itthybitthythpider

Ive noticed the trend with skilled, too. SNFs are the new sub-acute and sub-acute is the new med-surg. So all the long-term SNF patients are being sent to ALFs and ALF patients are staying home

Even a wet to dry shouldn't be soaked through. But yes, it would definitely need to be followed up on if you felt there was a mistake. If you look through the chart and everything and it does say "change q3 days and not a moment sooner" I would ask someone who is familiar with the resident why it shouldn't be changed sooner if it's soiled. Or again, call the doc and get clarification. Everything I've learned says if it's soaking through, the wound is too wet and will cause further damage to the wound. We are the eyes of the doctor, so it's up to us to tell them when a treatment isn't effective. And if they come back and tell you that's what they want, then document, document, document!

Even if the order states Change every 3 days, they should be changed as needed, also, especially if they are soiled or soaked through. Leaving dressings on that are soaked through is not the norm. I know where I work, we automatically put a change PRN for soiled or loose dressing order for every treatment. Even if it's not written, it should be understood. Unless you have an order that states "do not take this dressing off!" Then I would call the doc and ask if we can change it and what we should put on, and descibe that it is soaked through or coming off or something.

Oooh! I'd never heard that before. Just the clocks.... That's an interesting idea!

I've got my fingers crossed for you, too. Good luck!

How do you determine tissue tolerance?

You are lucky, coming from a psych background! We get a lot of psych patients in LTC. Some nurses forget they are supposed to be more than passing meds and charting! You'll get the hang of it, though. As far as patient load, it's usually 20-30, depending on your state and facility.

Vancomycin needs lab draws, too. and procrit and epogen

And the argument that ensues during change of shift takes longer than getting the actual work done and staying over! Plus the next shift never has time to get their work done, so then you have extra work that you pass on, then extra extra work is passed, and so on, and nothing gets done. Then we get in trouble for that! Higher acuity patients + Staffing and budget cuts = Catch 22 Get your work done, or leave on time, either way you get in trouble!

I've had a couple get upset at me for sending a res out (and especially for sending them out without telling), but I can always justify myself to them and my DON!

Keep your "brain" (the piece or paper or papers you write everything on) close and use it often! I like to color code mine with different pens and I write EVERYTHING down, even if "I won't forget /that/."

For a DNR, we call the doctor and the funeral home and family, and that's it. I have seen police involved, but I think that was for unexpected deaths. The doctor will pronounce when we call with our assessment. Quick and easy, really.

One thing that helped me when I was learning was to take a list of meds I didn't know home and look them up in the drug book. Same with new diagnoses. I'm still learning everyday, too! I love nursing just for that reason

Cheaper supplies, cutting out unnecessary supplies. They don't pay for over time. HUGE focus on therapy, so we have to bend over backwards for them to get minutes in. Skeleton crew for CNAs. No holiday pay for this fiscal year. Luckily, no pay cuts. And we aren't desparate for residents and admits

I shed many many many many tears my first year in LTC XD My coworkers and I had a "crying room" (the utility room on one of the stations) where we would go when we were upset or needing to vent or something. It's VERY stressful at first. I agree getting a full time position is better, but that's hard to do without having a job for 6 months or so.... I was there, feeling like I wasn't cut out to be a nurse, feeling like I should give up... It was hard, but so worth it! Ask lot's of questions, ask for help, offer to help out others so you can learn how to do things. Keep your chin up and don't stop putting in applications, even before 6 months is up. Good luck!