Lowest of the Low - page 3

Hi all, Hoping for some insight, support, advice. I have now been working LTC for 9 weeks. I am a new grad, had two weeks of training, and been on the floor on my own since then, hired as a charge... Read More

  1. by   PMFB-RN
    I think I used to work there If not then a place just like it where I was charge as an LPN.
    My advice is to quite (with proper notice) right away and seek a job on a med surg floor of a hospital.
    I usually advise new grad to stay away from LTC. The problem in LTC is that usually you are out there alone without lots of experienced nurses around to ask questions.
    Spend a year or two on a med-surg floor where you have expeirenced nurses, docs, RTs, ect around to help and teach you.
  2. by   Elektra6
    LPN here, 11 months experience. I quit a place last year because they were using AGENCY nurses to orient me in LTC, not even ones that went there all the time! They wanted to give me 3-4 days orientation to work the 3-11 shift. Never went back after a few days.

    Found another LTC, got 5 WEEKS orientation and have been doing okay ever since. I think you should leave this job, tell them it is not working out.

    CNA's can be tough on all newbies, even CNA newbies, so be firm, help them whenever you can and reap the dividends. Show them you respect their judgement about the residents, address any concerns they voice about them. The biggest complaints CNAs make is they voice concerns and the nurse doesn't address it. I always let them know what I did or plan to do. I would rather have them come to me 10x for nothing, than miss something important. This has worked out really well for me, but the beginning was rough going!

    a tip for wound care:
    I take 5 minutes at the beginning of my shift and go through the tx book and jot down all my treatments on the back of my census sheet. Come in 10 minutes early if you have to. After I do each one, I put a line through it. You don't have to worry about forgetting anything and you'll always know what you have to do. Example: Last night didn't do this, found a new tx at 11 pm. Need to follow my own advice.

    best of luck, you WILL find a job you like
  3. by   purplynn
    Quote from meanbird
    LPN here, 11 months experience. I quit a place last year because they were using AGENCY nurses to orient me in LTC, not even ones that went there all the time! They wanted to give me 3-4 days orientation to work the 3-11 shift. Never went back after a few days.

    Found another LTC, got 5 WEEKS orientation and have been doing okay ever since. I think you should leave this job, tell them it is not working out.

    CNA's can be tough on all newbies, even CNA newbies, so be firm, help them whenever you can and reap the dividends. Show them you respect their judgement about the residents, address any concerns they voice about them. The biggest complaints CNAs make is they voice concerns and the nurse doesn't address it. I always let them know what I did or plan to do. I would rather have them come to me 10x for nothing, than miss something important. This has worked out really well for me, but the beginning was rough going!

    a tip for wound care:
    I take 5 minutes at the beginning of my shift and go through the tx book and jot down all my treatments on the back of my census sheet. Come in 10 minutes early if you have to. After I do each one, I put a line through it. You don't have to worry about forgetting anything and you'll always know what you have to do. Example: Last night didn't do this, found a new tx at 11 pm. Need to follow my own advice.

    best of luck, you WILL find a job you like
    :yeahthat:
    As a new grad I also started in LTC. For the first couple of months I ran around like crazy, had a hard time developing a routine, feeling like an idiot and the worst nurse on the planet. I really does take a while to settle in.
    There were (and still are) a few nurse who are not at all supportive, patient, or helpful. Then there are those who are. The nurses who are supportive are who you should get your feedback from. Get to know your policy/procedure books. If in doubt, look up facility policy.
    I agree with every post thats states checklist, checklist, checklist!
    At the beginning of EVERY shift I start of list of who needs what during report. P report and count I go through my mar and tar to see what I have to do and make myself a flow sheet. It really helps.


    e.g.
    Skilled Assessments
    t,p,t,bp,spo2, ls,bs,skin,pain,diet,mobility

    VS
    t,p,r,bp

    ATB
    temps
    adverse reactions

    S/S
    i.e. cough,
    sinus,
    URI,UTI...

    Aerosols
    spo2,ls,coug

    DM
    iddm
    po
    fbs

    GT
    bolus
    continous
    flushes

    TX's
    creams
    procedures
    drsgs

    and so on.

    Anyway, I hope this helps! Hang in there!

    BTW, your DON hired knowing your level of experience. Don't let'em get you down. Know you limitations and don't be afraid to ask questions. No support = dangerous environment, for your "R" and your license. Don't be afraid or feel bad if you need to move on. Follow your gut!

    Keep us posted!:icon_hug:
  4. by   texas_lvn
    OP, have you had your "meeting" yet of where you talk about your goals? How is everything? Keep us posted, please
  5. by   banditrn
    Quote from purplynn
    :yeahthat:
    As a new grad I also started in LTC. For the first couple of months I ran around like crazy, had a hard time developing a routine, feeling like an idiot and the worst nurse on the planet. I really does take a while to settle in.
    There were (and still are) a few nurse who are not at all supportive, patient, or helpful. Then there are those who are. The nurses who are supportive are who you should get your feedback from. Get to know your policy/procedure books. If in doubt, look up facility policy.
    When I started LTC, I'd had many years experience as an RN, and it still took me a couple of months to get my routine down!!
    My mentor is the LPN who works opposite me on nites - we talk a lot, share problems and solutions about residents, and she gave me a lot of time saving tips for dealing with so many people.
  6. by   lvs2nrs3535
    thank YOU Thank You thank YOU..
    I think ( I hope) I know what you mean.
    Here are my personal goals as I responded on paper for this challenge.

    (Goals for Success

    Time Management/Organization.
    I will make a list of my treatments needed on my residents, with a check off space to help me maintain a quick visual reminder of what has been accomplished and what still needs to be addressed.
    I will keep room on the same list for questions I have which cannot immediately be answered, and a list for needs that must be addressed, (i.e., a patient missing belongings, a resident’s or their relatives requests) so that these issues will never be forgotten or remain unaddressed.


    Focusing.
    I feel that my biggest problem with focusing is feeling that I have to be there at all times for everyone and everything. I am going to focus on the task at hand, and have more confidence in my co-workers and my CNA’s that they can and will respond to the needs and demands of residents.
    When I am involved in a task, (i.e., documenting), I will focus on the task at hand with the concentration necessary. If I am unable to do so because of the environment around me, I will remove myself to a quieter space, (something as simple as moving to the other side to the desks).


    Professionalism
    During extremely hectic times of day, (i.e., Doctors there giving orders, patients beginning sun downing behavior, shift changeover, ect.), I will take a deep breathe, prioritize needs, maintain my calm in the center of the unit. I will also ask my nurse manager for help with the most urgent needs when I am unable to immediately meet the most urgent tasks at hand.
    Documentation: When documenting, charting and during reports I will keep in mind the absolute importance of this task, and not allow myself to feel rushed with the next task at hand.
    Personal Behavior: I will be very conscious of my approach and demeanor when I need to address co-workers, especially when I must request help. I will also document on my time management list who I have asked to accomplish what for a resident, and the reason. (for example, 1055 hours/asked Judy to address E. O., , resident digging in briefs, due to large BM. I am collecting supplies to obtain UA on said resident. I returned with supplies, helped Judy finish cleaning resident, and she helped me obtain UA.) At this point, these notes are for my use only, to keep track of who I am asking to do what and to help me go to my nurse manager when my needs are not met, for whatever reason. I very much respect the job that my CNA’s do, and know how busy they are and how hard they work. By documenting my requests, I hope to avoid coming across as rushed or stressed out. If I need to take the time to write down my requests, then I will ensure that I can communicate this request without any margin of error, and more importantly, avoiding ever mistakenly making the person I am talking to feel as if I am unsympathetic to their work load, or rushing them. I will also be able to maintain accountability for tasks in this manner, one of my jobs as a charge nurse.)

    As put down in the preceding document, I will address each of the issues that have been brought up.

    This was my written response to my 'warning'.


    In a small place you have to be careful of what you say and how you say it. When you are the "new guy" you have a place--the bottom rung. When it comes to making any kinds of judgments about the facility or the people that work there, the less you say, the better. Looking back, I would say that one of the biggest mistakes any new grad can make is to constantly apologize for their lack of knowledge or ineptness at their jobs. It's natural to say these kinds of things because you so-o-o want to do your best, but you know you are all thumbs and slow. But, you just have to clam up and keep these feelings and emotions to yourself when you are in the workplace. These kinds of comments said enough and over time tend to be seen as a sign of weakness and craving for attention and sympathy or pity. Some people will interpret it as whining. Many co-workers eventually don't want to put up with this, so you start getting all kinds of unwelcomed behavior from them. Some will latch onto the weakness and go for your jugular as happened with me. The more you talk, the more you reveal about yourself. That is not always a good situation. People are more reserved when it comes to taking issue with people who are quiet and speak only when necessary because they don't know enough about them or what kind of reaction they might get.

    You can't change past mistakes. But, you can learn from them. I know what is now going to happen for you because I was in management for some time. You are going to be asked to make some goals--in writing. Make your goals achievable and not general--goals that you know you can accomplish. You will be supervised very carefully. If they are determined to terminate you, they will use this as a way to do it. The minute they can show that you are failing to achieve a goal, you'll be shown the door.
    Last edit by lvs2nrs3535 on Oct 14, '06
  7. by   lvs2nrs3535
    Quote from motorcycle mama
    If they told me I would not be recommended for hire after my probationary period, no way would I go back to that shappy operation!
    Are you some kind of masochist? Get out of there yesterday!
    Hey, I am not a masochist, BUT, I already left one job because of the stress factors, and I do feel as if I dont put my all into this, I will just be the job-hopping, cant deal with whatever is thrown at me, run-away kind of nurse. This is not what I want. Do you have better advice? Leaving is easy, but I need help with how to stay.
    PS, posted my written reply on how I would deal with my challenges. Could you go back and read that and then critique me on it? I would appreciate it.
    Thanks so much
    KristyBRN
  8. by   MS._Jen_RN
    GET OUT. NOW.
    ~Jen
  9. by   MS._Jen_RN
    Quote from KristyBRN
    Hey, I am not a masochist, BUT, I already left one job because of the stress factors, and I do feel as if I dont put my all into this, I will just be the job-hopping, cant deal with whatever is thrown at me, run-away kind of nurse. This is not what I want. Do you have better advice? Leaving is easy, but I need help with how to stay.
    PS, posted my written reply on how I would deal with my challenges. Could you go back and read that and then critique me on it? I would appreciate it.
    Thanks so much
    KristyBRN
    Some people take time to find a place where they fit. You would not be job hopping, just finding a place where you (read- your licence)and your paitents are safe. There is an issue with a facility that is hiring a new grad and putting them in charge after 9 weeks. You are not the issue, but i would get out before their issues are yours.
    ~Jen
  10. by   barbyann
    In my line of thinking, the probationary period goes two ways! Do they like you and do you like them? I would plan to evaluate THEM at 90 days and see how they stand up

    Do you feel supported by management?
    Do you have the neccessary tools to do your job?
    Do you feel secure and safe on-site?
    ETC.....................

    Finding the right job takes some time. Happiness in nursing is all about a good fit for you and them! When you get it right it feels good!
  11. by   barbie90210
    [font=book antiqua]wow - let me just share a few of my choice memories from 1985 when i started as an rn. first of all i got a new grad program at a very large hospital chain. it was a thorough orientation and i was put on day shift on a very busy med/surg unit. oh wait - that's not the beginning.
    [font=book antiqua]during nursing school i worked as a nurse aide at a medium sized community hospital. after being there about three months the night sup called me into her office. she took out this writing tablet - a huge legal size and showed me about two to three pages of staff complaints against me. bear in mind that i was a cna - a new one at that. as i was a nursing student this was totally devastating to me. i don't remember what the complaints were specifically - just that i almost started crying when i saw it. i mean, the shock of being there so long knowing that someone was keeping a list of my mistakes and not sharing them was a little hard to take! i came to find out that this would repeat itself throughout my career span. ineffective and lazy management bow to certain staff to protect their own butts and it is very common. i'm not talking about exposure to one hospital either. a very effective way for managers to protect their position is to hire a "pit bull" charge nurse and let her go to work on the staff. anyway, the supervisor did not seem to care or show any emotion regarding my plight. coldly she said "i'm going to extend your probation". she was going to fire me for these "infractions" - and without any counseling or warning whatsoever! it was clear that she was such a miserable and hateful person that she enjoyed what she was doing too. fast forward to my graduation from school and applying to that same hospital as a new grad. the director of nursing sat in her office waiting for me, drumming her fingers on the desk and glaring at me for being 15 minutes late. i said i misunderstood the time of our appointment and apologized. she pulled out my file - and the list of infractions saying to me in a very cold voice "i thought you said there were no problems with your performance". i didn't get that job. on to being a new grad. i was responsible for entering orders because we had no secretary on the day shift. i missed entering a b-12 level because on this particular patient there were about 50 orders. the nursing manager called me in to her office and gave me a formal counselling. i was crying because i was so frustrated, upset, and overwhelmed. she looked at me and said "i don't know if you're worth it" - meaning that she didn't want to deal with me at all. i am not looking for pity here. i am telling it as it is and it's not a pretty picture. i'm sorry you are gong through that. it sounds like hell and maybe you will need to last one year before you can get out of there. try to avoid taking it personally. fly "under the radar" and avoid conflict with anyone. that's my recommendation. it may sound cowardly. however, the new manager is new (three weeks as you said). she is playing politics to solidify her position and does not care about you. your only hope (if you don't care about being fired) is to write this up and take it to the director of nursing. even if you leave you will have planted a seed as to this manager's character. in nursing it all depends on whether you can get the job done. right now the nurse aides have more longevity and political clout than you. this will change in time. you have my sympathy!
  12. by   barbie90210
    [font=book antiqua]also i agree with those telling you to consider leaving. especially when you are a new grad it might take you a few tries to find a supportive environment. you don't want a situation to occur that will invalidate your license. you are the most important thing here - not that nursing manager or the facility. you have to take care of yourself first and it sounds as if you are alone in a war zone!
    Last edit by barbie90210 on Oct 15, '06
  13. by   lvs2nrs3535
    THANK YOU all for the support. I sat down and wrote a list of my 'goals for success', and gave it to the DON and my nurse manager. They stated that they were very impressed. We will see. I have two more weeks to make my decision. I really do like my job, (much to my suprise, I did NOT think LTC was in my future), and at this point, I hate to give up, having truly put my all into this. So I guess I will see at the end of my probationary period. Will keep you posted, again, thanks for the support!
    KristyBRN

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