Help with LTC nursing

[cnjalbert]

i am a new nurse and i have been working at a nursing home for about 2 months on the 3-11 shift. i am a floater and have up to 32 residents. everyone's says it will get easier, but it seems to me that the only way it will get easier is if i give almost all my 5 & 9 meds together, except if they have the same med given twice on my shift. (with the exception on given insulin on time).

the administration says "they will never admit it, but they agree that this is the way the real world is". some have made the comment that i should have the med pass down by now. but i try to follow the administration times as much as i can. i don't know enough about some of the meds to know what is safe to give together and what is not. how do i know if administration is truly ok with the way their other nurses are doing things. do i just conform or do i question? i feel if i question, my job could be in jeopardy. but if i conform then how do i know ethically what is correct? this is my license i worked so hard for. i am so busy that i don't have time to get med times changed especially when each day i work i am on a different hall.

it seems like i spend all my time passing meds that i do not have time to learn the other aspects of my job. i feel i learn differently than most. so i am more cautious. i have made up a sheet to help me keep up with the meds to give and times. everyone comments that it slows me down. however, when i try not to use it i have the worse days of my life. i spend extra time off the clock trying to learn everything i can to get a jump on the day. however, it just seems like i am spinning my wheels and not going anywhere. how do you get organized where everything falls in to place? i love being a nurse and i know i am making a difference. i just don't want to lose my job for not keeping up and doing things "their" way.

thanks for any advice you can give

[AshiPanda]

Maybe a lot of the problem is that you are a floater nurse? I find it really hard to get anything done when my patients would constantly be changing on me...

I asked another nurse about the med times thing, and she said unless it's heart medications or things of the sort, she gives them all at one time.

[RN_MishMish]

I agree. Stability, knowing your people and getting familiar with their needs and meds will be easier when you are work consistently with the same ressidents. As a floater is it so much more difficult to build up this knowledge because your residents change all the time. Talk to manegement and find out if they can place you on a certain pod rather than have you float at least for a few weeks. Time management takes a while to build up and a changing environment isn't very helpful. Best of luck! :redbeathe

[RN_MishMish]

"How do you get organized?"

Like mentioned in another post, knowing your residents, their meds, their needs is a great piece but even if you'll have to be a floater for a while, eventually you will develop YOUR system, and see what works and what doesn't(or what slows you down). My system:

After getting report I take 10 minutes to quickly go over the MAR and mark on my list of residents t("the brains")the times of meds of each. I'd also mark on there if I have dsg changes, orders to take care of, skin checks etc. This way I know what needs to be done and when. Than I'll gather my supplies, anything I will need handy on the cart - I'll have ready and available - dressings, syringes, lotions, enteral bags. Anything I know is needed and is not located on the cart - this way I'll save mayself a few trips when it is really busy. The next hour I'll do my rounds - initially visit with and assess the residents. This way everyone is accounted for in terms of what they need for the evening and I have gathered the info to start documentation. I'll try to do most treatments before the big evening med pass. sometimes it works, sometimes I have leftovers for HS but at least I get a head start.

And yet, every shift there is something else that takes a big chunk of your time - an admission, a dischargse, a set of new orders from the doc, a resident who is sicker than the usual. There is never a dull moment, as you know. you will eventually find what works the best for you. If management wants you to be successful they will help you find the conditions you grow best in. If this shift doesn't - by no means you are a bad or incapable nurse, you need to find your corner.... Hang it there, it's true what they say you know - it does get better. and if it doesn't after you've tried - it's ok to find something that works better for you

Best of luck!

[rn_nxt_dr]

first, i suggest that you relax and read over briefly your patients'/clients' medications. have the latest drug guide book handy to check for adverse drug interactions if getting overwhelmed. there is nothing wrong with that because you are ensuring patient safety (the ultimate rule).

secondly, if you feel you are not so adept with medications, try reading pharmacology all over again to refresh and update your knowledge, we all need to do this from time to time because of constant clinical research results that may greatly affect clients.

thirdly, you are doing great! without fear we will not take that leap into the unknown. with fear we act more cautiously and with better perspective because we care about our clients. have faith that you are doing the right thing.