Phoenix4

So, follow up... I've had my first two shifts, my third is tomorrow. I had about 25 patients. The two aides handle clothing, toileting, feeding, but there is almost no interaction between the aides and the nurses. The RN (or LPN) on the wing handles meds, treatments, vital signs (they don't have aides do vitals). I had no idea that long term care moved so much faster than acute care! 25 patients, roughly 200 meds for the 4 pm scheduled meds. No ID bands, they move around all the time (so you can't just start at the first room and go down the hall like acute care, because they aren't there!). Most of the pics on the computer records aren't all that good, so I usually had to find an aide and ask where each patient was to give them meds. The first shift I was there started with the med cart "changeover" with the new med cassettes refilled. That meant that I couldn't start anything at all until almost 4 pm. When I wasn't done with 4 pm meds by way late, the LPN (who was in charge, she's very good) had to call the nursing director to decide how to handle it, ie which meds to just skip, and had to help me pass meds to get those finished up. The 2 hr "orientation" first (which they knew nothing about and were totally surprised, they said they usually just hand the keys to the traveler and that's it), then it was an 8 hr shift that became 12 hrs total. I was grateful for the orientation, at least I got some exposure to the computer records system. Some things though I wish they'd covered, like although they handed me the keys to the med room/narcotics stuff, no one said which key went to which thing! So I started with fumbling around trying to find the key to even get the med room open, trying every likely key before finally finding it. (There's a key to the med room, two keys for the medication cart {one for the whole cart, one for the narcotics drawer}, one key for the narcotic cupboard, one for the tackle box in the narcotic cupboard, another for the small tackle box that contains narcotics that need to be refrigerated. Naturally, I was fumbling with all those keys every time.) They had a room for me to stay in for the two nights in the assisted living part, it was plain but quite nice, and it was really good to not have to drive home after that. I slept pretty well from 1 am to 4 am the first night, but then of course tossed and turned from 4 to 8 am, thinking of all the treatments I didn't do at all (I did no treatments, dressing changes, or skin checks whatsoever). The second shift I could at least start at closer to the "real" time since there was no med cart change. I managed to get almost all the 4 pm meds done by 7 pm (and though 4 pm is the "big" med pass, they also have 5, 6, 7, 8 is another big one, 9, 10 and "bedtime" meds those vary more as to how many meds and how many patients get them). I did manage to get most of the meds done during the shift, still no treatments or dressing changes. I did still have to have help from the LPN on duty on the other wing to get the meds done. All their records are on the computer, and the first night I kept having trouble with the computer screen on the med cart seizing up and having to restart it. That probably cost me an hour. But, the real problem was likely that the battery was low because I took so long to get the meds passed out, so it didn't want to do its job. Which meant that if you can't see the screen, you have no clue what meds to give. I've never worked anywhere that CNA's didn't do vitals, is that typical? (No medication aides, etc.) The day nurses I took over for both commented that it was a huge workload for one person (as did another LPN who was working on the other wing). Yeah, that was encouraging... .NOT! Thankfully the LPN's from the other wing were helpful and tolerant. No breaks, no meals either day. Does this sound like a typical workload? I already feel just sick that I have to go back tomorrow! Maybe I should just give up nursing!

So a couple of follow up questions and a little bit of explanation. I took a job with a temporary staffing/travel agency, so I won't be a regular employee of the LTC, hence the 2 hr orientation. I've been out of nursing a while (raising kids), live in a large, sporificely populated state, and this part of the state I was told point-blank does not have a nursing shortage and no one would need to hire me anywhere locally. Must have job=I took what I could get. (And yes, I'm terrified. I'm not going in just blindly assuming everything will be fine. This is also why I appreciate SO MUCH people helping me with routines and suggestions!) My first shift is THURSDAY this week! (ACK!!) So follow up questions... It used to be in acute care, you had 1/2 hr before to 1/2 hr after the scheduled time to give the med to be considered "on time". I notice people are referring to an hr before and an hr after, is this an overall change in all areas, or is this usual for LTC but not acute care? (Starting med pass an hr before scheduled meds sounds like a great thing!) I'm not finding a "scope of practice" for CNA's in my state (even though they have to be certified, and you can look them up on the BON website). Is it usual for CNA's to do fingersticks? (I'm planning to ask about that at the facility too, but I'd like to have an idea of what's usual.) I'm praying for good CNA's, they are priceless! I was told once by a travel nurse that usually staff and facilities are pretty nice to travelers, because if they aren't, they won't come back :). Do you find that to be true? Or?? I'm open to any other thoughts, suggestions! And please know that I've appreciated EVERYTHING that people have taken their valuable time to contribute!

This is SO incredibly helpful, I can't tell you all how much I appreciate that you've taken the time to share this with me. This will help me so much with making it through my first shifts! (And please, feel free to share any other thoughts!) God bless you!

Thank you!! These are definitely helpful to me! Please, anyone else feel free to chime in :)

Through various circumstances, I'll be going into a small LTC facility with basically 2 hrs of orientation. I realize that different facilities will be different, but could anyone describe a shift for me? Does this start with report like acute care? What types of "treatments" might there usually be? Etc. No detail is too small to be interesting and helpful to me. Hints and tips appreciated! What staff would be usual for say, 25 residents? Needless to say I'm very nervous, and want to provide good care! Thanks for any input!

Here's the link to the tutorial you can download and do. This is exactly the same one that you do before starting the actual NCLEX exam (and yes, it does ask dumb stuff like what color is orange :) ). It's just so you have a chance to see the screen format that is exactly what the NCLEX exam will be. http://www.pearsonvue.com/nclex/NCLEX_Tutorial.exe I was glad I'd done ahead of time, then I didn't feel I had to read through the questions and answers carefully (which just being me, I'd feel compelled to do if I hadn't seen them before). It totally doesn't matter or count toward your exam, it is only so you have a chance to see what the screen will look like, where the next button is, where the clock is, etc.

For some study and testing tips and a rating of how different resources compare in difficulty to the actual NCLEX-RN, see https://allnurses.com/nclex-discussion-forum/review-nclex-rn-607853.html and https://allnurses.com/nclex-discussion-forum/passed-1st-time-601909.html Hope those help some. Remember, you have plenty of time to take the exam. You do not have to even finish all 265 (if you even got the full number of questions) in 6 hrs. If you do not finish, the computer will determine passing on the average difficulty of the last 60 questions. So really, you have 6 hrs to do at least 75 questions (15 are questions they are trying out for future tests and they don't count toward your result). Download the tutorial ahead of time from the Pearson Vue website, it will help you to see the exact format before you even go in there. You have to do that very same tutorial at the beginning of the NCLEX, it will help you relax if you've already seen that much. Once the test starts, take your time. When you get something that you think, yikes, I don't know! Don't panic, don't just pick something and go to the next question. Take a deep breath, pray. Then read the question and answer options again. Look for clues, the abnormal thing, one that doesn't fit. You have time, so if you need to, take another deep breath and read it again before choosing an answer. All the best to all of you!

Success2011, a big key to NCLEX is to not worry about the time. Seriously. I agree totally to take your time, it's not about speed. The actual minimum number of questions to answer and be able to pass is 75. You can still pass if you only do 75 questions in the 6 hrs! You do not have to finish them all in the 6 hrs. So, there is truly no time pressure. Take your time and think each question through. If you feel yourself beginning to panic, stop, take a slow deep breath and when you're ready, read the question and answer options again. From a post in this thread I started: https://allnurses.com/nclex-discussion-forum/passed-1st-time-601909.html "remember, studying is largely LEARNING, use a comprehensive practice test once in awhile to gauge how you are doing with improving overall. That was really a big help to me with doing practice questions. It was a reminder that I didn't have to know everything (and we just can't know it ALL), and practice with questions that I might know only a little, or nothing about and how to handle that. When I first started studying, at a question I had no clue on, I'd feel immediate panic. Sometimes I found myself frantically picking something and moving on (usually wrong of course!). Don't go there! If you read a question and think, hm, really? I have no clue. Deep, slow breath. Ok, read it again. Read both question and answers. Still no clue? Maybe it's a med you never heard of (there are so many, it's pretty likely to happen) and asking about side effects, or pt teaching about it. Another deep breath. Is there any info you can infer from the question or answers, like do you recognize anything about the generic or trade name? Does the age, condition, history of the client tell you anything? Usually you can come up with some hint that will help narrow your choices. Ok, so what if you narrow it to two choices and still pick the wrong one? Forgive yourself, and move on. I kept trying to remind myself that NCLEX isn’t really trying to trick you, it’s trying to find out if you can avoid killing somebody the first week! (And I did think that the NCLEX had fewer “tricky” questions than a lot of the practice question sources.)" You can do this. You have plenty of time to stop and take a slow deep breath whenever you need to. Hope this helps! Phoenix4 Passed NCLEX-RN 1984 Passed NCLEX-RN 2011

DARLENESKY!!!! :clpty::smiley_aa:nmbrn::hpygrp::dancgrp::w00t: I am SO HAPPY for you!!! I knew you could do it!!!! Answered prayers!!!! Thank you so much for letting me know, I was hoping to hear how it went!! God bless!!!

Hi JLO, I'm looking at WGU's RN to BSN program right now. I'm not sure what your situation is, but you mention you have no nursing experience. WGU has several programs, programs for already licensed RN's are the RN to BSN, RN to MSN. The pre-licensure program (you start without an RN and eventually get a BSN), is only available in a few areas because of the on-site clinical required (certain areas in Utah and So. California, somewhere else too, I don't have the list in front of me). WGU is looking fairly attractive to me, partly because they will accept my previous college credits from quite some time ago. At the same time I'm a little concerned about the way they are structured, you always take essentially a full course load, you can't take just a couple of classes at a time. The up side is that you move at your own pace, it's not a specific number of hours that you have to do. Good luck with your choice!

You can totally do this!!!

Honestly, I'm hoping that there are some jobs :). My situation is a bit odd, I have an ASN, graduated 27 yrs ago, worked FT for 7 yrs in a variety of settings (college health service, med-surg floor, neuro briefly, OR, Medicare peer review office). I have not worked in nursing for 20 yrs, and just taken my NCLEX again and passed. So, the job hunt will soon be on for me (my self-employment work is at its height for the next couple of weeks yet). As you can imagine, trying to find people I used to work with and under has been challenging after 20+ yrs, so I'm concerned about being able to get references from nursing jobs. I've been self-employed for the last 10 yrs, so my work references would be from people who have worked with me, but not that I have been employed by. Any thoughts/suggestions for my situation?

Darlenesky, have you taken your NCLEX? How did it go? I've been praying for you!

Oh, Calzo, if you hate nursing (and I certainly hate many aspects of it myself), you really may want to consider doing something else entirely! It is totally NOT too late to do that. There are so many online possibilities that you can work at your own pace to get a degree in something else while keeping your regular paycheck for now. Look into CLEP exams, a great way to get college credit cheaper and faster and be able to apply those to the degree you want. (Read policies carefully, not all colleges accept them, but most do.) A friend told me about her dad who wanted to be a lawyer when he was 20. Not enough money, had to be working, etc. so he didn't. When he was 30, he wanted to be a lawyer, but was married, had kids, etc. so he didn't. When he was 40, he wanted to be a lawyer, but had kids starting college, bills, etc. so he didn't. At 50, he wanted to be a lawyer, but had almost all of his 10 kids in college ('nuf said on that kind of expense!), so he didn't. When he was 60.... he went to college and did, indeed, become a lawyer. So my question to you is what she asked me... In 10 yrs, how old will you be if you DON'T do what you wanted to?

Hm. No particular advice, but I have to say that I hope you are not too old to consider doing this. I just retook my NCLEX and passed. I graduated 27 yrs ago, passed NCLEX then and worked 7 yrs in several different areas. I've spent the last 18 yrs homeschooling my kids and decided to study up and take the exam again. (My kids were my biggest encouragers as I studied!) My goals... well, getting a nursing job again (helping us get out of debt and helping kids in college), and I plan to take my ASN to BSN, maybe specialize after that. My oldest child is 31 (and in school specializing, he's interventional radiology tech now, heading for RPA). So, Calzo, if YOU are too old, I am WAY too old! I know that's no help, but given your question, I just had to offer this:lol2: