8781RN

Haha! Ok thanks! I did get a job and will be working in med-surg LTAC. I decided to focus on meds, and some of the practical hands on things, and chronic conditions.

Oh great, yea I feel a lot calmer now! I have a BSN and I haven't been out of nursing, just out of the hospital setting. Anyone have any advice?

Hello! I have been out of the hospital setting for 3 years. I'm going back and am excited! I've got all kinds of nursing books that I've kept, and even dug up my school notes from 8 years ago to review but I keep getting overwhelmed with what to look at first. Also I'm getting so frustrated because I don't remember what happens at the molecular level with so many things that I once knew. I'm going to focus on meds, calculations, and I guess start with respiratory, then cardiac, then fluids and electrolytes, but I don't know! Any advice?

I learned some more about the unit i'm going to. It does truly sound like a med-surg LTAC. It is a specialty hospital, the vents and the critical things will of course be on ICU, then there is a step down. They don't even do Cardiac gtts on the med surg, they send them to the step down for closer monitoring. So yes they will be more complex med-surg pt.'s but it's not 6 critical patients.....

Yes they have aides. Well I didn't go for regular med surg because I always hated starting out with 6 pt.'s, discharging them all, then getting 6 more. I used to do Cardiac Acute care but we had the same discharge admit rate (it wasn't strictly cardiac patients) and constantly had post Cath pt.'s with sheaths still in place or those worthless closure devices, etc. This med surg floor I'm going to has some Tele pt.s....I don't know maybe I'm way over my head and should call them back and let them know I've changed my mind.

No I haven't. I do understand they are very complex patients. The nurse to patient ratio is 1:6 there. The LTAC hospital has an ICU, a Step-down unit, and a med surg floor. They have a Mon-Fri wound care nurse and a 24 hr. RT.....

Hello, I need some advice on a decision I need to make. I will try to make this short. First here's my background: I've been a nurse for 8 years. I have been away from the hospital setting for about 3 years. I remember the dread at the start of my shift just wishing I could find an 8-5 job. I was disgruntled, I knew I wasn't getting paid well. Also I had a newborn so I wanted different hours. So I left and did 2 years as an RN Case Manager in a Supported Living Facility for disabled individuals. I didn't like the lack of structure and the attitude towards nurses was awful. I left and became a Coumadin Nurse for 1 year. That was really cool but as our clinic grew they wouldn't get me help, I had 270 patients! So I left. My previous boss where I worked at the Supported Living Center offered me the job I have now. It's hard to explain what I do. I work with mentally/physically disabled individuals (love my patients by the way). I have several patients whose care I oversee on group homes, and another handful in foster care, and some live on their own. It's very unstructured. No offense to my boss she came in and started trying to make things better but she doesn't even know what we are supposed to be doing. She's called the State Board to get clarification on things and they keep referring her back to the website. I have 50 plus people on my caseload and I haven't seen them all. So it's a liability and I don't like not knowing what the State Board of nursing requires of us. It's 8-5 and on call once a month. One nurse left and they decided not to refill her position. So I panicked and looked for a job elsewhere and got one! I haven't told my boss yet, i'm going to give her two weeks notice so I have a week to tell her. The thing is, NOW after I've accepted a new position, my current job is now going to fill the nurses position that's leaving with an LVN so that's good. They are going to hire on-call people so we won't have to be on call. So things are looking up. Although I don't trust that the positive changes will stick. SO HERE IS MY CURRENT DILEMMA I NEED ADVICE ON: The new job I accepted is at a Specialty Hospital, it's med-surg LTAC. It's only 3 12 hour shifts a week. (I chose this floor because there's not a revolving door of admits and discharges). I know at heart i'm a hospital nurse. It's what I'm used to and everything you need is right there (most of the time). In these 8-5 jobs that I once longed for, i've always ran into the same problem, LACK of structure and not always having the means to do the job, IF i was lucky to know what my job was. So maybe I needed to do all of that to realize I need to be in the hospital? I dunno BUT I'M SCARED!!!! I've forgotten so many things. I'm going to read, practice my med calculations, and ask lots of questions but i'm still scared. I've had patients crash on me before but i've never been in a code. This place has codes, the patients are sick. I'm afraid I will forget what I need to do. I think the pay is going to be good for what I'm doing but it will be about 270$ a month less than what I get now. So i'm having second thoughts!! The fear of all of this, and the possible changes they are going to make at my current job are making me think about staying. Do I take this big risk and go back to the hospital and get paid less but POSSIBLY be happier? Or do I stick with my current job, get paid more, get weekends/holidays off, and just HOPE that they stick to their guns with these positive changes? (even still I don't know how much better it will be). Any advice?

Wow that's great advice. I'm going to sit down tonight and evaluate everything and do the Risk Budget! My daughter is almost 4 now. If i'm going to have 4 days off a week, i think working some weekends will be okay. Yes, i've discussed it in length with my hubby and he's very supportiveof what I decide. He thinks my well-being is worth a paycut. I get to the point where I'm dead set on going to LTAC, but then my boss talks about how much better it's going to be at my current job. Another issue is that if I turn this job down after accepting it, if I change my mind and decide to apply again I don't think they would want to bother with me again.---and I've worked everywhere else in the city I live in and don't want to go back. But i'm going to sit down and try doing the Risk Budget and see if i can acheive any clarity. THANKS!!!!

Hello, I need some advice on a decision I need to make. I will try to make this short. First here's my background: I've been a nurse for 8 years. I have been away from the hospital setting for about 3 years. I remember the dread at the start of my shift just wishing I could find an 8-5 job. I was disgruntled, I knew I wasn't getting paid well. Also I had a newborn so I wanted different hours. So I left and did 2 years as an RN Case Manager in a Supported Living Facility for disabled individuals. I didn't like the lack of structure and the attitude towards nurses was awful. I left and became a Coumadin Nurse for 1 year. That was really cool but as our clinic grew they wouldn't get me help, I had 270 patients! So I left. My previous boss where I worked at the Supported Living Center offered me the job I have now. It's hard to explain what I do. I work with mentally/physically disabled individuals (love my patients by the way). I have several patients whose care I oversee on group homes, and another handful in foster care, and some live on their own. It's very unstructured. No offense to my boss she came in and started trying to make things better but she doesn't even know what we are supposed to be doing. She's called the State Board to get clarification on things and they keep referring her back to the website. I have 50 plus people on my caseload and I haven't seen them all. So it's a liability and I don't like not knowing what the State Board of nursing requires of us. It's 8-5 and on call once a month. One nurse left and they decided not to refill her position. So I panicked and looked for a job elsewhere and got one! I haven't told my boss yet, i'm going to give her two weeks notice so I have a week to tell her. The thing is, NOW after I've accepted a new position, my current job is now going to fill the nurses position that's leaving with an LVN so that's good. They are going to hire on-call people so we won't have to be on call. So things are looking up. Although I don't trust that the positive changes will stick. SO HERE IS MY CURRENT DILEMMA I NEED ADVICE ON: The new job I accepted is at a Specialty Hospital, it's med-surg LTAC. It's only 3 12 hour shifts a week. (I chose this floor because there's not a revolving door of admits and discharges). I know at heart i'm a hospital nurse. It's what I'm used to and everything you need is right there (most of the time). In these 8-5 jobs that I once longed for, i've always ran into the same problem, LACK of structure and not always having the means to do the job, IF i was lucky to know what my job was. So maybe I needed to do all of that to realize I need to be in the hospital? I dunno BUT I'M SCARED!!!! I've forgotten so many things. I'm going to read, practice my med calculations, and ask lots of questions but i'm still scared. I've had patients crash on me before but i've never been in a code. This place has codes, the patients are sick. I'm afraid I will forget what I need to do. I think the pay is going to be good for what I'm doing but it will be about 270$ a month less than what I get now. So i'm having second thoughts!! The fear of all of this, and the possible changes they are going to make at my current job are making me think about staying. Do I take this big risk and go back to the hospital and get paid less but POSSIBLY be happier? Or do I stick with my current job, get paid more, get weekends/holidays off, and just HOPE that they stick to their guns with these positive changes? (even still I don't know how much better it will be). Any advice?

Oh.... it was LTAC not LTC

Yea, that's exactly why I'm worried and felt the need to post. But I'm not so dumb that I didn't know to go ask someone to go back to their room. If you read the whole post, I know its long....it says there were more pressing issues such as : 1. Pt with defib vest had alarm going off to change the battery......take care of that and get ready to go ask a pt to go to their room....and right when I go to do that.... 2. Time to male sure the pt who I gave insulin to is eating......then...... 3. Pt with large decub on glute soiled himself and the dressing fell off and stool was oozing into the tunneled wound.... On and on and then it was time to give report. Would you have made going to get the pt in the day room a priority over the above?

Excuse me? You don't know our financial situation, that was a totally ignorant comment on your part, aside from being flat out rude. You know absolutely nothing other than that I'm ambivalent about taking a paycut. How do you know if I don't have a sick family member, how do you know if we have two incomes or not? Doesn't it make you feel oh so good when you make snide comments, just know you don't sound all that smart when you do.

I mean its 470 less pretax...

Well....the 281 is what I calulated for take home so it is after tax. Pre tax its 370$ less. Its a state job so in addition to the 20% taken out....and extra 6.4% is taken out. Well, you have good suggestions...we are coming to an end of our phone service contract so there's a chance to get a cheaper plan. Its the medical bills that are getting us too..

I circled my initials and documented pt. Was in dayroom most of the day. All I could think to say...because the three times or so I would go to their room they were in the dayroom with family.

A month. But, I turned it down and so they are going to make it a senior nurse position, repost the position and have me apply. This way I will be taking a 281$ monthly cut. The director said she would only do that if id be willing to take the position. Its a top notch clinic...I totally want to do it. But I'm worried about the cut. I had just planned on doing agency twice a month to make up the difference as I had just signed on to one. After having my first agency shift ever...I don't know if I want to HAVE to do it twice a month rather than just when I want in order to supplement my income. By the way I wrote a big long post about my first agency shift in the agency forum. What to do? I don't want to put my family in a bind but I hate my current full time job!

Hi! All of my past jobs have been acute care in hospitals. I'm a little rusty since I've been doing case management for the last 2 years. I went to an LTAC facility today, my 1st time working agency. I received report from an agency nurse and gave report to an agency nurse. Fortunately the nurse showed me all that she could. I didn't know I was going to be the only friggen nurse on the floor. Granted I had a med aide and there were two nurse aides..I hadn't finished charting and there were 2 dressing changes left that I didn't get to before the shift ended. There were two patients I didn't get to talk too because everytime I went to their room they weren't there. I was able to give my PEG meds and do a number of dressing changes though. The people who were always out of there room got their PO meds by the med aide. In addition to that I didn't get to set up new tube feedings for the oncoming shift. I'm used to having 4 to 6 patients and comparing all MARs and treatment flow sheets to the actual order. It drives me bananas to have 15 patients and just go off the MARS, since there's no time to check each order in LTAC. I don't like trusting that its correct. There were just too many pt.'s...and I was having trouble keeping in mind who had what...such as 2nd day post op permanent pacemaker vs the guy who went out with chest pain the night before and returned the same day etc. I'm comfortable prioritizing and making a cheat sheet to follow...but there was so much charting on the residents who didn't live there. I was barely able to eyeball everyone by the end of my shift which is a far cry from hospital nursing! I refused to give the meds that the med aide pulled on one pt. Since I didn't pull them myself. She said she never gives the meds to that particular pt. Because he is always inappropriate with her. So I told her I would give them if I pull them myself. I ticked her off a little but hey, its my liscense. She was a big help though and after she realized I wasn't a wench and she was nice. So I don't feel like I did anything wrong, I did the best I could do...but as far as from a state board of nursing perspective I'm a bit freaked out about anything coming back to bite me. My charting sucked and like I said...I wasn't able to keep my eyeballs on everyone. Am I just being too hard on myself because I'm used to a different setting and that's the way it typically goes in an LTAC? Be brutally honest but don't make me cry. Also any tips, tricks, suggestions, thoughts will be immensely appreciated!!!

Thank you!

I just got the offer today for the coumadin clinic which will be 437$ less. I did factor in benefits . Maybe I will get the offer for RN case manager and they can offer more. I signed up for agency to pay off some debt, but I would have to do it to make ends meet on a monthly basis and I don't think its worth it. Id rather spend time with my hubby and 2 yr old and just work agency if I felt like it. This is so fustrating. I'm stuck. I hate my current job, there's no communication and nurses are treated like crap. It pays the bills and that's all I get out of it. I should just be happy I have a job and healthy family but its sooooo frustrating.

but I'm a BSN with 7 yrs experience. 1 yr. Intermediate care, 6 months of psych, 3 yrs. Acute cardiac, abd almost 2 yrs in case management (long term care). I desparately want out of my current job. I had 2 interviews on Monday. One as a hospital CM in a hospital were I used to work and love. The other is for head of a Coumadin clinic. Both seem amazing and I would love to work at either one. But at the end of my interview at the Coumadin clinic, they said that it pays a lot less than my current salary. I did the math and it would be a 400 $ cut! (Its a state job so the online job description stated the salary but was misleading). During the RNCM interview she couldn't tell me the hrly rate but she asked me what I was looking for. When I told her she almost fell out of her chair. Its too high.....she said it wouldn't pay as well as floor nursing. I work with the state and have never been payed as well as I do now but I need to get out! If I told you why you would encourage me to leave but there's no time to get into that. The only reason I'm not back on the floor is because of the 12 hr shifts. Daycare closes at six. I'm so upset because if I get offered any of those jobs I don't think I can afford to with needing full family insurance and daycare. My hubby is making all he can. I have signed up with agency but its not garunteed id get two shifts a month on a weekend Anyone have any suggestions or advice. Maybe there is a solution I havent thought of

Hello, I'm a BSN with 7 yrs experience. All telemetry, a little psych, and the last 2 yrs I have been in case management at a long term care facility. Well, my ACLS has expired so I will only be sent to med surg or LTAC, which is fine because I've been off the floor for the last two years. So, my first assignment is on Sunday at an LTAC facility and I'm freaking out. I worked in a nursing home for two weeks once and I ALWAYS stayed past my shift because I took so long to give meds. I'm afraid they won't tell me something that I need to be doing. Not with my actual skills, Im talking about policies, or certain forms required. I need to do this pay my bills but I'm also excited to have some hands on to put on my resume after having a desk job for the last 2 years. Any advice will be appreciated. I saw in another post about making rounds with the nurse...does this mean after I get report just to eyeball my pt's real quick? I don't want to seem like I'm picky with my assignment....but I refuse to shy away from questions.