Changeover- Worst Night of my life (vent long)!!!!

[RNgrrl09]

I worked Friday night- which was changeover night and I am a new grad and just started a month ago on the 11-7a shift. I am starting to get the hang of my med pass and treatments, but this night was he!!. The night started off horribly- not only did I start off with 3 new admissions that were not completed yet, one had refused to be sent out- he had blue fingers and toes and his pox was in the 70's and the nurse before me stated he refused to go out and he was a complainer; the other new admission had a trach- that needed suctioning q2h and he was anxious- I had a new hip that was in quite a lot of pain. On top of this, everyone wanted prn pain medications- whenever I sat down to start the changeover. I also had two IV antibiotics that needed to be given- one was q12 and the other was q6. On top of this, the stna's did not get my vitals on my other patients and I had to run around to find them. One gave me the excuse that she forgot she had two- 2 rooms even though she had been in at the beginning of the shift. I was soooooooo frustrated. I did not start my med pass until 6:30 am- because of changeover and 2 really bad dressing changes that took over an hour. Suffice it to say- I did not get out until almost 1200. My supervisor did help with changeover on two of the admissions and one we had to call the doctor to get clarifications of orders, I also had to call to get clarification of orders on a patient that was coming back from the hospital, it was just one looooong, frightful night. I was glad that I was off for the next two nights, but I slept through the whole day- I did not awaken until Sunday at 5:00 am. I have a daughter, who is 15 and this is an age that can easily get into trouble- even though she is a good kid. She did not wake me, she got her own dinner. I was disoriented when I got up thinking it was 5 at night and it's dark and then seeing that it is 5 am. I was just soooo thoroughly tired. I know not every changeover will be like this and the rest of my days have not been like this. I'm just wondering if this is what I really want to do this- work in LTC. This is the first day that I felt that I could really make a medication error or forget a med order to write it over. We only had three nurses on this night and from previous experience (i'm going by hearsay), they usually have another nurse on to help with the paperwork. It was totally outlandish. Oh how I wish a hospital would call- I know that I will have other problems in another setting, but I would not have to worry about doing this paperwork and still providing care the patients need. I hate this!!!! I hate not having enough equipment, having 20 patients, fighting with the aids to get my vital signs, not having enough time in my day to do the things that I should be doing qshift. Having to write out everything little thing. I needed to take a day away from the situation just to try to get my head around the situation and that is why I'm posting today. Now I have to go back tonight and I am still tired. I'm just thinking maybe I need to go prn and concentrate on finding a full time job someplace else and maybe having to leave the state if I want a hospital position. I so don't want to do this because my daughter only has 2 more years of school. Oh well, they didn't tell you about days like these in nursing school. Thanks for allowing me to vent!!!!

[jensmomrn11]

I feel your pain. I am a new LPN grad that recently started my first job in LTC and I feel so totally frustrated and incompetent. Is all nursing this bad or is it just LTC?

[lisamc1RN, LPN]

(Hugs) You are not alone. I don't know any nurse who hasn't experienced that completely overwhelming, feels impossible to get all the work done, day. Those are hard days and can definitely make a nurse question his/her decisions. I just want you to know that as you gain more experience, more and more days will be much better. Hang in there. Ask for help. Treat yourself well.

[catlynLPN]

I hear what you're saying.

And some people think night shift nurses don't do anything.

[spunky1281]

Yep, that is how a changeover usually goes. I have never seen a changeover go good (well except when I trained in-those are nights guaranteed to go smoothly). For some reason residents have this thing where they can sense things and then will only want things when you are at your busiest...

[mommiedearest]

I feel like I was right there beside you sister! I've had days, nights, and evenings that were so overwhelming I wanted to drive away from that place far and fast, never to return! Not to mention having my car keyed in the parking lot by a nurse who I reported for reeking of booze at shift change! I've asked myself many times why I didn't become a teacher instead! Then a resident lets you know that you mean the world to them, or you work with someone who is a joy to be around and suddenly it's a great job again.

Thankfully changeover only comes once a month, and hopefully you get a break next time around! God bless ya!

[miss81, BSN, RN]

Let me tell ya, the hospital is no better! You'll get a "sick" admission (+ 15 of her persistent/crazy family members), a post op with a BP of 70/40, a confused pt pulling out this CVP line and your only "sensible" 40 year old patient, that you were sure would be no trouble, having chest pain all at change of shift!

We all have these days. Hospital Nurses too... Good luck and just remember you're not alone!

[rentalnurse, RN]

I can identify, I worked agency at a LTC a long time back and it was change over night. Well at places I had worked before most of the checking was done before hand and all I had to do was a quick once over and put the book together. Nothihg was done, no checks no med reconciliation etc. It was the worst mess possible and to boot there wasnt any staff nurses with me or a med tech I was alone with cna. There were so many things changed and nothing corrected I passed my morning meds with the old book and told the DON in the am what a freaking mess the MAR was. The day nurses were upset that I didnt get it all done for them. I hoped they spent the whole day trying to get it together.

[BEDPAN76]

The LTC where I work starts changeover 5 or 6 nights before the first. Usually, a 3-11 LPN will volunteer to do a double, to get a lot of them done, especially the "uncomplicated" ones. They put all the new MARS and TARS in new notebooks. On the first of the month, they change the labels to read the new month. Works pretty good although if that last night, you have residents falling and going bad, it's still a mess. At least you will come to really appreciate those changeovers when you are OFF! Good luck and hang in there. The first changeover is always the worst.....

[SunnyAndrsn]

Not every night is like that. After 18months in LTC, I still would like a hospital job (finally found one to hire me PRN but still need my benefits from the LTC), but I have grown to love my job. Some days still suck, I had one last night that was quite a doozy, but not as bad as what you are describing. Those change overs are a PITA. We'll let management know when it's pretty bad so that we can get some help. We have called a nurse in just to do the change over.

There is an unwritten rule that all CNAs, managers, family, and residents are aware of: If a nurse is sitting to chart, he/she is not busy.

Hang in there.

[arelle68]

When I started as a new RN in LTC, I cried my head off all the way home, and into the night. I didn't think I was going to make it. I was sure I would get fired, and almost did. I was thrown in without enough training, and told to "sink or swim". Of course, I made mistakes, and had to take some lumps. I wished I could make sandwiches at Subway or something. Anything else.

I still have hard days. Tonight was really hard. I had 2 incidents, and everyone seemed to be having issues. This is for sure though, I handled this night better than I would have 4 or even 2 months ago. Things are slowly getting better. I am getting really fast at med pass. I know all of my Rsdts, and what they need. A lot of it just flows. Practice and repetition. It will get better, if you just hang in and keep trying.

Who your CNAs are have a lot to do with how your shift goes. My CNAs are AWESOME and I love them.

[KarynicaRN]

You are going through exactly what it's like to work in LTC. You have my sympathy. I have been working LTC since I was an aide back in the early 1980's.

I work the 6pm-6am shift. Everyone thinks I have it made. Everyone thinks the residents are all in bed and don't need a thing. WRONG! I have a med pass from hell at 8pm for at least 30 of our 48 residents. Then after I think I can sit down and do my charting and doctors orders, residents all of a sudden want their pain meds. I was just down the halls and asked those who generally need a pain medication if they want a med and of course they told me no. Let me sit down and the whole place needs a Vicodin.

Then we have the one's that want to smoke until 10 at night. We only have so many aides who can watch those people. I don't smoke and I am the only nurse in the whole building, so I am NOT GOING ANYWHERE. Then you have the dressing changes, the hospice patients that need their morphine sulfate q 2 hours, then the am med pass that starts at 5am. No wonder LTC nurses are burned out.

Please take a good long look at your future. Do you see it there in that LTC facility? If not, start looking for something that makes YOU happy. You have a 15 year old that still needs you and if mommy is so burned out, it will be hard on her. Of course you have to work to provide for your daughter, but it's so sad to watch them grow up before your very eyes and miss so much in their lives. I have a 17 year old who has had to depend on her step dad for rides to school and back for ballgames. Mom can't be at the games..she works at night all the time..

I am sorry for the rambling. Just take good care of yourself and try to get your rest. If you decide that LTC isn't for you, at least you gave it your best shot.