Fedide

I love LTC. It surprised me, too. I started out in Peds, which is what I wanted to do. After 5 years, I took 7 years off to be a stay at home mom. When I took my refresher course, I did my clinical hours in a LTC facility, and enjoyed it so much. I took a job there after I finished the course. By reading these forums, I realize how fortunate I am. I have an excellent Administrator, DON, and Unit Managers, and we don't typically have a problem with supplies. Yes, there will always be drama/shift wars, etc., and yes, we all feel we could use more staff. But we are supported. The residents make me smile every day, and I get to work with great staff (for the most part...). I love the long term relationships. I love getting to know residents so well that I can just tell something is "off". I love their stories and their jokes. I hope you enjoy LTC. If it's the right area for you, I think you'll "know"

Yes, LTC is different, because it is not census driven like a hospital. We need "x" number of nurses per shift, and that number doesn't change. I worked PRN for a lot of years, we do not get cancelled. My commitment was one weekend a month (that was the minimum required from me, and what they were in turn required to schedule me for).

We count all schedule II narcs every shift. We do not count schedule IV (Xanax/Ativan, etc.) every shift IF it is a scheduled med. The count is kept track of in the MAR when administered, and it would be noted then if the count was off. We DO count schedule IV PRN cards every shift. As these are not used every shift, if a card went missing or a count was off, it could be a long time to notice, and impossible to pin point when it went missing. We do keep ALL meds locked at all times though, we cannot leave a cart unlocked if it is out of sight. (Schedule II are double locked). I'm very surprised your meds aren't locked at all?

Our eMAR has a spot for documenting water given pre and post med. I bypass it if I am giving a water bolus at the same time, because that is the water I am using for the meds. Can you add it to your MAR, or do you have to write a progress note?

It really depends on the unit I'm working and how many meds/treatments there are. I go through the MAR and TAR at the beginning of the shift, and write out the times things are due. Then on my report sheet I write the treatments that need to be done sometime during the shift. (So I can glance quickly at the sheet when I'm at the resident's room). I let the CNAs know if I need to be called when they are doing cares on someone to see a coccyx, etc. I then begin my 2300 and midnight meds. Then I begin my full rounds. I chart my vitals, sign the TAR, etc. as I go. Most of the things like checking O2 sats I do during first rounds. If they need a Medicare assessment, etc., and I know they often call several times during the night for toileting, PRN meds, etc., I might wait until they call to do the assessment.Of course if your shift starts crazy (a fall, a found skin tear, a lot of PRN requests) I might do a quick rounds to visualize everyone, then go back up and down the halls with the cart doing treatments). The only thing I save until the end is my Medicare progress note. If I am on a unit that has a ton of 0600 meds and PRN suppositories, I start those at 0500, the earliest I can.Getting your routine down will help, and that takes time. Everyone has a different system that works for them.

10 days. I think it was two shifts on days (to get to know the residents better), one with the med aide, then the remaining shifts on nights (the shift I was assigned to work).

It states the nurse must have a valid RN license in their home state, and obtain all others, including DC. I don't know how someone would be able to keep up with all the different CE's, renewal dates, etc. I should add their telephone nurse advice line positions state the nurse must hold a current license in their home state, and *may* have to obtain a license in up to 50 additional states/DC. I'm not sure why the difference, or what the legal requirements actually are.

I was reading a job description online (for a work at home patient education position) and it stated the candidate must obtain a license in every U.S. state, plus DC. It did state if you live in a compact state (I do), that you would only have to obtain a license in the non-compact states. (That is still over half the U.S.) I can't imagine the cost! Has anyone done this?

Yes, I did. I took seven years off while my boys were young. I then took a refresher course, and I have been working PRN for about 4 1/2 years now. I did the clinical hours for my refresher course at the facility I got hired at, so it was actually a pretty smooth transition.

The hospital I worked at used the overhead page system, but it was not called a "code blue", as everyone seems to know what that means. We had a number, "code ###".

I did. After 5 years of nursing, I left when my oldest was born. I took a refresher course when my youngest entered kindergarten 7 1/2 years later, and I now work PRN. I would do it the same way again. :)

It would depend on your facility's policy for PRN workers. What was your commitment as written on your hiring paperwork? I work PRN in a long-term care facility, my commitment is one weekend a month and one holiday a year. I give the scheduler 2 potential weekends, and I get assigned one of them. I can call out for illness, same as full time workers, but I could not call out because I decided I wasn't available anymore. I need to work the shift or find a nurse to cover it. It really depends on what your facility's policy is.

I knew going into nursing school I wanted to do Peds, though my favorite rotations in school were Peds, neuro, and psych.After graduation, I worked Peds private duty home care for a couple years, then worked in a Children's hospital for a few years on the medical unit, and I really enjoyed it.I took a few years off work when my boys were young. I took a refresher course, and had to do my clinical hours in a hospital or nursing home. I chose a nursing home, and I fell in love with it! Shocked me! I can't imagine being anywhere else now.