RN1822

I am in western mass and we recently had a MTF, with out the surgery, pt in an acute hospital that needed LTC for rehab. Our challenge was bed management as we did not have a private room available. I was in admissions at the time and while we were trying to decide what to do the pt found placement in a competing facility with a private room. We never came to a clear agreement on what was the most appropriate thing to do and honestly, I think our admininstrator drug her feet hoping this admission would go away. I think this is a complex issue and would love to hear how others have bed managed when there was not a private room available.

Good Luck at your new facility. I worked in several different positions in LTC for the last 8 years and was very happy to get out of LTC. My years of experience were exactly what you described. I am now working at a LTAC and I love it. That being said, I am also doing agency shifts at a local small LTC that is 5 star rated and I love it. It is nothing like the years of experience I had in traditional troubled large LTC. I am hoping that your new facility is a good fit and a great place to work!

I just took a couple of these test at my LTAC which is also my First RN position. The test were all open book and a PDR was made available to us. We all did fine and I think you will too. Remember to breathe!!

This is an interesting thread. I am a new Grad RN but worked as a nurse supervisor at a LTC facility in Massachussetts while I was in school. I have never seen an ADON that was a LPN but have seen several functioning ADONs that were LPN's that were given the title of "House Manager". At the facility I worked in this was a cost savings and also given to a strong LPN that was well liked. She is being taking advantage of financially and because she feels "lucky" to have this post, she is working herself ragged. I didn't realize how far out of the scope of my LPN practice I was asked to be until I entered the bridge program and got a reminder from a very nice instructor who was concerned for me. I had been an LPN for many years and had slowly started to pick up more and more responsibility as asked by Management. I can tell you that I did more of the admission assessments that any of the RN's, to include patient teaching, etc.. I can tell you that almost all initial assessments of new admissions in to LTC facilities in far western Massachussets are done by LPN's. I brought this up to a friend of mine who is a DNS at a facility where I pick up agency shifts and she said that it is a fine line and covered legally by the way the admission assessment form is worded. She stated that also there is a place at the end of this 9 page document for an additional nurse to sign if necessary. I think we will see more "House Manger" positions open up as a cost saving going forward.

I appreciate all the responses, I may have missed some sarcasm from the OT when he used the term "extra Sterile" which is one of the things that made me go "huhh?". I have watched the RT's and it seems that what they are doing is wearing clean gloves under sterile gloves to Suction and then capturing the suction tubing in the sterile glove as they remove it. This makes sense now that I have seen it in practice by some very conscientious RT's. Also, totally makes sense for a code brown or other Icky situation. This was all done on only one pt and then hands were washed before we left the room. I hope I didn't give the wrong impression that he was removing one pair of gloves and then moving to another pt with the other pair underneath. Sterile gloves for IV starts? I just use clean gloves but not a bad idea.

OK, so today one of the Respiratory therapist had some time and was nice enough to let me shadow him as he was caring for a pt that frequently decannulates. ( I work in LTACH). He put on two pair of clean gloves and then a sterile pair on top of that to make him "extra sterile"? I asked him about that technique and he said that was the 2 glove technique. I am new here and don't want to appear insane but, really......I have never heard of this. Is this specific to Respiratory Therapy or is this guy pulling my chain. We were replacing a trach strap. I thanked him for his time and went to finish up my pateints. Has anyone else heard of this?

It is the Springfield location. I am writing all of these things down to go over them with my rep. Thank you so much for all this information I really appreciate it more than you can imagine. One thing I thought was strange, There were about 10 of us in general orientation from all different disciplines (3 RN's) and they kept telling us they would let us know what out orientation schedule would be. They kept putting it off and the CNA's left on Thursday still not knowing their schedules. I stalked the scheduler down to get mine but she had to call the nurse manager to get more info and I left still not knowing when I work or when to come back. She said she would let me know Monday but, I just found it a little strange.

Thanks Esme, I am not sure what I need to know. I have zero union experience or exposure. I got a copy of the contract and it doesn't look like I have to do anything. I was worried that I would recieve a bill from the the union people but HR let me know that i can have my dues taken out of my check weekly and the amount doesn't seem to be very much. It looks like we get an extra 6 days of vacation and free CEU's from the Massachusetts Nursing Association (the union we are in). I will be meeting with the union rep on my shift on Monday just to say hello.

Well, two days of orientation down and 12 weeks to go. All is going very smooth so far. Everyone has been very helpful, i will find out who my preceptor is tomorrow and will meet with them. They told me that orientation was between 4 or 12 weeks depending on how much i felt i neede. The Education Nurse shared that it was absolutely fine to take the whole 12 and to even request more if you felt uncomfortable. I was surprised to learn that I am now in a union. I have zero union exposure or experience so I will be gathering information about that, I reviewed that contract and it looks pretty straightforward. I did not have to take a pre employment med exam but i will be taking one in orientation. My commute is about an hour but, i don't mind a commute. I like a little transition time between work and home. Thank you so much Asst admin for all the information!!

I worked LTC for the last 9 years and the first year was the most difficult. It will get better. I agree that clustering activities is one of the keys. If you are on a medcart, overstock it as soon as you hit the floor with any bedside small treatment items you can do while you are giving your pt meds (skin prep, bacitracin, telfa, kling, NS bullets, medicated creams, etc....). It might not seem like a lot of time is saved that way but, you really can get all the priorities completed with a little planning and some support. At the first of the shift, when you are giving your CNA's report, delegate what is appropriate to your support staff. You may also have to get comfortable with having a pt wait a few minutes for a CNA to assist them with ADL needs ( when this is reasonable). Remember that while you can certainly do what a CNA does, they can not do what you do. If you are spending a lot of time with ADl's you are going to have a hard time staying in compliance with a med pass. Are you able to identify what is slowing you down, is it the whole assignment or do things go smoothly until a certaion part of the shift? Ask questions of the nurses who seem to be doing it successfully. I don't mean the nurse who seems to have a ton of down time and is alway on break or on the phone. That nurse is just skating by and probably signing treatments and assessments she has not completed. Find the nurse who is steadily busy but seems unruffled, the nurse who takes her lunch but is back on time and ready to go. Even if people don't have answers to your questions as to how they do it all, I think just asking the questions demonstrates that you are focusing on improving your performance and are eager to learn. Good Luck and Hang in there it does get better!!

Okay, so at 830 in the morning I start my first day or orientation. My bag is packed, stethoscope, lunch, snack, water bottle, chapstick, nursing credentials, pens, scissors, highlighters and lifesavers.....I feel like I just packed to go away to summer camp. Now I am too excited/nervous to sleep. Bag repacked, different scrubs laid out, double check that socks still match.....OMG, I am supposed to wear scrubs to the orientation aren't I? They never said dress casually for the first part of orientation so I am going in a solid color scrub set. I did a test drive in traffice to see how long the commute would be and even found a safe and clean place for a midway bathroom stop if necessary. I believe I am ready to do this, now if I could only fall asleep!! I will update tomorrow when I have the details on the length of my orientation. Thanks everyone for all the information and wishes for success!!

I go to first day of orientation on Tuesday and I will update with how long the orientation is scheduled to last. I think it is 12 weeks. I am so glad this forum was added!

31.86 in a hospital in central Mass as a new grad RN which is a pay cut from what I made as a LPN LTC nursing supervisor, 34.00 or weekend LPN PRN 35.00 in the Berkshires. I was surprised that I had to take a pay cut when I recieved my RN. HMMMMM

If you think your current manager wants you out, she will probably give you a good or at least decent reference in order to avoid the performance improvement plan or the termination paperwork. Call the place back that made the offer and give them permission to contact your current employer. You already -don't have the new job- so they can't take it away from you. Is there an opportunity to meet quietly with your manager and share that you are considering other opportunities and ask her directly and professionally how she see herself supporting you with this and I she is comfortable giving you a positive reference. Identify your own strenghts first (Punctual, teamplayer, Strong sense of integrity,Eager to learn new skills, good with difficult families, calm in a crisis, etc...) and then ask her if she is comfortable sharing your strong points with a potential employer. Good Luck and remember to Breathe RN1822

I start the first week of September. I am very excited about the position although I was so happy when they offered my the job I probably should have asked more questions. I am starting on the most acute floor with their most complex patients. I haven't found any books specific to LTAC so I have picked up 2 CCU books from Barnes and Noble and I am trying to start studying now so I will have some foundation for my orientation. Good Luck on your new job as well. Keep us posted on your progess. Have you already started?