allyl

Already talk, read, and sing to him. We've been trying to get the parents to buy some crayons but they haven't yet. I'm not about to buy anything as several nurses have already gotten into trouble for buying things. That's a whole different topic though. I like the rice idea though. It's not like I'm ignoring him but am lacking the supplies to keep him entertained.

First the case, a pedi vent pt between 2-3yo who is cognitively all there but has severe muscle weakness. He is able to grasp and move his arms but has very little fine motor control. I've been with this client for over a year and really haven't seen any improvement in muscle tone. Speech has obviously gotten a bit better but can only really say 10 words. Also has PT and ST twice a week. Recently the mother has been making noise about how it makes her SO SAD to come into the room and he isn't being played with. Now this is a family who comes in 1, maybe 2 times a day yet both parents are unemployed and living with relatives while having 24/7 care. When this happens I'm usually documenting. I work nights so I really don't have to entertain him much. However, I do want to try and be helpful and would love to suggest activities that are age appropriate yet he could do. Currently he is addicted to TV and to be frank so are the parents. How much should a nurse be required to entertain clients? After all we do have treatments/ notes to do as well. I know we are to provide 'appropriate play therapy and developmental stimulation' but it's a bit hard when all there is are teething toys and stuffed animals, how is the day shift suppose to entertain him for 12 hours!?

I definitely agree with the majority. While you are definitely knowledgeable about best practice, the world is not "best". If you were working with one patient at a time of course you could do everything right but you're not, multiple people will be needing multiple things at once and patients are humans who have their own quirks. I think everyone else has covered the clinical aspect so I'll just echo about time management. I am still horrible about this but documentation should be done AS SOON AS POSSIBLE. As for feeding patients and AM care, why are you doing AM care?! The only time that is acceptable is if you are down a CNA or a patient asks for something you can do quickly while you are in the room doing YOUR job. Ex.- Pt just finished urinating in urinal and your there to give meds, of course you'll empty it for them and give them hand sanitizer! Wound care scheduled for the day but wants a shower first, they can wait for the CNA to give a shower who can then notify you when they're back in bed. Just have supplies ready to go so they don't have to wait around with a wet dressing. Also fully brief your CNAs, they are a super help if they know what you want and explain why. She can't have food today vs. She can't have food until after her scan at 10am but clear liquids are fine, I've ordered her an alternative tray if. This saves time as you don't have to discuss with the Pt why the tray is different and if the tray is normal they can alert you. Last thing, personally I love to orientate new people. Teaching is fun for me and I get to learn what they would do in certain situations while perfecting my own practice. While we all development tricks of the trade and shortcuts, having someone around watching what I do and questioning makes me aware of my own complacency at times. I always pretend that they are a State auditor so I try to do the 'right' techniques. That can make me realize, "Hey, I've been taking a shortcut and it really doesn't waste that much time to do it the correct way" or "This is a really useful trick I need to teach this person." Sometimes it's just newer practice that I've learned since the school way isn't always up to date (especially in wound care) or things that certain doctors like. One doctor who I didn't like personally was great to work with as he knew I would do the dressing change his way and I knew what supplies he would want for chest tube removals.

My infant vent Pt is already on Medicaid and is eligible for the Medically Dependent Children Program*here in Texas. I fully believe he qualifies for it and the need is there. It will provide great resources and Respite care. Now normally it has a wait list that is over 5 years long. To circumvent this wait, there is a Rider 28 where if the child is in a nursing home and is then moved home they can go straight into the program. The SNF stay can be as short as overnight with a MD waiver. This is all fine by me. The fishy part is when overnight is from 2230-0030. The SNF is paid for the use of the room in cash and then a single assessment is done by the facility's nurse. While remaining true to the letter of the law it just made me very uncomfortable. While probably not true fraud I feel this negates the purpose of the Rider 28 which is to bring institutionalized kids home. Does anyone have experience with this programs like this?

Apparently it's a schedule that rotates the weekends off that allows for some weekends to have 3 days off in a row.

Has anyone had experience with a "wagon wheel" work schedule? I just interviewed at a facility that uses it and while the DON explained how it is utilized by them I would like to know how people like it in real life. I couldn't find any info on the theory of how it works by googling either so any details would be appreciated. As a new grad I really don't know what type of schedule I would prefer or even what type is out there beyond the usual shift work mon-fri. I like the facility, I am just confused as to when I would be working. I have a follow up Interview with a manager tomorrow so while I could ask I would prefer to ask questions related more toward patient care.

HI, I just saw your post! I graduated from the SA Galen LVN program this June and went straight into the ADN program so I can answer your questions about Galen at least. I also have had clinicals with Hallmark students and will give what ever info I know. Accredidation: Yay, SACC accreditation. This means they are now regionally accredited so all colleges and universities should accept their credits. The agreements are a bit outdated as now you can go anywhere. Hallmark is not regionally accredited so most BSN programs will take you but you may have to do core courses(English, history, etc) again, they will only accept the nursing courses. Program Length: Yes it is 27 months but for 15 of those you can be working as an LVN and got to online classes, what I'm doing, for the ADN part. Admission Requirements: If you go from Galen's LVN to RN program you do not have to take the PAX RN and if you have taken the SAT in the past 5 years with a certain score, you don't have to take either. To be frank I have not heard of a single person failing the PAX PN anyway. The easy part is getting in the hard part is staying in. Each quarter the class sizes shrink from people failing. Cost: Personally I will be paying around $36,000 total. I transfered some credits which saves money and if you don't have these try and take some CLEP tests. Also DON'T buy new. At orientation, there is a textbook and uniform sale by former students or most are on craigslist. I spent $200 for my LVN year rather than $1000 for all new. Also Galen will be offering a BSN program by late next year. This would mean a BSN in 39 months. Admission to each program is automatic with a 2.5 GPA. Over all I quite like Galen. The instructors are usually nice and after SAC for my last degree it is positively heavenly. After talking with some other schools and having clinicals with them I also feel more prepared skills wise as I had to show some ADN students some things! As for jobs, almost anyone will hire a ADN including the fancy hospitals as long as you promise to get a BSN in 5 years. As RN-BSN programs are 1 year(and most entirely online), this gives you PLENTY of time. They will sometimes pay for it too. Salary isn't really increased but you have more prospects for advancement later. After all, who wants to be a floor nurse in their 60s? Sorry this was so long but I love talking about school. If you have any questions please ask!:)