DenraSam

Huh, looks like the fun takes a little effort? My facility tries too: We have hall decorating contests that are judged by the resident's council. Christmas, autumn, spring, holidays.. Crazy hair day, ugly Christmas sweater day (we sweated that day!) Movie nights with popcorn for the residents. Sleepovers with family members' kids. Our management used to come around with a taco cart, or a sundae cart for employees. We have monthly employee parties where we can attend, or punch in on our day off with raffle tickets earned by playing games like bean bag toss - the gifts range from a potted plant to vacuums to tablets, school supplies for the kiddos- this I am sure is costly, though... Last party was last week and they played musical chairs. I had a patient in distress and only heard the party though:( My aides brought me a plate, though. The cooks make up a special luncheon for these employee parties. We work very hard, often short-handed (like most places) - and we have fun together too - it takes effort though, for the special things.

I meant to add that I care - it's just difficult sometimes.

Hi CapeCodMermaid, I can understand that an error can happen initially: as you so well know, sometimes a nurse is interrupted while entering orders. Last time I was entering orders gradually decreasing lamictal while introducing depakote and then gradually increasing the depakote, I was interrupted 5 times. Three of these interruptions resulted in me having to leave the desk. It took soooo long to complete this order set because of the checking and rechecking. So I get that there can be a data entry error. There really needs to be safeguards in place for this. And in your case, this sounds as if this has obviously failed. My facility has a management meeting every morning in which the DON, ADON and various department heads go over charting, faxes, MD communications, etc. They write up a report and send it back to the floor nurse for corrections/family notifications and follow up. Yay! I wonder if it takes longer to write the report than to just fix the issues? :) I wish that we floor nurses had a desk away from the melee (can't remember the proper clinical name for the group of people we serve and work with) so we aren't interrupted so much. Med passes are crazy with interruptions as well. Any Tom, Dick or Harry (familymember/phone call/page/PT-OT/Environmental/PlantManagement) can interrupt this process. Ugh!

And there is only one thing we say to death: "Not today." Syrio Forel to Arya Stark in Game of Thrones:)

Wait! Is this a haiku? An EBR haiku about chux? Woo!

INFP: 1.5 years in an SNF (mixed bag of rehab, LTC amd hospice care)

Sometimes in my secret heart of hearts, I wonder if "they" care if our patients get well. Its not like healthy people make money for the industry.

SNF 1:17

In the SNF where I work, it is customary to dispose of the narcotics WITH the on call hospice nurse. When the resident passes away the hospice provider is contacted. When she/he arrives they assist with the preparation of the body, any family present at bedside, phone calls to funeral home and/or other family - and then we both dispose of medications as this needs to be co-signed by a witness to the destruction.

Back in the late 80's I worked as an "Animal Care Specialist" in the US Army. (military working dogs, horses, privately owned pets) We were commonly referred to as "vet techs" by the army veterinarians we assisted. We were trained at Walter Reed Army Medical center in DC. Our duties consisted of vaccinations, taking vitals, lab draws, lab tech work, IV starts, surgical assistance, assist with anesthesia administration, teeth cleanings, radiology, kennel maintenance... This just off of the top of my head. We were used as technicians, or specialists. We were trained very much on the "how to" rather than the "why". Did not know much about disease process. We in the veterinary field prided ourselves on the fact that human nurses and doctors cared for one species - the vets took care of all the rest:) (This may explain the "mere human nurse" remark.) Each species is very different and must be approached medically in very different ways. For example: medications safe for canine use will, in some cases, kill a feline. And don't let's get started on reptiles, amphibians, birds.. Anyway, decades later I went to nursing school. The training much more thorough and rigorous, especially with disease process. We know intimately the "whys" of what we do, and have much more autonomy than that of a vet technician. I can honestly say, having worked in both positions, that a vet tech is not a nurse. That said, I am not trying to take away any credit from veterinary workers. They are very knowledgeable and have some mad skills. They work with patients who cannot verbalize what the problem is - and it is instinctual for animals to mask any problems for survival purposes. But.. Its different, though - they are specialists, techs, assistants. Not nurses, really. I could go on and on, but Jeeze, I gotta get to the post office with Christmas packages and then get to baking. Happy Holidays:)

I've seen the term "tubi grip" which is a type of elastic, netted bandage that is shaped like a tube that can easily slip over an arm or ankle/calf. In many cases, our elders' skin is very thin and the adhesive of some dressings or tape may tear the skin during removal. If you cover a wound with a nonadhesive bandage, and then slip a tubi-grip over that, there is no skin tearing. Also, tubi-grips are good to protect PICC lines on upper arms - keeps them in place when removing shirts. ACE wraps can be applied for edematous extremities, kind of like TED hose. Seen these applied when the arms are edematous. I agree with the previous poster, check the original order:)

I work in an SNF, this is what I carry in my pockets: bandage scissors, pulse oximeter, multi-colored pens, Sharpie, pen light, disposable ruler for measuring wounds/skin tears, alcohol preps and brain sheet. Also quarters for the vending machine, lip balm and breath mints. I keep my stethoscope around my neck until assessments are finished, then it goes back in my bag until/if needed further. (I heard that exposure to skin oils/sweat will break down the tubing.) In my bag there is a wrist bp cuff, hemostats, magnifying glass, snacks and juice. In my car, a change of clothes (bad experience with poop prompted this precaution) I've been a nurse for 14 months and have found these are the necessities for the type of nursing I do. Used to carry even more stuff, this is pared down. All of these items have their own specific place so there's no fumbling or patting of pockets. Also, I like to wear a seasonal pin/brooch to brighten the scrub jacket and to have a conversation piece: Currently it is a colorful turkey resting on a pile of autumn leaves:) Oh, and haha - for days that my energy level feels low, I have a special pair of admission-repellant socks (compression, of course!). They really work, good juju:)

Hi and welcome:) I agree with the previous poster, try to get assigned to the rehab hall - you will tend to see more people with g-tubes, wound treatments, IV antibiotics and get exposed to more nursing procedures. In the specialties section, look into the Geriatric Nursing section, there are many topics that address how to get along in this environment, and to get along well. I started in a SNF a year ago and absolutely love it. The work can be overwhelming, so it's best to go in with a plan. I like to make sure I list all the residents who need medicare charting that shift. You'll need vitals and a focused assessment based on what the resident is admitted for, ie: infection, ortho, renal, CHF. Then I list those who I need vitals for, those who need closer attention - these residents could have fallen recently and we need to watch for pain or further injury. They might have new onset edema, a cough, diarrhea, emesis event and so on. Know which resident has O2, and how many liters- you will check their O2 saturation to be sure all is well and their portable O2 tanks are full:) Know who has a foley catheter so you can monitor output, who has pressure ulcers so they can be shifted frequently to offload pressure. I work evenings, so I like to know which residents I need for blood glucose checks/insulin injections before they go off to dinner. My facility likes to administer Coumadin right at dinner time, so I like to know who those folks and their latest INR are as well. I note those who are given nebulizer treatments, and the times. Find who is getting IV antibiotics, and the times of administration. You can try to find the oddly scheduled medication (doesn't fall into normal scheduled med passes). These things are sort of the framework of your shift - the things that are strictly scheduled - the rest of the stuff can be completed as you can get to it. As an evening nurse, it is easy for me to save dressing changes and skin treatments for when the resident is undressed and in bed. My aides and I have found a nice working relationship. I ask that they wheel/walk the residents to me before dinner, for meds. I ask that they report skin problems or anything unusual to me right away, and appreciate this when they do! I try to help them as much as possible when there's a moment or two to help reposition/lift, answer a call light, toilet somebody, etc. You can learn so much from the aides when first starting out - everything from facility procedures to resident likes/dislikes and which residents or family members or staff need to be handled with care:) When taking report, find out how the residents take their meds. How do they ambulate, or are they in a wheelchair. If they are continent, how many to assist to transfer to the toilet. Your aides will know alot of this, too. Don't ever be afraid to ask a question. Try to cluster your care if you can, it will save time... and your feet. Getting vitals, a focused assessment, accucheck, med administration along with a dressing change all at the same time is a tremendous victory - you'll see! Oh, and try to be sure your cart is stocked with everything you might need at the beginning of your shift. Water, cups, applesauce, syringes, nutritional supplement drinks, gloves, tissue... This is all I can think of right now. Best of luck to you - you can do this. You might not feel that way just now, but you can:)

I was taught that we should all use pens that look alike. If the pen is different it could catch the eye of anyone investigating any thing, and pens that are not black and ballpoint are subject to closer scrutiny. I prefer blue gel pens - but at work it is ALL black ball point.

Started my first job as an RN last September in an SNF with a 17 patient assignment - evening shift. In the beginning I was super anxious to the point of nausea before each shift. Heart racing, light-headed, turn the car around kind of anxiety. FSBGs, G-tubes, IV antibiotics, dressing changes and wound vacs... Afraid that everyone would find out that I was an imposter and didn't belong there. Often had to stay hours late to chart, especially after a night with one/two admissions or something out of the ordinary like sending a resident to the ED or a fall event (Or a resident found on the floor after sending another to the ED:( I sometimes left feeling like a failure. So - the good news is that it gets better. With six months under my belt, this profession seems doable. There's less anxiety, though still some butterflies with the new situations that always will pop up. I am learning and am beginning to believe that I can really do this thing. And so can you. It takes time, I guess.