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Straight No Chaser ASN, LPN

Sub-Acute & Long-Term Care Nursing
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Straight No Chaser has 4 years experience as a ASN, LPN and specializes in Sub-Acute & Long-Term Care Nursing.

Straight No Chaser's Latest Activity

  1. its the nursing station. For all those involved in nursing. I like my CNAs at the desk with me because then I know where they are and I can delegate when they're not busy.
  2. Straight No Chaser


    OK you guys. I work in a SNF with SO MANY psych patients. The dementia unit is more psych than dementia. I'm talking incessant screaming damn near my entire shift with little to no relief from the go to PRN trazodone. Facility reluctant to medicate them because of the red tape and the probability of getting tagged even though they absolutely qualify. It breaks my heart because its clear to me they are suffering, but CMS makes it so hard to medicate them because of all the patients who get chemically restrained. How do I advocate for them in a way where I'm being respectful of the facilitys view point but also getting results. We had the psych NP recommend zyprexa for one lady, somehow administration got the house doc to say no. So they are trying depakote. No difference. Its so bad that I changed my schedule around so I'll almost never have to float up there. I can't handle it. This is my first issue. Secondly, and more affecting my daily work life: Then I have a few of my long term patients on my sub acute floor that are SO BEHAVIORAL. Some nurses say "oh they're just psych" What does that mean? I'm having a hard time with the behaviors, especially. If a patient has dementia I can totally handle everything about them. But when they don't have dementia and they just seem to be badly behaved, attention seeking drama queens I have no idea what to do. (I don't say that lightly, im not that kind of nurse. I give everyone the benefit of the doubt) I've ended up forming pretty good professional relationships with them, but I'm making my co workers irritated because they aren't as patient or warm and they get the brunt of the behaviors. Personally I think they just want love and attention, and thats its. But there are a couple who I know are "misbehaving" just because its fun (or just because they can?) Bullying other patients, causing a scene to get the attention off of someone else (who really needs much more care than them) How can I better understand and deal with this behavior? I had a totally A&O patient who is completely independent and inappropriate for this setting ( but won't leave - long story) cause an absolute SCENE the other night and cause me to spend over an hour on her and her alone. Threatening to elope, etc. (This took away the window of time I had intended on spending on her roomate, who is paralyzed - I was going to help her set up her phone to use via her voice). Prior to now I thought she just wanted to know someone cared, but I think she may have done it because her roommate was getting too much attention from me. Is this a thing? Please help, I really am no equipped for this kind of nursing.
  3. Straight No Chaser

    LPNs are still good nurses

    I'm getting really irritated with all the "when are you getting your RN" questions I get. Or, when someone at work hears me say in an LPN (when I'm signing for something usually) and they say "Oh, I thought you were an RN". What's that supposed to mean? I'm a good nurse so I shouldn't be an LPN? I probably will get my RN so I can stay in my field yet also move up, but It will do very little for the role I'm in now. We literally do the exact same job as bedside RNs in this setting. (Sub-acute, some LTC). The only thing we can't do that ever comes up in this setting is pronounce. We don't give blood or blood products in this setting, so that's not an issue, nor do we IV push - and my state has a liberal scope for LPNs. I can assess, start IVs, work with PICC lines, administer through PICC lines, and administer TPN. (IV/TPN cert). So, I really have no need to get my RN if I'm to stay in the setting Im in. It won't affect my practice, I never have to "go get an RN" to do something for me (unless my patient dies, which isn't a problem really- although its annoying) I want it mostly because I love learning and I want the freedom to move around as I like and maybe eventually (like in 10 years) move up to ADNS, etc. LPNs are nurses, just like RNs. We have a different scope and a different knowledge base - but depending on the setting its not that much of a deficit. I'm missing critical care knowledge, nursing theory and perhaps more in depth pharmacology. That's about it. To be honest, I've picked a lot of that up as I've become more seasoned (seasoned is something I am not. Still marinating is more like it) but I have for sure expanded on what I learned in school. Time will tell how helpful it will be towards my RN. My local school would only have two classes I need to take (not to be taken concurrently so it takes about a year anyways). I guess what I'm saying is nursing is what you make of it. We all start off as babies with little to no idea of what we're doing, RN or LPN. We can continue to build on or knowledge or we can call it a day, use only what pertains to the specialty we choose and never progress, but we shouldn't. If you love being an LPN, just be the best damn LPN you can possibly be. Don't think you're not smart enough to become an RN (YOU ARE, you made it this far - that's the hardest part) and don't think there is anything wrong with staying an LPN. ESPECIALLY if you work in a SNF and you love it. You will always have a job and you will always be able to make a huge difference in the lives of your patients. Whether they be short term or long term or both. Admit when you don't know something and look it up. Don't listen to other nurses when they tell you something that sounds off - look it up. When you see a dx you've never heard of - look it up. When you get a new patient - read the H&P when you can, look everything up that you don't understand. The next time you see that dx it will feel awesome. If you're an RN and you think working in a SNF is beneath you, think again. These facilities need good, competent nurses. There is no such thing as being over qualified. If you're a new grad RN you're going to learn A LOT and you'll never judge a SNF nurse as long as you live if you move on to a hospital type role. Don't assume a skill level or knowledge base is sub par just because it belongs to an LPN, you might be surprised. Oh and no matter who you are or where you work. Help your damn CNAs. Never delegate out of convenience. EVER. If you are free, you can do non-nursing tasks. Always. If you are asking them to do something for you it better be because you are doing something they can not do. They are assets, not slaves. This also gives you a leg to stand on when you need to teach them or call them out. You will be respected and they are more likely to listen. I'm getting off a couple of busy shifts and I just wanted to write this all out. I don't know why I went in 5 different directions. Im putting it in the LPN corner because I feel like If I put it in general nursing I'll get a lot of negative feedback and thats not really super helpful. You guys will get it, and maybe it will help someone.
  4. Straight No Chaser

    Holding HS Meds

    Seroquel isn't a med that should be held because its an antipsychotic and doing so can cause recurrence of symptoms. You would have needed to contact the MD to hold it for sedation. Trazodone I one I feel comfortable holding per nursing judgement.
  5. Straight No Chaser

    Memory care-Can you pass meds in the dining room?

    Its a dignity issue and generally against policy most places. The exception is if the meds are to be taken with a meal. In reality, we do it but not when state is in the building and not if anyone asks.
  6. Straight No Chaser

    Why do RN's avoid LTC positions?

    Its really, really hard work and RNs have a much better selection of which to choose from.
  7. Straight No Chaser

    HELP! Old new grad in LTC need advice ASAP From LTC nurses

    You'll be OK. Don't be afraid to ask for more orientation if you need it. Don't worry about late meds, you can explain being late - you can't explain giving the wrong med/dose. Don't pick up bad habits and use your judgement. Most nurses in LTC take shortcuts, I don't care what anyone says. BUT it takes a long time to learn what shortcuts are safe to take and what ones are dangerous. If your gut is telling you to do or not to do something, listen to it. Don't be afraid to delegate to your CNAs and don't be afraid to ask them not to interrupt you. Don't be afraid to tell anyone to "please hold" while you are preparing meds. You'll be OK.
  8. Straight No Chaser

    Laws pertaining to LTC, etc.

    So I've been a nurse for 4 years in two different states. There are random things that I want to investigate or research, mostly related to policy/procedure. Not that which pertain to my facility, but in general. Anyone know a good resource to look stuff like this up? For example I had a resident try to elope. She is her own person, I wanted to find out if I'm even legally allowed to force her to stay. I ended up redirecting, but I hate not having a definitive go to place for this stuff. I also wanted to look up what the law says about discharging someone who is homeless, (long story). I like to have facts and whatnot when people ask me questions, rather than just dictate what I"m told our policy is. At the end of the day I'm more concerned with what is legal/ethical than what my specific policy is. I'd also like to just know what the law/BON says about specific things regardless of facility policy so that I have a baseline, if that makes sense. I just got off a double so If I don't make any sense, forgive me.
  9. Straight No Chaser

    LTC Residents and Workers Face Tragedy

    My coworkers and I have worked harder and under more stress than every before keeping this *** away from our little old people. Between them not being allowed to see their families and now not even leaving their rooms, the issues we are facing are compounded with the result of so much isolation and deprivation from human contact. Most of my patients aren't confused, although some are - and even the oriented ones are struggling with the loneliness and fear. On top of that the ones who are confused see us in masks and gowns and the fear only gets worse. We don't get to choose to stay out sick because we're worried or our jobs aren't doing enough to protect us (most aren't) - if we do that, these people suffer for it and that's not right in any scenario. To add fuel to the fire anyone we do have to send out comes back worse than when they left us because of how overwhelmed the hospital is right now. Then they have to go on a 14 day isolation period which is even more stringent than our new normal. Oh and because our census is lower than usual as we try to limit admissions to keep the virus out, our staff is getting cut. People who would normally eat in a dining room with supervision from one or two staff members are in their rooms, so meal time takes so much longer and there just isn't enough time in a day.
  10. Straight No Chaser

    Refusing Care of a COVID-19 Patient Due to Inappropriate PPE

    I was surprised to see that folks were looking to use the N95 masks, to be honest. This isn't an airborne virus, so unless you're working in an area which has equipment, etc. that could cause it to become airborne I don't see the issue, but it seems I'm in the minority.
  11. Straight No Chaser

    Why hasn’t pay increased? Hazard pay, etc.?

    I've never expected it. I knew what I was getting into when I chose to become a Nurse. I do think folks who are in support services like grocery stores, etc. should receive hazard pay, though.
  12. Straight No Chaser

    Gloves at all times?

    Um, no. Not to mention you can't wear them in the halls. Why would you need to wear gloves when you aren't touching the meds? Shes probably a housekeeper. Not to knock housekeepers, because they are the beez knees, but thats my theory.
  13. Straight No Chaser

    Nurse asks, 'Did you know I was there?' in touching viral post

    I feel like this could have been written by a CNA just as easily as a Nurse. They often don't get the credit they deserve and this is a huge part of their job as well.
  14. Straight No Chaser

    Nurse asks, 'Did you know I was there?' in touching viral post

    nothing more humbling or rewarding than caring for someone at the end of their life.
  15. Straight No Chaser

    It’s That Time of Year Again: Preparing for Influenza Season 2019-2020

    Surely as nurses most of us understand that vaccinations come with a normal immune response and that flu shots don't give us the flu, but that response. Even IF they aren't totally effective, I'd still rather take my chances of protecting folks and I think others should too. I don't really know why we even have to mandate, but obviously enough people were opting out that we do.
  16. Straight No Chaser


    This happened to me over thanksgiving. Its usually the shift before and after your scheduled holiday. So, if christmas eve was your scheduled holiday, you wouldn't get holiday pay for that shift. If Christmas was your holiday and you worked christmas eve as well as the next scheduled shift following christmas you would. Its a bogus policy and I had no idea it was so common.