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!!!

How are things at your new job? Is it any better for you?

Hats off to subacute/ rehab nurses. I just started as an RN in subacute I left a hospital psych position because I wanted to get exposed to things, wounds, colostomies etc. each nurse has a max of 20 the census for each of the 2 RN is 17 right now.. Just from my first week I think this is nuts! The nurse I with us horrible and has been there two years. Clearly cuts corners and is very unorganized and not efficient- there are 4 cnas , 2 per RN some good some need a kick in the pants! The facility is struggling and they are cleaning house! I am new along with a whole bunch if others because the new adm. Fired all of the old staff including the uppers. They want big changes. How can these nurses possibly do it all and leave by 3:30! My preceptor was still there at end if shift and hadn't even done her charting? I already came up with an organizational plan but they are so busy that I don't even know where things are, who everyone is, what I'm responsible for! No computers whatsoever! I'm a newer nurse and I wonder how with only 4-6 weeks of orientation and preceptors who are to busy to teach will I learn all that I need to know!

Have you heard about the job yet?

Sorry for the errors in my post used my iPhone

Yes and no- I got a job but another position that I was waiting to hear about . The ED position they did not give and said it was because I didn't have enough experience . I asked politely, " well- the nm who interviewed me the 1 st time knew that???" she said ," yes but don wanted to interview you." I said," ok but I don't know if you realize this but I never interviewed with him only the other candidate did! I talked with the nurses?" her reply- " OH" Any how it's fine because the day before I got an offer for a great opportunity at a subacute care closer to my home :) I start June 4 they told me straight up about the place the good the bad and the ugly but that I could get my skills and mice on. There is a brand new hospital that just opened right across the street! So I can apply there after 6-12 mths. Also they are very flexible with things:) I hope you hear back!!! Let me know ! Best of luck

PedsRN- I was told the don would call in about a week and at the end none of us needed to go back to hr. I did sign a release to check references. I know the job posting is pulled as of yesterday for the shift that I applied to they still have 3 other shifts open and I don't know what the other RN applied for:( I thought it was awkward that we were together and went to the dept together ? I know her and the NM seemed to hit it off but this was her first interview. I was told that during this second interview I would meet with hr and don ? But - I met only with hr and staff nurses ; I met with NM only for first interview... I'm stressed now because I would love to have this job:) You are right about them not wasting the staffs time. Maybe that's why we all went together

That's nuts?!? Sent by mistake ! Could you imagine if you took a different position because of the mess up ? Well- I'm glad you things worked out!!! I wish you the very best with the interview! I had my second interview ( for the same position)- last one was with the nurse manager.. This time I met with the staff nurses and HR and HR asked me to sign to check references:) when I arrived there were 3 of us waiting another RN who was there for her first interview and a girl for a tech position having her first interview ( I was the only one there fir a 2 nd interview) we all went to hr first then we all went with the DON to the Department.. I've never had this happen before! We all went into a room and the 3 of us actually all got along very well! They had the nurse educator come in, a manager and two staff nurses. I stayed with the staff nurses who said that it was an informal thing and they want to see if I'm a good fit. Toured the dept. talked with the educator who was awesome:) and then myself and the other two candidates were told we were done. ANY THOUGHTS!!!!!!!!!!!! What does this mean? I think it went well!

It could also be the degree you hold. They might want a BSN ? even if you have experience,especially if it is magnet. But the email may say not qualified. I just lost a positon because HR wanted the BSN which is in progess but they wanted it completed. THE DON PULLED THE JOB AND CHECKED MY REFERENCES and was calling to hire me then HR refused to let them. they fought it out and the DON lost. she told me to come back after bsn is done..Complete upset:9

My understanding is that it is illegal for a company to give a bad reference or say negative things. they can get sued. There are reference check companies ou there who you can pay to check what the previous employers are saying. I have done it and it was worth it and it cost only 30 bucks.

AHHH- Thanks, yes i figured. I interviewed with a nurse manager, about a month back and they said they were looking for someone experienced but that they do take new nurses and love to teach them. After the interview I was told I would hear in several days.There were a number of applicants. I finally waited 4 weeks to ask if the job had been taken or not(I never heard from them) and I was contacted by HR and she mentioned she was sorry for not calling me sooner. The DON wants to now interview me and then I am to go to HR. I really am hoping this is good:) I interviewed at another hospital where I have friends at and the interview was grueling but went well. I was called three weeks later by HR who told me because my bsn is not completed, I didn't get the job. THe DON pulled the job posting and checked my references and said out of numerous applicants, I got the job. I was an awesome fit and they loved me but...HR refused me because of my bsn not being finished! The DON fought for me and they still refused. The best part is HR never even met me or talked to me! It is a top hospital that doesn't even bring you in unless you meet every requirement. Just getting called is an honor. I was devastated and now this other position is my last hope. I would love to get back into the ED