Valcorie34

Thank you!!

Read the H&P, monitor labs and correlate what you are seeing. The experience with hands on care is so important. It will benifit you as an NP later

I was just hired in ED. I have worked Med/Surg and post acute rehab and as a nurse manager running a rehab. I would love some tips for starting in an ED. I am going to get a preceptor but I know this is a whole new beast.

I would live to hear your best advice for study tips, grades, ect in online NP programs. It's a lot of information to learn. What worked for you?

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!

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.

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.

I have worked at low staffing facilities and great facilities. I would ask yourself is this the job you really want? If it is something you want to put effort in, you are going to have to sit down with the DON and point out 1. They have low staffing and need every body they can. 2. Ask is it better to properly orient and train someone already hired or find a new nurse? Then give them two options they can train and mentor you, or you can leave. You need to point out you are a brand new nurse in a new job, you cant be trained as someone with lots of experience. You want high quality care and patient safety but you need the education to get there. Keep in mind, there are wonderful places out there that will value you and help you learn and grow as a nurse. They can be rare in some areas. But dont ever be afraid to advocate for yourself!

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?

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.

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.

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.

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

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.