RN returning after 10 years.

[ZZTopRN, BSN, RN]

Hello: I have been out of nursing for 10 years. I also let my license lapse but retook my boards and have my license again. I am going to start a refresher course the end of August. However, have not been able to find work until I have the refresher course. I did become employed a couple of weeks ago in a LTC facility with skilled and subacute care.

When I applied with a hospital they told me it was a good idea to work in a skilled LTC to renew my skills. But I was not placed in the skilled unit as promised. Instead I was placed in LTC with a backbreaking patient load. Apparently, this was to get me and leave me in LTC.

I persisted and asked for what I was promised. I got 5 days of orientation on the LTC, 1 day just observing. The DON did not want to put me in skilled, so the next thing I know I got a schedule with 2 days orientation in subacute, trachs and vents for 15 patients, 1 lvn and a couple of cnas, I think. Then on the 3rd day I am supposed to be charge nurse.

Do you think this is out of line, or are these patients less acute than in hospitals. It seems kind of scary to me with just 2 days orientation. Or maybe this is a ploy to get me back to LTC? It is pretty obvious the DON in not keeping her promise to put me in skilled care wanted to keep me in LTC. One of the nurses told me that new graduates didn't last in skilled care. But now I am going to be in subacute (med/surg nurse previously).

So I am hoping that to begin with these patients are less acute. Anyone know anything about these subacute facilities.

Thanks. Hope I get some info from you.

[suzanne4, RN]

Patients with trachs and vents need more than one RN for fifteen patients.

Don't jeapordize your license with that type of staffing. You worked too hard to get it back.

How man respiratory therapists are assigned to that size a group of patients? Do you have any?

[ZZTopRN, BSN, RN]

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Patients with trachs and vents need more than one RN for fifteen patients.

Don't jeapordize your license with that type of staffing. You worked too hard to get it back.

How man respiratory therapists are assigned to that size a group of patients? Do you have any?

2 DAYS of orientation? How can they do this, or is this their way of getting me to leave?

[ZZTopRN, BSN, RN]

Patients with trachs and vents need more than one RN for fifteen patients.

Don't jeapordize your license with that type of staffing. You worked too hard to get it back.

How man respiratory therapists are assigned to that size a group of patients? Do you have any?

I asked her about nurse to patient ratio and told her when I worked in acute care I had anywhere from 6 to 8 patients. She said this was "different" but didn't explain.

[spaniel]

If you can, dump this entire place and go to a teaching hospital or a place with a reasonably good reputation that provides a much more extensive orientation. You will learn the skills just as you did before. Alas, this short-sightedness is all too common in nursing administration. But don't let that be your problem. Recognize it as their inability to appropriately manage/educate and move on to a more highly regarded setting.

[ZZTopRN, BSN, RN]

If you can, dump this entire place and go to a teaching hospital or a place with a reasonably good reputation that provides a much more extensive orientation. You will learn the skills just as you did before. Alas, this short-sightedness is all too common in nursing administration. But don't let that be your problem. Recognize it as their inability to appropriately manage/educate and move on to a more highly regarded setting.

The 2nd day of orientation on the subacute unit, I noticed the one that was precepting me was giving some of the meds so we wouldn't be late. I really started getting worried when there was a patient who had a trach and was totally oriented and knew his meds "right down to the penny." Meds had just come in from the pharmacy and the preceptor thought he was "going to help out." He gave this very oriented patient 100 mg of a med that I don't recall. My cart was outside the door when the patient called to me, "I get 2 more pills." Sure enough, the MAR was 300 mg. What a scare. I quit the very next day. It was also disconcerting that the nurses there chart their meds at the end of the shift. I guess if they have the same patients all the time they remember what they get. But working in med/surg before, I had the habit of charting the meds right after I gave them. It didn't make me any slower. But I can tell you, I really got a scare out of that.

Another thing that bothered me was that no assessments were made. They always charted or copied off what the previous shifts had charted. I can tell you that put a scare into me. I don't care if they the patients were in a PVS state. I am obligated to give safe care.

I did not renew my RN license by studying to take the NCLEX to lose it. Thanks for your support.

P.S. I am starting my refresher course 8/29. A teaching hospital was where I started out as a new grad. I guess it is going to be harder now, because the HC industry is so profit driven, but I want to do it.

Again, thanks for your encouragement.