New RN working Rehab/LTC Im overwhelmed. HELP! - page 2

by Jamie6RN

12,093 Views | 23 Comments

Hello I graduated 1 year ago and just gt my first job. I just started orientation on a mixed unit 3 days ago. There are some rehab patients and some long term residents. I've been shadowing for 2 days and I have some moments... Read More


  1. 0
    Quote from SunshineAnytime
    I cant speak for anyone else... but going from 2 patients in my ICU preceptorship to 30 in LTC is a big learning curve. I am comfortable doing all of the responsibilities of my role as a nurse. I was criticized yesterday (my 2nd day on the unit) for not knowing where the biohazard room was. The nurse I shadow splits the unit with me for med pass. Giving report and being expected to answer family member's questions about the patients I did not provide care to is unrealistic. My nurse asks me to check and recheck meds on the MARs before I give them but then tells me I am moving too slow. I'm trying my best to keep up though but not meeting expectations is frustrating
    Make sure you get a good, thorough report from the off-going nurse, check the progress notes in the charts, and tell the family you will look into it. What types of questions? It is a very big learning curve, but any "big" questions they might have should be in the progress notes, the MD note, the PT/OT notes, or the labs and/or the patient himself/herself. Just ignore those that criticise you, it's a silly RN/LPN/CNA attitude that needs to be extinguished. Every person there knows you are new, should be helping/answeirng questions not pointing fingers. THere is no reason to check, and recheck meds. Look at MAR, confirm the 5 (6)rights of med administration, period. This explains why my nurses are struggling to get meds out timely, med needs to match MAR, end of story. Of course, double check insulin.
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    I think all of the posters have given you some great advice! It sounds to me that your expectations for yourself are high, as seen by wanting to learn. We have all been there at some time or another. Be easy on yourself, you are just starting! I have seen so many nurses try to transition from other specialty areas with unrealistic expectations. If you would like, you can private message me if I can help you in anyway. Good luck!
  3. 3
    Quote from pixie120
    I am not trying to mean here, and this is not directed at any particular nurse but after one graduates from an approved nursing program, with something like 1000 hours of clinical,how can a new grad realistically expect me, as a DNS, to believe that they are not 100% familiar with hands on nursing care? Calling families and MD's and supervising CNA's I can believe comes with time, but are you saying that you really do not yet have a bedside manner, and feel comfortable with what your nursing role is? Hands on nursing care is do the focused assessment, head to toe, and proceed. Don't try to outthink it or change it or reinvent it, just do it.
    My nursing school exposed me to 100 Percent responsibility, are you saying that you did not do a preceptorship? Were you never taking care of your own patients prior to graduation?
    I don't expect any nurse to know everything about a new facility but I expect her /himto know where the chart is, who the MD is , phone numbers for family, lab book, assignment book, and MAR/med cart, e-kit and the rest will come with time. One day of "paperwork" orientation should suffice for that, and 3-4 on the med cart of the unit that you will work on, and then..... be the nurse. Do the assessments just like in school and take care of the patient. (Will you be slow with the meds, absolutely, but if you are geniune and trying, we will support you, if you spend your time crying and complaining, we won't).THere isn't any special way to do this, the older, more experienced nurses just have more experience under their belt and build a repertoire of knowledge specific to what constitutes acuity vs chronic, that will take time, but KNOWING the patient is in respiratory distress, bowel distress, cardiac distress...that should already be in your knowledge bag. I appreciate your candor and this is helping me understand my nurses better, but my nurses are not new grads, and they have some of the same complaints? Am I missing something here?
    You are not trying to be mean?
    ricksy, boushie87, and LTCangel like this.
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    Clinicals are different then LTC/SN. They do not prepare you for the work load but stick to it and it will get better. It will take multiple times of calling doc...finding where things are..learning to talk to family...following schedule and computer documentation. Ask others for help in organization (most fellow workers would rather you ask than make a mistake. Remember they have been there before). Watch the more experienced nurses and see if they have a system you could use. Our facility has 34 pt with 1 RN and 2 1/2 aides. Many time she has to travel to the other wing because there is only an LPN. It can be very hectic and a schedule may need to be modified 6 out of 7 days! It just takes experience... (and the ability to not eat for 12 hrs haha)
    LTCangel likes this.
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    Eh, I wouldn't say she was being mean, but perhaps she was providing a little tough love. I graduated from a great, well-respected school, but wasn't given 100% accountability for my patients (although I always took that responsibility), and I got very few chances to speak to the doctors, call families, and supervise CNAs. For me, I feel that the nurses I were with while I was at clinicals, still wanted to have control of the situation so they would talk to the MDs and families. I don't 100% agree with this because speaking with the MDs and families is definitely a weakness for me. However, I still do it and have confidence that I know what I am doing. For my LTC clinical setting - I passed meds for one resident, one time. This in no way prepares a student for this type of setting. I'm not trying to complain though, because there really isn't any other way to learn how to be a LTC nurse until you're on the job. I feel that the best thing you can do is be confident with the skills you've acquired at school and remember that you are still learning!
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    Thank you all for your advice..this week is going much better..ive learned a bunch of the paperwork and am becoming more familiar with the residents and routine..tomorrow im switching floors..i dont know where ill be but im excited to see how another charge nurse runs the floor..maybe seeing another style of nursing will be good for me but really, i think i just need to go with it, just do my job the best way i can.
    SuesquatchRN and LTCangel like this.
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    I have the same problem. I am a new grad and have been working in LTC for 4 weeks now I am overwhelmed. I am on graveyard shift so am not getting enough sleep. I feel stupid when I ask questions and get brushed off at times. I think it is going to take time to feel confident. I am just going to ask questions of the people who are willing to answer them, and leave the others alone! I seem to always look stupid or make simple mistakes when I work with the nurse who brushes me off. I hate that she probably thinks I'm a complete idiot but there is nothing I can do about that.

    Anyway hang in there you are not alone!
    LTCangel likes this.
  8. 0
    Quote from SWiseRN
    Eh, I wouldn't say she was being mean, but perhaps she was providing a little tough love. I graduated from a great, well-respected school, but wasn't given 100% accountability for my patients (although I always took that responsibility), and I got very few chances to speak to the doctors, call families, and supervise CNAs. For me, I feel that the nurses I were with while I was at clinicals, still wanted to have control of the situation so they would talk to the MDs and families. I don't 100% agree with this because speaking with the MDs and families is definitely a weakness for me. However, I still do it and have confidence that I know what I am doing. For my LTC clinical setting - I passed meds for one resident, one time. This in no way prepares a student for this type of setting. I'm not trying to complain though, because there really isn't any other way to learn how to be a LTC nurse until you're on the job. I feel that the best thing you can do is be confident with the skills you've acquired at school and remember that you are still learning!
    Orientation in LTC should provide a good guide for what the expectations are. Passing meds is passing meds, the MAR is there, you open it, you do the 5 (6) rights of med administration, and then you assess your patient. If you are in the LTC part, fewer meds, stable patient, more to pass meds to, in the sub-acute much less, higher acutity, take your pick.
    Is anyone here saying that in the 1000 plus hours of clinicals, one was not "hands on?". In this state, in order to GET into school, must be a certified CNA and have CNA experience, and we have good reason for that. If after you graduate, you do not yet feel confident taking care of a patient, or a bunch of patients, more clinical time, volunteer, ask for internship, there are many ways to skin this cat.
    Simply stating that you are green and not yet seasoned, well...welcome to what we all had to go thru. but my question is, do you take the time to listen? and learn on your own? and seek a mentor or two or three?

    To this day, I have questions, not sure of all that is before me, but I do know I was comfortable from the beginning with the resident assessment portion, and following MD orders, a lot of nursing is cut and dried, not following instructions, questioning and being argumentative with mentors/instructors/management (all of which I have seen and experienced myself) is NOT how one will ever do well at the bedside. I have seen new grads tear into seasoned nurses and REFUSE to be trained, then turn around and quit without notice and claim they have classes to take or are now pursuing BSN/MSN etc. I have seen nurses tell nursing supervisors/RCM's and DNS the most ludacrious of things, things I wouldn't dream to say ever to a boss of mine, and I have seen nurses LIE when confronted about simple things. Either one has ethcis or one doesn't.
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    update! i have been working now for a little over two months and am now working the evening shift for about a month..evening shift is very different but im the charge nurse and needed to get the flow of things quickly..i think im doing a pretty god job..im learning to multi task and to always keep my eyes and ears open..im no longer scared going into work lol
  10. 4
    I used to think pretty much the same way Pixie did. Then I started asking new grads how much actual time on a floor they got. It's not as much as in the old days (yes, when dinosaurs roamed the earth and I did go to a hospital program so we had way more clinical time than the ASN or BSN students even then). One woman told me she had only ever had 3 patients in school. No wonder people are ill prepared to work in long term care where they have 15 or 20 or 30 or or or?!?
    We need to tailor our orientations to meet the needs of the new grads if we are going to hire them. We all spend a lot of time, money, and energy orienting new staff so we might as well make it count.
    Maybe we should go back in time to when we were expected to perform in school. I had to do a med pass for 25 patients every day for 2 weeks in school. I had to be charge nurse of a unit with 25 residents and nurses who had been nurses for years. I think we were far better prepared to step up and hit the floor running than the nurses are today.
    silverbat, NursieNurseLPN, nsue, and 1 other like this.


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