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.
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.
The reason why new nurses are overwhelmed in LTC and elsewhere is directly related to the corporate conglomerate systems that purchased the United States healthcare system for the profit of the top 1% at the top of the chain. These corporate systems then find doctors who will reliably order worthless diagnostic tests, medications , and supplements , and vitamins, and treatments to inflate reimbursements.
To the OP, paper MAR is no prize, but recently I had to chart a set of vital signs on pointclick care. One set of vitals had 20 clicks, not including the time it took to enter the data, and the bedside time it took to take them. EMAR sucks too.
Specializes in Critical Care; Cardiac; Professional Development.
3 hours ago, nate411 said:
The reason why new nurses are overwhelmed in LTC and elsewhere is directly related to the corporate conglomerate systems that purchased the United States healthcare system for the profit of the top 1% at the top of the chain. These corporate systems then find doctors who will reliably order worthless diagnostic tests, medications , and supplements , and vitamins, and treatments to inflate reimbursements.
To the OP, paper MAR is no prize, but recently I had to chart a set of vital signs on pointclick care. One set of vitals had 20 clicks, not including the time it took to enter the data, and the bedside time it took to take them. EMAR sucks too.
I am aware of this and am in no way new to the way things work. It does not change the fact that the OP has to find a way to adapt. The fact of being overwhelmed and struggling to adjust to the realities of nursing are universal across the healthcare system in the US and are not exclusive to those in LTC. I am confused what you are taking issue with in my response.
Been there and done that. I remember the 500 pound cart rolling over my foot every once in a while to only add fuel to the flame while I was passing meds for 30 patients, whom the majority of were total care. The things you do when you don't have many options can be frightening. I knew that by taking that job, it would get me where I needed to be one day and it did. If you have other options then don't do that job but if you don't try to stick it out. I also remember the liquid narcotics that for some darn reason would always be knocked over by the staff and it would not be caught by administration until the end of the week. Anyhoo, I made it and things are much better now.
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 ?
Just narcs get counted, you would NEVER have enough time to count all the meds. Be careful what you wish for!! ?
I use my report sheet. Once report is over, I make columns for 2,3,4,5,6,7,8,9,10 PM, I use a circle to denote the time a med is due. If they also need CBG I write that, as well as BP, P, T or O2 sat, Once administered, I cross out the med and write in the vitals. I also make room for nutritional supplements. I use a different column for tx. This way I have a map of my shift right in front of me when I start. Good luck.
Just narcs get counted, you would NEVER have enough time to count all the meds. Be careful what you wish for!! ?
I use my report sheet. Once report is over, I make columns for 2,3,4,5,6,7,8,9,10 PM, I use a circle to denote the time a med is due. If they also need CBG I write that, as well as BP, P, T or O2 sat, Once administered, I cross out the med and write in the vitals. I also make room for nutritional supplements. I use a different column for tx. This way I have a map of my shift right in front of me when I start. Good luck.
Thank you for the advice. I am trying to get use to the system they have in place. At my facility we have binders for everything it just a matter of remember to check the mar, tar, and patient charting book. I don't want to sound like i am a complainers it just that i don’t like to work and feel like a chicken with my head cut off. I have spoken to many senior nurse that i work with and most of them just go with the flow. From start to finish we are on our feet without any time for a break or much down time to chat and go over paperwork. I truly strive to confident in everything that i do.
Thank you for the advice. I am trying to get use to the system they have in place. At my facility we have binders for everything it just a matter of remember to check the mar, tar, and patient charting book. I don't want to sound like i am a complainers it just that i don’t like to work and feel like a chicken with my head cut off. I have spoken to many senior nurse that i work with and most of them just go with the flow. From start to finish we are on our feet without any time for a break or much down time to chat and go over paperwork. I truly strive to confident in everything that i do.
Bear in mind that it's impossible to do a decent and thorough job in LTC in the hours allotted. People in that field make their personal choices about what they'll focus on and what they'll let "go".
Remember- it's not you, even though you'll speed up with time. The systems we have for long-term care in this country are doomed to failure.
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 ?
That is entirely normal. Only controlled are counted. There's already a very limited amount of time in the day to pass meds as it is, could you even imagine needing to count all meds? Not even in the least bit a feasible operation!
Thank you many people i have spoken to told me to leave after 3 months. Thats if i can withstand it. I have gotten other offers at different places.
The paper MARS wouldn't necessarily be a deal breaker if you are otherwise well supported by your co-workers and management. There's no getting around the fact that LTC has a massive resident to nurse ratio, that's just the industry norm. It's difficult but not impossible to manage once you get a routine down that works for you. Expect that to take awhile, but you can do it!
The turnover in LTC however is extreme for a reason. There are good facilities but there are also some that are too awful for words. Is the "senior" staff there truly senior staff? How long do nurses stay there? If most of the senior staff have been there for years it's a pretty good indication that this is one of the better LTC facilities in the area. On the other hand if most or all nurses have been there less than a year that means there are better options out there and nurses leave when those better facilities have openings. Which given turnover even in good facilities happens pretty frequently. If you are offered a job at a facility that is managed better, has the supplies you need to do your job to the best of your ability, has decent support staff and has at least adequate staffing most shifts don't feel guilty about leaving this one.
The paper MARS wouldn't necessarily be a deal breaker if you are otherwise well supported by your co-workers and management. There's no getting around the fact that LTC has a massive resident to nurse ratio, that's just the industry norm. It's difficult but not impossible to manage once you get a routine down that works for you. Expect that to take awhile, but you can do it!
The turnover in LTC however is extreme for a reason. There are good facilities but there are also some that are too awful for words. Is the "senior" staff there truly senior staff? How long do nurses stay there? If most of the senior staff have been there for years it's a pretty good indication that this is one of the better LTC facilities in the area. On the other hand if most or all nurses have been there less than a year that means there are better options out there and nurses leave when those better facilities have openings. Which given turnover even in good facilities happens pretty frequently. If you are offered a job at a facility that is managed better, has the supplies you need to do your job to the best of your ability, has decent support staff and has at least adequate staffing most shifts don't feel guilty about leaving this one.
Yes many of the nurse have been there for years some before the company was sold 3 times. But we are short staff no nursing supervisor at night and have agency nurses on the daily bases.
LTC is tough, especially when you work the floor. My first job as a new grad was an RN Supervisor at a SNF and it was terrible not knowing anything and being the supervisor. Every day was mentally taxing, but I stuck it out for 3 months and landed a hospital job. Everything about the hospital job was so much better. The patient ratio is great, the coworkers are helpful, and the bosses are pretty good. 2 years and a few months later and I am about to start a new specialty in case management later this month at the same hospital. Just use your current job as a springboard to open new doors. "This too shall pass" is what I always tell myself in difficult situations.
there may be more organized and up to date places to work but ltc is basically the same where ever you go. if you do decide to find another job try rehabs or long term acute care or even a drs clinic. these are about the only jobs available for LPNs/LVNs
I have worked ltc for 26 years of my 30 years as a nurse. you will eventually learn to organize and prioritize your work the longer you do it. 26 patients is a rather light load compared to a lot of places. it seems I never could get off the med cart and unfortunately it is not the only duty you are responsible for plus It was virtually impossible to find and 8 hour shift in this field.
nate411
19 Posts
The reason why new nurses are overwhelmed in LTC and elsewhere is directly related to the corporate conglomerate systems that purchased the United States healthcare system for the profit of the top 1% at the top of the chain. These corporate systems then find doctors who will reliably order worthless diagnostic tests, medications , and supplements , and vitamins, and treatments to inflate reimbursements.
To the OP, paper MAR is no prize, but recently I had to chart a set of vital signs on pointclick care. One set of vitals had 20 clicks, not including the time it took to enter the data, and the bedside time it took to take them. EMAR sucks too.