A day in the life of a new LPN (sorry, long)

SuesquatchRN, BSN, RN · Feb 7, 2009

Nah. Welcome to being an LPN in LTC. I hate working per diem in LTC because you don't know the residents, they don't wear name bands, and only rarely will someone who knows the unit have mercy on you and help.

It isn't you.

systoly · Feb 7, 2009

Actually, you probably did a lot more that shift than some others might have. Most of all, you care, and believe me, the residents sense that. It makes them feel safe. Think about all the tasks you did accomplish, without help, in a hostile environment.

lookingbeyond, BSN, RN · Feb 8, 2009

So, I'm a casual LPN in ltc, which means I shedule myself to work when I want and hope there are openings. Yesterday (pm's) was my first day on the floor alone. I'm also in my last clinical semester at school for adn. I've oriented a total of 6 times in the facility and I'm brand new to the lpn world. Anyhoo, the last time I was there was about 3weeks ago. Then clinicals started and I needed to know my school schedule so I was unable to commit to work. I get to work and find out that I'm on a wing I've never stepped foot on and have 28 residents. The most I've had are about 22. I also have 7 blood sugars/insulins to give before supper.
I'm trying to be positive so I start out trying to remember what to do first. Treatment book, get report, get my cart ready, etc. Before I know it, residents are eating and I have yet to do 3 bs checks and insulin! I haven't finished my 1600 med pass that I started at 1500 amd it's now 1715! I take a deep breath, curse out management for putting me on this wing (inside my head of course) and expecting me to make it, and carry on. I finally get most of the med pass done by 1800 and instantly begin my next med pass.
Oh, I have to add that the nurse down on the other wing has been there for years, starts med pass late, finishes early, and never even asked how I was doing! I had my first physician phone call regarding a high bs (actually got that one on time)and had to ask her what info I would need besides the obvious. Turns out I was fine with the info, but I go to call and the numbers listed are all fax numbers. I go running down her hall again to ask where the numbers are kept. She looks at me like I'm clueless (I pretty much am at this point) and tells me where to find the roladex. Gee thanks for letting me know where it was the first time I was down here. All this is time away from the med pass. I get verbal orders (now, what do I do with those?) and think pt first and take care of him. I hand write the orders because I have no idea how to put them in the computer. I can't run anymore because I have to pee and haven't eaten since 11am, but I move down the hall and continue on my med pass. The only thing keeping me going at this point is my reward to myself. When I finish the last med, I'm finding the bathroom. Believe it not, this is what keeps me going.
Its now 10pm and I finally go and find the bathroom. I pee and cry at the same time. I then pull myself together and realize that although my shift ends in 30 minutes, I haven't started Medicare charting on the 5 residents that need it. The bs in my pt from before is still way too high and he's new. He's ill and getting iv antibiotics which I realized could have major impact on his bs. Nurse tells me not to call doc, just pass it on. Ok? I'm defeated at this point and pass the info on. Noc nurse agreed about not calling doc again. Ok, I know I'm new and have much to learn, but I don't think any more about it. I give report and begin my charting at 11pm. I finally clock out at 0100 and drive the 40 minutes home. I was honestly too tired to cry, but still felt and feel totally defeated and like the worst lpn ever.

OH how I relate!!!!!!!!!!!!!!!!!

lookingbeyond, BSN, RN · Feb 8, 2009

Actually, you probably did a lot more that shift than some others might have. Most of all, you care, and believe me, the residents sense that. It makes them feel safe. Think about all the tasks you did accomplish, without help, in a hostile environment.

I just told my husband today..."hostile environment"...Thank you for caring....

lookingbeyond, BSN, RN · Feb 8, 2009

OH how I relate!!!!!!!!!!!!!!!!!

So...I'm not the only one...I"m not alone...Thank you for your post!

chevyv, BSN, RN · Feb 8, 2009

I'm happy and sad to hear I'm not alone. I hope it passes and I won't always feel like I'm Indiana Jones running just inches in front of that big round boulder! How do you get through it without feeling like running screaming down the hall while pulling your hair out?

Nursepeach · Feb 8, 2009

Thank you for posting!! I am a LPN working in LTC. I hear all that you are say. Just reading your post and the ones that follow helped me so much. I feel the same way. I have worked as an LPN in this facility for just over 2 years and I feel like that. Not enough hours in the shift, running behind, frustrated, envious that get out on time every shift.

~MIA~, ASN, RN · Feb 8, 2009

I'm a new GVN, taking boards the end of March, so I know the feeling! I knew after the first day of "orientation" that I had to get myself organized. I made myself a spreadsheet with some of the things I HAVE to get done first, and then another with notes to myself of things I need to "fit in somewhere" and get done.

Here's how it goes...

column 1 -- list of 30 residents including their room/bed.

column 2 -- am accuchecks

column 3 -- am insulin

column 4 -- am gtube meds

column 5 -- am treatments

column 6 -- BP

column 7 -- Pulse

column 8 -- Resp. (and temp. if needed)

column 9 -- noon accuchecks

column 10 - noon insulin

column 11 - noon TX

column 12 - PRN (just so I don't forget to go back and double check my MAR)

I make a note of pts appointments, ones who go out for dialysis, labs, etc.

I have a list of my books that need to be charted in, such as ADLs, treatments, I&O, shift report, appointments, labs, Medicare charting, ABTs, and all that jazz.

I also have the aides listed and who they have.

I use a highlighter for the ones that need whatever is in that column ex. am accuchecks are all highlighted in yellow, the ones who don't need them are X'd out in that box.

I staple my list of "notes" to this page. I use the backs of the pages if I need to make additional notes to myself.

It makes it really easy to see "at a glance" what I need to do and "where" I stand.

Of course, I check for new orders and make sure nothing has been d/c'd, etc.

It's not perfect, but it's helping me keep "some" sanity, since I'm only on day 9 on the job. LOL :bugeyes:

This week I start orienting on 2-10 which is the shift I will be working, so I'll have to adapt it to that. :lol2:

systoly · Feb 10, 2009

I'm happy and sad to hear I'm not alone. I hope it passes and I won't always feel like I'm Indiana Jones running just inches in front of that big round boulder! How do you get through it without feeling like running screaming down the hall while pulling your hair out?

There are days when that frail 90 year old, who usually doesn't seem to make much sense, gently pads your hand and softly says, "I love you". It is those moments that fill up your tank and keep your motor running.

LesMonsterRN, ADN, RN · Feb 10, 2009

Wow, your post brings back some memories!

One of the most important things you can do for yourself as a new nurse, or a nurse starting in a new job, is to organize yourself and establish a routine. Mia posted a great example of what works for her. I will tell you, it's so difficult to get a routine going as a casual because you're not there a lot of consecutive days. It can be done, though, so don't give up. It might be helpful to carry around a pocket-sized notebook so you can jot down reminders or hints for yourself for the next shift you work and refer to them when you feel stuck.

And believe me, everyone goes through this to one degree or another. You are far from the worst LPN ever. Yes, thinking through things that might've gone wrong is helpful, but so is remembering what you did right and build your confidence on that.

Good luck!

Spritenurse1210, BSN, RN · Feb 12, 2009

Hang in there!!