Lowest of the Low - page 6

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... Read More

  1. by   clevelandrocksgirl38
    Doesn't the dialysis center change the dressing at dialysis? that would make sense to me. What is your homes policy? can you find that in writing? Alot of times LTC facilities hurry to write up new grads when they need to look internally and see where the orientation is lacking. They need to work with new grads instead of against them! Maybe this home isn't a good fit for you. There is one that is and with your skills so far (good call on the diabetic) you shouldn't have a problem. Good Luck this to shall pass!!!
  2. by   clulu53
    I agree that a new grad should not be expected to do all those things, especially w/o proper orientation. This is the fault of the facility that you chose to work for. I believe that they are extremely incompetant, not you. Do not feel as though your whole nursing career will be determined by their abuse of power. We all learn by our mistakes, and I would put my resume out there, & see just what is available. Keep looking up, never look down, I am sure that perserverance will be in your favor.
  3. by   moodychick
    Quit kicking yourself!!! I'd get out NOW!!! You can get a job at any hospital you want! There is such a nursing shortage; any hospital would be so glad to have you!!! Plus, orientation is longer; and you would have your peers to help you is you have questions! Don't make yourself sick and above all, don't sell yourself short!!! From reading your letter, I'm sure you're a great nurse! You just need a different setting!
  4. by   twotrees2
    Quote from KristyBRN
    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.

    though i say you at least got 2 weeks ( the gals where i work have gotten 3 days if that - even the new grads) your "excuses" ARE valid. you are learning - they shoudl NOT be expecting you to get it all in a feew weeks - unfortunatley thats how it is in many many LTC settings - i encourage all new grads i meet to try med surge first to help getting skills organization etc as it seems hospitals are better with preceptorship - maybe not all but many. even better get into a state run facility as i hear the mandated orientations ( my friend has worked in the facility she just went back to, is an experienced nurse of maybe 15 yrs or 20 , i dont recall, and she oriented for THREE MONTHS!!! mandatory - even though she knew a lot of it due to working there prior.

    your feelings are not unusuall - many of us feel the same way and we have been here for a while. i know we argue with the bosses about the orietation of grads who havent even passed boards yet but we get nowhere. its all about the mighhty buck.

    we all have and will cont to make mistakes so dont beat yourself silly over it - learn from it. the things you describe like yelling for help - that is what ANY normal person would do if they dont know - they would check ( and if able ask a cna but they are hard to find they have to work short too and end up not being seen to often to be able to "ask them cause they knw" ) further more - personally - i dont just "let them tell me" ( nothing against cnas) i check for myself until i hjave been showed they can be trusted to report to me and are good at what they do ( some just float through the job and i wouldnt trust em with asking even a name )

    the dressing - oh for heavens sake - it was probably not changed in eons anyhow- we can only do so much. i go in and manytimes dressings havent been changed in days and the nurse will report she never even had time to look, sad and i try to get to it but facts is facts - if they dont give staff the staff to get er done - it aint gettin done. and they dont get it..........

    move on - you dont need to be where you cant get taught what you need. you can be a great nurse with guidence- hell - we are all learning daily that medical things change so quickly. go to a med surge in a hospital and get some skills ( physical ones like tube feeds, ngs, ivs,caths, the like ) and learn to get organized - once you get that you will feel much better about yourself.

    so far no new grad has made it past a few months by us - some of us do the best we can to help them but we have our own issues on or wings to deal with and often cant get there soon enough - however - many may disagree - if only in lip service - but i do not know ANY nurse that i know personally who does not have quite a few shortcuts that are taken ( of course that is where experience comes - you learn what can be cut around and not hurt anyone to get the extrqa few min you need to get the really important stuff done) to get through the day and get done what needs to be - we hate taking these shortcuts - even though they dont physically harm our residents but they sure are emotionally hurt - and that is not fair - we are supposed to adress all areas and cant.

    good luck hon and my prayrs for you and your family.
  5. by   Hellllllo Nurse

    I am very impressed by your posts, and how you took action to improve your situation.
    No matter how it works out at that particular job, you are doing your best.

    I wish you much success in your nursing career!
  6. by   twotrees2
    Quote from gonzo1
    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.

    i agree with dont burn your bridges too - i have seen to many nurses do that and end up worse off- i am one of em - hard to find a job in such small area as ours when you are on the "black list" of leaves nno notice, stirs up trouble in regards to staffing etc etc lol - give them 2 weeks if they ask why tell them you wish to go to a hospital ( even if you arent - none of thier business) where you can gain clinical skillls better so that you can come back to LTC ( doesnt mean youd ever go back there but they might think hmmm maybe she will come back even more experienced) this will keep your foot in the door so to speak and perhaps even spften thier view of you. make it look like its thier idea - tell them i was thinking about what you said and i see i need to work on my skills and i have found a job which i can gain those skills with a good preceptor program.
  7. by   twotrees2
    Quote from Mulan
    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.
    yes if you can help it do not get into the pesonal life story with the bigwigs. they dont give a care - i made that mistake and foudn they use that against you whenever they can to control you. personally i dont even consider these folks coworkers- a coworker helps out and assissts - gives feedbackand such - at least at my place they do none of that - i have been tere 18 mo and yet to have even one eval........... i am sure there are some good ones - i have worked with one of the best D
  8. by   twotrees2
    Quote from Mulan
    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.
    yes if you can help it do not get into the pesonal life story with the bigwigs. they dont give a care - i made that mistake and foudn they use that against you whenever they can to control you. personally i dont even consider these folks coworkers- a coworker helps out and assissts - gives feedbackand such - at least at my place they do none of that - i have been tere 18 mo and yet to have even one eval........... i know there are some good ones - i have worked with one of the best DON ever - unfortunately she was so good and for the resident and staff she had to quit cause the stress made her physically ill.
  9. by   twotrees2
    Quote from Faye1
    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.

    its all about money and how they can NOT spend it and save thierselves a lot of money and make a good profit. :angryfire they dont care - bottom line is the almighty dollar - can see that when they charge 8.95 for a tube of OTC butt cream you can get at the dollar store for a buck - we have brought some a few times to be reamed out that we just cost them such and such - sad sad sad
  10. by   twotrees2
    Quote from meanbird
    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
    good advice - i also do that on my report sheet and cross off as i do it - i thenmake a copy and take it home ( with last names blotted out ) and i have a reminder sheet should i ever be questioned - remember to blot out names ( at least last names ) due to hippa we arent to take these sheets out - but in my warped maybe - thinking - if i have the first name and room number they question me - its gonna match with whatever they have there in the chart or TAR or MAR so i HOPE at least it would allow my buttt to be covered should they attempt to leave me siitting duck with state saying i did not do something - if its crossed out i know i did it i charted it and i aslo write whatever i have written in the 24 hour book as well so they cant change that and say i never said it ( i have personally seen them copy a paients record and make a nurse "redo" her charting so it fit THIER descrition and wording to protect THIER butts - sad sad
  11. by   twotrees2
    great job - now the important question is - will your main goal be to go elswhere where you can trul;y and realistically reach these goals - they are attainable - but from the sounds of it - not where you are now..... been there done that - your a good goal writer - mine were not so eloquent

    Quote from KristyBRN
    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.

    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).

    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.
  12. by   twotrees2
    Quote from rachelnward
    I'm sure you are feeling better by now. I have been a nurse for 10 years and my tip would be to start on night shift. I started as a charge nurse on night shift and then after a year moved to days. It is easier at night as there are less meds and treatments, the doctors are not making rounds and writing a bunch of orders, patients are sleeping, therapy team is gone, family members are not there making demands, etc. Just you and the aides and the patients, you have time for assessments and taking care of issues as they arise. I thought it was a great way to ease into nursing. I hope I'm not offending any night nurses, but in the experiences I've had, ICU/floor/nursing home, night shift is usually less stressful and busy. As a person who hates the feeling of missing something, missing following up on an issue, I choose to work were that is less likely for me. Also, consider a different type of nursing, like home health, where you can concentrate on one client at a time. Good luck!
    the only problem there is - her facility sounds so much like ours nd i tell you the nights have it even worse than pms - i would never work nights where 1 nurse is in charge of 90 residents and they may give you an extra aide if they can find one - just hd one and another is looking - leave for a new place cause its sadly understaffed even worse than pms.
  13. by   twotrees2
    Quote from KristyBRN
    Every single person who replied gave me something to think about, and most of all,the emotional support I needed.
    UPDATE........After my written goals to succeed was given to the DON and my nurse manager, I was told they were very impressed. I have also made an effort to live by my words. I cannot learn it all in such a short time, but I can and will maintain my calm in the midst of chaos. I am also covering the weekend Baylor shift for 5 weeks, (the Baylor nurse is on military duty), and I cannot believe the difference on the weekend shift. First of all I have a wonderful experienced nurse, (she is Filipino, reminds me so much of my mother-in-law), friendly, and soooo calm and capable.) It is such a different atmosphere, it is like working in a completely different place. My last two weeks of probation period are up next week, if I am not hired full-time, well, SoBeIT. I know in my heart that I have given it my all. I have discussed this with my DON, and she has said to me that she is very impressed with my "change of attitude". I did let her know that MY attitude has not changed, she simply saw me on a very bad day, when Iwas overwhelmed and close to crying. In other words, the calm capable one is the real me, but jeez, we all have bad days, huh? I also let her know how shocked I was at her attitude that she was ready to give up on me without even getting to know the real me, and/or my accomplishments. She acknowledged that she had probably seen me at my worst, and basically stated that she has changed her position on keeping me. Despite the initial instinct to cut and run, I think I am going to continue with my position. The CNA's present a challenge that is going to probably be there in any facility I work with, correct? So it is up to me as the charge nurse to find my balance, and not let them knock me off my stride. It remains to be seen if my choice to stay is the right one. I do feel so much more confident, and i have three more weeks of working the weekend shift and learning from my co-worker. After that, if I must go back to the weekday chaos, (this is still up in the air, if the nurse with the baylor position is called to active duty, the baylor position is mine), but if I must go back to weekday chaos, then I will do so with more confidence in myself. It also helps that every day I am learning skills that will stay with me a lifetime.
    Again, thanks so much for your support, emotionally I would have felt so alone without all your input. I have been actively recruiting friends of mine from nursing school to take advantage of this wonderful tool.
    Thank you Thank You ALL!
    it also sonds like you finally found a good preceptor to help you build on your skills with confidence - good for you!!! there really are good nurses out there as for the aides - well yes i think that is anywhere you go - my sugestion would be - let them know you will help them when you can ( and do it ) and also let them know when they are doing good ( lets them know you are checking upo aws you ultimately are responsible for thier duties too) and also let them know when they need to change something that isnt so good. you will find because you are willing to help when you can and also give good feedback when you do have to give constructive critism you wont be looked at as the mean old witch but someon ewho wants them to excell and do well. working as a team really is great. they will respect you and you in turn will respect them. oh and always when negatives need to be addressed do it out of earshot of any other staff and residents - that shows em you respect thier right to privacy - technically i suppose praise should also be done in private but i tend to praise in front of others and my girls seem to like that others know they are doing well nd they dont have to tell it and sound like they are bragging but thats just me and my girls everyone is differnet in approach