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Floor Nurse at a SNF

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  1. NurseAgatha

    Repositioning end stage of life hospice pts

    Even in end stage of life, repositioning is especially important if they have pressure sores. This prevents wounds from worsening, possibly even allowing them to heal, which is in favor of the patient's comfort.
  2. NurseAgatha


    Hello sv123, Thanks for your post. This question is difficult to answer because the scenario you described is vague. It does not give us any background information about the patient. Such information is necessary in order to properly evaluate this laboratory result, and decide what to do next. For example: What are the patient's diagnoses? Is this patient on anticoagulant therapy? Did the patient take any medications before the test that could have affected the INR? Does this patient have any mechanical heart valves? (If so, the desired INR range is between 3.0 to 4.0). In general, the following are the actions I would probably take, but keep in mind that I do not know anything about this patient: Observe the patient for s/sx of bleeding (e.g. nosebleeds, hematemesis, purpura, hematuria). Notify the MD of the lab result and any symptoms that you might observe. If the patient is scheduled for anticoagulant therapy, I would hold the next dose until you hear back from the MD. I imagine the MD may order you to give a dose of vitamin K. Please do tell me more about this patient. :-)
  3. NurseAgatha

    Can RN works as a floor nurse in Nursing home/LTC?

    Hello CapeCod, That's correct, I had forgotten. Thank you! By the way, I have really enjoyed your posts over the years regarding SNF. Very inspiring and educational for me, since I'm in that field as a new nurse. Keep up the great work at your facility and on this forum.
  4. NurseAgatha

    Can RN works as a floor nurse in Nursing home/LTC?

    Yup, it is currently done everyday, all over! I am an RN at a Skilled Nursing Facility that has plenty of LVNs, and even I work the floor on a daily basis. I do all the things that the LVNs do (med pass, treatments), and in addition, I hang IV medications. LVN's cannot hang IV medications. Even if they are IV certified, the most they can do is IV starts. For this reason especially, Skilled Nursing Facilities will always need RNs! Further, there is such a great market for RN jobs in SNF because most RNs are flocking elsewhere (e.g. to higher paying jobs and/or jobs with smaller patient ratio). It can be very challenging for SNFs to snag enough RNs. However, I have found that in some cases, you can make a salary that would be comparable to hospital. This is because in SNF there are always opportunities for extra shifts. In fact, I'm in the middle of working 8 days in a row as we speak! My earnings are through the roof right now, and working this much is not even all that hard on me because I enjoy it. It's a job I like. I feel very challenged. The shifts go by incredibly fast. I get great exercise while I'm there. I love taking care of my patients, who are like my family. I have fun with my coworkers, and feel comfortable with them. This kind of work gives my life meaning and purpose. I count it a blessing that I get to wake up and do this everyday, and get paid for it! I couldn't ask for a better life. I'm grateful for the opportunities that SNF provides for RNs. There really are some fantastic facilities out there, you just have to find them.
  5. NurseAgatha

    Transfering patients after a fall

    I am still a fairly new nurse, including one year of experience in Skilled Nursing, which is my current field. One of my weaknesses is in figuring out the best way to transfer patients in difficult situations, such as after a fall. Often my CNA's have better ideas, and make better decisions, than I do about how to move the patient. It is humbling, since after all, I am in charge and the leader. (I don't mean that my CNA's don't listen to me, but rather, they figure it out before I do, and come up with a plan better than I could have.) There have been some falls where I felt absolutely clueless about how to get a patient off the floor, and I had to rely on my CNA's to take the lead in creating a plan. But this isn't rocket science! Why am I struggling with this? I feel dumb. Maybe it's the stress and spontaneity of the whole situation that is blocking me? Currently, I just do the best I can as a leader after a resident fall, and even when I don't feel sure what to do, I remain calm, helpful, present, communicative, and supportive to my CNA's. How can I get better at my competency and critical thinking skills in this area?
  6. NurseAgatha

    What makes one a "great nurse"?

    In brief, I think a truly great nurse must equally possess all three of the following: Competency, Compassion, and Work Ethic. You are only as strong as your weakest link. For example, competency without compassion won't get your far, neither will compassion without competency, and so on! You get the idea. :-)
  7. NurseAgatha

    Starting IVs

    Fantastic answer, PsychNP! I definitely learned some new things from it. Thanks!
  8. NurseAgatha

    MVI tablet

    Why can't the basic OTC multivitamin tablets be crushed? Does it have to do with release timing? There is nothing on the bottle that says it cannot be crushed, however I was informed by other staff recently that it cannot be crushed. But my co-worker called the 1-800 number on the bottle and the representatives said that it could be crushed. What is the verdict on this, especially in regard to state surveyors? There are many different opinions!
  9. NurseAgatha

    Can a shy person be a good CNA?

    As a practicing nurse who supervises CNA's on a daily basis, I can assure you that these are the most important qualities of a good CNA: -Prioritizing safety (this includes promptly reporting to the nurse any concerns about the patient) -Following infection control practices -Upholding patient dignity -Cooperating and communicating with the nurses and other CNA's -Working efficiently and punctually -Having patience, compassion, and integrity The only problem I can think of with being shy as a CNA is if it hinders your communication (patient-related) with the nurses and other CNA's. Otherwise---YES, a shy person can be a good CNA! Your biggest focus should be on meeting their safety and other physiological needs. If you're not good with small talk, that's okay. Just remember to smile enough :-)
  10. When a patient is dying and expressing their feelings, sometimes they just want to be heard. Providing false reassurance can only increase their frustrations. The key is to simply give your listening ear, and one option for an appropriate and therapuetic response is a genuine "I'm sorry." It validates their feelings and struggles, and offers compassion and support, without compromising honesty.