bebu

Thanks again from the year 2012--this is so helpful! :)

Thanks for replying. :) I realize now the main comment got deleted. I'll try and add it here. What with knowing that about all the risks for CAD, and of course we don't write a nsg dx for CAD, just the symptoms, is there a reason we can't say "risk for decreased cardiac output"? Or "risk for acute pain"? The rules for risk dxs seem very arbitrary to me at this point. Another example: We can say "risk for loneliness" but there is no actual dx for "loneliness". Why not just say "risk for...(various human responses to loneliness)" instead of using the word loneliness, if we are trying to focus on resonses? There must be a big secret as to why, but I've not figured it out yet. LOL

I'm having trouble wrapping my head around this, and I would love it if someone could clarify... If a person is overweight, has HTN, has family hx of DM and MI, is sedentary, and eats high fat foods, why is there no way to say "risk for CAD" in nice, certifiable NANDA language--at least that I can see? I can see the Heart Attack DX: "Ineffective tissue perfusion (cardiopulmonary) r/t dec cellular exchange". But there is no "risk for" associated with this DX. You are either having a heart attack, or you don't need a DX. What is the way to diagnose the body's response to the narrowing blood vessels, or to say there is a risk for a negative response? I can't find this answer after a long while searching. Surely I am not the only one to try and answer this question! :oP I know many nurses eat their young. I assure you I am too old and tough to eat, so if you don't want to give an answer that can explain how I can see these things better (and particularly this question), please don't make snarky comments. I want to LEARN, not just get free answers. I have been reading all kinds of DXs, but don't understand this point yet. Thanks!

When I began my first job it wasn't at a SNF--I could smell trouble there a mile away! The ratio, the training... sound exhausting. To be in it for the long haul and survive (without ulcers, without becoming jaded/hardened), I think you have to think about how you are going to evaluate your work. Is it by the current DON? The Board of Nursing? The nursing school instructors who seem to linger in your head? You need these for knowing the standards of care for you to improve upon, but I think that, in the end, you are going to have to look at yourself in the mirror each night. And if you can say to yourself, with God keeping you honest, that you did your best to give the best care considering all the circumstances, then you have the right to sleep with peace of mind. And that trumps everything else, even if others don't understand or agree. The good news is that you care. Skills added to that over time will turn you into a great nurse. And I bet that when you see other struggling new nurses, you will be a real encouragement for them when they feel overwhelmed, so this experience will not be lost.

I would give my notice! :uhoh21: I am really sorry to think about what you are having to handle. I've been working at assisted living for a year, which is my first job, and I did it because I noticed the understaffing at the SNFs we were at. Some of my classmates took jobs at these after the program... and left as soon as possible. Your health matters as well as the residents--as well as your license. This home sounds like it should be shut down because it is unsafe!