Discouraged with LTC. Advice? - page 2
So I just got my license in January (graduated in December). The facility I'm working at has a long term care hall and a shorter term/more acute hall. I oriented on the long term hall for 3 shifts.. With a nurse who then got... Read More
- 0Mar 31, '13 by SuzieVNQuote from RoxieRN0511So I just got my license in January (graduated in December). The facility I'm working at has a long term care hall and a shorter term/more acute hall. I oriented on the long term hall for 3 shifts.. With a nurse who then got fired. I had never worked as a nurse at all except in clinicals, had never had more than 4 patients (at the hospital) and had never done paper charting before (the hospital I did my preceptorship in is totally electronic). So I get thrown out into the hall with 35 patients and a MAR when I had never seen one in my life! It was awful. Then I oriented on the more acute side and got a pretty good orientation there, did shift there on my own for about three weeks with no issues. I felt pretty competent and even had an emergency where we had to send a pt back to ER and the doctor told me I had done a great job. Suddenly I'm told by management a full time position has come available.. And it's on the other hall. I was scheduled to reorient to that hall.. And the day before someone didn't come in and they called me into that hall. It was insane. So based on THAT (coming in when meds were already late, not being familiar with the way they chart over there because my first orientation all the nurse did was have me pass meds and "chart" all day) they decided I needed MORE orientation (which I was happy about!) I went and did the orientation and it helped. The day I thought I was totally going to rock it, the night shift had missed a trough for an IV antibiotic so I didn't have it. I had to call pharmacy, assemble it from the emergency kit, etc. took about an hour out of my med pass. The rest of the day went smoothly in my opinion.
I specifically asked the person who was training me what management's concerns were and he said just speed and organization. On a LTC hall where the patients are roaming about and not in their rooms a, both of those just take time IMO. I'm careful about the meds I pass. I make sure I have blood pressures before I give bp meds. The CNAs do vitals, but it's totally impossible for them to get to it before I need to pass my morning meds. I'd rather know i'm not going to bottom out anyone's BP than get my med pass done in 2 hours and hope for the best.
I asked the DON if there were any concerns and she just said it wasn't me, it was because I am a new grad and they knew I had poor training. And then she talked about making sure not to make med errors but also meds are "late" if they're not an hour before or an hour after. So be accurate but super fast. I feel like I can't do that as a new nurse! The nurse who was training me had worked this hall for a year and popped all the pills by memory and then just glanced at the MAR to sign them off. I know I'm not going to be to that point anytime soon!!! I have a general idea as to what everyone takes but... I just got my license, would like to keep it and don't want to kill anyone.
I left last night feeling pretty good. I'm still a little slow compared to those who have been there for longer but I'm feeling more confident. Then this morning I'm told that Saturday, which was supposed to be my first solo shift, I'm going to be working the acute side again. ?!?!?! I'm fine with that - I liked it better over there - but my gut feeling is that they don't think I can hack it.
I'm so worried that I'm a terrible nurse or something. The ONLY thing my trainer has suggested that I haven't done is to come in at 540 in the morning for my 6 am shift. A) they told us in orientation not to clock in until 5 minutes before our scheduled shift time and working off the clock can cause immediate termination and b) seriously being there at 6 is a miracle for me in the first place. I am a single mom and have to take my kid to daycare in the morning so it's not as if I just get up and go. If he sleeps over at the babysitter's I can, but then there's A.
Anyway, any words of advice? Is it me? I haven't made any errors or had any incidents that were caused by my actions, but I just don't know. I feel incompetent and like they think I am incompetent but just won't tell me to my face. Ugh! I like the job. I hate the patient ratios. I like the people I work with and I love the patients already. But I don't know what to do differently. I just need more time and practice on that hall to get faster. I know they have a state survey coming up, so maybe that's why they're so concerned? No idea. Help!
IMHO, a nurse should not give a BP med or other med (i.e. insulin?) based on a BP or other parameter obtained from other staff, lab reports being the exception.
1. It's a crapshoot- did they really take the BP, etc.), or just write one down?
2. Good luck finding the BP/vital sheet when you need it.
3. It's just more efficient to take the BP yourself, at the time you pass meds. It may seem counter intuitive, but try it. And a wrod on temps- if there is any doubt whatsoever, I'll take it myself. Easier than finding out 15 minutes before your shift ends that a CNA forgot to get the temp on a patient, and it's 103?