knitnurse72

So interesting to read what other hospices do for on call! I work for a rather large hospice as a full time case manager. We are all required to be on emergency on-call for one week, Thursday through Wednesday. I am about to have my one year anniversary and have only been on call 2 of those weeks (last was 2 weeks ago) and I did not get called in either time, but it does happen occasionally. We do have regular evening, night and weekend staff, so our on-call is only activated if one of those nurses is out sick and they cannot find a replacement.

All of our field staff at my company have iphones, and they have them set up so that whenever we make a call, our company's name comes up on caller id, not our personal name.

I recently started in hospice as a case manager for a great hospice here in MA. As part of our orientation, we spent a few days shadowing at our hospice house and it was an amazing experience. Our house has 20 private rooms on 3 wings; there is one nurse and one aide assigned to each wing. The nurses gave lots of pain meds, helped with personal care, and provided A LOT of support to families. Overall, our hospice house is a very peaceful place and all of the nurses and aides I met there were amazing. I hope this helps a little bit - good luck in your new job!

Thanks to all for your comments. As one of you mentioned, I do love the nursing part of my job, and I love my residents, but the DON is definitely making life tough for everyone. Yesterday I did put in for a transfer where I oriented - they have a few openings. I've also applied to a few jobs elsewhere, and am going to take your advice to document everything. Our administrator is very part-time and word has it that he loves the DON, but I don't know that he's aware of how she treats her employees. I'll keep you all posted!

I apologize if this gets too lengthy, but could sure use some nursing/career advice! I am 40 years old, went back to school a few years ago to become a nurse. I graduated in December, passed the boards in January, and found my first nursing job in February. I am an RN, and while I am a new nurse, I have worked in health care for the last 20 years. My new job, which I've only had for a bit over 3 months now, is in a small long-term care facility that has only 33 residents. I did not take a job in LTC just so I would have a job - I actually very much like the geriatric population and had worked as an activity director at a great facility for about 5 years, and really came to love this population, so much of my job search was focused on LTC. So I was offered the job - it's full time, and the hours work well for me and my family. I also liked the fact that the home is really small - I felt like I'd really be able to get to know my residents and their families (which I have). But since I am a new grad, the company (which owns other facilities too) made me sign a 2 year contract and if I leave before the 2 years is up, I will have to pay them $5000 - supposedly that is the cost of training a new grad. I am kicking myself now for signing it, but at the time I thought, well, it'll be a job for 2 years and when the 2 years is over, I'll have 2 years experience that I can take elsewhere if I so desire. My first 5 weeks were spent at a different facility that is newer, beautiful, and very well staffed - they wanted me to get practice as a new nurse doing meds, etc., etc. It was great there - staff was great, I got comfortable doing meds, it's closer to my house - everything was great and I was loving being a nurse. Then I switched to my "home" facility, where I had one week of learning to do charge, then was completely on my own that next weekend. I have discovered that my boss, the DON, is really crazy, and I'm finding that I cannot spend 2 years working under this woman. The rest of the staff does not like her either and I have heard so many bad stories about her that it makes my head spin. She has been there for just over a year, and the long-term staff are just holding out that she'll leave soon, but staff morale is literally in the toilet. I've never seen anything like it. Here are just a few examples of what I personally have witnessed/been a part of (but there is so much more!): - DON does not like to do nursing care - on 2 occasions she wanted to look at wounds that I had to re-dress, and she would barely even go near the resident, much less even touch them. How can you be a DON if you don't like doing actual nursing care? - She makes up fake names and puts them on the schedule - yes, it is true - to make it look like there is staffing and when I call the agency (which she loves to use), they have never even heard of these people. So almost every weekend, I am extremely understaffed. - She doesn't know her residents at all - she came out of a room one day and told me that Mrs. Smith would like a grilled cheese instead of the fish. Mrs. Smith is dying and has been on hospice care and hasn't spoken a word in weeks, but her roommate Mrs. Brown asks for a grilled cheese every day. So I said, do you mean Mrs. Brown? She said no, Mrs. Smith. Me: Are you sure it's not Mrs. Brown? Her: No - Mrs. Smith. Finally I asked her which side of the room this person was on, and it was Mrs. Brown that she meant. (And there are more instances of this type of thing!) - But the icing on the cake was this past Friday. She called me and a CNA (who is an excellent CNA, by the way - probably one of the best ones there) up to her office. She needed to speak to the CNA because she had not stayed past her shift one morning (she works 11-7) and we were short on the day shift, and she needed to be "spoken to." I was called up as a witness. Instead of being professional and telling the CNA that if we are short, it would be nice if she were able to stay in the future, the DON proceded to yell at her, telling her that "from here on forward, are you going to pick your job or your family," then told her that maybe she should "go work in a bank and not work in healthcare, as maybe those would be better hours." She also pointed her finger right in the CNA's face and screamed "I don't care, I don't care about your family!" I have never witnessed anything like it in my life, and if I had been the CNA I would have up and left right there and never come back. I was even considering walking out myself if this is her attitude about mothers who work in healthcare. I am a mother, and most of the women I know who work in healthcare are also mothers or have some sort of family - boy/girlfriends, parents, etc. There was more to this intimidating, harrassing, discriminatory one-sided screaming, but that is the crux of it. Anyway, knowing that this is her attitude about mothers who work in healthcare (and yes, this woman is not a mother and is single - I wonder why), I am having a hard time making myself go back to work in there. The environment is truly hostile and I am so stressed out every day that I have to go to work, but I have this contract hanging over my head. My husband says there is no way I am paying that money if I leave, as I didn't sign up to work under such hostile conditions, so I have started looking for a new job. I did apply to the facility where I did some training, because if I stay within the company, I'd be able to keep up my end of the contract. But part of me doesn't even want to work for this company at all, if this is how one of their administrators acts. Anyone have any experience with this type of thing? Thank you!

I just started my very first nursing job and I work Friday 7-3, Sat & Sun 7 am-7 pm, and Monday 3-11. It's every weekend, but so far my 4 days per week fly by and I'm really enjoying my 3 days off every week, and always knowing my schedule. I was a unit secretary at a hospital before this and other than every other weekend, my schedule was never the same and I kind of hated that.

I have been reading some other posts on this topic and I'm realizing that my story is not unique, but I could certainly use some advice! I am 40 years old and just finished school in December, took the boards in January, and got hired at a nursing home in February. I am a brand new nurse but I have worked in healthcare for almost 20 years in some capacity, including being an activity director at a nursing home for 5 years prior to having children, and most recently as a unit secretary on a med/surg floor at our local hospital. When the time came to start job hunting, I thought about it a lot and decided to go back to LTC because I had really loved my job as an activity director and I really love that population. Also, having worked on a med/surg floor for 5 years, I realized that med/surg was not what I wanted to do. I applied to a few nursing homes, and also a few hospitals as well (who all wanted experience or a BSN), and I accepted a job at a small, 33 bed LTC facility. It's a full-time position and I work Friday through Monday, doing 7A-7P on the weekends, 7-3 on Fridays and 3-11 on Mondays. Definitely an odd schedule, but it works out for my family and I actually really like having those 3 days off during the week, every week. My job is to be the charge nurse, which in the beginning sounded great, but now I'm having second thoughts!! Because I'm a new nurse, my DON had me do 5 weeks of orientation, M-F, at another of their facilities to get some practice and become comfortable with things, which was great. I was on a sub-acute floor at a larger LTC facility and got lots of practice hanging IVs, had 2 G-tubes to take care of, had a huge wound to take care of, and I finally got pretty good at doing the med pass by the time I was finished. There were 40 patients on the floor with a charge nurse, 2 med nurses, the unit manager, plus the DON in the building, so there was always someone to help me if I needed it and they were all wonderful to me. The evenings had a charge nurse and 2 med nurses, plus an admissions nurse if there had been any admissions that day. My 6th (and final week) of orientation was at my home facility, doing M-F 7-3 with 1 3-11 shift, then I started my first 12 on Sunday, by myself, and I feel like all Hell broke loose. The nurses I oriented with during the week are great - they've both been there a long time, but they also think I should have had more orientation because this facility is a lot different than where I oriented. They have also begun to tell me about the DON, which apparently noone likes very much and has a reputation of not being very helpful to staff. The first thing that happened on my first day alone in charge was that a CNA burnt toast in the staff room toaster, setting off the fire alarm and summoning the fire dept. No one had gone over fire alarms with me (other than what I already know about RACE), and no staff was to be found on the first floor, where the majority of residents were sitting in the dining room, no staff supervision, and one was trying to rearrange furniture. I'm lucky she didn't fall and break something in the middle of the fire alarm. I finally found all of the staff, including the med nurse, down in the breakroom, looking at the toaster. Oy vey. A few hours later, a resident came back from the hospital and I had to do all of the readmission assessments and paperwork, which I had barely gotten any training in, and at the same time, I had a resident who seemed to be getting sicker by the minute - very lethargic, congested, fever, etc., etc. The DON had happened to come in and I went up and said I needed help! She helped a bit with my patient who was declining (who is doing much better now), but no help with the readmission or anything else. I felt so swamped with paperwork that I just wanted to cry. The med nurse was only there until 1, so I was all by myself from 1-7, when all of this was going on. When the night nurse came on at 7, I was still doing paperwork and hadn't given any afternoon/early evening meds like I was supposed to, and I felt like a total failure. Granted, most of those meds were supplements, but I just didn't have the time. The next day the charge nurse said if it happens again, do the meds and forget about the paperwork, the meds are more important and the nurse coming in at 7 can't sign off on 4:00 meds. The DON also told me the next day to make sure there were "no holes in the med book" from the day before, so I went through and circled everything because I didn't give them. The state is due in any time, I guess, and I don't know if she wanted me to lie that I gave them and just sign them off or not - she said it again later - but I couldn't, in good conscience, sign off that I gave them when I didn't, so everything got circled. Luckily there was nothing super important that caused a problem by being missed at 4:00, because then I would have felt even worse. So I went home Sunday night and crashed, and returned Monday for my 3-11, again as the only nurse in charge, and also responsible for meds and treatments. They had also gotten 2 admissions that day, so I also had to do 2 skin checks and document those, plus go through all the INRs that didn't even come back until about 7 pm and call and get new Coumadin orders, plus verify all the orders on the new admissions because the day shift didn't have the chance to, plus do all the meds and treatments for 33 patients that I'm still getting to know. I was there until 12:30 in the morning (I punched out at 12 because everyone has told me we are not supposed to do any overtime), but there was no way I could have left at 11. The night nurse was actually about 20 minutes late because she overslept, so I would have had to stay a bit anyway, but I sure had enough to do while I was waiting. I am feeling so overwhelmed and don't know if it's just new nurse jitters, or LTC, or this facility in general. Having worked in a hospital where each nurse only has 5-6 patients, plus a secretary, plus a supervisor, and having oriented at the other facility that always has at least 3 nurses on the floor for 40 patients, I am kind of feeling like things might be unsafe, but having read a bunch of posts on here, I'm finding that it seems to be the norm at LTC facilities. I am already super stressed out that I've missed things, and what if I miss something and get written up and end up losing my license - I was so stressed out yesterday that when I got home from doing some errands, I half expected a call from work saying to not come back because maybe I had totally messed something up!! But that didn't happen. I'm trying to take some nice deep breaths on my few days off, but am already kind of dreading going back to work on Friday and trying to get through the weekend. Will it get better? Should I look for another job? I don't really want to look elsewhere yet because I do really like the residents already - they are all very sweet for the most part, and the staff has been really nice, but I personally feel that the job is too much for one nurse to handle, whether or not she/he is a new grad. Help!!

Thanks for your input! As a new RN who has never seen this before, it made me nervous! But I'm glad to know I can act as a "doctor's representative."

I finished school in December and began my first nursing job 3 weeks ago in long term care, a population I love. Prior to this I was a secretary on a med/surg floor and while I learned a lot, I also knew I did not want to be a med/surg nurse. Prior to finishing school, I learned 2 things from 2 excellent nurses: med/surg experience will expose you to a lot and you will get very good with your nursing "tasks," but it won't necessarily make you a great nurse all around. The other bit if wisdom was that for whatever nursing job you take, they will train you and you'll learn what you need to know.

I recently finished school in December and passed the NCLEX in January, and began my first job as an RN about 3 weeks ago. Even though I am a new nurse, I have worked in healthcare in one way or another for almost 20 years, and I guess I always expect a certain level of professionalism from myself and from those I work with, although it doesn't always happen. Anyway, a few days ago something happened that I was very uncomfortable with as a newly licensed RN, but I don't now if this is something that happens in long term care. I have been orienting on a sub-acute unit at a LTC facility. There are 2 NPs who come in 3 days a week, and my personal opinion is that neither one is really that great, compared to other NPs I know, but that's okay - there are good and not so good people in every job. The nurse I was training with the other day had to call one of the NPs to get some scripts for a patient who was going home. The NP, instead of calling them in herself, from her office (it was 2 in the afternoon), gave the nurse her DEA # and said she could "just call them in." The nurse training me asked if I wanted to do it, but I said no - I was very uncomfortable calling in prescriptions, as I am not able to prescribe. Then later I thought about what if I did call (or the other nurse), and I/we decided to order all kinds of scripts under this NPs name and go pick them up, since we had her prescriber #??!! My last job was as a unit secretary at a hospital, and I never once saw a nurse calling in a script like that - faxing them to a pharmacy, yes, but not this. Is this a common practice in long-term care, or is this something people can really get in trouble for? Thinking about it still makes me uncomfortable and I don't think I would do it in the future if this situation arose again.

Very interesting thread! I just started my first nursing job this week at a nursing home. When I was in school, at all of my clinical sites (which were all hospitals), techs could do BS but we did them as students on our patients. All insulin had to be co-signed all the time, and I was taught that it should always be co-signed everywhere. But at my new job, the nurses do their own blood sugars, and there is no co-signing at all. Having been trained to have it co-signed, I have been having my preceptor check all of my insulins, but it feels kind of weird to me not getting the co-sign. And something else up for debate - getting the blood sugar. I was taught alcohol swab, let it dry, prick finger, get blood. Another instructor said you should wipe away the first drop of blood, but I've heard that it can be either way - that it doesn't really matter. And another nurse told me you "don't even need to use the alcohol - just prick the finger"! This week I've been doing what I learned at school but it certainly is an interesting debate.

I just graduated with my associate's and have a prior BA in music therapy. I have already accepted a job in long term care and start Monday and while I think my previous degree helped me a bit in landing a job, I think they were more impressed that I had supervisory experience from a previous job, as I will be in charge 3 shifts a week (yikes!). Definitely highlight on your résumé the skills you developed while using your other degree.

You can do it - I decided to go back to school at age 37 and just graduated at age 40, passed NCLEX on the first try 2 weeks ago, and just accepted my first nursing job. I also have 2 children and worked 24-32 hours a week while I was in school. It can be done - don't give up!

And I passed - just did the quick results from PearsonVue and it said "pass," so I would say the trick does work - woohoo - I'm now an RN!!

I took the NCLEX earlier this afternoon and it shut off at 75 questions, after about an hour and 20 minutes. Even though I felt okay with the test, I was thinking that I either failed miserably or passed with flying colors. After an anxious ride home, I tried the PearsonVue Trick and I got the good pop-up!! So I hope this means I passed! I graduated in December, got my ATT yesterday, and took it today because the next available date wasn't until Feb. 14, and I really didn't want to wait another 3 weeks, and I was feeling pretty ready (or as ready as I'd ever be!). So I hope the trick really does work . . .