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i work the same way, my name is ally too!! lol I have been a nurse since 2012, started LTC bout 2015 and have worked in that setting since. People will try to bully you or make you feel incompetent, you dont have to "fight back" but just do your job well and basically let them know they wont be getting in your way. you dont have to exchange any type of words, once they realize youre a great nurse they will back off.. i ended up becoming the charge nurse of all those ***es LMAO BECAUSE i was quiet and kept to myself, didnt get involved of the bs drama that goes around. management admires that because it's not often a nurse comes a long and just DOES THEIR JOB withtout a side show. like you said about how some nurses go around loud mouthing about everything that goes on , it is because they are insecure in their nursing. I had to work with this one nurse who would SCREAM BLOODY MURDER during every code.. then people tell me "you are sooo calm no matter what". They will realize who the better nurse is in the end, just stay focused it pays off trust me !!!!

just another controlling nurse...wanting thing her way..i can't stand having to work with ppl like that, they have poor skills when it comes to working as a team..which only makes life easier for everyone

I know what you mean, how rough it can be. I have always tried my best, had good intentions and still there were always those nurses who were mean rude and unhelpful. I came to the conclusion it was more of a personal problem and possibly even intimidation. All these older nurses seeing fresh faces coming in, they may feel threatened especially because a lot of us continue to go to school and have knowledge that may have taken them decades to acquire on the floor. I have learned to use those situations to my advantage, they expect you to get upset or stop asking questions or whatever the goal is and you have to show them your a strong nurse and can look passed these issues and put the patient and your job first, not petty drama. come out as the bigger person, I have worked in a lot of place as an LPN, and now i'm reaching the end of my schooling for my RN and it doesn't matter how much you do, people with that type of personality won't change, and you can't let it ruin nursing for you. Just be aware of it and ignore, because when they aren't getting the reaction they want they will most likely cut it out,(kinda like children ..) and probably find new prey unfortunatley. Nursing is brutal, and even more so when you don't expect it to be that way...when push comes to shove people have no problem throwing one another under the bus, for anything... that's why i continue my education so I can end up in a position to address and change these types of problems in healthcare.

I had a "situation" on my unit today and looking for some insight.. I work on a sub acute rehab floor in a skilled rehab, I have 18-20 patients with admissions/discharges and all the usual stressors of a shift... Many of my patients are tube feeds and trach/vent. I have a new patient, I am unfamiliar with, he was admitted on my weekend off and he has been having difficulty tolerating his tube feed. I noticed this soon as I did rounds, and held the feed. I had went to check the order but didn't make it back right away. My intent was to hold it for a little while and let him digest anyway as it was apparent he was not tolerating it and I felt the rate was too high for someone new to tube feeds in general. He was @ 55cc/hr in the hospital and they have him @ 85cc/hr here, why I have no idea. I consulted dietary for an answer. So of course in the 15-20 mins the feeding is on hold the family comes in (the wife is a medical lawyer!) and is furious as to why he is regurgitating AND why his feed is on hold , little do they understand I am trying to help him by holding it and figure out what might be better for him. In my research I find out the WRONG formula was hung 7-3 and was infusing all this time...which is my fault too yes, but I trust when I am getting report I am getting the correct information...learned that is not always the case... to get to the point I wrote my note that I notified the MD of the situation, that one formula was feeding and I held it and resumed the correct feeding without incident. We have a new per diem supervisor that seems to think I made a huge mistake by putting this in my note and should have not informed anyone of this. I feel like that is wrong and even though I am implicating myself, I need to report the correct information. I understand that there is an INCIDENT report but the medical record should contain what happens with the patient as well, or am i just completely wrong about this. It's not like I am writing "bed alarm was not in place and patient fell unknown to staff with sustained injury" I feel like I am trying to take responsibility but I need input from more experienced nurses. thank you for reading!!

I was on tonight, not to mention it was awful in regards to staffing, scheduling etc... Absolute nightmare. I was scheduled to one unit...I show up and the nurse says "he is here, we already counted, you can leave...oh can you use that phone I am busy.." Just rude. I showed up to work not deal with you're period. ANYWAY. I go down and switch as they need me...next time I am not agreeing and going home it was a nightmare... As I am in the middle of this nightmare, SUP asks can I stay over if needed tues for the 11-7 shift, sure no problem. OH we may also need you 7-3 since "people wont show up" Oh that's great, that's what you tolerate from your staff. (I work for an agency, not even for this facility anyway...) She mentioned we would have 4 hours to sleep if needed (UH PROBABLY WOULD) and it would be unpaid. This would be 24 hours of work , 20 if you took this 4 hour break, withing a 24 hour time period. I need some insight here. You can't have people scheduled because your staff "might not show" I live 30 mins from this facility, and have driven there in a snow storm. It was very dangerous and I choose not to risk my car or my own safety in that again. I left an hour early, just arriving by 3PM and sliding all over the road. I can't say this job means more to me than being home safe with my child and not driving that distance in the snow let alone, 24 hours of work?! In a facility where 8 hours could drive you nuts because they have no supplies, awful aids, and poor supervision. I would be moved to another unit each shift as well, I don't agree this is appropriate or safe by any means..I'll do what I can but will not bend over backward anymore for people who treat you like junk & never keep their word. It's too much stress. I am just curious in regards to how many hours are acceptable and what not. I would hate to call out, but I have been left with 40+ residents because others have done the same.

I'll end up deleting it after tonight, it's crazy long I know... I responded below. Ty for feedback. Always receptive to it. Night

you hit it on the nose. I pretty much came here to throw my feelings about what happened down, vent and look for some feedback. I am pretty much over it but I feel like a patient didnt get proper/punctual treatment due to all the chaos and lack of prepardness for any emergency (the crash cart was empty, two RN's were present and no one brought AED or anything with them...). We could not even call 911 for goodness sake, and I was unfamiliar with the facility, the staff, even the area in general but did what I could. I could feel every second pass like it was a thousand years while this woman needed this AED...thank god EMTS were quick. another day in the life lol

Hi just a quick gathering of opinion regarding something that happened at work tonight. A code was called. There was a major rift in communiction all the way down the line and altogether was a disaster. First of call, apparently no one heard this STAT even paged over head. I know I did not. Then I am being called on my unit by a frantic nurse to call 911, get an AED...who shows up to a code without an AED. I am an agency nurse so I change facilities often so , although it would be my fault, I had no idea where the AED was in this facility, and turns out there was only 2.... So still confused as to why a nurse on the third floor was calling me down on the first to address this because 1. I have no idea whats going on 2. you're completely panicked spewing information at me 3. you keep calling for all sorts of things not allowing me to address the first thing... The phones in this building would not allow anyone to call 911, the nurse I handed report off to said that's no surprise but...what the heck?! I called from my cell and they arrived shortly... In the meantime I ran all around the building in search of AED. A CNA passing by with his phone to his ear said "It's at the front desk" So there I go wasting time in search of an AED wondering what everyone else is doing....The girl at the desk was totally oblivious and she was the one who CALLED the stat over head. I said there is supposed to be an AED here I need to find it...her response "uhh, whats that"... my response... "A DEFIBRILLATOR, to restart someones heart! People are dying here...So no AED still, I reach out to the nurse next door who is just finding out of this from me and she goes right to the AED...RN supervisor tries to be angry with her when she arrives meanwhile I feel as though she failed majorly by not bringing it in the first place or sending the other RN to grab it real quick one floor below...wasting time calling around to nurses who are not anywhere near and mostly useless.... I could not believe the nurse just calling and calling do this and that, and my supervisor giving me and attitude when I asked her to flush my nephrostomy toward the end of my shift...which was also a 7-3 task... I feel as though this was not an organized code and the facility needs to inform and inservice staff and an AED should always be taken to a code ..and the idea that 911 cannot be called from inside...is kinda scary...idk

Hi, I currently work as an LPN with a very high census on 3-11 (2 units across from one another with 20 patients on each - 40 total with varying acuity), perfect setting for sundowning and all types of psychotic events :) So I float from acute/sub acute rehab to short term and long term units. Now that I am going on 6 years as an LPN, I have sorta gotten down the tricks of the trade in order to adapt quickly, but I still find myself running into the occasional road block or curiousity inducing situations...isn't that what nursing is all about anyway? So to get straight to the point I have been working for an agency and with this one facility about a year or so and am just getting to the point where I know every unit (all 12) and most patients that have been there, as far as what keeps them quiet and who needs to be dealt with first. Lately we have been getting a lot of new admissions and all with severe behavioral issues. This is something I am not particularly used to as my people are adjusted and we all pretty much have a routine and nice flow. The new comers have really put a damper on things causing behaviors all around. Some have even passed away. So as the nurse I have to protect the others and my staff. One pt in particular was extremely combative, aggressive, and verbally and physically abusive to staff. He was confused, delusional, and very difficult to control. His main diagnosis was Parkinsons along with the other common diagnoses (ie: dementia, hx of seizures, hypertension, hyperlipidemia, etc...) This man was seen by Psych on 2/21 and the recommendation stated to AVOID haldol ( because of PD daignosis) and use IM Ativan only on STAT basis. Now nobody had addressed this and by the time I came on and did see it, another nurse had given IM HALDOL x2, so when I called the 2/26 MD to request Haldol and explain the situation he was not happy and asked me to check the chart and read to him what psych had said...I can't even say how I felt when I started to say "Avoid Hal..." and I had to explain this was just put in the chart and I wouldn't think anyone would do that and this would be known so once I told him there was an alternative solution he was okay with that and I hung up. But bottom line is the doctor was very anti Haldol as way the Psychiatrist... So now I call back my supervisor who happens to be per diem, both of them...and says now the QUBEX only carries 5MG PO ATIVAN or 0.25 PO XANAX....why she suggested I am not sure because...that is psych's call and really not a valid suggestion, and then why we ONLY carry this 5mg ativan...when I have never seen a pt of mine take a higher dose than 2mg mayyyybee, boggles my mind. I can't even break that in half and get something. So I wasn't about to call the doc back after all that and ask for another order, and it's Psych's deal anyway....so "non-pharmacological interventions" it is.....they stressed this more than I had ever seen, so we ended up not giving him anything and taking turns sitting with him but I had him again tonight and it was even worse and he had to get something and it's a week later STILL with no PRN nothing. Psych said she wants to wait for the Depakote to work...Depakote?! This man is going to hurt one of us, seriously....they are not with these people 8 hours. So I call the MD again and unwilling but desperately ask for Haldol. He says no, and I explain further why we need to medicate this patient. He finally agrees to PO Haldol, but really fought me about it said "I thought we weren't doing the Haldol anymore". I am guessing because it must have severe effects with the PD, and interactions with meds like sinimet but are there other non narcotic alternatives? PO preferably? What are the effect when Haldol is admin to a pt with PD. Is 3-4 times harmful or does it have to be more frequent? Are there some other "non pharmacological interventions" my staff and I may not have tried. We have a heavy census and need to be able to handle these situations quickly or before they even occur. Currenly only standing Psych meds are Remeron 15 @ HS & Depakote 250MG BID. I am not sure the psychological effects of depakene on elderly psychotic, delusional, combative, aggressive, people with PD and Demetia/Alz....I will have to research this one .. I also have on other who calls out (screams out) HELP ME every second he's not asleep or doesn't have food in his mouth, it's some neurological thing or something I am not exactly sure, TBI maybe...and he is on the NUEDEXTA, Klonopin also and Pysch is telling us it is going to take up to 3 months to see an effect, so we have to hear this yelling all that time until it works IF it works and it makes the other residents upset and agitated because they all have dementia/Alz and other memory diseases and get frightended, defensive, or feel threatened very easily. It can feel like I am juggling sometimes but you get to know what works best to get everything to flow nice I am just curious about some of the meds and interactions with diagnosis if anyone has experience because I have working with these people a lot... Thanks!! ALR

This is a good question and I wonder why I NEVER considered this before I began working. My hands are constantly dry this is for sure. I have tons of lotions in my bag, car, bedroom, livingroom....always accessable. I use different oils and try different stuff but definitley use lotion while working. I am still an LPN and I could have 40 patients on good day....I wash my hands frequently during an 8 hour shift and the dry feeling on my skin can drive me nuts. I found the nail salon offers parrafin treatments for 5 bucks or sometimes free if your a regular or spend a certain amount. My lady knows I'm gonna ask so she just hooks it up...I wouldn't say it "ruins" your hands, as long as you moisturize, but it's something the rest of the population is not dealing with. I also noticed a few years back nurses were bringing the gallong Poland Spring jugs to work, they cost $1 or less, and this way you can stay hydrated because it's hot, you are moving a lot and bottom line your hands are going to be dry so you do what you can. Atleast you known you always have clean hands....

I have learned not to invest too much in supplies because I float around a lot and may never be in the same place twice. I am also careful not to forget things but if I do I consider it good as gone. People steal, I have learned to accept that, especially if they know you may not be coming back ,or they could be a float, there's a million reasons, they could have no reason at all. I am careful do a check at beginning and end to make sure I have what I brought. I keep everything in one place for the most part and bring only what I know I need to use. I always keep my stethoscope near by and am usually using it so it's never really in a place I would leave it behind, I saw they make clips you can get too but that seems uncomfortable. If I am working on a unit where I may just be an extra passing meds I'll leave it in my bag, those reuseable ones in the bottom drawer can do the job if need be. Of course saying all this I have had the stethoscope I got as a graduation gift 6 years ago until this day, I just have become so attached to it depite buying others, but I am still always afraid of leaving it behind so I guess that's why I never have. I would turn around before I left the building if I left it....I have bought others but always stuck with the one (Littmann Cardio III Raspberry*) and haven't found the need to invest in anything fancy just in case I did lose it, I would be upset about it. One other thing, if it's super SUPER nice, it's way more likely some one would snatch it (kinda weird with your name in it though...), mine is old, broken in just right, and even has some sentimental value. It's nothing less than top of the line too and not heavy or excessive like some stethoscopes. Nurses leave their stuff being all the time, it depends on a lot of things. I would always report it, make the staff aware to look out, and still label everything. I hope you get your stuff back. Maybe in a some alternative world, someone turned it in or put it in a weird place to keep it safe. But most likely not. I really hope people stop stealing, even had a patient steal $400 cash right from a nurses bag, on camera...no charges filed, nothing .

Hi everyone, I have the opportunity to pick up a pretty nice case and I am looking for some input on a few things. I currently work in LTC/sub acute as a float, looking for something a little less stressful for a 2nd job. At the present moment I only work weekends and pick up days here and there in between so obviously I have been looking for something else consistent. I was called by a staffing agency today with a case where I would ride the bus to school with a 9 year epileptic girl everyday, to and from. This case is kind of special to me because I was once too a 9 year old epiletpic girl, trying to be a normal as possible. I have had epilepsy most of my life, well controlled for many years now. I don't have ALL the details yet, but I would be taking the bus in the mornings and afternoon just as a precaution in case the child did happen to have a seizure. One thing I'm a little on the fence about is the hours. It is everyday that there is school, and I would have to be at the bus 6-9 then go back 2-5 for the ride home. I am somewhat hesitant to make a commitment to a case with such funky hours, I wouldn't want to ever not be there if I agreed to be. It is about a 40 min drive so I would be going back and forth morning and afternoon. It would only be until June so i don't think it wold be that bad but I am wondering if anyone else has worked a case that was similar and how that worked for you. Also, I am not sure if this a "normal school" or a school for special children. I am assuming that it is a regular school and I am guessing that I should probably NOT wear scrubs as this would make the child feel uncomfortable, but again looking for opinion. I float, sometimes I have had up to 3 jobs at once, so I have a my nursing bag with most of the things I think I would need in an emergency, is there anything that I may want to consider brining along that could be helpful in the event of a seizure? I have a CPR pocket mask, pulse ox, thermometer.... lots of bandaids, bacitracin even normal saline. Suggestions are helpful.. The child has been seizure free for quite some time, I don't think we will have an issue in the last couple months of school but I am just trying to get any input from nurses who have worked similar cases to really make my decision here. I am most likely going to go for it, but I don't want to make the wrong decision and than let the family down, so just reaching out to my fellow nurses!

Were you working as a CNA? Did anything ever happen? Maybe you just didn't recertify..

Probably going to be a little boring but get what you can. Once your on the floor there's no going back to "I'm a student ". Ask questions ! Lots and any you can think of. Look through charts, get familiar with the paper work, 24 hour reports ..

This appears to be an old article but something I am dealing with as my first year in long term/acute care. I float and some days my medpass is very heavy and always brand new to me. Today I had nearly 30 residents with heavy meds and treatments... I'm used to floating so I managed to get it done but it was NOT easy. I had to use all my skills to get it done.. The patients acuity varies so greatly from dementia to gtubes and IVS... I was glad to hear I "did better" than the new RN they recently hired for this unit but I feel sorry for anyone who has to call that their full time position . Unfortunatley, I haven't had a lot of guidance from co workers.. A lot of mean nurses , I have learned to keep to myself but being left hung out to dry has made me learn quick also. I have made myself a clip board I bring to both of my jobs with cheat sheets of anything i need often : ICD-10 codes, how to enter orders in different systems , which numbers docs prefer to be called on.. Anything for an easier shift. I also jump on my treatments while pts are still in bed, because once they are dressed... Chances are your not getting to that sacral or inner thigh dressing. Same with eye drops. I go around between 7 -730 and do all this plus insulin/sugars. I am able to get familiar with my MAR/TAR this way and can do rounds before night shift leaves if I have questions...