depressed about new ltc job

Kellyma · Jul 19, 2010

I'm not a LVN but I worked for yrs as a CNA in LTC. At first it was really hard, we were so short handed most of the time I was the only CNA that worked there (not registry or NA student) So I was the go to person for every question! and I was pregnant! there were times I hated it so much, but after I had my son and went back to work, I realized under improved cautions in the same place, that I was glad I had that experience, I was ready for anything and every time we were short and everyone else was flipping out I was like "this is nothing we got this" and I was always done early without cutting corners and able to help out others and give extra care to those who needed it. I really think it was a very good learning experience. You may not stay there forever or even very long but you might learn how to handle a lot of things that will help you latter in your career and life.

as far as bending the rules again I'm not an LVN but I'd be careful about that, you don't want to be stuck in a situation that you can't even really recall were things went wrong or have feel guilty about something that something could have been avoided.

Gerry1888RN · Jul 19, 2010

I have just finished my first week as a new grad RN at a sub-acute LTC. I sort of enjoyed it, and I'm starting to really know the residents. I also have pts with picc lines, g tubes and stuff, so I am doing more than just passing meds. I will still be working with another nurse for the next few weeks before I go on nights. I think you should ask for more orientation.

cebuana_nurse · Jul 19, 2010

I'm a new grad as of May 2010. Of course, there are few jobs in my area, so I'm trilled when offered a position in LTC. I recently finished my first week alone and hated it. All I do is pass meds all 8 hours. I have no time for patients interaction. I rush through everything I ever do. I'm suppose to work 3-11, but I find myself coming in at 2:30pm and leaving between 1 and 2 am. I cry before I go into work and cry when I leave. I have no time for anything else than work because the job is Monday-Friday. Some people at work tell me that it will get better with time....others say that it will never get better because they need 3 nurses on second shift.
I know most of you are probably thinking that I'm whining for no reason. I know that many people do this everyday, but I'm so depressed about it. I can't just quit because the bills are piling up, but I don't know what to do.
Not to mention that many people have told me to just pass 9pm meds with 5pm unless its a narc, which makes me really nervous. Is this the only way to get things done? It scares me to death to think that on Friday I had to sent a resident out to the hospital before 9pm med pass. I can't remember if I passed 9pm meds to her with her 5pm....can't remember if I signed the MAR before she left.
I'm scared, depressed, hate my job, and have no way out. I guess I'm just asking for some encouragement or advice.

When I was on orientation, my preceptor told me that if there are residents that only gets a sleeping pill at night or 1-2 medicine at 9pm to just give it all at once by 5pm to save some time. Did I ever followed her advice? NO. Whatever you do, it's your license is on the line. What if that resident died before 9pm, and you gave her Ambien before the she is supposed to get it? How would you explain this situation? You were given an option, but that doesn't mean that it was the only choice you have.

When I started LTC, believe me, I didn't stop whining/complaining about my job. You could read all of my posts after I got the job. It wasn't my dream job. Being in nursing for quite awhile, I came to a realization that there's no 'DREAM JOB'. Every job will have its pros and cons and later on, you'll realize that your 'dream job' may not be really the kind of job you think of. But you know what? It does get better. There are days that I always still find time to interact with my patients. I take a quick minute or two to ask them how they are doing, share some stories and a whole bunch of stuff. It may seem like we're only shoving pills down people's throats but you could always change that perspective. And eventually you'll enjoy it. If it doesn't get better for you, then you just gotta find your niche. Everything takes time.

We need our jobs to pay the bills. But I truly believe the saying that, "We work to live not live to work. Life is short-lived. Try not to be miserable, if you are, it's time to change jobs."

Good Luck!

Forever Sunshine, ASN, RN · Jul 19, 2010

Giving meds ahead of schedule or all at 9pm is not something I am proud of but its one of the tricks of the trade.

Be careful about it and use your judgement, but if its a daily med or colace. Don't wake them up. Also I don't wake them up to give them ordered supplements either.

Yes with dementia patients I combine their meds in one, because sometimes all you have is one try to get it in.

MisMatch, LPN · Jul 19, 2010

I just finished my first year as a LPN in LTC. Like you, in the beginning, I was scared, depressed and hated my job.

It does get better! I'm no longer scared, don't dread going to work and while I don't love my job, I don't hate it either. I look at this experience as "basic training" or "boot camp" for my future endeavors.

I work nights, but have done all 3 shifts. You will develop a routine, get to know the residents, get to know the med passes and become more efficient as time goes on. No, you don't pass 1700 meds with 2030/HS meds.

Getting to know your meds and residents will help. Know why certain meds are given at certain times and how often they are given. You will get to know who goes to bed when, who easily takes meds and who is impossible to wake up once they are asleep. Then use common sense/nursing judgement to bend the rules (maybe not legal, but reality). If someone gets a statin once daily at HS and is in bed sound asleep by 1900, I will give it to then @ 1830. BP meds given q4 or q8 hours need to be kept in the legal timeframe (usually 1 hour before/after the stated time).

I work nights, so the AM med pass and FBS is for 0630. If I have an early riser, I have no problem giving synthroid or doing a FBS @ 0400 which gives me a jump on my AM med pass. However I will not give insulin that early as it is too far from breakfast. Again, know your meds - how they act, interact and react with the body and other meds will help you expidite your med pass and be safe at the same time.

It took me about 6 months before I felt in any way proficient and comfortable doing this. Give yourself time. Try to find an experienced nurse you can go to as a mentor to ask questions and get feedback. That helped me a lot! Best of luck to you.

Finallydidit · Jul 19, 2010

HS meds are just that.. The residents bedtime, I have alot of Residents that are in bed sleeping by 8pm, and have no prob giving their HS meds at 7-7:30 even thou the MAR will say HS and 10pm. (That HS gives us liberity to use our judgement based to the individual Residents bedtime) And I agree with DaJulieness, Sometimes you only get one shot to give meds, and if there is no contraindications they can be combined. In most cases talking with the Dr. or NP to change times will prove effective. Like the little ole lady that has xanax sched at 9p, but really could use it at 6p. They usually have no prob changing times if warranted. My 9p med pass mostly consist of my diabetics along with a few sleeping aids. Think about it a Res gets a new order for Sched lasix BID, the Mar will automatically come out at sched 9a and 9p... Are you really gonna want to give lasix at 9p? No your should get the order changed BID doesn't always have to be Q12/hrs

prinsessa · Jul 19, 2010

I give some of the residents their HS meds before 9p. If they go to sleep before 9p why can't they have it before 9p? Insulin is one med that I never give at a different time.

caliotter3 · Jul 19, 2010

You have a job. Be thankful for that. There are far too many unemployed nurses who would die to have your lousy job. You could be just as unhappy waiting tables or cleaning hotel rooms or even working as the press secretary for the president. Just thank heavens you are employed. Things will even out eventually and you will either adjust to this job or find a better one.

sweetmama81 · Jul 24, 2010

You have a job. Be thankful for that. There are far too many unemployed nurses who would die to have your lousy job. You could be just as unhappy waiting tables or cleaning hotel rooms or even working as the press secretary for the president. Just thank heavens you are employed. Things will even out eventually and you will either adjust to this job or find a better one.

I think that you are being a bit harsh. I am pretty sure that she is aware that someone would love her job. However, she is here to say how she feels. I remember very well what it is like to start at a new place, especially when you are being taught to do things in a way that seems unsafe. Please, cut her some slack.

BoopetteRN · Jul 24, 2010

:nurse:I am so sorry that your experience has not been a good one. You do spend much time passing meds in LTC, but the more experience you have the better it gets. You become familiar with each resident, their meds, and the unit you work on. As you pass your meds you begin to notice more, and it seems to fit. Don't get frustrated, just give it time, I went through the same thing when I first started, we all do to some degree. Each facitlity is different, but LTC is a wonderful place to be.

JZ_RN · Apr 21, 2012

I don't pass meds before it's acceptable, however, if a patient has 8's and 10's, I will wait until 9 and give them together, otherwise, I sometimes get stuck in a needy patient's room for 20 minutes which I do not have time for. I will give 7's and 8's together, and 6's and 7's together. I have one patient who refuses meds when they are scheduled then complains no one gave them to her, I save her for last then take her meds, if she doesn't want them, I put her name on the cup and lock them up, and tell her to call me when she wants them. It's usually an hour after they are scheduled but they aren't something really dangerous. Administration and the manager know how she is. I always sign the meds off when I gave them, so they are always signed off right after administered, so I will always know. Some nurses wait until the end or even don't sign out narcs as they go but I am not gonna play around like that. I get the rude and mean patients out of the way first, so I am not dreading it the whole med pass. I have one resident whose meds specifically say don't give after "this time" and they are scheduled at that time, If it's within 15 minutes I give it but later than that and I just mark that I was "too late" because I am not overdosing her, she gets another one 4 hours later, and I can't always put her as first priority. Does it suck? yes. Do I HATE MED PASS with the burning passion of a thousand burning suns? Yep. But I push through. Until I get a job outside of LTC which I despise working in. No one respects us LTC nurses ad the job is miserable. I do my best for the patients and protect myself as much as possible.

GLORIAmunchkin72 · Apr 22, 2012

Fortunately for us at our LTC we are no longer bound by strict timelines. Only specific meds have specific times. It is much nicer and more resident and staff friendly. I usually start my evening medpass around 6:30 pm, try to catch the ones who go to bed early and finish around 9:15pm or 9:30.