Can I do this job???? I need advice please.

Specialties Geriatric

Published

I just started working in a 152 bed LTC/Sub Acute/Rehab facility. I just finished my first 4 days solo. I work days, and I don't ever ever ever get finished before 6 or 7 PM. My first day, I didn't finish my 9 AM meds until 2 PM...and I was STILL doing fingersticks. I nearly cried that day. Then when I got to the nursing station all my charts were lined up with new orders that needed to be carried out, labs that needed to be followed up, etc. Again...I nearly cried.

I had a med error, because I missed 2 doses of 2.5 mg Lomotil on a patient (2 consecutive days). It was my fault, I failed to see it on the MAR. I cried the whole night, went to work and told my supervisor. Then I told the patient (own RP) and she laughed. She is 81 years old and was a nurse for 40 years. She said, "You cried all night over that little tiny white pill that doesn't do a thing for me? Don't EVER do that yourself!" I felt relieved because I thought she was going to rip one into me. I'm just worried what MANAGEMENT is going to think. It is considered a 'narcotic' and I am new....I hope they don't fire me...I just started.

I had a 911 transfer the 2nd day. One of my patients BP was sky rocketing at 190/100 and she had been complaining of chest pains during the noc shift (but not during my shift, 911 was all on my case about why the NOC shift didn't call 911 when she was having the chest pains....I DON'T KNOW!!!). They sent her back to our facility 3 hours later...so I had to do a transfer than a readmit!

3rd day (when I wrote myself up for the med error) started out awesome. I finished my 9 AM med pass at 10:30 AM without a hitch! Then the **** hit the fan. The patient with an unstable BP started having a high BP of 185/100 again. Subsided only to 177/100 with due BP meds. So I had to spend forever waiting for the advice nurse, and all the relaying back and forth with the on call doc. Then another PT started to have a high BP and kept complaining of being hot on top, cold on the bottom. Had to call her doctor. Then another patients PICC line became clogged. Had to call the doctor, the pharmacy, the IV nurse, the doctor, the pharmacy, the IV nurse. All these phone calls kept me running up and down the hall and my record med pass time was diminished. I was behind yet again. I had to send out the PT that was feeling hot and cold. I had a new admit. Came back after endorsement to a million labs, Coumadin, bacteria, C diff... OMG. Had to follow those up. Had to document all that happened today. Had to do my charting. Had to write myself up for my med error and document.

I'm off today...but I dream about work. I dream about med errors. I dream about missing something on that damn MAR. They really ought to color code it or something!!! Pages falling out and crap...that's just not right. I'm worried that one of my patients might be crapping out while I'm doing my med pass. I have 20-27 patients. They all want PRN pain meds all the time.

*sigh* I love nursing. This is my first clinical nursing job. I had been working in a med spa for 6 months. But...can I do this???????????????? I really want to succeed, but I'm worried they are going to fire me in the end. They compliment me that I seem so calm and cheery, little do they know I'm crying or screaming inside. I don't sit down or eat or go to the bathroom while I'm there (well I sit while I'm charting for 3 or 4 hours). Is this going to get any easier...or is it just going to be like this forever? Am I going to get fired for my med error? UGH I can't believe I was so stupid, I'm so careful too! I count pills and everything before I give them!

Any tips for me? How to keep organized? How to stay on top of things? How to prioritize? I feel so lost sometimes. I really want to be able to do this job!!! Thanks for letting me vent, any advice is appreciated.

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Breathe. Just -- breathe.

It will come in time. Honest. And if they are telling you how much they like you believe it.

:)

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Specializes in Medical-Surgical.

Wow! I don't really have any suggestions other than just hang in there if you want to be there. It sounds very hectic and chaotic. I would freak out having between 20 - 27 patients. You sound like you are dedicated to learning and excelling in the job, so you will. I'm sure others have felt the same way but for some reason, most seasoned nurses, never want to admit they once too struggled. I am just one year into med-surg nursing and I am still overwhelmed at times but it is getting easier, you will too! Hang in there!!!!

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Specializes in LTC.
I just started working in a 152 bed LTC/Sub Acute/Rehab facility. I just finished my first 4 days solo. I work days, and I don't ever ever ever get finished before 6 or 7 PM. My first day, I didn't finish my 9 AM meds until 2 PM...and I was STILL doing fingersticks. I nearly cried that day. Then when I got to the nursing station all my charts were lined up with new orders that needed to be carried out, labs that needed to be followed up, etc. Again...I nearly cried.

I had a med error, because I missed 2 doses of 2.5 mg Lomotil on a patient (2 consecutive days). It was my fault, I failed to see it on the MAR. I cried the whole night, went to work and told my supervisor. Then I told the patient (own RP) and she laughed. She is 81 years old and was a nurse for 40 years. She said, "You cried all night over that little tiny white pill that doesn't do a thing for me? Don't EVER do that yourself!" I felt relieved because I thought she was going to rip one into me. I'm just worried what MANAGEMENT is going to think. It is considered a 'narcotic' and I am new....I hope they don't fire me...I just started.

I had a 911 transfer the 2nd day. One of my patients BP was sky rocketing at 190/100 and she had been complaining of chest pains during the noc shift (but not during my shift, 911 was all on my case about why the NOC shift didn't call 911 when she was having the chest pains....I DON'T KNOW!!!). They sent her back to our facility 3 hours later...so I had to do a transfer than a readmit!

3rd day (when I wrote myself up for the med error) started out awesome. I finished my 9 AM med pass at 10:30 AM without a hitch! Then the **** hit the fan. The patient with an unstable BP started having a high BP of 185/100 again. Subsided only to 177/100 with due BP meds. So I had to spend forever waiting for the advice nurse, and all the relaying back and forth with the on call doc. Then another PT started to have a high BP and kept complaining of being hot on top, cold on the bottom. Had to call her doctor. Then another patients PICC line became clogged. Had to call the doctor, the pharmacy, the IV nurse, the doctor, the pharmacy, the IV nurse. All these phone calls kept me running up and down the hall and my record med pass time was diminished. I was behind yet again. I had to send out the PT that was feeling hot and cold. I had a new admit. Came back after endorsement to a million labs, Coumadin, bacteria, C diff... OMG. Had to follow those up. Had to document all that happened today. Had to do my charting. Had to write myself up for my med error and document.

I'm off today...but I dream about work. I dream about med errors. I dream about missing something on that damn MAR. They really ought to color code it or something!!! Pages falling out and crap...that's just not right. I'm worried that one of my patients might be crapping out while I'm doing my med pass. I have 20-27 patients. They all want PRN pain meds all the time.

*sigh* I love nursing. This is my first clinical nursing job. I had been working in a med spa for 6 months. But...can I do this???????????????? I really want to succeed, but I'm worried they are going to fire me in the end. They compliment me that I seem so calm and cheery, little do they know I'm crying or screaming inside. I don't sit down or eat or go to the bathroom while I'm there (well I sit while I'm charting for 3 or 4 hours). Is this going to get any easier...or is it just going to be like this forever? Am I going to get fired for my med error? UGH I can't believe I was so stupid, I'm so careful too! I count pills and everything before I give them!

Any tips for me? How to keep organized? How to stay on top of things? How to prioritize? I feel so lost sometimes. I really want to be able to do this job!!! Thanks for letting me vent, any advice is appreciated.

My med pass really started to come together when I went in room order. (Tried that last night lol), You will also get to know your residents and who likes a pain pill with their pills so hopefully you aren't going back to each one giving a PRN seperately.

You can also ask them before you get them their pills. I like to go in the room before I get their pills out and tell them I will be their nurse for the night(most of them are very happy that i am their nurse.. they know they will get their pills and treatments and any questions and issues they have taken care of).. and also ask if they would like a pain pill. Obviously not all of them are able to make needs known.

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Good idea!!! ROOM order! New grad in a nursing home as well!

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I am trying room order. BUT I try to get those patients that like to go out for activities all day first because hunting them down takes time. I am getting there with the med pass. Ugh how I hate unlocking narcs signing it out 3 times and then making sure it's put in the right place for recount!!! Most patients adore me, the CNAs appreciate me and I appreciate them, and people think I am doing well staying composed. So i am hanging in there. I really took a huge blow on my self esteem with the med error...but i have learned from it. Double triple quadruple check the MAR. I wish the MAR was typed out or at least written legibly and color coded by shift would be awesome.

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Just hang in.

I had a lot of trouble with hand-written MARs and one thing I was doing wrong was looking for "holes" along the right without reading down along the left. Don't get into that habit - it's a great way to miss new orders.

And quit beating yourself up over med errors. Obviously, avoid making them, but they happen. No harm to the patient.

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Specializes in LTC.
I am trying room order. BUT I try to get those patients that like to go out for activities all day first because hunting them down takes time. I am getting there with the med pass. Ugh how I hate unlocking narcs signing it out 3 times and then making sure it's put in the right place for recount!!! Most patients adore me, the CNAs appreciate me and I appreciate them, and people think I am doing well staying composed. So i am hanging in there. I really took a huge blow on my self esteem with the med error...but i have learned from it. Double triple quadruple check the MAR. I wish the MAR was typed out or at least written legibly and color coded by shift would be awesome.

The ones who aren't in their rooms..I flag them and come back. Keep moving.

As for the narcs.. I Put them in the narcotic box in room order and in front of the first one I put something in front of it to hold them up. As I use a narcotic I put whatever I used in front of the the bottle or thing or whatever is holding up the packs of meds. Its easy to keep them in room order that way.

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Specializes in Gerontology, Med surg, Home Health.

Take a deep breath and let it out. Don't be so hard on yourself..you're still a new nurse! Room order is great if they stay in their rooms. One thing that helped me: I asked all the other disciplines-OT,PT, activities, hair dresser to check with me BEFORE they took one of my people off the unit. If you have a lot of rehab residents, ask the rehab people for a schedule so you can make sure you medicate those people before they go off the floor. We all make med errors. Missing a lomotil or two is not serious. Know at the end of the day that you did the best you could and that all the people in your care were far better off because you were there.

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The ones who aren't in their rooms..I flag them and come back. Keep moving.

As for the narcs.. I Put them in the narcotic box in room order and in front of the first one I put something in front of it to hold them up. As I use a narcotic I put whatever I used in front of the the bottle or thing or whatever is holding up the packs of meds. Its easy to keep them in room order that way.

They keep the narcs in alphabetical order of the last name of the patient. It corresponds with the count binder so if you put it in the wrong place, the count is all messed up and the oncoming nurse gets ******. Eh. I try really hard though to keep everything right, but my narc box is literally overflowing!

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Take a deep breath and let it out. Don't be so hard on yourself..you're still a new nurse! Room order is great if they stay in their rooms. One thing that helped me: I asked all the other disciplines-OT,PT, activities, hair dresser to check with me BEFORE they took one of my people off the unit. If you have a lot of rehab residents, ask the rehab people for a schedule so you can make sure you medicate those people before they go off the floor. We all make med errors. Missing a lomotil or two is not serious. Know at the end of the day that you did the best you could and that all the people in your care were far better off because you were there.

I work on the rehab side so yeah they all go to OT and PT at different times. They usually will tell me oh I'm taking 307A to PT at 10:00 please give her pain meds before hand. Which is another reason going in room order is hard. Thank you, I freaked out when I saw that I missed the lomotils. I owned up to it ASAP and did not place blame on anyone...so i hope that will be seen as a positive and not so much a negative.

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I just say thumbs up to the 81 year old patient, former nurse, that did not want that Lomotil anyway!

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