No longer an Orientee / LOSING MY HEAD!

  1. Beginning yesterday, I was no longer an orientee. I am employed at an LTC. The nursing to resident ratio is 1:36, but the facility has begun to split that so sometimes it is 1:18. If a nurse calls in sick in that wing, the other nurse is to take over the whole 36 residents. Guess what? On my first day off of orientation, the other nurse called in sick. I had 36 patients, 8 fingersticks (usually out of whack, so sliding scale is always put to use), 2 on ATB, 3 Falls (neurochecks), 2 G-tube, 1 trying to cut something out of her eye w/ scissors that she won't give up without being combative, seems like millions of prn's given upon requests, etc. etc. etc. AHHHHHHHHHHHHH! I'm going to scream.... To make matters worse, I called my work today to see if the other nurse is still ill, and SHE IS. So, again, I'm on my own w/ 36 residents on the west wing. Don't you think they should call someone to fill in her spot for the night? This is so unfair. I'm a new grad nurse too, and this is my first job. I love nursing, but if I continue nursing this route, I'll go crazy. This is tooo much. Unsafe and low quality of care *screams*.
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  2. 10 Comments

  3. by   pickledpepperRN
    This is unfair for you. Most importanly it is unsafe for your residents.
  4. by   tiroka03
    I feel your pain. My first LTC the noc shift ration was 1:48, with one lazy aide to help. I'm not sure what to say that could help. Give it time, and you will find ways to function faster. The residents will get to know you and trust you more, then passing meds may go faster.

    Personally, I think it is not fair. If you deciede to stay, in about a month you will be feeling a lot better. If you don't think you can last, you may want to try homecare.

    I would suggest you look on line for a site that gives nursing home ratings. If you find the one you are working in has problems, it is a sure sign, you should jump ship. You don't want to lose your license because of a mistake that could have been avoided if you weren't rushed.

    I used to have 24 accuscans in the morning, along with all the morning meds. In slower times, I would set up the alchol wipes, strips, and lancets, in a row. I also had a carry along bucket which I threw my waste, and it held a small sharps container. I would take all my accuchecks first, then come back and give the insulin. I found it easier to keep moving with the poking, because it slowed me down so much to do both at the same time.

    I also had my own worksheet which I had all the things I had to cover on nocs. for instance

    room accuchecks insulin
    212 312 6 units reg
    214 118 0
    215
    ---------------

    room 02 sats treatments results extra

    201 90RA -- -- NPC
    223 92 2L -- -- --
    254 842L albut neb 91 2L thick yellow mucus

    -----

    I would preprint these worksheets with the room numbers on and just fill int the blanks every night. you can easily change the orginal copy by using white out and photocopy it.

    I also had the med times

    00 01 02 03 04 05 06

    222 -- 211 -- 200 -- 200 225
    224 213 212 202 229
    225 221 218 230
    222

    this way I knew from the get go, where my busy times would occur, and just who had what coming. I would cross off the rooms as I did the meds so I wouldn't acciedently miss them. It helped at the start of the shift, because the meds were on time, becasue I wasn't so wrapped up checking the mars. I still checked the mars, but it made the start a little less frustrating.

    hope this helps.
    Last edit by tiroka03 on Nov 19, '06
  5. by   tiroka03
    sorry the chart wouldn't print the way I planned. I hope you get the idea anyway.
  6. by   destiny5
    May I also suggest that you check Medicare.gov - The Official U.S. Government Site for People with Medicare website. It will give you LTC facilities in your area, their addresses, and it will list their violations, nurse to patient ratios, etc. I found it helpful when I was searching for my first job.
    I initially accepted a job at a LTC facility because I needed one. I was feeling uneasy because it was my first job, I knew the orientation would be minimal and I had an overall "uneasy" feeling about this particular facility. I discussed this with my former instructor and she gave me some advice that I am going to share with you. She said, "Never be that desperate for a job that you are willing to accept any working conditions. You are the one with the license. Never work at a facility that you would not want your name associated with just for the money or the fact that you "need a job". She went on to say that she'd turned down other teaching positions offering more money because our school had "standards" where the other schools standards were less evident. --- I took her advice and I found a position at a mental health facility-- I set my own hours, my pay is the same as LTC was offering, My Nurse Manager is taking me under her wing and providing one on one training. She is supporting me through my transition to RN and is helping me become a more confident nurse.------ I would never want my first position out of school to be in LTC with virtually no training. There is one facility in our area that offers six weeks of training (I'm not referring to this one).-------
    Advice--do some research. Go to a facility that gives adequate training, nurses that are willing to help, and a facility that has a good rating, few violations, and one that won't put their nurses or patients in jeopardy with unsafe ratios.... Good luck
  7. by   pagandeva2000
    Quote from nursekhat
    Beginning yesterday, I was no longer an orientee. I am employed at an LTC. The nursing to resident ratio is 1:36, but the facility has begun to split that so sometimes it is 1:18. If a nurse calls in sick in that wing, the other nurse is to take over the whole 36 residents. Guess what? On my first day off of orientation, the other nurse called in sick. I had 36 patients, 8 fingersticks (usually out of whack, so sliding scale is always put to use), 2 on ATB, 3 Falls (neurochecks), 2 G-tube, 1 trying to cut something out of her eye w/ scissors that she won't give up without being combative, seems like millions of prn's given upon requests, etc. etc. etc. AHHHHHHHHHHHHH! I'm going to scream.... To make matters worse, I called my work today to see if the other nurse is still ill, and SHE IS. So, again, I'm on my own w/ 36 residents on the west wing. Don't you think they should call someone to fill in her spot for the night? This is so unfair. I'm a new grad nurse too, and this is my first job. I love nursing, but if I continue nursing this route, I'll go crazy. This is tooo much. Unsafe and low quality of care *screams*.
    This is what scares me about the nursing homes...that the nurseatient ratio is usually horrible, from what I am hearing. I'd be scared to death. I believe that this is grossly unfair, but it seems to be the growing trend...
  8. by   pagandeva2000
    Quote from destiny5
    May I also suggest that you check Medicare.gov - The Official U.S. Government Site for People with Medicare website. It will give you LTC facilities in your area, their addresses, and it will list their violations, nurse to patient ratios, etc. I found it helpful when I was searching for my first job.
    I initially accepted a job at a LTC facility because I needed one. I was feeling uneasy because it was my first job, I knew the orientation would be minimal and I had an overall "uneasy" feeling about this particular facility. I discussed this with my former instructor and she gave me some advice that I am going to share with you. She said, "Never be that desperate for a job that you are willing to accept any working conditions. You are the one with the license. Never work at a facility that you would not want your name associated with just for the money or the fact that you "need a job". She went on to say that she'd turned down other teaching positions offering more money because our school had "standards" where the other schools standards were less evident. --- I took her advice and I found a position at a mental health facility-- I set my own hours, my pay is the same as LTC was offering, My Nurse Manager is taking me under her wing and providing one on one training. She is supporting me through my transition to RN and is helping me become a more confident nurse.------ I would never want my first position out of school to be in LTC with virtually no training. There is one facility in our area that offers six weeks of training (I'm not referring to this one).-------
    Advice--do some research. Go to a facility that gives adequate training, nurses that are willing to help, and a facility that has a good rating, few violations, and one that won't put their nurses or patients in jeopardy with unsafe ratios.... Good luck

    Thanks for providing this resource. I tried to search for information and was at a loss of how to begin searching for their violations and SPECIFICALLY their nurse to patient ratios. Would you please direct me a bit? Thanks again, this is very helpful!
    Last edit by pagandeva2000 on Nov 19, '06
  9. by   destiny5
    I couldn't find out how to get to it from the home page either. I saved the link on my computer so here it is. Medicare.gov - Nursing Home Compare - Geography Questions I always search by proximity. I put in my city, state, and the distance of the nursing homes I'm interested in. I normally do a search within 25 miles. Once you do this you will have to check off all of the nursing homes that you are interested in (up to 10 at a time). You can then get detailed information about the LTC facility. Once you are in a specific facilities page, check show all--- thats where the meat of the information is. It also compares how a particular facility fares among state averages. It is so handy. When I started looking for a job, I printed out the 52 facilities within 25 miles of my home and called every one of them to find out if they were accepting applications, hiring, etc. so that I would have an idea of where to go. I also looked at their violations. There were some that had 35 when our state average was 9. Those facilities I avoided..... There are other websites that charge for this information. Why pay when you can get it for free. Hope this helps.
  10. by   destiny5
    oops---I guess I put a city & state in the link. If you're not from Portage, Indiana it can be changed....................
  11. by   classicmusic09
    Quote from nursekhat
    Beginning yesterday, I was no longer an orientee. I am employed at an LTC. The nursing to resident ratio is 1:36, but the facility has begun to split that so sometimes it is 1:18. If a nurse calls in sick in that wing, the other nurse is to take over the whole 36 residents. Guess what? On my first day off of orientation, the other nurse called in sick. I had 36 patients, 8 fingersticks (usually out of whack, so sliding scale is always put to use), 2 on ATB, 3 Falls (neurochecks), 2 G-tube, 1 trying to cut something out of her eye w/ scissors that she won't give up without being combative, seems like millions of prn's given upon requests, etc. etc. etc. AHHHHHHHHHHHHH! I'm going to scream.... To make matters worse, I called my work today to see if the other nurse is still ill, and SHE IS. So, again, I'm on my own w/ 36 residents on the west wing. Don't you think they should call someone to fill in her spot for the night? This is so unfair. I'm a new grad nurse too, and this is my first job. I love nursing, but if I continue nursing this route, I'll go crazy. This is tooo much. Unsafe and low quality of care *screams*.
    Dear nursekhat, I've been there, It's one of the cruelest situations, I know of, not to mention unsafe, especially for a new grad. If you're, DON or your Adminstrator, won't remedy the situation, by calling in some help, then I would say, look for something else quick! This is how nurses get burnout! Have you applied at any hospitals? I know the pay is less, but you should have a more balanced, workload. I suggest, applying at a VA hospital. Wishing you Success!
  12. by   augigi
    How long was your orientation? Expecting a new grad to take 36 patients on your first day is patently unsafe. Put your concerns IN WRITING to your DON. Tell them that you will not work alone, and that if someone is sick, they need to call agency. Otherwise, leave and find a safer job.

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