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!!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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!!
your orientation sounds inadequate, but what do i know? i've never worked ltc and orientation is months in the icu. as for the rest of it -- this too shall pass. it sounds like typical new nurse stuff . . . we've all been through it. those of us who stuck it out figured it out, and yes, something just clicks one day. at least, for me it did.
you know what? your next shift will probably be awful, too, and the one after that as well. but keep at it and one day you'll find that the med pass is no longer so overwhelming and it's really wonderful to be able to keep mrs. jones comfortable in her last days. or that you enjoy chatting with the residents or that you get a sense of accomplishment by getting through your work load on time. and then things will start to get better.
you're always going to have bad days, but being new is awful because you are new at this and you haven't got it all together yet. it's normal. it will pass. the only way to get to the other side where you're an organized, confident nurse is to go straight through it. it sucks, but there you are. good luck.
long term care is a very special calling, and i'm glad that there are nurses there who want to do it right. you may be taking care of my mother tomorrow!
There has been a lot of good advice give already (ask the other shift about the way they take pills etc.)
I am just going to add that I do NOT suggest getting into the habit of pre-pouring. Not a good thing to do at all...I would rather have medications given a little later than the hour window if necessary (especially if the order is for a once a day med) than to pre-pour and accidentally make a total error where a whole cup goes to the wrong patient. Not a good habit...
And don't forget to check name bands religiously until you get the hang of who the residents are. And even check after you think you know who they are!
Also, as far as who takes their pills what way...look at their diet and fluid consistency and go from there. Crushed and non-crushed...unless you have a cheat sheet, sometimes finding that out is trial and error! :S
Does something just click one day and then you are able to do it? YES
I'm freaking out over here! NORMAL
Here's my tip: Talk to the CNA's before med pass and ask them to bring you the diabetics prior to mealtime. Mine are all on wheels and have to be brought to the dining room. Then, duck into an empty room and accucheck/insulin/pills.
Does something just click one day and then you are able to do it? YES
I'm freaking out over here! NORMAL
Here's my tip: Talk to the CNA's before med pass and ask them to bring you the diabetics prior to mealtime. Mine are all on wheels and have to be brought to the dining room. Then, duck into an empty room and accucheck/insulin/pills.
I like this idea. I did this one day when I was horribly behind due to the usual crazy 2 hours before dinner and continuous interruptions. So I had a CNA bring out the residents who needed a fingerstick.. lined them all in the hallway and I got it done in about 5 minutes.
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.
I had one place that didn't use report sheets- I guess they assumed everyone to just know and memorize what happened in the course of a day. What I did was grab a piece of note book paper (I had learned ahead of time when I came early) that I always carry in my bag- since you never know when you will need paper...
What I did was quickly write the room numbers then after each one I wrote down- Patient's name. Then I added this info with blanks where I could write yes or no-
Diabetic (fingerstick times also)-
Vitals (do they just need heartrate, full vitals, blood pressure, oxygen saturation, or none- so I can look ahead of time)-
Pills (whole, crushed, applesauce, pudding. I've learned some that are regular diet may have a hard time swallowing pills without it being in pudding. I acutally have one- she is regular diet, has no problem with food but takes her pills whole in pudding for ease)-
Ect. (this part was for the regular report info, or any extra questions I had about the patient)
At our place, all residents have their picture in the MAR. Under their picture, special instructions are written....crushed, whole, thickened, etc. Saves a LOT of time.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
at our place, all residents have their picture in the mar. under their picture, special instructions are written....crushed, whole, thickened, etc. saves a lot of time.
At our place, all residents have their picture in the MAR. Under their picture, special instructions are written....crushed, whole, thickened, etc. Saves a LOT of time.
Maaaan I wish ours had that. It would make it sooo much easier. Granted at the bottom of the MARS we have the diet type. But that's it. But it would be amazing to have their pictures with all of the instructions- especially how they take meds!
I'm desparately trying to get into nursing school an running into road blocks. What I'm reading hear is very discouraging is this what nursing is really like?
Yes, the pictures with each MAR along with special instructions allows everyone to stay organized and our residents to receive safe care. Works great for new staff too because they have a visual of each person. The pics are updated regularly if and when the resident's features change.
everyones advice is greatly appreciated! i'm feeling slightly more confident. tomorrow will be my second day on my own, but it should be a little bit better because now I know what to expect and there will also be a charge nurse with me on the unit :) the pictures and how they take meds on the MAR sounds sooo helpful. one of my main problems is not knowing who is who, and if or not they can take their meds whole or need them crushed and put in applesauce or pudding or with juice or water or whatever. i've seen a few pictures of residents on our MARS. But these pictures were SO outdates they threw me off even more, because then I was doing a double take because the resident looks NOTHING like they did in their picture from 10-15+ years ago.
i am going to try my best to organize myself for tomorrow and get through my med pass (no matter how long it take me) without freaking out or wanting to break down. i can't explain it but when i'm in the situation it just feels SO overwhelming, when there are a million things that need to be done and it's all you. i can't thank you all enough for your advice, you can believe that i have went through every single post and have written down everyone's ideas and i'm going to incorporate as much as i can to get me through this weekend!
I'm so nervous!!
Ruby Vee, BSN
17 Articles; 14,051 Posts
your orientation sounds inadequate, but what do i know? i've never worked ltc and orientation is months in the icu. as for the rest of it -- this too shall pass. it sounds like typical new nurse stuff . . . we've all been through it. those of us who stuck it out figured it out, and yes, something just clicks one day. at least, for me it did.
you know what? your next shift will probably be awful, too, and the one after that as well. but keep at it and one day you'll find that the med pass is no longer so overwhelming and it's really wonderful to be able to keep mrs. jones comfortable in her last days. or that you enjoy chatting with the residents or that you get a sense of accomplishment by getting through your work load on time. and then things will start to get better.
you're always going to have bad days, but being new is awful because you are new at this and you haven't got it all together yet. it's normal. it will pass. the only way to get to the other side where you're an organized, confident nurse is to go straight through it. it sucks, but there you are. good luck.
long term care is a very special calling, and i'm glad that there are nurses there who want to do it right. you may be taking care of my mother tomorrow!