Guilt: Not being able to do it all!!!!!

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Specializes in Geriatrics/Family Practice.

I just started at a LTC facility and like the previous one I worked at, it's very short staffed. The big concern I have is that I attempt to jot down things as I'm passing meds to address when I'm done, but due to all he!! breaking lose everyday, I don't seem to get those jotted down things done. Well last night on second shift I did go listen to some lungs and did some pulse ox's (had to borrow pulse ox from another unit, because heaven for bid if my unit had one of it's own). I found out one of the patients had an O2 of 90 at room air, one had mild crackles on expiration. I called and got new orders and ended up leaving way to late. There were more things I wanted to get done, but knew I had to work again to day and wanted to leave work somewhat on time. My question is, why is it that I work late everyday, whether it be first or second shift and yet when I walk in on second shift the nurse is reading a magazine and out the door by the time her shift even ends. What am I doing wrong? Or what are they doing? I'm a fairly new LPN, but I do put my heart and soul into trying to do everything I can to assist in the care of my residents (trying to do a mini assessment) while trying to pass meds, and all the other stuff. Charting is the last thing I do and I chart on everything that is out of the norm. I feel bad because I don't get everything done I would like to, but I also feel there are two other shifts, so why don't they pick up on some of this stuff? I had one nurse tell me last night that she will not do any CNA work. I do, because like I said otherwise I don't get to see their butts, periarea or do my mini assessment. No I don't have time to do CNA work, but because they are always short, I help, and it also helps me (assessments). Sorry this is long, but I'm just already getting tired of the short staffing and heavy workload, but I feel for my residents who are mostly helpless and need me to advocate for them in some way. I do find that I'm constantly saying I'll be right back, Give me five minutes, etc. Bless the residents hearts, because I do feel so sorry for them and try to give them all I have to give during my shift, but I am only one person. My big fear is that I'm going to get into trouble for missing something, yet I assessed and found 5 other things that day. I'm stretched to the max, and by the end of my shift I'm physically and emotionally drained. Any positive input would be greatly appreciated. I don't want to quit because I bond very easily with my residents. Some already know me by name and their little faces light up when they see me, I don't want to leave them, but fight for more help and better quality of care.

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Your post is so touching, it is obvious that you care so much. I happen to think that sort of caring is what the ill, injured, elderly need the most. When nurses post here complaining about this and that, what they are actually saying is that these things keep them from caring for patients properly and the guilt this failure produces is tearing the nurse apart. It certainly is what I am talking about when I post my rants about managment and hospitals and healthcare in general. At least it helps that I learned along the way to at least partially place the blame on the system that doesn't care to pay the cost for doing things correctly. On the other hand, I have never completely convinced myself that if I somehow could be smarter, quicker, younger and healthier I would have been able to keep up with the impossible demands. The only thing I can say is that coming here and reading post and talking to people in the same boat has helped a me lot. I will also say that you will never find a perfect LTC facility but you can find a better LTC facility.

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The guilt should lie with those that created the type of facility you describe.NOT the nurse.And what's worse is the type of facility you describe is the norm.

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

The nurses that are sitting reading are the ones who should feel quilty. You will run into these types of workers occasionally. Just do what you know is right and realize that 1 nurse can't do it all. The above posters are right. It is administration that causes these situations by going with chronic short staffing to try to safe a few bucks.

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Specializes in Med/Surg; Psych; Tele.

Kstec,

Just like Oramar said, it is obvious that you care so very much. You and people like you are what nursing SHOULD be about. But indeed it is true that we are all working in an impossible system that puts $$ and paperwork before patients.

Also, like Gonzo said, those nurses sitting around reading suck! I can understand the *occassional* brief interludes for comradery (sp) in the workplace, but they can read or surf the net at home! It truly infuriates me to see that in the hospital b/c something always needs to be done and someone always needs help.

You sound a lot like me. While I'm not a new nurse, I'm definitely not seasoned either. Yet I still don't delegate nearly as much as most nurses. And as a result, here I am today burned out. I don't enjoy going to work anymore. I get in a foul mood just thinking about work.

I have always found nursing to be stressful, but initially, the intrinsic rewards of helping patients outweighed the stress somehow. But please heed my warning: This does not last forever - Yeah! Another thing to feel guilty about - I'm not as caring as I used to be.

I never thought it could happen to me, but I have grown somewhat hardened. As corny as it sounds, I honestly think it is a matter of survival - an involuntary mechanism if you will. THink of it like the idea that fish will eat until they die (dont' know if they really do). People like you and me just keep on and on giving everything we've got, saving nothing for ourselves, even draining the reserve. This mechanism kicks in to stop us essentially from killing our souls and ourselves (stress does kill or shorten your life). We are only human with FINITE reserves!

I finally came to the realization that I don't want to spend my life giving myself away and having nothing left for myself. I'm sorry, but that does not make me selfish. You need to understand also that I have some kind of neuro d/o or CFS where I need a lot more sleep than normal people. So there just hasn't been enough time for ME!

Sorry to ramble, I just don't want you to end up like me. So, I implore you, please delegate more, quit trying to do EVERYTHING since you are not Wonder Woman, and be proud of the great patient care you are able to provide! Do this b/c your patients need you. If you burn out, your replacement might just be the lazy a$$ who sits at the desk and reads! :angryfire

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Kstec,

I have always found nursing to be stressful, but initially, the intrinsic rewards of helping patients outweighed the stress somehow. But please heed my warning: This does not last forever - Yeah! Another thing to feel guilty about - I'm not as caring as I used to be.

I never thought it could happen to me, but I have grown somewhat hardened. As corny as it sounds, I honestly think it is a matter of survival - an involuntary mechanism if you will. THink of it like the idea that fish will eat until they die (dont' know if they really do). People like you and me just keep on and on giving everything we've got, saving nothing for ourselves, even draining the reserve. This mechanism kicks in to stop us essentially from killing our souls and ourselves (stress does kill or shorten your life). We are only human with FINITE reserves!

I have made observations something along this line also. Sooner or later, one way or another most nurses will take steps to save their own life.
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Specializes in Psych, ER, Telemetry, Float.

Thank you for doing what you are doing, I personally am not able to do LTC work and admire ppl who are able to handle that type of nursing.

To re-iterate previous posters: learn to delegate better to your staff and only do what you can do. It will do your pts no good if you burn out (or worse get hurt on the job!).

Most importaintly know you are doing a great job and positively impacting on your pts lives. Thank you again for doing what you are doing.

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Specializes in Geriatrics/Family Practice.

Well tonight was another one of those nights, where you have two CNA's and me with 35 residents. I went into to cover a resident and noticed she was put into bed with no gown and feces in her diaper. So rather than grab the CNA who was taking care of 16 other residents, I grabbed a gown, washcloths and off to cleaning I went. A few minutes later the CNA who had her said "Oh you do CNA work too?" I of course said that I was not above doing it in anyway and I would help anyone if I have time. I did find that after three days in a row of helping lift, transfer and reposition that my back hurts like heck. I'm laying in bed with one of those heat wraps on my back and 800mg of ibuprofen in my system. I quit clinic work because there was not enough patient care and now I'm getting to much (in over my head). I love my residents, but like I said God bless their little hearts and please help them and make this money hungry world somehow learn to take care of its elderly. What's said is that on my unit which especially breaks my heart there are 3 Huntington's women, all right around my age, with young to older children. One is so young that she has a 9 and 11 year of girls. I look at her and my heart breaks. One of the other ones shakes so bad she can't hold anything, but the other day her youngest son (an adult) called to check on her and I talked to him for a while then I went and got her. In her shaky little voice she kept saying that she loved him and missed him as tears ran down her face. I of course got teary eyed, but a warm feeling of being her nurse came over me. Well enough rambling, and thank you all for your positive input. Nursing is hard and we all went into with an idea of what it was going to be like, unfortunately for most of us it ended up being different. I went into it for that queer little warm fuzzies you get when you are in the position to make someone feel better, or comfort, or stabilize, etc. I get to do that, but it comes at a price. Working beyond my physical capabilities, doing to much paperwork to cover the facilities a$$, meeting alot of the rediculous rules that the state has implemented and all of this at the cost of the residents well being. Well I'm going to try and sleep, but damn is my back killing me. I didn't just hurt it recently, I hurt it working as a CNA about 18 years ago, and it's just gotten worse. Working LTC just irritates it, but I'll keep on trucking and raising cane until I'm exhausted, fired, or I get some changes made. Again, thank you all.

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I'd work with you any day!

I guess I consider myself a bit seasoned to LTC after 12 yrs, but last year, I took a job in what looked to be a "nice" LTC. I had to leave after 6 months. "It" just wasn't there for me. I was doing the same thing you were. It wasn't really, really short staffed, but it just didn't seem like the staff was working well together. When I would come in, I would find those residents who were kinda just left from the last shift. You know....the ones that you can just hear the crackles and wheezes at the door...or smell. How can you leave that? Trust me...the residents probably see you as an angel when you come in to work and look forward to seeing you!

As far as getting involved in ADL...I'm not afraid too and will do it if I'm going in to do the dressing or cream etc.

My current LTC that I have been calling home for the last 12 or so years might not be the ritziest (we are finally getting a remodel), but I can call it home! We might not be the best staffed, but they do work together (or with me) for the most part.

When I go to do the dressings, creams, etc...I know when the CNAs have done ADLs and inct care and will go then or after they are done....saves a heck of a lot of time.

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I was just about to post asking the same question. How in the world do other nurses get their job done?

I have been working as a nurse in LTC for 2 weeks now, my 1st job as a nurse. Everyone I work with keeps telling me I am doing a great job... but I stay at least an extra hour every day and still don't get everything done that I want to.

I am still learning about my residents, I try to chat with them and do a mini assessment while I'm passing meds, butI can't seem to get everything done.

We are always working short with the CNAs. I answer call lights and do all I can to help. I just don't know what I need to do to become efficient...

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I'm in the same situation as many of you are as well. I just became an LPN 2 weeks ago.:yeah: I do have an advantage though of having been a CNA for 3 of my 6 years at the facility I'm at now and of having an INCREDIBLE orientation as well as working for a great facility. I'm still on orientation but trying to do everything by myself and the nurse just being there if I need help. I just find that it's taking me so much longer than the other nurses to do med pass. They say I'm doing fine and it will just take me some time to speed up, but that's almost all I am able to do! :uhoh3: I think the hardest part for me is being a "newbie" after finally becoming so confident as an aide. Anyway, I think it's just going to take time to get a routine and get the hang and flow of my new career as a NURSE! :nurse:

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I know exactly how you feel, I find that I leave things for the next day, you know things that can wait. Wound assessments for instance, if done on day shift I will still look at wound do dressing or whatever however I won't chart on it until the next day. Respiratory assessments are something that can not wait obviously I would chart on that. In my LTC facilty I look at 8-10 skin problems a night and only chart on 4-5. I found that doing rounds with the CNA's being the most helpful. In the beggining of my shift I put stars around things that need to be addressed right away or that shift. It helps. Our DON informed nursing that skin problems only need to be charted weekly. My goal is to chart on skin problems q 3 days even if another shift already charted on them.

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