taramb7263

FYI- I only work subacute because I'm an RN . Lpns go to ltc. We are acute to subacute and rehab so on top of your med Surg , I do ortho, trache pts massive wounds with vacs, pegs ng tubes , palliative care and hospice:))) in addition to cardiac. Respiratory neuro( stroke, subdural hematoma , vp shunts . Ostomies etc we get cardiac on milnirone via Pumps , Iv infusions for infections plus CA pts it's endless . Every day I learn something new . I left ED psych and it was the best thing I did because not only have I gained skills ,I have been forced to work under extreme stress, do most things on my own without support and learn to prioritize and delegate for an average of 18 pts in addition to meds in 2 hrs for all , vitals, bs checks, assessments ;juggle it around pt/ot wound care tx and take off orders, deal with pharmacy issues , labs, diagnostics and ****** off family members screaming when something isn't addressed! My day flies especially when I also have to document on all pts also ! Subacute is NOT LTC nursing. Btw it's helped me a lot to not be a whiny new nurse and push myself everyday .., I still want back into the ED but not psych this time. I have over a year now and started to apply again. I got 3 calls in two days for interviews based on my job in subacute ; an ED/trauma hosp, an ED hosp and a medsurg/ rehab in hosp( which btw, the hosp rehab starts @ $40 / hr and goes up with each shift ) so just don't R/O this type of nursing:))) I hope my interviews go well and if they don't I still have an awesome job with great pay that just let me switch to part time hope you land in a great position!!!

Frustrating I know... But focus on your work... Many find ways to cheat but just keep yourself focused on your work. 100's don't matter and questions are subjective . Just get out and pass NCLEX. She can score perfectly but when you take NCLEX there is no way to scam and you can't predict what it asks you. It's all critical thinking. You will pass and she will fail bottom line. FYI when you start working it's the same thing. Nurses cheat hide and cover up and you need to make sure you don't .

You nailed it! I work ft in subacute and it is nuts how busy we are:" plus we usually have the max pt load which is 20 and depending on the acuity , and charting all the time all day I always get out late. We have more issues with aids calling out then rns. Our facility staffs subacute with RN s mostly and lpns when no rns are available:( my dilemma for not wanting to go to work is more personal that patient work related. I don't see calling out to be professional unless it's necessary... Otherwise just put in for pto:) the patients do suffer and I hate running my behind off to compensate for someone who doesn't come in.

I work in mercer county

statement: I agree with the comment of not showing possession of any coworker, you are a team and pt satisfaction is the ultimate goal. question: Most places allow you to assess but based on my knowledge, an lpn is an lpn not liscensed in assessment or such hence the RN and the NCLEX and the degree. (and i know most lpns are capable and some with much experience)this is not to insult any lpn:)by state board standards lpns are not trained to assess and teach. the rn should always reassess, which yes, some new grads may know less but ultimately the RN is responsible for you and the aides. When push comes to shove its her @#* on the line. I find it is alway a battle of "well, I think I know more" Just work together and do your job and worry about yourself and your patients. Don't waste negative energy on the BS work together and remember why you chose to walk into a facility and take care of another human being.

I have recently read an article about this and the issue regarding a "slow code" it was quite interesting. I guess it is considered unethical by some but I guess it is a case by case decision.

I have been in my job for almost 5 months and after many days of driving home crying it all finally clicked. I am an RN in a very busy heavy care subacut unit, a big change from my psych position. I am a nurse for a little over a year and this position is hard. But, I am learning so much! I am exposed to so many skills and I have a wide variety of patients. patient load is max 20 with assessments, woundcare, traches, enteral feeds, ostomies, ortho, neoro, respiratory, neb txs etc no charge nurse, I do all my orders, deal with problems with an outside pharmacy, family issues you name it! CNAS who are lazy and expect me to do their job while I pass morning meds in less than 2hrs for 20 pts, I also find I utilize my psych skills on a daily basis. It is hard because of the patient load but I am getting faster and faster. I am learning to prioritize and delegate and I have become assertive with the slackers in order to provide great care. I have already received several thank you cards and letters to my DON for the care I provide. I work 8 hours/5 shifts a week, no lunch and never pee! I love my patients and I hate the shady nonsense. I practice safe and I am learning to call out those who don't. I think this was the best choice as a new nurse to push me to be a great RN and I know at this point, I could step onto a hospital floor again and do great things with 1/2 the pt load!!!! For those who think subacute nurses are not real nurses, think again. We lose nurses weekly because they run away crying because of the work load!

Hi, how are you. I intervied there for the core 2 position about 6 months with 4 of the rns at the interview. They were great and I was waiting almost three weeks to hear back. The job was pulled and I found out they checked my references. I have two friend who were nurses there who told me I had the position. then the twist. The manager loved me pulled the job and sent my stuff to HR to call me in to do paperwork and Hr fought her cuz my BSN is not yet completed. the manager fought with her for a week and I finally received a call from HR saying I did not get the postion because of my BSN in progress! so- good luck if you have a bsn you may be in the running also if you have experience which I did. let me know how you make out. PM me!

Sub acute care is a good place because you can utilize your skills in a fast paced environment. They always need good RNs. If you have a tough skin and know how to practice safely then your good. I work in one and there is politics but as a newer RN who left a hospital, I am learning tons and I love it. My facility is so busy so the patient load for me right now is 14 but I get a max of 20. They are more likely to hire an asn if you have experience.

Thanks. I have had great results. I have recently learned to work with the wound vacs and I have had success because of the input. I truly appreciate the help.

The wound was the result of AC from hip fracture that got infected and the pt developed mrsa . The surgeon had to debride it because the infection was down from the top of the hip to the knee. We had retention sutures to start with partial wound open. After several months the wound is about 14 in in length and 8 inches deep with the trochanter visible. She is a very large woman and it is left lateral hip. It is a constant problem and it takes 20+ minutes to just pack/ dress. Then I have constant issues because in am I switch her from a lg vac down to a sm portable vac which she insists on for therapy even the the nurses feel it is unable to keep up with the wound. So- all clamps open tubing clear suction @ 125 and it will beep and say tubing blocked or can muster full and the pressure will fluctuate. I am frustrated because it is a continuous problem for staff and pt but noone is taking the time to solve the issue it is just temporary fixes!!! I have stressed to the pt cnas and pt to please not pull on tube when dressing ( the pt wants it a particular way and I have tried to secure the tubing with sx tape to anchor it si that it doesn't weaken the dressing seal but she has refused to let me do it staring the tape irritates her! Which now once again without doing this there is a problem . I'm do frustrated and I appreciate the input!

I work in a sub acute unit and we have a wound care nurse who visits and gives new orders once a week. I have a pt who had a substantially large wound and she has continuos problems with the vac beeping and the dressing losing suction pressure. I have asked the cnas and therapist to please be careful when caring for and dressing her. Any ideas what can cause this or how I can improve the dressing stating intact? The charge nurse changed the dressing yesterday and 1 hr later I had problems and no drainage???

Just curious.. why did you turn down the medsurg position. I would have started there before a rehab floor. You need to delvelop skills and med surg would help you to do that. I left an emergency psych position as a new grad. It was all psych and barely any emergency! I had a position in a hospital but I resigned because of multiple issues. I interviewed with several ED managers and they all said ," So, even though you worked in ED psych, you really have no skills?" What an insult because I did, they just weren't enough. Now- I work in a freestanding facility across from a brand new hospital. It has part subacute and part ltc. I only work as a subacute nurse never in LTC. I have 20 pts max with two cnas. I am responsible for everything unless there is a charge that shift. I do all meds, Finger sticks, ekgs, tube feedings, colostomies/illeostomies, cpm, wound care/wound vacs, traches with suctioning, chf protocol, neuro checks,pain management, respiratory txs, o2 therapy etc. I have learned more in the two months that I have been there than I ccan even tell you. I take off orders, put in IVs, call to pharmacy, call the drs, call for labs, deal with dietary and nutritionist as well as pt/ot. etc. btw did I mention 20 pts...!!!! I tell myself everyday when I want to quit " Hang in there, get your skills and move on" I would love to work medsurg because 6-10 patients would be a dream!!! If you are assertive and fast and practice safely which is key because if you don't trouble will find you, it is a great place to start. Again I came from ed psych which is a piece of cake compared to subacute care. I was told by HR that 1 yr of subacute would get me a job but LTC will not (back in the ED).

Hi! I work in a rehab facility. It has long term but it also has subacute, two floors. I work in sub1. I came from emergency psych with 6 pts to subacute with 20! I agree that subacute is a better start. I've never worked in longterm but I will say you will learn.. for example I have a total care pt with trache and frequent suctioning, another trache no suction both with peg tubes one is continuous, 8 diabetics, 1 wound vac with a 1 foot in length wound and 6 inches deep that has retention sutures, cpm machine , several with chf continuos o2, neb txs, and routine heparines / lovenox. Dvt fractures of hips shoulders casts all of it plus meds for 20 and wound care for 7 so I can agree that you learn lots of skills. I am new and graduated last may and I learned a lot in a short time. Bad thing though is assessments are quick, unless complaints of something . We do the orders call drs pharmacy plus we never have supplies and bp machines suck so I'm always doing manual which I'm great at now. It's a good alternative to a hospital. I interviewed at several EDs and they all said they would consider one year of subacute plus my Ed psych

This sounds exactly like where I'm working! Plus figure in psych- anxiety, denial, grieving, attn seeking etc! But we have 20 pts max!!! How do you plan your day? I'm filling nurses who I can see have bad habits cut corners and leave 2 hrs late because if charting!!! Any ideas that you can share about prioritizing? They have a report sheet that carries over and their meds adm record also but I made one that I copy on shift and I split it into categories like wound care, iv, c/s, o2 therapy and I put the room number and name so I can have a quick reference . This is how I did it in the hospital but only for 7 not 20!!!