Lowest of the Low

Specialties Geriatric

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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.

If they told me I would not be recommended for hire after my probationary period, no way would I go back to that shappy operation!

Are you some kind of masochist? Get out of there yesterday!

Jeez...when I hear this stuff it scares me. Do I really want to become a nurse? I had absolutely no idea how smart nurses really are...why do they get so little respect? I mean, salespeople get more respect than this.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

I think I used to work there:) If not then a place just like it where I was charge as an LPN.

My advice is to quite (with proper notice) right away and seek a job on a med surg floor of a hospital.

I usually advise new grad to stay away from LTC. The problem in LTC is that usually you are out there alone without lots of experienced nurses around to ask questions.

Spend a year or two on a med-surg floor where you have expeirenced nurses, docs, RTs, ect around to help and teach you.

Specializes in Home Health, PDN, LTC, subacute.

LPN here, 11 months experience. I quit a place last year because they were using AGENCY nurses to orient me in LTC, not even ones that went there all the time! They wanted to give me 3-4 days orientation to work the 3-11 shift. Never went back after a few days.

Found another LTC, got 5 WEEKS orientation and have been doing okay ever since. I think you should leave this job, tell them it is not working out.

CNA's can be tough on all newbies, even CNA newbies, so be firm, help them whenever you can and reap the dividends. Show them you respect their judgement about the residents, address any concerns they voice about them. The biggest complaints CNAs make is they voice concerns and the nurse doesn't address it. I always let them know what I did or plan to do. I would rather have them come to me 10x for nothing, than miss something important. This has worked out really well for me, but the beginning was rough going!

a tip for wound care:

I take 5 minutes at the beginning of my shift and go through the tx book and jot down all my treatments on the back of my census sheet. Come in 10 minutes early if you have to. After I do each one, I put a line through it. You don't have to worry about forgetting anything and you'll always know what you have to do. Example: Last night didn't do this, found a new tx at 11 pm. Need to follow my own advice.

best of luck, you WILL find a job you like

LPN here, 11 months experience. I quit a place last year because they were using AGENCY nurses to orient me in LTC, not even ones that went there all the time! They wanted to give me 3-4 days orientation to work the 3-11 shift. Never went back after a few days.

Found another LTC, got 5 WEEKS orientation and have been doing okay ever since. I think you should leave this job, tell them it is not working out.

CNA's can be tough on all newbies, even CNA newbies, so be firm, help them whenever you can and reap the dividends. Show them you respect their judgement about the residents, address any concerns they voice about them. The biggest complaints CNAs make is they voice concerns and the nurse doesn't address it. I always let them know what I did or plan to do. I would rather have them come to me 10x for nothing, than miss something important. This has worked out really well for me, but the beginning was rough going!

a tip for wound care:

I take 5 minutes at the beginning of my shift and go through the tx book and jot down all my treatments on the back of my census sheet. Come in 10 minutes early if you have to. After I do each one, I put a line through it. You don't have to worry about forgetting anything and you'll always know what you have to do. Example: Last night didn't do this, found a new tx at 11 pm. Need to follow my own advice.

best of luck, you WILL find a job you like

:yeahthat:

As a new grad I also started in LTC. For the first couple of months I ran around like crazy, had a hard time developing a routine, feeling like an idiot and the worst nurse on the planet. I really does take a while to settle in.

There were (and still are) a few nurse who are not at all supportive, patient, or helpful. Then there are those who are. The nurses who are supportive are who you should get your feedback from. Get to know your policy/procedure books. If in doubt, look up facility policy.

I agree with every post thats states checklist, checklist, checklist!

At the beginning of EVERY shift I start of list of who needs what during report. P report and count I go through my mar and tar to see what I have to do and make myself a flow sheet. It really helps.

e.g.

Skilled Assessments

t,p,t,bp,spo2, ls,bs,skin,pain,diet,mobility

VS

t,p,r,bp

ATB

temps

adverse reactions

S/S

i.e. cough,

sinus,

URI,UTI...

Aerosols

spo2,ls,coug

DM

iddm

po

fbs

GT

bolus

continous

flushes

TX's

creams

procedures

drsgs

and so on.

Anyway, I hope this helps! Hang in there!

BTW, your DON hired knowing your level of experience. Don't let'em get you down. Know you limitations and don't be afraid to ask questions. No support = dangerous environment, for your "R" and your license. Don't be afraid or feel bad if you need to move on. Follow your gut!

Keep us posted!:icon_hug:

Specializes in Med/Surg, ER and ICU!!!.
OP, have you had your "meeting" yet of where you talk about your goals? How is everything? Keep us posted, please
:yeahthat:

As a new grad I also started in LTC. For the first couple of months I ran around like crazy, had a hard time developing a routine, feeling like an idiot and the worst nurse on the planet. I really does take a while to settle in.

There were (and still are) a few nurse who are not at all supportive, patient, or helpful. Then there are those who are. The nurses who are supportive are who you should get your feedback from. Get to know your policy/procedure books. If in doubt, look up facility policy.

When I started LTC, I'd had many years experience as an RN, and it still took me a couple of months to get my routine down!!

My mentor is the LPN who works opposite me on nites - we talk a lot, share problems and solutions about residents, and she gave me a lot of time saving tips for dealing with so many people.

Specializes in Med-Surg, LTC, Rehabiliation Nursing.

thank YOU Thank You thank YOU..

I think ( I hope) I know what you mean.

Here are my personal goals as I responded on paper for this challenge.

(Goals for Success

Time Management/Organization.

I will make a list of my treatments needed on my residents, with a check off space to help me maintain a quick visual reminder of what has been accomplished and what still needs to be addressed.

I will keep room on the same list for questions I have which cannot immediately be answered, and a list for needs that must be addressed, (i.e., a patient missing belongings, a resident’s or their relatives requests) so that these issues will never be forgotten or remain unaddressed.

Focusing.

I feel that my biggest problem with focusing is feeling that I have to be there at all times for everyone and everything. I am going to focus on the task at hand, and have more confidence in my co-workers and my CNA’s that they can and will respond to the needs and demands of residents.

When I am involved in a task, (i.e., documenting), I will focus on the task at hand with the concentration necessary. If I am unable to do so because of the environment around me, I will remove myself to a quieter space, (something as simple as moving to the other side to the desks).

Professionalism

During extremely hectic times of day, (i.e., Doctors there giving orders, patients beginning sun downing behavior, shift changeover, ect.), I will take a deep breathe, prioritize needs, maintain my calm in the center of the unit. I will also ask my nurse manager for help with the most urgent needs when I am unable to immediately meet the most urgent tasks at hand.

Documentation: When documenting, charting and during reports I will keep in mind the absolute importance of this task, and not allow myself to feel rushed with the next task at hand.

Personal Behavior: I will be very conscious of my approach and demeanor when I need to address co-workers, especially when I must request help. I will also document on my time management list who I have asked to accomplish what for a resident, and the reason. (for example, 1055 hours/asked Judy to address E. O., , resident digging in briefs, due to large BM. I am collecting supplies to obtain UA on said resident. I returned with supplies, helped Judy finish cleaning resident, and she helped me obtain UA.) At this point, these notes are for my use only, to keep track of who I am asking to do what and to help me go to my nurse manager when my needs are not met, for whatever reason. I very much respect the job that my CNA’s do, and know how busy they are and how hard they work. By documenting my requests, I hope to avoid coming across as rushed or stressed out. If I need to take the time to write down my requests, then I will ensure that I can communicate this request without any margin of error, and more importantly, avoiding ever mistakenly making the person I am talking to feel as if I am unsympathetic to their work load, or rushing them. I will also be able to maintain accountability for tasks in this manner, one of my jobs as a charge nurse.)

As put down in the preceding document, I will address each of the issues that have been brought up.

This was my written response to my 'warning'.

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.

Specializes in Med-Surg, LTC, Rehabiliation Nursing.
If they told me I would not be recommended for hire after my probationary period, no way would I go back to that shappy operation!

Are you some kind of masochist? Get out of there yesterday!

Hey, I am not a masochist, BUT, I already left one job because of the stress factors, and I do feel as if I dont put my all into this, I will just be the job-hopping, cant deal with whatever is thrown at me, run-away kind of nurse. This is not what I want. Do you have better advice? Leaving is easy, but I need help with how to stay.

PS, posted my written reply on how I would deal with my challenges. Could you go back and read that and then critique me on it? I would appreciate it.

Thanks so much

KristyBRN

Specializes in Orthosurgery, Rehab, Homecare.

GET OUT. NOW.

~Jen

Specializes in Orthosurgery, Rehab, Homecare.
Hey, I am not a masochist, BUT, I already left one job because of the stress factors, and I do feel as if I dont put my all into this, I will just be the job-hopping, cant deal with whatever is thrown at me, run-away kind of nurse. This is not what I want. Do you have better advice? Leaving is easy, but I need help with how to stay.

PS, posted my written reply on how I would deal with my challenges. Could you go back and read that and then critique me on it? I would appreciate it.

Thanks so much

KristyBRN

Some people take time to find a place where they fit. You would not be job hopping, just finding a place where you (read- your licence)and your paitents are safe. There is an issue with a facility that is hiring a new grad and putting them in charge after 9 weeks. You are not the issue, but i would get out before their issues are yours.

~Jen

In my line of thinking, the probationary period goes two ways! Do they like you and do you like them? I would plan to evaluate THEM at 90 days and see how they stand up

Do you feel supported by management?

Do you have the neccessary tools to do your job?

Do you feel secure and safe on-site?

ETC.....................

Finding the right job takes some time. Happiness in nursing is all about a good fit for you and them! When you get it right it feels good!

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