RegisteredNuisance

So I recently accepted a per diem position as a Clinical Documentation specialist. I come from a background of about half and half med surg and rehab. I asked the recruiter if they would provide job training regarding job functions, workflows, etc and she said, "No, they won't train you." Am I in over my head? After browsing the ACDIS website, it seems like I may be wildly unequipped to do this job without some training... does it sound a little weird that they want to shove someone right off the dock like that? Although, the recruiter was a bit like a used car salesman as far as the interview went... the interview was about five minutes and she said, "Okay so I'd like to offer you the position..." What have I gotten myself into?

I had mine out when I was about 25 or 26. They were all growing in at a severe angle and it was causing me a decent bit of pain in my lower jaw. As with all testimonies, I preface mine by saying your mileage may vary. Everyone has different pain tolerances/experiences etc. They put me completely out - I'm not completely sure whether that's conscious sedation or not. That said, my wisdom teeth removal was all four - two on the top, two on the bottom. They took my vitals, started an IV, stuck an oximeter on my finger and put a nasal cannula in my nose. Unbeknownst to me the sedative was already running when they put the nasal cannula in and I remember asking the assistant if the oxygen had an additive that was making me dizzy and she said something to the effect of, "no, that's just the-" and it was curtains until I woke up. You don't dream, you just don't exist until you wake up. Not scary or painful at all. Pain wise, I had zero pain at all, but I took two Norco tabs when I got home and slept for the rest of the day. They'll write you a script for some kind of pain reliever before you leave. Don't take that stuff for longer than you need. I had terrible insomnia after just a few days of taking it once I stopped. Overall conscious sedation is the way to go if you want it over and done with and have a day off to spare. I've had terrible teeth my whole life and the whole novocaine, hold your mouth open for hours, try not to drown in your own spit thing is super uncomfortable. Don't feel like you have to suck it up. If your dentist offers you conscious sedation and you'd rather do that, do it. Just make sure someone drives you home and maybe make you a soft meal in the evening.

My goodness. You had a hell of a week, didn't you? That sounds... exhausting. Also, huzzah for you! You solved my scrub pants problem! I'm 5'4 with a bit of a badonk and you may have just solved the equation. Thank you, friend.

favthing, as well as the other commenters: thanks for the feedback. The one thing that will keep me from doing well in this new position is self doubt and feeling overwhelmed and out of control (of the workload, not so much myself). Those are going to be my challenges going forward, and I appreciate the comments from those of you who have enjoyed working in LTC. It's easy to get a negative perspective from reading comments from other LTC nurses, so if anyone else has a comment on their positive experiences, that would be helpful. :)

Also, the CNAs that just got hired were told they were critically needed by the DON and I agree. When I worked on the floors my CNAs were the only thing keeping me from being buried in work and I've always *tried* to make them know that. You always get a few that see RNs as lazy chair sitters who use charting as an excuse to boss them around, but typically if I'm delegating something to my CNA, it's because I have something that HAS to be done that they CAN do, that I just don't have the time to at the moment. Sometimes that involves charting. I try to give a rationale so they know I'm not just pointing fingers and throwing orders around. Rambling now, leaving...

Of course you can. I didn't leave M/S and go straight to LTC. I'm returning after a break of about two years. This seems like a lot, but I had to take some time off after a rough couple of years. Upon considering my options for returning to work, I knew I like home health having worked in that specialty for a few years, but was willing to give clinical work another go. I did not like the two hospitals I worked in in terms of employee culture or the chaos of the hospital floor. Lots and lots of backbiting, tattling, etc. From the replies here it sounds like LTC can be just as busy and confusing, but I feel like the place I'll be working at has a better working environment and more supportive team. I'm not saying Med Surg is awful or that it's any less valuable or busy than LTC, but I do feel the latter might be a better fit. At any rate I'm committed to making it work. I feel more rested and my personal life is much more stable, so I'm hoping this will work out. Make sense?

Lori, thank you for this contribution. As someone with no familiarity with this subject matter, this was very informative.

Ha! Awesome. All about context, lol.

+1 there. While that's kind of what it is, you can look at it as the "OK" for you to utilize to allow yourself to slow down and really get the five rights down. Really however you look at it, best to see it as a positive and know you're not looked down upon as "that guy". Glad it went ok, OP. Sounds like your administration is pretty level headed which isn't always the norm.

Another agreement for the scheduled vs PRN option here. Pain, nausea and other symptoms are NEVER the nurse's prerogative to judge. If the patient says they're in pain/nauseous, we have to assume they are. The "but" here is that we do it regardless if it's true and most nurses know sometimes, it's not. It's not our place to judge. Sucks, but it's a standard of care in place so that the people who are telling the truth have their needs met. I would keep on the management if you can't get the med rescheduled to q6.

Wow. I will NEVER complain about snow in Flagstaff again! I live 10 miles out of town which is 13 miles from my house but my neighborhood is county, not city. We still get the plows and gravel out and they're quick about it too, which is great. I think we got two feet of snow in the last few weekends, on top of the nine inches we got the weekend before that. Thankfully out here it's just a matter of driving steadily, no quick maneuvering and you'll be fine. We had to have our neighbors help me dig out my car since I didn't go anywhere during the storm. It was a four man, 1 hour operation to dig a subaru out of the driveway! LOL But wow. After reading the previous posts... sounds like that was a cakewalk!

This is one of the reasons there has been so much talk and effort to make nurses more willing to report mistakes and med errors. Your charge nurse should have responded more calmly. My first question would have been to the patient's status. THAT is a reason to freak out. I didn't see you mentioning you're a new grad in your original post, but the charge should have realized her position to provide an example for you by staying calm and assessing the situation. But forgive me for displacing blame here. The error was still made by you. However, it's common. I've made a few on the hospital floor and you did the RIGHT thing by admitting it. When you have a meeting with your supervisors and directors, I can't stress transparency enough. You will not benefit yourself by attempting to CYA with less than the total truth. Stress that you were scared for your patient, aware of the gravity of the error and now realize the importance for double checks. And in the end, if you get written up, get placed on a different unit with less acuity or if even if they dismiss you - keep breathing. It won't necessarily keep you from ever working again. I anticipate, based on what happened for me, is that you'll get a verbal warning or a write up and be a little skittish for quite a while. Please do NOT doubt yourself. The thoughts you think about yourself, regardless if true, are a self-fulfilling prophecy. If this were football I'd give you a smack on the butt and tell you to get back out there.

Okay, let's hear it! You can't post "hey I made a funny!" without sharing it. What was the one liner?

^^ Was about to make that same comment. This is a striking contrast between the now popular post on medical professionality of appearance. It would be interesting to add RNDynamic to your follow list, see what they post next.

Lavenderskies: For the unaware: what's SDN?