florence2012

Wound care is part of my job as the weekend RN at a nursing home. I have been taught that Santyl is a enzymatic debrider that works in a moist environment and destroys the collagen that holds necrotic tissue in place. Also, that it is not to be applied to healthy tissue. I am currently being chewed on for dc'ing Santyl on a wound that is closed on plantar surface of a heel, but not quite filled in, has no slough. I changed it to skin prep q day to toughen the new skin that has formed. I am being told that calcium alginate "activates the Santyl and stimulates granulation," and that Santyl will continue to be used on this wound, even though it has no slough, because it stimulates granulation. What??? What do you think of this? Also, I am being told that there is never any reason for me to change a treatment on the weekend. !! I am very frustrated, but respect all you wound care nurses so much. Please advise.

If I was 18 and knew what I know now, I certainly wouldn't be a part of an accelerated program. Administration scrambles for teachers at the last minute, trying to find someone, anyone, who will teach during the summer term. My assessment teacher had never taught level 1 before. The regular term students are treated with more respect. They are the real nursing students. They have their pictures on the faculty room wall. They get better, more thorough instruction and better organized clinicals. We often felt like the "step-children." None of us even attended graduation because it seemed like we weren't really welcome. Sad, but true. Any of my classmates would say the same.

I'm curious, too. And I'm glad I didn't see this thread when I first started. I was already scared to death.

I am that nurse. Well, not exactly, but she could be me, two years ago. I learned as fast as I could. I worked the floor PRN. As soon as I learned how to do something, I would do it for my weekend nurses to help them out and get practice. I asked for and got orientation with a CNA so I could know more about what they do. I asked tons of questions. I read a lot. I found out that I am very good with problematic people and demanding family members. Twice, I have smoothed things over between a nurse and family member to the point that the family member went to the nurse and apologized. I do grunt work. I clean the floor. I pick up trash. I sanitize the nurses' station. I talk to the police when there are complaints of abuse or theft. I interview witnesses and write reports. I make sure we are properly staffed. If I don't know something, I find out. I bring breakfast for my nurses and CNA's on Sunday morning. And, believe it or not, my BSN education has helped me make decisions and be a leader.

How nice!

I am a terrible interview. Next time I am asked about my greatest weakness, I'm going to say, I don't interview well. Look 'em in the eye and give a good handshake. Good luck!

I went back to school at 49 for my nursing degree. The only reason I have loans to pay back is that I already had a degree and was not eligible for grants. Check into grants you could get. Much better to get more schooling while you are living at home than go back when you're older. I don't know your situation, but wanted to suggest that you explore all your options. Good luck to you!

What an inspiring story! Thanks for sharing it here.

I have learned a few things that save time. 1) Listen to bowel sounds and lung sounds while the BP cuff is working. These are blanks you must check off in the medicare nursing notes. Don't just sit there, do something! 2) If your diabetics are hanging out in the dining room, go do your sticks in there. Then do the ones hanging out at the nurses station. Then go to rooms. If you can do one person's meds and stick at the same time - bonanza! 3) Learn to get out of a room without appearing rude. Sometimes inching toward the door works, sometimes not. 4) I like to go in a whiny patient's room and sit next to them and talk for a minute. It's worth it because it saves time down the road. A patient who is given time feels cared for. One who is brushed off will keep needing more and more. I once made a list for my neediest (emotionally) resident. It told her when she could next get pain medication, what time the next meal was, etc. I told her I would come check on her at a certain time and I did. It helped a lot.

When a privacy issue comes up for me, I ask the patient if they would like some privacy before I begin. They almost always say no, but if the visitors are uncomfortable, they take this as their cue to leave the room. And this is kind of chicken, but if I'm not comfortable doing something in front of other people, I say, "We're going to need a little private moment here, if you don't mind stepping out for a little bit..."

CapeCodMermaid, Nascar nurse, and amoLucia, thank you so much. It's been almost two years now. I'm still not comfortable on the floor, but i managed to complete a shift last night. I do ask for a partner on things I'm not sure about, and my lvn's are happy to show me how much they know. No one has ever refused or gotten impatient with me. Last night i did tube feedings and tube meds out the wazoo, so I'm ok on that skill! Thanks for the encouragement. florence

Thank you for the replies. It has helped just to write this down and realize that the list is finite and can be dealt with! I watched a video yesterday and plan to do this on a regular basis. Great suggestion. I don't know how nurses functioned before Youtube! Sometimes I am offered a day on the floor with a med aide. I will certainly say "yes" to those. And follow the LVN's around on treatment days to learn skills I need. I used to do that all the time and kind of let it go. The med pass remains quite an intimidating prospect for me. I am thorough and have been told that I can't be unless I want to spend 24 hours a day on the med cart. It's a conflict I haven't been able to resolve in my mind.

I graduated in August of 2012 and finally got one single job offer - weekend RN supervisor at a local nursing home. I was scared to death not to take it, and scared to death to take it. I took it. At first, I did only wound care and supervising every other weekend. Soon my DON asked me to come in for 12 more hours a week to help with care plans and MDS's. I was paying my bills and student loans and putting money in the bank! It seemed ideal. Then our census went down and they cut my 12 extra hours. They still called me in when the treatment nurse or DON was out, so I still managed to pay my bills. Next on the list of things to learn was floor nursing. The first night I worked, the med aide had to come in and help me finish passing pills! She only did it because she likes me, she said. I didn't cry, thankfully, but I wanted to, and the experience made me start to hate my job. They started calling me in to work the same hall on day shift from time to time, and I got a little better, but it's so very hard when you do something only occasionally. I got to where I didn't dislike it so much and even started to have time to actually eat lunch. The last time I got called in, it was a different hall, and it's the hall everyone says is the hardest. Several residents were starting antibiotics, which I had to get from the emergency box, which takes time, and there were so many new drugs and drops and patches, etc. I was lost! Thankfully, the next nurse came a little early and helped me out and it got done, but it was pretty horrible and I hate adding to someone else's workload. Here is the crux of this message: I have been working as an RN for a year and there is a long list of skills I still do not have. 1) IV medications and starts 2) sending a resident out to the hospital 3) inserting a Foley by myself 4) blood draws 5) I have never actually spoken to a doctor about a resident! 6) breathing treatments! I'm afraid if I don't work the hall when they call me, they will stop calling at all and I won't be able to survive on my two weekends a month. I don't think I can get a different job, because of my lack of skills. I want to have a plan in place for advancement or learning, but so far I don't. I feel so bad about myself when I come in from floor nursing. My self-esteem is very low. I guess I'm asking for encouragement and/or suggestions on how to get better or find another part-time position.