depressed about new ltc job

[MissJessica,RN]

I'm a new grad as of May 2010. Of course, there are few jobs in my area, so I'm trilled when offered a position in LTC. I recently finished my first week alone and hated it. All I do is pass meds all 8 hours. I have no time for patients interaction. I rush through everything I ever do. I'm suppose to work 3-11, but I find myself coming in at 2:30pm and leaving between 1 and 2 am. I cry before I go into work and cry when I leave. I have no time for anything else than work because the job is Monday-Friday. Some people at work tell me that it will get better with time....others say that it will never get better because they need 3 nurses on second shift.

I know most of you are probably thinking that I'm whining for no reason. I know that many people do this everyday, but I'm so depressed about it. I can't just quit because the bills are piling up, but I don't know what to do.

Not to mention that many people have told me to just pass 9pm meds with 5pm unless its a narc, which makes me really nervous. Is this the only way to get things done? It scares me to death to think that on Friday I had to sent a resident out to the hospital before 9pm med pass. I can't remember if I passed 9pm meds to her with her 5pm....can't remember if I signed the MAR before she left.

I'm scared, depressed, hate my job, and have no way out. I guess I'm just asking for some encouragement or advice.

[CNL2B]

Whoa -- I don't do LTC, but NO, you can't pass your 5 pms with your 9's! Hold your horses right there! Unsafe with big red sirens --- lots of HS/9 pm meds are q12h/BID. What if the AM BID med was given late, then you are giving the 9 pm dose at 5? You could be looking at only 6-7 hours between them. What about insulin? Do they piggyback all their HS insulin onto their dinner insulin as well (or do LTCs not do insulin q meal and HS)? I can see so many potential problems with that one.

It sounds like you work in a bad place. You probably either need to go through the appropriate channels to try to fix some of this, or leave, but please don't jeopardize your license or do something dangerous in the meantime. Don't pick up any bad habits either. Rely on the good, safe techniques you learned in school. No -- nursing school is not like the real world, but the real world shouldn't be like that.

Best of luck. You'll need it.

[RescueNinja]

Start looking for a new job, but for the love of God don't give up the job you have until you have signed on for a new one! Are you able to request more time with a preceptor?

[CrazierThanYou]

At my job (I'm a medication aide), we can give meds up to one hour early or one hour late. No more than that.

I am just starting nursing school but while working as a CNA in LTC I really didn't observe the nurses doing much of anything but passing meds, with the exception of the charge nurse and the treatment nurse. I guess there really isn't much time for anything else. Perhaps you will get faster with time and it won't take so long?

[JenniferSews]

One hour before or after. Don't pass 5pm with 9pm.

It WILL get better. You'll learn the routine and it will get much easier. You'll have time to interact with your residents and hopefully enjoy your job. LTC is tough, and wasn't where I envisioned my career, but us new grads can't be picky. Hang in there and give it a couple of months.

[FLArn]

Sorry to say that passing meds and writing a few hurried notes is about all you will ever have time for. Most places I worked in LTC each nurse had 30 patients in an 8 hr day that gives you 16 minutes per patient per shift for EVERYTHING you need to do for that patient. That includes meds, meals, treatments and charting. Any interaction with patients must happen during these activities. Oh and that is only if there are no admissions; then all deals are off. (P.S. this is why I don't work LTC any more!):yeah:

[Bebet39]

Don't be afraid, because the same thing happens to everyone. People just don't talk about it. Unfortunately we all work to pay the bills. As far as just passing out meds, the key is to learn all the medications. Learn all brand names vs. generic names. I know you want to do other things, because we all go to school to be nurses not pill pushers. Keep looking for other jobs and obtain some certifications. Look into specializing, like critical care, ICU or even home health. There are opportunities; you just have to keep looking. Hang in there. Don't be depressed.

[tokebi]

It really does get better with time. You get faster and faster as you really get to know your residents -- their meds, habits, likes and dislikes, quirks... I felt exactly like you when I first attempted LTC three years ago. Now I've come to cherish my relationship with the residents. Because of the nature of LTC, I think it's one of the most delightful place to practice nursing.

But... it's also the nature of LTC that makes it so difficult to practice "proper" nursing. Because we're always short on time, unsafe practices are so entrenched among the nurses, like giving 9pm meds along with 5pm meds like you mentioned, among many others. So be careful. I'm currently experiencing the repercussions of such actions.

I still believe that LTC nursing is so rewarding that I'd like to see you stick it out a bit longer before you make a decision. But, if you find that you just cannot practice safe nursing no matter how efficient you become, then there's something wrong with the facility, and you should leave in order to protect yourself.

[RNBearColumbus, BSN]

Wow. OK.. take a deep breath. What you are going through is normal for a new nurse in LTC. And some of the other posters are correct. It WILL get better. You WILL develop a routine, and you will be able to spend time with the patients that need you to spend time with them. And you won't need to spend time with every single one of your patients. Not all of them require it. If they are stable, and not having any problems, you move along to the next patient. This gives you time to spend with patients that really need it. (I hope that made sense.)

As far as passing your meds goes, it's a dirty little - not - so - secret that some nurses do pass meds from various times together. For example, passing the 4-5-6 timed meds together, and then passing the 8-9-10 (HS) meds later in the evening. The most important routine to get down is the med pass routine. Once you're comfortable doing that, the rest will fall into place. And it will come with time. I was on the job 6 months before I finished my AM med pass (With 28 patients) in less than 3 hours.

Are there any of the other nurses there that you trust that you can talk to? I'm sure they've all been where you are now. What about talking to your unit manager / DON? I know some can be real pains, but some are also very supportive. It's not like they don't realize that you are a new nurse and still ahve a bit of a learning curve ahead of you.

Hang in there. LTC is very rewarding, and once you get the groove, I think you'll be just fine.

[NotFlo]

I really feel for you. I'm three years in now and I can say in some ways, yes, it does get better, but some of the things you are having a hard time with never really go away.

You will get faster and you will get to know the patients. You'll learn all the meds and you'll figure out who is snoring by 7 pm and who is still up. The med pass will get a little tiny bit smoother and quicker every time you work.

However, the med pass will still dominate your time and will always be the big daunting thing that has to get done each shift. There's no way around that when you're dealing with passing so many meds to so many people. But you'll find you have a little more time for other things.

Unfortunately I still feel like little more than a pill pusher. I don't feel like it's possible to do assessments the way I want to do them on every patient (a lot of nurses I know rely on kind of "eyeballing" the pt.)

Combining med times is something a lot of nurses do, but I wouldn't even try it if I were you. The only times I do something like that is when I discover night after night that Mildred is snoring by 7pm and is difficult to arouse to take her 9pm meds...nothing like waking someone up for a sleeper and colace. I worked on a dementia unit where the nurse on the other hall told me I'd "better" combine my 5pm and 9pm med pass "or else". Well, I didn't, and ended up having to wake almost every single person up from a sound sleep for their 9pm meds. Why the regular nurses didn't get the times changed are beyond me, but I think they were so in the habit of combining 5s and 9s they didn't even think about it.

[tsentas]

Hello Miss Jessica... I can so relate to your situation. I was very unsafe in my first nursing job. I went into nursing in my earyl 30's and was so excited to get my first job. After one week orinetation on a high risk antinetal floor, I was on my own from 11PM - 7 AM with one other nurse who was also a new grad... talk about unsafe!

Listen to your instincts... don't give meds off schedule. If your admin won't help you, look for another job. I did and then loved my life. I went to a major teaching hospital in Boston and had a ten week orientation with a preceptor and then staff support for the next twelve weeks. I learned tons...

Best of luck to you....

This is my first time posting on this site... I just found it today and love it. What a great resource for nurses. After 23 years in nursing, I now work from home and love it.

[itsmejuli]

I'm a new LPN and started my first job working in an LTC in April. I work 7a to 7p every Sat and Sun.

Its really hard in the beginning until you get to know your residents. Now that I know their meds, accu check times, etc. my time management is getting better.

Its still a hard job, I'm always watching my time and trying to stay on top of everything that needs to be done. I usually have 20 residents to pass meds on, chart and do wound care. But this weekend I had 30 because we didn't have a third nurse for some reason or other. And no, I couldn't get everything done.

I can tell you that I have ended up in tears a few times at work. And I'm always waiting for that phone call on Monday giving me hell for missing something or other.

It does get better, I promise. I keep telling myself the same thing...it gets better.

I like my residents, even the needy ones who can consume a lot of my time. I had one this weekend who was terribly upset and acting out. She needed TLC. I made a phone call to someone special to her and my resident talked to her. Not even 10 minutes after getting off the phone this LOL was sound asleep. When she woke up she was in much better spirits. This made my day :)