1st day working agency, advise please!

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Specializes in Acute cardiac care, Psych., Med-Surg, CM.

Hi!

All of my past jobs have been acute care in hospitals. I'm a little rusty since I've been doing case management for the last 2 years. I went to an LTAC facility today, my 1st time working agency. I received report from an agency nurse and gave report to an agency nurse. Fortunately the nurse showed me all that she could. I didn't know I was going to be the only friggen nurse on the floor. Granted I had a med aide and there were two nurse aides..I hadn't finished charting and there were 2 dressing changes left that I didn't get to before the shift ended. There were two patients I didn't get to talk too because everytime I went to their room they weren't there. I was able to give my PEG meds and do a number of dressing changes though. The people who were always out of there room got their PO meds by the med aide. In addition to that I didn't get to set up new tube feedings for the oncoming shift.

I'm used to having 4 to 6 patients and comparing all MARs and treatment flow sheets to the actual order. It drives me bananas to have 15 patients and just go off the MARS, since there's no time to check each order in LTAC. I don't like trusting that its correct. There were just too many pt.'s...and I was having trouble keeping in mind who had what...such as 2nd day post op permanent pacemaker vs the guy who went out with chest pain the night before and returned the same day etc. I'm comfortable prioritizing and making a cheat sheet to follow...but there was so much charting on the residents who didn't live there. I was barely able to eyeball everyone by the end of my shift which is a far cry from hospital nursing!

I refused to give the meds that the med aide pulled on one pt. Since I didn't pull them myself. She said she never gives the meds to that particular pt. Because he is always inappropriate with her. So I told her I would give them if I pull them myself. I ticked her off a little but hey, its my liscense. She was a big help though and after she realized I wasn't a wench and she was nice. So I don't feel like I did anything wrong, I did the best I could do...but as far as from a state board of nursing perspective I'm a bit freaked out about anything coming back to bite me. My charting sucked and like I said...I wasn't able to keep my eyeballs on everyone. Am I just being too hard on myself because I'm used to a different setting and that's the way it typically goes in an LTAC? Be brutally honest but don't make me cry. Also any tips, tricks, suggestions, thoughts will be immensely appreciated!!!

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Did you sign for the txs you did not complete? If not, what did you do about the tx record? Leave it blank?

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Specializes in Acute cardiac care, Psych., Med-Surg, CM.

I circled my initials and documented pt. Was in dayroom most of the day. All I could think to say...because the three times or so I would go to their room they were in the dayroom with family.:(

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I circled my initials and documented pt. Was in dayroom most of the day. All I could think to say...because the three times or so I would go to their room they were in the dayroom with family.:(

Sounds like this is LTC (nursing home) vs LTAC. Huge difference! If pt was in the day room, why didn't you just ask them to return to their room for the treatment or med?? That's what I do and at my LTAC, if I charted something as not done because the pt wasn't in their room, I would be written up!

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Specializes in Acute cardiac care, Psych., Med-Surg, CM.
Sounds like this is LTC (nursing home) vs LTAC. Huge difference! If pt was in the day room, why didn't you just ask them to return to their room for the treatment or med?? That's what I do and at my LTAC, if I charted something as not done because the pt wasn't in their room, I would be written up!

Yea, that's exactly why I'm worried and felt the need to post. But I'm not so dumb that I didn't know to go ask someone to go back to their room. If you read the whole post, I know its long....it says there were more pressing issues such as :

1. Pt with defib vest had alarm going off to change the battery......take care of that and get ready to go ask a pt to go to their room....and right when I go to do that....

2. Time to male sure the pt who I gave insulin to is eating......then......

3. Pt with large decub on glute soiled himself and the dressing fell off and stool was oozing into the tunneled wound....

On and on and then it was time to give report.

Would you have made going to get the pt in the day room a priority over the above?

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Specializes in Acute cardiac care, Psych., Med-Surg, CM.

Oh.... it was LTAC not LTC

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