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Leonardsmom,LPN's Latest Activity

  1. Leonardsmom,LPN

    What do you consider a heavy patient assignment?

    From what I have been seeing where I work now as a nurse compared to other places that I have worked at when I was a CNA, is that the people who are being admitted are sicker, more unstable than I have seen in the past. Where I work we are a 100 bed facility with half of our building being long term and the other half short term rehab. On all of our units now we have trach patients, currently 5 in the building. Out of those 5 only 2 are stable. One of the trach patients that I did the admission on about two week ago requires extensive care, is a quadriplegic with a stage 4 decubitus sacral ulcer that has a wound vac, and is receiving antibiotic therapy for MRSA. They were placed on a unit where the nurse working that hall usually has 20-25 patients depending if all the beds are full. The rest of the patient load includes another trach, several others with CHF, COPD, a young stroke patient that has had about half a dozen falls and so on. This is suppose to be the area that is considered long term, with more stable patients, unfortunately is not the current reality. We we have had agency nurses who have come in, that don't return saying that it is the worse experience they have ever had. We have a lot of patients that in reality need to be in the hospital still, at least in an LTACH floor where the nurse to patient ratio is lower and closer monitoring can be done. The problem stems from a few different areas, I believe. The first is the insurance companies that we only pay for a person to stay in a hospital for so long, many patients I think are being moved out of the hospital before they should because the insurance company will only give a person so much time. Another issue is that at least where I am at, is that the building had not been making money for so long (changes in company running the building, and changes in management) they lower the standards of what they will take into the building, allowing sicker patients to come in. The companies running these nursing facilities continue to staff the way you would staff a long term care unit, the problem is that we are no longer representing what LTC facilities use to look like, and we are starting to look more and more like what you would see in a med-surg floor or an LTACH floor, however with less staff and higher nurse to patient ratios.
  2. Leonardsmom,LPN

    How did you spend your first nursing paycheck?

    Scrubs for work and a nice pair of dankos, don't regret spending the money on them and plan on getting another pair soon. Several months later with some of my money earned with all my overtime I got myself a Littmann cardiology 3 stethoscope, was able to use it for the first time today and already very happy with the decision to upgrade my stethoscope.
  3. Leonardsmom,LPN

    Please help, question about NG tube? TIA!

    This, I have worked with nurses in the past that used cola to unclog feeding tubes. However as JustBeachyNurse said the acid in the cola degrades the tubing. Flushing with water after checking residual, giving meds, or feeding am through an ng or peg tube will prevent clogging. Also my experience so far is that there is also a routine flush that is done each shift with an amount in the MAR that tells you how much to flush with (may differ depending on the policy of the facility).
  4. Leonardsmom,LPN

    Made my first med error

    This here is great advice. At some point all of us will make a medication error in our career. The other night I came close to making one myself and had almost pulled a Med that had been scheduled and given earlier in the day. The place I am currently working at still uses paper charting and a paper MAR, my experience with clinicals has been with an EMAR which shows in an organized fashion what meds are due when. I caught my near mistake and from that knew that I needed to be more conscious in my scheduled times and meds making sure that I am paying attention to the military time that is used in our records. Learn from what had led to your Med error and use it to improve yourself as a nurse.
  5. Leonardsmom,LPN

    Lvn New Grad ICF/ID

    Some things that I would want to think about is how many clients are you going to be responsible for, will you have other nurses that you will be working with that you can use as a resource if something happens and you don't know what to do. When you go on these trips with the clients are you going to be the only nurse, what other staff is going to be with you that can assist? What is the acuity of care for these clients? Also have you ever had experience working with those who are intellectually disabled? Those are the type of questions that I would be asking and wanting to find the details about before making a decision if the job would be a good fit as a newly licensed nurse.
  6. Leonardsmom,LPN

    Pearson vue registration help

    My att came within 24 hours after I made my payment to Pearson vue.
  7. OP as others have mentioned you can also report this to the state. Especially since it has been a month since you had contacted the agency about this. The department that would handle greviances would depend on the state, but if you contact your states licensing board they should be able to direct you to who you would need to talk to. So sorry that this has happened to your family.
  8. Leonardsmom,LPN

    First day was tough:(

    OP from the sounds of it you did really well. I am guessing that this is your first time providing patient care outside of nursing school? It takes time to get a routine down and day shift can be a very difficult shift to try to learn on when you are new. A few things I would suggest after having worked as a CNA for 8 years is when you first get in the floor and get your assignment get information about your people. Who requires what type of assistance for bed mobility, what is their transfer status, are they incontinent, are they a fall risk, and anyone who has dementia. This information will help you in being able to plan your day some and know which residents you will need to see first along with any that you will need to get help with. For any of your patients with dementia make sure when you first approach them do so calmly. Even though you might have a dozen different things that you need to get done take time with them and don't rush. They will pick up on that which can add to their agitation and make things worse. When end asking for help from others working on the floor with you, make sure that the supplies you need are already there. If you need assistance with a transfer make sure the equipment is already in the room and the resident is ready to transfer. When I worked as an aide one of the most frustrating things was when someone would ask me for assistance with a transfer and I would come in to find that they still needed to get the resident dressed. If you work with the same residents on a consistent basis, things will get easier with time. You will know what works with certain people and you will get better at managing your time. Also try not to take what some people may say to heart. There are some residents who do not handle change very well and will give new staff members a hard time. I had one lady who was like that, it took some time for her to get use to me but after she did we had no problems. It took me a few months to really feel comfortable with the job, working with the same group of people helps. Eventually you will get your routine down and speed will come with experience.
  9. Leonardsmom,LPN

    SMART goal for family education

    Is this for an actual patient or a scenario that you have been given? What thoughts do you have so far? There is no details given in which one could base a nursing diagnosis or goals upon. All nursing diagnosis and goals need to be based upon what the patient needs, what I may say for a 90 year old woman when it comes to diet is going to be completely different than what I would recommend or see as the needs for a woman in her 20's that is pregnant. Their needs are different and so will be the goals for each individual.
  10. Leonardsmom,LPN

    Happy,In denial, overwhelmed, nervous and worried

    Agree with the above posters, there is a lot of learning that you do within your first year of nursing. I am in the same situation as you are at this time, I took my NCLEX-PN on May 26, found out two days later I passed. I started applying for jobs the Tuesday after Memorial day and had an interview on the spot at one of the places along with a job offer. I start my orientation next week Tuesday at a rehab/LTC facility. The facility that I will be working at is one of the better places with the average resident to nurse ratio being 12:1, other places closer to me tend to usually run a 30-36:1 ratio. During my interview I also asked the DON what type of orientation for new nurses do they offer. She told me that the typical orientation to the floor is 3-5 days, however if I did not feel that I was ready to be on my own they would work with me and they had one nurse that they provided with a month long orientation. I know that going into this job there is much that I don't know, but I also know that the place that hired me knows this also. I will have other nurses around me that I can utilize when I need help and when I am unsure of something I need to make sure that I am using them as one of my resources. Am I going to make mistakes... yes, am I going to do something that may potentially or will harm a patient in my care... yes hopefully nothing that is life threatening and when it does happen that I learn from that and never repeat that mistake again. Yes I am nervous in starting this new job, it will be the first time in the past 9 years that I will be starting a job in which I really do not have any prior experience, that can be a scary thing but it is also an opportunity for me to learn and to grow if I allow it to be. You passed the NCLEX-PN which means that it was determined that you are competent to be safely working at the level in which they consider a new grad to be at, trust in what you have learned so far and don't be afraid to ask for help from those around you. Also when looking for a job, look for a place that will be supportive of a new nurse, ask about how many people you will be responsible for taking care of on a normal shift, what type of orientation do they provide or are willing to provide. Also think about what is important to you within a new job that will help you to be successful and grow. Good luck :)
  11. Leonardsmom,LPN

    max capacity lift test?

    That is just absurd!!! That guy and stating the only difference between male and females is fat distribution, really how about all the scientific evidence about muscle mass and strength, geesh. Honestly unless this is the only job that is available, or the pay is so much higher than other jobs in the area I would probably tell them thanks but no thanks.
  12. Leonardsmom,LPN

    Are transfer forceps necessary to be used in foley catheterization?

    The kits they had us use in school had the forceps on the inside. Personally I prefer the kits with the swabs tends to be a little less messy and a little less fuss. However you work with what is supplied. I prefer to use separate sterile gloves that are not included in the kit. I have the opposite problem usually and the universal gloves are usually a little too big :)
  13. Leonardsmom,LPN

    LTC Charting: A Beginner's Guide

    Happy that I came across this post. Will be printing it out for a reference when I start my first job later this month. Thanks commuter, great information for a new nurse.
  14. Leonardsmom,LPN

    Are transfer forceps necessary to be used in foley catheterization?

    The first forceps would be for opening the wrapper, although I would think it would be easier to do so with your hands since the outer inch of the wrapper is not sterile. I don't believe that you could use those first forceps for arranging your supplies since once you touch it with your non-sterile hand it is no longer sterile. I am guessing the kit has cotton with a package of betadine, the second forcep in the kit would be used to fluff the cotton and use it when providing peri care before catherization so that you can keep the hand you are working with sterile.
  15. Leonardsmom,LPN

    Need Advice!!!

    As others have said focus on you, these girls are responsible for how well they do in nursing school. If you do study well with a group, keep an eye out for people in your class who you feel you might study well with. However, until then focus on what you need to do to be successful. If you guys are in fundamentals more than likely most will do well on the first test, which tends sometimes to be more similar to the tests that students have had in the past. It tends to Bettelheim tests later on that start to give some more problems, especially when you start getting questions that involve in application of the information, prioritizing and critical thinking. I myself have done some study groups with one or two other people, however I so far I have done better on my own. Good luck.
  16. Leonardsmom,LPN

    Should I use my tuition reimbursement from work to get my RN?

    Other posters have made some really good points to think about. Few other things I would suggest to think about would be for work requirement how many hours were you working when you did your LPN? Did you work that many hours or less, how did you do with keeping up on your studies and grades? Also if you do not pass a class do you have any requirements to pay back that money right away? As for the skills, the skills that you are going to be learning in the RN program are going to be ones that you do not perform as a PCT or even as an LPN. While I don't love doing skill check offs in my program we have the opportunity to practice before hand. With my program if you don't pass your skill check off the first time you do remediation on the skill and then do another check off. So far nobody in my program has failed for being unable to pass their skills. We have had people have to do remediation usually because they didn't prepare before hand.