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Skilled Rehab Nursing
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Valcorie34 has 3 years experience and specializes in Skilled Rehab Nursing.

Valcorie34's Latest Activity

  1. I have worked in skilled nursing for a long time. I love it. I think the biggest hardship for most nurses new to the field of rehab is time management. I usually customize my own brain sheet after getting to know patients for who has anticoags and what kind. What diet, what is on TAR. Find a great nurse you can ask questions when you need it. Dont save your charting for the end of your shift. Try to tackle a few patients at a time through out the day. Those are great ratios. I bet you will love it! Congrats on your new job!
  2. Valcorie34

    Combination Rehab/SNF? Confused new grad RN

    I work in Skilled Nursing Rehabilitation. I love what I do. Skilled rehab is primarily for patients that have left the hospital and need therapy and nursing to continue to progress to a discharge home or at their baseline of care. It can be a 1-6 week stay depending on the patients needs. After a 3 day hospital stay Medicare usually covers 100 days of skilled care. The primary patient population is post-op hips, knees, falls, cardiac surgery, dialysis patients, CVA/TIA, small bowel obstruction, and infections needing long term antibiotics with central lines, or wound care. The SNF setting has a lot more wound care than most hospitals because a lot of patients come to use with large wounds that need nursing care. I love seeing people over several weeks, getting to know them, and seeing them recover. We also provide patients and families high quality care and support for end of life care when patients are unable to be at home on hospice. As a nurse manager at a SNF I work as a team with floor nurses, dietitians, PT, OT, Speach therapy, doctors, and wound care nurses, and psychologists.
  3. Valcorie34

    Ointments/Wound care for Geriatric Patient

    I think there are a few things to consider before recommending a product. First if you are concerned about infection is there periwound redness, increase in discharge, odor, or warmth around the wound? It may be something that needs a wound culture especially post cancer treatment if the are immune compromised. Second if the wound a surgical wound? Are the edges approximated? Is the wound bed dry or wet? If the wound is dry you need to add moisture, anacept might be appropriate with secondary dressing of a gauze border dressing. If it is too wet you might try a foam dressing with silver (foam Ag) for moderate drainage or a silver alginate (soaks up heavy drainage). The silver works for infection but it is effective for about 5 days then doesnt do much so you should change it to a silver free dressing to save the patient money. Keep in mind in you need a wound culture you want to do it before using anacept or silver. It would be good to have a provider assess it too.
  4. Valcorie34

    Organization tips as RCM

    I am thrilled to be starting soon as an RCM. But I am looking for tips or methods others organize their information about their residents, wounds, interventions, falls ect. Do you usually keep a log outside of your computer system like PCC, like excel or just stick with computer? Any tips?
  5. I would report her to the state hotline for abuse. That is abuse of pt rights. I would also document the name of the nurse who stated she gave him something as she is complacent. It is not ok at all. That could equal a harm tag if not documented. Plus it is one of your patients on your shift. You don't have to be able to prove it to report it. Furthermore don't waste meds with her again. Yikes.
  6. Valcorie34

    Feeling lack of respect

    I am really feeling a lack of respect at my work. I was hired from RN floor nurse work on a cart and charge nurse, into a manager (Rcm)role in July. Only every month it turned into just wait we need better staffing. We can't do it just yet ect. Meanwhile I helped pick up extra train in on my days off. I did quarterlies, I did recaps each month ect. Then they hired a new RCM. My spot 2 weeks ago. I was assured oh, the next is yours. We want you on our rehab side. We are so sorry. It will not happen again. We may want to use you as a charge nurse off the cart. That's fine bit they moved someone with a lot of complaints to admissions/charge. Then today they hired another RCM. I already had an interview, negotiated wages, and scedules, all of it. Really upset. But today, I come home to a nursing comission letter stating I was turned in for inappropriate delegation. There was zero evidence and it was closed. I didn't even get a call from work about this AT ALL. I just feel disrespected. I come in extra to help out, I work basicly as weekend manager on the cart. I handle staffing, A&I, allegations, problems in the building, labs and treatments for other nurses in a 100+ bed facility. I always show up, I get good feed back. But lately I just feel dumped on. I love geriatrics but I am thinking of packing it in for a hospital job.
  7. Valcorie34

    Falls interventions

    We fit the interventions to the situation leaving door open onnroom, 15 min checks with documentaion. First up, for day or meals for impulsive people. First down for those trying to self transfer to bed, non skid strips on floor, fall mats once in a while and care planning they can be on mat with bed low of they roll out of bed often. Tape on floor to mark where furniture goes if the fall trying to reach night stand items. Enforcing a Q2 toileting policy with CNAs. Eve fall group in activities room with 1 CNA or activity staff between dinner and getting people in bed. The most effective for me -I have an 'anti-gravity group' at my nurse cart when I am on the floor and play music quietly while I work and keep an eye on impulsive people climbing out of W/C if other interventions arent effective.
  8. Valcorie34

    New RCM/ADON share some wisdom

    I am starting as an RCM/ADON in my facility next month. It is a very busy skilled nursing facility. I know the building and people here pretty well. I have a lot of support for the transition. But I really want some good tips and wisdom you may have collected to help me be successful. What have been the biggest challenges and stuggles, did you find and ways to help get through it?
  9. Valcorie34

    Speedy med pass

  10. Valcorie34

    Length of Time Body Can Stay in Bed After Death?

    I think the correct answer about belongings is as much time as the family needs (within reason). CNA staff can bag up items. If they will be a long time more than a half a day then facilities should be able to move items to a safe area. As far as a body goes I had some one pass at 2 am, the funeral home couldn't come until 9am that was too long. The family wanted to come at 6am to view body, but the funeral home was a 3-4 hour drive away. yikes. Generally ask the family first if they would like to come it to pay respects before funeral home comes, then move everything as quickly as possible
  11. Valcorie34

    Fall Prevention with Psychiatric Patient

    Our facility also does not use alarms. It can be frustrating at times. I guess for interventions look at soft touch call light you can place by hip while in bed, so if they try to stand the call light goes off. Non skid foot wear, put walker or w/C by bed so it is easier not to fall if they do get up. we had someone with psychosis recently we had to cover mirror it set off halluciantions. room by nursing station, and 1 to 1 supervision if up ambulating with hallucination or after multiple falls. If they have had several falls the best thing may be a 1 to 1 person. Although convincing manamgement may be like pulling teeth.
  12. Valcorie34

    Frustrated...advice about suspension

    I am an RN in a LCT unit. I work 6pm-7am and have two med carts for the acute care sections of my building, I have the HS med pass for 44 residents, EVE shift and NOC shift treatments 2 MARS, and an AM med pass for the same. I am very busy (what nurse isn't). Recently a coworker has a family emergency so I said I would pick up their shift. I was pitching in to help out as we are already short on nurses. I worked 140+ hours in doubles over 10 day. I was feeling really burnt out. During this time my executive director was fired for mishandling an allegation so corporate was like ants all over the building. On my last day, It was a really bad shift. Nurses before me hadn't premedication our high pain people and I had a running list of 10 people at a time who needed me. My RCM filled the station with charts that needed admits, assessments fixes, or had a dozen or so new orders. Plus a stack of lab results came back, so they needed to be noted, charted, residents and families informed and new orders completed. My RCM said don't leave until these are done r/t corporate audits. At 1 am one of my CNA's was leaving and told me resident X had pain. I lined out the LPN helping with orders on how to do an order and checked on my resident who was sitting on the side of the bed rubbing his leg (post op hip, A&O x4) He said he was up to bedside commode and hurt, but didn't want pain pills, offered ice pack he said he would just go back to sleep. I helped him to bed. At 4 am, CNA said his light was on for pain, I brought 10mg oxycodone. I went back to files. Then had to do check and changes for female only, then last rounds. I stayed until 10 am finishing the paperwork. I was a rough morning and made for a 16 hour day. I finally get home and get 1 hour of sleep when corporate calls and says resident x had a delay in getting his pain meds. They wanted me to make a statement but gave me no details about the allegation. I told them the facts at HS med pass I had to wake him for blood sugar and Lantus and offered it, he said no which was unlike him, I checked on him at 1 am and stated his non-verbal indicators of pain and the offered interventions, then later int he morning he requested pain med. They said it was fine and all cleared up. Later I was called by my DON, I was SUSPENDED for NEGLECT, but if I sign a form it all goes away and I can go back to work. They interviewed my CNA she said he wanted a pain pill. So obviously I didn't sign it out until 4 am and they don't know why or the reason but there was a problem. And I didn't sign the pain sheet correctly. (granted I was one of the few nurses who signed it at all, it rolled out with the new MAR this month but 'training isn't until 19th) I was so upset I didn't go to Christmas party tonight. But I need to sign this before my shift and even though my DOn says it's not going in your file, don't worry about it just sign it. I don't feel right about it. AT ALL! I can't force someone to take narcotics, I offered non-medication options. People have the right to refuse. I don't even know what his statement was. I have made a med error there (I filled out form and reported myself) I didn't give a medication that was due in time. I was trained at accepting pharmacy medications by a nurse manager (improperly) and our delivery driver swiped 4 fentanyl patches from signed in the pile. It was investigated by state and it had happened at multiple facilities. But because I didn't follow policy (sign date, time, double sign with another nurse, initial next to the name and write qty) I came in, asked for a drug test, searched the building and when no patches were found I was suspended for 24 hours I didn't gripe. even though other nurses on that night with me did not even have to write a statement. I think I have a good attitude and roll with things and I think it makes me an easy target/scapegoat. MY QUESTION after all that rambling is should I sign the suspension paperwork? I really don't feel right about it. IF I go to apply for another job, I am sure it will come up. Plus it is my reputation. If I do something I feel like I deserve it. But if I don't sign I don't think I have a job. But they are down 3 nurses and I don't think they will let me go. I am very upset, maybe form working so much also.
  13. Valcorie34

    BSN is a joke

    I am getting my BSN online and attending GWO George Washington University. Many of the classmates from ny ADN program are sayign similaar things about thier classes. Especially people attending WGU washington governors and move at your own pace classes. But I am really finding the curiculum in my program relevant. I see myself using a great deal of it. Things like learning how manage quality improvment, root cause analysis ect. Consepts are broken down to a level that relates to floor nurses and relevant managment topics like Med errors, vulnerable populations in your area, understading health care policies and how it relates to your specialy ect. I have been very happy with it.
  14. I am so happy you clicked here to read this. I could REALLY use some advice. I am a new grad RN. I have worked LTC for 3 years as a CNA then as a Nurse Tech for a year doing wounds/ostomy care and then the last 6 months on a med cart as a floor nurse. I just couldn't pass narcotics. I worked in a good facility with high standards. I graduated and accepted a sign on bonus and more $ at another facility. I was all excited new job Woohoo. I am still orienting. But I am seeing a lot if issues. Many of which may be due to the infection control/education nurse who is orienting me. I am working on a cart with her. But I am appalled at the lack of professionalism and infection control. No gloves for injections, no gloved during wound care on a bleeding skin tear. She *licked* something off the floor from under a pt. bed to see if it was a pill or candy. She didn't want to use ice in a bucket on her cart to put med plus or pudding in. (12-hour shift hot weather, needs refrigerated or thrown out). She didn't talk respectfully about her pt to other staff, used the F bomb all shift, and wasn't professional to a few residence (not abusive or reportable but not good). Some of the other nurses I met seemed much better. This CANT be reflective of everyone. But she is training people and her attitude has rubbed off. I am also a bit annoyed there is a checklist for skills for new grad RN. I have to watch her do a skill, then she will teach me the skill, then I do it for her to be able to do it. I have really strong clinical skills. I have had excellent mentors. I have higher standards then she does with more EBP. I know it sounds bad to be a 'new grad' and say I am so good don't train me. But the things she showed me already with ostomy changes and wound care were SO WRONG! the ostomey appliance was too close to the stoma, there was a reddened area of skin she should have documented and notified the provider. A few patients had c/o pain she gave them meds and when that didn't resolve it she said I can't do anything I am NOT going in there and ignored them. I went and assessed and handled it, as well as an IV that infiltrated. She got annoyed and assigned me 8 hours of training videos for the rest of the shift. I was pleasant and nice. I was not confrontational. But I am with her twice more this week. I just don't know how to handle this. My gut says just to establish myself as the nurse who just does it right. Who says something when there is an issue or something I see wrong. The problem is I don't know everything. I may not know the right way to do it. plus it is my first 90 days and she is evaluating me. HOW the heck do I handle myself in a way that keeps my job, requires good care of pts and does the right thing ethically? I am not just going to quit I made a commitment. I just need to navigate the waters and improve the quality of care. I could use some tips LOTS of tips.
  15. uworld has a great online test bank of questions with good practice tests. There are tons of test banks, it isn't the only one. But it is one I have been using, and like it. Did your school have HESI tests or other practice tests you can use to review?
  16. Valcorie34

    Help, did I get hired onto a sinking ship?

    Maybe you could consider being a leader and encouraging change to more EBP. If meds are not labled then be the nurse that insists things are done to a higher standard. If employees say a prson treats nurses badly... wait and see if it happens (don't listen to the rumor mill.) If it does, even if it is a doctor be direct, in a tactful way and state I appreciate constructive critisism. I do not appracite being put down. Dont allow others to reat nurses in a condicending manner. Be a leader and see what happens.