I don't think I can handle this!

[eldragon]

WARNING: VENT VENT VENT!

I'm in the middle of my fifth week in a SNF, as a medication nurse. This is also my first LPN position.

I thought I was so fortunate to land the first job I applied for, and in fact, right there on the spot! However, this job is torture. Here's what my day was like today:

0645: Get to work 15 minutes early to find the six boxes I ordered to re-supply the med room, still not carried to the med room. Go inside the med room and see medicines for 3 new patients, all sitting on the counter, not put up. (We're talking dozens and dozens of cards here.)

0655: Count narcotics.

0700: Go to the dining room, where I am responsible for physically placing each tray in front of the 24 people in my dining room. I then pour coffee, etc., and pray for the pts to eat within 40 minutes, because I know what is waiting for me: the 0900 med pass from hell. Usually I end up taking a tray from one woman who suffers from dementia, and cannot understand why she can't sit there playing with her butter all day, while I watch. Everyday, she's mad at me for taking her tray.

0745: I push my cart out and probably have at least two people who are screaming for pain medicine - and I am required to give it within 15 minutes of their request.

0800: Start my morning med pass, doing all vital signs myself. Last week we had 18-20 patients, but now we have 26. This is a SNF, and orders change almost everyday. We got 7 new admits in the past two days, and everyone takes 12-30 meds at 9am - including multple inhalers, patches, PO, etc. Many pts have dysphagia. There are two peg tubes, and right now we have four known narcotic addicts, who each require pain medicine q 3 hours, sometimes up to 3 different meds staggered. Meanwhile, pts are in PT, the beauty shop, the shower....or outside smoking. I have to run them down individually.

10:30 - I'm supposed to be done with my 9 am med pass. Yeah right! That's about 5 minutes per person - and just gathering someone's drugs can take longer than that - much longer if the person is new and the meds aren't to be found in the cart. Then I have to find the patient, take vitals - and have them swallow the pills, which takes several :banghead:minutes if the pt can't swallow more than one pill at a time, and can't hold their own water.

10:30 CBGS on 10 patients. Of course, you realize I am way behind on my morning med pass, right? Nobody is getting their CBG at 10:30 right now.

11:00 my unpaid lunch break that is deducted from my check, whether I take it or not. Hello? I'm still passing the 9 am meds! Lunch for me isn't happening today!

11:30 - insulin for those that need it. But again, I'm way behind.

12:00 Trays are out, and everyone is waiting on me to get in the DR to pass them out. Too bad I haven't sat down, peed or even had a drink of water since 06:45 this a.m. I feel like crying by now I can't sit in the DR, either. It's standing room only for me.

12:45 Lunch is over? Back to work, hopefully I can get in 15 of minutes of charting and beg for the MAR back from the infection control nurse who is glaring at me for having it all morning. Now would be a good time to pee, even though I'm dehydrated from not drinking anything since 0600 this morning.

1300: Start passing 1300 meds, and most people get them. Also I have to fit in flu shots, pneumonia shots, B12 shots, etc. I have two more hours of my shift to get everything else done - calling the pharmacy, faxing new orders, all the charting I am responsible for, restocking the med cart, etc.

1500: Gosh, I seriously hope I'm finished with whatever I needed to do. I feel guilty because I had to race around like a chicken sans head all day. My back is killing me, so are my feet. The charge nurse is asking me this, asking me that. I guess my replacement is late.....keep on working.

1530: On a good day, I'm walking out. On a bad day, I'm calling my daughter at home and telling her I'll be late again. "What's for dinner, mom?" I have no idea. I'm too tired to go to the store. I can't take it.

That's been my day. No feeling of a job well done for this nurse. I can think of 10 things I wish I could have done better today. Will I get written up for not being able to find those 5 meds I couldn't give? Probably.

Oh, and today, the charge nurse asked me to get a demented deranged patient to take some medicine to "calm down," and I crouched down on the floor, and asked her kindly. She grabbed my hair - yes, most of it - and shook me like a ragdoll. "Leave me alone you ignorant *****!" I wanted to cry.

And this was my day. Did I mention I am earning $14 an hour?

What can I do? I just started, how can I quit? HOW?

HELP!

[Rexie68]

WOW. I can't understand why they give you silly rules. Our nurses don't pass trays unless the CNA's are way short staffed. Of course no administration likes OT, but not having pts taken care of is even worse!

Perhaps look for a job at a non-profit facility? I noticed a big difference when I changed jobs from a for-profit to a non-profit. Good luck. God bless.

[JeanineLPN1984]

Dear Eldragon, I feel really bad for you. I have never worked in such a poorly organized place. I did on a few occasions encounter silly rules, eg. CNA's arent supposed to use gloves for residents unless they have a bowel movement! Oh yeah, and I had HIV patients on TPN and they werent supposed to wear gloves???? I don't think so, we all stood together ( supervisors, nurses and CNA's) and said if these are the new rules, let's call the state and see what they think. The aides got all the gloves they needed.

My place I've been at is still a great place to work, if were short a nurse, a supervisor takes the med cart, the dining duty is done evenly by everybody and admissions go smoothly with other nurses pitching in. I really love where I'm at and it's one of the best run facilities I've been in -out of 6. Some of the nurses have been here for over 20 years!!!. I wish you best and hopefully you will get a much better place to work at, because it sounds like things are only going to get worse.

[Cindy_A]

I agree with Jeanine, it will only get worse. Hopefully, you can find a much better place to work. As you've read some of the posters work at wonderful places, they actually do exist. Good Luck!

[marnacla]

Sounds like your place is lacking strong nurse leadership and a nursing voice.

[eldragon]

Yes, that must be true.

I am looking for another job, but so far no luck.

It doesn't help that I am scheduled to work so much - split days off every other week - and I mean split. Last week I was off Sunday and Thursday - then worked Friday, Saturday, Sunday and Monday and am off today. I go back tomorrow, Thursday and Friday and hopefully I am off the weekend because I'm already getting burned out, after only 8 full weeks.

There are several nurses quiting at the moment, for the same reasons I have noted on this thread, and new reasons. First - the schedules aren't posted until Saturdays - and the new schedule starts the next day. You can imagine how inconvenient it is to be off on Saturday and not know if you are off the next day. Planning is impossible.

Then, they cut back on nursing staff.

A real problem also is that they aren't approving anyone's vacation. "They can't cover it," and don't even tell you - the schedule just doesn't reflect your vacation. I for one need a few weeks to plan my vacation, as my husband works and needs a decent notice also, and we travel - sometimes to Europe and airlines do not book next day tickets at prices we can afford.

I do not want to put in year then wait - week after week - for my vacation.

Another thing that is bringing we nurses down is that they are accepting anyone into the facility - on our SN unit - even if there is no rehab potential. Hospice patients are coming in and requiring total care, and that level of care is hard to provide from overworked staff. There are patients dying weekly - this week there were three on our hall. It's depressing to be around so much death.

Yesterday we had two codes at the exact same time.

(Lost one.)

It's all bringing me down even more than before. But I need the paycheck right now - so on I go until?

[Jvilleredhead22]

I just starting working in LTC after spending all my career in a hospital, so I sure can feel for you. It is VERY depressing, feeling like you never are getting what you should done, that you are not doing all you can for your patients, and your situation is much worse than mine. The added responsibility is enormous....especially when the first thing they tell you is not to call MD unless is emergency or critical labs, you write the phone orders and MD signs them off. Everybody in the place is sick of me asking questions, and guess what... I got exactly THREE days of orientation. I didn't even find out where crash cart is until today and I've been there a month. Any advice from you guys in LTC would be appreciated. I stay up at night thinking about the things I needed to do today and making lists for tomorrow....i.e. why I'm still up now. And to think I took this job b/c the hours made it possible to be with my girls more as my youngest daughter was just diagnosed bi-polar and is having a lot of problems. Now I'm wondering just what I got myself into, but I do care for these patients (residents) and want them to have the care they deserve.

[CapeCodMermaid, RN]

Whoever is telling you not to call the doctor is giving you bad advice. Not notifying the MD is one of the most frequently given tags in DPH survey. Unless you trust all your docs to back you up, you shouldn't be writing telephone orders without actually talking to the doc.

[eldragon]

Yesterday I slipped a letter under the DONs door, describing how that job makes me feel and a pre-warning that if things don't change pronto - I'll be putting in my notice.

I'd love to share the letter, but I don't feel comfortable putting it up on this forum.

Before the morning was up - I had conversations with the "number 2" and the DON, separately. They both assured me that they agree 100%, and are trying to help change my situation.

The DON was holding my hand, it was so phony.

Anyway, she told me it was ludicrous for me to be expected to take the vital signs and do CBG's, and give insulin! She told me I wouldn't be doing those things anymore.

Still - I had 30 patients yesterday morning. Reminder: this is skilled nursing - and orders change every single day - new admits and discharges daily, also. I am usually running around looking for misplaced meds and calling the pharmacy - using holiday stock - have many pts on pain medication, etc. So 30 patients is not just a huge workload - it's an unsafe, ridiculous one.

Anyway - not doing CBG's and insulin gives me a lunch-break, at least.

And after lunch, the DON saw me and reminded me that I wouldn't be doing vital signs either, except "BP's." UH. If you are doing bp's you'd might as well do the rest, right?

I'm off this weekend. Thank goddess. But Monday looms large.

[nratchet]

We have 1 or 2 CNA's on our hall, and they are responsible for showering patients, helping them toilet, and making beds. They are quite busy also. At our facility, the nurse has to take vital signs. And in the dining rooms, a nurse has to physically place each tray in front of the patient, to "make sure the right patient gets the right tray." We also have to record intake for each patient, and cannot leave the DR for any reason as long as a patient is eating, or playing with food, as may well be the case. Oh, and I can't sit down at all. And I have to make new seating charts for the DR once a week, and give copies to the kitchen, the charge nurse...and two other places. Oh, and I am in charge of any menu requests.

Run, Eldragon, Run!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[nratchet]

I feel bad for my patients.

By being dumped in a place like this, they are wronged several times, and losing people who care, like me, is just another bad thing that is happening to them.

The only way to stay in a job like this, is to routinely cut corners, and even lie about things you do/don't do.

Unless they come up with a way to add more hours in the day, my workload simply isn't reasonable.

The DON is off this week, probably lounging in Hawaii or someplace, paid for by the extremely wealthy man who owns the facility I work at, and others like it. She's basking in the sun, enjoying a huge bonus, I'd imagine, for running the place on the cheap.

Just last week she had a meeting during which she told us the owner was losing money, and how lucky we were to have so much staff, because the facility could certainly operate with less.

She also called us into the office another time, just to tell us that "we don't want to work at another facility, because working conditions are bad there." Never mind that they start new nurses five dollars more an hour, it's not someplace worth working.

HMM.

Anytime they tell you another place is worse than the one your at remember this.....THEY ARE PROBABLY LYING THROUGH THEIR TEETH

[nratchet]

i too have been working in ltc for 9 months, i just cant take it anymore, administration is increasing workload and decreasing staff for the same $23 measly dollars!!! i go home with a headache, backache, and footache, every day!! i have 20 patients minimum + dressings, fingersticks, medpass, + the annoying family members who think you know it all and call you in the room for everything, um no! i can't fix the t.v every month i open an issue of advance magazine and see local hospitals becoming more progressive and modern and trying to improve health standards, while these 3rd rate ltc's are in the stoneage, dishing out more work to their staff with no means or intentions to improve quality care! i'm forced to take 30 min lunch breaks and leave after my shift is long over! i'm tired of managment complaining about the nurses and tired of nurses complaining about other nurses, we work so hard and if you forget 1 signature in the mar which is practically a 100+ pages! your in for it! huh, no where is perfect i know but i need somewhere where the nurse to patient ratio is low and management and nursing staff work hand in hand to ensure quality care! + i'm in nursing school and that's its own stress, not to mention i've probably gained 20 pounds, i would not recommend ltc to anyone, its not worth it!

just because your facility is bad doesn't mean all of them are. i've worked in two ltc snfs and let me tell you....i've expierenced the bad and the good. as far as your patient load, forced break and getting in trouble for leaving holes in the mars.....here the patient load is 30-36, we get sited for holes in the mars and breaks are taken out of our checks whether we take them or not. oh, and by the way....i am an rn, have been in this business for 9 years and you are being paid more than me.

[eldragon]

I wanted to update and tell everyone that my letter really worked. I've worked 3 full days since they read that letter, and things have changed.

Now, the treatment nurses do CBG's and even give insulin. An RN helps with the vital signs. And the DON said I don't have to go to the dining room for breakfast, I can use that time to get my meds ready.

Well, so far I told them that I will stay in the dining room for up to 45 minutes, because I fairly enjoy that time with the patients, and can get a good idea of who the new ones are and how the everyone is. I also build a rapport by helping with their meal requests and learn food allergies.

Today we had a staff meeting, and an RN covered the lunch dining duties so I could start my afternoon pass an hour early and be able to go to the meeting.

So while I am still busy as a bee - which I like to be - everything is manageable now.

It just goes to show that a letter, a well-written and well-thought-out letter, can make a difference when the DON cares. I think she does.

(She has been pitching in everywhere lately, even worked as an AIDe yesterday!)

So right now, things are pretty good.