Lowest of the Low

Specialties Geriatric

Published

Hi all,

Hoping for some insight, support, advice. I have now been working LTC for 9 weeks. I am a new grad, had two weeks of training, and been on the floor on my own since then, hired as a charge nurse. The job has been challenging, to say the least. I have 24 residents I am responsible for, plus the challenge of Cna's who have been there for 15 to 20 years, and seem to have something against me from the start. NOT all of them, just a few. I was pulled into the DON's office today and told that as of today, she would not reccomend me for hiring at the end of my probation period. The DON is new, started 3 weeks ago. I was told that my proffesionalism was not good, (I was giving report and did not know that DHS was there, and my supervisor told me afterwards that it was not okay to complain in front of them, I was giving the usual report, what was and mostly what wasnt done, ect., ect., my fault, but I did not know she was there!) I also missed dressing changes on one patient, the last time her dressing for her peritonial cath was changed was on 10/01, she is gone for dialysis on Tues and thurs from 6 to 1, my shift ends at 3, the docs come in at 1 to give orders, anyway, bad excuses, I did mess up, but I work only 4 days a week, what about the other 3 days? When I told my supervisor I was feeling overwhelmed, Which I was, they never let me do anything, then they throw it at me and say, "Why dont you know how to do this by now?" Anyway,those are really no excuses for my mistakes, but to call my professionalism to task when I am still learning? And to be written up? I have been crying all day. I called in sick yesterday, I had vomiting and diarrhea in the morning, called in at 5am, my scheduling director called me at 8am to ask if I could cover Thursday, my husband answered the phone and relayed the message as I was vomiting at the time. I dragged by butt to work today, despite a fever, chills and sweats, sore throat and a headache that made me want to vomit more. I really should not have been in there, I wore a face mask so as not to kill a resident with this bug. I had confided in my supervisor about my personal problems, she acts like a friend, only to have this thrown in my face during my meeting with her and the DON. I feel so betrayed, so very stupid.

WHY? What are the expectations of a new grad? I have had one med error, it was a transcription error on my part, I have done my best to maintain my professionalism during harrowing times, (residents sister sobbing heartbrokenly beside me, dementia patient hitting me cause I had 'her' shirt on, constant yelling, sundowning which I only get the very first part of, I know, ) God I feel like such a dummy. If you cant tell, I am feeling so stupid, probably because I really thought I was doing a good job. Maybe not a great fantastic job, but a competent, safe one, as I learned how to become a really great nurse, you know? I feel like a failure.

I was written up for concerns about my professional demeanor, my inability to focus, and time management issues. I do understand the focusing issue, she told me I let to many things 'distract me', like residents screaming out "HELP, HELP". It has taken me some time to know which ones are really needing help, but while I am learning, and I dont know the residents that well, how am I supposed to know which "HELP" is real or not? The time management issue is because of the dressing change I missed.

The Cna's dont report to me, and last week I heard them commenting on a resident who was playing 'possum', and I dont know why, but I thought to myself, "Jeez, he always yells at them when they are mad", and I went to check on him, long story short, his blood sugar was 56, he was going into a diabetic coma, and they would have left him in bed. I ended up doing IM glucagon, his physician came in, I assisted him in doing IM dextrose, and he came out of it. The doctor told me he would have died. I feel like I have good instincts, if I am just given the chance. Now I am evaluating every thing I do and say, I am afraid to talk to anyone, and I am so discouraged I feel like I made the biggest mistake of my life. I am so sorry to ramble on to everyone, I am just so hurt and discouraged, insulted and I feel so stuck. Sure, move on and find another job, and be a job hopper. To top it all off, my husband just lost his job.

Sorry everyone. Thanks for letting me vent. Friday I have to meet with the DON and my supervisor and give them my list of 'goals to hellp me succed in my job'. Half of me wants to walk out and say the heck with you. I have put my all into this, I am not half-***** with anything I do, and your expectations are ridiculous. The other half is to proud to let anything or anybody say I cannot do this job. In the meantime, I still have to pay the bills. and they wonder why there is a nursing shortage.

sorry about the typos.

Thanks for being here.

I do understand the focusing issue, she told me I let to many things 'distract me', like residents screaming out "HELP, HELP". It has taken me some time to know which ones are really needing help, but while I am learning, and I dont know the residents that well, how am I supposed to know which "HELP" is real or not?

Do they expect you to ignore every help? Even those who constantly cry wolf may at some time need real help. You cannot ignore that. A coworker once made the mistake of ignoring an elderly man who had a habit of yelling "help" and then one day he yelled "help" and she ignored him. Turns out he did need help as he had slipped out of his wheelchair and had broken a hip.

You are a new grad and they should be more considerate. Two weeks orientation does not sound like much. I'm an aide and I rec'd a month of orientation.

IMHO, you should quit. From your post, it sounds like it isn't going to get any better. Management sounds like it has an attitude problem. Is the turnover rate high? I would quit before I was accused of something I didn't commit. Good luck.

Ahhhhhh.......New DON, DHS on the premises, new charge nurses (and new grads at that)......

In LTC this all screams: PROBLEM FACILITY!!!!!!!!!!

Run...Run very, very fast. With all due respect to some of the other posters the situation will NOT get better for you, at least not at that facility.

:yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat:

Get out fast!!!!

Specializes in ED, ICU, PSYCH, PP, CEN.

I am so sorry you are going through this. If you research this forum a little bit you will see that many new grads have had this problem. And the problem is not you, but the facility that you work at. There are many places that try to take advantage of new grads. You need to run from this place. Carefully read what all the posters have to say, don't burn bridges, just put in your 2 week notice. You will have no trouble finding another job. I recommend med/surg at a local hospital with a nice/appropriate orientation. Keep us posted, we care.

Yep, I'd be outta there!! I got 4 days orientation to LTC, but I'd been a nurse for many years. Even so, there are still things I'm finding out that weren't covered during 'orientation'.

Working in LTC takes excellent organizational skills, something most new grads need time to aquire. Even with all my experience, it took me a couple of months to 'hit my stride'.

OP - don't feel bad about yourself - you need to be in a more nurturing, structured environment until you 'find yourself'. Good luck to you.

Specializes in med/surg, telemetry, IV therapy, mgmt.

after a terrible fiasco with an acute hospital job where the don had lied to me about my starting wage and the area where i would be working, my first "real" job after graduation was in a nursing home, no orientation. it was very frustrating and many of the other charge nurses weren't much help. it was like they were watching and taking bets on how long it would take before i drowned. thankfully, the director of nursing was more understanding. all i can tell you is that at first i focused on routine things such as getting medications and treatments passed. i started to make lists of things i had to do and prioritize them. as time went on, and because of errors i'd made, i learned about things that were important had to be addressed. nothing upsets a person worse than learning you make a mistake. looking back, a big problem was that no one would tell me when i was making errors. they knew about them, but they weren't talking to me about it. very dysfunctional behavior on their part. i suspect this goes on a lot in small facilities like this which only adds to problems that new grads like you or i have or had. on the other hand, i wasn't asking for any feedback either. i was going along my merry way thinking everything was fine.

in a small place you have to be careful of what you say and how you say it. when you are the "new guy" you have a place--the bottom rung. when it comes to making any kinds of judgments about the facility or the people that work there, the less you say, the better. looking back, i would say that one of the biggest mistakes any new grad can make is to constantly apologize for their lack of knowledge or ineptness at their jobs. it's natural to say these kinds of things because you so-o-o want to do your best, but you know you are all thumbs and slow. but, you just have to clam up and keep these feelings and emotions to yourself when you are in the workplace. these kinds of comments said enough and over time tend to be seen as a sign of weakness and craving for attention and sympathy or pity. some people will interpret it as whining. many co-workers eventually don't want to put up with this, so you start getting all kinds of unwelcomed behavior from them. some will latch onto the weakness and go for your jugular as happened with me. the more you talk, the more you reveal about yourself. that is not always a good situation. people are more reserved when it comes to taking issue with people who are quiet and speak only when necessary because they don't know enough about them or what kind of reaction they might get.

you can't change past mistakes. but, you can learn from them. i know what is now going to happen for you because i was in management for some time. you are going to be asked to make some goals--in writing. make your goals achievable and not general--goals that you know you can accomplish. you will be supervised very carefully. if they are determined to terminate you, they will use this as a way to do it. the minute they can show that you are failing to achieve a goal, you'll be shown the door.

if you want to stay in this job and give staying a shot, i would sincerely let them know that you are committed to changing and improving. ask daily for feedback. that is how they will know you are committed. don't wait for them to tell you if you've done something right or wrong. put some onus on these leaders to give you some guidance and preceptoring by asking it of them as things come up. they, as leaders, have that responsibility to you if they are going to put you into some kind of rehabilitation. and, don't let anyone else on the staff--not the cnas or the other charge nurses, know what is going on. what goes on in the meeting between you, the don and your supervisor on friday is strictly confidential between all the parties involved and no one else's business. discussing it openly with others is a sure way to put you on a fast track out the door. even if they violate that confidentiality, as sometimes happens in small places like this, don't you do it.

if they are not going to be willing to enable you to improve, then their intention is merely to collect documentation to backup your upcoming termination so they won't get stuck having to answer to the state with regard to them paying out unemployment benefits to you. (if they fire you without documented cause or attempts to rehabilitate problems you are having on the job you are entitled to unemployment compensation and they have to pay the state back for it.) the graceful way might just be to start looking for another place to work. at a new place you bring with you some of the wisdom you learned on this past job.

i also wanted to comment about this new don of yours who called you into her office and told you she was not going to recommend you for hire after your probationary period. that, to me, is a red flag of an inexperienced manager. that is the wrong thing to say to an employee that is on probation. it is also wrong to dump all your discretions on you all at once. evaluation of your performance should have been a regular ongoing activity of which you should have been part of. you might want to point that out. her job is to assist you to become a better employee by helping you out, seeing that you get more instruction, and getting you connected with resources to help you do that. that was also denied to you and i would point that out as well. unfortunately, this is the poor caliber of management and supervision staff that all too often is hired and staffed at long term facilities. it is just sad. this is not the proper behavior for a director of nursing. so, if you decide to stay here and while they are putting some goals on you, put some performance requirements on them as well in order to help you achieve those goals. this is supposed to be a two-way street. don't let them bully you.

I would resign and look for another job.

One thing, you said you had confided in your supervisor about your personal problems and she threw it in your face in your meeting with the DON. I don't know what type of problems you are referring to, but in the future I would keep any personal problems to myself, what you described happens all too often. These people are coworkers, they are not your friends or family and they don't care about you. Keep your personal life to yourself.

Good luck.

Daytonite - that was a most excellent post!!:yeah: :yeah: I'm going to print that out to refer to for myself from time to time! :)

I remember 13 years ago my first job was in LTC also. I had worked as a tech before going to nursing school.

My first eval was also very bad and I can empathize with what you are going through. I stayed to try to prove them wrong but in retrospect, it was the wrong decision for me. It was a negative experience from the beginning and it didn't get better.

I moved on to a hospital and spent the rest of the 13 years in the ER. I succeeded in that position because I had proper orientation and supportive colleagues.

You will also but I would move on now if I were you. Sometimes I hate nursing when I hear of stories like this. Negativity gets us no where.

I just accepted my first position as a DON. Because of my past experience, I will never react this way. This is a "reaction" not proaction on her part. As far as I'm concerned, the loss is hers.

Move on.

Specializes in Gerontology, Med surg, Home Health.

Unfortunatley it's not just LTC that does this....my first evening as a new nurse on a med surg floor in the local hospital...the supervisor told me I was going to be the Charge Nurse ....but, I said, this is my first evening here...yes, she said , but those initials after your name RN mean you're in charge. That was after one 8 hour orientation of which 6 hours was about IV's.

Now some 20 years ago, most of which have been spent in LTC....We all take what we've learned as we go. I tell brand new nurses who come looking for a job on my sub-acute unit to think really hard about the challenges they will face,especially on a 3-11 shift, of being a brand new nurse with so much responsibility. It's the business...most places can't afford to have 2 week orientations. I am very honest with the nurses who come to see me. I don't want their first experience as a nurse to be horrible because they don't have the skills and we don't have the time to teach them. We give them as much orientation as we can, but a subacute floor in a SNF really isn't the best place to start one's career. I refuse to hire for the sake of hiring only to put the poor new nurse at risk of having the bad experience you're having.

Specializes in ER/ ICU.

Get out as soon as you can. New grads should NEVER be in charge. They lack hindsight and foresight that only comes w/ time. Sounds like patient safety is not of concern. Try a step down unit or med surg unit that has good rn to patient ratios.

Welcome to LTC. They will eat their young!! As a new grad, you should have been supervises by someone, and believe me when I tell you this, the DON is responsible for you!! You have given it your all and do not worry about a thing. Someone out there will appreciate you. We all make mistakes. If you were perfect, you could be God!!!! Have worked with LTC for some time now and I have seen it all, Be at peace with yourself and good luck.

Specializes in Med/Surge, Psych, LTC, Home Health.

I have to agree. Go find yourself a med surge job. Most hospitals are constantly needing med surge nurses and usually will offer an adequate training period. I would recommend about 12 weeks, though my hospital only had about 6 week orientations for med surge nurses; a majority of them did okay with that.

Med surge can be stressful, but IMO, nothing like what you are describing. Good luck!

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