New RN working Rehab/LTC Im overwhelmed. HELP! - page 2
Hello I graduated 1 year ago and just gt my first job. I just started orientation on a mixed unit 3 days ago. There are some rehab patients and some long term residents. I've been shadowing for 2... Read More
Aug 9, '11Joined: Aug '11; Posts: 8; Likes: 12Clinicals are different then LTC/SN. They do not prepare you for the work load but stick to it and it will get better. It will take multiple times of calling doc...finding where things are..learning to talk to family...following schedule and computer documentation. Ask others for help in organization (most fellow workers would rather you ask than make a mistake. Remember they have been there before). Watch the more experienced nurses and see if they have a system you could use. Our facility has 34 pt with 1 RN and 2 1/2 aides. Many time she has to travel to the other wing because there is only an LPN. It can be very hectic and a schedule may need to be modified 6 out of 7 days! It just takes experience... (and the ability to not eat for 12 hrs haha)
Aug 10, '11Occupation: Registered Nurse From: US ; Joined: Jul '11; Posts: 10; Likes: 7Eh, I wouldn't say she was being mean, but perhaps she was providing a little tough love. I graduated from a great, well-respected school, but wasn't given 100% accountability for my patients (although I always took that responsibility), and I got very few chances to speak to the doctors, call families, and supervise CNAs. For me, I feel that the nurses I were with while I was at clinicals, still wanted to have control of the situation so they would talk to the MDs and families. I don't 100% agree with this because speaking with the MDs and families is definitely a weakness for me. However, I still do it and have confidence that I know what I am doing. For my LTC clinical setting - I passed meds for one resident, one time. This in no way prepares a student for this type of setting. I'm not trying to complain though, because there really isn't any other way to learn how to be a LTC nurse until you're on the job. I feel that the best thing you can do is be confident with the skills you've acquired at school and remember that you are still learning!
Aug 10, '11Occupation: full time charge nurse on rehab unit Specialty: ltc, rehab ; From: US ; Joined: Aug '11; Posts: 3; Likes: 9Thank you all for your advice..this week is going much better..ive learned a bunch of the paperwork and am becoming more familiar with the residents and routine..tomorrow im switching floors..i dont know where ill be but im excited to see how another charge nurse runs the floor..maybe seeing another style of nursing will be good for me but really, i think i just need to go with it, just do my job the best way i can.
Aug 27, '11Joined: Oct '10; Posts: 47; Likes: 20I have the same problem. I am a new grad and have been working in LTC for 4 weeks now I am overwhelmed. I am on graveyard shift so am not getting enough sleep. I feel stupid when I ask questions and get brushed off at times. I think it is going to take time to feel confident. I am just going to ask questions of the people who are willing to answer them, and leave the others alone! I seem to always look stupid or make simple mistakes when I work with the nurse who brushes me off. I hate that she probably thinks I'm a complete idiot but there is nothing I can do about that.
Anyway hang in there you are not alone!
Aug 29, '11Joined: Jul '11; Posts: 255; Likes: 174Quote from SWiseRNOrientation in LTC should provide a good guide for what the expectations are. Passing meds is passing meds, the MAR is there, you open it, you do the 5 (6) rights of med administration, and then you assess your patient. If you are in the LTC part, fewer meds, stable patient, more to pass meds to, in the sub-acute much less, higher acutity, take your pick.Eh, I wouldn't say she was being mean, but perhaps she was providing a little tough love. I graduated from a great, well-respected school, but wasn't given 100% accountability for my patients (although I always took that responsibility), and I got very few chances to speak to the doctors, call families, and supervise CNAs. For me, I feel that the nurses I were with while I was at clinicals, still wanted to have control of the situation so they would talk to the MDs and families. I don't 100% agree with this because speaking with the MDs and families is definitely a weakness for me. However, I still do it and have confidence that I know what I am doing. For my LTC clinical setting - I passed meds for one resident, one time. This in no way prepares a student for this type of setting. I'm not trying to complain though, because there really isn't any other way to learn how to be a LTC nurse until you're on the job. I feel that the best thing you can do is be confident with the skills you've acquired at school and remember that you are still learning!
Is anyone here saying that in the 1000 plus hours of clinicals, one was not "hands on?". In this state, in order to GET into school, must be a certified CNA and have CNA experience, and we have good reason for that. If after you graduate, you do not yet feel confident taking care of a patient, or a bunch of patients, more clinical time, volunteer, ask for internship, there are many ways to skin this cat.
Simply stating that you are green and not yet seasoned, well...welcome to what we all had to go thru. but my question is, do you take the time to listen? and learn on your own? and seek a mentor or two or three?
To this day, I have questions, not sure of all that is before me, but I do know I was comfortable from the beginning with the resident assessment portion, and following MD orders, a lot of nursing is cut and dried, not following instructions, questioning and being argumentative with mentors/instructors/management (all of which I have seen and experienced myself) is NOT how one will ever do well at the bedside. I have seen new grads tear into seasoned nurses and REFUSE to be trained, then turn around and quit without notice and claim they have classes to take or are now pursuing BSN/MSN etc. I have seen nurses tell nursing supervisors/RCM's and DNS the most ludacrious of things, things I wouldn't dream to say ever to a boss of mine, and I have seen nurses LIE when confronted about simple things. Either one has ethcis or one doesn't.
Oct 12, '11Occupation: full time charge nurse on rehab unit Specialty: ltc, rehab ; From: US ; Joined: Aug '11; Posts: 3; Likes: 9update! i have been working now for a little over two months and am now working the evening shift for about a month..evening shift is very different but im the charge nurse and needed to get the flow of things quickly..i think im doing a pretty god job..im learning to multi task and to always keep my eyes and ears open..im no longer scared going into work lol
Oct 12, '11Joined: Nov '02; Posts: 6,056; Likes: 9,194I used to think pretty much the same way Pixie did. Then I started asking new grads how much actual time on a floor they got. It's not as much as in the old days (yes, when dinosaurs roamed the earth and I did go to a hospital program so we had way more clinical time than the ASN or BSN students even then). One woman told me she had only ever had 3 patients in school. No wonder people are ill prepared to work in long term care where they have 15 or 20 or 30 or or or?!?
We need to tailor our orientations to meet the needs of the new grads if we are going to hire them. We all spend a lot of time, money, and energy orienting new staff so we might as well make it count.
Maybe we should go back in time to when we were expected to perform in school. I had to do a med pass for 25 patients every day for 2 weeks in school. I had to be charge nurse of a unit with 25 residents and nurses who had been nurses for years. I think we were far better prepared to step up and hit the floor running than the nurses are today.
Nov 8, '11Joined: May '11; Posts: 4; Likes: 2Hello Capecodemermaid,
I am a new grad and I have had 4 days of orientation but only two of those days were on the floor with a charge nurse. I am considering leaving this position in an LTC, because it is very overwhelming and I do not feel safe passing meds to 32 patients without really having the opportunity to assess them or read and know their history. My question is even though I know these patients are not acute, how can sending a new grad with two days orientation be safe for the patients? I really did not get even get oriented to the paperwork or charting or the steps to take about contacting the physicians. Other nurses at the facility are kind, but they are also just trying to get their meds out, so many times I am alone trying to not freak out about taking care of all these patients. I just do not feel new grads should be given 30+ patients to start regardless of their training or the acuity of the patients. I see the nurses at the facility I work at passing meds that are not on the MAR to patients that just request it. How can we reasonably be expected to be familiar enough with the patients and medications to be able to make decisions about their care? When I ask other nurses their routine or how they check to make sure the drugs they pass are for the right patient they just tell me that they know the patient. The don't even take vital signs just to have a baseline of the patients. I personally as a new grad do not feel safe and fear that I could lose my license. I really do not know what to do because I know its difficult finding a job right now, but at the same time I want to acquire good nursing skills not just get the work done. I do not want to just copy nursing notes from previous nurses or vital signs from other nursing notes, like how one nurse told me to do when I asked for help with my charting. I really do not know what to do because I know I could stick it out and get the routine down, but is this really improving my skills as a nurse?
Nov 8, '11Joined: Oct '10; Posts: 47; Likes: 20I agree with you capecodmermaid! As a new grad I came out of school with very few clinical hours. The first year of school we only did 12 5hr days a term. The second year we did 8 hours but only 12 days per term til the last term when we did 135 hours of preceptorship. In my case the preceptorship had nothing to do with my current job.
I agree with Pixie who says that we all go through this but at times it is overwhelming! I pretty much get into a panic at times. This of course doesn't help because then I don't get anything done well.
I know there are some who are confident right from the start and I think that is great for them! I however am not that way and just want to be a good, competent nurse!
I don't know if it makes a difference but being older it takes me a bit longer to learn. I just have to jump in and do my best to learn.
Nov 8, '11Joined: Aug '04; Posts: 4,352; Likes: 7,6181000 hours of clinical? Ha! I graduated 18 years ago when there were massive lay offs of nurses and they would barely let us do anything more than a bed bath in clinicals.
That said in most new jobs you are going to feel totally overwhelmed at first because everything is new and different and you are the odd man out. A rite of passage that really never changes.
Very glad to hear the OP rallied and is doing great.
Jun 1, '13Joined: Jun '13; Posts: 1; Likes: 2Pixie........ I am a new nurse and when I start my first job next week I pray i do not have to work along side someone like you!!