Changeover- Worst Night of my life (vent long)!!!!

When I started as a new RN in LTC, I cried my head off all the way home, and into the night. I didn't think I was going to make it. I was sure I would get fired, and almost did. I was thrown in without enough training, and told to "sink or swim". Of course, I made mistakes, and had to take some lumps. I wished I could make sandwiches at Subway or something. Anything else.
I still have hard days. Tonight was really hard. I had 2 incidents, and everyone seemed to be having issues. This is for sure though, I handled this night better than I would have 4 or even 2 months ago. Things are slowly getting better. I am getting really fast at med pass. I know all of my Rsdts, and what they need. A lot of it just flows. Practice and repetition. It will get better, if you just hang in and keep trying.
Who your CNAs are have a lot to do with how your shift goes. My CNAs are AWESOME and I love them.

You are going through exactly what it's like to work in LTC. You have my sympathy. I have been working LTC since I was an aide back in the early 1980's.

I work the 6pm-6am shift. Everyone thinks I have it made. Everyone thinks the residents are all in bed and don't need a thing. WRONG! I have a med pass from hell at 8pm for at least 30 of our 48 residents. Then after I think I can sit down and do my charting and doctors orders, residents all of a sudden want their pain meds. I was just down the halls and asked those who generally need a pain medication if they want a med and of course they told me no. Let me sit down and the whole place needs a Vicodin.

Then we have the one's that want to smoke until 10 at night. We only have so many aides who can watch those people. I don't smoke and I am the only nurse in the whole building, so I am NOT GOING ANYWHERE. Then you have the dressing changes, the hospice patients that need their morphine sulfate q 2 hours, then the am med pass that starts at 5am. No wonder LTC nurses are burned out.

Please take a good long look at your future. Do you see it there in that LTC facility? If not, start looking for something that makes YOU happy. You have a 15 year old that still needs you and if mommy is so burned out, it will be hard on her. Of course you have to work to provide for your daughter, but it's so sad to watch them grow up before your very eyes and miss so much in their lives. I have a 17 year old who has had to depend on her step dad for rides to school and back for ballgames. Mom can't be at the games..she works at night all the time..

I am sorry for the rambling. Just take good care of yourself and try to get your rest. If you decide that LTC isn't for you, at least you gave it your best shot.

Funny what you said about working at Subway. I have found myself in Walmart at 1 am after a horrendous 3-11, and just wanting to be one of those gals stocking the shelves & joking around with each other. It looked like Heaven compared to my job!!

Changeover night is the worst night of the month. My facility is so against overtime that I am not allowed in early on the night of the changeover. Usually many or most of the charts are not checked. I do what I can, but usually only work one or two nights inthe week prior to changeover. I spend the first night going through 60 charts to make sure all orders have been transcribed into both sets of books. Then I start to do what ever I can do to get ready for the change over. But, usually it is a big mess. It is not humanly possible to care for your patients and check the charts and changeover all the paperwork. I still get stressed, but I refuse to accept any negative remarks from day shift. After all if these same nurses would help check the charts like they are supposed to in the first place, the changeover would have 1/2 a chance of going smoothly. I have my priorities, the patients still come first. However everything, and I mean everything else comes last. The changeover dominates my night. I dont care if I work late the next morning, I plan on it, overtime be darned. If I can't get it all done, I make sure all the night things are checked, so I can chart my meds and treatments. Then I leave the rest. I put the new mars in front of the old ones, this at least gives the day shift a running chance. But, honestly I can't carry the whole load, and I refuse to. If you do a haphazed job of checking, and you make an ommission or mistake, its your license on the line. I am not willing to be the sacrifial lamb.

Jeez, you brought back nightmares for me. Three years ago my first LPN job was in an LTC on night shift. And I tell you the single most hated part of nights for me was the dreaded changeover. The week or so leading up to the end of the month would be spent playing catch up b/c of certain lazy nightshifters who refused to work on their share of changeover on their shift. One nurse in particular either requested off or called off every changeover night-no exaggeration- and since I was the float nurse, I would inevitably end up on her floor with all the half-done or not done MARS and TARS she'd left for me. And since she usually would call off, the supervisor would end up working a floor and therefore be of no help.
I've had many nightmarish nights like the one you describe, and you have my sympathy. Keep trying for a better job! There is one out there for you.

Can someone tell me what a changeover is? I have never worked LTC.

My heart goes out to you, as a new grad in LTC you have a very tough row to hoe! I couldn't have done it- I don't think I could do it now after 25+ years of nursing. Your post highlights just what I have been saying to anyone who will listen about the state of nursing today. Incomplete or unclear orders from the doctor- it's the nurses job to fix it; lazy NAs or nurse techs- the nurse has the ultimate responsibility to do thier job , pharmacy screws up the meds- the med giver- the nurse is where the buck stops, the floor covered with goo- the nurse walks through it or cleans it up- not to mention the risk to patients and visitors. The official term for what nurses are doing is "patient advocate" or "patient care coordinator", but what it amounts to is "scapegoat". As long as we are responsible for every aspect of the patients care going right, but have no control over the support staff, medical management requirements, and equipment needs, staff nursing is going to keep getting the dirty end of the stick. I don't have a solution, or even encouragement, but you are not alone in what you are feeling. I would never encourage one of my daughters or grandchildren to follow in my footsteps.

Changeover is when you have to take all the old med sheets, treatment sheets,CNA flowsheets, etc OUT of the books and replace them with the ones for the new month.
Before you replace the MARs and TARs, you are supposed to edit them...check them against the current MD orders to make sure they match.
It's not a horrible thing in every facility. We solved many of the process problems by just buying 2 sets of binders....the old ones are whisked away to medical records and the new ones go out on the unit.

It may go smoothly if there have been no additions/subtractions to the MAR. If you as the nurse don't catch errors/omissions in meds or tx, it is a med error for you. So you have to check the telephone orders, dietary, pt,ot, pharmacy reqs, opthlomology, psych reqs, yada, yada, yada. And if there are errors in any of the preceeding, you will be blamed anyway. We worked hard for our licenses. In Mass, they don't consider LTC/Sub-acute care to be "real nursing" (in most hospitals anyway). I would love to see some of these snotty magnet facility nurse-managers do what we do in sub-acute and with 25-50 patients at that.

BTW, take your own v/s don't rely on the cna's. Too many of them just plain make them up. And if you give a cardiac med based on a CNA's v/s report and your pt goes all hypotensive on you, IT WILL BE YOUR FAULT AND YOU WILL BE SUED, FIRED, BLACKBALLED ETC.

Maura-
I work in Massachusetts and haven't run into the same prejudices as you. When I tell other nurses what I do, especially when I was working in and then running, a sub acute floor, none of them demeaned me or my skills. Most of them said they couldn't do it if a gun were but to their heads. Everyone has different talents so let's not play the game we detest by calling other nurses names.