At least I hope this feeling is normal...

[MissCharlieRN]

This is just a little bit of a rant to try to ease some pre-work jitters...

I swear I can see my heart beating through this crisp navy-blue scrub top.

I'm sitting on my couch with that nervous butterflies-in-the-stomach feeling. Today I start my second full week of work on a new shift. This means new coworkers to meet and try not to look like an idiot in front of. I don't want to say that I dread going in to my new job, because I don't. Overwhelmed is a better way to describe how I feel every time I swipe my time card.

I (yes, me) am responsible for the care of about 24 residents every time I walk in the doors of my new job. I'm responsible for their medications, their wound dressings, their new orders from the doctor, their blood work, their condition, their CNAs, their blood sugar, their blood pressure, and of course any new admissions that decide it would be an appropriate time to show up. As a "baby" nurse, this is all quite terrifying. Last week I was left to do the med-cart all by myself and there were more than a few times where I felt the tears welling up in my eyes. Why? Well, probably frustration more than anything else. There are so many people with so many different medications. Some of them were crush, some of them were whole. I hated having to track my preceptor down to ask her who gets what (it wasn't on the MAR). It was time consuming and frustrating. I hated walking into the resident's room only to find an empty bed... Then the hunt through the building began. Most of the times they were in physical therapy. Sometimes they were outside smoking cigarettes. All of them were, however, very time consuming. I started my 9am med pass around 7:30am, and I didn't finish until 11am. I had countless interruptions from the PT/OT department, wheeling residents up to the med cart for their medications while I was in the middle of preparing someone else's morning pills. I was ready to pull my damn hair out.

So now I'm sitting on my couch rationalizing that this is normal for a new nurse to go through. I'm remember back when I started work at my retail pharmacy job and I was being trained in photo. I swear I needed an Ativan just to get through those shifts. I was a nervous wreck. Then when I was trained as a supervisor, I'm pretty sure I felt the same way.

So this is normal. But it's different. This is taking care of people... not taking care of pictures or money. I'm arguing with myself that I'll never get this time management down, that I'll never find a routine... and it scares me.

My DON is giving me 3 weeks of orientation and if I don't feel ready she'll give me more. I think at the end of this week if I still have that terrified, sick feeling in my stomach, I may ask for more. I'm just so scared it will reflect poorly on me, but I don't want to cause harm to any of my residents.

[MassED, BSN, RN]

you'll get used to it. Why don't you have the info on the MARs on your residents? Can you make a note of who gets what (crush, etc) so the next shift you'll already know? Maybe get a schedule of the PT/OT/activity list and who is going where, so you'll spend less time tracking down residents?

You'll get to know them, the order, and things will even out with the routine. Your organization will improve. It might not feel like it now, but it will. Everyone feels this way. You are not going to feel comfortable until there is somewhat of a routine. That's natural and normal. Hang in there and good luck.

[littlebit3]

I promise you it will get easier. It just takes time. You will learn who gets what, when. You will learn who gets therapy at what time, and to catch them before they go or when they come back. You will get a routine of how you do things, and it will get better. I started out as a new nurse in LTC and it took a good 3 months before I started to feel comfortable. The best way to learn it is to do it...over and over and over again. One tip I have that helped me: Pick out another nurse in the facility that you think is a good nurse. Notice how she does things, even little things. Then, mimick her - pick up her good habits, not the bad ones of course! Don't be afraid to ask questions to your unit manager and other nurses, because one day you will be able to return the favor by helping another newbie!

[debi49]

I know it doesnt feel like it now, but you WILL get a rhythm down, and get to know your residents. Good luck to you!

[Short-Stuff 23]

Wow, it sounds like you have described me!! I started a new job in LTC at the end of July. I do not have any experience as a CNA and I felt sick to my stomach EVERY time that I went to work also. It has gone away but some days I still feel that knot! I have evtnually gotten somewhat of a routine down but it it almost impossible to do everything that they are asking of one nurse! I feel like LTC nurses have too many residents! I feel like I cannot give the quality of care that I would like to. I am finishing up my RN year and maybe find a job somewhere else after school but for now, I am staying here. On the bright side, I have learned alot in the last 2 months! It is crazy how much you learn on the job compared to the classroom. I wish you much luck!! You will get to know the residents and know where they usually hag out at!!

[CapeCodMermaid, RN]

You will be able to do this. Ask rehab for a schedule the day before...or let them know it is NOT acceptable for them to interrupt your med pass because they want to take someone off the floor.

[SuesquatchRN, BSN, RN]

Just hang in there. Believe me, you'll get it down. And tell PT to wait their turn.

[sweetjot]

Im in the same situation. I have at least 48 residents on every shift, and I work as part time in 3 different units, so I can't really keep up with what's going on. I don't know what's going to happen everytime I walk into the unit. I got 6 days orientation and that's it. All I can promise is to finish the med pass, and charting. I rarelly had time for dressings and never had time to do MDS. I guess everyone experience these thing at the begining, just try your best!

[mazy]

Absolutely normal what you're going through, if you were't worried then you probably wouldn't be a very good nurse. That nagging and fear you are experiencing will one day turn into a source of great strength and you will be great.

I'm not sure how much hunting down of residents I would do, especially if it means that residents who are not able to get up and about will end up waiting for their meds while you look for people who can be up and about their business -- and who can come to you.

But I think that once you were there for awhile you will get a feel for their routines, they will get used to you and you'll be able to time your med pass as they are heading out the door.

The advantage to morning med pass is that you can usually catch people while they're going in to the dining room and coming out -- everyone needs to eat! I usually park the cart right outside during meals and they line up for their meds as they're going in and coming out.

The disadvantage is that the day starts with a heavy work load and there is so much to do, it is so easy to fall behind.

As for crushes and wholes and applesauces and puddings and the like, I usually kindly ask the night shift nurse to remind me in report who is what, they won't always know but they can definitely help. But after doing the pass a few times you will remember.

The CNAs can often tell you that too. Your CNAs can be a great resource! Eventually you will learn who you can count on.

Do not let PT get to you, they will drive you nuts, I once filed a grievance against PT and OT because they were making my life impossible with the whole "I need to work with this resident NOW. You need to medicate this resident ASAP! Call the dr. I want this, that and the other." Believe me, I made that grievance stick, they were inserviced and I did not have any more problems with them.

Remember you are in charge of the most important part of the patient's care. Everyone wants what they want when they want it, you just keep focused on you and what you need to do.

You'll be fine.

[DizzyLizzyNurse]

We write right on the resident's picture that is on their MAR how they take their meds. When I worked afternoons, I'd make the CNAs, activities, therapy, families, etc wait to take a resident away until I gave them their meds. Or if someone wasn't nearby I'd wait and go to the next person. I'd go down the hallway with my cart, looking for residents. Then I'd go to the front lobby to look for the ones I had missed. Then activities and etc. Most residents keep a schedule so you will learn where they usually are at a certain time. Can you ask someone who's used to working your end of the floor for a schedule they use or tips with different residents or whatever? I usually give tips to the new nurses or aides. If you are feeling overwhelmed ask for help.

[MissJessica,RN]

This feeling is completely normal. You are very lucky to have three weeks of orientation. I started as a brand new RN in LTC with 33 residents to care for with three days of orientation, yes, three days! It was very, very hard for the first month alone. I cried before work and after. Now, I've been there for almost 3 months and I absolutely love it. You will develop a routine. You will learn that Ms. W has therapy at 10am, Ms. J always sits in the lobby, Ms. B stays in bed until 12p everyday and that will make your med pass much easier.

As you people interrupting you, you are the "boss" of your residents. Very kindly tell PT that they will have to wait on you. Tell you CNA's what you need to know immediately or what can wait until you finish your medpass. Taking the time to get to know your CNA's and educating them will be very useful. Plan to do all your charting and calling the doctor (for non-emergent tasks) at a certain time of the day.

It will get easier for you, I promise. But in the meantime, my heart goes out to you. I was there once and it was a very trying time in my life. Hold your head up high and just do the best you can....and always ask questions if you need to.

[Lizzie21]

I totally feel the same way you do. Remember to take one minute and I mean one full minute to breath and relax in silence. I feel like that helps me clear my mind. I know how frustrating it is to not be in a routine. Shoot, i'm a new grad and have no clue what i'm doing. I know people say it takes a year to feel really comfortable as a nurse. If you need the extra help and more orientation then i would totally ask for it. if you don't feel comfortable just ask for more time. there is nothing wrong with that!