Lacking Skills After a Year

[florence2012, BSN, RN]

I graduated in August of 2012 and finally got one single job offer - weekend RN supervisor at a local nursing home. I was scared to death not to take it, and scared to death to take it. I took it.

At first, I did only wound care and supervising every other weekend. Soon my DON asked me to come in for 12 more hours a week to help with care plans and MDS's. I was paying my bills and student loans and putting money in the bank! It seemed ideal.

Then our census went down and they cut my 12 extra hours. They still called me in when the treatment nurse or DON was out, so I still managed to pay my bills.

Next on the list of things to learn was floor nursing. The first night I worked, the med aide had to come in and help me finish passing pills! She only did it because she likes me, she said. I didn't cry, thankfully, but I wanted to, and the experience made me start to hate my job.

They started calling me in to work the same hall on day shift from time to time, and I got a little better, but it's so very hard when you do something only occasionally. I got to where I didn't dislike it so much and even started to have time to actually eat lunch.

The last time I got called in, it was a different hall, and it's the hall everyone says is the hardest. Several residents were starting antibiotics, which I had to get from the emergency box, which takes time, and there were so many new drugs and drops and patches, etc. I was lost! Thankfully, the next nurse came a little early and helped me out and it got done, but it was pretty horrible and I hate adding to someone else's workload.

Here is the crux of this message: I have been working as an RN for a year and there is a long list of skills I still do not have.

1) IV medications and starts

2) sending a resident out to the hospital

3) inserting a Foley by myself

4) blood draws

5) I have never actually spoken to a doctor about a resident!

6) breathing treatments!

I'm afraid if I don't work the hall when they call me, they will stop calling at all and I won't be able to survive on my two weekends a month. I don't think I can get a different job, because of my lack of skills.

I want to have a plan in place for advancement or learning, but so far I don't. I feel so bad about myself when I come in from floor nursing. My self-esteem is very low. I guess I'm asking for encouragement and/or suggestions on how to get better or find another part-time position.

[amoLucia]

Have you touched base with your Staff Devel person for some extra training? Seems like you've identified some specific areas of need so that can help refine some training.

You could add other skills as needed.

[CapeCodMermaid, RN]

This might not help much but most nurses don't do blood draws in long term care....we call the lab.

I second what amolucia said..speak to the SDC about extra training. You can find all sorts of videos on Youtube about some procedures you've not done. Give yourself some time.

[ponytailman]

For me the best way to obtain floor nursing skills was to work the floor and ask as many questions as u can. Staff development, videos and p n p r helpful, but nothing teaches organization, critical thinking and prioritizing then floor work consistently. Your wish list indicates maybe looking for a second job trying skilled or transitional nursing often found at nursing centers

[florence2012, BSN, RN]

Thank you for the replies.

It has helped just to write this down and realize that the list is finite and can be dealt with! I watched a video yesterday and plan to do this on a regular basis. Great suggestion. I don't know how nurses functioned before Youtube!

Sometimes I am offered a day on the floor with a med aide. I will certainly say "yes" to those. And follow the LVN's around on treatment days to learn skills I need. I used to do that all the time and kind of let it go.

The med pass remains quite an intimidating prospect for me. I am thorough and have been told that I can't be unless I want to spend 24 hours a day on the med cart. It's a conflict I haven't been able to resolve in my mind.

[CapeCodMermaid, RN]

As one of those nurses who went to school way before anyone had ever thought of the internet and youtube...we weren't allowed to graduate until we had done all the basic skills. I was 2 months away from graduating when I told the instructor I had never given an IM injection since none of my patients had one. She immediately paged over head to all the nursing stations in the hospital to page her if anyone in the hospital needed an IM. By the end of that one day, I had given 50+ IM's...nothing beats doing the skill with someone.

[Nascar nurse, ASN, RN]

I spent 10 years in an office (actually a closet - haha) doing MDS's and was always fearful of not learing new skills as things developed. I found the best policy was just to openly admit that I didn't know the new stuff & I wanted to be informed when new stuff came up. Had a couple fantastic LPN's that just loved knowing they knew more than me in some situations but also loved to "show off" all they knew. They were great about coming to get me when a new procedure came up. There's no shame in not knowing...the shame is not admitting &/or figuring it out. Someone will help you - just ask.

[amoLucia]

Another thing ... always let your co-worker nurses know to call you for any technical tasks that may come up (and they would just routinely handle themselves). As supervisor, you need to be spot on for all the tasks that come up during the shift.

To add to your to-do list, I would include familiarity with setting up wall or table-top suction, green O2 tank use, wall or concentrator O2 equip, and esp, any & all pump use. I speak of this personally as it took me forever to use a new enteral pump as we changed over. One of my staff LPNs had to walk me thru its use more times than I could count. As super, I didn't DO pumps directly myself often enough, so God love that nurse for her patience 'til I got the hang of them for when I had to cover the floor. I've taken unused pumps out of storage and set them up for troubleshooting and training for staff (you can figure out hanging ABT this way).

Get a handle on all the types of documentation that is required of your staff like significant change-of-status with hospital transsfer, psych summaries,incident reports (with all the attendant protocol). You may also be required to do pronouncements with death certificates (facility/State specific). As RN super, you need to be able to follow & jump in to insure that your staff have done their jobs correctly. Supervisors supervise.

Really, really know what's in your e-box and IV box and what's on your 'crash /E-cart'.

And there is no shame to asking for a second body to go with you for a task. Tasks are just tasks and will become second nature with experience.

[florence2012, BSN, RN]

CapeCodMermaid, Nascar nurse, and amoLucia, thank you so much. It's been almost two years now. I'm still not comfortable on the floor, but i managed to complete a shift last night.

I do ask for a partner on things I'm not sure about, and my lvn's are happy to show me how much they know. No one has ever refused or gotten impatient with me.

Last night i did tube feedings and tube meds out the wazoo, so I'm ok on that skill!

Thanks for the encouragement.

florence