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Thanks to all who responded I see that everything that was done in the hospital could have been done in house. I'm learning to put all of the pieces together.

I worked in acute care for 5 yrs, then I come to Ltc and find that's it's a totally different nursing world that's gonna take some getting used to. Recently I was caring for an 86 yrs old man. The day before the CNA was preparing to shower him and he began to complain of a severe HA and stated he was too weak to get up. VS: 97.2-92- 148/98-20-96% RA. I gave him Tylenol and told the aide to bathe him in bed. He said headache was gone. Next day aide comes to get me and he's very clammy small emesis and weak. VS: 99.1-120-96/42-26-93% RA. I lower his head elevate his legs and call the supervisor because I'm calling the doc to send resident to the hospital because I think he's septic. Blood cultures were taken recently for possible UTI. Super comes and elevates his head and gets BP 120/48. Now this resident recently. He had lab work done which showed WBC' S 64K. He had an appt already setup to see and Oncologist the next day. The supervisor saw his bp improve and said let's get an order for Cipro and wait for his appt tomorrow. But with residents head up he felt sick so I lowered his head again and now bp 88/42 hr 100 temp 100.2. I gave him Tylenol an hour later temp is 100.6 and he's still clammy. I call the doc on call again and he said send resident to hospital. I checked POLST he is DNR but limited intervention. Doc comes in next day and was very upset he went out because he went to hospital already once within 30 days and he was going to see Oncologist the next day. At hospital he was found to be retaining urine and pseudomonas in urine. The supervisor told me given his age and Co morbidity and possible leukemia if he had gone septic and died it would have been labeled natural causes. That the resident no matter what did not require immediate care. Can someone tell me what I should have done differently?

I know just how the OP feels. Though I have experience as a nurse, LTC nursing is new to me and it sucks. At the facility in which I work there is only one vitals machine for the whole 5 floors. They're constantly over staffed. Some nurses get finished faster than me because they don't give all the meds. I find exelon patches that I put on a resident still on their back with my initials 4 days later when they're supposed to be changed daily.

I recently went from 5 years of med surg to being an LTC nurse working on a skilled floor. I was told that I would have 5 DAYS of orientation which turned out to be 3. I quickly went on this site and found that that is not uncommon (I had 6 wk of orientation for med surg) I was okay with that because it turns out that I was able to orientate rather quickly to LTC way of nursing. So I've been independent on the floor for 4 days and now I'm training someone??? That is not fair! I am still trying to learn all of the residents' names and how they take their meds and now I'm training someone. It this normal?

Also, you want to study lab values, you must know what is abnormal because you will need to notify the MD to get orders to correct imbalances. You should try to arrive 1/2 hr early to check the labs, vitals, to see what orders still need to be completed and to make sure all meds were given on the previous shift. Then, get report, identify the times that meds are due, check to see what new orders there are, if you are on a telemetry unit, interpret your strips and then start your shift! Good Luck!

I had a patient who had Alzheimer's disease. She was as sweet as pie while I was giving her some applesauce with her meds. She said can I please have some more and thank you. When I had to turn her to change her dressing, she called me the N word in every ugly way that you can think. I never responded. When I was finished caring for her, I made sure she was tucked in and comfortable and she said "Thank you sweetheart."

Last month, I posted mistakes I made while being overwhelmed with charge nurse duties and staff nurse duties. I ended up being terminated. I think the punishment was way harsh (I thought I would have been suspended for a few days) but I can respect HR's decision. Though I should not have made the mistakes, I chose not to hide them, I told the truth. Now when I am applying for jobs, I chose to tell the truth on my application and I am basically being labeled as damaged goods and I can't even get an interview. I just want advise on how I can gain employment and move on from this. I don't want to hear about unions, my past employer didn't have one. I don't want opinions on how healthcare is evil and how easy it is to get let go. I just want someone who has been where I'm at whether they were let go for mistakes, wrong fit or any other situation that caused them to either be forced to resign or get terminated to tell me how they were able to gain employment. It has been a month now and I am going insane with beating myself up, feeling like a failure and going through depression as I have worked consistently for 17 years. I know the longer I am employed the worse it will be. I don't need anyone beating me up anymore than I have beat myself up, I just need some advice on how to land an interview. Thanks.

Yup the doctor ordered the stress test and the bb but I got yelled at for giving it. Thanks for the comment.

Absolutely Sally I will do just what you said thanks for the feedback.

I had 5 patients to care for the night I gave the betablocker. I was doing q1hr pressures on her and Q1hr blood sugars on another patient and straight catching a patient and I was charge nurse. The night of the blood sugar incident there was no excuse.

Recently I made some very stupid mistakes. I had a patient who was admitted for hypoglycemia. When he came to our floor his blood glucose level was 94. Later he was ordered 30units of lantus. I was supposed to scan the patient, scan the meds and then give the meds. Instead, I scanned the patient, and skipped a step and gave the meds. I inadvertently gave 30of humalog instead of lantus. When I went to scan the med immediately it came up humalog and my heart dropped!!!!! I instantly got terrified because a patient on my watch a few weeks ago got out of bed and broke her hip. I checked the patient three times but neither me or the nurse checked the bed alarm. The next day I told the nurse practitioner expecting him to call the family but neither he or the daylight nurse called the family and the family was livid that no one was notified. I didn't get reprimanded for this at all. But then this blood sugar incident happened. After I panicked I tried to correct the blood sugar by giving him lots of sweetened juice but of course it didn't bring his blood sugar up fast enough. His blood sugar went to 30 and he felt a little dizzy but never loss consciousness. I kept thinking "just scan the lantus and say he went hypo because of it" but I couldn't bring myself to lie. An hour later, I told the residents who were on the floor and they told me to get d50 which I did and his glucose level came up. But it kept going up and down because the humalog was still working. The daylight crew came on and I stayed until the patient was stable. When I left his glucose was 108 and he felt better but the doctors were livid. Not only did this happen but the night before the blood sugar incident I had a female patient come in for elevated blood pressures. She was in the 190's and very symptomatic. She had severe headaches, vomiting and rigors. She was ordered to have a stress test. The doctors who ordered her stress test also ordered for her to have a beta blocker. There are standard orders not to give beta blocker with thin 24hrs of a patient going for a stress test. I completely forgot the order or that she was going for the test. My priority was to bring down her blood pressure to alleviate her symptoms. She had betablocker and lisinopril ordered that the doctors ordered. When they found out I gave the betablocker, they were upset with me. The next day the stress test was cancelled and the patient ended up being cathedral and stunted. But this betablocker issue and the blood pressure issue led to me being suspended. My co workers don't feel that I should have been suspended but take full responsibility for it however the blood pressure incident is where I don't think they should count that against me. I deserved what I got and after being a nurse for 5 yrs I should have known better. I could have lied and easily covered it up but I told the truth. I'm scared that I'm going to be fired. Being the main provider for my family and so close to Christmas I am soooo scared but I definitely learned a good lesson. I just needed to get this off of my chest I feel humiliated and ashamed. I will respect any comments that come my way.

Thanks for the responses unfortunately I work for a major corporation and if I wanted to switch positions the hiring manager would have access to my performance review so I'll just do like you all have said and work on making my review more positive this year

Hello all, I need help on this subject. Recently, I received my performance review. It was the worst review I ever received. I sat down with my unit director and we went over the topics. She couldn't tell me why many of the negative comments were included in my review. I earned my BSN and my med/surg certification but neither were included in my review. I told her that I want to advance my career to perhaps a clinician, nurse practitioner or patient care coordinator but I need the develop the confidence to do so and she put this in my review saying that I have shown to suffer from low self confidence and that I am not able to focus on the task at hand. She said that I do not go above and beyond. However there were multiple time I was mentioned in our weekly updates as having gone above and beyond. Also, there were wonderful patient comments that about me that were sent to the CNO of our hospital. I let my unit director know all of this. She kept assuring me that I got a very good review because although she put these negative comments in my review, in each section that these comments were listed, I received either a solid or superior performer rating. At the end of my review I did write my rebuttal to the comments that were made but I don't know what good it will do. I told her that I am not going to be able to advance my career because when a prospective employer sees my review they will not consider me for any positions. Any advice on how I can fix this?

I have been where you are and truth be told, I'm still there but it's getting a little better. I work nights on a 28 bed unit and I get no less than 8 pts every night. I have 6months experience now but I still feel like I'm running around like a mad woman sometimes. You just have to get a routine going and stick with it. There will be days and nights when the routine cannot be followed completely but you need something to help you manage your time. You may start by getting your assigment and seeing who your aides are. Then listen to report or getting verbal report from prior nurse. After you have that information, check the meds and make sure all were given up to the time when you come on shift. Look at labs (any imbalances? Where they corrected? Was the doc notified? Look at the vitals any instabilities that were not there previously i.e. bp high, does the patient have a trend of this? if no does the doc know about this? Make sure all orders are signed off. Do not let the prior nurse leave until all of this is checked. Usually I come in about 1/2 hr early so that I have time to look at all of this. Once you have the information you need, go see the nurse with your concerns so that you are not left running around trying find answers to these issues. Next see your aide and let them know who needs vitals and blood sugars and if the the pt needs daily weights, i &o's and any urine samples or poop samples (c diff, guiac, occult etc) Once you have that done, start to see your pt's starting with the most unstable and going to the most stable. If you have meds due at that time, bring them and assess and then pass meds so you are multi-tasking. Try to assess a few, chart a few so that you are not so backed up in your work. This may not work all of the time because you may step on the floor when all hell is breaking loose but this is a guide that will work when the floor is not so chaotic. And once the floor calms down you may be able to go back to this routine. Hope this helps! Also, you may need a nurse brain sheet to help you organize your pt's info so that you don't miss anything and you can give a good report. I am attaching what I use, hope this helps! Under meds, write the time they are due. Revised Nursing Brain Sheet.doc

Take comfort in knowing that he was surrounded by caring people in his final hours. That's how it should be. God Bless You.

Hi Rivernurse, I'm sorry this is happening to you. It truly is a learning lesson though. Everytime something like this happens, you have to learn what you did wrong so that you're less likely to repeat it. When you find abnormalities, you have to ask what is being done about this. If you don't find the answer, call the doc. At the beginning of the shift, get a piece of paper and section it off by the number of pts that you have. Look at the orders and write down what has to be done i.e. dressing changes, qshift foley flushes , nurse blood draws, etc. Also, if you see an electrolyte that is abnormal and there is nothing done about it, include it on your list to follow up with the docs. Keep checking orders and labs and update your list as necessary and scratch off things that are completed. If while doing assessment, you find that a pt's has a complaint that is non-emergent, include it in the list of things to contact the docs about. Have faith, you can do it.

I too oriented on days for about 6 weeks and then my last two weeks were nights. This week will be my third week on my own. I'm still trying to find my rhythm but I am very glad that I had a chance to see how things operate in the daytime. It's a myth that the night shift is so much more "laid back". I am running from the time I hit the floor until the time I leave. Many people do not sleep at night and even when they do, they awake with SOB, chest pains and a whole list of other needs.

Yesterday was a pretty bad day. There were a few things that went wrong but I think my ultimate problem is a lack of time management due to me wanting feeling like I need to do everything. My patient's light went off. He had diarrhea and needed his brief changed multiple times. Being that my med cart was near the patient's room, I was constantly going in to clean him up. I call the PCT because in my mind, I thought, why call her to do something that I can do? Constantly going in set me back and everything else just went downhill after that. When will I learn?

Jka, I know just how you feel. It sounds like you are telling my story! I work on a med/surg floor. I'm in 4th week of orientation. I am up to 5 pts and have to get to 6 by the end of orientation which is in another two weeks. I too will soon be put on nights which will be my permenant position. Having to admit and discharge pts and deal with orders, tasks, making sure pts are medicated at the appropriate times and dealing with abnormalities is all taking a toll on me too. I can remember when I had one, two even three pts and I was thinking, "this is not as bad as it seems". Then I got a pt who was dying and the family kept me in the room nonstop. If it wasn't for my preceptor who helped to effectively communicate with the family, I don't think I would have been able to keep it together. In the midst of the family needing me, I had 3 other patients to deal with. We can make it though, we just have to learn from our mistakes, ask questions and keep looking at meds due, orders and labs at least every hour if not more.

Congratulations on finding a job. I think 10 weeks is a good amount of orientation time and you should make the best of it by being a sponge and absorbing all that you see and hear and by asking questions on every single thing you are unsure about. Then once you get the answer, don't keep asking the same question over and over, try to retain the information. Don't worry about brushing up, it will come to you and what doesn't to you, the more experienced nurses should be able to help you with whatever you need. I was the same way, I wanted to know what I could do to prepare for my new job but once I got in there, things started coming to me and it will be the same for you.

Oh yeah!!!!!!!!

I was so worked up because I saw that my temporary permit said null and void. I now know that its because whenever you take the NCLEX, your temporary permit is immediately no good because you either passed or failed. I did another search on my name and found my RN license is active as of today. No need to pay for quick results. I prayed on it, studied hard and passed. To God Be the Glory!!!!!!!! I pray that everyone preparing to take the test is blessed with an RN license. If you don't make it this time, pray on it that God will show you your weaknesses, brush up on them and take it again.

Hi, I took the NCLEX yesterday and am waiting for the quick results. I looked on my state board of nursing website for license verification and it says that my temporary permit is null and void. The quick results are not available for 48 hours. Does this mean that I failed the NCLEX?

Some of the things you can go home and practice. For instance, how to apply sterile gloves, get a few pair and practice at home. Practice vitals and Head to toe assessment on other people. You can practice bandaging people by taking home some extra bandages. Look out on this website for info on calculationg drip factors rates and such. Don't let this discourage you, take a deep breath and have faith in yourself.