Bombed my second shift on my own

[venousr3tuRN]

So I started my second day on my own after training for about 21 days. This morning when I woke up I told myself that today was gonna go smoothly. I guess I jinxed myself because as soon as I started my shift, the day started to not go my way. I worked the 7 - 3 shift and came in early and before I clocked in I did my rounds to make sure the residents were still here and still alive. I clocked in and then we had our morning huddle to endorse anything that happened during he night. There weren't too many tasks that needed to be followed up on so the morning started of great.

At about 730 the RN supervisor tells me that one of my residents is having difficulty breathing and that we're gonna have to send him out. I'm totally lost on the paperwork that you would need to send someone out because there's a million things you need to add to it. I get some help with it which I appreciated and we sent that resident out. The supervisor was kind enough to do the computer documentation needed for that resident and let me start my medpass. I was already now about an hour behind when I am allowed to start passing, and on top of that I missed a qshift skin check for one of our VIP residents so I start it at 9.

I'm still getting to know the residents there so the pass takes me about 3 hours to complete. I spend most of the day trying to catch up with the pass. I finish the first pass and already have to start the noon pass. After completing the second pass I now have about an hour left before shift ends. It is now 2pm and I still have to do my weekly summaries, charting that I need to do on about 4 residents, and Medicare charting on 3 residents.

I barely finish one of my summaries when the Treatment nurse informs me that I must do a "change of condition" or COC on one of the residents because she hasn't been eating well. So she helps me with that and we are able to finish it fairly easy. Then 15 minutes before the next shift comes on one of the CNA tells me that while she was assisting a resident, he acquires a skin tear. So now I have another change of condition to do, including other documentations because of the type of incident.

So right when the next shift comes on they do a skin check for the VIP resident and find new marks. I'm horrified because I missed the skin check in the morning so now it makes it hard to say if the marks were there on my shift or the start of the next. Another COC must be done now. I still have yet to finish my regular charting. I stay there on my own time to finish my charting and start those COCs. I have never really been trained properly on all the paperwork so I struggle and ask all the questions I can but can only get little help as everyone is busy themselves. I stay until 7 pm finishing all my charting. I was only able to start the COC documents for the 3-11 nurse before the RN supervisor tells me I should just go home because I've had a long day and the nurse will be able to handle the rest.

I feel really bad because the 3-11 nurse was called to the DONs office and word was she was possibly getting chewed out for what happened with the skin check coming on to her shift. All of the nurses were really encouraging saying that it happens and that it'll be okay. I feel really horrible for putting the rest of the work on the 3-11 nurse. I just need to manage my time passing to 30+ residents better. It's just so hard since I'm still getting to know them and what they take and how. I'm trying to do everything correctly and trying to get faster at it so I have enough time to chart and whatever else happens. I just feel so behind. Sorry just needed to vent.

[venousr3tuRN]

Do you not have a charge nurse? Our charge nurse is the one who is in charge of making the calls and doing the paperwork if someone gets sent out or passes away. Also, they transcribe orders that come in from the dr. We don't. We write our own protocol orders and stuff like that and do checks on new orders in the mar to make sure they are correct, but we don't go back and forth to the office to look at new orders that are being written during shift. If its a stat order they let us know, otherwise, its usually given at the time its next scheduled. I don't know if I'm explaining that right. I don't know what a treatment nurse is, but if they are a nurse who is doing their own assessment, why aren't they the ones doing the alert charting? If our wound care nurse sees a resident during the day they update in the chart if need be, they don't tell us to do it. Does physical or speech therapy also tell you to update what they have done with a resident?

Also curious, you have a resident where they have required q-shift skin checks? wow I'm surprised they don't get irritated with having to remove all their clothes and have their bruises etc measured and checked 3 times a day!

My position is as a charge nurse and we do our own medpasses, write our own orders, admissions, etc. We do have one supervisor on the floor to help with the admits and follow up labs. The treatment nurse takes care of all the residents with skin breakdowns and basically only report back to the charge nurse if any new breakdown has occurred which the charge nurse is responsible for charting the COC. I'm still fairly new--been there a little under 2 months--and take some time to do the medpass which leaves me little time to chart. I usually end up having to clock out for my break and chart through it to catch up, if at all. If a COC occurs, I end up staying after. At first, I was staying on my own time, but our administrator talked with us saying that we can stay over as long as we get supervisor approval and that they have the budget for overtime if we need it to finish all of our charting. However, I've experienced much indignation from the supervisors about having to stay over to finish. I've now resorted to clocking over 30 min to an hour of overtime and then working the rest on my own time to appease them. And yes, we have a couple VIP residents that require the q-shift skin checks due to the copious amounts of complaints made by the family about marks on the residents which are caused by the residents themselves due to the fact that they exhibit continual non-purposeful movements and on medications that cause them to bruise easily. The resident I missed the skin check on happens to get at least 1 COC per day if not more. Her chart is thick with the paperwork. It's very challenging, day to day, and I have noticed my anxiety has gone up a little working there, but I still maintain hope that it'll get better. I just wish that we had a little more support.

[WanderingSagehen]

Sounds about right for a typical day. You will get the hang of it. Its not.possible.to know how to.do it all in the beginning. We have to push our work to the next shift. I always dread the 1st 2 hours of distraction but someone told me they are what helps me know what my job is for the day. At some point you will combine tasks, like those skin checks with your med pass. I have 8 mo exp and finally feel more in control but it took 6 months. Of course now I am interviewing for hospital jobs and I probably should stop as I do enjoy my work at.the SNF.

[soonrn2527]

Good thing you have 21 days of orientation. I only had 1 day for am then I started with my own. I went home at 7 pm. I was couple of hrs behind the time when I finished my med pass. I havent had ny lunch that day.it was really a tough day. I had gt and bs monitoring and atb med. I missed some of atb and even for the blood glucose test.

[MisMatch, LPN]

Venting is good! I was in your shoes 4 years ago, wondering how I would ever develop proficiency in getting everything done each shift. It has been a long journey, taking 1 day at a time (sometimes 1 minute at a time). There are good days and bad days (sometimes good weeks & bad weeks). It took at least 3 months for me to no longer feel like a fumbling idiot then another 3 months before I had any sense of proficiency. At the 1 year mark, I sighed, relieved that I believed I could handle it. Now, I still have times of exasperation alternating with proficiency.

Find good support "mentor" nurses. I went to mine a lot for the first 3 months. Mine weren't assigned by the facility, I sought out those experienced nurses that I respected who were willing to nurture (not eat) their young. They knew I was a willing learner, hard worker and able to do the job. They also knew I needed lots of guidance.

Watch other nurses, ask them questions, ask for suggestions, observe "tricks of the trade" that work. You will eventually develop a plan that works for you.

Give yourself time. You sound like a wonderful conscientious nurse. It does get better!

[soonrn2527]

Just know I realized that I forgot some of my resident to make a progress notes and medicare notes im afraid that it would result in a big problem.