Ok this is the deal...today there was an opportunity that was presented to me. I am 3 weeks shy of graduating from LVN school and have been pounding the streets hard. I have several offers and am trying to figure all this out. This one scares me a little and I need to see if I am rationalizing all this out right.
It is for a PICU position. From what I was told, they will train you as long as you need it, you have major support from the other staff (and from what I saw, they did look like they were working as a team). What my conern is, the LVN's do everything the RN's do. IV Cardiac Meds, fresh cabbage and stent patients. I mean these are real sick patients who could crater at any second. Patient/Nurse ratio is 4/1, she said that we basically let her know when we are ready for our own patients and we add to them when we feel we can handle it. Benefits sound promising, and they really do support you going on for your RN. Which was a HUGE plus for me. The payscale is VERY low, I could work in a Nursing home for almost $7 more an hour. The only shift diff's they have are $1.25 for nights, but currently they are only hiring for days. The hall has 35 patients and 2 CNA's.
Do you think that a brand new graduate could handle this. I feel like I am freaking out. I am scared to death. IV Heart Meds?????? Fresh Cabbage and Stents???? Can anyone say "Code Blue"???
Can I do this - I guess the reason I am really considering this, is because WHAT AN AWESOME EXPERIENCE IT WOULD BE. But would it be worth it?
Is this normal? I am thinking most hospitals around here don't hire LVN's for ICU floors, shoot most hospitals won't even hire LVN's.
If it were you would this be something you would consider? Please don't bash me, I am just wondering if my stomache is turning because I am scared or because I know its not for me.
I am in the Ft. Worth Tx area and there basically is a Hiring freeze for all LVN's when it comes to hospitals. So for this opportunity to be open, I had to atleast go and talk to them.
Yeah, I was thinking that even when CABG's are one day post-op that a 4:1 ratio was too much-especially with the small amount of CNA's present. That is a whole lot of ambulating and incision painting and getting up for meals that you would be responsible for since the CNAs are just trying to put out fires. That is all in addition to the meds and assessments, the rapid a-fib, and the heart surgeons yelling at you because you don't have their room set up for chest tubes to be pulled, while you try to set-up the pacer wires on another pt going bad.
I would think this may not be such a great start for you. 4:1 ratios is horrible for ICU, let alone fresh post-op. And LPN's pusing cardiac meds? Um, no thank you. Not to offend anyone, but as far as I know it's illegal and then who is responsible for the complications? The RN in charge. Sounds dangerous and they sound too needy, which means trouble for you.
Is it flow blow emergency clinic or is it an urgent care???
I think urgent care would be good, but realize it will push you with your skills as a new grad. It has enough variety, my only concern is the orientation they would offer you. With new grads that is really what it comes down to...a REALLY REALLY GOOD orientation. In my opinion.
But I think it is a way better choice than a nursing home...where I came from...now this may be different in other areas...Generally a nurse had a pt. load of about 30-1...you pass meds generally twice a shift, sometimes a third time if a pt. has an different time dose. You had 2 hours to get all the meds out..meaning if it is scheduled at 8am...you started med pass at 7am and end at 9am. Generally the second med pass of the day was a little lighter but the first one is a big load, you can barely get done in time. I say this because you may have pt.s that require, oral meds crushed up, need inhalers, patch changes, Dig(required apical pulse), eye drops, injections, and a topical ointments. So you can figure about 3-4 hours of your shift is passing meds..now the other 4 hours is your assessments, generally I had about 10 assessments a shift, remember we are talking elderly here, several disease processes going on, several in depth assessments. So you figure about 15 min to 20 min for total assessments, that ranges to about another 2-4 hours of your work...so there is almost your entire day your talking 5-8 hours we are upto. Now mind you, there is more yet. Helping to feed pt. helping to position pt. Checking BM's, supervising 3-5 CNA's. Now don't forget we have to get charting done. Now lets say someone falls on your shift or someone goes to the hospital or passess away...not only is sad but extrememly stressfull making sure you follow all protocals and policies. Nursing homes for good reason are monitored closely, there are several rules and regulations. Due to that monitoring, Nursing homes imploy several, I mean several policy and procedures which is a good thing. But straight out of school and for time after that, you are trying to remember what you learned to apply it to real life and now you throw all of that on it? Again I stand by my original statement, nursing homes are good for seasoned nurses, who have their technique down to a T and can focus on following what needs ot be done. The two nursing homes I worked at, there was not good team work and people would stab each other in the back, left and right...I just don't agree with that, I just don't think that is something a new grad. should learn how to cope with.
I would go for the emergency clinic, slight concern that it is an ER that you are either working under your skills or working above them. Remember for LPN's we walk a very fine line of what our scope of practice is...that is due to how it is wrote by the board and how it is interpreted by each facility. So we must error on the side of caution. I do think an urgent care wouldn't be bad, possibly good, as long as you were slowly brought into the role.
Good luck, Please ask anymore questions you have...
Annette
It is an Urgent Care, I applied with them my first semester and they called me immediately. They don't me to apply closer to graduation. So, 3 weeks away, I did apply and they are hiring GVN's, it is just a matter of are they hiring close enough to me. There are several in the Dallas Ft. Worth area. I checked off about 7 that I would be willing to drive to. We have a Career Day pretty quick and it looks like there are going to be 10 different places there that will have the opportunity to talk to, one of them is a hospital the rest are Nursing Homes. That particular hospital has no LVN positions open, except for clinic positions.
It's kind of frustrating because there are tons of RN positions that are going unfilled, but they won't even consider an LVN in alot of these hospitals.
The Nurse I worked with in my ER Rotation yesterday said this happens alot, the try to fade out the LVN's but then realize they can't do it without them, so then the hiring freezes stop. I sure hope so for my sake, I had no idea when I started school it was going to be like this. This is the first I have realized I may be in trouble. I thought there were nursing shortages here. Maybe I am not looking in the right places. I have faxed probably 30 resumes and applied to 20-25 jobs online. Surely something will come my way.
Be patient hun, your job will come around...remember with nursing..there is nothing with changing jobs. If a clinic position puts you in a hospital, that has good benefits, good reputation, closeness to home and other values you may have..then I say take that position. You will then have a much better chance at transfering to a med/surg or other position.
I know sometimes it looks difficult, getting your first job always is...but I will tell you this, I have been an LPN for 5 years...I have worked in 10 different positions, most of the time in a different field. The jobs are out there, you just need to get that first year of experience ( I stand by what I said, not a nursing home). Then you make yourself wanted, you increase your skills, I did this by...becoming a CPR/First Aide Instructor, paid for my own ACLS and PALS, since places where I worked didn't let LPN's do it (however they loved that I had it and I was on the crash team), did my IV Certification (my school didn't include that). I immediately started continuing my education (they like, looks good, really helps LPN's, I can explain how but not on this board, I feel it would start a small rival). Computer knowledge and capabilities is a huge selling point.
I would recommend you went for the clinic position or urgent care position, NEVER stop looking for what is out there...you never know what may come...no one keeps there first job forever...plus I don't recommend it in nursing. You gain respect as a nurse as you gain experience and a variety of experiences. I know currently work with the Air Force...several different jobs to my role, some things I do the Air Force as their RN's doing...this one pt. came in and I was able to recognize that he had either Non-Hodgkins Lymphoma or Hodgkins Lymphoma, I was able to lead my Provider I work with in the right direction...prevented him from treating the pt. with a viral infection...but I got that because I had 6 months experience in hematology/oncology...so you see I think changing jobs are good for nurses. Here is another trick, espeacially as an LPN, you change a job and eventually you begin to get paid for what your worth, you gain high levels of respect from other nurses. Lets say this, I make the same amt. in this state as a new RN grad...which no LPN's make that, but I am worth that and it is recognized by the Air Force of my qualities.
So don't stress thinking your first job has to be your dream one, cause it won't...the most important thing is to find a job that is good at recognizing the need for a slower orientation process and offers a diverse population of patients.
Good luck...keep asking questions...it will help you understand...
Oh gosh, I am so glad I asked, I new I was feeling funny/weiry. I wasn't for sure, but I new something wasn't right.
I really appreciate the words of wisdom, that in and of its self is much more valuable to me then anything I have gotten all year. The school that I am at is the number one LVN school around but these are things our instructors, because of time, don't tell us.
cardiacRN2006, ADN, RN
4,106 Posts
Yeah, I was thinking that even when CABG's are one day post-op that a 4:1 ratio was too much-especially with the small amount of CNA's present. That is a whole lot of ambulating and incision painting and getting up for meals that you would be responsible for since the CNAs are just trying to put out fires. That is all in addition to the meds and assessments, the rapid a-fib, and the heart surgeons yelling at you because you don't have their room set up for chest tubes to be pulled, while you try to set-up the pacer wires on another pt going bad.