New LPN in LTC and I am drowning

Specialties Geriatric

Published

I feel so ashamed hearing numbers like 30 and 50 per nurse - I have between 18 - 22 patients, am going into my 1st month on the job and I am drowning. Is this not the career path for me?

I worked so hard to try to find a job - and I cannot even manage (on average) 20 patients. I work 2nd shift - I get my cart organized, label which patients on my hall get FSBS and skin treatments, and I finally thought I had it - I was able to start charting at 7pm one night last week. But then there was a new admit. Then a fall. I spent at least 45 min. getting the fall situation under control and montoring the patient, then I have another patient yelling at me (yelling - literally - NURSE! NURSE!) which upsets the other dementia/alzheimers patients on the floor - so one or two of them start screeching too - in the middle of all that I have a CNA come tell me one of the alzheimers patients took their clip alarm off their shirt and threw it across the room under a bed (we are out of bed alarms - hense the fall with another patient) - and while I am monitoring the fall patient I have another patient telling me he is in pain and will wait outside for me - I told him thats fine, I will be out in a few minutes, I had to monitor a resident that had fallen.

He gets upset with me - starts badmouthing me as he wheels away because I dont drop everything and give him his pain med - so after I am done sorting out fall risk person I have to go sort things out with irritated pain med person - then man with alzheimers keeps trying to slide out of bed and by then it is about 830 and i havent started my 2nd med pass. A new patient doesnt trust our facility and requests that I bring in each of the packets of meds that I am giving her because she doesnt believe that I am giving her the right thing - so that takes 20 minutes because she is new and I have to go to the other side of the building to receive her meds from the pharmacy drop off that happened at 7 as well.

I dont want to compromise patient saftey - but I am not getting off my 2nd med pass until after midnighte - the 3rd shift nurse has been there over an hour and its time for him/her to pass meds and I still have the cart because I dont want to compromise a patients saftey because of other issues I had to deal with earliier in the evening.

I am learning a lot. I LOVE my residents, but I dont know how to improve on my med passes. I am even multi taskiing and doing more than one thing while I am passing out meds (vital signs, assesments skin preps) while I am in the room with one patient - and I am not staying and talking to them for any amount of time at all. I leave every nite at the earliest midnight - on Friday I didnt getoff work until 230. And I still missed stuff - or I feel I did anyway. I just dont know how to get it all done and not compromise the patient saftey. People keep telling me I will get into a routine - when? Things are always going toc ome up. Its never gong to be smooth - so I need to adjust. Any advice/support is appreciated. Im drowning.

Thanks again all - I appreciate the support. I am really glad I am not alone in this. As sad as it sounds that this seems to be the norm, I at least feel now that I am doing the best that I can and that takes some of the pressure off.

Yes - my CNA's are terrific - they do the turning of patients and do vitals - there are some meds that require (based on the MAR) to have BP and pulse or just pulse done before I can give them - I have a seperate pulse ox that takes pulse but sometimes it doesnt always pick up on certain patients so I have to use the BP machine. My supervisor has helped me - she has done one med pass with me to try to help show me how to prioritize - she normally does all the admissions and she has been doing all the paperwork for me (except charting) so I can stay on the floor and get used to assessing my residents and get used to their meds. However she has 3 other halls that she is in charge of - 4 total - with 3 out of 4 of those halls having new nurses in training (I am the only new newbie - the other 2 are RN's who have experience but are new to the facility) and they have sometimes double the amount of patients I have to pass meds on plus she has to help with getting meds checked in when the pharmacy comes. She rarely leaves more than an hour before I do to make sure I am only left with charting to do. Honestly in this situation I am not sure how she could do better - but I dont know because I am just starting my 4th week. Couldnt she get in trouble for not helping the other 2 new RN's too? I am thankful I am not afraid to ask questions - I have even asked the girls (the 2 new RN's) what they do to help them go faster - one of them pulls 6-7 of the residents meds for the 2nd med pass before she goes to dinner, writes on a clear cup and puts them in her drawer then never goes offsite for dinner. I am not going to do that. One leaves the top part of the cart unloocked so she doesnt have to keep reaching for her keys to unlock it and keeps the cart turned towards the wall so residents wont get into it - I am not going to do that either - if state were there for either of those things I would get in trouble. I am up now because I am just sick to my tummy about going in today - I am trying not to think about it - but I feel like all the joy is being sucked out of what I thought nursing was - I know part of it has got to be my atttude and perspective on things - which I am trying to adjust - I just simply feel overwhelmed. My supervisor was in the middle of doiing a new admission when the fall occured - she couldnt come and assess the patient - she came later - but I couldnt bring him out on to the hall with me for the first hour I monitored his vitals every 15 min. because he was so scared he had fallen. I did stay down towards that end of the hall and finsh my med pass down there, but the residents that were up at the 1st of the hall got irritated with me even tho I explaiined the situation to them. I dont know what else to do - I really really dont. The whole situation is just dishearteniing to me. I love my residents and its not their fault - I just always felt nursing was what I was led to do - its whats been in my heart to do - and now it just makes me sad. And after working so hard to get here to be a new nurse I am disappointed that I dont have a better attitude about things and that I am constantly feeling sad. I guess I should try harder to count my blessings and just be glad I have a job.

I graduated March 2016. Passed my NCLEX in May 2016. I got my first job offer May 23rd(a week after passing nclex). I was so excited!!!:roflmao: First week of orientation was all videos. Second week, started on the floor. First couple of days, was on 7am-3pm shift. The other days were 3p-11p. They hired me to work 3p-11p. Let me tell you...it was horrible!!! Being a new nurse, I never thought that I would be responsible for 30+ lives at one time. It really opened my eyes. This company was so unorganized, it frustrated the crap out of me!! I would have headaches on days I had to work because of it. I didn't think it was legal for nurses to be responsible for so many lives while giving safe and efficient care. I guess I was wrong...appparently after doing much research, it is legal for a nurse- patient ratio of 1:30. I think that is just awful! Something needs to be done about this!!

Specializes in Nursing Home.

2nd shift evening shift is very hard . When I was a new Nurse in LTC I worked 2nd shift five e evenings a week. It's a very difficult shift and no one seems to like it for long. I had 38 residents under my care and 2 large med passes very close together. Lots of last minute evening physician orders and new admits every other day.

When I had a new admit I knew it was an automatic two hours over shift. When I had a fall I knew it be at least an hour. Second shift is nursing home nurse hell. Behaviors and sun downing start to set in. Lots of falls. There's just not enough hours in second shift to get the work done.

Some advice that made it a little easier, gibe meds that are irrelevantly scheduled at 8pm like mag Ox, ferrous sulfate, etc etc at on the first med pass eliminating extra work that doesn't need to be. That's what I used to do. Also I had to be firm with the residents and CNAs. There was no time for residents to take up 20 minutes of my time just go take a cup of 3 pills. And I had to learn to delegate and do it well. May not be liked but it's a must that shift is just too busy for the Nurse to do things CNAs should be doing. Personally Iike a good CNA with a good head who was able to solve some problems without demanding to see the nurse for every ridiculous little reason. Also had to cut down nurses notes to only what was necessary. No need for long paragraphs of redundant information on weekly charting.

But the BEST ADVICE, advice that really changed my life for the best is when I switched to 3rd Shift. I fell in love. Plenty time to do my work. Never overwhelmed. Feet are always under me. And get absolutely awesome sleep In the morning and day time. And the facility that once stressed me out had now been a job I love for over a year and a half because of the switch from 2nd to 3rd shift. Good luck to you .

Specializes in Pediatric.
2nd shift evening shift is very hard . When I was a new Nurse in LTC I worked 2nd shift five e evenings a week. It's a very difficult shift and no one seems to like it for long. I had 38 residents under my care and 2 large med passes very close together. Lots of last minute evening physician orders and new admits every other day.

When I had a new admit I knew it was an automatic two hours over shift. When I had a fall I knew it be at least an hour. Second shift is nursing home nurse hell. Behaviors and sun downing start to set in. Lots of falls. There's just not enough hours in second shift to get the work done.

Some advice that made it a little easier, gibe meds that are irrelevantly scheduled at 8pm like mag Ox, ferrous sulfate, etc etc at on the first med pass eliminating extra work that doesn't need to be. That's what I used to do. Also I had to be firm with the residents and CNAs. There was no time for residents to take up 20 minutes of my time just go take a cup of 3 pills. And I had to learn to delegate and do it well. May not be liked but it's a must that shift is just too busy for the Nurse to do things CNAs should be doing. Personally Iike a good CNA with a good head who was able to solve some problems without demanding to see the nurse for every ridiculous little reason. Also had to cut down nurses notes to only what was necessary. No need for long paragraphs of redundant information on weekly charting.

But the BEST ADVICE, advice that really changed my life for the best is when I switched to 3rd Shift. I fell in love. Plenty time to do my work. Never overwhelmed. Feet are always under me. And get absolutely awesome sleep In the morning and day time. And the facility that once stressed me out had now been a job I love for over a year and a half because of the switch from 2nd to 3rd shift. Good luck to you .

Ooooh I could not agree more with all of this! I recently switched to 7-3 shift after a year on a busy floor doing 3-11. All of the admissions, all of the falls. All of the incidents.

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