[compassionate_1]

Hello all, I am a new nurse and I just got a job as an LPN in a Long term care facility, working the 7p-7a shift. This is my first job in LTC and even though the majority of my clinicals were done in LTC facilities, I have had a rude awakening! I have only worked 2 nights and I am already concerned if I will be able to continue working LTC! They have assigned me to 2 halls, a total of 32 patients, 25 of which I am expected to pass 8p, 9p, and 10p meds to all at once, a total of about 150 meds, all in about 2 1/2 hrs! I am very by the book and very safety minded. The other nurses at the facility have stated that "no one" can do this job by the book and get everything done. I have been told that in order to get things done in the "real world", short-cuts must be made, just dont get caught. That seems crazy to me! I have been in tears the past few days, trying to figure out what to do. The residents are getting some meds too early and others too late. The CNA's will disappear for hours at a time and the amount of paperwork that is dumped on the night shift is overwhelming. I want to do things the way I was taught, the safe way, but I cant get everything done, no matter how fast I try to be. Please, if anyone can give me advice on how to get things done quickly and safely, I would really appreciate it! Also, is my pt load normal for night shift? Day shift nurses only have 1 hall each, why do the night nurses get 2 halls? The residents are mostly sleeping, but all require alot of meds.

[Tait]

My process for this situation:

1) Take a deep breath, let it out slowly.

2) Ok now, feel comfort in knowing we have all been here. New nurses, trying our best to comply with all the things we learned in school. As with all things, practice makes perfect. As you work you will incorporate all your safe habits with ease, as if becoming fluent with a new language. Right now it feels cumbersome, in a few months it will be second nature to chart this, do that paperwork, and pass those meds.

3) Look to your peers. Is there someone you feel exemplifies your image of a safe nurse? Is there someone you could turn to that might be more supportive than the "cheat and don't get caught" nurses?

4) If not head to your manager, look for support from her/him. In the end they want safe nurses as much as you want to be one.

5) Give it time. A luxury in LTC, I would be lead to believe, is the consisteny of the same patients week to week. You will get thier habits down, and know who to hit up first, who to give the sleeping pill to early and who is going to consume a lot of time as they turn each medication over and over in a sun-downers moment.

6) If you still feel there isn't enough support, look for a new job! Nursing does not limit us to just one narrow path. There may be somewhere more fitting for you.

Best of luck, and keep your chin up!!



Tait

[2shihtzus]

Im a med surg nurse, and while I dont have 25 patients to pass meds for, I do understand wanting to do things by the book, as we were taught in school. Give it time. I think once you get your routine down, it will be easier. As far as "taking shortcuts", I think thats lousy advice, especially when it comes to passing meds. Do you have a window regarding med passes? Where I work, if a patient has a 2100 med, we can give it as early as 2000 or as late as 2200.

[househome]

This brings back memories!! Relax, we all have been there and you will pick up speed and do the job right. It takes a while, but you need to take your time and learn the job. If your manager is supportive go to that person. Talk to others. Trust me, no one did a perfect job right away. You will be JUST FINE.

[Dolce]

Oh you sound just like me a few years ago. I think I came home in tears almost every shift. Its a wonder how I made it through that first year. Hang in there. Every nurse goes through the first year as a new grad. It is good that you want to do things "by the book." Reality and "by the book" can coexist. But, some nurses find that there are more efficient ways of doing things that are safe and also faster than the 24 step-by-step instructions that Perry and Potter mandate for changing a bandaid.

Some tips for the all-important med pass....

Set up everything before your pass. Ice water, applesause, thicken-it powder, ensures, cups.

Begin the med pass at the end of one hall. Work your way down the hall, skipping the difficult, complicated or slower patients.

Be focused. Be task oriented. Do not allow yourself to become distracted. You can do it.

After all the easy patients are done go back and give meds to the slower/more complicated patients.

Some patients have bowel care, suppositories, creams, lotions and potions scheduled with their meds. I also give those last. You have to know how to prioritize. Lotions and potions are not as important as heart drugs.

Best of luck to you. I think you are on your way to becoming a great nurse!