Skilled nursing facility helped.. !!!

Specialties Geriatric

Published

Im a newly licensed LVN in California, i got a job in a 140 bed SNF facility.. and the ratio is 1:35 residents. I worked AM/DAY shift. I have tons of insulin and gt feeding.. and i always ended up by 12 noon just struggling giving medications, then i need to prepare lunch medications too so its pretty hectic ive never been stressed in my whole life i felt to give up first they rotate me while training me in different station. Then on my 4th day on the floor they put me in a station that they only trained me 1 day and i will be alone with my own judgement the rn supervisor saw me struggling she helped me medbpass and charting during my shift someone transfered in the hospital due to fever, new admission and hypoglycemia. this coming week im gonna be alone i dont even knew who's who and whenever new admissions, change of conditions, i dont know what to do like my kind went completely blocked that i just end up crying and blaming myself that im so stupid i dont even know how to contact the doctor etc. lots of the staff was telling me you must have your own routine and you will get through it when you got used to it. Im struggling with documentation i ended up going home from day shift at 6pm. It sounds crazy but i m so shocked like i have anxiety im on my feet from 7am until 2pm just doing medpass for morning and lunch with no break no water at all. Any tips how to get through with medpass ?Would you guys give me tips or some survival notes in SNF.

Specializes in Skilled Rehab Nurse.

How much training did you get? If you don't know the procedure for contacting a doctor, it seems like your orientation period was not long enough. I called my first doctor on day 2 of my orientation.

Zesikajia

2 Posts

Only 3 days of shadowing they did not go through for documentation. They just shadow me doing med pass.i already did med error and they let me sign a drug variance. It was so stressful they just put me in one station i dont even know which client is and some doesnt even had name band so ineed to look for a cna to ask which is who whichbis very time consuming and when im not done doing med pass they will stress me out that its already late in still on the cart. And everybody lookinv at me like im so stupid i felt really down like very stressful the whole day and still i look like an idiot doesnt know what to do. I asked the other charge nurse der she said no one gonna help you here you will learn on ur own. I was so heartbroken i dont know that being a nurse is stressful like this i felt like crying everyday.

Specializes in Skilled Rehab Nurse.

That does not sound like a good place to work unfortunately. I got about 10 shifts of orientation. By the end I was doing everything while the person orienting me was getting bored. I am a new RN as of January and float between the skilled nursing units at our facility. I still find med pass stressful particularly if I'm dealing with new admissions (who inevitably come with incomplete orders). We're also short on CNAs in the one unit so I often have to try and answer call lights in addition to my med pass.

Specializes in Pediatric.

#1 tip. You absolutely must, must, *must* take a break. Even just ten minutes to pee, drink water, and inhale a protein bar. Take a few deep breaths. You will be 100% more productive after that tiny break than you would, trying to power through in the name of "saving time."

2. Just do your best. That is literally all you can do. Yes, you will forget things. You will make mistakes. Someone won't get their 1200 calcium, you'll miss a skin prep to heels, someone will fall and your coworker will give you an attitude. Just keep on keeping on.

3. If you decide it's not for you, that's ok! But if you push through, you WILL eventually master the LTC beast.

CapeCodMermaid, RN

6,090 Posts

Specializes in Gerontology, Med surg, Home Health.

I've been working in SNFs and LTC longer than some of you have been alive. It gets more difficult by the day. Reimbursement has not increased at the same rate as acuity. We are expected to do more with less. At my last facility we had patients with chest tubes. If we all keep 'doing the best we can' thinks will never change. Somehow we have to band together to get better staffing for these residents.

GSDlvrRN, MSN

100 Posts

Specializes in Telemetry.

We must work at the same place OP.

I had 2 days orientation, then I was on my own. A month after being alone the director asked me if I was ready to be off orientation and if I was already alone. That was a pretty dumb question!!!! I was thrown out there in the same way you were. I feel very under trained and I have learned things the hard way. I was put on night shift (aka alone) in my second week. Thank God the CNAs help me with names and faces. Building a relationship with your aids will save your butt! They cannot do your work but they can make you feel supported.

I wrote important numbers on the back of my badge. I make checklists to help me with med pass. For example, I make a list of people who need blood sugars, and a separate list of people with GT feedings. (And I thank the heavens when someone doesn't need coverage!!) Know which medications can be delayed such as supplements and which medications and residents you need to get to first. I do not stress anymore about meds being late because I know that every nurse is in the same boat as me. I have 46 residents (8 GTs, 15 fingersticks and multiple confused people, and one or two actively dying, and dealing with their family)on my shifts. I clock out for lunch and chart while I eat. Thats just what you have to do sometimes. And if you stay after to finish up that is okay. If you get asked why you are always staying over be honest and express your concerns.

Med pass will get easier as you get to know the residents and what medications they take at what time of day. You will also get to know who is a finger stick, who is a GT and so on. Eliminating distractions such as beeping GT pumps also helps. I always make sure someones feeding or water is not about to run out during my med pass. My morning med pass goes so much easier when my fallers are not trying to get up, people in pain are happy, and I have anticipated the needs of my residents throughout the night so everyone isn't asking for a PRN or to get up to the bathroom. You are not stupid OP, the conditions you described are pretty much how any LTC is. Reading posts in this discussion board helps me a lot! We all complain about patient ratios, med passes, staying over, stress, and the multiple demands we face in LTC. We are here with you!

Here is something else. I worked in acute care with a 1:5 ratio before LTC. My job in LTC is more demanding and stressful. I used to be able to call security for a combative patient, RT for respiratory issues, Xray for new chest pain, lab for a stat lab draw, rapid response for change in condition, and the doctor used to be at the bedside within 30 minutes if I needed him/her to consult. None of that stuff now! Which gives me more responsibility aka more pressure. Kudos to you OP for the effort you are putting in. It shows great responsibility and it shows that you care about doing a good job.

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