Flying solo after 2 ‘training shifts’

[newgrad41]

Hi everyone. I am a brand new grad and I am extremely anxious about my new job in LTC. I have little experience in LTC - one and a half semesters during school (cut short by COVID). I applied to a bunch of various open positions in my area when I registered earlier this month and accepted pretty much the first one that got back to me which is a staffing agency. 

They hired me to work in a LTC facility on a 4 month contract.

The facility gave me my schedule of 2 back to back ‘training shifts’ and then the next shift (tomorrow!!) I am on my own, the only nurse on a unit of 30 residents.

I completed my first training shift yesterday and realized that I didn’t feel as if all the bases would be covered within 2 shifts so I emailed the DOC and spoke with the scheduling coordinator about having at least one more training shift. 

They said no, and that I will do just fine. 

I am extremely anxious and sick to my stomach at the thought of being in this facility, as a supervisor, that I spent a total of 2 shifts in with another nurse who only had me complete med passes during those shifts. 

I don’t want to risk my licence that I just got and I really don’t have anyone to turn to for advice, I feel very uncomfortable with how quickly they want me to fly solo, and I don’t want to be reported for abandoning my assignment, so I am showing up tomorrow, and I am expected to work the rest of my 2 week schedule they provided me.

What would you do if you were me?

 

[hppygr8ful, ASN, RN, EMT-I]

Sadly you are experiencing something that is all too common in many LTCs. The managers know there is a huge turnover and they don't care enough to actually train someone in a manner that will make them want to stay .This is why I don't really like LTC facilities for new grads. Still you can learn a lot there. Relay on any experienced staff who is willing to offer insight and help you learn. Even nurses aids and LPNs can teach a new RN a lot of things if you remain humble and teachable. When I did LTC for a year with previous 6 years experience in Acute care, L&D and Psych and still felt like I was drowning most of the time. Breath, buy a good pair of running shoes and take it on. If something doesn't feel safe to you ask for help or clarification if you don't get a good answer ask again. You really don't know what you are capable of until you try.

Hppy

[Lynker, LPN]

How did you end up doing? I know LTC can really wear you down sometimes. Do you have any questions? I think of myself as pretty well-versed in LTC.

[CKPM2RN, ASN, EMT-P]

That was my sink or swim first job. And what a rough swim that was at first. Thank goodness we had a med-tech so I didn't have to do standard daily meds, just tube-feed, injected or inhaled, etc. But I was fighting for air every day to try to keep up. I made it 8 months before I found a different position. My advice to you is after two months, start putting out resumes. Also, stop for just a minute every hour somewhere out of site, close your eyes, take a deep breath and try to relax a moment. Then hit the floor running again. I know what you're going through. 

[Queen Tiye, RN]

I am just now seeing this post but you would be most definitely risking your license.  It is difficult for a seasoned LTC nurse to care for 30 Pts, and impossible for a new grad with two days of training to do it.  No nurse can properly care for 30 LTC Pts.  

Are you and LVN or RN?  If you are and LVN, perhaps try going to a SNF/ LTC with a smaller nurse to patient ratio, 1:12.  Then if you want out of LTC, you’ll have experience to apply for positions in another discipline.  Good luck!

[lilblue, LVN]

I did LTC as a new grad LVN and it definitely was not easy at all. I did get more training than 2 shifts but I had 45 residents and what made it even more difficult was a lot of them were wanderers who constantly tried to escape the building or fall. I only lasted 5 and a half months before I left to do private duty because it was 2020 and that year was bad enough on it's own.

If there's anyone higher up like a DON you can speak to, I would definitely do so because as someone else said, you are putting your license at risk but it could be doable if you want to give it a try.

[CKPM2RN, ASN, EMT-P]

21 hours ago, Queen Tiye said:

 It is difficult for a seasoned LTC nurse to care for 30 Pts, and impossible for a new grad with two days of training to do it.  No nurse can properly care for 30 LTC Pts.  

My facility could have one LVN or RN to up to 39 patient/residents. We had room for one more patient/resident but that would have mandated another nurse so we never went over 38, just in case. This was SNF/LTC combo. It was unsafe every day, thank goodness I had a team of stellar CNAs to keep me informed of the status of everyone

Are you and LVN or RN?  If you are and LVN, perhaps try going to a SNF/ LTC with a smaller nurse to patient ratio, 1:12.  

I would have LOVED to work with only 12 patients!

 

[JKL33]

For others reading this, remember that you can say no just as easily as they say no.

The more that you take it all upon yourself and sit at home feeling anxious, nauseated, scared, crying, etc., etc. so that they can have what they prefer, the more it will happen and continue to happen. Not to mention it's a terrible way to set the tone of your relationship with that employer. If they are unwilling to provide even minimal training, they won't give two hoots about anything you ever say. They will have no intention of respecting you, and part of that will be because right out of the gate you told them they didn't need to.

When you say you need more training and they say, "No, sorry not sorry," your next response is, "I might not have been clear. I will not be taking report unless there is someone here to train me each of my next [3, 5, 7] shifts."

[JKL33]

PS: And you say it just like that. Standing up straight, making good eye contact and using a confident, appropriately professional tone.

[FashionablyL8, CNA, LPN]

I agree that you should ask for more training. Taking care of 30 LTC residents as a new grad is unsafe, IMO. Perhaps if a lot of them have no meds scheduled and are fairly independent, it would be doable. But from what I've seen, most residents get a LOT of meds, many need their meds crushed, and then you have the ones that refuse or spit out their meds. Then you have to clean them up. What about G-tubes or trachs? It's also difficult before you get to know the residents. My main fear when new is giving the wrong meds to a resident. You have to be very careful and being desparately rushed does not mix with being careful.

I'm a new LPN with 8 yrs if experience giving meds as a MAP cert staff. I have 20 residents when I work the dementia floor and I'm busy. I can't imagine being new at giving meds and having 30 residents with only 2 days of training. I think this is unfair of the company to ask this of a new nurse. They know you won't be "just fine" and you are smart to be scared. I'm not sure how contracts are enforced but I would refuse to take this assignment without further training. Just for reference, I got 7 days of training and could have gotten more, but I requested to be on my own due to already having med experience. 

Best of luck- I hope to hear how it turns out.

[Queen Tiye, RN]

. . . and let’s not forget the practice of only giving the”main meds” to speed things up.  Don’t do it.  I think the grand majority of nurses in LTC begin excited about their jobs and wanting to give excellent care, but soon find out that in facilities with high ratios, that it is impossible.

[Hoosier_RN, MSN]

I went back and read this twice. This nurse went through a staffing agency. The agency and LTC facility doesn't care about experience, or lack of. In fact, being with agency, this nurse was lucky to get 2 training shifts. This is why a new nurse should NEVER go agency right out of the gate, even if it's the only game in town