chinacatRN

I work in a rehab facility. Many of our patients are LTC and many are there for PT/OT and sent home. We also have patients on ventilators and those who have trachs. Our patients are more critical than those in a typical LTC facility and many of them are very needy. We also have RTs who work most days and nights. Anyway, today I had this one pt who is trached but no longer vented. This pt is very high anxiety and freaks out over the smallest things - such as having to wait for her egg at breakfast. Today, she had a major panic attack. Her pulse was high, her BP was high, she was diaphoretic, and her rr was increased. Her doc recently began tapering down her haldol because the family doesn't want her to be on it. She's also allergic to most other antianxiety meds. I called both her primary care md and her paleontologist and both docs thought her symptoms were related to the anxiety. I received the order to give her a higher dose of another psych med that she already receives because the doc still didn't want to give her the haldol. My nursing judgement was called into question by the other staff nurse, the new ADON, and the RT because I didn't address her bp. Yes, I did, but both docs thought it was related to the anxiety. Giving her a dose of metoprolol or whatever isn't going to treat the underlying problem. After I gave the med and the pt had time to calm down, her vs all returned to normal. No one said anything, of course. This happens on a daily basis and not just to me. I've never worked at a place where my nursing judgement was questioned in this manner - it seems very rude and impolite. A nurse's judgement should only be questioned if it's believed she's being unsafe. I feel like a glorified med aide - all I'm there for is passing meds and doing the grunt work. Every time I need to make a nursing decision, my judgement is called into question. I've also been treated rudely by the administrator. I'm still on my 90 day probation period. Instead of waiting the full 90 days to decide if they liked me, they judged me once after only working 2 weeks on the floor and said staff had complained that I was slow and unhelpful. Um, hello, I've only been working 2 weeks and I know hardly anything - so of course, I'm slow and I can't help much because I don't know anything, but I always did my best to try to be helpful. After 2 months, they changed their minds and decided I was "valuable". I was told it was unacceptable for me to have my car repaired on my day off because that made me unavailable to come in to work - even though it was my day off. When I told them I was pregnant, they chastised me for not telling them at my interview and the administrator said that if I was hurt at work, she'd fight my claim for workmans comp because she knew I'd just be filing so I'd get paid while on maternity leave. I have never been treated this way at a job before. I have never been talked down to like this before. My last day of work is 11/8 and I plan on using my maternity leave to find a new job because I can't stand to be treated this way anymore. What do you guys think? Am I in the right or am I overly emotional from this pregnancy? (Sorry for.any typos -.I'm on my kindle)

Ok, so now I hate my job even more. I left a job I mostly liked because I wasn't getting enough hours to survive on. Then I end up with this turd of a job. Then I find out that there's this night nurse (at my current job) who knows someone at my previous job and is spreading rumors about me at work about how I got fired for falsifying documentation! How unprofessional and immature is that? And she doesn't even know me. We don't work the same shift. We've only said a few words to each other. I just don't get how someone can hate someone else enough to do this - especially when they don't even know them.

I currently work in a LTC. The facility is a little different - we're not your typical "old folks home". We have a ventilator unit and most of our patients are there temporarily for SNF and pt/ot. I've only been there a month and I frickin HATE it. When I was hired I was told RT would be on the clock 24/7. To handle the vents and trach patients. That was a lie. And trying to answer vent alarms during morning med pass is ridiculous. Not to mention the super needy patients who are freaking out at 0630 thinking they're going to die if they don't get out of bed or get suctioned RIGHT NOW. Then there's management. Last week, I was called on my day off and told I needed to come in (a half hour drive) and write a nurse's note on a patient. Since it was my day off, my car was being fixed. I planned it for my day off purposely. I told them I'd come in as soon as I got ny car back. The administrator informed me that it was unacceptable that I didn't have my car and to be in by 2pm or I was fired. The training is horrible. I was accused of not being a team player, even though I do other people's work all the time - willingly, with a smile. Almost everyday I work, I'm there an hour or more past my scheduled shift. I've never gotten a lunch break - ever. Eating lunch consists of stuffing my face at the nurses station while charting. We're severely short staffed. Oh, and when I told my boss that I'm pregnant, I was yelled at for "hiding it" from them - they said I should've told them during my interview. Seriously? It's illegal to ask someone if they're pregnant during an interview. It's illegal to discriminate based on pregnancy, just like the color of someone's skin. I get told almost everyday that I'm doing something wrong. I live in constant fear of being fired - but it's not really fear when some days you hope to be fired just so you don't have to go back. The administrator -after finding out about the pregnancy - told me she'd fight any work related injury claims on my part because she thinks I'd get injured just to get paid while off work on maternity leave (that thought never even crossed my mind). So if I really do get injured I'm in trouble. Not to mention the fact that because if the heavy work load I feel like I'm unable to provide good patient care and everyday I go to work I feel like my license is in jeopardy. I feel like everything I do is scrutinized - like I walked into a big witch hunt and no matter how good of a nurse I am, I'm screwed because it's so busy there and so chaotic that mistakes are more easy to make than anywhere I've ever worked. I do everything I can to cover my butt, but I don't think it's enough especially now that I'm on their radar since I'm pregnant. Anyone else in a situation like this?

I've worked LTC for the past 2 years and many times I've felt like a servant. In nursing school, I felt like you do - and there are those nurses you can tell who are on the verge of burn out and they're having a bad day and everything is making them upset. But no matter where you work - LTC, med-surg, PINS, ICU, Cardiac, whatever - you have one or two of those patients or residents who is very attention seeking and/or needy. I've had residents who hear me pass by their rooms and call out, "NURSE!" just so I can come in and grab them a tissue. When they are completely capable of wheeling themselves over or even just reaching over to get it themselves. That's when it becomes irritating and ridiculous. Or, in LTC mostly, you get those residents who become irritated when they can't be pushed back from dinner IMMEDIATELY even though they're perfectly capable of wheeling themselves back and are careplanned to wheel themselves back because they need the exercise. Or there's patients/residents who want you to move the curtains around half a dozen times or find the correct channel on the TV. When lots of these types of things happen in a shift, then I feel like a servant. I don't feel like a servant when someone needs a pain med or when the CNA needs help transfering or cleaning someone up. I agree that sometimes people just need to vent. Sometimes you're pulled so many different ways and there's so many things to do and the next thing you know your shift is over and you've realized you've haven't eaten anything or even taken a bathroom break in the last 12 hours. That's when it's difficult to take. Especially when it happens often. I don't know about hospitals, but in LTC it's especially frustrating because (during the day shift anyway) you have the DON doing nothing - you look in there and she's sitting at her desk, unwrapping hershey's kisses and staring at the computer screen, yet you and the CNAs are running around like crazy trying to take care of everyone and answer the call lights. It's frustrating when capable people are sitting on their behinds while you're running around.

I was an LPN when I got my first nursing check in June 2011 (yes, I'm new ). I used it to buy school clothes for my little girl, pay for daycare, and put it savings for when I started the RN program later in the summer.

Everyone forgets things. Life happens - especially on a hospital floor or LTC facility. Pts are demanding. Things need done. Sometimes things get missed and no one is perfect. What works for me is getting into a routine. After report, go through the mar and make note of when meds are due. Make note of any treatments that need done and if certain pts need assessed at certain times. I carry highlighters in a couple different colors to hilight certain things I'm afraid I might miss. If you have time, check out lab values and other petinent data and make note of anything out of whack. Then assess the pts for the first time and go from there. Each facility runs a little different so my typical day may not run like your typical day. Carry a "brain" sheet where you can write everything down to remember later. Use sticky notes or colored pens or whatever helps you best. How did you stay organized in school? Use the tools you learned in school to help in the workplace. As just try to learn from your mistakes. I agree with pp who said to give yourself a time limit - definitely before you walk through your front door, you should no longer be thinking about work. If it helps, talk to yourself in the car ride home or sing loudly to music or whatever. Write down your mistakes that you remember and put them with your work stuff (I have a work "bag" that is organized and full of pens, supplies, and stethoscope) and make a rule that after you write it down, you can't think about it anymore. Nursing is a 24 hour job and if you stayed after your shift every day to finish the things you didn't get done or forgot, you'd be there forever.

I know EXACTLY how you feel. I worked in LTC for almost 2 years before burning out - I'm not a burn out as a nurse but the only way I will go back to LTC is if my life depends on it. My school required we get our LPN before we could move on to the RN program. I wanted a nursing job after I got my LPN but the only places in my area (small town) that hire LPNs are clinics and LTC. A clinic would be nice but the hours would NOT work with RN school. So I ended up at LTC. And you will NEVER ever get everything done. First of all, day shift is the worst and lab days and Fridays and end of month are the worst of the worst. Lab days you get tons of new orders based on labs that need processed and processing orders is a lengthy process. Fridays the docs seem to all try to fax everything back in before the weekend - at least where I worked they did. So that means more orders. And end of month seems to be when a lot of docs will show up last minute to do rounds and you have to cater to their every whim. Anyway, if it helps, maybe you should switch to nights? Nights are much less hectic than days. Yeah, you'll have residents who won't stay in bed or will experience change of status, but you won't have faxes (unless there's some left that the poor day nurse couldn't finish) and you won't have much family or any docs showing up. I've worked both 6pm-6am and 6am-6pm shifts in LTC and the night shift was BY FAR the easiest. I would have stayed night shift if my husband hadn't gotten a different job. So, if you can't work at a hospital quite yet (are you LPN or RN?) then I would suggest switching to nights, if possible. I also agree with pp about prioritizing. And I don't know about your state laws and facilty policies, but some facilities allow CNAs/CMAs to apply certain treatments such as creams, powders, lotions, etc. If you can get a job at a hospital or clinic, do so. Even dialysis or wound center...any place that has better staffing. LTC facilities are known for their horrible staffing. Even the BEST facilities have staffing issues. I work for a temp agency and last night I was sent to the worst LTC facility I've ever been to. The care provided was great and the place was nice but staffing was a nightmare and there was too much put on the nurse. I was only supposed to work 2-10 and ended up being there until midnight to complete paperwork. I had to pass supper meds for all 50 residents, complete assessments on 5 residents and hot chart on 12 residents, plus do all the treaments and HS meds as well. It took me 4 hours to pass supper meds. I will never work the 2-10 shift there again. Also the nurse was responsible for checking all door alarms, personal alarms (bed alarms, pressure alarms, floor alarms, etc), and passing HS snacks. Seriously? Needless to say, snacks did not get done - my 2 diabetics had blood sugars on the 200 range and everyone else was zonked by 1930...not to mention I did not have time to pass snacks. I had to fill out an incident report on a fall and on a skin tear as well. And then these facilities wonder why they have all these issues. The administrators are getting paid $$$$ while the care of the residents goes to you-know-where. And it puts the staff at risk for injury and the nurses at risk for losing their licenses.

Glad it went so well! Would it be possible for you to post a photo of this box? I'm friends with someone who just became a part-time nursing instructor and she's looking for project ideas. Thanks!

When I was working at a LTC facility, a new employee, an RN, was hired on for nights - she had been an RN for 20+ years and it was obvious she was burnt out. Very negative about orders, saying things like, "Why the hell did they order THAT? That's stupid" and constantly questioning anything and everything. Anyway, one night, we had gotten a new order for a resident with some mouth sores - magic mouthwash. Pharmacy forgot to send it so we'd have to wait until tomorrow. This nurse said, "When I worked in the hospital, we used to mix that stuff up all the time. I'll just grab some liquid benedryl and make it myself!" Of course, I advised her not to. After I left, I called the DON and let her know. The nurse never did get written up. She also wouldn't do 90% of the treatments because they were "stupid and unnecessary" and she didn't get written up for that either. This is a funny one. A nurse I worked with a year ago (she's since quit) had the worst gas problems I've ever seen...or smelled. She would fart at the nurse's station constantly - and they were the SBD type so no one knew when they were coming. One day, the doc (who was very young, very good-looking, and who she had a crush on) came in to do rounds and she didn't know he was there. She let one loose and almost screamed when he said, "What is that awful smell?" She didn't say anything and let him believe one of the residents (who liked to sit around the nurse's station) had been incontinent.

There's only travel agencies and LTC facilities offering sign on bonuses in my area. I haven't seen a hospital offer a sign on bonus in I-don't-know-when. And the LTC facilities that offer them are NOT worth it. They are severely understaffed (thus the bonus) and can't keep the staff they do have. I would much rather not have a sign-on bonus and work in a well-staffed hospital and have less stress than get $10,000 sign-on (before taxes), have no staff to speak of, have tons of added stress, and be stuck in that job for the length of my contract. Ugh.

Well...the DON said she wouldn't report that I was terminated to the BON. I guess my state (Iowa) just requires you let them know when your employment ends. I went online to the IBON website and filled out a form to let them know I was no longer employed through that LTC facility and the form didn't ask if I was terminated or laid off or anything. So here's hoping I'm in the clear.

Thanks for all the support, everyone. We have seen a therapist as a couple twice now and it has helped me but he says he doesn't "like someone telling (him) how to act or feel". Don't know where he's getting this, as the therapist has never told either of us how to act or feel, she's just giving us the tools to try to get through this. I'm feeling much better today after giving myself some time to deal with his reaction. I know that people who are depressed or have other untreated mental issues are not stable but it still hurts. I do have a few jobs interviews lined up and I've been working for a temp agency - though that will NOT work out long term as some of the places I've been have been complete nightmares. Anyway, everyday is a battle. One minute he acts like he cares, the next minute he doesn't. He spends all his time in the basement "to think alone" and he refuses even the idea of taking an antidepressant, though I think it would help him A LOT. He's going to see my psychiatrist (whom I see for my ADHD meds) and I'm hoping she can talk him into something but getting him to take it is another story. He's like one of those patients in a nursing home who always refuses his meds and you have to wheedle and bribe him to get him to take them. But he's A&Ox3 so bribing him with pudding or cake or a soda isn't going to work lol. So therapy is our only option now. He said to me yesterday that he doesn't need help, that he'll continue to just hold everything in and it'll all be fine. He doesn't want to say bad things about people in therapy. I explained that's what therapy is for. He has a private session lined up. I told him that the therapist legally can not and will not tell anyone - not even me - what he says during a private session. He could call me all the names in the book if he felt like it and she won't tell a soul. And I gave him permission to - I told him to tell her exactly how he feels about everyone and everything because no one will find out and it will make him feel better. I don't know if I got through to him or not but I tried. He's agreed to continue with therapy. I just think he needs to go more often - probably weekly for at least 2-3 months, then every 2 weeks indefinitately. Thanks again. I appreciate it!

I have a job interview on Thursday and need advice. It's at a small town hospital (in the town I live) but even so I'd like to be prepared as possible. I've had my LPN since June 2011 and my RN since September 2012. I've worked in long term care pretty much since I've had my LPN in June. I've interviewed at a smaller hospital than the one I'm interviewing at on Thursday (it was in a town 30 mins away) twice and didn't get called in for a second interview or anything. Just got the form letter in the mail. It's kind of disheartening because I really thought I did well. So I really, really want to do this interview right. I really want this job - it's 2 minutes from my house and it's not LTC which is pretty much what I'm asking for now. Here are my questions. 1. I was fired from my previous job - see my other posts. An accident occurred, the facility wanted me gone, so they wrote me up for everything they could find until they could fire me. I was told I was fired because I "falsified documentation" by writing the wrong date on a bandaid when I changed it. I don't want to lie to a potential employer but I also don't want to word it wrong or go into too much detail. The firing was last friday - not even a week ago - and I'm still emotional about it. Any tips? 2. How to dress? I have tattoos on my arms which can easily be covered with a long sleeve shirt. I also have a tattoo on the back of my neck and I have short hair which doesn't cover it. I was thinking a nice, dressy scarf to hide that. Long sleeve dressy top and nice slacks with some flats. 3. What were the hardest, most difficult questions they have ever asked you in an interview? What were the weirdest? 4. I've been told that I should try to be smiley and bubbly during an interview. What is your opinion on this? Any other tips/advice would be helpful. I really need/want this job. I've applied for positions at this hospital before but they're notorious for hiring from within. Thanks so much!!!:)

I didn't get a chance to read all the responses, but I can tell you I know how you feel. Something very similar happened to me. I worked as an RN charge nurse at a LTC and rehab SNF facility for almost 2 years with nearly perfect attendance. I nave had any write ups or reprimands. Then, a couple weeks ago, a resident fell in his bathroom. The CNA who was transferring him off the toilet only used a 1 person assist instead of a 2 person assist. They also got him off the floor before I could assess him and take his VS. By the time I was able to assess him, he was so angry that he would absolutely NOT allow a full head to toe assessment. I was able to look over his extremities, his back, and his butt. No skin tears, lacerations, bruises, swelling, redness. No c/o pain except generalized achiness which is normal for him. He wouldn't do ROM for me but from what I observed throughout the day, his ROM seemed wnl for him. I documented everything. Incident report completed. MD notified. Message left for family/POA d/t no answer when called. Nothing new noted overnight per the night nurse either. The next day, his right leg was slightly swollen and he had c/o pain. They sent him to ER and he ended up having a hairline fracture of the femur. I come in to work a couple days after the incident (it was my weekend off) and I am told by corporate personnel (who were there investigating) that I failed to fill out the incident report correctly. I informed her that I have been filling them out the same way for 2 years and never have been informed that they were completed incorrectly. Later, I am called into the DON's office and written up because I didn't complete a head to toe assessment on the resident even though I documented on EVERYTHING (nurses notes, incident report, fax to MD) that he refused the complete assessment. They also write me up because the CNAs complained that I "don't help out enough". Hard to help out when your patient load is so high that you can barely complete all nursing tasks that need done. I complete the work week without incident. Come in next monday and am informed I am terminated d/t writing the incorrect date on a bandaid - thus "falsifying documentation" because they didn't know if I was the one who actually changed it, even though my initials were on it. Anyway - there are many facilities out there who know they can find another nurse and if they think they're in trouble will stop at nothing to get rid of the source. In my case, state will come in to investigate and the facility will tell them that they fired me and the CNA who were the "cause" of the incident and state might give them a flag or something. In your case, having you resign will hopefully mollify the persons in charge, the lawyers, and the patient. No, it's not right that you were given such a huge patient load and expected to sink or swim. Your supervisor should have helped out more and in my opinion, who should at least be reprimanded. It sounds to me like they used scare tactics to force you to resign because they didn't want you telling the truth about your patient load and the rest. At least you didn't sign anything. Sorry this happened to you and I hope you find a better job! I also agree that you should "make them" fire you. It's more work for them and you'll get benefits. I don't know where you live, but I've filled out TONS of applications and not one has asked me if I've ever been terminated. And legally, they can not give any info as a reference that can not be proven in a court of law - at least where I live. For example, a potential employer could call my work and ask for a reference and if my prev. employer stated I was fired for falsifying documentation, I could sue them because it's never been proven in a court of law, nor did I sign anything that stated I falsified documentation.

Believe me, I know how you feel. A lot of it depends on the work environment. I feel like nursing homes/long term care facilities breed more gossip. In my last job, I worked at a nursing home and the CNAs ran that place. They would seriously make up stuff about certain nurses to get rid of them. There was one nurse who was AWESOME - been a nurse for 20 years, cared about the residents, knew how to do her job and how to talk to people. But the aides hated her because she'd make them do their job. Don't think you could get away with forgetting dentures, glasses, or grooming/hygiene when she was around. And the aides hated her correcting them, even though she was always nice about it. They complained to the DON so many times that she was written up several times and they made work a living hell for her and she quit. I think it's absolutely ridiculous. CNAs have no idea what training or schooling we've had nor do they know everything that's required of us. They should not be allowed to get us in trouble. The DON should have investigated and gotten the CNAs under control. They should have been written up for retaliation. Anyway, workplace gossip is awful. You never know who's going to run off and tattle to the boss about the most stupid, asinine things. If you have a good boss, she'll realize that these people are just trying to kiss up and get on her good side. If you have a boss who is less observant or who doesn't care, she'll play into the hands of these people and your job could be on the line. My ex don even admitted she took the don job because of the hours, pay, benefits, and how close it was to her home. She didn't give a flying you-know-what for the residents and the scary thing is that there are a lot of professionals out there just like her in the nursing field. I'm sorry you're dealing with the stress and pressure from your job. I wish I had advice to help you but I don't - I'm struggling as well. Just know you're not alone and many of us feel the same way you do. Good luck!