txgal34

on my med surg floor vs are taken at 2000,0000,0400. i had a similar situation where the midnight vs (got at 0030) were high with no PRN's ordered for the BP. when i called the hospitalist he asked if they were sleeping. when i answered yes, i just also added this was the Q4 hour VS check. he did give me an order. i had to laugh when at the 0400 VS check when another nurse had to call with an elevated BP and was asked the same question....lol...!!!!

this is my first hospital job...so this place is all i have to go on. we are med surg nurses, obviously trained, but not cardiac nurses....possibly why it is the way it is. i know larger hospitals that have a true "tele" only floor, we don't. we have icu and ccu. yes, acutally all floors here seem to stay quite full. if someone goes into NEW afib with RVR they are 90% of the time transferred to the unit. if it's not new onset, then usually not. as you probably would think...we do have a fair amount of transfers from med-surg to unit, then back again! not sure why policy is that way...but it is.

First, it is not a "tele only floor." They lump two floors... one is medical, one is surgical and if tele is ordered, tele box is on. On one floor our tele tech sits and watches the monitors which are for both floors. While this in not a rural hospital, it is on the outskirts of the city. We can do IV lopressor just not true cardiac IV meds like cardizem. actually IV cardizem and IV dig are the only two i have heard of that we call an ICU nurse to give....it is hospital policy. all drips (except heparin) go to the unit. no, we don't have a step down, they got rid of that a few years ago. when IV cardizem is pushed it has to be an ICU nurse and a crash cart there too. i can honestly say in the nearly 3 years i have been here i have had icu have to come up twice. IMHO, if they are sick enough to have a cardiac drip they have no business being on a true med-surg floor where you are taking 5-7 pt's.

....i love it! i had a family member track me down as i was standing in front of the elevator to leave. just a simple hug and thank you for the attentiveness and explaining care and the planned care! i love the education part of nursing, and always love to do pt. education while in the room rounding or while giving meds! we also have "kudo cards." i value them because it meant my pt or family member took the time to write out their appreciation of me. sometimes you can never make a pt/family member happy, but the appreciative ones make it worth it!

My med-surg has LVN's and RN's. We have tele on both floors. While the acuity is higher on a tele pt, both RN's and LVN's get tele pt's and it doesn't change the amount of pt's we get. All nurses have PALS and ACLS. We also have a tele tech on the one floor to watch both floors. On our med-surg floor, only and ICU nurse can IV push cardiac (cardizem, etc) med and if they need a drip, they are sent to the unit.

thank you everyone for the positive comments. i now have a little over a week under my belt and am feeling much better. my confidence is growing every day! sometimes i think you just need to hear "it's going to be ok" and i thank you for that :)

thanks MomRN0913, I asked the DON to review my documentation as I have done LTC documentation but this is different system. I asked and wanted the input to ensure i was documenting correcting instead of going on for a month and finding out that I wasn't doing it the right way. She was not critical or mean at all, I just took it personal because what she pointed out was like "remember I showed you that you have to click on the MAR in the middle of the page to document the insulin?" well...now I do....oops! I had forgot and you pull the template box down in the notes box which has you document the amount, site, etc...so it is like double charting to me and while I have use multiple systems, never Kinnser. Other feedback that made me feel dumb was just , "you should have documented this/that" and realizing that she was right, I should have. I guess I wanted to impress her and instead felt like I appeared like I don't know much. It is hard when in LTC I was praised for my thorough documentation, and now I have been knocked off my pedestal...lol. In in LTC I can ask a fellow floor nurse for help if I have a question, I try to not bother the DON (possibly avoid is the right word...lol) but this is a small agency and I feel awkward having to contact her every time I have a question as she is the go-to person. There are a few other nurses, but not able to contact them for questions. During training when I was able to speak to another nurse who works there I picked her brain as much as I could. I do love the one on one time with the pt's....in that aspect it was exactly what I expected :)

"kind swear is a challenge". Meant Kinnser.....darn that auto correct...lol.

Thanks for the comments....I guess it's hard feeling lost and feeling like I don't have the answers so often. I am so used to be "in my element" that now I am definitely out of my comfort zone. I love learning new skills, but it's challenging not knowing answers and not having the answers and having to call a DON to get one. Kind swear is a challenge....like I forgot (part of my feedback) that while I did the NN of giving Lantus that you also chart under the med section. I just have to trust myself that with time it will come :)

The feedback was asking DON to review my submitted documentation.

I have worked LTC for 3 1/2 years and decided to get out of the rat race and try some HH. I love the idea of spending one on on time with my pts and actually being able to talk to them instead of the crazy rush of LTC. I was given some training, and they are slowing weaning me into the process a few pts at a time. Working in LTC, I have great time management skills and am used to thorough documention. We are on Kinnser, which is new to me. This HH only takes MCR pts. Today I saw my first two pts on my own. First, let me say I am a perfectionist. I asked my DON for feedback, and when given feed back beat myself up for feeling like I should have done it. I feel overwhelmed, then I feel like an a failure for being overwhelmed by this as I can work a LTC floor with 25 MCR pts but stressed at 2 HH pt's! I feel like I am a bit lost and have to call the DON multiple times to ask questions. Is this normal for a HH newbie, I hope?

i think you have to look at several factors. I am in TX, so it may be different here. I choose the LVN route because it can be done in 11 months (fulltime student). Here, there are crazy waiting lists to get into RN programs. LTC is EASY to find a job at as an LVN. RN's are finding a tough time getting a job, though it can be done. Here, hospitals rarely hire LVN's so if you were set on working in a hospital then LVN would not be a good idea. ADN will take twice as long, though so many more doors will be open as an RN. Try to get a part time job as a CNA/PCT when in school if possible because that makes it a million times easier to get a job at the facility.

not all LVN's/LPN's are "jealous" of the RN. I graduated with a 4.0 from an LVN program. I CHOSE the LVN route. I will in some point in the future probably pursue my RN, however I am quite content in the LVN role. TX is very liberal state "we work under the supervision of an RN" so if facility policy permits and we have been properly facility trained, there are not restrictions. I am lucky that I have worked with excellent RN's, sometimes new grads. I know coming out of school I had a lot more clinical experience and would glady help when they needed help with a procedure (cathing, etc.) that they were not proficient at. However, their knowledge is much greater due to the classroom education that I did not get and are able to easily explain a question I may have because RN's have had that in-depth classroom education I have not. Maybe the concern of the OP is not having an RN in charge of the LPN's, but more of a concern if/when an emergency happens, will the RN be able to know what to do? I am very competent, however when I have any doubt on a pt, will get my RN to take a look at the pt to verify or ease my concern.

...for concorde you have to take the NET test. they used to sell the study guide, but no longer do (or so i have been told). but you can go on amazon.com or ebay and get a used one. you are required to acheive certain scores on the math and reading comprehension sections. their are a couple of other sections, but those are not used to compute the score. reading comprehension speaks for itself! math, you need to know fractions, decimals, and percents and how to convert each one to each one. though i took math up to calculus in high school...without the study guide i probably wouldn't have done well as i had been out of school for about 15 or so years. it just memorizing the formulas and the NET study guide walks you thru the study guide. i don't think the test is hard, just got to sharpen up on the math if it's been awhile. i work at an LTC and am very happy. you will do 720 clinical clock hours, and a little more than a third were at an LTC. initially i had never planned on the LTC route, but it's a perfect fit and i work with a great group of people. though one day i may wish to go to the hospital, the experience was negative and i don't mean the "LVN/RN thing". i mean as in LVN/PCT, LVN/LVN, LVN/RN, etc. very negative group of people seem to work at some of the hospitals. and while i would like to think this was just my clinical experience i have known others already in the field (even out-of-state) who left the hospital enviornment or the medical professional due to the hospital enviornment or other co-workers. i love my job and work with a great group of nurses, CNA's and staff! i only say this because if you do want to work in a hospital, do know as an LVN it is not impossible, but will be extremely challenging to find one to take an LVN.

tiffanyyy1390, i am glad you are going for it! don't let them make yourself think you can't do it. i gradutated concorde with a 4.0 and saludidictorian...and no, i wasn't a 4.0 student 15 years ago in high school! ...and i had no medical background. level one was the most challenging for me because for those in the medical field seem to know most of it and those of us not were being introduced to a whole new world! i graduated second in my class, and that is figured on the whole vn graduation of day and evening so that means second out of 94, even though 75% of the class were ma's or cna's. when it comes down, how well you do has nothing to do with whether or not you work in the medical field and completely to do with your studying habits and determination. i also excelled at clinicals. to be honest, i think procedure wise it is easier for us with no previous med experience because you have a very structured way to do and be tested on procedures. when you don't have a clue, you do as taught. some people with the med experience had to put more effort into the skills as they learn the bad habits which go on in the "real world" but are not the acceptable when you are doing skills check off. for example, a friend of mine who had been a ma for 20 years failed the skills check off the first time at the end of level one for breaking sterile field. she deals with it all the time at work and know it. "technically" even when you throw something in the trash hands must be away from body and above waist. during her cath skills check off her hands were at waist level when dropping trash into can. though hands were away from body and in the real worldas long as you hands were kept sterile you would keep going, however for concorde skills check off that is breaking sterile field and a skills check off failure. just like on tests.... i have seen people with previous medical knowlege answer questions wrong because that is the lab value they use at work, or the med they use for that disease, etc. so sometimes have no previous knowledge and starting from scratch can make it easier. i know this first hand as i now am working as a nurse and i see the huge difference from the "testing procedures" to how we actually do it in the facility! good luck!!!!!!!!