Starkrav

Hi All, I am a new RN looking for work. So far I have not had any luck landing a med-surg/hospital position. A few of the home health care agencies in town are hiring, and I'm considering applying. But here is my concern - Once I work in home care, will it be difficult to get a job in a hospital? Will I pigeon hole myself by starting in home care? Do any of you have experience going from HH to Hospital? Thanks!

Thanks guys. You all have great suggestions. I've decided to wait to apply until after my appointment with the OB on February 1st, just to see what she says. I know many women work high stress jobs or night positions while pregnant. I'm just not sure I'm willing. The latest research shows that moms who work high stress jobs or more than 30hrs/week are more likely to deliver preterm or have complications like pre-eclampsia. Financially, I need to find something, even if it's part time. And as much as I want to stay away from med-surg, I think that's probably the route I'll have to go. I'm just going to push to find a part-time position. I figure two 12s a week would be manageable and still provide necessary experience.

Hi all, I graduated in November, discovered I was pregnant a week and a half ago, and took and passed my boards a week ago. I am thrilled to be pregnant, because with my health history I wasn't sure if I would be able to conceive. At the same time, the timing is far from great. Now that I'm pregnant I feel unwilling to work night shifts or an extremely stressful job. That obviously limits my options. I'm looking in to clinic work, hospice, and hospital day shifts (which I probably won't get). I'm afraid to spend a year+ in hospice or clinic only to find that I am then stuck forever in those areas. What do you guys think? Will I get pigeon-holed into non-hospital work if I start out that way? Should I tough out a high stress hospital job and risk complicating my pregnancy? Should I go back to school? Any other ideas? Thanks!

The DON told me that I could use her as a reference even if she is no longer the DON, because she was at one time my DON. Is that not actually the case? =/

I think it depends on what is most important to you. Schedule? Pay? Experience? Nurse-patient ratio? Any long term goals that you need to consider? Also, at the small hospital, do you know if low census is a common problem?

Thanks Crunch. It's been a bad situation and your comment is nice to hear.

Man oh man, I wish I had time to do everything. If it was only a matter of choosing when to do what, then I wouldn't have a problem. When I say, "is it okay to blow off a resident request?", I mean it. I literally do not have time to take care of everything. And neither does the nurse after me, or the nurse after them. So what happens is constant neglect and rushed assessments and lousy charting. Is that okay? It seems like quite a few people are okay with it. I'm told over and over that "that's nursing." To me, it is not okay to treat human beings so poorly. Am I missing something? Are my expectations way too high? And yeah, I know that there is no way for me to know for sure if the BPs were fabricated. But this particular resident is completely coherent and is not the type to cause trouble. Part of me believes him when he says his pressure hasn't been checked in a month. Another thing on that - I would hardly blame my coworkers for cutting corners. We are all forced to do it. It's just a horrible situation all around.

Why check the BP? what about resident rights? When I read through the incident reports filed by state for our facility, several of the deficiencies occurred simply because a resident asked for something that they did not receive. I get the point; the need to prioritize. But I still think it's wrong to not take care of a resident's request. And I guess the implication with the BP is that the resident is concerned. In the real situation I dealt with, the resident had a history of uncontrolled HTN and he felt that no one had checked his BP in awhile. And although other nurses had charted BPs on him, I have come to believe that they were BSing the numbers. It has been a ongoing problem. Just yesterday I took his BP and it was 180/90. His last weekly BP was 140/60. Totally possible that it jumped within a week, but also totally possible a nurse fabricated his reading.

If I were in your situation I would ask for additional orientation. Explain that you cannot safely identify every resident using the facility's ID system, and that you do not feel comfortable passing medications on your own until you become familiar with the residents. It doesn't take that long to learn everyone's name. A new nurse should NOT be expected to ID residents based on an outdated photo. And I personally would be very nervous accepting an ID from a CNA I barely know. Also, who says an ID tag has to be plastic/paper/unattractive? People voluntarily wear metal ID tags for diabetes, drug allergies, and the like. Why is it so unreasonable to ask a long-term care facility to provide a metal tag for safety? Oh I know, very few facilities would actually be willing to pay for those... Also I understand the concern of ID bands getting mixed up, but it would be easy to do periodic audits to ensure each resident is correctly identified.

I cannot accept the poor staffing in LTC; it makes me sick. The facility that I have been working in has two floors. Downstairs has 36 residents, which has 1 nurse and 2-3 aides on days. Upstairs has only 14 residents, with 1 nurse and 1 aide, but there is little to no dietary help. Upstairs used to be manageable until they accepted a resident that should be getting private nursing care. She requires 2-3 hours of one on one care per shift (I'm not exaggerating), and gets that level of care because she has turned the facility in to state before. On nights, there is only 1 nurse in the building and 2 aides. Lack of staffing results in 2 assists being transferred by one person, residents not being turned, not being changed frequently and sitting in filth, call lights going off for 10 minutes or more. It's disgusting.

I live in Iowa, and my understanding is that Certified Medication Aides (as we call them) can only pass non-parenteral medications. Like you, I am questioning my facility's use of CMAs. I tried to find some sort of scope of practice for CMAs in my state, and can't find it anywhere. I have doubts that CMAs are being used appropriately in my facility. For example, the CMAs administer breathing treatments without performing assessments. And management has eliminated documentation of lung sounds and sPO2 from the TAR for this reason, so even LPNs and RNs are not required to document assessments with breathing treatments. Seems fishy to me.

Exactly! It makes absolutely no sense! Well I ended up putting in my two weeks notice. Not because of the scheduling, but because of the job itself. I knew I hated the job, and the facility was a disaster... but it wasn't until I began searching online that I figured out just how bad the facility is. It's rated one-star, has 22 health deficiencies (state average is 6.2), and has had 5 complaints with state in the past 15 months. We had an incident with the night nurse (fracture she failed to address immediately) that will be bringing state back to the facility asap, and I want to get out before I get pulled into some facility-wide shut down or who knows what. I have never had a nursing job before, so I really didn't know if what I was seeing every day was normal or not. The great thing is that our newest DON is WONDEFUL! When I put in my notice, she completely understood my concerns. She even confided in me that she debated about putting in her notice on a daily basis. And she said she would give me a glowing reference. I couldn't be happier. Well, I could. My stomach still turns every time I think about the care the residents are receiving. There is part of me that wants to call state with everything I know....

Thanks everyone. It helps to hear other perspectives. I ended up putting in my notice last Thursday. The final straw for me was feeling like my license was at stake. I know nursing can be crazy, but I do think the facility I have been working in is exceptionally bad. I checked online, and the facility is rated one-star, has 22 health deficiencies (state average is 6.2), and has had 5 complaints with state in the past 15 months. I read through the incident reports with state, and I could see how every single one still occurs on a daily basis. I feel a bit more hopeful now that I can find a job in nursing that is less insane. Although I'm nervous, because I don't want to land anything similar to what I just went through. Mariebailey - thanks for the suggestion! I know little about public health, other than home care and vaccination clinics. I'm going to do some research on your suggestions.

In the nursing home we refer to the patients as residents (it's a long-term care facility).

Want to know the most frustrating part? When I was first hired, I was working every other weekend. I had heard from fellow employees that the schedule changes all of the time, so I approached my boss and asked her - "since I'm only here every other weekend, how often should I check the schedule to make sure it hasn't changed between my shifts? or, will you let me know when the schedule has changed?" Her response: "we'll call you." This is the same woman that yelled at me about how the schedule can change at any time. The woman I keep talking about is my ADON. Like I said, we have had 4 DONs. The newest DON actually seems like a very nice person. So maybe if I stick around a little longer, I can get to know her well enough that I can talk to her about everything. Such a nightmare.