pomegranate

I had been getting the skins early in the morning but now the DON wants me to work the same hours as the rest of the office staff so she has "more accountability" and "knows where I am" (aka, she can't ask me to do things if I'm not there at the same time she is. I do not sit in an office all day so it makes no sense because she isn't going to know "where I am" at all times anyway unless she hunts through rooms... have tried explaining that it is easier to do treatments if I work 6-2 or 7-3 because therapy and activities and meals interferes greatly with my ability to do things working 8-5 (Especially since I have to go to stand up which takes an hour out of that time!!) but she wants us all to work the same hours and will not give me a reason why (the ADONs are mad too because they previously had one work 7-4 and the other 9-6 so we had greater hours of coverage but nope all nursing management is now 8-5 no matter what your job is...) Whenever I relay complaints I am told to fill out the grievance myself and if I don't she comes after me asking for it, same thing for stuff like "patient got a skin tear in therapy and the charge nurse didn't call the family so now it is your responsibility." She is even trying to dump other things on me like telling me that since I have to call a particular family weekly about the patient's wound I also have to tell them about the patient's weight loss and increase in hallucinations, other nontreatment related things. I tried to explain to her that it would probably be better if the ADON did it so they could discuss the patients' overall health and the family's other complaints (of which there are usually many) and she again got mad at me and told me that I am a nurse so that it is in my scope of practice and therefore I can do it so I should because "it'll only take a couple minutes." I'm being nickel and dimed to death. you know, typing all this stuff out just made me realize there is probably no real answer other than to quit because she doesn't respect me or my time. I have been doing most of these things for a year and have managed my time fine, but all this "just a few minutes" things have been adding up to hours out of my week.

See that is the problem. I am not being allowed to delegate anything. Corporate policy is that the treatment nurse must do all skin checks because the charge nurses weren't doing it. I am held responsible if a skin tear gets infected and I have to monitor their progress again per corporate. it's just too much!

I've been treatment nurse at a 100bed SNF for the past year, and recently our acuity has ramped WAY up with regards to wounds. We got a well known specialist on staff and now we are getting admits left and right. In addition we have a new DON. Looking back at my paperwork I averaged between 15-20 patients daily in the past few months. That number has jumped to 25 or so patients...with 38 wounds that I am expected to personally treat each day, some twice a day. In addition I am supposed to do 12 skin assessments a day, measure and monitor all skin tears and surgical sites at least weekly, careplan, monitor pre-albumin levels and report to dietitian, make wound rounds and check that patients are being turned every 2 hours, clean the biohazard room, order supplies/clean the treatment area in the supply room, inservice CNAs, attend the daily meeting which takes an hour, round with the MD weekly (takes about 2-3 hours) go to the QI meeting which takes 2 hours, call all families weekly (which ends up being a recitation of all their grievances about every little thing in the facility and I have to fill out complaint forms constantly) and measure, and also fill out "Pt noncompliance" and "Pt education" forms DAILY in addition to documenting daily about noncompliant patients. In addition I am supposed to be a "unit manager" all of a sudden, this was never formally part of my job duties before --I helped out the ADONs when my census was low, but now my new DON expects this on a daily basis and if I say that I can't do something because I'm busy I get a very negative response from her. The ADONs understand but she is very hostile towards anyone saying they have too much to do. SO now I also have to deal with issues like pharmacy recommendations and checking admissions etc along with conducting part of new employee orientation. I end up turning all these bed-bound obese patients by myself, changing their briefs and doing incontinent care, wrapping legs with ACE wrap, putting on TED hose, putting lotion on, toileting, etc just because if I do not do it or if I ask a CNA to do it I will be waiting around for hours or it won't get done (I have experimented with not doing it/writing up the person for not doing it and it just doesn't work.) I don't think of myself as "above" this care but it does take a lot of time out of my day. Anytime I delegate anything it just does not get done, period. The DON's response to this is to do it myself because "it'll just take a couple minutes." I understand that changing one person's brief "only" takes 20 minutes (because there are never supplies and by the time I get in there the person is guaranteed to be covered in diarrhea or dry, sticky BM) but when I have to do it for 10 patients on top of the actual wound care--it does not work. I get yelled at constantly and told "It's in your scope of practice" if I request that a task be directed to another person. I just don't know what is reasonable for a LTC/SNF wound nurse to expect. The weekend wound nurse is also overwhelmed, she told me she feels that what we are being asked to do is completely unreasonable, and she does not have to do half the things that I do (care plans, family updates, any of the unit manager stuff.) These things have all been irritating since I took the job, but with the sicker patients we have, it's becoming overwhelming. I tried to speak with the DON about this and she just threatened to fire me and get someone who can do the job... I think I do as good of a job as I can with the resources that I have, but I cannot do all these things in 8 hours, nor do I want to keep working 14 hour days (and now I am getting warned about overtime.) How do I get her to understand that I am not being lazy or "passing the buck" but that this is just too much? I offered for her to come and shadow me for a day but she said she is too busy to do this. Should I just cut my losses? I really like doing actual WOUND CARE but all this other stuff... it's getting to be too much.

I'm confused, what is the difference between the two? Is one track easier or harder? Different pre-requisites? Which has a better reputation? I am considering the LPN-RN track, FYI.

In Texas surveyors ALWAYS look at pain management of LTC patients and, uh, 10 days is NOT ACCEPTABLE anywhere. ONE day is not acceptable for a patient to not receive their pain meds. You better make sure you are charting your ass off about harassing the doctor to get those meds or you will get in trouble too when they come asking why the meds weren't there, because the doctor sure as hell isn't going to say that they 'forgot', they're gonna say the nurse didn't call. Put it on the 24 hour report, chart every time you call, and you better be calling at least 3x/shift... it sounds like it's time to get your DON/Admin involved and if they don't care...you need to look for another job, because ain't nobody got time for that.

Don't tell anybody how old you are. I became a nurse only weeks after my 20th birthday. I hit the floor and people would make comments about how I was so young to be a nurse and ask how old I was, and I didn't ever tell anybody until my 21st birthday was approaching, a year after I started working there. They didn't believe me til I pulled my driver's license. Of course now my nickname is "Little one" at work, but they had already learned to respect me as a nurse, so my age doesn't really ever come up except when talking about stuff like old tv shows :) . One thing that's helpful is to be assertive and use a low voice--I had the habit of speaking in a high pitched voice due to trying to be nice/polite and also out of nervousness, but people will take you more seriously if you don't do that. But you've got kids and experience as a CNA. You're not green, you're grown, and you shouldn't feel bad responding to questions about your age with non-answers like "Old enough" "I'm grown" "85" etc. Or play it off like "And how old are youuu?"

I had small stretched ears (6g, 4g) in nursing school, when it was expressly forbidden and our clinicals manager used to talk about how disgusting they were all the time and look at everyone's ears really closely (as close as she could be without being in your space) She was the only one who noticed the whole time and she asked "Are those gauges?" and (since they're not called gauges...) I blithely replied "No" and she said "Oh, ok then" and went on. I think as long as they are conservative like colorfronts 99.5% of people won't notice.

I did, but I'm 'tragically unorganized' lol. one of them was only $5. Worth it since my program would send you home if you showed up to clinical without your stethoscope. And now I have a little collection going on: my littman that I bought in nursing school, the cheap one I bought as a backup, another cheapo that they gave me in nursing school that I could never hear a damn thing out of, and my mom's from when SHE was in nursing school that she gave me when I graduated. (I don't use that one because it's too short to hang around my neck and I wouldn't want to lose it.) I'm thinking about getting a cardiac one because I'm a little hard of hearing and would appreciate not having to strain to hear stuff. lol.

95 y/o Patient on hospice for lung cancer, inoperable, chemo will not help, hence hospice. Family wants CT scans of the lungs every month. why? "we NEED to see how big the tumor is." because that's not a waste of medicare dollars? we're not treating it, it doesn't matter how f@#$#@g big it is. -____- The things I see people do to their family members. "I WANT EVERYTHING DONE!" when the best thing would really be...nothing.

we get to wear colors other than our designated uniform color. i think that's it. lol

Lol I would think the last one would be a line of smaller women saying "Can you help me put the pt in bed" and "Can you help me pull the pt UP in bed" lmao

Our lab is pretty good about stats, usually will come within an hour or two, and we get the results very quickly after that; x-rays / dopplers /ekg take a bit longer, but within a few hours. Our pharmacy is not good with stats. Stats can take 6+ hours to come sometimes. It doesn't help that our pharmacy is located 2 hours away anyway....

I have been on the floor as an LVN in a LTC/SNF a little less than a year, this would've been my thought process if it were me: 77 isn't that low, but with these people who have long-standing norms in the 200s, it is unusual. The other VS were ok? With new or increased confusion in the elderly, what I've learned is you always want to check for a possible UTI, dehydration, or pneumonia. These are the biggies that cause changes in condition imo that can be treated without absolutely requiring a return to acute care. Part of SBAR is the recommendation/request at the end. So in this case, if I had been you, I would have requested for a stat* CBC, BMP, UA with C+S, and to monitor VS including FSBS (I would get an order for VS even despite it being a nsg action, so you have a means to document it in the MAR/wherever you document that kind of thing, and to ensure that there's continuity, so next shift doesn't just blow it off.) Those 3 tests will give you a wealth of information, and monitoring the VS will give you a means to make sure the resident isn't going downhill while you're waiting for them to come back. In your resident the BMP would've most likely shown elevated creatinine or BUN, when the UA came back it would've shown whether they had an infection or other abnormalities associated with renal failure, the CBC for the WBC count (and just to rule out any new onset of anemia or any other crazy thing.) Depending on the doctor they might also order some extra things like an anemia workup, CRP, D-dimer, etc...but usually they will wait for the results of the first round of tests to do that, unless for some reason they suspect another cause. I have to say your doctor sounds pretty rude. Ours were impatient with me at first when I was brand new because I was so nervous and I didn't know anything. But as time goes on, I have learned some things; I still feel stupid half the time calling them, though. Make sure you always have a copy of the updated chart/MAR, recent labs, VS, and think out what you are going to say before calling! I write a list of things to report, that way I don't forget any, because I get flustered on the phone (esp with some of our 'nicer' doctors.) Saying she seems a little more lethargic than usual is going to frustrate some types of doctors because that varies from person to person, you saying that could mean that she's just having an off day, nurse xyz saying that could mean that the patient is halfway to comatose. know what i mean? however, most doctors will take your word for this kind of thing because you know (or will get to know) the patient much better than they do half the time, especially when it comes to how they behave on a daily basis. I know this post is long, hope it helps a bit. *I say this because our lab comes within a couple hours to draw the stats and we get the results pretty soon after that, these may not work for you if your lab only comes in the AM or whatever.

Well some good news--if your state has Med Aides, you could probably do that too. i know in TX you can get your med aide certification after a short time period as an experienced cna, i bet you would have an easy time with that considering you have the pharm tech cert behind you.

There are some serious issues with vo-techs, but the Commuter hit it right on the money. These schools are very appealing to people who are not able to meet the demands and jump through the hoops that regular colleges and universities demand. I know because I'm one of them myself. When I decided to go into nursing, it was after I had received bad grades doing another major at a university. To get into the community college program, I would have to take several tests, a years' worth of pre-requisites, and then be placed on a waiting list. Placement determined by GPA. Seeing as I had bad grades in the past, I thought about it and realized that either I could go and take comm. college classes for a year and then pray and hope I'd be accepted into the program; retake the year's worth of bad grades, then the years' worth of pre-reqs, then wait and see if I got in; or sign a piece of paper, take a loan, and go to nursing school and become a nurse by the end of the year. For me it was a no brainer. Was it financially a good choice? Yes and no. I did not have a job or other way to support myself. I needed to be able to make a living wage as soon as possible. And I wanted to be on my way and in my career. So I went to a vo-tech. I graduated at the top of my class. I feel like I got a okay education. But I also think you get out of it what you put into it. I wanted to work hard, so I did, and I learned a lot. Others did not. There were many students in my program who completed all the pre-reqs and didn't get in to comm college programs because they did not get straight As. Or who had attended a nursing program and didn't pass, and were kicked out for not passing. Or who needed to go part time. Or needed more fin. aid help. Or lingered on a waiting list for over a year. Etc. As far as what VICEDRN said about the students not wanting to hear a bad word about their schools...Have you ever TALKED to any of them? Everyone in my program knew they were being taken advantage of and paying too much, and complained about not getting a good education. But it was the best option at the time for them personally. The votechs are willing to work with you on many issues which comm colleges are not...for a price.