Momtomykiddos

I work in LTC, and work with several single-parent CNAs. Look for a daycare with flexible hours, or into before or after school care. As a single parent, you can likely qualify for daycare assistance, too. Per diem can be a good way to go. If you're concerned about not getting enough hours, can you apply at more than one place? At my facility, there are some people that work half shifts, and they'll work the second half of days and the first half of eves. Different facilities also have different shift times, so that might be something worth looking into as well. Set aside some time, do some research, and make some phone calls! Call around to daycare centers and home daycare. Look into assistance for daycare. And call around to facilities and positions to fond out what kind of hours and flexibility they have. As previously mentioned, home health and hospice are good with flexibility. Just keep looking--there are options out there!

What kind of documentation did you do when you held the med? There's a big difference between simply not giving a med (appears as if you just overlooked it), and thorough documentation as to why you held it--assessment of patient, nonverbal pain score, administration times of other PRN meds, your plan to reevaluate pain, notification of the doctor. How often is it ordered? Is she maxing out on her PRNs? If this was a once a day med, and she is taking max PRNs, her pain might not be controlled throughout the day without it.

I think there is a common myth that nights on LTC are quiet. All the residents are asleep, right? At least, that's what the people who do the scheduling seem to think, hence the insane ratios at night. But you have people sundowning. You have insomnia, from people napping during the day. You have pain issues. You have people self-transferring because there are fewer aides, decreased lighting, and residents who don't have their hearing aids or glasses, and all of that and more leads to more falls at night. Then there are the tasks that get relegated to night shift. So when you have down time from patient care, you have glucometers to QC, and fridge temps to check. Our night shift nurse also switches out the papers in the MARs and the TARs at the beginning of the month. They're also responsible for switching out the nebulizer tubing that is in a lot of the rooms. Then there's the charting--higher ratios means more people to chart on--even if you don't have to chart on everyone, you still have notes to write on more people. Short answer: no, there isn't more down time in an LTC.

We were able to do some ED time when I was in school. It wasn't a full rotation, but we had a rotation that was kind of a grab bag of places we didn't get for a full rotation. ED, cath lab, dialysis, outpatient lab...places where they didn't want a ton of students underfoot, but we got exposure to the area for a short period. The ED, for me, was great. So many different patients, so much going on, so many different skills to practice. It was great for some who didn't know what kind of population they wanted to work with--they were at least able to narrow down the type of cases they liked over others, and practice a bunch of skills.

I work 8 hour shifts, days or evenings. I've only been off orientation a month and a half. And this is my first job back after several years out of the medical field. That at said, I am getting better, but I'm still a little slow. Day shift, I usually end up staying an hour, up to an hour and a half. Evenings are better. I get out of there on time, or within fifteen minutes, generally speaking. Of course, being in LTC, if someone falls, or gives themselves a teeny cut while cleaning their little electric trimmer (true story), the incident report can keep me later, especially if it happens later in the shift.

Had one of those last week. There are the days when you know you aren't getting out on time, then there are the ones where it looks good. I work LTC, per diem so I work days or evenings, with little consistency as to which of the four "neighborhoods" I'm on. I was working evening, so 2-10:30. Had all of my meds done, treatments done, charting done. Night shift nurse arrives at about 10, starts getting report/counting since she's taking over all 4 carts. I would normally be third in line, but told her to go ahead with the other nurse since I had to take off a patch (confused, falls risk, likes to self transfer so she goes to bed late so we can keep an eye on her longer. She's sitting in her wheelchair, and the patch is on her back. I can't get to it, so I wait until she's in bed, so I can just go in and pull it while she's in bed). It's 10:25. I'm walking down the hall. Going to pull this patch, count and report off, then I'm out the door. I'm glancing in rooms as I walk down the hall. Look into one, and sure enough, LOL is sitting on the floor by her bed. She was fine, but fall out of bed=incident report, of course. And of course, she's still mine. Why couldn't she wait ten more minutes to want her shoes? And why did she want her shoes? Never could figure that out.

Gloves for blood draws, eye drops, and injections. We don't always do all of the above on a daily basis, but when state is there, do it! Also privacy is a big one. Many residents won't care about doing their medications, finger sticks, or insulin in the hallway--state does care. Verify the resident before you give meds. State doesn't care that you may have worked with this person forever--ask their name before administering meds. Apical pulses for dig. Clean your stethoscope and glucometer after each resident.

I like to when I can. I won't sit on their bed, and there isn't always n extra chair, but I try to, especially when it's someone who takes. Little longer to take their meds. I feel like it shows I'm not rushing them. And I got into nursing for the people--so I like spending time with my residents when I can, not just rushing from one room to another to complete my med pass. And I always sit down when assisting a resident with a meal. Again, so they don't feel like I'm rushing them. I try to make up what I can of my cheat sheets and assignment sheets sitting in the hallway with a resident instead of behind the nurse's station. It might be the only time in get to sit with a particular resident, and I like chatting with them.