x19amanda

I work one part time job and two per diem jobs on a weekly basis between 45-65 hours weekly. If you don't value the experience anymore and don't need the money then work one job

Very good points, thank you. One full time job is very stressful now that I think back to previous FT jobs prior to nursing. I think it's just learning how to manage & not letting outside stressors & work stressors combine because it can drive you to crazy town.

24yr old RN, began in 2013 at age 22 working as overnight supervisor/evening charge in LTC. At 23 picked up 2nd PT job on a Outpatient Behavioral Health Clinic at small local hospital in a high crime/poverty area. Both jobs requiring separate knowledge base & set of skills. At 24 picked up 3rd job as Per Diem on a med/post-surg floor at same hospital. I regularly have been working all 3 jobs on a weekly basis, working each at least 1-3 days/week. I feel very competent in my critical thinking & ability to work autonomously, but this has also been accompanied by moments of high stress & anxiety that can be unbearable. I blame this on myself, for not working one FT job, so could familiarize myself with a routine etc.. But...I still enjoy it. Fellow nurses, do you think I am gaining valuable experience working in 3 different areas or do you think as a nurse with only 2yrs experience I should be focusing on one speciality? Pros vs Cons?

Hey, it's okay! bad grades come with the territory. take it from someone who failed a semester of nursing due to not really giving a ****, to beginning to truly put all my blood sweat and tears into it and continue to fail. the third semester is the toughest in the program I grduated from and I cried everyday wondering how all my effort continued to bring me failing scores on my exams. I then found the answer. I stopped putting myself down and I became optimistic (even though I failed the first 4 out of 7 total exams at this point) . I changed my studying; I began to record every lecture and relisten while writing every single thing the lecture instructor said on the tape. I then rewrote every single one of my notes and read the book. I finally began to pass, and by the last semester I had a 4.0 with two exams being 100's (2/7exams). just believe in yourself

I currently work as an outpatient RN on a behavioral health floor, and we have recently reveieved a governement grant of over 4million dollars to renovate the floor and integrate kiosks that offer service such as medicaid, housing, etc. We also now have a primary care office, that has exam rooms and a full time nurse and MD. Each client that comes for their appointment with either me (the injection nurse), there therapist, or psychiatrist, is now asked to complete paperwork and is offered to be linked with ou primary care office on the floor. It's great!

I've been working in a LTC/Rehab facility for almost a year and far from the contrary it has truely made me a strong nurse and even though I dont utilize many skills I have to say I am thankful this was my first job. I have learned so much in regars to documentation, critical thinking, communicating with doctors and other staff members, and time management. I work both 3-11 and 11-7 which are two different ball parks. 3-11 RNs consist of getting report, receiving any labs from the fax, (usually a lot of PT/INRS, BMPs, CBCs), then I do a quick round to ensure all residents are accounted for and any who have alarms have them on their person. Next, I review the MD message board, and collect all charts, meds, info pertaining to what I need to convey to teh doctor as well as any charting from previous shifts and think up any recommendations. After that, I usually review the charting from teh daytime, and then look through the communication book which may alert me if family members or other areas need to be contacted. If there is any admissions, I have to do all of this and the long process of an admission. All together, this takes quite some time, especially if there is many labs and admissions. Also, if there is an MD in for rounds I assist with this, and chart document and writer off any orders made. In between all of this, if somebody falls, any skin issues, or needs to be sent out I am responsible for all of this as well which can be quite time consuming because documentation needs to be thorough to cover your ass. Also, you spend time helping your aides toilet and answer call lights. At night, it's a whole other story. Mainly, youre super short staffed, have paperwork to get ready for teh day, documenting falls, hospital admissions, etc. Also, toileting many many residents. Enjoy!

One simple answer...time. I've been at the same LTC facility for almost a year with 120 residents, and I can now feel comfortable knowing almost everyone's diagnoses. You get to know by when situations arise and looking into their charts, or when passing meds you relate their medications to their pathophysiology, and by communication between staff. It takes time, so for now I'd freshen up on care of clients with COPD, CHF, DM, Dementia, and other cardiac issues. Give yourself time!

LTC was my first job as well approx 8 mths ago; I was overwhelmed as a supervisor/charge nurse and taught myself the 30 person med pass (no tx nurses and no aides allowed to do any creams etc). ITS OKAY! This experience is great no matter how many people overlook LTC nursing. My time management is amazing and I am confident in making critical decision with no other nurse around in the middle of the night. Itll be okay! Nursing is stressful.

o2 tubing and nebulizer masks and o2 get changed once weekly by 11-7 shift. MAR change over is done as well by 11-7 shift. so two floors by usually one or two nurses in 8 hours plus if anything else happens in the facility. its a hassle to say the least

yes we do. some nurses count coumadin by dating next to the cartridge when removed, and antibiotics are usually ordered with the correct amt of dosages in the cartridge needed, so you can tell if one wasnt given.

Thank you for all of the feedback. I saw the client today, and he stated he was only sore for a few days which is expected. Over the phone he made it seem as though his arm was swollen and tender which was not the case. I do give many of these in the gluteal, but in this case hes a young male and I am 22 and he does not like the idea of this. I have noticed I no longer have an issue with oozing, because I do not remove until at least 10 seconds and use the 11/2 needle on all clients unless they do not have much body fat. So far so good. I find the men to be bigger babies when it comes to the shots than the women haha. Good suggestions everyone!

Hello, I recently started working in outpatient psych, and regularly give Haldol and Prolixin Decanoate injections, as well as Invega Sustenna and Risperdal Consta. So far, I have been able to give the injections effectively, without any site reactions or decompensation. Sometimes though, I get nervous that I am not administering the injection correctly. I have noticed every once in a while the Prolixin oozes out a little, but I started using larger needles to prevent this. Also, I have one client who receives the Invega injection in the deltoid, and has been having issues. The first injection apaprently I gave too far down, and caused a hardened area under the skin and pain. I felt horrible, and he was afraid to come back to me. I finally got him to come in again, and administered the injection again in the deltoid (per request) and he explained it was great and didn't hurt at all. I just called him today a month later and is now complaining of hardness and pain under the skin at that site too! I feel so stupid and that I am doing something terribly wrong. He has never had this issue before. I give at least 20 other people Invega and they have no problems. Can someone help me understand or give me advice as to prevent this from occurring?! Feeling helpless. P.S-I either pinch up the skin and insert fast at a 90 degree angle or use the z-track if they are larger.

I may want to rip my hair out and run out the door d/t short staffing, behaviors, MDs, admissions and paperwork, but all in all these residents live here, not me, and I get to go home at the end of the day. They worked their whole lives, not knowing that one day they would suffer from chronic illness or terminal diagnoses. Some of them do not have any family, or just wish the end was near. I feel as though they are my family, and doing everything in my power to live their last years in peace is the least I can do for this lovely generation. Just to spend time talking (when you have time) makes the world of difference. Administering all tx's, meds, toileting and changing without skimping d/t time will have you leaving work knowing you did your best to show these residents they are cared for. My residents with the most behavioral issues seem to melt my heart the most, as they cannot help this and the moments when they smile and laugh make my job worth while. Saying good morning to a 95yr old dementia patient and letting them know they are care for makes my life complete.

I understand your reasoning, but if it was scheduled it needs to be given. How often is it scheduled? If the resident is given other prn meds throughout the shift, than those prn meds should be ordered for Q so hours that does not interfere with the scheduled meds thus causing harm. Hopefully the MD took this into consideration before ordering the meds which I'm sure they did. This resident seems to be in severe pain, possibly Hospice? Always give a scheduled narcotic.

The MD that wrote the order should have not wrote it for "anxiety." It should've been written for restlessness and agitation, because who is to say that his person is experiencing anxiety? You would have to really prove that which may be hard when the patient is having extreme behavioral issues. If it's ordered prn for agitation and restlessness this can be proven that it was administered appropriately when documenting what S/sx were occurring. I hope that makes sense.

I began working outpatient psych at a local hospital approx 2mths ago. I am one of two RNs on teh floor. My job is administering all medications such as IM's that are given Q2 or 4weeks, such as Prolixin, Haldo, Invega, and Risperdal. I comlete an nurses note on each appointment, do tx plans for those without therapists, work with pharmacy, case managers, hold all sample meds for the hospital, run clozaril groups every wednesday, and other paperwork and responsibilties. My job is very indepedent which I love. I have my own office which I do my work in the way I want to. I schedule when I want and what days I want, so if I want 4 hours of down time to catch up I schedule around that. It's a great field to see my clients progress and live normal happy lives, and being able to listen to their stories and help each one is just as rewarding and it is truely saving lives.

i started as a new grad 6mths ago...i was terrified. some advice: 1) ask questions...they are never dumb. there is always someone with more experience. 2)communicate with your aides efficently 3)DOCUMENT DOCUMENT DOCUMENT-cover your ass. 4)Incident reports are long and annoying but essential to prevent lawsuits and state health inspection deficiencies. 5)Customer service-you may want to rip your hair out with needy residents and family members but just keep as mile on your face. 6)dont forget nursing 101-help aides provide incontinent care etc. 7)know your residents meds, dx's etc. so youre aware of critical changes in status. 8)Learn the med pass prior to the desk... 9)COMMUNICATION from shift to shift.

well usually all the labs that were drawn that day should come at the same time, and i collect all necessary resident's charts so I have the proper information at hand if certain labs are effected by medications etc. I also have suggestions ready to go; such as increasing fluids, daily weights, increasing a certain med etc. i also look at the MD book to see if there is any messages that need to be communicated to the MD from throughout the day as well, so I can get it all done in one phone call. After getting orders for anything left in the md book and with labs, I write the order, put it in the MAR, house report, chart on teh computer, fax what I need to pharmacy, and call any HCP's for any ordered psych meds, tx's (incidents) etc. Im new as well, trust me you will get the hnang of it.

If an office job is too stressful I dont know where else would be less....

My charting. I've been noted several times but the DON, other RN's etc on how detailed and thorough my charting is, especially when it comes to discharges and admissions. I like to give a full adequate summary of what is going on that way the next shift doesnt have to quiz me on any incident, they get the full story through the notes. Plus any behavioral/pt complaints can be fully noted that way I can say I tried everything I could and was aware of any dissatisfaction.

If anybody falls, you immediately assess the postion that they have fallen in, and begin vitals and a head to toe assessment. Ask the res if they remember how they fell, if they hit there head (if they did Neuro's should be started) and check for ROM and any skin integrity issues. After reviewing all that, get res. back into bed etc. If the res. experienced any skin issues begin skin treatments etc. If it's a serious fall I'd call the ambulance before calling the doctor for an order because obv they wount say no. Next call the doctor or we have a doctor book to leave the message on how it occurred etc. Call family members next. STart documenting on the incident with incident reports, on house report, in the charting. Take steps to prevent reoccurence such as if they need a floor mat etc. It will happen often so be ready.

If you document on the PQRST each time and the effectiveness of each prn medicaiton, there should be a pattern as to if the medication is working effectivenly or not. What type of pain was the pt experiencing? It could be something very serious. The doctor should've altered his prn pain medications completely if the pain was unrelieved; pain is whatever the pt says it is! sounds like a bad dr.

Okay, so I am sure most of this is in my head but here it goes. I have been working as a new RN in LTC for 4 months now. I work overnights as the supervisor for both floors. It was stressful at first but now I am familiarized with most tasks and feel comfortable. The only time I don't is when I really want a second opinion on a acute situation and the only two nurses working are LPNS that are newly graduated as well. This can sometimes be stressful, but I feel as though I've always done the right thing. MDs known to be rude are never to me even when I call them at 4am, meaning I must be making appropriate calls/decisions. So far I have barely gotten any feedback! I began to pick up on 3-11 very quickly, so I could receive feedback and ask more questions since there is more than one RN on during evening shifts. I was never trained on the med pass, but I quickly began to pick up on 3-11 med pass and be efficient. I also do the change overs at night and do not make mistakes. I am very young (22) and sometimes feel as though I am out of the loop. I feel like all the other RNS communicate with each other and I am just "there". I wish I felt more included sometimes, but I feel as though they don't value my opinion? They just appreciate that I pick up shifts and don't make mistakes? The only thing I've been told is my charting is excellent, but I want more! I want constructive criticism; I wanna be told what I could improve! Sometimes I feel as though I'm just there for my RN so when LPN supervisors make decisions I can sign the paperwork. I don't know if they find me a valuable member of the team or just a filler for shifts. I do everything right but I just feel like I could be doing more. When I give report to the one morning RN I feel like sometimes she looks at me like im stupid, but I don't have much to tell her since night shift can be pretty dull. Does anybody else feel like they aren't as involved as they should be? what can I do different?

I graduated in May and started in June in LTC....not many hospital jobs. I do not think this has caused me to lose my skills or lose knowledge. I still read and keep up to date on info all the time. If a resident comes in with a CVP line, IV ATBs, dressing changes etc I am not nervous at all to perform these tasks because it all comes back to you. As for eventually landing a hospital job, I do not believe this will stop me from doing so. My school has a great reputation, and many girls I know do not have any job yet. I still feel as though I can go onto a Medsurg floor and do great; have you seen the LTC med pass! I now have experience working the desk, supervising, and doing a med pass. My facility has 120 residents; 30 are rehab. I run both floors at nights, do the desk on both floors, and have done every halls med pass. I say I can go into a hospital and do great.

you sound like you are doing a great job. You are being formal, polite, and very professional. You cannot spend all your time with one patient and you are going back to your nursing school roots it seems and doing the right thing. Some people are just better talkers! it doesn't mean that you did not do your job. Sometimes it's better to not be in the spotlight, good or bad. I too am a new nurse and sometimes feel SO AWKARD if I am stressed and doing a new task, diff shift etc. Sometimes I feel as though ppl are juding me so I stutter or sound stupid but I know I'm not. You aren't the only one! Nobody has complained about me but sometimes I just laugh at myself and think wow I seemed nervous etc. Ya just gotta laugh:-)