Busy week

Phew, I'm on my last day of working 8-4 doing pedi homecare and orienting 5-9 at the nursing home. As exhausting as this schedule has been, I think I might ask to do the same thing next week, after my 12-hour orientation shift on the shift I'll be working there.

I love the nursing home so far! Everyone's been super friendly and helpful. I think I've made a good impression so far. Despite the fact that I've been out of the med/surg environment for a while (the longest period of time since I started), a lot of it came flowing back once I got on the floor. I've been assigned to follow a different LPN each orientation day to get a hang of their routine for medication passes and treatments.

I got to do my first intra-dermal injection (a PPD test)! I was a little nervous I'd mess it up, never having done one before, and I had a hard time visualizing the bevel of the needle since I'm stuck wearing old-prescription contacts until I find my misplaced glasses. I slid the needle in to the skin of a patient's arm and was rewarded by a perfect bleb containing the PPD. I also got to administer some g-tube medications, gave some insulin, passed a bunch of meds, did some dressing changes, and I had a blast doing it. The LPNs couldn't help but crack up when they saw how enthusiastic I was about getting to do a dressing change.

Working the floor has been going well so far, despite the fact that they still use paper charting (ugh!), the books and forms remind me a bit of my year in the group home for adults with autism. I'm still getting the hang of the workflow, but there are even bigger challenges coming up at this job.

See, I'm being hired as the -charge nurse-. As I explained before, I have a feeling that this is more to fulfill the facility's medicare requirement to have an RN on shift by hiring someone who won't mess up the experienced LPNs system. I got a taste of what kinds of things I'll be doing as charge, as I had to manage a constant influx of information from the CNAs, requests from residents and family members, and a census that included a lot of confused, forgetful people on a variety of medications.

I've discovered that once I'm off orientation I'll be able to write orders for PRNs (like anti-emetics and anti-diarrheals), X-rays and even Labs! It'll be a while before I can really exercise this ability efficiently, but the thought of being able to order Albumins, 'lytes, U/As, tox screens, etc is really exciting to me for some reason.

I think I've made a good impression on the LPNs so far. We all realize I have a lot to learn, but doing little things like asking to see the sliding scale when one of them hands me a syringe of insulin to administer shows them, at least, that I'm aware of what I'm doing, even if I'm doing it a bit slowly at first.

It looks like getting the job done on the floor in a timely fashion requires a lot of things that I would have considered cutting corners after my training in med/surg. There's "too much to do" to dot all the i's and cross all the t's the way I've been taught it's supposed to work. Even still, I'm holding on to those imperatives my clinical faculty imparted to me. Even though I didn't always get it right while I was in school, I managed to carry a lot of their stern reminders and warnings with me (which I guess was the point).

I'm definately going to have to bring a notebook with me to jot down notes on all of the requests people make. I'll probably have to get another one of those multi-color pens as well, from the looks of it.

I got approached by an MBA who works for one of the big dialysis companies, he wants me to email him my resume and references and get me hooked up at a dialysis clinic near where I live. I'm seriously considering it, since the Pedi homecare job is starting to look like more stress than it's worth. Not from the patient, mind you, I think I'm doing great with the kid's care, it's the -mom-. When I told this to the LPNs at the nursing home they all nodded knowingly. They said it was the parents that kept them out of Pedi, not the patients. We'll see what happens.


Chris said...

I think you should try to stick with the pedi care through the end of the school year at least. My guess is that the kid would be better off with that stability. In med/surg, you would have to deal with a crappy family. Here, same.

PM, RN said...

Yeah, I came into this assignment planning on giving the kid at least a year for the sake of his continuity-of-care. There's no "school year" at this point to speak of, pre-school is year 'round here, and the kid'll be there for two years instead of one because of his developmental delays.

There's a lot of other stuff that's starting to bother me though, and making me think I might only be doing this for like 6 months (if I last that long, I'm one snide comment from the primary caregiver away from dropping the case). I want enough to put on a resume to say "hey, look, I can do this and this", which was why i decided on a year at first.

The PCG is often rude and talks down to me, sets up elaborately detailed plans on how I'm supposed to accomplish my tasks, and then changes them around all the time. I'm starting to think the kid's dehydrated and needs more free water via g-tube but the PCG got all defensive and hostile towards me when I brought it up, saying something about how the body "breaks down" water differently than it does the feeding formula. Bleh. Lots of teaching needs, and complete resistance to any kind of teaching at all. It's a disaster waiting to happen. I'm also starting to think I shouldn't be administering the lactulose-apple juice mixture that the PCG is preparing, since I'm basically administering a med that I haven't seen an order for and don't know the exact dosage of. On top of all of that, the agency's chart for the client is held up in an audit by the state and i haven't even seen it yet. When I ask about calling the client's doctors, the PCG gets all defensive and calls me "unprofessional". It's just starting to be way more trouble than $25/hr is worth.