Trying2BLPN

I agree with basically everything already said. I am a new grad. and was hired at a large LTC facility. I was initially hired for LTC floor but but when I showed up for my first day the DON was pleased to inform me of the good news that they managed to find a place for me on the rehab unit, which would be wonderful experience for me. Ha! I soon figured out why this unit is staffed with about 50% new grads and travel nurses. All the other nurses in the building hate it with a passion and will do almost anything to get out of being floated to it, for the reasons everyone's already mentioned. Sometimes I think I'm holding my own and sometimes I think I'm in a very dangerous situation. Recently the acuity level has shot through the roof. I think it's worse right now than it's ever been. I have 18-20 pts. on my hall, fresh hips and knees, TWO peritoneal dialysis pts. requiring three exchanges between them on my time, 9 diabetics with fingersticks, a trache. that requires frequent suctioning and of course q shift trache. care, a g-tube pt. that gets bolus feedings twice on my time, a wound vac, a PICC line getting IV abx., a post CVA who thinks she can walk by herself and frequently falls. There are the dsgs. It's just crazy. I have to do all my own admissions and discharges pass meds., assess, do my own treatments, fingersticks and vitals, apply cream/skin prep to the heels (and what's with the skin prep? Do other facilities do this for heels, and do you think it works? I am not finding it very effective to prevent breakdown on the heels...) of just about everyone. It's very overwhelming bordering on scary sometimes. Then almost everyone is medicare and requires charting. I agree about the qid fingersticks. I keep asking WHY certain people get them qid...there is at least one getting them qid who doesn't even have coverage ordered and has been between 100-120 every single time since admission, yet they wont stop the qid fingersticks. I don't get it.

I don't know what this poster's exact situation is, so I don't know what she should do, but I just wanted to say that I am obese and a nurse and I walked for "miles" up and down halls tonight and have the burning feet to prove it. I also lifted, transferred, tugged, pulled, bent over and everything else that goes with being a floor nurse in a LTC facility. So there's one obese person who walked for "miles and miles" just like every other nurse and will do the same tomorrow and the day after.

Hmm. I woud love to complete my med. pass without distractions, unfortunately I am required to answer call bells and toilet, etc. patients while I am in the hall doing my med. pass. because the corporation doesn't want to hire enough CNAs. I swear I see MARs in my sleep and daydream about lines and little boxes on my days off. I would love to take charge of making sure our completely jacked up MARs were straightened out but unfortunately I can't squeeze and extra minute out of my day and I already stay over an hour late every night just charting (I'm on a medicare floor and a full head to toe narrative note is required on every pt. every shift.) I really think the way these places are set up they are just about asking for a catastropic medication error to occur. I think the entire system is broken and needs to be rebuilt from the ground up.

Pt. was discharged today, actually. They want me to start next week. Thank you for replying! I don't know why I'm so freaked out about this...I guess it's the whole private duty thing and I was a bit freaked to be approached at work.

I've been taking care of a gentleman at my facility for the past six months or so. This is a terminal patient. Recently the patient and family decided to take him home and initiate hospice care. The patient has a few things the family needed teaching on, namely a G-tube and a Foley cath. We've been teaching in the facility. The pt's adult children are fairly competent with the G-tube and handling the Foley (hospice will of course be changing it out as needed, etc.,)but the wife still needs a lot of reinforcement. The children all live 2-3 hrs. away so the wife will be the primary caretaker and have responsibility for passing meds through the tube, changing the feeds, etc. One of the pts. daughters took me aside the other day and asked if I would be willing to come in for a couple hrs. for a week or so to reinforce teaching with the wife and also to show the private duty aides they hired how to use the G-tube. I didn't commit to anything at the time and today they asked about it again. This is a very nice family and I enjoy working with them, and also the extra money would come in handy right now, but I keep thinking if I accept and work finds out I could get into trouble somehow. I can't seem to find a policy prohibiting this but really this facility has so many policies about so many things scattered across so many resources I don't know if I could locate it if it does exist. What if people at work find out somehow? Also, I'm wondering if there are liability issues? I've always worked for a facility or agency (did home health for a couple years) and never worked on my own. So, I guess my quesiton is would accepting this assignment be an "okay" thing for me to do from an ethical, legal and work standpoint? Are there complications or issues I haven't thought of? Has this ever happened to anyone else (been approached by a family for private duty? It's never happened to me before and I was really taken aback, obviously).