later they cut my orientation short due to how well i adapted to the previous shifts so that felt good...taking over a shift as charge with 5 days orientation and not even knowing "how" to contact the oncall MD, the pharmacy, or staffing to deal with call offs...that was terrifying. Ive since coped and things are going well.
  13. CareteamRN70

    For those new grads who are employed, what's your method?

    Perseverance. In the two months after I passed boards I put out 55 applications. I attended two healthcare job fairs, utilized my nursing schools career services, used internet job sites, and handwalked resumes in. I was able to get 5 interviews. The most heart breaking job I almost got I interviewed for twice, did two job shadows, and did followup phone calls only to never have my calls returned. Out of frustration I actually applied for the same exact job with the same company only a different facility. Turns out this company had multiple recruiters based on location of individual facilities. This time around I was hired within 3 days of my first interview. If I had written off this company, after my first try at employment with them bombed, I would probably still be looking for work. So like the above posters stressed don't burn bridges and don't give up...and yes i was starting to slump into depression but failure to obtain a job was just not an option.
  14. CareteamRN70

    "Don't get stuck in LTC"

    I'm new to LTC nursing, but I chose it as my area of practice. I also heard that I would lose my skills working in LTC..I was told I would be a glorified med passer and babysitter (second part I found very insulting). Well here I am, a few weeks into my first nursing job, in LTC, and I honestly think i have learned more in these two weeks then I did in all 2 yrs I was in school. Theory and practice are two distinctly different animals I found. I have been honing my assesment skills, my practical skills with g-tubes, trachs, dressings, wound care, and tons more. I have had reason to call the on call MD a few times and the first time one asked me what interventions I suggested or what was my idea of what was wrong I was floored...had to criticly think on my feet (yes..I'm that new). It's like that old saying they used to use in military recruiting "We do more by 6am then most people do all day". Now that I am getting to know my patients I find myself going home and cracking my old medsurg and pathology books to study up on their distinctive needs, scanning common meds I pass with my PDR, and I was told if I ever float to another facility within the company I may learn vent care for patients that require it. I am struggling, it is alot to cover, and my orientation was two weeks ago for 5 days...but I am waiting for one of my friends from NS to say "Well, your just a LTC nurse"...because I'm gonna answer "Damn straight I am"
  15. CareteamRN70

    Feeling guilty about working over shift end

    I want to thank everyone for you comments, encouragement and advice. I must stress since this seems to be a focus in a lot of the replies: I do not work off the clock for any reason...if for no more reason then I want to practice under my companies liability. IF I did clock out and chart I wouldn't feel guilty like I do..I'd feel po'd. That being said, yes my place of work is rough..it "feels" understaffed (remember I am new to LTC and Nursing in general), but I love the work and my residents. I just feel bad that I can not seem to fit my shift into my 8 hours alloted, it is a combination of wanting to not hit my company up for OT money just because I can't seem to get done on time..but mostly it is a prideful thing within me.."I" feel like I should be able to do this within my shift and tbh my pride is taking a hit. The advice given here will be very helpful in both helping me with my time management as well as rewireing my brain to deal with the old saying &*$# Happens...ie there are going to be long shifts no matter what I do.
  16. Hi, I just started my first nursing job at a LTC facility on the night shift for a 52 bed unit (well 52 current residents). I feel like I am a living contradiction. When I graduated Sept 2010 I was told I would hate LTC (I love it). I was told since I was new it was unlikely I would get a night position (Out of 55 applications put out only offer I got was my current position 11p-7a). I was told I would not have to worry about charge nurse duties at first (after 5 days of orientating on days and eves I found myself alone on nights as charge). I was told I would have trouble with my aides..and this is a half truth as my aides are a mixed bag of great wonderful workers and a few that hide from me after shift start and I have to hunt down in breakrooms, on other units visiting friends, or out on the parking lot. I had never worked (tbch I had never worked as a nurse so this may not be that great a revelation) with QMA's before and God bless each and every one of them. I did not know how much I appreciated them until I came in one night and I was paired with another nurse and no QMA. I swear the next time I worked and I saw I had a Q working with me I wanted to buy them flowers cookies and coffee. My main problem is (and please no snickering from you more experienced LTC nurses) it was stressed that I had to be out of the building after about 10 minutes or so after shift end... Well when I was orientating that was not a problem...but I noticed the rest of the nurses would just start charting as I was leaving. Once I started working I saw why. They have med passes, tx's, plus a ton of other stuff to do, and at shift end getting the last of the blood sugars, temps, vitals, etc. That doesnt include the fact that the next shift of nurses seem to show up when they feel like it (anywhere from 15 minutes to an hour after shift end). So Im waiting around to do narc counts, give report, and to pass on any other info. First "real" shift I worked by myself I ran about 40 minutes over shift..I told myself I was new and I suppose that was to be expected. The next time we were short aides and so I helped with AM adls, I worked an hour past shift playing catch up. Then next night I had a hell night (again no snickering..this may be a walk in the park to some of you but for me it was pure chaos). Had a resident fall, spent time looking for every form i needed that were scattered around the station, calling Dr, DON, family members, and doing 15 min Neuro checks plus full skin assesment. Was at work hour and a half past shift end. I was positive I would come in to at minimum a written warning or verbal warning. Nope...Unit manager I spoke with just chuckled and said "Welcome to LTC". I am really torn over this. I am trying to find ways to have better time management, I ask every other nurse I come into contact with how they do it (and they all say for the most part they still work over shift). I've made todo list for myself with times I should have x amount of things done..I budget time for emergencies such as falls, change of status events, short staffing of aides, etc...but nothing seems to help much. Some of the aides have insinuated that the RN's work over on purpose for OT..I just don't see that. So am I being naive? Should I just accept that my shift ends when I have finished all tasked and not what my clock out time is supposed to be? - and I refuse to work "off-clock" in anyway if I may be expected to actually do patient care in my finishing up tasks. Looking for advice, suggestions, or at least encouragement that it is possible to squeeze an 8 hr shift into 8 actual hrs. Big J