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!!!!
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.
Funny what you said about working at Subway. I have found myself in Walmart at 1 am after a horrendous 3-11, and just wanting to be one of those gals stocking the shelves & joking around with each other. It looked like Heaven compared to my job!!
Changeover night is the worst night of the month. My facility is so against overtime that I am not allowed in early on the night of the changeover. Usually many or most of the charts are not checked. I do what I can, but usually only work one or two nights inthe week prior to changeover. I spend the first night going through 60 charts to make sure all orders have been transcribed into both sets of books. Then I start to do what ever I can do to get ready for the change over. But, usually it is a big mess. It is not humanly possible to care for your patients and check the charts and changeover all the paperwork. I still get stressed, but I refuse to accept any negative remarks from day shift. After all if these same nurses would help check the charts like they are supposed to in the first place, the changeover would have 1/2 a chance of going smoothly. I have my priorities, the patients still come first. However everything, and I mean everything else comes last. The changeover dominates my night. I dont care if I work late the next morning, I plan on it, overtime be darned. If I can't get it all done, I make sure all the night things are checked, so I can chart my meds and treatments. Then I leave the rest. I put the new mars in front of the old ones, this at least gives the day shift a running chance. But, honestly I can't carry the whole load, and I refuse to. If you do a haphazed job of checking, and you make an ommission or mistake, its your license on the line. I am not willing to be the sacrifial lamb.
Jeez, you brought back nightmares for me. Three years ago my first LPN job was in an LTC on night shift. And I tell you the single most hated part of nights for me was the dreaded changeover. The week or so leading up to the end of the month would be spent playing catch up b/c of certain lazy nightshifters who refused to work on their share of changeover on their shift. One nurse in particular either requested off or called off every changeover night-no exaggeration- and since I was the float nurse, I would inevitably end up on her floor with all the half-done or not done MARS and TARS she'd left for me. And since she usually would call off, the supervisor would end up working a floor and therefore be of no help.
I've had many nightmarish nights like the one you describe, and you have my sympathy. Keep trying for a better job! There is one out there for you.
My heart goes out to you, as a new grad in LTC you have a very tough row to hoe! I couldn't have done it- I don't think I could do it now after 25+ years of nursing. Your post highlights just what I have been saying to anyone who will listen about the state of nursing today. Incomplete or unclear orders from the doctor- it's the nurses job to fix it; lazy NAs or nurse techs- the nurse has the ultimate responsibility to do thier job , pharmacy screws up the meds- the med giver- the nurse is where the buck stops, the floor covered with goo- the nurse walks through it or cleans it up- not to mention the risk to patients and visitors. The official term for what nurses are doing is "patient advocate" or "patient care coordinator", but what it amounts to is "scapegoat". As long as we are responsible for every aspect of the patients care going right, but have no control over the support staff, medical management requirements, and equipment needs, staff nursing is going to keep getting the dirty end of the stick. I don't have a solution, or even encouragement, but you are not alone in what you are feeling. I would never encourage one of my daughters or grandchildren to follow in my footsteps.
Specializes in Gerontology, Med surg, Home Health.
Can someone tell me what a changeover is? I have never worked LTC.
Changeover is when you have to take all the old med sheets, treatment sheets,CNA flowsheets, etc OUT of the books and replace them with the ones for the new month.
Before you replace the MARs and TARs, you are supposed to edit them...check them against the current MD orders to make sure they match.
It's not a horrible thing in every facility. We solved many of the process problems by just buying 2 sets of binders....the old ones are whisked away to medical records and the new ones go out on the unit.
It may go smoothly if there have been no additions/subtractions to the MAR. If you as the nurse don't catch errors/omissions in meds or tx, it is a med error for you. So you have to check the telephone orders, dietary, pt,ot, pharmacy reqs, opthlomology, psych reqs, yada, yada, yada. And if there are errors in any of the preceeding, you will be blamed anyway. We worked hard for our licenses. In Mass, they don't consider LTC/Sub-acute care to be "real nursing" (in most hospitals anyway). I would love to see some of these snotty magnet facility nurse-managers do what we do in sub-acute and with 25-50 patients at that.
BTW, take your own v/s don't rely on the cna's. Too many of them just plain make them up. And if you give a cardiac med based on a CNA's v/s report and your pt goes all hypotensive on you, IT WILL BE YOUR FAULT AND YOU WILL BE SUED, FIRED, BLACKBALLED ETC.
Specializes in Gerontology, Med surg, Home Health.
Maura-
I work in Massachusetts and haven't run into the same prejudices as you. When I tell other nurses what I do, especially when I was working in and then running, a sub acute floor, none of them demeaned me or my skills. Most of them said they couldn't do it if a gun were but to their heads. Everyone has different talents so let's not play the game we detest by calling other nurses names.
I actually had a nurse recruiter say this to me last week. No kidding. She was the one that was impressed with my resume, skills, education, certifications and references. She walked my resume to the Nurse manager who was the one that turned me down because "LPN in sub-acute care is not real nursing. She is only a new grad RN" That is a direct quote. This was not a Boston teaching hospital either. It was a local community hospital desperate for nurses.
I have other anecdotal stories along the same lines but this one was striking in its stupidity.
Specializes in Gerontology, Med surg, Home Health.
Every now and then our local hospital has a Bridges Program. They try to get nurses who work in other parts of the business come to the hospital. ONLY the nurses who work on the sub acute floor have ever made it to the hospital.
I was a visitor in an ICU...arrived in my scrubs. The nurse there offered me a job. I said.."Oh no..I work sub acute, I couldn't do what you do.' She laughed and told me that she had tried to work on a sub acute floor but it was too hard....too many patients..one lady is coding and a family is complaining that mom didn't get her hair done. And then she told me all the other nurses laughed at her because she couldn't remember all the different places there were to document this or that.
People are learning more and more every day what we do in LTC...
OHHH do I hate changeovers! They are always a mess. One of our night nurses usually comes in and starts on them the 27th of each month and what I do to help her is separate them all and put them in order by hall and room number for her before she comes in (if Im there when they arrive) I make all new blood sugar sheets for her also and put them with the appropriate mar. I paperclip each persons mar to keep them all straight. If I get a chance I work on what I can and then she picks up. This past time I didnt get to really help her do them other than separating them. We had tons of admissions on my shift etc etc. So I was good to get them separated for her. Then if I work the last day of the month I take off the old mars, staple them in order and then put on the new ones so that whoever comes in on third has one less thing to worry about with it. Im the only one that bothers to try and help out with this which gets frustrating but if it were me Id want some help too.
If you truly want to work in a hospital get out now. The frustrations you describe are a part of every LTC facility
and if you stay in LTC long enough Hospitals may pass you by because they will assume that your skills are diminished. Good luck and stay positive:loveya:
mommiedearest
6 Posts
Funny what you said about working at Subway. I have found myself in Walmart at 1 am after a horrendous 3-11, and just wanting to be one of those gals stocking the shelves & joking around with each other. It looked like Heaven compared to my job!!