I have been in LTC for a long time...10yrs as an aide and 3 1/2yrs as an LPN. I know a few things and I know I have a lot to learn. I love my job as a nurse, I love taking care of the residents. I have a passion for what I do. So now here is my problem. I just relocated and have been searching for full time work. I just took a job in a nursing home for per diem work with hopes it would lead to full time. I spent 2 days in orientation with the HR and ADON going over the policies, procedures and getting all the required CEUs. I have 3 days total of on the floor orientation (YIKES!!!) I just completed my 2nd orientation tonight and I have never been so concerned in my whole career. My first night and tonight on the floor, I worked with a nurse who has been there for 5yrs. We worked the sub acute/rehab unit with 35 residents. On this unit, we have 12 bloodsugar checks with sliding scale coverage, three wound vacs, four residents who have dressing changes, 5 residents who have tube feedings, currently 3 residents on IV ABT and two trach residents. Med pass times ar 3pm, 5pm and 9pm. We have 3 resident assessments every night, chart on every resident who is on ABT and do all of the medicare charting (about 9 residents). It is a very heavy, busy and demanding unit. I know I can handle this unit once I get my routine in place. My problem is the way I am being trained. The nursing training me is teaching me how to cut corners. She gives some residents all their scheduled meds at one time, BP meds, DM meds 3pm 5pm..all at one time at 9p. I asked another nurse that I met in orientation and she said that is just the way some nurses do things so they are done on time. I get the impression that this is common practice here. Tonight was very busy, we had a resident that coded right at the start of the shift. Everyone came to help. Everyone was just kinda standing around so I jumped right in and started CPR. The supervisor RN came to assist and took over compressions while I gave air with the ambu bag. I then noticed the RN was doing the compressions wrong...he was compressing his stomach and not his chest!! And he kept stopping to check his pulse...even though another nurse was already checking and telling him to continue CPR. I told him he needed to move up but he wouldnt listen. I was so glad to see EMS arrive and one of them took over compressions. I continued to bag until he was transfered to the gurney and the paramedic took over. After that was over, I had a resident fall and suffered a very large skin tear, so I took care of that. I had a family member upset because they felt their mom wasnt getting enough to drink. Two resident who are tube fed had clogged feeding tubes so I had to buy a coke and unclog them (works every time). One of my diabetics had a bloodsugar of 590..so I gave the resident his sliding scale coverage and schedule lantus. No orders to call MD but I did anyway and was ordered to start NS IV 75ml/hr for 72hrs, 25 units Novalog NOW and repeat bloodsugar in 1hr and update MD. So I had to start the IV and get the fluids started. The bloodsugar did go down but not by much and MD was updated. Then at 7pm, we had an admission show up, so that had to be dealt with. The nurse training me basically let me do one side of the hall and she did the other side. But she kept jumping over and popping meds out (without even glancing at the MAR) and then telling me that she gave three residents their meds that were on my side. She was also rushing me, telling me we have to be off the floor by 9pm so we can get all the charting done. I guess the only thing I really learned from her was what NOT to do. My question is should I stay or should I go? My problem is that I really need a job right now. My husband and I are seperated and he is no help with money. He hasnt given me one red cent in months. Sorry this isnt Dr. Phil..but still. I am a single mom and I really really need this job. I did not go into nursng for the money...but now is the time I need it. But this place scares me. All I heard from the ADON was what a great place this is and how they got 5 stars from the state and no deficientcies were found on the last survery. Frankly, I dont see it. Like I said, I know I can do the work once I get my routine down. But there is just something I dont know about this place. I am still looking for full time work. Any advice would be great!!
Sep 6, '12
Well, knowing what I know now, I would first write a note asking for 2 more days of orientation, with another nurse if possible and not state the reasons in the note just that you fell the need to see how other handle the hall. Also give a copy to the DON and to the Executive Director, so that both are aware of your request. Leave a paper trail. Leave out your concerns of the other nurses "short cuts", also leave out the personal drama. The note will give you a paper trail to CYA in case they don't give you more orientation time.
As for the other nurse popping meds without the use of the MAR, it's done, and since you've been in LTC for a while, I'm sure you know that this is not really the way to do it, but it is done, especially if the nurse is one who knows their resident and their meds and knows what they get and when, in a regular routine some just know, if there are med changes then it is or at least should be passed on in report for a few days, so the other nurse, even though she used the wrong procedure, should have signed for the meds at the very least and would have noticed any problems at that point. Hopefully there were no holds on the meds she gave.
Good luck and hang in there.