First day on your own?

AngelicDarkness · Jul 7, 2011

It does take some time. I missed BGs and BPs when I firsted started out on my own. I've been a new grad only 8 months, and it honestly clicked after I was there about 3 weeks. Going in early is a great way to start. I go in early to prep my meds. This frees up time later when going through the MARs. Take your time. Don't rush. You can do this!:)

SP1CEGRL · Jul 7, 2011

what do you mean by prepping your meds? Do you mean you pour them ahead of time? Someone reccommended that I go through the MARs each day before my shift and in my cart, move up the medication packs that I would be using during that shift, that way I could just pop them in order when it came time, and not have to worry about looking through meds I didn't need to give. I think this sounds like a great idea, but I'm worried it would take up too much time

Been there,done that, ASN, RN · Jul 7, 2011

Sounds like an impossible job. Experienced nurses couldn't do it.

Don't feel guilty... get another job. They are out there.

Even home care would be a good start,learning meds , basic care, etc.

Good luck.

If its any consolation, I've been doing this for 30 years, felt like crying @ work recently.

Sigh... the life of the nurse.

Daisy_08, BSN, RN · Jul 7, 2011

it sounds like you did not have adequate orientation.

i'm starting a new job in ltc next week (!!!). they have three units. i'll have three shifts on 7-3 and three on 3-11 on one unit and will have only 3 different nurses orientating me. then i'll work on my own for a shift, if it goes well then i'll move on to the next unit and so on, plus a few nights.

good luck, the transition for student to nurse is hard, but it sounds like you have really supportive co-workers and that is a good sign that the manager came to help you. it will get easier; i remember my first day i was still doing 8am meds at 11. it took me a few weeks until i was even able to take a break.

good luck and congratulation on having a job! :yeah: :yeah:

Forever Sunshine, ASN, RN · Jul 7, 2011

what do you mean by prepping your meds? Do you mean you pour them ahead of time? Someone reccommended that I go through the MARs each day before my shift and in my cart, move up the medication packs that I would be using during that shift, that way I could just pop them in order when it came time, and not have to worry about looking through meds I didn't need to give. I think this sounds like a great idea, but I'm worried it would take up too much time

DON'T PREPARE YOUR MEDS AHEAD OF TIME(PREPOUR!) I recently did this just for the hell of it to see what it was like.. and I know what I'm doing with med-pass now. I was so confused. It took more time because I kept going back and second guessing myself.. and I kept thinking.. "what if I gave the wrong cup to the wrong person??" I will never prepour again and I strongly advise doing that.

Do your meds carefully and take your time. Our MARS go in room order.. so thats what I do. I start at the first room and keep going until I reach the back of the book.. Flag those who aren't in their rooms or don't want their meds right now.. and come back later.

I used to flag stuff but not anymore.. another poster on here.. I forget his username ..shared this way. .. you take your unit census sheet or report sheet.. with residents name. After you give a resident meds from the first medpass you slash their room number once... for the second medpass.. slash it again.

Get your fingersticks done right after receiving report and counting narcotics. Then once the insulin is given ..start your medpass. Get your cart set up with everything you need applesauce, pudding, water, juice, spoons, straws, cups, pill cups, pill crusher and pouches(if you have those), syringes, alcohol pads, etc. Then start . if a resident refuses.. document the refusal and move on.

It will take awhile to feel comfortable and have patience with yourself.

Brea LPN · Jul 7, 2011

So I only started my first LPN job at a nursing home last week. I had three days of orientation and then they threw me on the floor by myself, even though I am a new grad -- "sink or swim" I sank. Bad. I made sure to arrive super early for my shift, but that didn't seem to help me one bit. After the night shift nurse left, I went through the MAR looking for my diabetics so I would know who to do finger sticks on. IT TOOK SO LONG. The breakfast trays were being handed out to the patients before I had a chance to do my accuchecks, or even find out who my accucheck patients were! It was BEYOND frustrating! I tried flagging my book according to the med schedules but I hadn't developed a technique yet so I ended up just confusing myself even more. I started my med pass after I finally finished all of my insulins, but it took me forever. Patients were refusing meds from me because I was new, and I didn't even know how to properly document this on the MAR. I had no idea who got meds crushed/in applesauce/in pudding/whole/with juice/with water and the CNAs were busy with patient care. Patients were yelling out things like "Nurse I can't breathe" from their rooms so I would go in and check on them to find out they only needed something like water or a boost up in bed, and all of these interruptions really slowed me down. My short orientation had been on three different units, during three different shifts, with three different nurses. Needless to say, I had a very hard time finding most of the medications, vitamins, supplements, feedings, and injections I needed to give and got overwhelmed very quickly. It was so hard to hold back tears. Thankfully, my supervisor was great when I called her and came to help me and helped me get through almost my entire med pass. Even though I know I was undertrained - I have read this is the norm in most places, and I feel stupid for really freaking out on my first day. I'm so nervous to go back because I feel like the same thing will happen during my next shift. The staff members were all so supportive and kept reassuring me that I will get the hang of it, but is this really how it is? Does something just click one day and then you are able to do it? I'm freaking out over here!
The supervisor asked if I thought I had adequate training and I told her no, not at all, but I believe the plan is to still put me by myself for next shift, which will be 3-11 I'm so nervous!!

Yes, something just clicks one day and then you are able to do it. Until then, just do the best you can. I remember when I first started nursing, even in orientation, I thought I made a huge mistake by going to nursing school and wasting my mom's time and money and my time and money. I thought I wold never be able to be a nurse. But one day I thought "I finally got this."

hope3456, ASN, RN · Jul 7, 2011

I hate to say it but the 'experienced' LTC nurses use shortcuts - arguably illegal but the 'powers that be' seem to look the other way. They give the 1600, 1800 and 2000 meds all at one time

Forever Sunshine, ASN, RN · Jul 7, 2011

I hate to say it but the 'experienced' LTC nurses use shortcuts - arguably illegal but the 'powers that be' seem to look the other way. They give the 1600, 1800 and 2000 meds all at one time

This is done at our own risk though. I think the OP should get the idea of a medpass and routine down.

joanna73, BSN, RN · Jul 7, 2011

Not all LTC nurses lump their meds. Our nurses don't. The meds are given within a reasonable time frame. We do not give O800, 1000 and 1200 meds together at my facility. Please don't assume everything, simply because you worked at a poorly run facility. LTC seems to always have a bad reputation.

WittySarcasm, BSN · Jul 7, 2011

Alright I started the same way as you and through trial and error I have learned some tips that have helped and I'll pass them on to you. I started in agency so I was always at a new nursing home every time and very rarely got to know the people (so that's how I'll give the tips, as time goes on you'll get to know people a little better)

1) In report ask the previous nurse how everyone takes their pills- crushed, whole, applesauce, pudding or whatever. Some only take certain juices while others don't care. And as they tell me I just make a quick note. Some nurses will be annoyed at first, but just ignore that. It will help you in the end a lot.

Also I will ask the night nurse (or previous shift nurse) who is diabetic. The other nurse will know you're new. Will understand that you don't know everyone. Like above some nurses will be annoyed, but again- so what. If they get annoyed fine, but it will help you so much more.

2) Remeber one of the golden rules of med passes- you have an hour before and an hour after to pass the meds. I group the meds together. For example I work the 3-11 shift so my passes are 5pm and 8pm. At the 5pm shift I pass the 4, 5, 6 meds and then the 8pm med pass takes care of the 7, 8, 9 meds. You may have a couple stray meds here and there.

Also another golden rule- the first hour (once you know the diabetics) is usually the time you can quickly check stuff. This is the time I use to check the MARS for med times. One way that has helped me- and keeps me from continously flipping the book- is to write the med times for each person. That way if a certain patient doesn't have meds for the first med pass then I don't loose time looking at MARS.

3) And the most important rule- EVERYONE IS HORRIBLE AT FIRST! Any nurse that tells you they did their first med passes perfectly when they were a new grad is most likely lying. When I first began I would go without lunch- or clock out but still work through it- eating snack like foods at my med cart. Everyone is horrible. It is hell when you first begin. But as time goes on and you get a rhythm down and figure out just what works for you. You will get better and you will look back and laugh at the times you wanted to cry.

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I would say you didn't get a good orientation. Perhaps ask if you can get more. Just because you seemed jipped.

And as for pre-pouring meds. I say don't do it. Some swear by it. I tried it once and ended up relooking at the meds before I gave it to each person just because I would second guess myself so I would end up counting how many I was supposed to give and how many was in the cup. I found it to be more of a pain then help and decided that it really wasn't worth it. Some swear it makes it easier, and maybe for some it does. But for me, nah...

drmorton2b · Jul 7, 2011

I like the idea of prioritizing the diabetics first. Maybe if possible mix that in with the patients on Digioxin and HTN meds also.. get their apical/vitals.

Also have a list of the residents and room numbers and use that as your report sheet. Some places don't use report sheets if not develop your own. Make a blank one with the room numbers or just something to write the pt name. diabetic Yes/NO, etc. other notes.

Prepouring meds is foolish unless you have 1 patient which wouldn't happen in any setting.