Constantly worrying about work (new grad and first new job in LTC)

[avalon789]

This week marks my first month (and my first week on my own) at my new job in a LTC facility and I honestly think I have no idea what I'm doing. I have gone through 7 shifts of orientation on the floor with 4 different preceptors (there was one I actually liked and learned from the most. The rest were meh). It was supposed to be 3 days but I asked my DON if I can have a couple extra days with a certain preceptor and she was able to accommodate me.

Now that I will be on my own from now on, I am constantly worried about messing up, not charting well enough or even having enough time to do it, my time management (morning med passes have been killing me), reordering meds, etc..

On every orientation day, I always asked my preceptor if I was on track with my morning med pass (I would start at 630 and my goal would be to finish by 1030). They always said, "Yes, you're doing well and you're getting a little faster." (I hardly believe them. I always end up finishing at 1200 and that's when I start doing 1200-1400 meds. So I'm on my feet doing med passes/bolus feedings until 1400).

I'm afraid that I take too much time passing meds that I rarely have the time to do other tasks like checking on my residents (making sure they didn't fall) charting, obtaining consent from residents/responsible parties, following up on medications, reporting to the MD of abnormal labs, taking T.O's, and taking admissions and doing discharge, and etc.. Not to mention the unexpected (we had a code on my last orientation day and I just froze on the spot. I realized how unprepared and useless I felt. I've seen a code in my clinicals as a nursing student but...this time I froze:eek:. Not the greatest thing to do during a code.

I realized the unexpected can throw me off my flow and I became a little paranoid. That day, I checked on my residents and asked if they felt any pain or discomfort even doing quick checks on napping residents just to see if they're still breathing.

I've read numerous posts about new grads and their LTC experiences and the responses from seasoned LTC nurses. It's somewhat comforting to know that most of you have experienced the same things I've been experiencing and giving the assurance that it does get better.

But the big question in my head is....how do I know if I'm on the right track on getting better at being a nurse? Is my constant worrying an advantage or a disadvantage? I can't stop thinking about work. I'm always adjusting the times on my med passes (One day I did it by room number. On another day I did it by who needs insulin/BS readings first) just to see what works efficiently:writing:. This week I'm thinking of doing it by medication (insulin/BS readings, who's on metformin, who's on HTN meds, who needs a bolus feeding, then the rest). I really want to be up to speed with the rest of the nurses on my floor (I work with 2 LPNs and CNA's. I'm the only RN).

I know my DON is waiting for me to ask her to transfer me "downstairs" (a.k.a LTAC; where it is more disorganized/chaotic and where they desperately need RNs.). I told her I want to familiarize myself with the flow first and refine my time management skills. I know I'll be able to learn more technical stuff downstairs but I personally feel like I'm not ready for the meantime (perhaps in 2 months I'll be ready).

TL;DR: Had a week's worth of orientation on my floor. I'm scared sh**less about messing up and falling behind on my shift everyday. Will my constant worrying be my downfall? How do I know if I'm on the right track to getting better at my job?

[RhetoricalQuestion]

We all start there. It just means you're actually looking at the medications and not blindly signing the MAR like many LTC nurses.

[tealover88]

HI! warning: long comment coming.

I experienced constant worrying at my first nursing job on a TCU/LTC as well. I only lessened slightly after i had 6 months under my belt, at that point I really did feel more self-confident in my abilities and knew how to MANAGE my unit. As a nurse u delegate and manage CNAs and your patients. You will develop the skills of how to prioritize and bundle patient care and assessment. Your attitude and how you react to stress will also affect the culture of the unit. Granted I ended up leaving SNFs because of the politics and bureaucracy and bad nursing, I did have a rhythm for my shift that allowed management of unexpected occurrences.

I will say though that you received a surprisingly short orientation as a new grad, I received 4 weeks of orientation which was the norm for a new grad at this nursing home. So just there you have a lot more to figure out, BUT you are not alone! Don't be afraid to ask a coworker whose completed their med pass if they could do a treatment for you and document it and then just report to you if anything significant was noted. Or help with an admission. The unit is a team.

the FIRST thing that is SO important is that you always get a look at all of your patients FIRST thing in your shift. Not knowing what your patients looked like at 7 am and if something were to happen and you couldnt pin point if the last shift left them like that or if it happened during your shift is NO good. Change of shift is hectic, so if you could show up 3 mins early to your shift and due a quick head check of your patients it will put you at ease during your report to know that they are all present and accounted for and you'll know what questions to ask the nurse you are relieving. I made the mistake of not doing a quick round on my patients and then ended up with surprises that hacked my shift up. But with doing my quick check I have found disoriented patients working their out of their beds to surely fall with bed alarm not sounding. Its a life saver.

As for speeding your med pass up.... that will honestly come with practice and familiarity with the patient and their drugs and where are they located in the cart. Another thing that may help is making sure that when youre working the cart that is all youre doing for that time, no side convos with coworkers and with the patients its just asking if they have any pain and in and out. you can chat a little bit more when u grab vitals because that lets you know cognitive status. so maybe immediately following report you just bang out all your vital signs and assessments before the medpass. also MAKE SURE your cart has everything you need on it before you start your medpass. if there's only a couple of syringes, then restock have applesauce pudding cranberry juice miralax, skin prep for some quick txs on hand. the less you interrupt the medpass the faster it will be done. I didnt go room to room in order for my medpass, the state would rather you do that method they do not like to see a lot of jumping around. but i based my medpass by what time meds were due. Also at the beginning of the shift glance through ur treatment book, and treatments that can be bundled during patient care, let your CNAs know to grab you when they are dressing so and so and it will make treatments much less intrusive for everyone!

All those tasks you mentioned that need to get done will get done. Abnormal labs need to be addressed immediately, these are the sickest patients and putting it off to the end of the shift may have consequences. For any labs or orders that need to be taken off, let your supervisor know you're bogged down at the moment, ask another nurse for help taking off orders. But there will be days where you will have to interrupt ur medpass to address all these things, it will be okay. If your nursing home is still paper MARs then you have little to worry about no one will know you had to give a med 2 hours late, it's not ideal in the least, it's not legally okay but it's nursing reality. Move as fast as youre comfortable with and knowing that youre moving at a still safe pace. And also you need to be nursing smart, what can afford to be given a little late? what do you need to make sure gets into your patient in a timely manner? Again everything is about prioritization. Since you are on the day shift, you have the most resources available to you and MD respond should be fairly quick versus the evening shift.

Lastly, you will know you are doing well when your patients tell you wonderful they think you are or when you see your patients getting better or when you see them pass peacefully with loved ones near. Which will happen and it's a great feeling and makes all the effort well worthwhile. I wouldn't be afraid of the downstairs unit, you should be assigned less patients and have more staff in that type of unit and you may find it easier to manage than 20 something LTC patients.

Good Luck! And remember there are many niches in nursing if you find that this is not the place for you and there's no shame in it.