Is this Normal? Need some perspective!

Nurses General Nursing

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Hi there,

This is my first time posting. I have read many posts on this site and have found the different responses very helpful. My dilemma is this: I am a PN student. I've passed all of my nursing classes and clinicals except for one med surg, which I have to repeat. My school doesn't offer it again until January 2010. I was disappointed and concerned about forgetting all of the skills I had just learned so when the opportunity presented itself to work as a nurse intern I was delighted. Well...that delight has quickly turned to frustration. I work in a very large LTC facility. School so did not prepare me for this. I've worked as a CNA for 21 years so I understood the classroom environment is very different from the real world but actually being in it has still been a shock to my system. I do two med passes a shift for thirty people each and am also expected to do all of the treatments, skin assessments, etc for the whole floor which is 53 people. In addition to that, I'm also expected to help pass trays, record meal percentages, I & O's, and check that all of the residents have their alarms on, mats down, boots and elbow protectors on etc. The CNA's are supposed to being doing some of this stuff but half of the time when I check I find that it's not done right or at all so I need to fix it. I have had 9 days of orientation and am expected to be on my own now. I am still struggling with my med passes. This has taken up most of my orientation. It's a big strech to go from giving one resident meds once during a shift in clinicals to 30 twice a shift. I feel the need to rush or my coworkers will be angry with me for being behind. I've already had a few errors and they were really basic ones, rules that were pounded in to our heads in school. I know the reason is because I'm rushing and not doing all of my checks. Most employees there have no patience for new people. I get a lot of eye rolling and sarcastic remarks. It's so frusterating and hurtful. I know I'm an intelligent person. I'm leaving my shift feeling like such a failure. Part of me thinks what they are expecting me to accomplish in a shift is crazy. I understand that as you learn the residents, meds, and treatments you can incorporate them together to be more efficient but all of that takes time. My orientation has been a joke, I've been on my own for most of it. I've spoken to the DON on two occasions and she followed through once on making sure someone was with me. She told me yesterday the administrator probably won't approve any more orientation. It's so frusterating! I was really looking forward to learning and using some of my skills. I don't want to be a quitter but think I may have to. I don't see how I will ever accomplish everything I'm expected to in one shift. I haven't even gotten to the paperwork yet. From what I've read on this forum, the first year is the hardest. Should I hang there or am I in an impossible situation?

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Specializes in Utilization Management.

I'm going to assume since you have to repeat a med-surg course that you have not actually graduated from PN school. So you are working in LTC, functioning as a nurse, without a license to practice? Are you with a licensed nurse doing all of these med passes, tx's, etc? Either I'm confused or something is wrong at the place you are working.

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Specializes in LTC.

You're doing a med pass and you're not a licensed nurse? Am I missing something too?

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I'm working more as a med tech but have the title of nurse intern. I am able to do insulins and the treatments that the med techs are not able too.

There is a licensed nurse on duty but she is not present with me when I do everything.

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Specializes in Utilization Management.

Hmm. Sounds like a typical day at the LTC's where I've worked. It is frustrating and difficult. It wa always a thrill to have couple of wound-up relatives on a Sunday added to the mix during the lunchtime chaos of meds, GTubes, Accuchecks, insulin, and low staffing.

And the charting! Good heavens, just thinking about it makes me want to go hide in the closet and drool.

But you'll improve, don't worry, and those who treat you badly now are not worth getting upset over; they forget they were new once too.

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Specializes in Psych, M/S, Ortho, Float..

From what I can gather here, it sounds like they are abusing you. They want you to work as an RN without a license, pay you dirt and if anything happens you will be left out to dry. My suggestion would be to work as a CNA for a while until you get back to school. Or play computer games, or Walmart. Don't jepordize your licence before you get it. This does not sound like a good learning environment. IMHO.

Good luck,

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Specializes in LTC/Rehab, Med Surg, Home Care.

Considering that you are working as a nurse intern, without the actual PN license, I think this sounds like a dangerous situation. In my state, we have trained medication aides. When a shift can't be filled by a nurse, we will use TMA's. This sounds like more of the capacity that you can (without the license) work without supervision. Without having a mentor/preceptor readily accessible each shift that you work as a nurse intern, I would be very wary of working in the capacity you are describing--signing off on skin assessments, for example.

Now, my guess is that the facility you are working in will state that you ARE being supervised, but the snarking by your new co-workers would be evidence to the contrary. How quickly nurses forget our first year!

That being said, what you are describing (minus the comments by co-workers) sounds like a pretty typical brand-new nurse experience in an LTC. It DOES get better. It DOES take more than 9 days of orientation to be comfortable. It WILL get better, if you choose to stay.

I would recommend looking for a facility that would allow you to work as a TMA instead. When I work with a TMA (and there are only a few that I'm really comfortable working with) as the floor RN, I have to supervise their work, I still need to do the insulins, and I do not let them do skin assessments. For those that are in nursing school, I will ask them if they want to come with me for wound care, catheter changes, and skin assessments.

Something that I do not think is stressed enough for LPNs in school is delegation, delegation, delegation. It IS stressed more for RNs. You will learn this as you go--especially with all those things in the treatment book like shin protectors, alarms, etc. You will get to the point where it's automatic, but this takes a long time. Heck, at this point when I can't sleep I run through my AM med pass for my residents :-) I can tell you which residents have alarms, if it's a pressure pad, a tab, etc. You learn to cluster your care so those precious few minutes a day that you have with each resident counts--you'll hand them the medication, look for the alarms, and say "how is that scratch/bruise/abrasion on your arm/leg,shoulder etc doing? "Oh, can I see your....and check for the shin/arm protectors."

It helped me to have the treatment book on my med cart. I've also seen new nurse who use two report sheets--one for the previous shifts info (some will use a different color pen) and they use that sheet for reporting items. The other sheet is for vitals, treatments, blood sugars, etc. They fill in who needs what and then staple the two sheets together back to back to flip back and forth.

Just another organization idea to try and help :-) Good luck in whatever you decide to do, but please know that the overwhelming feelings are pretty normal. School simply does not prepare you for what the day to day activities of nursing are really like.

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Specializes in Public Health, TB.

This sounds very much like my first job. And the main charge nurse made sure that I knew that she was the "nurse" while I was only the "practical" There are always some some negative staff who seem to make it their life goal to cut you down. Please don't let them bully you.

Instead rely on the people you know really care and trust to do their job and let them know how much you appreciate the good job they do. I firmly believe that people will rise (or sink) to your level of expectations. Feeling like you always have to correct others' work is so negative and draining.

It will get better. And i hope you are able to enjoy interacting with your clients, because that the best part, IMO, of working in LTC.

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Specializes in ER.

Run and do it fast!

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You're doing a med pass and you're not a licensed nurse? Am I missing something too?

You didn't do med passes in clinicals?

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Specializes in Utilization Management.

I did med passes in clinicals with my instructor or the nurse right next to me. If I was to do them on my own during clinicals...I would've gotten written up at the very least.

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Has no one ever worked with a nurse intern?

A lot of the posters appear horrified that the OP is passing meds and working as a nurse without a license. This is what nurse interns do. They work under the RNs license (as in clinicals) and pass meds, do assessments, and perform treatments- just as we did in clinicals, but they get paid for it.

It is not shocking- but very common.

However, this place appears to be taking advantage of the OP. That is way to much to ask of a student- or an experienced RN.

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