Help my first job feels like a nightmares

Nurses General Nursing

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Specializes in CCRN, Geriatrics.

I recently got hired at my first nursing job which is a ltc facility. I an extremely overwhelmed and want to go and find another job. The most confusing think about it is the system for passing meds. Unfortunately this facility is still living in the 80’s and still uses paper for everything. The mar is a binder you carry around all day on the med cart with over 1000 pages many of them are ripped out or hanging on by a tread. I am having a hard time adjusting too it. I also asked for a list of policies and was told the policies are scattered all over in the nursing station in many of the file cabinets

In the nursing school that i attended everything was all digital. To top it off i work 3-11 were we are short staffed so i am constantly watching the first door to make sure a resident doesn't escape because we do not have overnight security or a nursing supervisor.

The nursing patio ratio ranges anywhere between 25-32. Can anyone give me any suggestions on learning how pass meds with a paper mar. I witness two nurses administer the wrong meds because of this system. Most of our patients have dementia and do have wrist bands and the mar is missing pictures of them. I asked the staff several times for help and they all seem to brush it off because many of them have been there for 20 years and know all the patients.

Any advice? I am so afraid of making a mistake.

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Specializes in CCRN, Geriatrics.

I also add that i am very computer savy i honestly wish we had an electronic mar i have so much trouble reading the hand written nurses notes and medication orders

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Specializes in Infusion Nursing, Home Health Infusion.

One way to make a paper MAR work is to make your own worksheet.I used to write down my rooms numbers and pt names and only list the times something was due..like this. 242 A Harrison Amy...1600. 2000 242 B Jones Janine 1700. 2100 2300. Then once it is given and NOT before I I would cross it off...then once charted I would circle it. You have to find a way that works for you.If you know the times you can then go to the MAR to see what is due. You can also customize your system.If you want to know if it's an IV medication you can put IV next to it.You are going to have to be very careful and check name badges.While the system is not modernized it can work with some careful planning.

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Specializes in Critical Care; Cardiac; Professional Development.

Being overwhelmed in the first year to two years is a normal state of adjustment for ALL new grads, not just you and not just this job. You got some good advice above on how to cope with the learning curve. Don't be afraid of getting creative to help yourself out. Some of what makes it hard lies in the thinking "If only...."

If only there was electronic health records, not paper charting.

If only I were in a different facility/specialty/hospital/floor.

If only they did things like they taught me at school.

If only I felt the drive of making a difference every day.

This kind of cognitive dissonance is a big part of why so many new grads do not make it in nursing. Resilience is becoming a key feature for successful nurses given the jacked up health system we "enjoy" here in the US.

Things you can do to help yourself out while you settle in:

Be open to suggestions on how to organize your work process.

Take care of yourself when you are NOT at work. Consciously enjoy your time off.

Notice when you are engaging in patterns of thinking that amplify your stress/anxiety and make a conscious decision to give yourself perspective and turn the mental phrases into ones of empowerment.

Locate and nurture a mentoring relationship with another nurse in your specialty. Choose carefully. You don't want someone to gripe to. You want someone who will help you get past this adjustment period.

Realize that if you switch specialties, you are back at the bottom of the pile and will start all over again with feeling overwhelmed and being stressed/anxious. Doesn't matter if you are a new grad or have 10 years under your belt - learning a new specialty always means relearning how to organize, think and assess. Changing jobs will not make this type of stress better. It will continue it. Therefore start identifying the things you do like about your job as well.

Best of luck. You are not alone.

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Specializes in CCRN, Geriatrics.
7 hours ago, iluvivt said:

One way to make a paper MAR work is to make your own worksheet.I used to write down my rooms numbers and pt names and only list the times something was due..like this. 242 A Harrison Amy...1600. 2000 242 B Jones Janine 1700. 2100 2300. Then once it is given and NOT before I I would cross it off...then once charted I would circle it. You have to find a way that works for you.If you know the times you can then go to the MAR to see what is due. You can also customize your system.If you want to know if it's an IV medication you can put IV next to it.You are going to have to be very careful and check name badges.While the system is not modernized it can work with some careful planning.

Thanks for the advice. I tried coming in early to do that method but because we only have one mar book its impossible to do so. Im still in training and many of the nurses rush me and say they don't have time for me to write down everything. I can totally understand because there is 10 blood sugars, 4 g tubes, one colostomy and one trach pt and 3 patient that require tar paper charting the workload is tough.

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Specializes in CCRN, Geriatrics.
1 hour ago, not.done.yet said:

Being overwhelmed in the first year to two years is a normal state of adjustment for ALL new grads, not just you and not just this job. You got some good advice above on how to cope with the learning curve. Don't be afraid of getting creative to help yourself out. Some of what makes it hard lies in the thinking "If only...."

If only there was electronic health records, not paper charting.

If only I were in a different facility/specialty/hospital/floor.

If only they did things like they taught me at school.

If only I felt the drive of making a difference every day.

This kind of cognitive dissonance is a big part of why so many new grads do not make it in nursing. Resilience is becoming a key feature for successful nurses given the jacked up health system we "enjoy" here in the US.

Things you can do to help yourself out while you settle in:

Be open to suggestions on how to organize your work process.

Take care of yourself when you are NOT at work. Consciously enjoy your time off.

Notice when you are engaging in patterns of thinking that amplify your stress/anxiety and make a conscious decision to give yourself perspective and turn the mental phrases into ones of empowerment.

Locate and nurture a mentoring relationship with another nurse in your specialty. Choose carefully. You don't want someone to gripe to. You want someone who will help you get past this adjustment period.

Realize that if you switch specialties, you are back at the bottom of the pile and will start all over again with feeling overwhelmed and being stressed/anxious. Doesn't matter if you are a new grad or have 10 years under your belt - learning a new specialty always means relearning how to organize, think and assess. Changing jobs will not make this type of stress better. It will continue it. Therefore start identifying the things you do like about your job as well.

Best of luck. You are not alone.

Thank you for your words of encouragement i am a firm believer in thinking positive and praying. I just cant phantom making a mistake after working so hard to obtain a license.

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Specializes in CCRN, Geriatrics.
1 minute ago, Lovethenurse2b25 said:

Thank you for your words of encouragement i am a firm believer in thinking positive and praying. I just cant phantom making a mistake after working so hard to obtain a license.

Also i want to add is it normal for an ltc facility to only count narcotic medication ? For example we have a draw full otc bottles of meds like Tylenol vitamins etc and we also have 30 med cards with meds like flomax, lasix, carbidopa/levodopa and metoprolol that aren’t counted ever during the shift. Is this normal/ safe ?

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Specializes in Infusion Nursing, Home Health Infusion.

You don't have to write down everything...just the times meds are due.Please don't let others rush you...it's not fair, especially when you are trying to learn.

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Specializes in Psych, Addictions, SOL (Student of Life).
9 minutes ago, Lovethenurse2b25 said:

Also i want to add is it normal for an ltc facility to only count narcotic medication ? For example we have a draw full otc bottles of meds like Tylenol vitamins etc and we also have 30 med cards with meds like flomax, lasix, carbidopa/levodopa and metoprolol that aren’t counted ever during the shift. Is this normal/ safe ?

Typically only Narcotics are counted - you will find this just about everywhere you work.

Hppy

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Specializes in CCRN, Geriatrics.
15 minutes ago, hppygr8ful said:

Typically only Narcotics are counted - you will find this just about everywhere you work.

Hppy

Thank you thats good to know i wasn't sure. I want to ensure that everything is done by the book so i don't get pulled into any legal cases

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Specializes in Geriatrics.

Wow! 1000 pages? That is crazy. E-Mars only adds technology to the mix - which can still be just as daunting. For paper MARS, I used a paper report sheet with columns for times and checked off each as I went. I would build up the tool as I went along and make a master copy for the next day. Focus on your time critical tasks and meds, clean up all the other broad shift stuff at the end.

For all the other stuff, I would ask to make an appt with your shift supervisor. Perhaps he will have other perspectives or tools to consider.

Easy Does It.

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With 30 residents, you cannot create your own worksheet and list ALL of the med times. You can use a worksheet, however, to organize your fingersticks, charting, treatments and things like that.

When I worked the floor, I never had photos of my residents. The armband is their ID and if you keep working on the same unit, you WILL get to know them all. Some nurses I worked with used to mark the MAR somehow (sticky notes, for example) to indicate the resident had meds to give on the next med rounds - to prevent having to flip through EVERY piece of paper at every med admin time.

It seems like an impossible task at first, but you will get more efficient as time goes on. It sounds like the MAR papers need those sticker reinforcements where the hole punch is, to keep it from falling apart. Since they are used for a whole month, they are definitely chewed up by the end!

Good Luck!

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