KdubsRN

hi everyone! i work on a ltc floor in a hospital(it's orthopedic rehab but considered ltc because pts can stay for more than 2 weeks, longest someone has stayed since i started working was 2.5 months). all the newgrads are required to work on a project concerning issues or problems on our units. i asked the nurses on my floor for ideas. the nurses enter admission orders for the physicians. it's time consuming and many times the mds will accidentally leave out meds that are important. we've had pain medicine, asthma meds, and cpap orders missing. we'd like the physicians to enter the orders instead of the nurses. i know that nurses don't enter the orders on the acute care units, we are the only ltc unit in the hospital. who enters admission orders in ltc? physicians or the nurses?? if it's the norm for the nurses to do it in other facilities, this will not be a viable project. if it's not the norm, then i may be able to use this as a topic. thanks in advance for any responses! : )

I'm not sure if they could be part of the problem, maybe your co-worker is just a deep sleeper. My younger brother had trouble waking up for school because he is a deep sleeper. You literally have to slap him to get him to wake (which i do not do but was encouraged to by my brother...). My parents got him a vibrating alarm clock and it solved the problem. It shakes the bed and he wakes up. http://www.thinkgeek.com/homeoffice/lights/8f1a/

someone just recently left my floor. we had a tea party. everyone bought in desserts. i don't think you can ever go wrong with sushi or dessert. honestly, they will probably be very happy if you left a heartfelt card and maybe a photograph. : )

Thanks everyone for all your advice! I interviewed and got the job! My manager will be giving me 3 weeks of orientation. Ratio is 9 patients. I'm excited about this facet of nursing I have never considered and hope it is a good fit for me.

So looking through some previous posts I've realized sub-acute nursing units have nurse patient ratios of 1 nurse to 7 or 16 patients. I guess whether it is the same pace as med/surg or slower depends on how many patients one has. Still...is a sub-acute rehab floor more manageable than a med/surg floor? and should I ask for a one week orientation? The position I have an interview for is a 11pm to 7am shift. What kind of things go on during that shift? I appreciate any advice.

Hello Rehab Nurses! I am a newgrad who has been working on a post-op lung surgery/medsurg with tele floor. I have just completed my 12th week of floor orientation and my manager told me that I am not a good fit for the floor because I am too slow. I have been improving and taking 4 patients a day. My manager wants me to be able to take 5 patients. Unfortunately, I was told to resign or be terminated in 2 weeks. I spoke to human resources about transferring to another floor. I was told that the sub-acute rehab floor in our skilled nursing facility is slower-paced. I have an interview on the sub-acute rehab floor on Thursday. Has anyone worked in both med/surg and sub-acute rehab? Is sub-acute rehab indeed slower-paced or more manageable? What is the nurse patient ratio like? Since I may be transferring, should I ask if there will be any sort of orientation at all?? Even a week of orientation since it is a different floor? What are the differences between sub-acute rehab and med/surg? What other questions should I ask?? I appreciate any advice.

I agree! 16 back to back would be real rough. I am a newgrad and would not be comfortable with a new grad as a supervisor. From other threads I have read on allnurses, it does seem to be getting more common for newgrads to be pushed into supervisory roles in LTC because of short staffing. I just don't think it would be safe without experience. I wish you the best of luck in whatever you choose! :)

Xtxrn from what I've read on allnurses, LTC is just as stressful and fast-paced as acute care nursing. One can have 30pts in LTC.

Thanks for following up and sharing!! I will definitely hang in there. You've given me hope and am glad you found a less stressful job!

I can relate. I started in August and still have time management issues. I found out about brain sheets 3 weeks ago and made my own. They are really helpful to me! If you haven't heard of them here is the link to the brain sheet thread https://allnurses.com/cardiac-nursing/share-your-brain-266401.html Also here is a website that has saved my butt because of all the things I hadn't learned in nursing school. Its an ICU website but you may see a lot of things on the website in medsurg and LTC, like an explanation on interpreting lab values. http://www.icufaqs.org/ Youtube is also a good way to watch skills you may have only practiced once on a dummy in nursing school. Lots of pts post videos about caring for their trachs, colostomies, etc...Some videos may not be textbook accurate so be sure to review your nursing skills book when you watch a skill, so that you don't pick up any pt habits that are not kosher to nursing. This site has skills videos that are actually made by nurses http://www.saddleback.edu/alfa/# It takes me 2-3 times to "get" how to do things sometimes. So, if you are like me, I found you can look up the directions on the manufacturer website for equipment like enteral feeding machines or PCAs. Another thing I learned...its ok to carry syringes, alcohol pads, flushes in your pockets. This has saved me a lot of time. I hope some of this helps. Good luck!! to you and all of us who are new!! :)

Wow!!! Your sheets were very thorough!! I wish I knew about brain sheets when I was a student. They would have been very helpful! Thanks for posting your brain sheets everyone!!! They have opened my eyes to how I can improve my own sheets.

I graduated in May and got a job as a nurse on a post-op lung surgery/medsurg floor with tele. I am on my 12th week of orientation and am still too slow. I have taken 4 patients twice at night and twice on days. I did well with 4 pts until my last 4 pt day shift. I need to be able to take 5 pts by the end of orientation. I really want to be able to speed things up. My preceptor can't figure out why I am so slow and neither can I. I am always doing something whether its charting(we just started electronic charting), giving meds, dsg changes, etc... So its no because I am slacking. Does anyone have advice? Some of the nurses gave me an organization sheet they use; I started using the organization sheet about 4 weeks ago which has helped. I'm on the meeker side and feel bad cutting pts off when they want to talk but I have learned to do that as well. Sometimes I have passed by pts who are just calling "nurse! nurse!" and I go to see whats wrong even if they're not my pts. Usually its nothing important(pillows, phone ringing and pt can't reach it because they're weak) but I always wonder what if they fell out of bed or something??? so I check. I also found that when I am the only one charting by the tele screen, there is no one else but me to go check on the pt if someone starts alarming, which takes time as well. I know its sad, but I have started charting in empty rooms where I won't be bothered by the tele alarms. After all there are 4 or 5 other experienced nurses there as well to answer them. I've finished my charting on 4 pts as early as 10am and as late as 5pm and this is my initial assessment that needs to be charted. NOT good. I really need to be able to do initial charting by 12pm. I've found that with 4 pts everything gets done that needs to be done, I've just been charting late because of interruptions or because by the time I'm done with morning meds and assessments its time for 12pm meds and reassessments. I don't know how much longer my manager will allow for orientation. After 6 weeks of orientation I was told that I would need to think of other options if I did not pass orientation. It is my 12th week now. How can I become faster at what I do??? Please help!!!

I'm a new grad. The physicians usually give parameters to hold if systolic b/p is

In my hospital, standard is 8 weeks, 12 for ICU. In the past I've heard 16 for the heart failure unit. I am at 12 weeks right now on a medsurg/intermediate care floor.

I got an e-mail from Lehigh Valley (in PA) about 3 weeks ago. They are hiring! Florida Hospital is also hiring, but I hear nurse to patient ratios aren't that great in Florida.