Challenging First Days

[carolh]

Alright here I am a new Graduate Practical Nurse. I couldn't wait to graduate and get a job. I looked forward to finally being the nurse after 15 years of being the CNA. I was lucky, I was offered a great full time position at a LTC Facility the day after graduation. I started orientation 2 days ago and I have never been more exhausted and sore in my life! Last night I passed meds to 24 residents and I swear some of them got in line twice lol! Our shift is from 2:30 to 11:00 and if it weren't for my preceptor I would still be there this morning. I can't believe how long it took me to make two med passes last night. I know, I know it was only my first time passing meds to a full assignment, but I am really wondering how the heck I am going to be able to pass the meds and do all the treatments and charting. My preceptor thinks they may put me on by myself on Friday and I don't mind telling you that scares the heck out of me. Even though I was throughly exhausted last night I could not sleep. I worried all night long about whether I had done everything right. I guess, aside from unloading, I would like to know how everyone else is doing and some tips on how to do my job a little more efficiently. A little encouragment would also be greatly appreciated !

[JentheRN05, RN]

I have a report sheet that seems to help. It has times (which are adjustable) for making sure you have all the meds passed. If your interested feel free to PM me.

[Daytonite, BSN, RN]

When you first start, nursing in LTC can be very exhausting. After all, you are not used to standing on your feet 8 hours at a time. Your med passes are going to consume a lot of your time. When I worked in LTC on a 3-11 shift I tried to hit the dining room at 5pm because it was easier to pass meds while all the patients were congregated in one place. However, you also have to know what name belongs to each patient's face and that is going to take you some time. It is normal to worry about whether you've done things right during your first days of work. A great deal of your fatigue right now comes not only from the physical stress, but from the mental stress as well. It gets better, I promise.

The insider trick to passing meds to 24 patients is this. Over time you literally do memorize who gets what. Because the patients and their medications don't change all that often it is hard not to memorize them. However, that doesn't mean that you never look at their med sheet until the end of your shift to sign off their meds as being given. You are going to see some nurses doing this and it is wrong. That is not what you were taught in school either. I am always amazed when we would find a stray pill on the floor and when we picked it up and looked at it we would know immediately what it was and which patient it had probably been meant for. Some day soon, you too, grasshopper, will be able to do this.

This same process of memorization occurs with respect to treatments and doctors orders. Over time not a whole lot changes and so these things kind of get ingrained in your brain. The biggest help for you will be when you start to be able to put names with patient's faces. That, unfortunately, takes time.

As far as worrying about being on your own and getting all your meds and treatments done. . .you can only put one foot in front of the other at one time. You just plod along. Getting things done yesterday is a common nursing complaint--welcome to the club. Eventually the shift comes to an end and it is time to go home. If you have any questions about whether you are handling something correctly you ask one of the other nurses in the building. If you are the only nurse in the house make sure you are given a number of the supervisor or RN who is on call. Don't hesitate to call this person for advice or to talk a decision over. That's why they are on call.

Perhaps in a bizarre way this will make you feel a little better about your work. 30 years ago when I first started working in nursing homes it was common to pass meds and do treatments for 50 patients! Can you imagine that? We used to double pour our meds--something which is an absolute no-no these days. At 3pm we would stand at our med carts and put each patient's pills into souffle cups for the 5pm AND the 9pm med pass. We never looked at the med sheets either because we knew the meds by heart. If we passed a patient in the hall headed toward the dining room we just whipped out their 5pm cup of meds, poured them a glass of water from the water pitcher on the top of our carts, watched him take his meds and went on our way. It worked well for the time, but for many reasons this way of doing things and the total number of patients we had to be responsible for had to change. By the way, we knew double-pouring was wrong and we hid it from the DON. God help us if the state board came around for an inspection. Then we had to pour each patient's meds at the time we gave them. What a pain that was! (I'm being sarcastically funny.) :rotfl:

[carolh]

Thanks, you don't know how much it helps just to talk to someone who has been there too! I can not even imagine passing meds to 50 people! My God, they should have passed out rollerskates to all the new nurses there lol. I love geriactrics and have wanted to be a nurse for so long that I am determined to stick it out no matter what! I hope someday I will be able to write some words of advice to a new nurse and make her day better as you have done for me. Thank you!

[missnurse01, MSN, RN]

this is why you guys in this field rock! i never could do it, am glad u all do and that u enjoy it. good luck in your career.