Help! Sinking at first job as LPN.

[BC_Nurse]

Hi Everyone,

I am a new LPN grad and am working my first job as a nurse at a LTC facility. I graduated last summer, and waited until March to look for employment as I went right back into school (prereq's for LPN to RN program) after I received my nursing diploma. I regret not finding work sooner because I am feeling VERY rusty and have lost a lot of confidence. I do realize that I can't go back and change this, but it has to be mentioned as it adds to the problems I've been having at work.

This job was the first I interviewed for, and I was so thrilled when I got the call that I had been hired. It is a private facility that is funded by a specific religious/ethnic group that is different from my own. As a result, 95% of the staff and residents speak a different language than myself so there is a definite communication barrier, and also makes learning names a challenge. I am not used to working at a place where the staff is allowed/encouraged to speak in languages other than English and it has definitely been a little unnerving.

The work enviroment is very intense and with only 3 days of orientation (1 in the Special/Complex Care unit, 2 in the General Care unit, day and night shifts) I'm feeling quite hopeless and afraid to be on my own. The patient ratio is 1:50 on the general side (RNs work off the floor) and 1:20 on the special care side (no RN, just 1 LPN and 2 care aides.)

From the first day of orientation I was asked to work shifts on my own. I received many calls during the length of my orientation (the orientation shifts were scattered over a 2 week period) to work shifts alone but refused them all. I feel very guilty about declining, but I am just not confident enough to work without supervision at this point. The nurses that oriented me were really nice, but too busy to really walk me through what they were doing. Needless to say, I didn't learn too much during these 3 days. I was able to pass meds to a small number of residents, and even this I found to be difficult. Shortcuts and cut corners (especially during med pass) are common practices among both RNs and LPNs at this LTC facility and are used because it would be impossible to get everything done on time otherwise. When I voiced my concerns about passing meds to residents I had yet to get to know, I was told to check ID bands and follow dining room/bedroom lists. Unfortunately, half of the residents don't wear ID bands, and the lists are not updated.

Safety and quality of care are of utmost importance to me, and because it is MY license on the line and not theirs, I can't help but feel extremely overwhelmed and unsure of myself working here. I have asked for more orientation shifts to which my DOC/manager replied "Well, I could give you more shifts but I'd rather you jump right in to learn the routine. If not you will just orient yourself to death." :uhoh21: 3 days is the amount that every nurse gets, no matter what position. I regret not clarifying the length of orienation prior to starting but I can't do anything about that now. The last thing I want to do is appear to be unmotivated or to leave a bad impression and I already feel as though that is the road I'm headed down, especially since I have rejected a handful of shifts already. Now I'm beginning to think that they hired me out of sheer desperation and do not like the immense amount of pressure they are putting on me to work alone. :stone At the same time, I am conflicted, because I was told that getting right into it would be the best way to get the routine down. *sigh*

My DOC wants me to work an odd shift next week (11am-7pm) and I would only be responsible for dinner meds so I could theoretically focus more on covering the floor, doing treatments/dressings and completing paperwork. The shift is 2 days before my first final exam though so the timing is a little off but doable if I manage my time over the week. Should I take it? Or should I ask for more orientation shifts after finals are over as I'll be taking a week or so off until I feel more comfortable?

My apologies for the length of this post. Any tips/advice would be greatly appreciated. Thank you for reading!

[Hospice Nurse LPN, BSN, RN]

OMG! I have a hard time with my ratio of pt. to caregivers and we all speak the same language. I think I'd have to start looking for another job.

[kat7ap]

I would seriously consider looking for another job ASAP. That is an outrageous pt load. The only places I've seen that have that ratio are when you have a medication aide who passes all your PO meds. You are right to stand up for yourself and not accept that. Don't let management bully you out of a proper orientation. Sadly, most LTCFs major concern is the almighty dollar and they don't care much about you or the residents.

[linzz]

This ratio is pretty large and even here in Canada, we have large ratios but 50 to 1 is too much. Most places would have the RN assist with the breakfast med pass as this is usually the largest. Are they really short on RN's, maybe they are just really short staffed. I would be careful working at this place. JMO.

[BC_Nurse]

There are medication aides at the facility, but they only pass meds during lunch. RNs are always on but never pass meds or do treatments on the floor except during the 11pm-7am shift.

Maybe I'm just letting my lack of confidence get to me...I don't know. I accepted the 11am-7pm shift because I only would be responsible for supper med pass and treatments. I am applying for jobs elsewhere, and already have an interview tomorrow at a mental health care facility that has only 25 beds. I really hope I get the job!

[CITCAT]

:redbeatheYour not sinking!You just haven,t found the right place go job hunting. the patient ratio sounds too much in the states i dont think they so that but only on midnites 11p-7a Suggestion Can you do agency work?

will that fulfill,your financial obligations, but give you flexability to study, and whatever Youll make it your young,:grpwlcm:

[BC_Nurse]

Thank you all for your thoughtful replies. =)

As nervous and scared as I am, I made the decision to take on the 11am-7pm shift this week because I figured it would be a good shift to decide whether I should stay or go. I spoke to my DOC and she gave me a brief overview of my shift routine and it consisted of covering for the LPN (who will be completing online patient assessments) on the floor so (vitals, glucs, treatments, doctor's orders, labs and follow-ups) and administering meds alongside an RN in the dining room at suppertime only.

My biggest fear is making a med error because I don't know the residents, and there are 46 of them to give meds to at dinner. Any advice regarding med pass would be appreciated! As silly as this sounds, I am dreading recording day report for 3pm because many resident names are super hard to pronounce! I'm going to give it my best shot anyway. I'm still a little unsure as to how to organize my day, what tasks should I do first? Also - I've observed two different practices for signing the MAR - one nurse signed only the narcs before she passed them and all others later, and another signed as she went along but only did this on the special care side because there are less residents. In school we learned never to sign the MAR before meds have been given but with 46 residents, I'm not sure if I'll pass meds on time if I do it "by the book".

Thank you for reading and please wish me luck!

[vicky1964]

Girl get out of there , you need to be in a hospital or working for a doctor there are so many good LVN jobs out there ,your just setting your self up to fail.

Panic plays no part in the training of a nurse.

[pagandeva2000, LPN]

Many areas limit LPNs to long term care, which is famous for horrible nurse to patient ratios. But, I think I would try the 11a to 7p shift first to see how it works. Maybe it would be beneficial to you, and it seems that you really wish to give every option a try before you give up. I still think that it is horrible, how they leave these nurses to drown and yet claim that the patients are receiving excellent care.

[KimmieNEAL]

I would run out of there so fast it would make their head spin! I do NOT see how they keep any nurse at those numbers. You are not sinking.....you have been anchored down. They have sat you up for nothing but failure. Do not stay and let that situation beat up your confidence. Too many jobs out there for that! Good luck!