Lowest of the Low

Specialties Geriatric

Published

Hi all,

Hoping for some insight, support, advice. I have now been working LTC for 9 weeks. I am a new grad, had two weeks of training, and been on the floor on my own since then, hired as a charge nurse. The job has been challenging, to say the least. I have 24 residents I am responsible for, plus the challenge of Cna's who have been there for 15 to 20 years, and seem to have something against me from the start. NOT all of them, just a few. I was pulled into the DON's office today and told that as of today, she would not reccomend me for hiring at the end of my probation period. The DON is new, started 3 weeks ago. I was told that my proffesionalism was not good, (I was giving report and did not know that DHS was there, and my supervisor told me afterwards that it was not okay to complain in front of them, I was giving the usual report, what was and mostly what wasnt done, ect., ect., my fault, but I did not know she was there!) I also missed dressing changes on one patient, the last time her dressing for her peritonial cath was changed was on 10/01, she is gone for dialysis on Tues and thurs from 6 to 1, my shift ends at 3, the docs come in at 1 to give orders, anyway, bad excuses, I did mess up, but I work only 4 days a week, what about the other 3 days? When I told my supervisor I was feeling overwhelmed, Which I was, they never let me do anything, then they throw it at me and say, "Why dont you know how to do this by now?" Anyway,those are really no excuses for my mistakes, but to call my professionalism to task when I am still learning? And to be written up? I have been crying all day. I called in sick yesterday, I had vomiting and diarrhea in the morning, called in at 5am, my scheduling director called me at 8am to ask if I could cover Thursday, my husband answered the phone and relayed the message as I was vomiting at the time. I dragged by butt to work today, despite a fever, chills and sweats, sore throat and a headache that made me want to vomit more. I really should not have been in there, I wore a face mask so as not to kill a resident with this bug. I had confided in my supervisor about my personal problems, she acts like a friend, only to have this thrown in my face during my meeting with her and the DON. I feel so betrayed, so very stupid.

WHY? What are the expectations of a new grad? I have had one med error, it was a transcription error on my part, I have done my best to maintain my professionalism during harrowing times, (residents sister sobbing heartbrokenly beside me, dementia patient hitting me cause I had 'her' shirt on, constant yelling, sundowning which I only get the very first part of, I know, ) God I feel like such a dummy. If you cant tell, I am feeling so stupid, probably because I really thought I was doing a good job. Maybe not a great fantastic job, but a competent, safe one, as I learned how to become a really great nurse, you know? I feel like a failure.

I was written up for concerns about my professional demeanor, my inability to focus, and time management issues. I do understand the focusing issue, she told me I let to many things 'distract me', like residents screaming out "HELP, HELP". It has taken me some time to know which ones are really needing help, but while I am learning, and I dont know the residents that well, how am I supposed to know which "HELP" is real or not? The time management issue is because of the dressing change I missed.

The Cna's dont report to me, and last week I heard them commenting on a resident who was playing 'possum', and I dont know why, but I thought to myself, "Jeez, he always yells at them when they are mad", and I went to check on him, long story short, his blood sugar was 56, he was going into a diabetic coma, and they would have left him in bed. I ended up doing IM glucagon, his physician came in, I assisted him in doing IM dextrose, and he came out of it. The doctor told me he would have died. I feel like I have good instincts, if I am just given the chance. Now I am evaluating every thing I do and say, I am afraid to talk to anyone, and I am so discouraged I feel like I made the biggest mistake of my life. I am so sorry to ramble on to everyone, I am just so hurt and discouraged, insulted and I feel so stuck. Sure, move on and find another job, and be a job hopper. To top it all off, my husband just lost his job.

Sorry everyone. Thanks for letting me vent. Friday I have to meet with the DON and my supervisor and give them my list of 'goals to hellp me succed in my job'. Half of me wants to walk out and say the heck with you. I have put my all into this, I am not half-***** with anything I do, and your expectations are ridiculous. The other half is to proud to let anything or anybody say I cannot do this job. In the meantime, I still have to pay the bills. and they wonder why there is a nursing shortage.

sorry about the typos.

Thanks for being here.

I would resign and look for another job.

One thing, you said you had confided in your supervisor about your personal problems and she threw it in your face in your meeting with the DON. I don't know what type of problems you are referring to, but in the future I would keep any personal problems to myself, what you described happens all too often. These people are coworkers, they are not your friends or family and they don't care about you. Keep your personal life to yourself.

Good luck.

yes if you can help it do not get into the pesonal life story with the bigwigs. they dont give a care - i made that mistake and foudn they use that against you whenever they can to control you. personally i dont even consider these folks coworkers- a coworker helps out and assissts - gives feedbackand such - at least at my place they do none of that - i have been tere 18 mo and yet to have even one eval........... i know there are some good ones - i have worked with one of the best DON ever - unfortunately she was so good and for the resident and staff she had to quit cause the stress made her physically ill.

Jeez...when I hear this stuff it scares me. Do I really want to become a nurse? I had absolutely no idea how smart nurses really are...why do they get so little respect? I mean, salespeople get more respect than this.

its all about money and how they can NOT spend it and save thierselves a lot of money and make a good profit. :angryfire they dont care - bottom line is the almighty dollar - can see that when they charge 8.95 for a tube of OTC butt cream you can get at the dollar store for a buck - we have brought some a few times to be reamed out that we just cost them such and such - sad sad sad

LPN here, 11 months experience. I quit a place last year because they were using AGENCY nurses to orient me in LTC, not even ones that went there all the time! They wanted to give me 3-4 days orientation to work the 3-11 shift. Never went back after a few days.

Found another LTC, got 5 WEEKS orientation and have been doing okay ever since. I think you should leave this job, tell them it is not working out.

CNA's can be tough on all newbies, even CNA newbies, so be firm, help them whenever you can and reap the dividends. Show them you respect their judgement about the residents, address any concerns they voice about them. The biggest complaints CNAs make is they voice concerns and the nurse doesn't address it. I always let them know what I did or plan to do. I would rather have them come to me 10x for nothing, than miss something important. This has worked out really well for me, but the beginning was rough going!

a tip for wound care:

I take 5 minutes at the beginning of my shift and go through the tx book and jot down all my treatments on the back of my census sheet. Come in 10 minutes early if you have to. After I do each one, I put a line through it. You don't have to worry about forgetting anything and you'll always know what you have to do. Example: Last night didn't do this, found a new tx at 11 pm. Need to follow my own advice.

best of luck, you WILL find a job you like

good advice - i also do that on my report sheet and cross off as i do it - i thenmake a copy and take it home ( with last names blotted out ) and i have a reminder sheet should i ever be questioned - remember to blot out names ( at least last names ) due to hippa we arent to take these sheets out - but in my warped maybe - thinking - if i have the first name and room number they question me - its gonna match with whatever they have there in the chart or TAR or MAR so i HOPE at least it would allow my buttt to be covered should they attempt to leave me siitting duck with state saying i did not do something - if its crossed out i know i did it i charted it and i aslo write whatever i have written in the 24 hour book as well so they cant change that and say i never said it ( i have personally seen them copy a paients record and make a nurse "redo" her charting so it fit THIER descrition and wording to protect THIER butts - sad sad

great job - now the important question is - will your main goal be to go elswhere where you can trul;y and realistically reach these goals - they are attainable - but from the sounds of it - not where you are now..... been there done that - your a good goal writer - mine were not so eloquent

thank YOU Thank You thank YOU..

I think ( I hope) I know what you mean.

Here are my personal goals as I responded on paper for this challenge.

(Goals for Success

Time Management/Organization.

I will make a list of my treatments needed on my residents, with a check off space to help me maintain a quick visual reminder of what has been accomplished and what still needs to be addressed.

I will keep room on the same list for questions I have which cannot immediately be answered, and a list for needs that must be addressed, (i.e., a patient missing belongings, a resident's or their relatives requests) so that these issues will never be forgotten or remain unaddressed.

Focusing.

I feel that my biggest problem with focusing is feeling that I have to be there at all times for everyone and everything. I am going to focus on the task at hand, and have more confidence in my co-workers and my CNA's that they can and will respond to the needs and demands of residents.

When I am involved in a task, (i.e., documenting), I will focus on the task at hand with the concentration necessary. If I am unable to do so because of the environment around me, I will remove myself to a quieter space, (something as simple as moving to the other side to the desks).

Professionalism

During extremely hectic times of day, (i.e., Doctors there giving orders, patients beginning sun downing behavior, shift changeover, ect.), I will take a deep breathe, prioritize needs, maintain my calm in the center of the unit. I will also ask my nurse manager for help with the most urgent needs when I am unable to immediately meet the most urgent tasks at hand.

Documentation: When documenting, charting and during reports I will keep in mind the absolute importance of this task, and not allow myself to feel rushed with the next task at hand.

Personal Behavior: I will be very conscious of my approach and demeanor when I need to address co-workers, especially when I must request help. I will also document on my time management list who I have asked to accomplish what for a resident, and the reason. (for example, 1055 hours/asked Judy to address E. O., , resident digging in briefs, due to large BM. I am collecting supplies to obtain UA on said resident. I returned with supplies, helped Judy finish cleaning resident, and she helped me obtain UA.) At this point, these notes are for my use only, to keep track of who I am asking to do what and to help me go to my nurse manager when my needs are not met, for whatever reason. I very much respect the job that my CNA's do, and know how busy they are and how hard they work. By documenting my requests, I hope to avoid coming across as rushed or stressed out. If I need to take the time to write down my requests, then I will ensure that I can communicate this request without any margin of error, and more importantly, avoiding ever mistakenly making the person I am talking to feel as if I am unsympathetic to their work load, or rushing them. I will also be able to maintain accountability for tasks in this manner, one of my jobs as a charge nurse.)

As put down in the preceding document, I will address each of the issues that have been brought up.

This was my written response to my 'warning'.

In a small place you have to be careful of what you say and how you say it. When you are the "new guy" you have a place--the bottom rung. When it comes to making any kinds of judgments about the facility or the people that work there, the less you say, the better. Looking back, I would say that one of the biggest mistakes any new grad can make is to constantly apologize for their lack of knowledge or ineptness at their jobs. It's natural to say these kinds of things because you so-o-o want to do your best, but you know you are all thumbs and slow. But, you just have to clam up and keep these feelings and emotions to yourself when you are in the workplace. These kinds of comments said enough and over time tend to be seen as a sign of weakness and craving for attention and sympathy or pity. Some people will interpret it as whining. Many co-workers eventually don't want to put up with this, so you start getting all kinds of unwelcomed behavior from them. Some will latch onto the weakness and go for your jugular as happened with me. The more you talk, the more you reveal about yourself. That is not always a good situation. People are more reserved when it comes to taking issue with people who are quiet and speak only when necessary because they don't know enough about them or what kind of reaction they might get.

You can't change past mistakes. But, you can learn from them. I know what is now going to happen for you because I was in management for some time. You are going to be asked to make some goals--in writing. Make your goals achievable and not general--goals that you know you can accomplish. You will be supervised very carefully. If they are determined to terminate you, they will use this as a way to do it. The minute they can show that you are failing to achieve a goal, you'll be shown the door.

I'm sure you are feeling better by now. I have been a nurse for 10 years and my tip would be to start on night shift. I started as a charge nurse on night shift and then after a year moved to days. It is easier at night as there are less meds and treatments, the doctors are not making rounds and writing a bunch of orders, patients are sleeping, therapy team is gone, family members are not there making demands, etc. Just you and the aides and the patients, you have time for assessments and taking care of issues as they arise. I thought it was a great way to ease into nursing. I hope I'm not offending any night nurses, but in the experiences I've had, ICU/floor/nursing home, night shift is usually less stressful and busy. As a person who hates the feeling of missing something, missing following up on an issue, I choose to work were that is less likely for me. Also, consider a different type of nursing, like home health, where you can concentrate on one client at a time. Good luck!

the only problem there is - her facility sounds so much like ours nd i tell you the nights have it even worse than pms - i would never work nights where 1 nurse is in charge of 90 residents and they may give you an extra aide if they can find one - just hd one and another is looking - leave for a new place cause its sadly understaffed even worse than pms.

THANK YOU ALL SO MUCH FOR YOUR SUPPORT

Every single person who replied gave me something to think about, and most of all,the emotional support I needed.

UPDATE........After my written goals to succeed was given to the DON and my nurse manager, I was told they were very impressed. I have also made an effort to live by my words. I cannot learn it all in such a short time, but I can and will maintain my calm in the midst of chaos. :chair: I am also covering the weekend Baylor shift for 5 weeks, (the Baylor nurse is on military duty), and I cannot believe the difference on the weekend shift. First of all I have a wonderful experienced nurse, (she is Filipino, reminds me so much of my mother-in-law), friendly, and soooo calm and capable.) It is such a different atmosphere, it is like working in a completely different place. My last two weeks of probation period are up next week, if I am not hired full-time, well, SoBeIT. I know in my heart that I have given it my all. I have discussed this with my DON, and she has said to me that she is very impressed with my "change of attitude". I did let her know that MY attitude has not changed, she simply saw me on a very bad day, when Iwas overwhelmed and close to crying. In other words, the calm capable one is the real me, but jeez, we all have bad days, huh? I also let her know how shocked I was at her attitude that she was ready to give up on me without even getting to know the real me, and/or my accomplishments. She acknowledged that she had probably seen me at my worst, and basically stated that she has changed her position on keeping me. Despite the initial instinct to cut and run, I think I am going to continue with my position. The CNA's present a challenge that is going to probably be there in any facility I work with, correct? So it is up to me as the charge nurse to find my balance, and not let them knock me off my stride. It remains to be seen if my choice to stay is the right one. I do feel so much more confident, and i have three more weeks of working the weekend shift and learning from my co-worker. After that, if I must go back to the weekday chaos, (this is still up in the air, if the nurse with the baylor position is called to active duty, the baylor position is mine), but if I must go back to weekday chaos, then I will do so with more confidence in myself. It also helps that every day I am learning skills that will stay with me a lifetime.

Again, thanks so much for your support, emotionally I would have felt so alone without all your input. I have been actively recruiting friends of mine from nursing school to take advantage of this wonderful tool.

Thank you Thank You ALL!:thankya:

KristyBRN

it also sonds like you finally found a good preceptor to help you build on your skills with confidence - good for you!!! there really are good nurses out there :) as for the aides - well yes i think that is anywhere you go - my sugestion would be - let them know you will help them when you can ( and do it ) and also let them know when they are doing good ( lets them know you are checking upo aws you ultimately are responsible for thier duties too) and also let them know when they need to change something that isnt so good. you will find because you are willing to help when you can and also give good feedback when you do have to give constructive critism you wont be looked at as the mean old witch but someon ewho wants them to excell and do well. working as a team really is great. they will respect you and you in turn will respect them. oh and always when negatives need to be addressed do it out of earshot of any other staff and residents - that shows em you respect thier right to privacy - technically i suppose praise should also be done in private but i tend to praise in front of others and my girls seem to like that others know they are doing well nd they dont have to tell it and sound like they are bragging but thats just me and my girls everyone is differnet in approach :)

Hi Kristy,

Just reading the thread here and thought I'd chime in...

It caught my attention because several LTC's in my local area came shopping for Charge and Manager nurses in our school just before graduation.

I believe they actually gleaned a few of us too.

The thing is, and the thing everyone seems to be 'leaning towards' but not saying outright is this...

You aren't stupid.

You aren't doing anything wrong.

The problem is that you're simply not qualified to fill the position you've taken.

Please don't take offense to that statement, as I mean none.

The fault isn't yours, it is the facility's, or those that chose to hire you.

As a fellow new grad in an ICU, I know how you feel. There's a lot to learn.

However; you should really do some critical thinking about your situation.

Consider that currently you're a college grad with a nursing degree, and/or license, and that's pretty much it. You did not learn to be a nurse in school.

Possibly the best thing right now is to consider that you would be better off to become a nurse before you try to tackle being a nurse manager.

It isn't a 'hang in there' situation. It's more like a 'do yourself [and anyone relying on your care/leadership position] a favor' situation... so that you don't find yourself either on the receiving end of an attorney, or crying in the hallway as they wheel the body out. Sure, It wasn't your fault, but you're in charge and should have known. [re: sign here, P/P manual read. sign here, trained and checked off, sign here, you give us the right to....]

Justice is blind my dear, and your wonderful facility or buddies in the system will serve you up with duck sauce when the fire's hot.

I would hope your license means more to you than does jumping line to a charge position.

Finally, I have to say, if one of my parents were in a LTC and I heard this story, I would carry them out on my back if I had to, just to get them out of that place. And again, it isn't about your drive to succeed and hang in there, it's about qualifications, experience, and ability, so please don't take offense.

Please do think about that though.... what would *you* do if you heard a 9week old nurse was now in charge at your loved ones facility?

Just some food for thought.

Good luck in whatever you pursue.

rb

yes and what brings a chill to me is when these bosses will say yes theyd have thier family in there - you know they are lying or stupoid. ourlast DON brought her dad in when she came - she didnt last long and dear old dad went elswhere also -

Specializes in Telemetry/Cardiac Floor.
Here's my $0.02 on this issue: QUIT as soon as possible!

If my nurse manager told me she would not recommend me for hire after my probationary period was up, I would see absolutely no point in returning to a place that does not respect me in return. Your skills would be appreciated at another facility. I wouldn't even bother returning to this place ever again.

My thoughts exactly!!!!:yeahthat:

Many places in the health care industry are setup for failures no matter what you do (including my current employer). I'd stay emotionless with them, believe in yourself and look around for another job. There's got to be a place that you will find yourself comfortable with and may takes a while to find. I have worked in different fields and my eyes are really wide opened by how dysfunctional healthcare managements are.

I was recently recommended by a coworker to raise my voice to the CNO about the problems on the floor. But what good will this bring to me? Literally nothing ! Things are presetted and won't change (at least won't changed by me). If I talk against their "presetted" ideas, I'm sure I'll be black listed. And I have seen this happen to a coworker.

So, I'd recommend you to look around. When you are ready to quit and they ask why (which is a BS), just make something up and move on. Don't need to get emotional with management. If you do, they'll probably bad mouth you after you have left such as "so and so just left, yeah right, she is bi-polar, blah, blah, blah..." Not much suggestions here but hope this helps.

LTC ,this is typical, I say UNIONIZE! This is the only way things will get better, nurses nee PROTECTION and a VOICE.

Specializes in Gerontology, Med surg, Home Health.
LTC ,this is typical, I say UNIONIZE! This is the only way things will get better, nurses nee PROTECTION and a VOICE.

You seem to have the same answer for EVERY post on here. A union will not make sloppy nurses better..will not make stupid nurses smart..will not help good nurses get better. It will only make it harder to get rid of the slackers.

Specializes in Brain injury,vent,peds ,geriatrics,home.

Im so sorry about your negative experience.You probably know in your heart !!you are a great nurse.!Ive been through a similar experience as a new grad.I had very little orientation also.Thought thats how it was supposed to be.I worked there for 2 years ,learned as much as I could,from different disciplines,Respiratory therapists ,RNs ,LPns .I started suffering from panic attacks.I used to call the facility at 2,3 oclock in the morning fearing Ive forgotten to do something,(I pride myself with being very consciencious and caring)(I feel you are the same way)A strong trait of nursing is kind and caring nature,please dont suffer,especially at the expense of your physical wellbeing.I personally ended up shpping aroundfor a new position,which I totally love ,You might need to do the same.Please dont be discouraged..I know youll be a good nurse

+ Add a Comment