Nuieve

I know there's no scientific evidence... which only proves whatever research that was done on it was deeply flawed. My 15 years of experience tell me there's a connection between dementia exacerbations and severity of encephalopathy during full moon phases. I've seen it so many times, and so many times I checked the calendar on the worst days if it was a full moon, and it was. It's supermoon here tonight. My dementia patients are losing their minds. 2 ended up in restraints. The mildly cognitively impaired pt that was doing OK a few days ago gradually sundowning more every night for no reason. I know it sounds silly, however I do believe Moon's gravitational pull does affect us in some way, how - I don't know. Not goofy fairy tales, just there's some science we haven't discovered yet. " NEW YORK -- The first of four supermoons to rise in 2023, July's lunar display will appear to be brighter in the night sky than any other full moon event that has occurred this year. The full moon rose on Monday, July 3, and reached peak illumination below the horizon at 7:39 a.m. ET, according to The Old Farmer's Almanac. Local weather conditions allowing, you can view the celestial event by looking to the southeast after the sun sets. "A supermoon is when the moon appears a little bit bigger in our sky," said Dr. Shannon Schmoll, director of the Abrams Planetarium at Michigan State University. "As the moon goes around the Earth, it's not a perfect circle. So, there are points in its orbit where it's a little bit closer or a little bit farther from the Earth."" SOURCE: July 2023 supermoon: Buck moon will be 14,000 miles closer to Earth than a typical full moon event - ABC7 Chicago

I work in Critical Care, top floor. We have a helicopter pad on top of us. Whenever the helicopter is used, the whole floor gets full of fumes, I guess I'm more sensitive, I'm literally choking the whole time, other employees note the stink but don't really complain. The worst part is that it linger for an hour or so. You'd think a helicopter comes and leaves, should take 5 minutes top, but it's like it just sits on the pad idling or something because our AC is turning on and off but the fumes are not going away, for an hour or so usually. I literally can't breathe this whole time. Sometimes I'll leave the floor and go to some private room where the smell is not so bad if time allows... We're acute care, lots of resp patients, it's been like this for as long as I remember. Can anything be done about it or should I just suffer quietly?

I work in a rehab center. We're famous for accepting patients every other single nursing home refused. Mostly drug junkies, alcoholics. I noticed in hospitals they rarely get more than 5-10mg of hydro or oxy. Once they come to a nursing home (or I noticed from records from other nursing homes), their pain pills prescriptions start growing exponentially. 5mg, in a week 10, in two weeks 30 and so on... Start with hydro 5, in a month they have MS 30mg TID and Oxy 20mg QID. Now I know SOME of them do have pain. But most of them are just homeless guys with nothing wrong with them to warrant such high doses of narcotics. I know how it works, patient comes to the doc and says "it's not working for me, I'm in a lot of pain". Doc has no other choice but to bump pain pill dosage. Now I wonder, are docs required to up pts dosage of pain meds whenever they ask? Are they legally required to? Afraid to end up in a lawsuit and just decide it's easier to give these people what they want rather than deal with lawsuits later? Maybe it's my particular place, but 1 year ago 80% of narcs were hydros. Now I maybe have 10-15 cars of hydros, and about 80-90 of mostly MS and oxy with some dilaudid and methadone in between. The other problem is that once they taste hydro once or twice a day, they get hooked up and keep asking for it regularly after that even if source of their pain supposedly resolved. And then you find them drunk... and/or selling those MS tablets to strangers that come to visit them. When I was doing my clinicals in the hospital, the nurse I was with... she just completely ignored new pts with drug seeking behaviours. She would go on with her assessment and not run for pain pills or look for doc to up them. Many pts come from hospitals c/o that it takes forever to get a pain pill in a hospital. It's like hospital docs/nurses are more confident or better protected. In my place, you don't give a junkie his oxy so he can go and get drunk/high, you can get reported to the state/fired. So there dear, take all you can have. It's all yours, enjoy... go buy some whiskey with that, I heard it makes it even better. The law wants you to have as many narcs as possible, we don't have enough addicts in this country. Should I ask the doc to up your MS from 120mg TID to 180mg TID because you have a boo-boo on your finger? No problem...

Ok, a little update. So I did orientation in both nursing home. First one, luxury, very easy. Only 15 pts, most of them take just a few pills. No treatments. But the people their require extra caution as they're rich and my bosses expect you to kiss their... money. And today I got a call from supervisor, they were investigating two things - one, ulcer that was reported missing, but it was there - issue I had no slightest clue about as I didn't do admission assessment, and neither did I or had to do any skin checks on that person. I don't even know what I had to do with this. The other one, I put a wrong time on narc sheet (0900 instead of 0700) and then crossed it out after the other nurse came to see when was the pain pill given last. (it was written correctly on MAR, but she didn't check it). Apparently she went and reported this to my supervisor (and maybe added the ulcer thing to that too), which pretty much confirms the other things I've heard from people I know that work there - if you will be working there, WATCH OUT. These are nasty people working there, and they will be looking for reasons to report you all the time. Which, in other words, makes it no-brainer that I don't want to work there. I'll take a few more shifts there and will bow out in a month or two. The second nursing home: what a depressing place. Made an ok first impression, but after orienting there... what a dump. Rooms for people are tiny, and the staff there looks... depressing. Everybody's old, worn out, nobody seems to know what they're doing, disorganized, miscommunication left and right... and people look like I can't trust them either, quite unpleasant. These experiences were a real eye-opener for me. Just made me realize what a good job I have now. To be honest, I don't even care about how much of a raise I'm gonna get (if at all). Some things are just worth more than money - energetic, friendly, trustworthy work environment. Not to mention the valuable experience I get here... yes it's hard to work with these very sick people, but I'd rather work with them and get actual nursing knowledge than pass 3 pills to plain old people and not learn anything. Overall, as tired as I am, I'm glad I went to these places. If I had to, I would work there. But no way I'm quitting my job to go to any one of those. Not even if they offer me extra buck or two. Now I have to figure out how to slowly taper off my presence there and quit peacefully. Thanks for everyone's support and advice on this matter, I really appreciate this.

Oh yes, I will have to! Don't need a 4th job I don't want! My current job is my first one, so I was still inexperienced with interviews, and had that newbie "will not bring up compensation during initial interview" mindset. I guess it didn't work out, so for sure next time, compensation will be brought out during the first interview (if I grow some guts by then). Second nursing home I applied to (the very nice one), they just called me and had me write a letter of interest in full-time position (they assumed I would want one). They have a nurse going on maternity leave soon, so there's a chance she might not come back. So I'll be the first in line for her position. I guess this will be my second chance to re-negotiate the pay. I could say "for on cal 25 was ok, but for full time I need you to match my current pay, I can't afford to lose income". I hope I have enough strength in me to say that.

Thanks everyone for your encouragement. All said true. Also, I think... ok, I got lower rate now, but if I prove myself worthy to them as a potential fulltime employee (which I will work hard to do), I will have another chance at re-negotiating pay later, if a fulltime position comes up.

I feel guilty for them spending money on me on orientation. And also, I live in a smaller town, we don't have all that many nursing homes, everybody knows everybody, I don't want to get a reputation of someone who gets hired, gets their orientation money and is never seen again. Reliability is my feature, I have 100% attendance record. If I commit to something, I will follow through, and that's my burden.

I work at SNF making $26.25/hr. 12-hour shifts, 3 on 4 off. Flexible schedule (get my vacations when I want them, management very accomodating and I love everyone I work with). But the clientelle is as bad as it gets: homeless, narcs, alcoholics, mental... we don't accept just old people with money. We only accept those every single other nursing home turned down. It's very hard, but I'm used to it. Recently I had some thoughts this place is not a good long-term place. Pay and schedule are good, but the place is just dangerous, and maybe I could use something less stressful. I thought about applying to other nursing homes, check them out and move to one that meets my needs best (same/better pay+less stress). I applied to one, they have lots of facilities in many states (to some of which I might want to relocate in the future, so I thought it's convenient to have a job that can transfer you easily to another state). Stated my current rate on their application. Got $27 for on-call (no benefits, obviously) which will turn into $23 with benefits if I go full-time. Did 1-day orientation. Still need to schedule the other 2 days. I thought "ok, will keep this just for the future. not going to go full-time". Nicer place than mine, only 15 pt per nurse (I've got 26), but lots acute too. Two days later I got a call from another nursing home, this time it's a high-end, luxury private pay place. Very luxury, very easy to work in, nice place for long-term work. They offered me on-call job, I thought "why not". They mentioned the possibility for going full-time soon. I went for orientation there too today. Always wanted to work there... but... salary wasn't discussed during initial interview a week ago (I didn't bring it up). However I did state on application my current rate and expected rate - I put $28-32. Before going for orientation I made firm decision that when they tell me the rate, if it's below what I make now (26), I will not accept the job. The only problem, they threw the whole orientation at me before I even got a chance to ask about my rate. At the end of orientation, I finally asked them... $23 plus 2 for not having benefits=$25. I was asked "is it ok?"... I didn't have the courage to say "no" because, well, I was already hired and went through the day, so I just shrug and said "I guess so". Very disappointed with myself. Let's make it clear. My current job is my home. It's a tough place to work, but I got good pay, excellent schedule, flexibility, and, well for overtime, I get $40/hr (time and a half). So there's no incentive for me to work on call anywhere else, even if it's easier. If I knew that I'd get $23, I probably wouldn't even bother to apply. Now my place don't raise much... since I worked there I got 25 cents raise last year (less than a percent). We've got a new admin who looks like he won't be don't much in this regard, there's a chance I might get stuck with my current rate for years. I know second place does raises... at least they did years ago when my wife worked there. They're also 8-hour shifts, rotating schedules (I have fixed days now), and, as I said, too strict about everything, so no flexibility like I have now. But much, much easier work. Maybe 5% of what I do now. So there... I feel burdened by all these on-call jobs. To put it simply - I don't need them, as I only looked for the as trials to see if I want to move to other places. But I always thought other places will match your rate by default. I have bills and absolutely no desire to cut my income. I don't know what to do with these jobs. I'll have to finish orientations (which means no days off for probably 2 weeks), and then... I don't know, work in each place once a month just to keep myself on a roster? Or just stop working after a while if I find out those places aren't really worth the pay cut? Three bucks is a lot, could be 3 years of raises... Any advice/insight would be helpful and appreciated. If any of you been in the same position, let me know how it worked out for you.

By some accident, our RCM did the evaluation for pretty much all the stuff 3 days before my one year anniversary. However she told me HR lost? all the evaluations, so she had to redo them for everyone. When asked if this comes with a raise, she replied "I wish. They gave everyone a raise in October". Hmmm, I remember seeing my rate increase whopping 0.9% an hour in October, I always wondered what the heck was that about. So I got my "well above average" evaluation done. Now in two days I would ask for one, but now it's done, and I don't know what to do. Should I go to the DON and ask for one? I find that 0.9% flat out offensive, I need at least 3-4% like most people here get. I spoke with another nurse who works in my place, he said he didn't get any raises in 3 years working there. I spoke with yet another one, same thing. I'm just curious, is this normal, or should I fight for it and how?

I think the numbers don't mean much without info on patients acuity. I'll take 60 alert and oriented people who only take 1 pill a day, don't have treatments, and are generally stable and independent, than 20 alcoholics, schizophrenics, narcs, psychos, quadrilplegics, obese who on breathing treatments, PRN narcs q 4h, take pills crushed, on IV and or tube, half diabetics with QID checks and insulins, constantly nauseated, scared and each has their share of ulcers, and that require 2 aides to roll them just to put a patch on them, and with some MRSA sprinkled on some of them.

I'd rather do medpasses than treatments. But then again, I like routine, I find it relaxing.

I gave up on treatment carts long ago. Completely useless for anything but skin prep. Can never find anything there. Whatever I leave there is gone the next day, and no replacement. Always go straight into the med room, even for something trivial like gauze 2x2s.

Our facility pays $3 more than all the hospitals in our town (starting wage).

While for some it's a no-brainer... more money, status etc... but have any ones of you taken an upper level position (manager, resident care supervisor etc...) and regret it later, possibly going back to pushing cart? In our facility this type of job is all about logistics. Tons of paperwork, calls, issues resolving, endless meetings, there's very little nursing in that, it's just typical office/management job. And, oh, an 8-hour 5-day, Mo-Fr schedule. I have 12hr schedule (with a few 5-days off in a row periods), and I love it. Tons of free time, come get the job done and leave life. And plenty of paid overtime opportunities, so that I'm sure covers most of salary difference. What do you think about that? If you were given an opportunity to be promoted to a management job at your facility, would you take it?

But please, be honest. And by first, I mean the very first of your career. Today I had my first one (I've been working for just a month). One of the aides found the pt dead. She was still warm, but she looked completely dead. I rate my response at 3/10. I forgot about all the rules/right sequence of CPR even though I took my CPR class just a month ago. Luckily the old lady turned out to be DNR, so I did no harm but I did learn a very valuable lesson... on how to do it properly (hours after incident when I remembered every single detail of what I did wrong). I learned I'm able to remain calm and the next time I will be prepared and won't make the same mistakes, hopefully. Tomorrow I'll ask my RCM to maybe implement drill codes. I think we need them.

I had my clinicals in a hospital m/s, and in all honesty I didn't like it one bit. Yes it's high-tech and all that, but it's not something I'd like to do for prolonged time. Every day I went there like for a servitude. I'm a laid-back person and it felt too tense... neverending tension. LTC where I work now feels "just right", I love having the same pts day after day so I can learn them and their needs, I love the relaxed atmosphere, a friendly chatter with a pt now and then. Yes, I have to run a lot, but somehow it doesn't feel like a sucking-life-out-of-you work. I actually catch myself looking to go to work now and then (which I never thought would be possible before). And when they call me in for extra shift, I never feel upset I lost my day off. I think I found where I belong.

Thank you so very much Chris! I'm a 2 weeks old nurse... new graduate. I kind of expected wound care to be addressed during my orientation, but due to the acuity of pts (or lack of thereof to be precise) we don't have many wounds. Maybe one or two per shift. Most of the time day shift nurse changes it. So I just don't have any exposure at all. Yesteday we had a fall, pt cut/teared his arm and I was wondering what the heck I was supposed to choose to cover it up. I did clean it with saline, but then I just pulled the first thing that I saw in the tx cart - some adhesive 2x4 patches. They were a bit too large, but when you have a bleeding pt you don't feel like spending 10 minutes pulling out stuff out of cart and evaluating it whether it would be any good, you just grab whatever will work. I'm afraid the day shift nurse will be appalled by my decision, but I feel I did the best I could at the situation. Anyway, thanks again for helpful writeup.

Is there a guidelines for skin care? Our facility doesn't have the protocols handy (our instructor should have ones, but she got into car accident and we don't have a replacement yet) We have dozens of dressing types and creams. I have no idea what to put when. Sometime we get orders, sometimes not, sometimes the orders come later after you already took care of it. For example, surgical incision. Or stage 1-2 ulcers. Or cut. Or abrasion. Or scab. Or PICC site. Or bili site. Or peg tube site. Or some other type of wound/lesion. I've been working only 2 weeks, but this is one simple but at the same time puzzling part of my work. Our med room is stocked with 3 218 879 types of dressings, bandages and what not, and when the time comes to change the dressing (when it's not written in the TAR) I'm really scratching my head. Should it be adhesive or non-adhesive? Transparent or regular gauze? How many layers? What cream? Changed how often? I feel stupid for asking about what kind of dressing the new pt needs/has and how it needs to be done. I would really appreciate some structured info on what to use when and how.

Ok, I'm new (my 3rd week) in a LTC, so for what it's worth: - missing meds... and especially when the previous nurse(s)s charted med as given... some obscure med that other pts don't have (to borrow) and emergency cart doesn't have either.... and this med somehow was given several times in a row... I call the pharmacy and find out they didn't even have the order for that med! - interruptions from NACs with reports for stupid stuff I don't even care about ("I came in and the thrash bag in room xx was full"). Pts who beg meds just because "i always take it at 15:47 and not a minuter later... Interruptions from anxillary stuff with requests to help them with something not really important. - wandering pts... this is drives me nuts... you pour the pills, you gather up all the insulin, glucometer, their SVNs... barely hold it all together, run to their room... and it's empty... and noone seen the pt. arrrrghhh... - demented pts who are at risk for falls who just don't want to stay in their chair/bed and keep setting off the alarm every 20 seconds - demented pts who don't know what's going on and scream "help me!!!" on top of their voice 24/7 and can't be reoriented and whose sole purpose in life is to fall out of bed - demented pts who wander in their walkers into the nursing station or your med cart every 2 minutes and grab and move stuff around - managers/docs who don't do anything about all above mentioned pts... not even an order for PRN antipsychotic. I swear it take me at least 30min every shift moving these demented people out of the way/out of harm way/reassuring them/putting them back into chairs/putting tab alarms on - badly written MAR order that miss one or more "rights" - residents asking me to adjust their bed/turn on TV/rearrange their bed table/give them extra towel/urinal/ other stuff NACs do... and running into/around the hall and not being able to find one NAC on the floor - pts lining up for meds... I know some of you love this, but I prefer to give meds at my own pace/order. I'd rather them at their rooms. - s....l....o.....w pts. Those who can't make up their mind what they want. Or those who just keep mumbling boring unneccesary infortmation before/while taking their meds and explaining to you why and how they take every pill since the day they got admitted. - when you pass on some undone Tx or info and you came back 2 shifts later and it's still not done. - lazy NACs... patronizing NACs... "I've been working here for xxx years, and if you're new you probably now that you should take care of your NACs and they will take care of you"... after starting cleaning the pt and then leaving her half covered in poop on her side for 20 minutes - and it's not really a pet peeve, but rather a reality of LTC... OBESE pts who can't move around.... impossible to do any kind of TX without bringing two aides with you to move them around.

- being 2 weeks new nurse - a 1 hour meeting in the beginning of shift. - a new admit (my 1st one that I actually did a part of... assessment and documentation) - start medpass 2.5 hours into the shift - wandering/missing pts, half of them... have to run around the whole facility to find them - everyone suddenly all needy and in pain or just losing their marbles for no reason at all - A&I just when I started catching up (never done these before) - understaffed NACs... 2 for 27 pts... one of them is slow, lazy and annoying - one of the NACs walking away 1.5 hours before the end of shift with only 1 left - another res screaming for help 24/7 and falling down the bed every two hours (we have mats under her bed, so it doesn't count) - a brand new (inexperienced) nurse as a partner on the other side of the hall It wasn't fun.

In the last 4 days I forgot to punch out of lunch 3 times (I only been working there for 2 weeks). I just keep thinking about patients and things I need to do, and I don't spend lunches in the lunch room where the stupid Kronos is, and the lunch room is way off my beaten path so nothing reminds me of its existence until it's too late (we MUST punch out for lunch... even if we don't have time to have a lunch). You have to go to your supervisor and have an oops form signed (which makes you look like a complete moron, especially when you do it twice in a row... and third time two days after) I had clinicals in a hospital and the nurses there forgot to punch often too. I hate Kronos, and I hate myself for not being able to remember to use it. And I hate Kronos for making me feel this way even more.

The nurses I work with seem to remember each drug a patient has. They just pull them out of carts, pick the ones pt needs at this time (including vitamins) and then verify/chart them in MAR book. They just know what every patient takes. At this time (having worked for about 10 days now) it seems impossible to me. Do you also remember all your pts meds? How long did it take you to memorize them (assuming most of your pts stay for a while in your LTC)?

Today I did the complete morning pass. 5.5 hours. But I know I'll get better. My wing is the hardest one out there, and it's day shift. I've only been orienting on day shifts, I'll be working evenings. Yesterday I studied the cheat sheet (my preceptor wrote me), so even though I still didn't remember faces very well it helped a lot today with connecting name to faces and to certain facts about a lot of residents. Starting tomorrow I'll have some more orienting but on evenings only now.

Assuming you had not prior experience with LTC/nursing home like type of nursing. I mean med cart, 25+ pts... I just started my 1st job at LTC... Right now, it takes me about 5-10 minutes per person to find, verify each med... add forgotten ones, double-check ones that I suddenly felt an urge to verify etc... You can do the math... 4 hours to complete a pass, I barely fit it. I haven't tried yet (just my 2nd day of orientation). The nurses there (including manager) told me it takes about 3 weeks to get into the rhythm/become proficient so I shouldn't stress myself too much (which I don't). The cart is well organized, the pts have pics in the chart and everything is in order except the meds don't have both generic and brand name (they usually have only one of them written there, or one name in the chart and another (substitute) in the cart), so I often get confused as to what the drug really is, and have to ask my preceptor. I'm curious how long did it take you to become fast and efficient at giving meds, and how many pts did you have?

I AM Nuieve, the original poster. :)