Could use some opinions and/or advice.

Luv2BAnurse · May 27, 2007

It does take time. You are a new nurse. You are still in orientation. If you still feel that way near the end of your orientation, speak to the DON and request a little longer. I know that nurses have a lot of responsibility in LTC, I can't even imagine being responsible for meals (goodness gracious!), but it does get easier once you get a routine. Ask other nurses there how they manage the time.

kstec, LPN · May 27, 2007

There's the state's way and then there's reality. If your facility is so strict on certain things, then have the ADON, or DON do it in a timely manner and by the book. Yes it's nice practice (doing it by the book), but it's not real. I just graduated last year and took my first LTC job in Dec. 2006, I quit three days later. Then they actually called me back to give me a more in depth training. Well after it was all said and done, I learned my patients and what each one liked and then I figured out safe shortcuts so that I could spend more time with my residents rather than spending 4 hours doing my morning med pass strictly by the book. You'll find your niche. Like my instructor always said, when in Rome, do as the Romans do. They may tell you they do it by the book but ........ And for any LTC nurses who say they do it strictly by the book with 30+ residents, please tell me how, because obviously I'm not cut out for this type of work.

Daytonite, BSN, RN · May 27, 2007

i worked quite a few ltc jobs over the years. many times i had 50 residents to do all the same things you mentioned having to do. i was always working full time. it often took several weeks before i even started to feel like i was getting to know the patients. the first weeks of a job were pretty much trying to digest all the information about the facility and the way they do things. then, trying to get through all the regular routines of giving medications, the treatments and dealing with the cna assignments. my immediate goal in the first weeks was to just get through each day, get all the meds passed and all the treatments done. once i began to get settled in after 3 or 4 weeks (working 5 days a week) i began to start getting to know the patients. this all takes time to figure out.

you said you are working part time, so it's going to take you longer. you haven't said how long you've been at this job. if it's been 6 months, then i'd say you've got a problem. but, if you've only been at it, part time, for a month or two, you're being too hard on yourself.

nightmare, RN · May 27, 2007

This is a bit sideways to the thread but how do you identify your residents for drug rounds when you are new? Our drug Kardex has a photo of each resident beside their prescription sheet so that new staff can identify them,after all a lot of the residents don't know who they are!

CapeCodMermaid, RN · May 28, 2007

It is bad advice to tell a new nurse to forgo doing it by the book and to use 'safe' shortcuts. It is possible to do it by the book although it takes time and a lot of organizational skills. Your patients need the right med in the right dose and the right route a lot more than they need you to 'be' with them. I am not heartless and long for the days when patients weren't so sick and we did have time to 'be' with them, but these days when most patients on a subacute floor would have still been in the hospital 10 years ago, we need to do more than just be there.

YooperNurse · May 28, 2007

I have to agree with the cape cod mermaid. I would never ever not go by the book, especially as a new nurse, nor would I ever recommend it. It is one thing for a very experienced nurse to take a shortcut here and there, they know the exact timing of things and have a pretty good guess of how things will fly, but to start out taking shortcuts? Not a good move for your career. You gotta learn the ropes, and sometimes it is damn hard, you may have to move on to the next job to find easier ones, but everyone knows that nursing is a learning by doing experience.

lovingtheunloved, ASN, RN · May 28, 2007

LTC is fun, especially Alzheimer's. Learn to embrace the chaos. It isn't going to go away. The nurses I work with get everything done and have plenty of time to be with the residents. We have a fantastic administrator and DON, which make a HUGE difference.

kstec, LPN · May 29, 2007

For you that spoke of not taking shortcuts and doing it strictly by the book, I commend you, especially if you have 30+residents, treatments, new admits, someone going bad and two aides. If your that good, let me know your secret, because I was trained by very seasoned LPN's and RN's and they say do your best and bless the rest, because you are only one person. No I do not leave out anything in their treatment or medications, but there are ways to cut corners. As much as I'd like to chase someone down to give eyedrops in their room, when it's time and they don't want to go to their room, the hallway it is. I've not made an error yet and my patients are well taken care of. Or when a nurse calls in and I have 50 residents, my choice is either do my best or walk out and not except the assignment. I'd like to see some of the state inspectors do a better job than most of us do with some of the rules they put on us.

CapeCodMermaid, RN · May 29, 2007

Again "do your best and bless the rest" is fine AFTER you've been a nurse for a while, but to start out with short cuts is bad practice.

Some of the rules are absurd, but they still are rules so we all have to learn how to cope with them.

We always schedule the majority of our gtube meds on the 11-7 shift if they are given once a day. The patient doesn't suffer and the surveyors aren't there to make you go crazy.

Giving meds in the hallways-against the regs...BUT if you know your patient is always in the hall way at med time, either change the time of her meds OR write it in her careplan that she wants her meds given where she wants them. We had a woman who refused to have her blood sugar checked in her room but didn't mind a bit if we did it while she was in the hall by the nurses' station. So, we care planned it that way and documented in a nurse's note and we were fine.

Learn the right way first and then you'll be able to take safe shortcuts.

SuesquatchRN, BSN, RN · May 29, 2007

Again "do your best and bless the rest" is fine AFTER you've been a nurse for a while, but to start out with short cuts is bad practice.
.......
Learn the right way first and then you'll be able to take safe shortcuts.

:yeahthat:

I was "taught" from the beginning to cut corners and it took me a month to unlearn a lot of very bad, dangerous habits.

I'm one who does it "by the book." But we are well-staffed, and that makes a huge difference.

To the OP: focus on meds and vital tx. A sad reality of nursing is that we have aides to give a lot of the care and caring that, to me, is part of nursing.

Daytonite, BSN, RN · May 29, 2007

I'd like to address the topic of following/not following rules. Whether they are rules of law or rules of the facility, they are in place for a reason. I was working in LTC 32 years ago before some of these laws were passed and some of the things that went on were awful. After report, if there even was one, medications were "double poured" and left in carelessly unlocked medication carts where staff and residents could get to them. There were no state mandated nurses registries as there are today. Aides were people who walked in off the street and were hired and (hopefully) trained. I became a witness to one aide who got angry when a patient was incontinent moments after his bed had been changed and watched in horror and tried to stop this aide from pulling his wet draw sheet out from under him and start rubbing it in his face to "teach him a lesson". The night shift charge nurse at the time was busy sleeping. I talked before about the 3-11 charge nurse who passed all her meds for the shift at 6pm and spent the remainder of her time on the phone. She also gave hypnotics to patients that were noisy to shut them up so she wouldn't have to be bothered with them.

When the state surveyors come to a facility they also hold meetings with the staff. These meetings are announced, by law. No one should be afraid of these people who do surveying work. Besides making an audit of the facility, they also have the responsibility of teaching. Go to one of these meetings with a list of questions. Ask them how can a nurse possibly get all the medications passed to a 50-patient assignment in a two-hour window of time, etc. They will tell you. They are in facilities all over your state. They see the laws being followed in hundreds of different ways and they will share them with you, if you ask. Many of these people were instructors before they became surveyors.

Based on what I've learned from these people over the years, tube feedings, medications and some big time-consuming treatments can be rescheduled and done on a different shift or at a different time from the regular med passes. At one facility we started moving the majority of the daily crushed medications going down G-tubes to the night shift at 4 or 5am to coincide with the dressing change on the G-tube. This took a huge load off the day shift. Some medications were shifted to the noon med pass where most of the residents were in the dining room because there was no contraindication not to do that. The charge nurses are still supposed to be working together as a team with the DON at the helm if that's what it takes to get changes like this made.