I'm my own worst problem

[JBMmom, MSN, NP]

I'm going on five months at my LTC job, new nurse, no prior LTC experience. I have yet to leave on time- usually about an hour late- this past weekend it was an hour and a half because my floor was legitimately crazy (even according to other staff). However, last night half way through the shift another nurse informed me "You'll never get out on time, you're too nice" (she did it in a very nice, constructive feedback way, that's not my issue). The rest of the night I was really disappointed to learn that she's right. I had a confused resident in someone's room, it took me 5 minutes to walk him back to his room, another resident was yelling in the dining room that he needed water- I listened to this for 10 minutes while I was down the hall with my med pass, then got him water when I was going by. When residents come up and talk to me, I respond, if they want cookies when I bring their meds, I'll go get cookies. I guess right there I found my hour. I understand the nurses that are able to do what they need to with more focus, I don't think I'm a better person than they are, I just can't do it (at least not yet). I want to leave knowing that not only did my residents get their meds and treatments, I want them to feel like I cared for them. Fortunately, I get paid if I'm over- I'm only part time and nowhere near overtime pay, so I don't think they care. But, if someday I'm told it's an issue, I don't know what I'll do. How do you find the balance?

[AngelRN27]

Quite honestly, based on my limited 10 month experience in LTC and the hundreds of posts that I've read in this section of AN, it seems like leaving late is just part of the LTC culture. We have a lot of work to do in 8 hours. Period. LOL

I consider myself pretty efficient, and I work the 11-7 shift, but I still leave late maybe 2-3x per week. Really any small break in routine means you're staying.

At least you get paid to stay. LOL

[chrisrn24]

I work overnight so it is different but my suggestion is to delegate. Nobody is gonna die if they don't get their cookies now (unless they're hypoglycemic)

Another suggestion would be to carry extra things on your cart that you know people might end up needing.

Of course there are times where you have to help now but if someone is sitting quietly in their chair and says, "I have to go to the bathroom" have them put their call light on for an aide. The only exception I can see to this is if the person is a fall risk and is getting up independently.

As far as chatty people, say "I wish I could stay and talk but I have to keep moving down the hall. I'll talk to you later, Mrs. X."

[IaCountryGirl]

Cookies and water are something the CNA's can fetch and I would delegate that. We do keep pudding packs and a few things in the med cart, not only because we use pudding and applesauce for crushed meds, but I will hand those out if the snack cart isn't in the vicinity. One of the aides usually takes the snack cart room to room about mid afternoon and another passes fresh ice and water. For people who drink high amounts of water, we typically give them two pitchers of ice and water to help tide them through the shift.

[CapeCodMermaid, RN]

We all need to decide how to balance what we do. You certainly can delegate cookies, but it's more than the cookies...it's the time you give to the residents that matters. When you have more experience and can complete the tasks in a more timely matter, you will have time to spend with the residents. I had 3 reports to write today. I also had a resident who hardly ever comes out of her room. She came out today and all she wanted was to sit outside for a while in the warm sun. All the CNAs were busy so I said "come on...let's go". We spent 30 minutes outside....just sitting. She loved it. I stayed late to finish my reports and all was well.

[JBMmom, MSN, NP]

Thanks to everyone for the feedback. I certainly have delegated stuff like cookies, that might have been a bad example, it's just that usually everyone is so busy that when I ask, the CNAs never get to the "little things" (like cookies) either because they forget or get sidetracked. I did start keeping some stuff, like cookies, on my cart so I don't have to walk so far, but I've also started making a list of other things that might seem small, but will make the task part go faster. CapeCodMermaid, you hit exactly what I was trying to say- I want to spend the time with residents, and until my tasks are faster, things like that will slow me down. But, I'm okay with that for now- it will get better.

Thanks to you all, this LTC world is still so new to me, I'm trying to get a handle on how to do it best.

[Sadala, ADN, RN]

You know, I'm not sure how this fits in, but I'm going to talk about it anyway. One of the most touching things I have seen was during my first clinical rotation (which was in LTC). There was an RN there who was gruff and abrupt with students. We were all afraid of her. She was definitely all business, all the time. She was rather short with other staff as well.

One day, I wandered into my patient's room to find this same RN attempting to give meds to an (almost) obtunded older woman who was a fall risk. Her bed was all the way on the floor and one had to kneel on a mat to care for her. That nurse was doing just that, kneeling at her side, speaking in kind, soft tones to the patient, encouraging her in a calm voice, and generally, well, loving her and encouraging her along.

It definitely seemed to me that although she could be short with other staff, she was making, by far, the best use of her time in patient care. And she was doing it because she cared about those patients. Because there was nobody around to observe during those moments. To me, she was doing the things that REALLY matter in the world of nursing. I was touched and the thing is, I don't even think she saw me observing this. But I respected her immensely after that. I thought that she had her priorities straight.

[dallet6]

I do this as well. when I'm on a floor where I know the resident's and their meds and how they like them, I can do those extras. When I'm working on the floor with faster turn around and residents with higher accutiy needs, I still feel like I need to do them. But I get so behind when I do. The residents' don't understand or even care that you are doing a med pass when they need someone to do something for them and there's no aide around. I feel guilty as hell when I'm doing a med pass and a resident tells me they need to use the bathroom. I have to tell them I'll go get their aide, who is often taking someone else to the toilet so they can't run right in there. I do what I can for people, and then feel guilty about what I can't do.