WheresMyPen

Hi all.. Question for my fellow bedside nurses.. I am currently an LPN and I work as a floor nurse at a SNF. I absolutely love it. LTC/subacute rehab is my niche. I love the elderly and I love the clinical and bedside experience. I also love my noc shift. Im pretty much completely happy and comfortable with my career right now and I don't want anything to change. But I am scared that changes will come soon, because I am about to graduate with my BSN.. So I'll be a BSN/RN. This sounds ridiculous as im typing it, like oh no I've advanced my career how horrible! Lol. Well I am scared that I'll be taken away from the bedside, unless I find another job in a hospital maybe. I see this happen at my job, where someone gets their BSN and then they are shoved into a charge position/ADON. I am a relief charge nurse on the weekends and i haaaate it with a passion. I love running around crazy busy with direct patient care.. That's my happy place. And politely declining doesn't seem to be an option. They'll either give an ultimatum or just blindly ease people into it. Before I became relief charge I was under the impression that I was only gonna do it when the charge and other relief charge were unavailable, then it turned into every other weekend. I I worked in the hospital as a PCA, and I liked it. I am not anti-hospital nursing. But I saw the nurses being taken right away from the bedside with the EMR. I think im the only person at my job who loves paper charting (and night shift). Yeah the paper charts and paper MARS are a pain but I like that I spend more time with patients than at the nurses station. Anyone else out there who can relate to this or make any suggestions? Thanks. Just wanted to vent.

First, I want to say that CNAs are valuable and I do not question their abilities, and I don't think anyone here feels any differently. I used to be a pca/CNA and I truly appreciate the experience I had as one, and the CNAs that I've had the pleasure to work with. Second, i am a little bit lost on the side note you're making about pressure ulcers and how it relates to LTC vs acute care(and I mean that sincerely, not to be disrespectful). But I wanted to just add: Its not just the nurses responsibility to take measures to prevent the ulcers, it is also within the CNA scope of practice to turn the patient Q 2 hours. Both the nurse and CNA should be diligent in taking steps to prevent the ulcers. However even the most diligent care cannot always prevent them. You can turn a pt all you want sometimes, and they'll still get them if they are not absorbing nutrients like protein and vitamin c properly. Weight of pt is also a problem a lot of times. Underlying illness in the pt is a huge factor contributing to developing the ulcers. These pt's who come to you with the skin breakdown may or may not have been very well taken care of.. But my point is, there's more to it than meets the eyes.

I work in a SNF that has a LTC side (two hallways=60 pt total) and a subacute/rehab side (also two hallways, 60 pt total). There seems to be no difference in acuity level. All of these pt have IVs, piccs and midlines, Shiley caths, wound vacs, trachs, surgical incisions and drains, IV ABT, hip fractures, neck fractures, back fx, g-tubes.. Literally no difference in workload or required skill level when I float to either side. day and evening shift has 4 floor nurses and a supervisor. That means floor nurses get 30pt each. Except at night, floor nurses get 60+ each. we also only have 4 CNAs in the whole 120bed facility at night. So rehabs and subacute are not always better than LTC, not where I am anway. Always do research before accepting a job. 18 patients is a very good ratio for just PO and injections.

I never said you are going to kill people. Your words don't offend me. Go ahead and keep reading my posts if you want I dont mind, but it's not gonna help you. I hope you can realize your wrongdoings and learn from them. The things you mentioned could get your nursing license taken away. And you could seriously hurt someone. You need to seriously reflect on yourself and how you handle stress. Gettinf organized and managing your time better will help you in any situation, especially at work. Thanks to overcoming my "make believe" ADD I learned a thing or two about that.

How do you know I'm not as busy? I didn't say, "three meds" to give I said that I have three med PASSES. Every shift is busy for different reasons. I cover a lot of other shifts and I love my night shift but it is not easy at all. And no one expects you to be perfect or to follow up on every thing, but you come off like you are just making excuses. They expect too much of you, they're bullying you, they're catty. You can keep blaming everyone else or you can admit that you have made mistakes, improve them, and move on without making any more excuses.

Also want to add: 1) I am a night nurse and I can assure you that it is not easy. And there are meds. I have 3 big med passes. Midnight, 0400 and 0600. I have 60 patients. More than half of them are total care and have all sorts of tubes hanging out of them. The other half are all fall risks. We have barely any staff so we all just help each other. We do chart checks, 90% of the dressing.. All the wound vacs and we change all the tubing for nebulizers, O2, chaths, humidifiers, everything. I literally do not sit down. 2) part of the reason us noc nurses may come off "cliquey" is because as I stated above, we help each other through everything. We're a tight knit bunch with not much support. We get a lot of things dumped on us, and we do our best to follow up with doctors but what doctor wants to be called in the middle of the night for a non-emergency? And speaking of emergencies. Not so easy to handle with very little staff. 3) your errors are BIG ONES! First you, "forget" to give a diabetic their insulin, or, "didnt have time to" ...But you also mention not endorsing that a diabetic pt had an appointment the next day, and they could have missed breakfast. You give the 1700 meds with the 2200 meds together but they need to be spaced out. Some meds are time specific to maintain therapeutic values in the blood at all times. Some meds are spaced out to avoid drug interactions. Some need to be before bed, some after meals. We've all been in stressful, overwhelming situations and environments, but that's no excuse to cut corners like that. i suggest you speak with the hospital you are at, if you still work for them, and ask for increase in hours. Maybe that is a better environment for you.

It doesn't sound like you are taking any reaponsibility for your actions...

Trust the intentions of others. It's hard, but work on fighting the urge to get emotional. Instead, think rationally. 99% of the time people give their input to help us, even if it's not what we want to hear. Yes, there is that 1% of people who simply put others down to feel better about themselves. (not nurses- I mean anyone from any profession)

Im kindve the opposite.. I work nights but I'm losing weight cause I'm still so busy. But I do have some healthy tips for you. I work out on my nights off. I am up all night while everyone else is sleeping. By myself at 24/7 gym and I actually prefer it that way lol. I also have a Fitbit which I wear all the time. At work I do a lot of walking. I don't know what kind of facility you work but I work LTC and have around 60 PTs and its busy even at night. If you find yourself getting bored.. Take a few rounds and walk to check on the pt's. Take healthy snacks that will satisfy you. When I snack at work I eat a lot of cashews, fruit, pretzels, yogurt and hummus. When I come home I am dead tired so i get lazy. Then I sleep the whole day. So I understand your dilemma trying to work out on the days you work. But by snacking on healthy stuff at work, all the walking, and being active on my days/nights off. Just gotta stay busy and you'll notice that when you eat better, you'll feel better, and it will get easier to keep the good habits.

Best advice that I could give to anyone regarding attendance is that if you are not contagious with anything, If it's not a family emergency or something that truly prevents you from working, go in and push through. It is sad when managers will not bend rules for people who have unfortunate circumstances, but there's not much we can do other than our best. I have a chronic illness and I always just push through. I've gone to work in pain, with horrible headaches. I just go in and give my coworkers/superviser a heads up that I am not feeling well and they usually help me or are understabding if im moving slower or need a break. If I am contagious then I will stay home. Luckily I don't get contagious illnesses very often. But if I were to be susceptible to that I would look into my options to avoid being penalized. A lot of my coworkers call out for things like not getting enough sleep, headaches, procrastinating in school and needing the day off to catch up. What's worse is that tey tell me these things knowing that I won't say anything but it makes me angry, honestly..I don't see those as circumstances that should excuse an absence. It's not just about avoiding punishment but I think of my coworkers every time I don't feel well and want to call out. I think about how someone's going to have to come in on their day off, or stay a double. The last three days we were short because of call outs. It's understandable if it's a contagious illness or someone is so sick they cannot perform, or unforeseen circumstances. Those are different. But on the other hand if someone is always playing the, "car accident. Family emergency. Unforeseen circumstance" card, then i question their honesty. That's why I feel that attendance policies are important. They should be fair though, I agree with that.

But on a serious note. Unless it's a highly contagious illness, or violating policy to be at work in the first place (ie. The flu), then i don't see how this is relevant to patient care at all. If she passed her pre-employment physical, or was simply not asked about her condition, she's not obligated to tell anyone. I have early onset Parkinson's and ADD. I did disclose this to the doctor the physical, but my direct employer is not obligated to know, unless the medications stop working and I became a safety risk. IT bothers me that having any illness would make OP think it's a moral issue. Are you even a nurse?

Oh no! Be careful! You may catch it! And even if youu don't, that dude will suck away your soul! Like a black whole! HTN is An abomination unto God I tell you!

Wait I'm so sorry I think I am wrong guys! Lol. This Rn was also a social worker. I just read consumer affairs.. it's the social work license that has a grace period if not renewed due to no notice. I see nothing about the nursing license now that I double checked. Totally got confused. In my defense this was years ago when I was a CNA. and my memory is shot Lol. My bad!

I didn't know that someone's medical condition was a character flaw?

Had my CEUs done early, renewed on time, but I know an rn who didn't get hers renewed for almost two months because she never got the letter. She was still working. I checked my website to see if it's accurate and it is.

Update I wrote a letter to my DON and cc'd administration and HR last night. Daughter is not allowed to speak with other residents. Private visits will be arranged in private areas or PTs room only. If she does not abide by these rules she'll be banned from the facility. thank you for all your insightful replies. I knew it was slander or something crossing lines, just couldn't think of the correct term.

definitely. The minute she said she didn't want me to care for him I went right to my DON, no resistance or pushing on my part at all. agreed it's best he's not my pt anymore. Sad thing is pt felt like I didn't want to care for him anymore because that's what his daughter told him, which is what he told another nurse. I let it go completely but when other patients started asking me and my coworkers if it's "true that I don't have a nursing license" and stating what they'd been told my the daughter, it got to me. I don't like having to answer to a bunch of my patents, "yes I am qualified to care for you." And day nurses having to explain to other family members that the daughter is misleading them. What a ridiculous situation

I'm so glad you were able to apply our input and overcAme the struggles of your night! Keep at it! You may find that some nights will be harder than others, but don't give up! I like what another poster said, that you're not just doing this for nursing, but to improve your life overall! Just keep reminding yourself that you are worth it to keep trying to make changes for the better. Whatever career you end up going into, you'll be happier to have more control over your struggles. Don't hesitate to ask for help when you need it.

thank you. I am going to talk to my DON again or maybe I'll email her. I barely ever see her anymore. But I brought this up twice to her and my supervisers.

yes I am relieved that I am not in direct care with the pt anymore but I do still feel like I'm in the line of fire. Day shift nurses kept having to tell other patients that I do in fact have a nursing license and not to listen to this mans daughter. Ive never had someone blatantly lie about me to others, even after her wishes were granted. I should probably start walking around with my license attached to my face lol

I know it's not outright discrimination I just didn't know if her lies to other pts and family could be legally stopped if She doesnt? Cause the DON is just not doing anything anymore and I have been told by other nurses that she is saying that my license isn't valid, that I am still in high school and have no nursing education. It borderlines something.. Im just not sure what.

Yes I see that now. I had misread the OP and was under the impression that the lady asked her. I would not give anyone advice off the clock unless I had overheard the pharmacist tell her something absurd, like "eat 5,000mg of sodium with every meal for your HTN!" LOL

can you call her?

If she could lie about me like that who knows if she'll accuse me of anything else that isn't true

i think my DON tried to assure her the best she could but the daughter didn't care. I guess we just had to do as she wished. I enjoyed caring for her dad (such a nice and funny man) but I was relieved to not have to deal with the daughter when taken away from his care....until she told other patients and families that I don't even have an education or real license! Im scared because I am about to finish my BSN program and I don't want anything to get in the way of my job, reputation.