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!

[Nurselacey]

I would quit!!. I worked in a LTC facility and I had 28 patients and it was extremely busy but I also had 5 nurses aides and they did all the vitals, dining room and ADLS for the patients--and I was swamped. I wouldn't put my license in jeopardy--We work too hard to become nurses to risk it at a bad facility.

[Jvilleredhead22]

Well, I can't really say things are great but I did talk to the girl or "oriented" me along with another RN who works at the LTC facility where I work, basically asking them to tell me why I should stay.... I explained some of the issues I was having and the RN volunteered to help me with some of the stuff that I didn't get in orientation. I am still finding out things every day that I didn't learn, but it is getting easier and I am starting to be able to really concentrate on what is going on with my residents instead of just barely keeping my head above water. Have also gotten to know the APN who works with our MD here, and she is very helpful and approachable. I guess I am saying I'm not giving up just yet.

[Nurselacey]

It does get easier as time goes on...Just make yourself a spread sheet type of thing that you can update as patient/conditions change. It helped me out a lot...

[TraumaNurseRN]

Eldragon,

How awful for you! Is this position worth your license and the grief of wearing yourself too thin? There are good jobs out there....have you tried a hospital?

So what if you quit....sounds like they can't keep LPNs there anyway. :nono:it's them...not you.

Where are the nurses....and what the hell are they doing alllll day? Sounds as if they need at least two people to pass meds. Again, what are the RNs doing??????

No job is worth losing a part of yourself or your family network.

I say quit!!!!! Go somewhere else that gives safe care...sheesh

[TraumaNurseRN]

Eldragon

.....wanted to add.......Who can swallow 30 pills before breakfast....that is breakfast sheesh

[AZMOMO2]

sounds like half your day can be given back to you to do the important things that only the nurse can do like "meds" if they would just properly hire , train, and or delgate CNA tasks back to the CNA. So if 2 CNA's can't handle showers, bathroom needs and feeding they should hire another. Every place I have worked at and even trained during clinicals in schools, the CNA's give the trays and supervise and feed during meal times. Come on like the CNA ( who had to take a state board exam and I'm sure had questions of feeding and establishing resident identity) can not read or locate the proper resident that goes with each tray?

RUN,RUN far away

[eldragon]

Things have been much, much better.

The letter I wrote to the DON made a world of difference.

They delegated permanently all CBG's and insulin to treatment LPNs. And now - RN's share the responsibility with me to monitor the Dining Room and do vital signs.

I get done everyday now and always get my lunch break.

While it's not the perfect job, it's good for now.

I'm building my skills and gaining more confidence as a nurse, and that is a good thing.

I'm still open to other opportunities but at least I do not think about work all night long, and manage to feel a sense of accomplishment each day.

YEAH!

[TheCommuter, BSN, RN]

Every place I have worked at and even trained during clinicals in schools, the CNA's give the trays and supervise and feed during meal times. Come on like the CNA ( who had to take a state board exam and I'm sure had questions of feeding and establishing resident identity) can not read or locate the proper resident that goes with each tray?

I work dayshift at a nursing home, and a licensed nurse must be in the dining room while the residents are consuming food. This is for the protection of the residents, in case one of them chokes. A nurse needs to be there in case abdominal thrusts need to be done, etc.

[changeofpaceRN]

Have you considered a different shift? What about a different facility or type of facility like ALF? I had a similar experience in the beginning (but not AS bad because I didn't have anything to do with the dining area). I switched to 11-7 for my sanity. It's busy but in a different way (more paperwork but less on your feet med pass). I sleep during the day and am awake when everyone gets home in the afternoon. I also get paid $3 more per hour working nights. It was worth it for ME. I know not everyone can take the night shift and it does work hard on your body but this is the only way I can work in LTC and earn a decent paycheck while finishing my RN program. I think LTC facilities are understaffed and underpaid- especially the day shift that does so much for the base rate. I just switched jobs and I went from 30 pts to 60- that is horrible even at night but I have good CNA's and I prioritize well so I'm managing. There is nothing worse than dreading your job and being miserable.

On the up side, you are new and as you get used to the drugs and where things are, med pass might go quicker. When you see some of the same people every day and you know they will ask for their PRN's after you leave the room, you start to think ahead and ask if they want them now ect.. just take 1 day at a time but it does get better- maybe not at that facility but not all facilities are like THAT. I have worked in 4 so far.

[eldragon]

Changeofpace - thanks for the tips but I work in the skilled nursing medicare unit - a step-down from the hospital. The patients change frequently - staying anywhere from 2 weeks - 3 months, and most leaving in about a month. Sure, I anticipate PRN's and stay on top of it, but there are so many variables at play.

We get down to as low as 20 pts on occasion, but usually have 25-27. I do all the meds for them, and the doctor comes by twice a week, often changing meds, adding some, stopping or changing others. So I deal with the pharmacy alot, calling them several times a day usually. Then there is almost daily problems regarding the meds not being in the persons bin, and I have to do detective work to find out if the med was delivered, and if so - where the heck it is. Often it is in the wrong bin - another shfit, PRN, etc. That is frustrating.

The morning med pass takes me about 3 hours, I'd love to do it in less time, but I don't see how. I am doing vital signs on the patients, have peg tubes, patients who need their meds crushed, etc. And the patient is almost never in their rooms during the morning med pass. They are in PT, speech, getting a shower, or in the beauty shop, or any number of other places. There are often setbacks - and it takes the full three hours to do the pass safety and correctly.

If other nurses do it in less time, as some claim to be able to do, well - my answer is : that's because they aren't doing it right. Sorry, but I see the MARS. I see where a nurse initials that a med was given, sometimes several nurses, but I can't find it anywhere - and I finally have to call the pharmacy and the pharmacist tells me the med was never sent - it's on order.

That tells me that most of the nurses I work with just initial the box. And they will lie to your face, insisting they gave it.

In the meantime, I'm making the lowest wage there. And today - Memorial Day - I don't get paid because I was off. Oh, I worked Saturday and Sunday, but I was off today - so no pay. The ones who were off Saturday and Sunday are working today - at time and a half.

And I'm back tomorrow for four more - before I get two off. That's another thing I hate about my job - split days off every other week. And that will never change - it's for everyone.

[Rexie68]

i work dayshift at a nursing home, and a licensed nurse must be in the dining room while the residents are consuming food. this is for the protection of the residents, in case one of them chokes. a nurse needs to be there in case abdominal thrusts need to be done, etc.

is this a reg? we keep a nurse on the unit, but rarely in the dining room...she may walk in and out to check on someone, but usually only the cnas and feeder aides are in the dr. maybe this is something that varies from state to state. all of our cnas are certified in cpr, though, and know how to do the heimlich. i'm curious, 'cause no one from the state survey has ever mentioned it. thanks!

[JeanineLPN1984]

Dear Eldragon,

I'm so glad you wrote that letter and changed things for the better. Sometimes the "bosses" are so busy handling other fires, they really don't notice what is going on. Alot of nurses end up leaving without ever saying what is really wrong. Kudo's to you for standing up for yourself and making your patients safer. This will serve you greatly in the future, when other roadblocks come your way.

I'm still at my great place and I love working there. Hate to say this but I just had 6 days off in a row ( just the way my 12hr. shifts fell), Now I'm back to 3 days on, 2 days off. But they let me take my vacation at the end of the month with no fuss. I love my place and my aides are awesome.

They go out of their way to make the residents happy and they know how much we nurses couldnt do without them. I have some things for them for next week for nursing assistant week and the facility does some pretty great things for them.

Take care Jeanine:redbeathe