mtjoanna

[ATTACH=CONFIG]23551[/ATTACH]

I started my nursing career in a psych hospital, so became pretty adept at documenting "exciting" events very factually. Unless two patients/residents had an encounter/altercation, mentioning another resident, and his/her situation in the charting is not generally appropriate--though for your private records, it's perfectly fine. It is technically not within our scope to attribute a specific emotion to another person--you can say that "daughter appeared to be angry" but not "daughter was angry," then follow that up with observable facts: stepping very close to this writer while speaking in a raised voice, taking a photo of this writer without this writer's consent." Something like that, anyway. You want to keep your charting as free of your emotions and frustrations as possible--this tends to demonstrate your level of professionalism. It can be hard to divorce yourself of your frustration/angst sometimes, but it's an excellent skill to develop.

At my previous facility, I was the only nurse in the building from 1800-0600 and had up to 54 residents at one time. The 1800-2100 med pass was brutal as most of the residents had multiple meds and there were a lot of diabetics with BGs and sliding scales, and all that goes on with a typical LTC med pass. I was kinda the primary noc nurse for awhile, so I did some rescheduling of meds. Down one hall, they were all ordered for 1900 (this was the special care unit; when I passed meds in that unit, I was giving the CNA there her 30 minute break, so would do that hall first); down another hall all meds were 2000, and down the 3rd hall, 2000-2100; most of the meds were ordered as "HS," not at a specific hour of day, so I had that freedom. It permitted me to stay on time most days. I could even, usually, deal with a fall or two and still have most of the meds done on time.

My facility actually has 2 transitional care units, each with 16 beds. During the day, two nurses staff each unit with a max of 8 patients while at noc, there's one nurse to the 16 residents. Now, the evening med pass is a breeze--the first SNF I worked at, I was the only nurse for 48-53 residents, so I got pretty efficient at the med passing business--16 is easy peasy. But, at night, there's little to no back-up for emergent situations, which do occur. We are getting people sooner from the hospitals, so they are sicker and more delicate. Most get stronger and go home, but there are some who experience respiratory or cardiac issues, infections, complications r/t the emergency surgeries that they went to the hospital for originally, so you have to be pretty on top of your assessments and dressing change knowledge, and be willing to actively advocate for your patient if you see something amiss. During the day, there's another nurse, the unit manager, and others around in case something occurs, while at night, you really don't have a lot of backup. Our facility requires that all the nurse managers, and all of the nursing administrators (from DON down) to take call, so you can always call them, but it's not quite the same as having another nurse in the building with you. As far as less acuity at noc because all the patients/residents are asleep--that's kind of a running gag with noc shifters. It can be quite busy, especially since you generally have fewer people to answer lights, help people to the bathroom, deal with outbreaks of Noro-virus and other such things. I actually prefer nocs partially because there are fewer managers around, getting in the way of me doing my job, but probably at first, I'd recommend a new nurse stick with days--you'll get more exposure to the different jobs that the PT, OT, ST folks do, deal with more of the dressing changes, so you'll see more wound care (which I find fascinating), and not be alone in crises. If your facility has an in-house hospice facility, that's worth checking out too. I'd love to do hospice, but right now with my Dad dealing with stage IV lung cancer, his chemo not working well anymore and me looking at going through hospice stuff with him, I don't think that's the place for me yet. It's a special privilege to be part of someone's last days, to help make that terrifying event less terrifying to the patient and the family, to be part of easing fears, finding solutions to difficulties as they come and finding ways to truly be a patient advocate. Sometimes that means wading into icky family dynamics, going toe-to-toe with providers, and encouraging the proper use of pain medications--which many people don't want for fear of becoming addicted. Even as they lay dying. It may not be med/surg, but it really encompasses the full range of nursing skills and is an honorable use of your days/nocs.

I'm currently working transitional care. I started my career in psych, moved to long term care--which I very much enjoy--but because of the need for full time hours, moved to the transitional care unit. I'm working nights, which I wouldn't necessarily recommend for a new grad. The unit I work on, during the day, has 2 nurses, each with up to 8 patients, dealing with a wide variety of medical issues. Lots of hips and knees of course, but also CABGs, back surgeries, wound care, respiratory issues, dealing with PICCs, catheters, IVs, feeding tubes, new colostomies, etc. I very much enjoy it. You get to build more of a relationship/rapport with the patients than you can in med/surg but unlike LTC, the goal is for them to get better and go home. On a side note, I've not yet found the transitional care "specialty" section here on allnurses--or is it lumped in with LTC?

I have had a few instances of people asking me about stuff--the greenish chunky discharge from her ear, what this color of poo might mean. My advice generally consists of "that sounds like an excellent question for your provider."

Not cheesy at all! One thing that means a lot to us "pee-ons" is having sincere recognition from the bosses.

I'll freely admit that I used my first paycheck as a nurse to fulfill a life-long dream and bought myself a horse. I've never regretted her!

So, a year has passed since this incident. Six months ago, my husband and I moved to another town and I am working in a different facility. This facility is non-profit, owned by a church denomination and has been wonderful. There were several more issues between th DON and myself and I finally got to the point where I couldn't take it anymore. I came close to giving up nursing. This new job has allowed me to rediscover my love of nursing and has cemented my enjoyment of long term care. The staff to patient ratios is smaller, there are providers who are much more responsive/responsible, and my supervisor and DON have a LOT more common sense and common courtesy. My overall stress level has reduced so much I've been able to stop some medications and I no longer face going to work with a feeling of dread with my stomach in a tight knot all shift. There are hectic days, but none of my worst days have been as bad as a normal day at the previous facility. I NEVER want to work in a for-profit organization again. Ever.

I did that with mixed results. It was good with all the nurses and most of the CNAs but I did have some issues with a few of the aids. One of them specifically told me "I'd be just fine if you showed me some favoritism. Seriously." We worked it out eventually but there were some bruised feelings on both sides when I didn't show favoritism and occasionally had to call her out on poor performance.

It's a long-term care facility, not in a hospital, though they have PAs and NPs that round daily from both local hospitals. There are actually 2 transitional care units, both set up very similarly to each other and I'll be working in both units. During the day there are 2 nurses and 2-3 transitional-care aids (CNAs with extra training) for 16 residents. My shift will be 1800-0600, will have all of the 16 residents, and from 1800-2300 will have two transitional-care aids and one aid after 2300. I came from a facility where I worked the same hours and was the only nurse in the building for 45-53 residents, so the 1:16 sounds pretty good.

I am currently in orientation in transitional care. I've worked at this facility for 6 months in one of their long-term care units and have loved it but they didn't have full time hours for me there and the transitional care unit did, so I've moved departments. I had some transitional care residents at my previous facility but they generally were recovering from falls or pneumonia, things like that. So far, I've oriented 2 of my 6 nocs of orientation and one was very, very quiet, the other showed me that I have a LOT to learn about dressings and post-op care. I'm seeing fresh CABGs, hips, total knees, a fresh abdominal surgery with wet-to-dry dressings, am told that there are often PICCs. I'll be working nights, so won't have much in the way of back up available and am feeling excited about how much I'll be learning but also a bit overwhelmed and not wanting to screw up. Those who have made this transition, what words of wisdom do you have? What resources would you suggest?

I know! I've had that same "work harder not smarter" line of doo-doo from someone who had never touched a patient...

I couldn't find whether or not video links are allowed (via youtube). I suppose I'll find out if it's not allowed I saw this on my facebook today(my facebook info is NOT in the link) and ended up laughing so hard I almost experienced bladder incontinence!

So I've just completed my first week of solo nursing at my new position. This week, I had a fall, a death and our wing went under quarantine, as 4 elders ended up with diarrhea within an hour of each other. The CNAs employed at this facility are pretty top-notch and handled the situations smoothly and professionally, so they were not the major catastrophes that I've gone through at my previous facility. At my previous position, I had a minimum of 8 hours of paperwork each night, so after the initial frantic med pass, most of my 12-hour shift was spent sitting down working with the blankety-blank computer. Here, I work an 8 hour shift and spend 7 of those hours on my feet working with the residents and 1 hour on the computer. I now have time to look at the (fantastically adorable) quilt that one of my elders is piecing together, to clean the droopy eyes of another elder (who is so sweet that the residents argue over who gets to take care of her), laugh with the elder who laughs at me and asks to dance. I'm still busy passing those pills, but it is part of my job now and not the main focus. My feet, legs and lower back are sure feeling the difference after 4 days of this! The shoes that worked for me at the other place aren't quite up to this job. I've ordered some others to try and otherwise try to not hobble too noticeably at work. I also have to get some better compression socks. But even with the feeling that someone slapped my feet with a 2x4 for awhile, I'm happier at this job than I have been with nursing for some time. These are just details that need to get ironed out, and losing some weight would go a long ways towards helping that. I've noticed that I eat far less than I did at the previous job--I am hungry and enjoy my lunch but am not snacking my way through the shift.