I feel like I'm losing all of my nursing knowledge

[RN_Vinny]

He, I'm a new grad and I've been working in a LTC facility for about 5 months now. I am an RN and when I first applied for the job I was under the impression that I was going to be a staff nurse. Well the administrator liked me so much I went straight into being the Restorative Nurse. I HATE EVERY MINUTE OF IT. This is going to be long. OFFICIALLY i have been the restorative Director for about 2 months now. The previous restorative director was moving to Seattle and they needed an RN to replace her. I was ecstatic about getting department head experience straight out of nursing school. However, I am drowning. Our current census is 204 residents, it is just me and 3 RNAs. I hired another nurse to work with me who then quit on me soon after. It is impossible to complete the amount of paperwork due weekly, handle all the falls for the facility, buy and manage all assistive devices and fall preventative devices, run all the restorative programs, assess the residents quarterly and new admits by myself. I am drowning and have become depressed as my work gets further and further behind with no new prospects. Not even the nurses on the floor can help because we have a huge staffing issue where there's 1 to 2 spots open per shift that either aren't covered, leaving a nurse to work 2 floors or calling an agency nurse to help. It's horrific, truly. That's not even my question just a rant really. As I sit and pound out this paperwork everything that I feel like I learned is leaving me. I feel like I can't even really call myself a nurse because I am still so clueless about a lot of things. Th e patient loads at this facility are ridiculous. 50 on th e psych unit to 1 nurse, 45 on the dementia unit to one nurse and 30 on the skilled unit. Ive had to work the floor before, after only being oriented 2 DAYS before they threw me to the wolves, I cried that day. I had time to pass meds only which took me 4 hours to pass am meds with the next med pass schedule the next hour. Anyway to my question, how do I keep my skills so that I don't look like a dipshit if I get a hospital job which I've been trying to do for months. I can't remember anything it seems, and I feel like such a fake and a failure. Any nurses in ltc that then transitioned to a hospital ... how did you keep on top of your skills you worked so hard to learn?

[JBMmom, MSN, NP]

First, wow you're in a tough spot. That workload sounds like it would be overwhelming to anyone and your staffing sounds like something that would make it difficult to provide adequate care. I hope you can find something else soon. To answer your question, I know a number of nurses that transferred from my LTC facility into acute care positions. You are not a fake and a failure. You are doing your best with a very challenging first job out of school. When you have an interview for an acute care position, highlight the skills you have developed like time management, communication with patients, staff, families, assessments in a wide demographics range from psych to skilled nursing. Anyone hiring someone from LTC is going to understand that the skill set is slightly different in acute care, but it doesn't mean you won't be qualified. You're gaining valuable experience, just focus on what you bring to a new position. Good luck where you're at and with finding something else, because where you are sounds like a nightmare.

[nurse2033, MSN, RN]

You have leapfrogged over using your bedside nursing skills into the next level, management skills. It sounds like just about anyone, no matter how experienced, would be overwhelmed. You should focus for a minute on the basics. Do you have the staff and materiel to provide safe care? (I think I know the answer.) You haven't said what you have done to request resources or assistance. You need to bring the situation to the attention of management immediately. And I mean a paper (i.e. email) trail. It sounds like you are very high risk for an adverse patient safety event. It sounds like you need more staff to help you accomplish your tasks. If you can't come close to accomplishing the tasks required for your job you need to either increase your ability to handle them, or reduce the number of them. Only you can judge which is possible. If management knows about the situation and has done, or will do nothing, you need to find a new job. Your career is at risk if something bad happens. I don't mean to scare you, but if you plead with management for assistance and they don't provide it, you have transferred some of the liability to them. I would think that your nursing skills are the least of your worries right now. If conditions are well below acceptable you should call the state and report the institution. I wouldn't worry too much about losing this job because it sounds like a pile of ****. But you have an obligation to the safety of your residents. Best of luck!

[RN_Vinny]

When I accepted this position, the then Restorative Director was alone as well, and had been for 6 months. I told the administrator that I wouldn't do this unless I have a second nurse and we did. I was excited about having help and not being swamped and overwhelmed like the previous nurse. Unfortunately, my nurse who is an LPN started a bridge program and quit on me, without notice by the way. So its been about a month now and I am so afraid, because our state window opens next month, that all of the tags will be because of me. But they know that I am behind, I remind the administrator on a daily basis that I'm behind and need extensive help. I am salaried but IM also a new mom with a 7month old who cant devote her life to a 60 hour work week just to make up. I shouldn't have to. They say that they are looking but the teamwork and the way this place is right now, I doubt we will find anyone anytime soon. It took them 6 months to find help for the previous Nurse and I cant last that long. I've been filling out applications like crazy, everyday, all the time, on my phone during my lunch. The longer I am here, the more depressed I become and nervous. I feel like I got this opportunity and now I'm tanking and its frustrating. The only skill that I utilize are my assessment skills, and even then I get reminded of things that I should have done or forgot to do. Its just a lot to deal with. Thanks for your comments!!!

It also makes me nervous because we have had state in here a few times and the last time, the surveyor asked for me. I handle all the falls and the interventions on top of everything else and I was so nervous about my interventions and my investigations and everything. She started asking for lists and I have not been able to update a list since the last RN left... ugh just a lot :'( and im trying to be patient. I don't want to leave here and go to another LTC facility when I want bed side hospital experience but to keep my sanity I may have to.

[RN_Vinny]

Oh and its even harder for me because I don't have my bachelors and a lot of hospitals in Chicago are magnet and only accept those with bachelors.

[nursy1, BSN, RN]

It will all be okay & the right job will come along. Right now consider the fact that you are in a better position than someone without employment. I too felt that I was in a position that was making me lose my nursing skills. I worked in a long term care facility in a position that was newly created & I did very little patient care. I felt like it was useless. I hated it & I was too depressed.

Just remember this too shall pass. You made it through school & you are employed!! Keep trucking forward & looking for a new position, one will come up. I had to do my "crappy" position for about 9 months, applying for other positions the whole time. Its discouraging to keep applying & not hear anything back. At the hospital I currently work at it was application #79 that got me the call back. Persistence pays off.

Also, as much as you feel that you aren't using your skills, you are. As it was mentioned above, you are learning valuable time management skills. When you do interview for a job, highlight what you have utilized. Interviewers will understand that you are coming from a different world & have a different skill set than a nurse who is from bedside care. Just emphasize how you enjoy what you do, but your goal is to work in bedside care with patients.

I wish you the best of luck, keep your chin up. It may take some time, but everything will work out.