What would you do? (a dilemma about 'lost skills')

gentlegiver, ASN, LPN, RN · Aug 1, 2008

How do I get back the skills I may have lost over the years? There are no refresher courses for LVN's in my area. I have done all that resercah already...have been looking for YEARS..even contacted the BVNPT for help. I have considered an online course, but really want to relearn the clinical parts also, and don't believe I can find a hospital in my area that allows that. (The online courses make you find a hopital where you can do clinical portions) Should I even be concerned about the skills I may have lost over the years? Do you really use all that you learned in nursing school in your day to day job? Should I consider LTC/SNF or an MD office? Where else do LVN's work?
Any ideas or suggestions would be really appreciated!

I would apply at a LTC, they are always looking for help, and you always have someone working with you (unless you work the 11-7 shift) who can show you what to do. I have run into a few situations where I had no idea where to begin on a treatment for a pt. I basically stated this and they had no problems training me to do the job right. It is very easy to lose skills, most places know this, so they don't look down on the Nurse who asks for help. Better to request re-training than to do the job incorrectly!

CA_LVN · Aug 1, 2008

Thank You gentlegiver for your input. Funny you mention 11-7, that is my usual shift! :-) (I like the night time quiet) But I am not against going back to more 'normal' hours. I am sure my 'body' would appreciate it!

Even though it says I just registered on this site, I have actually been a member in lurk mode for many years. I have noticed through reading posts that 'losing skills' or 'leaving the workforce' is brought up somewhat often. I have seen quite a few posts about taking refresher courses and such. So, I know what your saying about it being easy to lose skills is no doubt true. I have actually felt some comfort in knowing that I am not 'the only one' :-)

Two pieces of advice I remember vividly from when I was in nursing school: The instructor told us "DO NOT go directly into home health or MD office...get at LEAST 1 years med-surg under your belt first" and "NEVER give up your license willingly." At least I did one of those! (I will NEVER let my license expire, even if I leave the field someday) I am an LVN, always have been always will be :wink2:

Thanks Again,

Looking forward to more responses...

pagandeva2000, LPN · Aug 1, 2008

I totally understand your story, because it could have happened to me. I worked as an aide at a hospital clinic and was offered a leave with pay (also tuition paid) to become an LPN. While I was in school, I thought that because I was offered such an opportunity, that I would have probably had to go to med-surg (I mean, investing ALL of this money into me, I was SURE that they would want me to return to the grind). Well, when I got my license in 2006, they told me they wanted me back in the clinic, and had to do 6 weeks med-surg as a new grad. Those 6 weeks up there were overwhelming and wild! I didn't get to understand how to work IV piggybacks, and keeping up with those orders drove me mad! I took the first thing smoking out of there and ran to my clinic, shivering.

In any event, I started working for outside agencies on the weekends off doing home care as well; I was just like you...very selective on what assignments I took, etc. And, I was also a vaccination nurse. These were well paying positions, but it started to sort of haunt me and I knew in my heart that I needed a med-surg background, but I was afraid. Also, I am determined to remain in the clinic, because most nurses are not fortunate enough to have weekends and holidays off. If I give that up, I may not be able to make it back. With plantar fasciitis and just plain being tired, I don't want to handle med-surg on a permanent basis.

Well, fate stepped in. The vaccination nurse hustle sort of piddled out, and my friend who works in one of the med-surg units at my hospital told me that our facility does not pay overtime for nurses that work in different departments but we can sign up for the agency, get two days orientation and begin working med-surg per diem. I decided to bite the bullet and do it. Best decision I ever made. I have three friends that told me that they would keep their cell phones on and if I needed ANYTHING, to call them and they would walk me through it (I have called them on a few occasions). They helped me during my two day orientation, and then, I did it! I am happy, because, now, I go in every other weekend for at least one day, sometimes, I may just schedule myself for every Saturday for the month of August. It was not as bad as I thought. I worked faster than I believed I would, the other nurses love me and for the most part, they have embraced me. I basically go in when I feel like it, am gaining the experience and I am honest when I say I don't know something. This situation is a bit unique, because it doesn't happen everywhere like this, but it works for me. As I said before, I have no intention of leaving my clinic position. I have steady hours, weekends and holidays off. I feel I would be insane to give it up, especially since it is a choice spot. But, I am getting my bedside experience in a way that I can control, and because so far, I am doing so well, I go more often than I expected to.

I would say to follow the suggestion to go to LTC, at least for nights or weekends. You can work at a slower pace, most of the patients in LTC are predictable/stable. If you fall into a snaffu, call the supervising RN for assistance. You'd be used to dressings, tube feedings, medicating several people, insulin coverages, etc... But, don't think that because you haven't done floor nursing that you are not a nurse...that is the beauty of our career, may it be LPN or RN...there is a variety of choices. Good luck!

starcandy · Aug 2, 2008

I was a LPN since 1986 and worked the first year in a nursing home. After that, I started to work agency private duty and nursing homes part time for a while. I had four small children at the time and decided to be a stay at home mom for 6-7 yrs. I returned to nursing in 2001 working midnights in a LTC. I bought a Clinical Procedures manual and a drug book for Amazon.com and went from there. I learned a lot, but I felt I needed more to have a more thorough clinical picture of my patient. Because of the lack of retraining for LPNS in my area, I decided that is was best for me to pursue my RN. I think working in LTC is a good idea and I am sure you will do fine.

CA_LVN · Aug 2, 2008

Thank you pagandeva2000 & starcandy. I am thinking also that finding CEU's (more than what I do to keep license active) & maybe seminars & webcasts etc. might be a good starting point too. I am a very visual learner, and not fond of reading at all!...So not sure how books & such will do...but worth a shot. I think I will make a seperate post inquiring specifically about suggested books, CEUs & such for my situation.

Please keep the feedback coming :-) I really appreciate it!!!!!!

pagandeva2000, LPN · Aug 2, 2008

Thank you pagandeva2000 & starcandy. I am thinking also that finding CEU's (more than what I do to keep license active) & maybe seminars & webcasts etc. might be a good starting point too. I am a very visual learner, and not fond of reading at all!...So not sure how books & such will do...but worth a shot. I think I will make a seperate post inquiring specifically about suggested books, CEUs & such for my situation.
Please keep the feedback coming :-) I really appreciate it!!!!!!

There is a textbook that I brought (after graduation) that I refer to constantly called "Foundations and Adult Nursing" (not the exact title), by Christensen and Kockrow that has a wonderful CD that reviews skills such as lung and heart sounds, and other clinical things. I would purchase a new version to ensure that the CD is included.

iwanna · Aug 2, 2008

CA_LVN,

Wow, you want to get your skills back and you worked in home health/private duty. Funny, I want to get my skills TO work in home health. I am afraid to be independent because of my lack of skills. I went into Behavioral Health. But, I undertstand what you are saying. The cases that you are taking are very limited, and within your scope of knowledge. However, if you were an aide before, I am sure that you have more skills than you give yourself credit for. I know of many CNAs that could put me to shame. When I worked on geri-psych, I would have been lost without my aides. I learned from them. And, I actually taught some RNs how to do EKGs.

In my situation, I had a chronic illness brewing while going through nursing school. In fact, I was not even there for my final two weeks of school and missed graduation. I was in the hospital, seriously ill, but I pulled through. Took my boards a few months later. Then got a nursing job in a nursing home a few months after passing my boards. And, it only lasted a mere two months.(if that) I only worked PT. I was ovewhelmed. On my days off, I was in bed so exhausted from the days that I worked. So, I ran as quick as I could. Too many patients for me to handle and not enough help. I gave them a week verbal notice and a week written notice. I vowed to never work in a place like that again.

I have worked in Behavioral Health nursing. I have been on disabiity for past four years. However, I am ready to return to nursing. I am limited to find a job not physcially demanding. I was thinking home health/agency/private duty.

I am looking into taking refresher course online. It is 80 hrs. of theory and 120 hr. clinical. Although, I am responsible for finding my own clinical site. And, currently this woman does not have aprroval for either one of my states, that I am licensed in. However, once I find a clinical site willing to accept me and have preceptor, she will contact that state to get qualified for approval. It is a lot of work on my part. But, the only other option was to go to school 75 miles from me. Classes were two days a week, and clinicals were two days a week. And, I believe that would have been a great opportunity as to learn clinicals in a teaching hospital in Pittsburgh. However, way too far for me to commute everyday and the homework on top of that would be way too draining. Another pro, in this scenario is that SSDI would pay for this,since it is already approved by the SBON in PA. But, I believe that the cons outweigh the pros here.

So, I am doing the footwork on my end for the self-study course. I checked out a hospital, and they asked me to give them an outline and they will let me know. But, the lady who has the business of self-study has also suggested that I try nursing homes. She said that nursing homes are more apt. to accepting self-study refresher students, if they agree to work with them for a certain amount of agreed time. My fear is that in a nursing home, that I will not be able to handle the phsycial demands. Originally, I was thinking about going to nursing home to get my skills refreshed. But, I am way too green. I graduated back in 1996. And, have just worked in Behavioral Health. My other disability insurance will pay for this course once this woman get her acceptance for state of OH. But, she will not apply for her approval until I have things all squared on my end.

Good luck to you. In your situation, going to nursing home seems like a good fit for you now. Part of me is thinking perhaps trying a NH in OH for clinical if the hospital end falls through. I just hope that I find a place that will really utilize me and "teach" me the skills that I need.

Please keep me updated about your situation.

CA_LVN · Aug 2, 2008

I wanted to quote & respond to "iwanna' but for the life of me, I can't figure out how!! Sorry. So, I will do it a different way :-)

RE: "I am afraid to be independent because of my lack of skills."

I hear ya! The only way I can do this is because it is all I know! As I said, I am very cautious about the cases I take, and have been very blessed that most my cases have been very long term ones (like each has lasted 2+ years) So, I get to know the patient & their situation well. And again, these are simple, stable cases. But that "what if" scenario bugs me. And "feeling" like I should know more than what I do, and that I don't have the skills to go elsewhere if needed/wanted is becoming a problem.

Re: "I am limited to find a job not physically demanding. I was thinking home health/agency/private duty"

With what I know of Home Health/Private Duty, you could at least be more 'selective' of which cases you would accept. And all the cases I have been on are one on one type of situations. And I have never had to be on my feet for 8 hours straight etc.

RE: "I am looking into taking refresher course online."

Me too. I can't find anything either. Lots of RN refresher courses..but what about the LVN's (LPN's)!?!

RE: "Originally, I was thinking about going to nursing home to get my skills refreshed. But, I am way too green. I graduated back in 1996. And, have just worked in Behavioral Health."

Yep. Similar to me. Graduated long ago, but have only been in one area (and in my case a non demanding area) since then. I can see how this could happen to many nurses in other areas too though. If you go into a MD office or any other specific place place to worked, you could easily loose the skills you don't use there. I am IV certified, but have never started an IV outside of training. I have not done a blood draw or given an injection in 10-15 years or so. Same thing for inserting a catheter etc. UGH! :sniff: AH..but I can handle trachs & g-tubes!! :wink2:

I do know from my research on this, that MANY nurses find themselves in this situation. I am also surprised at how many nurses actually let their licenses go inactive or lapse totally, then need/want to get back into nursing later. There are many posts on this here, and on other nursing forums. Most seem to be RN's though. Probably because there more RN's than LVN/LPN's. I will never, ever let my license expire or be inactive. I know it cots to keep it going, but it would be so much worse or more expensive to totally start over!!

Re: "Please keep me updated about your situation."

You too. I am interested in the online course you are considering, if you care to share.

Daytonite, BSN, RN · Aug 2, 2008

i don't want you to feel alone. because of some problems i ended up going into private duty nursing within a year of graduating from nursing school and did that for almost 3 years. the money was very good not to mention all the wealthy and famous people i got to meet. however, i worried like you about what would happen because i was not keeping up or learning things. one thing that you have going for you that students do not is confidence working with patients and people. you know how to do a procedure for the first time with someone and not let on that it's the first time you are doing it. students don't have that luxury--everyone knows they are students--it's advertised on their uniforms and they generally have to reveal it to their patients. you don't.

i got my first hospital job after working staff relief with a temporary employment agency. the nurses and hospital liked me so well that i was asked to come on staff. it was an opportunity that fell from heaven and i wasn't going to waste it. i asked the nurse educator for any information she had on procedures, i checked out the textbooks that were on the nursing unit where i was working and went through the policy and procedure manual to refresh myself. if there is a nursing school near you, see if you can get permission to access their audiovisual materials, particularly the nursing procedures. you can also buy cds of nursing procedures. there are free online videos at http://www.csufresno.edu/dcg/videos/faculty/dutra/n110a/, http://lib2.hacc.edu/nursing/nursing104/ and http://lib2.hacc.edu/nursing/nursing206/. you can ask permission to audit nursing classes at nursing schools for no credit if there are no refresher classes in your area and just sit quietly in the back of the classrooms. hobnob with the instructors after class (after all you are licensed, so you are one of them), pick their brains and see what kind of books they have in their offices and what they can recommend to you. some hospitals depending on how large they are have medical libraries and have some nursing books and videos. talk to their medical librarians to see what kind of access you can have to these materials. the larger a hospital, and if it is a teaching center, the more likely they are to share what they have with colleagues. as a licensed nurse, you are a colleague, kiddo.

someone mentioned ltc and i've worked there too. there is a lot of autonomy to working in ltc. you will get experience doing a lot of procedures there. because of their need for good lvns many will be willing to work with any shortcomings you might have.

no education is ever wasted. what education does for you is make you aware of resources to increase your knowledge. a formal education only opens the door. the rest is up to you, you have to be your own advocate, and depends on your ingenuity in expanding your own education.

CA_LVN · Aug 2, 2008

THANK YOU so much Daytonite for your response. It was thoughtful & so supportive! The links you offered were great!! I have already watched a few videos :specs: Even something so simple as donning sterile gloves is good to have a refresher on. Yes, I could have done it had I needed to ..but SEEING it done just helps to bring back the 'little' details one might have forgotten!

I really appreciate everyone who has taken the time to write back to offer me support or resources.

Keep it coming....I read every post!

iwanna · Aug 3, 2008

CA_LVN,

Here is the site of the course that I am considering. Most of the info is listed on the links of this site. It is www.lpnrefresher.com. And, the cost is $625. I received info on refresher course at school in PA and it cost approx. $1200 or 1300. (not including texts) Although, clinicals would already be set up at a univeristy teaching hospital. Unfortunately, this is too long of a haul for me. A great opportunity, but way too far. So, the online lpn refresher course seems the way that I am going. I live on the border of OH/PA. I believe that I am going with OH, since they pay more. And, I feel there is always a chance that the place may want to hire you. So, I will go with the higher paying state.

I am pretty sure that I will be taking this course. Unless, I should happen to get a job. I have recently applied to a mehadone clinic and other Behavioral Health clinic. But, I don't think the pay is that great. I think my best option is to get refresher and work private duty. I will keep you updated.

Umm, I put my license on inactive status when it was up for renewal in 2006. It was not looking good for me to ever to return to nursing. I was so depressed and could not see paying for something that I would probably never use again. I just re-activated it in Feb. 2008. Then in June, I re-activated my other state license. It really did not cost any extra, except that my PA license expired just a few months later. :banghead: However, if I had waited one more year, it would have been a great hassle. Fortunately, I fell under the category where I was employed as a nurse within the last five years.

Oh, BTW, she is only taking enrollment through Dec. 2008. You can send me an email to let me know how you are doing.