optimist

New RN grad here (with LPN experience), very rural southeast, just accepted an offer for outpatient Dialysis position, 3 twelve hour shifts, $24.50/hr.....Im still smiling!

Thank you for replying! Where did you do your clinicals if you dont mind me asking? I live in central NC and cant find anything in Greensboro,High Point, Winston Salem, Thomasville, Asheboro, Kernersville,Lexington, Siler City or Burlington. Everyone keeps telling me they wont have any preceptors available or they wont renew thier contract with DCCC. Ive been in contact with Karen but she may be spread too thin because it takes her at least a week to get back to me on anything. Since recieving my acceptance letter, the mission to find a clinical site has been a significant source of stress in my life, I hope the rest of the program doesnt go this well :/

Hi and thanks for taking the time to read, Ive recently been accepted into Davidson County Community College LPN-RN bridge program. For the clinical aspect of instruction, the student is responsible for securing their own preceptor in a acute care/med/surg setting for 120 hours each semester (total of 2 semesters). I need to find an RN in the triad area (Asheboro,Greensboro,High Point,Burlington, Siler City) that is willing to precept for me. As an LPN, I work under my own license and can give meds, do TXs, just about whatever you need me to do. Just think of it as having an extra set of hands for an entire shift! Ive contacted the education departments at all my local hospitals to find one with no success (either theyre not returning my phone calls,my emails, or theyre not in their office) If you can help me or have any suggestions, it would be greatly appreciated!

First semester nursing school...explaining my rationales for each med I was giving that day.....couldnt understand why the instructor giggled at me each time I said ass-a-teem-an-if-en (aceteminophen LOL)

Whats with this complaining? You have a job. You get extra pay for working a weekend. You want extra money on top of extra money because its considered a Holiday? What about those that dont observe the holiday? should they not get holiday pay because its not a holiday to them? suck it up princesses working holidays is pretty much the standard for being a nurse!

I do wound care in LTC. Last week I had a pharm rep representing a very popular debriding agent contact me to give a demonstration on the proper application of this med and new guidelines for ordering from pharmacy. I thought it was very nice that she brought some informative brochures and breakfast. This week she contacted me about setting up a time for her to 'make rounds' with me on the patients Im using her product on so that she could demonstrate 'hands on' the proper thickness of application and other uses. Now I dont know about you guys, but I dont feel comfortable with a pharm rep seeing my patients wounds, some of which are in very personal areas. I didnt want to give her a definite answer until I talked it over with my DON. Are Pharm Reps clinical professionals held to the same HIPPA standards? Is it appropriate for them to make rounds on patients that may or may not be able to give thier consent for such a demonstration? Any input would be appreciated, Thanks!

Ive been working weekends only since my daughter was born in 09 and I wouldnt have it any other way! I didnt want her growing up in daycare, I wanted to be the one to teach her how to walk,potty,talk,manners and I must say that her having a one on one teacher her whole life has put her ahead of the game intellectually. It is crummy missing family events on weekends (not to mention christmas 2 years straight!) but its worth it. We save a ton on childcare and with all of the bonuses and shift dif's for weekends I have the equivelant of a full time paycheck only working 2 days a week. I also have a backup sitter for things I need to do during the week like pick up an extra shift or appointments that arent child friendly. I highly reccomend weekend shift for parents of young children, that one on one time you spend with them while they are young is invaluable.

I do wound care in LTC. I had a pt admitted 6 weeks ago following surgical intervention for hip osteomyelitis. During that hospitalization he suffered many complications from infection including sepsis,prologed ICU stay and intubation.Came to me with a beautifully healed incision to that hip, no dressing needed no complications. So yesterday the CNA calls me to look at a puddle of fluid that had collected under him. I found a pin hole opening in that beautifully healed scar that was spurting massive amounts of blood tinged pus. It was a tiny hole but had significant depth to it.He had a low grade temp but couldnt feel any pain secodary to other DX. I call the on-call service and the NP gave an order to culture,xray and pack. #1 I can culture but we dont have an onsite lab and the sample wouldnt even be picked up until Mon afternoon. #2 I didnt feel comfortable packing such a small opening that obviously had a large cavity under it, I couldnt be positive that all of the packing would come out (he wanted an alginate product in there that turns to gel when its wet). I explained to the NP that I didnt feel we could adequately treat this in house and the pt has a history of severe infection to this area. The NP says "well those are my orders, if you still want to send him out please document it was against my orders". So I talk it over with the pt (he is A/O and his own responsible party). He is very distraught and worried and wants to go to the ER, he asks what I would do. I told him if it were I, I would want the best care possible. He says "well send me out please, I dont want this to get bad again". So out he goes and I had to document Pt sent to ER against NP orders. I just feel so wrong going against what the NP ordered. I know I did the best for advocating for him but should I have pushed for him to go out or treated it in house like the order said. This is just really bothering me today, like I did the wrong thing. Last I heard the pt was admitted to start IV abt until he could get an ortho consult monday a.m.

*caregiver/staff ratio *inadequate staff training *odor control issues *medicare/medicaid budget cuts *implementing stimulating activities for Alz/dementia pts *mass herding policies that serve to convenience staff instead of pts (i.e. all pts must get up and in the dining room by a certain time so that one caregiver can sit between pts and feed one with the left hand and one with the right hand) *I could go on and on

"Tell me when Im in all the way" (measuring the depth of abd fistula) "I dont like how juicy this is today" (referring to copious exudate in previous abd fistula) "could you open your legs a little more? the light in here is terrible and I cant see where Im going" (LOL monthly cath change)

Latex finger cots?

Hmm, Is that position in the greensboro NC area? If so I think Ive seen that position advertised for quite some time now. If im not mistaken, I believe that is just a fancy term for a regular LPN slingin meds all day. I think at one time Brookdale was advertising a 'Resident Care Coordinator' for their memory support unit, which turned out to be an entry level LPN for their locked alzheimers unit. Not that that would be a bad position, im just saying maybe that company uses glittery labels for their openings to draw in more potentials. Be sure to ask why that position is open and good luck!

I love my job! Been doing wound care in LTC for 2.5yrs now. Weekends only. I love the autonomy of working at my own pace, having the time to take a break or help a L.O.L put her makeup on in the morning,sitting and talking to a lonely demented little man.I love only having to focus on a specific part for my assessment (granulation vs nongranulation,exudate type,s/s of infection,etc). I love having the time to help other nurses out when they get overwhelmed but being able to do my own thing when I myself am swamped at the time. I love being obligated to only 2 days a week,with the other 5 to do as I please, or picking up whatever days I want to supplement.I love doing the gross stuff that few other nurses enjoy. I could vent on and on about the difficulties of LTC as a whole, but in general I really do love MY job.

As a child my mother SWORE by mayo on sunburns! Can you imagine my torture in bed at night with HOT MAYO slathered over my face and shoulders. yuck!

I think a lot of this trend is $ related. The SNF Im at is beginning to accept more and more acute pts because they can charge more for their care. As the older 'retirement home' pts expire, they are replaced by trachs, fresh off the vent with multiple wound vacs and a tube for every bodily function. Unfortunetly, though they can charge medicare/aid more $ for the care of these people its not directly improving the care we can provide. We're not educating staff on proper care of such acute patients. We're still using outdated generic supplies and equipment for them as well. Nurses in todays LTC have their work cut out for them, we take care of patients sick enough to be in the hospital but without the supplies or resources a typical hospital would have.

As if unemployment rates arent already sky high! Now you can be denied a job because you're A:too fat B:Have inherited high BP or cholesterol or C: partake in (legal) nicotine products on your personal time.Before you know it you will be expected to be physically attractive, have perfect grammer and good teeth!! Ridiculousness

I visited a Dermatologist today to check out a painful spot that had developed on my lip. It came up in conversation with his assisstant that I was a nurse. She glanced at my chart and remarked "I see you dont have insurance, and you're a nurse? How can that be? Surely you realize how important insurance is." My response "I dont buy into the insurance business and Im prepared to take the finacial risks that that may entail". She rolled her eyes and went on about her business. This is not the first time Ive caught flack for being a nurse and not having medical insurance, as if my involvement in the healthcare field should somehow guarantee that I be excluded from the millions of Americans living without health insurance. The truth is, my employer does not offer coverage for part-time employees (which I choose to be due to family obligations). I could be added on to my husbands work policy on which he carries himself and our daughter but at a price of over $700 a month (heck he would practically be working for just insurance!). I could get my own policy to the tune of $150 a month and pay outrageous copays for every visit and Rx. But Ive found that barring any major emergency/Dx that Im coming out much better NOT having insurance. The dermatologist gave me a discount for paying cash so my bill was only $60 (an insurance copay would have been $70). When I get sick I go to urgent care where they also give cash discounts, I pay $86 whereas hubby and baby have an urgent care copay of $200. I go to the health dept for my yearly GYN visit and BC pills to the tune of $90 (as based on my income) whereas when I had insurance I paid $35 per visit plus $25 a month for Rx. Im saving a ton of money not being insured. Now I know that if anything major comes up Ill have a ton of bills to pay out of pocket, but thats why they make payment plans. I just cant justify paying $1800 a year for a healthcare discount program (i.e. Insurance) And just because Im a nurse does not mean I should have to have insurance!

The investigation was substantiated because they claimed we were not meeting this patients "psycosocial needs". When they interviewed the staff, 90% of them quoted the exact same line....."I only go into Mr.X's room if I absolutely have to,I do whatever he needs and I get out of there quickly". Its not that anyone was intentionally neglecting him but he was so rude and mean to the staff that no one went out of their way to offer anything more than what he asked for. Of course the aide would go in and offer a bath/shower, but once he refuses that aide would move on the other 10 people she had to care for that day.

I work in LTC doing wound care. We have this very cantankerous patient that came in with a small wound to a lower extremity. He is well known for verbally abusing many staff members (especially non-caucasions). On numerous occasions Ive gone in to do his wound care only to be verbally assaulted, called ungodly names and sent out with a big fat refusal to perform his care. He also refused meds, showers, baths, weights, and vitals. Well, without regular treatments to that wound it began to deteriorate and he of course blamed the facility. He called the 'state' with allegations of neglect. Would you believe, that although we had documented his refusals out the wazoo, his allegations were still found to be substantiated!! This man is completely alert and oriented, his own RP in fact, but because he has a dx of schizophrenia, we are not to allow him to simply refuse. Now I must go in and offer to perform care for him when he refuses I must leave and come back within 2 hours to offer it again and accept whatever verbal assaults he throws at me for bothering him again. When he refuses that time, I must ask another nurse to attempt. When he refuses that person we must contact administration at home if need be to come in and convince him to accept care. This is the only person we do this dance for because he caused that big stink with the state. Any other A&O person is allowed to refuse care, its their right, right? Is it just me or does this happen in other facilities? I feel like its a waste of my time trying to convince one person to allow me to care for him when there are so many more that want and need my help.

If Im picturing this correctly, is it a horizontal surgical incision (wide and narrow?) If so I would first cleanse the periwound with an antiseptic wound cleanser (antisept,silvermed wound cleanser,etc) then I would use a large gauge needle and syringe filled with NS (or your wound cleansing product of choice) to directly cleanse the wound. The pressure from the syringe will debride the wound of dead cells.

PRECISELY!!!! I use this trick when Im waiting on my pharmacy to return my call for my refills, work to return my phone call, basically any phone call that Im really waiting on.I also like leaving my phone just out of reach on the bathroom sink and hopping in a long hot shower~never fails, it WILL ring!

You're going to feel really overwhelmed for the first weeks/months.Nursing school does not teach you how to administer meds to 30 people in an hour,while performing neuro checks on the frequent faller Q15, responding to emergencies, hunting down missing meds, answering questions, etc. Just remember the skill of time manegment will come with time! Take deep breaths and dont give up. It takes a special kind of nurse to work LTC and I hope that once you get your routine down, you'll enjoy it. Congrats! Oh and BTW, please dont be THAT type of nurse that thinks the initials behind your name means you're above putting someone on the toilet or fetching a glass of water.Its one thing to delegate, but be good to your CNAs they are invaluable in this type of setting.

Ive been doing weekends only since my daughter was born 2 years ago. While it does suck that I miss out on family cookouts,weddings,social get togethers, etc. (oh and Christmas for 2 years straight) none of that compares to being at home with my lil one 5 days a week. I have time to do the grocery shopping,cooking,laundry, visit family, take week-long vacations.Im not stressed out about missing her and hubby all week. Plus I save a TON in childcare since she can stay with dad or gparents on weekends. Weekends also pay better without the stress of manegment breathing down your neck. I would highly reccomend if you have children not in school yet. They are only this little once and you will never get these years back!

I made the choice of family over career when my daughter was born 2 years ago. Since then, Ive worked weekends only (12hr days) with no insurance or benifits. This way I get to stay home with her during the week and she stays with her dad or family on the weekends. Not only have I saved a TON in childcare but I get to spend these years with her that, to me, are priceless. If I need extra $ I can sign up for an additional shift or two. When she starts school, Ill get a FT job but for now I wouldnt have it any other way.