First time at a nursing home

Welcome to the US and welcome to LTC!!!!!

I don't mean to scare you off with your first assignment here but I have 3 recommendations:

1 = Carry your own malpractice insurance. You'll read here on AN that many of us HIGHLY recommend doing so. A lot of us use NSO (they're on-line).

2 = Always be careful about your narcotics, esp when you count. Some NH staff become lazy or sloppy. You'll want to trust your co-workers, but be very careful and vigilant.

3 = Respect and listen to your CNAs (nurses aides). They're the backbone of NHs and they really do know the pts best. They can 'make or break' many a nurse. A good CNA is worth her weight in gold!

Just know that I tell EVERY new person I've worked with the same things.

Again, good luck!

Thank you for your thoughts and welcome me! Since we in Germany have a very other system doing care, it is helpful to get any hint. I appreciate the big chance I have. I know I am able to learn very quickly, but there are even what is allowed to a RN and what to CNAs lots of differences, we do not even have CNAs and LPNs in Germany, all is the responsibility for a nurse. So one of my biggest challenge will be to learn what to delegate and what to do by my own, what to handover and what to keep to me. I will ask during my orientation as much as I can.

How is it going....

After just two days of orientation I had to do all by my own. I bothered my colleagues, which a most often LPNs, with everything! Not enough with this, I ended at the skilled nursing floor where I also have to do a lot of treatments and admissions.

I love my job. I love my work. I love the residents.

But sometimes it is simply overwhelming. I was not teached well in nothing regarding this facility (processes, orders, x-rays, labs, assessments, documentation...)! The one who thought me is already fired cause she made a mistake, and even if I ask the charge nurse and I am told the next day this is wrong. I have no time for a proper documentation and no time to take care of really sick residents.

I am evenings, so the morning LPN blames everyone for not doing their jobs well than her, she runs every day to the DON which is not helpful at all, she just blames me for not doing my duties properly but I am an RN and have to, we have to be out in time and done all duties which is impossible right now. We have no computerized system, all must be done by hand, especially the paperwork for a new admit.

It is enough if I just have to do my two med passes, the treatments and the charting. And reporting properly takes also 15 minutes as well. Than taking the orders and new admits.... this is too much and even the ADON which is on my side told me that she has to say nothing anymore in this facility, she just tries to keep her job.

I don't know what to do right now, without any other US experience than this I won't get another job. But I love to work.

Yesterday:

- we have no supervisor nurse for weeks now in the evening, none in the morning for about 10 days

- one admission, came in at around 5:30pm

- had to send a lady out at around 11pm, my night shift disappeared cause he had not received report from me at this point, so it still was my resident, I wrote in the nurses notes for days and also at least once a week in the 24 hour report that her edema increased that her skin is leaking, SOB, oxygen at 88% with her, the PA did not even look at her in the morning!

- we are not allowed to stay too long in overtime

- no help from nobody

- I will be written up for sure today not doing the treatments

I don't know what to do. I care for this people but we do not get any back up support from the facility. My CNAs are running all day to get the work done, and than the DON comes and tells me, in room ... there is a call light, why is no CNA there.

In order to get the most important work done, please give me any advice how to proceed.

Welcome to the USA. Everything is money driven and we are suppose to care even though the time allowed isn't enough in some cases, depending on the nursing home you are working in. Unfortuately, things are getting worse than better and if you are lucky enough to find that nursing facility that is running well, stay with it. They are keeping the residents at home longer so when they do come to the facility, they are either so demented that keeping them safe is the real task and or they are so demanding, you worry every moment if you'll be reported to state. I don't know what the answer is and know many nurses leave the profession d/t the way things are now.

How it is going.... part two:

I became more and more confident with all documentation, did my treatments, wrote my paper stuff for admissions, passed meds, whatever... my morning nurse is a kind of b..., she blames everybody for doing nothing than herself, calls the DON for everything, is always ready in time although it is almost impossible even without the lot of labs I had in the evening, I did miss an initial here and there, was blamed for, my patients have been well, but this seems not to be that interesting, was blamed for sending people out to the ER, even the docotor said I have to... new rule, we have with change of condition first to cal the DON or ADON before we call the doctor or 911. Cause we have no supervisor to get a second meaning or assessment I have to waist time in call this ladies at home.

Finally there was a complaint about me about not given pain medication...

I was suspended 6 days.

An old lady after hip surgery was admitted, I got all her meds in, she wanted her pain meds i gave it to her, after 5 hours she complaint to to receive her pain meds, family upset, I explained that she has to cal for it cause it is not scheduled, it is prn (like I did the day before), she wanted anyway to try just one oxycodone, I explained in this case I could give her the next after 4 hours when she states pain level 5, she and the family wanted just one. After two hours she requested again another which I had to refuse and explaining everything again.

Next day this lady with her family wanted a pain med but I was assigned as supervisor to the dining room and are not allowed to leave until the next nurse arrives, which was late due to a new schedule she wasn't aware and also nobody came and told me this lady wanted meds. When I came back family totally upset, lady crying, she states she was scared about me cause I did not give her the meds... I explained that I was mandatory assigned to the DR for supervision and had no chance to leave. I also apologized and immediately came back with her meds. The lady took them and was later sleeping with a smile in her face.

Next day I was off and when I came back to work I was catched by the ADON when I came in and had to go to the DON to be informed that I am suspended for at least three days for investigation d/t not properly given pain medication. I was totally upset. Told about the lady's family, wrote a report etc.

I did not hear about a week than I was called in back to work. Just an hour inservice by the DON that clients should be proper medicated at any time (which I could not do as I repeatedly stated) and was also away from my cart now starting floating the LT area. Also, I did not get paid for the days and I was after request told that I am guilty not handled right and I also scared this old lady to death.

What do you think about?

I would like to complain but not on the company itself, I am leaving in ten days anyway, but they do not treat the employees well and the clean their hands and everybody knows that I did make no mistake and they punished me anyway.

Does anybody have similar experiences or did I simply get the worst place for work? One nurse after another is leaving, some after just two or three weeks of employment, some did not even come back after the 1st day alone on a cart. Is this really normal here?

Welcome to the U.S.! I am so sorry to hear that you have had such a rough experience so far. I know it's no fun to feel like you are drowning without help. I currently work in a LTC facility, and have for the past 5 years, as an aide, then as an LPN. I am not an RN, so I'm sure there is some difference in our job roles; however, you should not have to work in the kind of conditions you are now. It looks like you've been working since May? If I were you, I would try to find another prt time job in the area maybe. Just to get your foot in the door somewhere, and get some other experience. Look for other job opportunities. It's true you haven't been in the U.S. long, but I think that the right place would look at how long you have been a nurse overall, not just how long you've been a nurse here in the states. Once you get a little experience elsewhere, try to get in full time and quit this job. If you can't though, and just have to make the best of a bad situation, maybe you should come and talk to the daytime DON. Ask if you can meet with her, schedule a time, and then just tell her how it's going. Ask her for advice on how to handle the patient load. Have her show you where they keep all the protocols for everything, and make copies for yourself so that you have them when you need them. Ask her to clarify what is not clear to you, such as when you were told something by a charge nurse, and then told the opposite the next day. If that doesn't help, then I would say just start job-hunting for another place in earnest. I promise, not every LTC facility is that bad. Mine has some issues, but nothing like that. Good luck! I hope things change soon!