sarahlee23

At my facility, when a med aid is scheduled on one of our halls for day or PM shift (we never have med aids on at night), the nursing-specific tasks are assigned to the nurses on the other 3 halls. Each of our 4 halls is divided up into thirds, and each third is assigned to a nurse on one of the other halls when there is a med aid. This way the assessments, etc that a nurse must do still get done every shift a med aid covers a hall. For example, if hall A has a med aid then rooms 1-6 are assigned to the hall B nurse, rooms 7-12 are assigned to the hall C nurse, and rooms 13-18 are assigned to the hall D nurse. The nurses check with the med aid and look at the MAR/TAR for that hall at the beginning of the shift, and then periodically check in with the med aid to see if anything has come up. It eliminates any confusion as to who is responsible for those tasks and ensures that the med aids know who to have assess the resident before giving a PRN.

My classmates in nursing school thought I was nuts because I knew when I started that I wanted to work in LTC. At the time I had been working as a CNA in basic care, and I loved working with that age group. Even after all my clinicals in other areas, LTC was where I wanted to work. I started in a facility that does both LTC and rehab, and have been there a little over 7 years now. I got 2 weeks of training to PM shift and then a week to nights, and I work primarily nights. I worked with some very helpful nurses when I first started, and now I try to be that helpful to the new nurses we get. Management sometimes drives us nuts, but I still love LTC. I honestly can't imagine working anywhere else. I am responsible for 2 halls and 50 residents at night, which can be crazy when a fair chunk of them are up at night, but I know I would be bored out of my mind if I just had one hall at night (and I hate, hate, hate being bored...the CNAs I work with always know when it's a slow night and I've run out of work because I start organizing the cupboards).

I recently had one of the CNAs I work with on nights tell me that she likes working with me and that I'm easy to respect because I listen to the CNAs, I pitch in and help them when needed, and I have good ideas. That CNA is wonderful, and I really needed to hear that at the time.

I work nights in LTC, and one night I was giving one of the residents with dementia a wheelchair ride around the building since sometimes that helped settle him. At one point he turned to me in his wheelchair and said "Do I need to call your mother?" Out of curiosity I asked him if he thought it would help. He stared at me for a moment, then I got "Not a **** bit." All of us got a laugh out of that one.

I talk to myself quite a bit. The CNAs I work with regularly don't even bat an eye anymore when I do it. Anyone who picks up a night shift is usually caught off guard when I start in. Usually I'm talking about my own clumsiness, wondering why I can't find anything I need, swearing and yelling at the computer because PointClick Care froze up again right when I really needed it, or wondering why that one person who is on their call light 60 times doesn't ever seem to sleep at night.

It does get better as the residents get to know you as well. I've had some residents get upset because I was late with meds or didn't bring them at the specific time they want them (one lady I care for wants her 12am meds at 12:30am) when I first started working with them. Once I got to know them and they got to know me, it got much better. I usually work nights, but occasionally I pick up part of the PM shift and do the 8pm med pass. Because the residents know me pretty well by now, they are much more understanding when I get behind and bring them their meds late. Instead of getting upset, most of them just tease me now. It takes time, but it does get better. Don't give up.

I usually work the night before and the night after our nurses meetings. I only go to the ones that are scheduled so they fall when I have that night off (which happens once a year). I keep telling everyone at work that I will start waking up and going to 2:30pm meetings when everyone else has to get up and come to meetings at 2:30am. If I get up and go to those meetings, then I miss out on half the sleep I normally get because I can't get back to sleep afterwards. Then I don't feel safe to work that night because I'm so tired, and I believe that the residents I care for deserve better than that.

I have a BA in English. I realized as I was finishing the degree that while I love writing, I didn't want to make that my full time job. So went to nursing school because I loved my summer job as a CNA.

To me accessing the port instead of just doing a peripheral draw is worth it if that's what the patient prefers. But then, I had a port put in for chemo last year. My veins were hard to find before chemo, and it's even worse now. And after chemo, it hurts horribly even when the really good lab techs do a peripheral draw. I used to just have them do a peripheral draw until it started getting so painful. I'd rather just have the port accessed and avoid the pain of trying to have a peripheral draw done. I usually try to do lab draws and my scheduled flushes on the same day so everything gets done at once. The cancer center I go to has always encouraged me to have my lab draws done through the port.

My mom used to be horrible about calling when I'm sleeping for work. And she wouldn't call just once...she'd call up to six times in a row and leave at least 3 voicemails. So I started turning the volume on my phone low enough that it wouldn't wake me up, and told her that I was absolutely not going to answer the phone when sleeping for work. And I started emailing her my work schedule. After a couple months, she finally figured it out. The only problem is now she calls when I really need to be getting ready to go to work. Everyone else usually doesn't try to call me unless they know I have a night off since I'm usually up all day when I get a night off.

Sorry about your grandma. At my facility, we check the wanderguards every shift to make sure they're working, but we've still had a few issues. A couple weeks ago someone eloped and even though her wanderguard was working the alarm never went off when she left (fortunately, she had walked over to the assisted living facility next door). Day shift actually had someone elope once despite the locked door, working wanderguard, and alarm going off. Afterwards, we were told that due to fire regulations, if a resident pushes on the door for 10-15 seconds the door will open. So when I work nights and the door alarm goes off, we always make sure we find out why.

I worked with a nurse who was from Korea for awhile. She spoke English well, but when she first started working she struggled with the charting. As she gained experience and got better with written English, her charting improved quite a bit. She was always asking questions, writing things down, and looking things up so that she could improve her English. I never had trouble understanding her, and neither did the residents we cared for. The only time we had an issue with someone having trouble understanding her was the first time she had to call the on-call MD, but fortunately the MD that night was very patient with her.

Can you just schedule it online? When I scheduled mine, I had to do it online because when I called they told me there were no available times the day I wanted to test, but I was able to schedule for the day and time I wanted online.

I had a knee brace on prior to surgery when I took my NCLEX a couple years ago. They asked if I really needed it, and once I told them I was supposed to wear it until surgery they let me leave it on. But they did check to make sure I hadn't stuffed any cheat sheets in it.

In addition to assessing the resident and checking whether the low blood pressure is normal or part of a trend, I also check with the CNA to see which arm was used for the blood pressure and have the blood pressure checked on the other arm. There are a couple residents at the facility I work at who have blood pressures around 90/60 in one arm. But if you check the blood pressure on the other arm, it's normal. And this is normal for those residents, which is why for those residents I make sure to chart which arm we got the blood pressure on. I've only worked for a year and a half, but I have not had to call the doctor about a low blood pressure during the night as the majority of the time it's normal for the resident. The rest of the time, there's something else going on, and fortunately the nurses there for days or PMs have had the doctor address it already.