MommaRN86

Hi all! Question for home health nurses. I hurt my back about one year ago and required surgery. I am going to be cleared by surgeon to return to work but want to preserve my back as much as I can. Is home health low back strain??? I heard from my HH RN after my surgery that it was a great option, but I am wondering how often you are required to transfer patients? Do you do a lot of lifting, transferring, ambulating, and personal care of your patients? Thanks in advance!

Hi Nurses, I am in need of some career help. I injured my back badly about 9 months ago lifting a heavy patient resulting in a laminoforaminotomy with distectomy L5/S1. My neuro has hope that I will legally be allowed to return to physical work in the next couple months. However, because of the injury and affects on my family I'm thinking I need to avoid this ever happening again at ALL costs. Honestly it has taken me about this long to pick myself up by my bootstraps and figure it's time to try something new. I love being a nurse. I really enjoyed geriatrics and especially love the bedside. However, since my injury I am realizing it is probably smart to stay away from a lot of physical work. I have been a nurse for about 4 years, however have worked part time for the past three because I have two little ones at home. Can you help me brain storm career options for me? Masters degree is not affordable now unless I am working(although I'd love to get it). And case management seems to require more experience than I have. Am I missing something, or do I have to walk away from nursing altogether???

Thanks for your feedback! Just to answer your question Taramb7263, I have already worked Med-Surg for over a year and although I got a great foundation, Med-Surg just isn't for me. I love geriatrics and enjoy working in the less acute areas. I like education and actually enjoy primary nursing, so was looking for somthing that would let me do more of that. Thanks again for your feedback

Hi there, I am on the hunt to begin something new in my nursing career. I was blessed enough to get three offers this week. I turned down the straight up med/surg unit and am leaning towards working in a hospital on a rehab type floor. (its called skilled care unit? kind of like long term care, kind of like rehab per the manager). Sorry if I sound clueless, when I applied thought it was med/surg. The manager said most patients are IV free, no trachs and not a lot of feeding tubes. Now here is my question. It is a twenty bed unit.... Two nurses and one cna. So I could have about 10 patients. This scares me only because I keep thinking med/surg and that would be way too many...I'd be comfortable with 5-6 patients maybe 7 on nights. But these patients are obviously less acute. Any thoughts? Is this a safe load? I also like it because manager says I can float to med/surg if I'd like. Seems ok, but just want some advice. Thank you for any help!

PS: Even though I said I'm an RN, there is an LPN who has the exact same job duties as I do where I work.

This might be a late response, but thought I'd add here what I do in AL. I am an RN and am called the team leader for memory care. I have 14 residents that I am responsible for and I oversee one or two CNA's who help care for our dementia residents. I do all med passes for these residents, take new doctor's orders, assist with monthly evaluations etc. Because I work the PM shift, I am also on call for any emergencies in the Assisted Living/Independent Living sectors. I respond for falls, CP, SOB or really anything that the CNA needs back up for. That part can be exciting but also slightly frustrating because I don't know these residents as well or have only met them once or twice. I also do certain medications in for AL residents not living in memory care. I have never worked in a SNF, only the hospital, but I would think that the biggest difference is just that a resident living in AL really has to be somewhat independent. You should be seeing residents here still able to perform some/ most ADL's who don't require any extensive or technical medical care. I usually think of it as being more of a "wellness nurse". Kind of like a school nurse only for adults. I didn't really understand the nurse/patient ratio when i first started, but now I understand why it can be way higher. That being said, the range of level of care probably varies greatly from facility to facility. Sometimes residents that need a higher level of care are still placed in AL for various reasons. Thats when it gets tricky. Good luck with your job search!!! hope this helps!

Hi Hmellish, I really enjoy my job now. It is a lot of independent thinking. I do feel more autonomous and that is very rewarding. But there are also times(being a newish nurse) that I wish there were more policies and procedures to follow here. It is a lot of "thinking on your feet". For me I would say that it is much more of that than in the hospital. I learned a ton working in Med/Surg. but at times it felt very routine. There are definitely challenges here, but I feel more rewarded in this field. I get to know my residents and their families and establish a close relationship with them. Thanks for asking. Good luck to you!

Thanks for all the feed back! My biggest concern is with my memory care residents. They cannot and should not be sent out if possible without a representative/family member with them and their decision making power is of course limited. But when I contacted my resident's POA, he refused to allow transportation and she was in extreme pain. I understand not wanting advanced life sustaining treatment, but to allow one to be in so much pain is unethical. The physician told me I had to follow POA's wishes. I went to DON. Wondering if one would have to go to court to have POA changed/revoked?

Being new assisted living facility, I have many questions regarding liability and also difficult POA situations. I am the only RN on staff in the PM at my facility and am the "go-to-girl" for residents living in independent and assisted living quarters. I have had two situations now where the POA did not agree with my emergency treatment decisions. One situation was regarding a res with C/P, pain to the Left arm, abnormal vitals, and EKG changes. I of course wanted to send her to ER and called 911...POA refused. Second case regarding dementia res. with severe flank pain, POA refusing eval. Other than contacting MD or DON what else can be done? Would it be better to call for emergency help first and then get POA permission after? That has been the case (in regards to C/p sit) but I am wondering if I am somehow liable if I hear back from POA (as I am not always able to reach them stat) that they don't want treatment. Isn't it always better to err on the side of providing care than denying it? I trust my nursing judgement but some of these decisions POA's are making seem unethical, esp. since in these examples res want treatment. I feel so helpless in providing my residents care in these situations!!! I feel especially helpless in providing care for my resident that I care for with dementia. How is it ethical for POA to refuse any sort of work up for res. with extreme pain. Very frustrating. I also feel that being in Assisted Living your hands are tied sometimes. I feel like I am always balancing on doing too much or not enough. The residents in AL/IL are all somewhat independent and have the right to make informed health care decisions but I cannot help to feel sometimes though that to not take an action is somehow neglectful. Anyone working in this field have any ideas or help? Thanks!!

Thanks for the response! I think I have used Mepilex before in the hospital I think. Very nice product. Wish we had it, I guess it's too much $$$$ but I will suggest it!

I work in an assisted living/independent living facility and last night I got an emergency call(I am the only nurse in the building in the evening). So I went to the resident's room and she had fallen and had a skin tear. I cleansed the wound, used a bit of bacitracin covered with a absorbent foam pad and covered with a 4x4 and used paper tape. Is that the best way to treat the skin tear? I know in the hospital we commonly used tegederm, but it really seems that that would pull off more skin when its removed. Any ideas???? thanks in advance!!

I should have clarified. There is NO RN OR LPN on staff after my shift, so its the CNA that I'm reporting to.

It's odd though because there is NO RN on the shift that I am handing off too. So if I can't get the CNA's to listen to me then there is no one else over seeing the care of the patients and I find that to be unsafe.

Thanks for all the feedback! Feel extremely frustrated that the information I was giving CNA's is very pertinent to their care of the pt's and I was completely unheard. I should not have to assert my position as the RN, that's a given. The DON will have to handle it from here.

Rachel Ray's 30 minute meals is an awesome cook book. The food is fantastic and EASY. Also crock pot is a good idea. I like to buy Bertoli bag's( that italian frozen food) and frozen lasagna with salad for the nights I am working. You can make a big batch of soup(like minestrone/chicken noodle) and keep it in the fridge for a week or so. Don't feel bad about it, you are working hard to support your family, but I know how you feel.

Hi all! hope I can get a little bit of advice from those of you who've worked in long term care. I have a BIG problem. At night, there isn't an RN on staff, and when i attempt:mad: to give report to the CNA's they literally walked away while I was talking. I had to ask them to stay and listen to me finish giving report. They complained about everything I asked them to do and gave me a list of reasons why they wouldn't do them. Then they began talking about the pt's meds and stuff(which they had no idea what they were talking about). They wouldn't even look at me while I was talking and told me that I shouldn't give report on every pt. (which i wasn't, only telling them 3 things that were issues that day with the pts!!). So MAD, tried to assert my place but found it INCREDIBLY difficult!. any help??

Hi All! Are there any gerontological nurse practitioners out there? I've been a nurse for almost two years, and always planned on becoming a NP. Realized I adore geriatrics. Can anybody tell me about your program? how long it took and about where you are working now? Did it take a while to find a job, and is there a great need in your area? Can you give me an idea about the setting you work in and an average day for you? Thanks in advance for any help!!

Thank goodness for this post! I just got called by IAN. I had given my bio information in the mail figuring it was free and I could put it on my resume. They really pressured me to give like 700 bucks and then kept down grading to eventually 30 but I said heck no. They really try to pressure you for money. But if you don't give any, I guess its just like "who's who" or whatever, except that I wonder if it will actually end up looking stupid to put it on your resume? Ah well, be careful of these people!

Thank you so much for the feedback everyone. i am learning so much each day I work. And it is true so true that the nurses role in AL is ever evolving. I know I am lucky to be at a well run facility and I just keep reminding myself that I am not in the hospital anymore (YIPEE!)

Just keep practicing is good advice. Also, with the elderly, take off the turniquette as soon as you get a flash. One of the older nurses showed me a cool way to practice. Grab some IV catheters and also some IV tubing. Tape a piece of tubing to something and then practice with it like its a vein. It will help you get the motion down of advancing the catheter. Just doing it a lot will help though. Jump at every opportunity. And don't feel bad if you miss a few in a row. Thats how it goes. Good Luck!

Wowzers that sounds crazy, and I too work in AL. Its really not work risking your license which you worked so hard for, or worth hurting a patient. Good luck to you!

Here are some sample interview questions I received. 1. Tell about a time you got in an argument with a co-worker and how did you handle it? 2. Tell us about a time you went above and beyond with a patient? 3. Tell us about a difficult patient? 4. How do you organize your clinical day? 5. How would you prioritize(insert patient scenarios) 6. Tell us about a time you made a mistake, how did you handle it? They really can ask you anything. My advise is think about some real life examples you have with patients. Try to remember difficult situations and how you handled them. Think of times you really helped a patient(in other ways than just physiologically) and then you can hopefully use these examples in whatever questions you are asked. Its also ok to use examples from school, such as how you worked as a team with fellow students. Also, if you are asked a negative question, try to remember to state how it helped you grow, and what you learned from it. Good luck to you!

Hi there! I suggest doing practice assessments on everybody you know. Do a head to toe on your mom, dad, bro, sis, boyfriend whatever. Also when doing a head to toe, think of the big systems. 1. Mental status-ask patient for name, hospital name and date 2. Listen to heart/lungs 3. Abdomen(bowel sounds/bladder distension) 4. Check Gu status(catheter in place etc.) 5. Check pulses/lower extremeties(swelling etc.) 6. Check IV sites, Picc line sites etc. for s/s of swelling, bruising etc. ...Then look at the equipment in the room...IV pumps, foley, feeding pump etc. and be sure there are no issues there. That is a real life head to toe in the hospital setting. Good luck to you!!

Hi all: Looking for a little advice from all you great nurses out there. I just started a new job at an assisted living near my home. I previously worked Med-Surg/Oncology but left to find my "niche" because I didn't feel fufilled and came home stressed out all the time. I began to forget why I became a nurse. I love my new job, but am having a really hard time learning the differences between the hospital setting and LTC. For example, I feel like my new co-workers think I'm overly cautious and paranoid. Our residents on my unit(memory care) have pre-filled pill boxes that are filled by a different RN once a month. I am supposed to dispense the pills without checking(there are like 10 per person per time period). I have pulled the pills myself so far. Is that normal practice? Also the CNA's dispense meds in Assisted living, and sometimes will on our unit too if there is no RN on that shift.Suppossedly its because we are assisted living and not skilled so the cna's just give them the pills. I am sorry if I sound naive, this is all so new to me. But the residents do seem very happy, and everyone is so well taken care of here and also it is a private institution. I just feel like there are unorthodox practices. Sorry if I sound naive to all this. Anyone have similar experience? Can anyone tell me about the Assisted Living Center's they work at? Thanks for any help you have!!

I totally feel your pain! I thought that after the first year of nursing, the feeling of carrying the weight of the world on your shoulders would end. But for me it didn't. I finally realized that I needed to try something new. To remember why I became a nurse to begin with. Would it be possible for you to go into home health working with peds? or some other non traditional peds setting? I worked med/surg-Onc. for a year, but always LOVED geriatrics. Just took a job in a memory care unit and am loving it. Thinking about grad school to become NP(in geriatrics). Good luck to you!