Discouraged with LTC. Advice?

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    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 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!
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  3. 12 Comments so far...

  4. 2
    I doubt they switched you to the acute side because they didn't think you could handle the long term side. Sorry to say, but I don't think they care if you can handle it or not. Face it, you are the "newbie" and will be moved to wherever they need you. The nurses who have been there longer probably refuse to switch halls---no matter what.

    As far as trying to speed up by "memorizing" the meds so that you can fly through and just skim the MAR, forget it. Even on long term units meds do change. You don't want to find out after you gave the meds that the dose was changed, or the time was changed, or that the med was d/c'd. And don't count on the nurse who received the orders to change dose-time-or d/c a med to have either marked the box with the change or to remove the d/c'd med. People do get busy and sometimes miss a step when orders change. So take your time passing meds. Just try to avoid distractions--residents wanting to chat--other staff asking you questions which could wait. In other words, you know what you need to do for safety. I would rather run a little late and give the right meds---then be done early and worry about errors.
    NamasteNurse and sallyrnrrt like this.
  5. 4
    Its NOT you. I work in LTC myself and let me tell you once you get the med pass down you will be fine. You need to learn your pts and use your judgement. I am a agency nurse and at the facility i work out there are 5 units and I can tell you that I dont think any of the med passes are easier thatn others on the floors, you need to be more CONFIDENT in yourself, it makes a HUGE difference in your job performance, trust me this comes from experience!!! I during my med pass do NOTHING but that unless there is an EMERGENCY!! I dont anwer call bells,pass trays, help lift etc....you get too distracted and A make a error or get behind. I have a great set of CNA'S that i work with and they know i will help when and if i can. I also dont think when you are NEEDING VITALS to determine weather a med is to be adminstered or not you should let the CNA'S take them, TOO ME THATS WAY TO RISKY and I need/want my liscense. I also know that the general rule is ONE HOUR BEFORE AND ONE HOUR AFTER but i can say from experience I dont think that really happnens most days but I come pretty close, just give it your best effort and you will be ok, there isnt anyone standing over your shoulder timing you!!! Take it easy you will be fine...its your floor and your pts......learn how and when they get there meds and the best way to get them into them as well. I have some that I only give them meds when they are eating and some that get meds only in a drink.......you will find your way!!! good luck
    salvadordolly, sallyrnrrt, LTCNS, and 1 other like this.
  6. 0
    Hi I graduated past August for LPN. I finally found a job in a LTC. My question is they make us come in when a CNA calls in. Is this legal? I don't mind helping out but it doesn't look like they are trying to fix the call in problem. There are many. This is Georgia. I don't have certification for CNA. Does this matter? I went back to school working in home health and assisted living without a certificate and decided I want to be able to do more and earn more while giving care. Trying to find out not just for me but other nurses I work with.
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    Curious why you think it would not be legal? The work that CNA's do is the nurses work that can be delegated, certainly you should be qualified to do the parts of nursing that can be delegated to unlicensed personnel?
  8. 1
    Well my first piece as someone who has been in LTC is to never ever give meds by memory, even if you have been on a hall ten years, always always check the MAR. People do not d/c things as they should, even in EMR. I had a specific hall full time for 6 months, I knew every med by heart and I would still check every pass. I see many nurses doing that, and while I get it saves time, I would rather get sited for giving a med 30 minutes late than giving one that was dc'ed two weeks ago because I didn't check the MAR and the dc'ed med was never disposed because that happens all the time!

    My facility had the do not click in before 5 minute rule either but that was impossible to do. I needed my vitals before the AM med pass at 7 a so I had to come in 30 minutes early off the click to do them because the STNA's were way to busy with their 35 patients between 2 aides.,,most of my residents were total care and took a lot of time for the aides so if I wanted to give Bp meds correctly I was going to have to get them.

    I am always of the opinion that I am going to be safe no matter how long it takes me. My very first med pass on my own took four hours. I made sure I did the most time sensitive ones, like accu checks first and the least ones were last. But I left that day knowing I gave the safest care possible and that's all I care about. I did get quicker once I learned my residents and was able to complete med passes within the time frame within 4-5 weeks of being there full time. You will get quicker as well, my best piece of advice is to not pick up other nurses bad habits. If you feel funny about it chances are it is wrong. LTC is very hard and draining but it does get easier as time goes on.
    sallyrnrrt likes this.
  9. 1
    I also forgot to add because I wish I would have known this as a new grad in LTC is ask yourself every shift "did I cover my ass?" My top two priorities at work are my residents and covering my butt so my work never comes into question. I thoroughly chart and double check etc every shift. I can leave work without worrying I did something wrong as long as I answered yes to taking care of my residents the best I can and covering my behind the best way I know how.
    NamasteNurse likes this.
  10. 1
    Thank you soooo much for reassuring me!!! I was feeling so inadequate but I was just trying to be safe. The DON said it takes her 4 hours to do that morning med pass... Yet somehow after 4 shifts on that hall and less than 2 months of nursing I'm supposed to be faster?! Ugh.

    I got to work this morning and figured out that I was moved to the other hall because they had scheduled someone to orient on that hall. Sigh! I'm clearly not ready to TRAIN anyone! So that's a relief that it's not just because they hate me or anything. I'm on the acute side by myself and I think it should go well barring any major complications
    sallyrnrrt likes this.
  11. 2
    Hey!! Stop worrying so much!! Sounds like you are a great nurse getting used to her job/surroundings you just graduated, give yourself a break. If your bosses hired you they know what kind of experience you have and should take it in consideration. Just get into "nurse mode" when you work and give it your all. Then when the shift is over, go home to your baby and know you did everything you could for him/her. You'll do great, just have confidence (and caring ). The rest will come with experience.
    salvadordolly and NamasteNurse like this.
  12. 1
    No matter which hall/unit you work on, get organized before you start your shift. I make a checklist on my report sheet to give me an overall picture of what needs to be done on my shift. I always have a standard format where I list labs that need to be drawn, BS checks, insulins, treatments and folks that I need to chart on and then I list all of the tasks that may be specific to that hall/unit. I add to the the list as needed and check off as I go.

    Learn about your CNA's. Good or bad knowing their habits will only benefit you. Have a quick 2 min meeting with them after you receive report to keep them in the loop and address any concerns they may have from their initial walk through. Use this time to let them know what YOU expect of them. Communication is key and you may be surprised at how much better folks work when they feel like a team member instead of just an employee. Always say thank you and be respectful. It drives me insane when a CNA brings an issue to a nurse and the nurse responds with a roll of the eyes and a snide comment. CNA's are your first line of care and can be your best ally.

    Being proficient at the med pass just comes with time. The unit/hall, patients and meds may change, but your overall technique, although interchangeable, can remain the same.
    NamasteNurse likes this.


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