2ndchance85

Hi All I am currently working on a medical surgical floor in a hospital but before that I worked in a Long Term Care Facility, considered to be subacute care. I see job postings for Inpatient rehab in hospitals and just wanted to ask a nurses who worked in a hospital in this type of department what your responsibilities are. Currently I pass meds, do assessments, admissions, discharges, get/give report on patients going to surgeries/procedures. When I worked in the long term care facility I mostly passed meds and did wound care, and PT/OT did come to see some patients but we really weren't that involved except pain management. For inpatient rehab nurses, what are your daily responsibilities? What do you find most challenging/frustrating about it and what are your favorite parts? When I worked in a long term care in a facility the thing I hated the most was having patients put on the facility who were unstable, some even too sick to even be out of an ICU unit. Does that happen in acute rehab? How long do patients typically stay? Any feedback is welcome!

I agree with the other posters to not take this personally because unfortunately no matter how attentive you are to a patient/family sometimes it is never enough because they can be toxic and manipulative or under a lot of psychological distress. It's not a time management issue as much as a boundary issue. As a nurse I feel like it is important to be as diligent and offer the best care you are able to give but we are also human beings and not machines. Some patients in the hospitals have expectations that a nurse will run at the snap of their fingers because we are medical butlers, not medical professionals. I hate when nurses have the expectation that they will not get any kind of break during their shift. I always force myself to eat, even if it's for 15 minutes (we only get 30 minutes anyway for 12 hr shift). I am a newer nurse as well and do struggle with time management sometimes, and a lot of that can be do patients who will waste a lot of your time. It does help to anticipate needs (how often to give pain medication, procedures patients are going to, etc) but some patients and their families are ridiculous. They call every 15 minutes, 5 family members call asking the same thing, they want you to spend a half hour in their room answering questions you don't have the answer to. I think if you set boundaries between you and your patients you will have a better time. It really sucks to have a patient "fire you". The worst experience I had was a patient was needy and nasty and then there was a mistake so on top of her treating me like I was incompetent I felt incompetent. If you have strong management behind you setting boundaries won't be a problem, and if setting boundaries gets you "fired" from a patient that's their choice not yours. I think it's the art of nursing to manage time, have boundaries, give good care, and not get totally burnt out.

I moved to an acute care setting and it present different challenges but not 20 patients! The most I have now is 10 with a LPN to help me. I can't believe I dealt with so many patients before! I've gotten better at putting IVs in and if I can't get them I have more help putting them in now. Sometimes I do have a patient that won't work with me but having 1 out of ten is much better than 1 out of 20.

Thank you for sharing this post @starlitex1280! I have been a registered nurse for over a year and struggle with delegation as well. I am soft spoken and really struggle; especially since a lot of the aides are older than me that have worked in the long term care facility for 10 plus years and have the attitude that they do only certain tasks and that's it. To be honest I've been slacking a bit since Covid 19, I was working on being more assertive and following up but I'm so exhausted I just do a lot of stuff myself. The main responsibility the aids have besides ADLs is taking temperature, heart rate, respiration rate. No blood pressure for some reason. When I was a CNA I had to take all the vitals(different facility). I've been doing everything besides it takes 30 seconds to take a temperature and 30 minutes to chase down a CNA to get them to take vital signs. Even though it saves me an hour doing vital signs it kind of causes a problem, because some of the aids are good and do the vital signs. So we're doing something twice because a lack in communication/delegation. It's difficult because even though I know most of the aids at this point, I can't have 10 minutes left in the shift, see that 5 temperatures are missing. First of all, for the patients safety, if they have a temperature it needs to addressed in the beginning of the shift, and second, it's miserable to be late because of that. I think it's really hard to feel out how to communicate with aids who refuse a task. Sometimes it's just about forcing myself to be assertive, especially if I ask for something to be done and it's just not. Sometimes they do forget because things get busy, sometimes I've had CNA's tell me it's not their job/patient. Sometimes it's as simple as asking nicely (and this works better if they work regularly with you and they see you help with bedpans, turns, getting water whatever) but sometimes you have to tell them it's their responsibility (Even this put nicely as possible makes me feel rude and awkward). I've also had to call a supervisor once because an aid wouldn't move residents out of a room because it wasn't the right day to clean the room according to her. Not only does it look bad on me to call the supervisor, it wastes their time. Obviously it wasn't a lack of delegation or communication but respect from the aid, and I think this gets tricky. I do agree with @Ella26 that you have to observe if the CNA is only refusing tasks that you give them, or particularly being disrespectful to you, because maybe it needs to be brought up to a supervisor. I've had a few CNAs who give me a problem and I probably should've brought it to a supervisor, but I don't want the supervisor to brush it off and then it be miserable to work with the CNA because the behavior continues and on top of it they're angry that I complained (this obviously a work culture problem). @AceOfHearts<3 I really like your suggestion about communicating why you need the task to be done, I do that now but not as detailed- it's usually "I'm doing a medpass!" so maybe that will help. I always thank my CNAs at the end of the shift, and always try to help if I have downtime (LOL I rarely get a lunch break!). I went back to school when I was older to become a nurse because I wanted to help people, and I believe a big part of that is being kind and treating people fairly, patients and coworkers. I need to be able to delegate appropriately and effectively to deliver good patient care. I was just replying to this post but advice is always welcome!

I've honestly never done a mock interview with a friend who is a nurse, that's a good idea.....the door closes pretty tightly after an interview though with managers here, at least the places I've interviewed at. I don't bring a portfolio, maybe in the future I will. I have my EKG and phlebotomy certification but I honestly have excluded them from my resume because I took them a few years ago, never really used the skills so I feel like it's false advertising because I don't feel comfortable performing those skills.

This post is more directed towards nurse managers or people who hire nurses: I currently work in a long term care facility and am trying to transition into an acute care role. I currently just had an interview for an acute care role, I thought the interview went fairly well but I was passed over. To be fair, I know there's a decent amount of competition and it was a magnet hospital in NYC, it's possible that they just liked someone better. The issue I'm having is this is the 4th time I've been passed over for a role. Of course I get a little nervous with interviews, especially since each one tends to be a little different, the last one in particular because they focused on my assessment skills from working in a LTC facility and how I would do in a acute care setting. My resume and experience is attractive enough to be called in for an interview, does anyone have any advice on possible blunders that I might be committing besides the obvious (I wear a suit, make eye contact, have answers prepared)? Any input is welcome.

I think the major difference between a hospital and a long term care facility is the nurse to patient ratio- I work in a long term care facility which is nicer than most, and the nurse to patient ratio for long term care/ short term care is 1:20 (this is not as much as other places which can be 1:40 ?)....the things you usually get report on are abnormal VS or antibiotics, something really important because otherwise everyone just depends on the computer or if there's a regular nurse they'll help, but sometimes them helping makes things worse because they waste your time telling you things you can see easily in the computer, or they haven't worked the assignment in a month and they get patients confused. I think that's really why I don't like about it....you have to do so many task driven things you really don't know the patient's conditions (you get some ideas by their physical condition and types of meds they have), you just don't have time to look through the file for 20 people.

Thanks for the tip about asking for an alternative way to give a med and volunteering to do a task to gain experience, I will try both. If I know the patients I can arrange my med pass on how combative/uncooperative they are, but if they are all new to me they are all new to me. That's one of the skills I'm looking to work on, I've seen more experienced nurses able to convince patients to cooperate (sometimes it's just a matter of letting them warm up to you and coming back to them later), but this is extremely hard if you have 20 patients, and 5 of them are not cooperative. And sometimes, even with support, they are just not having good days and will not take medication. Ideally I would like to say that I would like to take the holistic approach and try and see if there was an underlying problem (there is a great instagram post: "If the residents are giving you a hard time they are having a hard time."), but I'm already so pressed for time I can't. I think a lot of it has to do with how well the patient knows you as well.

Hi All I know this subject can be redundant and for everything else that is going on with a pandemic I feel like it's out of place, but I'm going to post this anyway! I will reach my 1 year anniversary as a nurse in mid April, and I feel like I should be more adept/confident/faster than I am....I am always running behind, and especially when I'm floated and don't know any of the patients. First of all, let me say I work in a Long Term Care Acute Facility, so the patients ratio is 1:20 on non vent floors and 1:10 or more on vent floors if they are short staffed (it happens often). On the non vent floors I'm pretty comfortable (though slow), because patients tends to be less intense (don't have to take BPs 3x per shift, every other patient isn't on contact precautions), but really that's on an assignment I know (even short term patients are there at least a month). If I don't know the assignment, I feel totally overwhelmed and incompetent. Types of meds are different, wound care is different, etc. Does anyone have advice on how to prepare for new patients and develop a flow so to not feel like your drowning? I look up general things about patients like wound care and starting tube feedings but there's only so much time before you need to get moving. Is this something that becomes more comfortable with time or am I missing something? The other nurses I work with are supportive but I still feel embarrassed that I feel so behind. And even though I am more comfortable with familiar assignments I feel like I am always behind. (Experienced nurses how are you so fast at med passes!) Technical skills....things I passed on a nursing school exam on a dummy but now feel totally ill equipped and terrified to do...IVs, Inserting GT tubes...I rarely do them so when they come up I have an anxiety attack and ask for help, but then never get the experience I need to gain confidence....how do I get past this hurdle? I want to learn the skill but am terrified of hurting a patient, and I can't bother everyone for everything especially when we are short staffed. Am I being too soft/lacking confidence? If so how do I change this? I don't mind the facility I'm in I just feel overwhelmed sometimes. I'd like to say it's just the patient to nurse ratio but I don't think that's it. I want to move to a hospital setting because I want to learn more but am sometimes worried if I feel incompetent in a LTC facility if I would make it in a hospital....I hear it's more difficult. Any advice to a new nurse who's trying to gain confidence/get it together/manage stress is welcome. Thanks!

Hi All! I am currently working as a nurse in a Subacute care facility (long term and short term) and although I like some things about it I find the nurse to"resident" ratio is too much for me to handle, I never finish on time and constantly feel rushed. Because of this I've been considering other options such as a Home care nurse or something like Dialysis. Could any dialysis nurses tell me their day to day work flow? Nurse to patient ratio? Likes and dislikes? Any feedback is welcome! Thanks nursing peeps!

Yeah, I probably just needed to hear someone confirm it. Thanks!

Hi All I'm due to graduate in early December with my BSN and the school I'm going to is telling me I shouldn't have a problem taking the NCLEX in late January.....hopefully all goes well and I pass the NCLEX, but I'm going to start applying to jobs now just to get the ball rolling. I'm planning to apply to NYCHHC (the new city hospital system), some long term care facilities and I was also considering applying through the temporary staffing agency that I'm hoping to find some work as a CNA through (once I'm done with school, my schedule is too weird now, and I wouldn't apply to the staffing agency as a nurse until after I passed the NCLEX). I know new grad orientation can run from 6 months to a year typically in NYC, but I think it's shorter through the agency. Has anyone started their nursing career through a staffing agency? Thanks for any input!

Hi Vertical Horizon Thanks for your input. Do you mind me asking what you did in the medical field? I work in a hospital but not with patients, I worked for a bit in a Dr's office but not much besides that. When you were in nursing school/working as a nurse did the technical skills intimidate you (sounds silly I know)?

Hi everyone I'm an adult student (I'm in my thirties), I work full time and am taking my sciences to try to get into an accelerated BSN program. I also volunteer two times a week. While volunteering is interesting and rewarding, I was hoping to do something that would give me a better feel for what the physical work of nursing would be like. I want to take a phlebotomy course because I would have the idea that it would allow me to get the feeling of doing something "medical". My question has three parts: A. Has anyone done a phlebotomy(or similar type of course) before going to nursing school and did it make you feel more comfortable when you did your clinicals? Did it solidify your decision to become a nurse? B. Has anyone gone into a nursing program with no type of experience in patient care before hand? Were you stunned/shocked/jarred when you started to do medical stuff (taking blood pressure, starting IVs, etc)? C. As anyone working as a nurse, how much technical/medical work do you do? I know nurses on medical surgical floors can be responsible for feeding/bathing/taking blood/wound care etc but if you work in an outpatient facility you wouldn't do things like that, of course I know you must do some technical work, but is it more administrative (charting/observing) or more technical/medical(giving meds/physical care)? Please feel free to answer any or all parts of this question! Any feedback (which is reasonable) is welcome, I'm feeling a little lost in this way; and since I'm stupid busy with volunteering and taking the prerequisites to try to get into a accelerated BSN program and I want to try to see if it would be worth adding one more thing to my schedule. Thank you!

I'd love to get the phlebotomy certification and try to get a job doing that. I actually already took a course in EKG but never took the exam. If I was in less of a time crunch I'd probably take that route.