Bombed my second shift on my own

JBMmom, MSN, NP · Apr 23, 2013

That's a tough introduction to working on your own. I've only been on my own a couple months, and thankfully I haven't had an admission or someone sent out yet, because I know that would easily put me a couple hours behind with the paperwork involved. When you have a chance I'd just check in with the 3-11 nurse, briefly apologize- because it does happen to everyone- and ask for some feedback about suggestions she might have to help the situation in the future? That way even if she was annoyed at some point, she might see that you're looking to ensure it doesn't happen again and she won't feel like you're willing to dump stuff and walk away. Better luck with the next shift- welcome to LTC!

venousr3tuRN · Apr 23, 2013

Yeah I plan to apologize to her the next time I see her. I really want to take responsibility for it so I think Ill talk with the DON tomorrow. I have the day off so I can't do it as early as I wanted to. I'm nervous now because I work the next 6 days in a row. I'm just hoping things go a little more smoothly in the coming days. Thank you for the advice I definitely will ask what I can do to better acclimate to nursing in LTC.

allnurses Guide · Apr 24, 2013

So I started my second day on my own after training for about 21 days. This morning when I woke up I told myself that today was gonna go smoothly. I guess I jinxed myself because as soon as I started my shift, the day started to not go my way.

Yep, that's a jinx! It's probably more realistic to say, "I'm going to get through whatever comes my way!".

At about 730 the RN supervisor tells me that one of my residents is having difficulty breathing and that we're gonna have to send him out. I'm totally lost on the paperwork that you would need to send someone out because there's a million things you need to add to it...I was already now about an hour behind when I am allowed to start passing [meds], and on top of that I missed a qshift skin check for one of our VIP residents so I start it at 9.

Ah, yes...the paperwork.

Sometimes, I notice we all get slightly peeved when a patient begins to have issues on a busy shift. We know we are there for that very reason-- to take care of those issues, but sometimes it does seem like the paperwork takes up more time than the issue itself... and prevents you from attending to the needs of your other pts in a timely fashion with quality.

Generally, I cope by getting the crucial "must-be-done-now"" portion of the paperwork out of the way and anything else (like writing a note about the note you wrote for the form you filled out :rolleyes: ) gets filled out between meeting the needs of my pts.

Some stuff can wait.

Is there a certain time you must get the q shift skin check done by? I wouldn't worry about being a bit late with that, as long as I did it within a reasonable amount of time, wherein I could address any issues I might find.

I spend most of the day trying to catch up with the pass. I finish the first pass...have to start the noon pass...still have to do my weekly summaries, charting that I need to do...Medicare charting...barely finish one of my summaries...must do a "change of condition"...have another change of condition to do... including other documentations...I'm horrified because I missed the skin check

Not surprising you missed something, is it? You had a lot to deal with and got overwhelmed.

This is normal... ask anybody what their first few days alone were like.

I accidentally double-dosed my pt with Ativan in my first week! Sure, it was the most relaxed my pt had been-- ever-- and thank god no harm came to my pt, but I was so overwhelmed and disorganized! I was horrified too!

I feel really bad because the 3-11 nurse was called to the DONs office and word was she was possibly getting chewed out for what happened with the skin check coming on to her shift.

Why would she get chewed out for that? She didn't do anything. Why would people even spread the "word" if they don't know? Honestly.

All of the nurses were really encouraging saying that it happens and that it'll be okay. I feel really horrible for putting the rest of the work on the 3-11 nurse. I just need to manage my time passing to 30+ residents better.

That's really nice you have supportive coworkers.

Try as you might, you cannot always finish everything that comes up in your shift. We try, but there is a reason why nursing is 24/7.

As long as you are not passing off stuff because you don't want to deal with it, that's okay.

It's just so hard since I'm still getting to know them and what they take and how. I'm trying to do everything correctly and trying to get faster at it so I have enough time to chart and whatever else happens. I just feel so behind. Sorry just needed to vent.

It gets better as you keep at it.

Venting is good for the soul.

Just replying to offer you support.

Good luck and hang in there!

:up:

ADN2B · Apr 24, 2013

When I stay over, I get paid. It is not your fault that there is so much work that you are required to stay over documenting. I'm sure you even worked through your breaks and lunch. Get paid.

snazzy-jazzy, BSN, RN · Apr 25, 2013

It is hard, don't beat yourself up. Have a read of my thread on here. I only was given 3 days of orientation though and was thrown in doing a few shifts on my own between each one. I had a worse experience though and I had to resign due to the lack of training given, really being behind is something you will sort out and is not your fault, you're new.

IaCountryGirl · Apr 30, 2013

Don't be yourself up- we can not be every place at once. It took me awhile to get used to this, but I have learned to prioritize. Safety is always number one, med pass comes second. This is my DON's mantra too. The med pass will get faster, but don't skimp just to make it faster. That's when med errors occur!

I am one that also does the "must-be-done-now" paperwork right away but leaves the rest for later. For example- doctors orders come in. Lets say you have several that come in. A couple are "ok, i'm aware" faxes where the doc isn't issuing new orders. Those go in my "I'll get to it later" pile. A couple have new orders on them- Those get seperated also. Therapy treatments? Those can wait. Therapy leaves shortly after I get there so time is not of the essence. New medication order? Those take priority. I write it out on the T.O., double check it, fax the pharmacy then take the T.O. to the MAR and write out the new order. The white copy of the T.O. now goes in my "i'll chart on it later pile".

I also grab a blank report sheet at the start of my shift. It's sheets of paper stapled together with the residents names and room number in a box. I use it to take notes on residents as a we do report, then goes with me on my med cart. As I get vitals or dispense a prn, i write it in the residents box. This saves me time later on when I go to chart and write out my section of the main report sheet because all of my pertinent information is together.

lindseylpn · Apr 30, 2013

Hang in there it'll get easier. I started out in ltc and I did all my charting at the end of my Shift when I first started too. Soon you'll have everything memorized and be able to do a med pass in your sleep :-)

freesia29, ASN, RN · May 3, 2013

21 days of orientation???wow. I am a new grad LPN, and i am only getting 6 days. 2 in each unit as i will be a float. today was day 2, of orientation in the locked dementia unit and i left crying. i made a med error on my 2nd day. the order was written y and i misunderstood it. at least the don said it wasnt myfault...it was written iincorrectly......but i was so worried. i am feeling defeated on day 2. i know to hang in there. i am just not sure if i can handle 21 dementia residents on my own with 2 aides. how long does it take to get the hang of this?

thanks.

venousr3tuRN · May 3, 2013

I'm only about a month and a half into my job and I'm still trying to catch my bearings. I'll admit that it's gotten a little better since my second shift, but its still a challenge every day. People say that it takes at least 6 months to start feeling confident in your job. They also say it'll be 1+ years until you feel like you truly know what you're doing. Trust me, there have been many shifts where I felt like I wanted to break, being pulled in so many directions and not knowing what to do next. Whenever I feel like that I just take a deep breath, compose myself for a moment, and take it one task at a time. I'm starting to prioritize a little better but I know there's always room for improvements.

I wish I had more time to give to each resident, but with all the paperwork they require, it makes it next to impossible. I try my best though. I got chewed out for the first time by a resident's family for not waiting for them to arrive to give meds. My DON, Administrator, and coworkers were really supportive which helped a lot. My DON even called on her day off to see how I was doing and saying that I have the full support of the entire staff. I think as long as you have really supportive management and coworkers, you should be able to manage.

LTC is a very challenging job from what I've experienced so far. You're going to be a little behind when you first start but know that it is normal and that it is expected that you won't be able to function at full capacity while you're still learning your new role. Ask your coworkers for help. There's no harm in it, even if they are busy. From my experience they will-more often than not-help you as much as they can. Lastly, there's ALOT of documentation, ask for examples of how it should be done. Better yet, ask your DON how he/she wants all the documentation done. My DON actually showed me how she wanted it and even helped to improve upon some that I've already done. The gist, take advantage of all your available resources.

Good luck

lovegeriatrics · May 5, 2013

So I started my second day on my own after training for about 21 days. This morning when I woke up I told myself that today was gonna go smoothly. I guess I jinxed myself because as soon as I started my shift, the day started to not go my way. I worked the 7 - 3 shift and came in early and before I clocked in I did my rounds to make sure the residents were still here and still alive. I clocked in and then we had our morning huddle to endorse anything that happened during he night. There weren't too many tasks that needed to be followed up on so the morning started of great.
At about 730 the RN supervisor tells me that one of my residents is having difficulty breathing and that we're gonna have to send him out. I'm totally lost on the paperwork that you would need to send someone out because there's a million things you need to add to it. I get some help with it which I appreciated and we sent that resident out. The supervisor was kind enough to do the computer documentation needed for that resident and let me start my medpass. I was already now about an hour behind when I am allowed to start passing, and on top of that I missed a qshift skin check for one of our VIP residents so I start it at 9.
I'm still getting to know the residents there so the pass takes me about 3 hours to complete. I spend most of the day trying to catch up with the pass. I finish the first pass and already have to start the noon pass. After completing the second pass I now have about an hour left before shift ends. It is now 2pm and I still have to do my weekly summaries, charting that I need to do on about 4 residents, and Medicare charting on 3 residents.
I barely finish one of my summaries when the Treatment nurse informs me that I must do a "change of condition" or COC on one of the residents because she hasn't been eating well. So she helps me with that and we are able to finish it fairly easy. Then 15 minutes before the next shift comes on one of the CNA tells me that while she was assisting a resident, he acquires a skin tear. So now I have another change of condition to do, including other documentations because of the type of incident.
So right when the next shift comes on they do a skin check for the VIP resident and find new marks. I'm horrified because I missed the skin check in the morning so now it makes it hard to say if the marks were there on my shift or the start of the next. Another COC must be done now. I still have yet to finish my regular charting. I stay there on my own time to finish my charting and start those COCs. I have never really been trained properly on all the paperwork so I struggle and ask all the questions I can but can only get little help as everyone is busy themselves. I stay until 7 pm finishing all my charting. I was only able to start the COC documents for the 3-11 nurse before the RN supervisor tells me I should just go home because I've had a long day and the nurse will be able to handle the rest.
I feel really bad because the 3-11 nurse was called to the DONs office and word was she was possibly getting chewed out for what happened with the skin check coming on to her shift. All of the nurses were really encouraging saying that it happens and that it'll be okay. I feel really horrible for putting the rest of the work on the 3-11 nurse. I just need to manage my time passing to 30+ residents better. It's just so hard since I'm still getting to know them and what they take and how. I'm trying to do everything correctly and trying to get faster at it so I have enough time to chart and whatever else happens. I just feel so behind. Sorry just needed to vent.

It gets easier. I started on my own on a skilled floor after following someone for 3 days. That's 3 days of training on the floor before I was on my own. I had just graduated. I have now been there for almost a year and I have become the queen of multitasking! I can print out paper work to send someone out while charting and passing meds. You get to know which aids to go to for help and you know who likes their meds when and how. It used to take me two hours to do a med pass that now takes me 1/2 hour. And I always leave 15 minutes after my shift ends no matter how many rms, coc, or admissions. It gets better!!!! But it takes a while... Hang in there. You will get it! Xoxo

dallet6 · May 7, 2013

Do you not have a charge nurse? Our charge nurse is the one who is in charge of making the calls and doing the paperwork if someone gets sent out or passes away. Also, they transcribe orders that come in from the dr. We don't. We write our own protocol orders and stuff like that and do checks on new orders in the mar to make sure they are correct, but we don't go back and forth to the office to look at new orders that are being written during shift. If its a stat order they let us know, otherwise, its usually given at the time its next scheduled. I don't know if I'm explaining that right. I don't know what a treatment nurse is, but if they are a nurse who is doing their own assessment, why aren't they the ones doing the alert charting? If our wound care nurse sees a resident during the day they update in the chart if need be, they don't tell us to do it. Does physical or speech therapy also tell you to update what they have done with a resident?

Also curious, you have a resident where they have required q-shift skin checks? wow I'm surprised they don't get irritated with having to remove all their clothes and have their bruises etc measured and checked 3 times a day!