springchicken2+2

I'm a recently graduated LVN. This week I started my first job in a Transitional Care nursing unit (LTC facility Annex). I'm concerned about my weak assessment skills. I really have not yet found a system that works for me. I usually have 8-12 patients on a shift. Every time I chart I find that there are many things that I forgot to assess on my initial walk-through, so I end up making several time consuming trips to re-assess my patients. Any advice on routines that work well for a quick head-to-toe would be greatly appriciated!

YES! I recently graduated an LVN program and I thought this MANY times! Two of the most importaint things that nurses need to know to simply function at their jobs is LABS and DRUGS! In school we got diddly squat of both! Unless we were hurridly looking up drugs or a lab value in clinicals. I don't know about others...but I can not learn that way...not with 100 other things going on at once! So, now that school is over I am having to cram to learn as many drugs and labs as possible before my preceptor let's me out on the floor on my own!

These are some great ideas! It seems like common sense now that you mention it, to first get to the bottom of this residents anxiety before deciding exactly what my next step will be. I have only worked as an LVN for 4 days now, and being new it is so easy to be so "task oriented" that I forget to just use a little common sense when dealing with problems! I guess that is normal at first! What makes me so angry about this situation is that my preceptors deceptive actions are the reason that this situation is going to be so hard to deal with in the first place! The resident does feel totally justified in refusing her insulin, because she has been lied to so much and believes that a smaller amount is controlling her BS! I just want to tell her, "No...they have been feeding you a bunch of bull...!!" But...I could just imagine all the dramma that this would cause! I would probably be fired for not going to the DON first...

Hi! I am a new nurse and just started working in a Long Term Care Facility. I am of course overwhelmed, as I am sure all new nurses are when they begin their careers. My preceptor certainly does not do much of anything "by the book". She has long abandoned universal precautions, and (as far as I can tell) does not ever assess her patients (she simply relies on the CNA to let her know if an issue arises and simply copies the information charted on previous shifts concerning patients whith edema, respritory issues that need monitoring, etc.). This, I realize, is going to be something that I run into anywhere I go. However, there is one issue that is bothering me more than any other. There is a resident on our hall who is a diabetic. According to my preceptor she once "bottomed out" and is now scared to death of it happening again. She is on a sliding scale (her bs runs quite high- usually over 320). She usually requires about 12 units of insulin at 1600 (according to her sliding scale). However, she does not ever want to be given this much. Every day it is the same routine (accoring to my preceptor), she needs X amount of insulin, but will insist that the nurse give her less. For example, if she needs 12 units she will insist that the nurse only give her 5. She is totally competent and in control of her own care. In order to avoid conflict, my preceptor will LIE to this woman about the amount of ilnsulin she is giving her! She will say "Well, your sliding scale calls for 12 U, but I'm just going to give you 5..." Then she draws up 12 units and gives it to her anyway. I know that once my training is over I will have to resolve this issue (obviously by getting the doctor involved). What I am struggling with right now is whether or not to report what my preceptor is doing to the DON. Everyone that I talk to (nurses in the area, etc.) advise that I just stay out of it. They seem to think that I would be courting disaster by reporting her. Please! Someone give me some advise! I really feel that I should say something...am I'm I just being naive?!