I need ADVICE!!!

  1. I am a brand new nurse orienting with LTC for another two days before they cut me loose. I think I have no problem as far as following policies and what to do but the issue I have is proficiency. I am still slow comparing to other nurses. Today (third week of orientation) I decided to take charge by telling my preceptor I want to do everything so when time comes I will be ready. Well, I found myself overwhelming. I had patients right next to me on my face demanding meds, a pt's husband insisting his wife take her med now while I was taking care of another patient. I felt so overwhelmed and almost breakdown, but I managed to keep my cool and pushing through. There is another mistake made. I tossed a prefilled osteoperosis med syringe into sharp container without knowing it is reusable. How dumb right?! My preceptor had to call ADON to remove the med from sharp container. I apologized to both for not knowing it's not suppose to be disposed. Although they said, it's okay after what I had done, I just feel like I might get boot out if I keep making this kind of mistake.

    Questions for all LTC nurses: How do you manage your time throughout your shift without getting behind? So far, I have seen that each nurse function differently. Is it okay to start passing out meds around 7-7:30 for 9AM oclock meds? My preceptor today did. She said as soon as she received her report/shift change she starts passing out meds. From my understanding, you have 1 hour window (I asked her this) but she said if you start out at that time you will never get it done on time.

    I need some advice on what I can improve on and function more efficiently. I could barely made it out alive after passing meds then charting. I didn't get to complete treatment book, transcribing physician orders. If I factor in everything suppose to complete my me accordingly, I would need an extra 2-3 hours after my shift to get it all done
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    About FutureRN_NP

    Joined: Sep '06; Posts: 140; Likes: 39
    from US


  3. by   Merlyn
    Rome wasn't built in a day ether are fast nurses. It will come. to the wife that was in your face, just tell her to wait you will get to her husband next. What is she going to do go to the supervisor and say you would give her husband his meds because you were in the middle of giving an another patient his meds. I remember an idiot (Iam sorry) a patient that said I would not give him his 9 PM meds at 5PM and he was going to report me to the supervisor. I picked up the phone and said you want to call her or should I. The guy looked painic stricken. He quitly said No. That was the last troble I had from him. You have to be compassionate but tuff.
    The Russians have a phase "Step by step. you'll become a little faster and better with each passing day. Keep with it, Kid.
  4. by   LoveMyBugs
    Little by little you will get there. You will learn who wants meds at certain times. Find out from your facility what their policy is for passing meds. In mine the AM med pass starts as soon as you get report 0630 goes untill 10am. There are residents timed meds 8am, 9am, ect. so for those patients I already know that and try to get to them at those times, you do have the hour before and after, but for people who get meds q4 hours I try to be on time.
    Again all of that comes with practice and knowing your residents, also knowing who needs crushed in pudding/applsauce.
    Again practice and time, and not to scare you I have been working in LTC for a year and there are days when I have stayed 2-3 hours over my shift, when everything seems to have gone wrong, however those days are few
  5. by   DizzyLizzyNurse
    You will not get the boot for throwing out a syringe not knowing it was reusable. I did that once. It's not even a mistake. Give yourself 6 months to a year to catch up to the other nurses. And relax. You will be fine.
  6. by   limey
    Three weeks orientation??? Are you serious??? I am a nurse for two years now working in LTC, the same facility where I also worked as a CNA. My first day as charge nurse on the floor in the Alzheimers Unit with 26 residents and two CNAs came after only ONE DAY of orientation. I have learned that you have to be the judge as to what to attend to at beginning of shift. If there is nothing critical to attend to, take care of whatever duties you can get out of the way before time to pass meds, because you can never predict what will happen on your shift from the time you get report. Make sure you know where your aides are and they know where you are at all times. Depending on what kind of administration the facility has, you may have to fight for yourself and your aides to get good results of care of the residents. Many times our administration has tried to put only one CNA and an orientee NA on my hall, of which I believe is a disaster waiting to happen. Working LTC is very stressful, but can also be very rewarding. Just do your best and I wish you lots of luck.
  7. by   noahsmama
    They didn't tell you that syringe was reusable before you threw it away, and you didn't somehow magically know? Oh my goodness, you're going to be a terrible nurse!

    Just kidding of course -- how could you know something like that unless they told you? Now that you know, you'll never throw one out again.

    As others have said, you will get faster. Sounds to me like you're doing really well for a brand new nurse. Good luck!
  8. by   Forever Sunshine
    You will get there..give yourself time and patience and don't let the line of demanding residents/family at your med-cart bring you down.

    I would not let that fly. If I'm with a resident and someone wants their medication they have to wait until I'm done. Yelling and screaming at me won't make me get meds out any quicker.
  9. by   brandy1017
    They didn't actually fish the syringe out of the sharps container I hope! That would be dangerous, dirty and disgusting. I hope I misunderstood what you said.
  10. by   CapeCodMermaid
    No one expects a new nurse to be as fast as a seasoned nurse. I hate that the med pass has become the be all and end all of the LTC nurse's day. Most of the residents don't need half the meds they have. Take your time, try to ignore rude family members. You can ask them to leave you alone so you don't make a mistake. If it were their family member, they would want you to take the same care.
    The tone of your post isn't one of complaining or whining....you'll be great. Give yourself some time.
  11. by   NotFlo
    Heck yes I would start the med pass the second I got out of report. I would punch in as soon as possible (typically seven minutes of) and quickly stock the cart, count, and get report done as quickly as possible. Even better than starting at 7:30 is starting at 7:15. When I float to a long term care floor with 30 pts and forever med passes believe me I am flying to get those accuchecks and get the insulins and meds going as early as possible.

    I can't keep the med pass to 2 hrs anyway (it takes at least 3 hrs on a really good day...) so I'm certainly not going to stress over starting early. Better to start early than to be passing the 9 ams at noon...
  12. by   DizzyLizzyNurse
    So I had my first day off of orientation at my new place. I was put on a LTC unit since my unit was shut down (long story). If it makes you feel any better I was so slow even with my years of experience because I didn't know the carts or the residents. So slow, in fact, that the aides joked that I spent 7 hours out of the 8 hour shift passing meds. So don't worry about it!!!! You are fine!
  13. by   DixieRedHead
    OP, back in my LPN days, I medicated 62 people twice a day. The first day I was on my own, I was still giving 9 o'clock meds at 1 pm and I did start at 7.
    Time and practice, time and practice.
    After about 3 months that nine o'clock med pass was finished at 930 after starting at 7.
    You will get there, hand on.
  14. by   morte
    a newer "method" of insuring compliance is giving windows on the MAR ie colace, one, by mouth, daily, between 8 and 11....

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