How to juggle as an LPN

Nurses LPN/LVN

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I need help. I want to be a better nurse, be able to handle responsibilities and be able to juggle it all and do it in the time frame I need to. So how? I recently quit a job before getting fired. Here is the reason: I am an LPN working in skilled care unit, have 20 residents, some long term care, med pass going on, call lights to help answer, go to the front door of our building many times due to 2nd shift no one to let people out or in building, answer and help families with questions along with med pass, yes, I'm trying to get it all done, 4pm hang vancomycin but have to get trough per the chart, NOT THE MAR., yet I was told verbally the day before to do this, so 4pm rolls around, getting blood and running across town to lab, I am at work, 4:30 comes, blood goes out to lab, I continue passing meds, doing blood sugars which is around now,

I take a 10 min lunch because I am running out of time, I have to chart still on all these people, I start charting at 5:15 pm and finish around 6 and take my 15 min break if any, run back to see call lights going off, get more pain meds passed as requested and are due, so its 6:45 time to get ready for the 8pm med pass, I start, reminding of call lights, pain meds, crush meds, read the mars which are all in writing and make sure to pull the right meds, then a fall occurs, so I still have not got the lab results for hanging vanc back yet, but a 30 year nurse tells me the lab will fax it, so I continue on with med pass, all the while I barely get to leave my shift at 11:00 and still no fax from the lab.

I get a call the next day from my boss on my day off, she yells at me asking to explain why I did not hang the vanc. I told her because lab results were not back and I was told the lab would fax results to us and we did not get them back by the time I had left. So I did not hang the bag. She was livid!!!! yelling!!!! My day off!!!!! I told her another nurse explained to me the lab would fax results, she said I am responsible and should have called the lab. In fact, the lab was called at 10:30 but it was then too late to hang the vanc. So I was told I was going to be wrote up again and my job performance was being looked at. THE QUESTION HERE IS, HOW DO I GET ALL MY JOB DONE, AND BE ABLE TO GET LAB TO GET WHAT I NEED TOO? I did not have time to call but was told the lab would fax to us.

I am a fairly new nurse in this facility, did not know the lab needed to be called, yet I got in so much trouble. I just need help with when to do things, how to prioritize. Am I in the wrong here? I get the importance of getting things done, but we work 8 hour shifts, some days its impossible to do it all.. What to do? Please give me advice??????????????????//

TN

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Just reading that gives me an idea of how unorganized you may be at work. It actually made my head start to hurt a little bit. Do you use any sort of cheat sheet to help you remember to tie up loose ends? I find it helpful to keep a short list (index card sized) of "must complete" tasks with me at all times. I constantly refer to the list, add new tasks, erase completed tasks and re-prioritize.

It was OK to wait for the fax, initially ...but when the fax didn't come (within a few hours) it should have been followed up on. Your supervisor's reaction was a little severe, but I get the impression this is not the first thing about your work that has upset her. From what you wrote, it also seems you are quick to "pass the buck" and blame others when things don't go right. That can be infuriating to people trying to correct or guide you.

My "tough love" response would be to get organized and use common sense. Don't say, "Jill told me to leave all the bed rails down so it's not my fault the patient fell and fractured his skull." And when you do get corrected, own it. Let the person know that you understand what you did wrong and why it was wrong. And most importantly, let them know what you plan to do differently in the future.

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You do not need to wait for the trough to come back before hanging the vancomycin unless your facility policy says to. Waiting for that result is not realistic in LTC where labs have to be sent out, although sometimes, depending on the hospital, waiting for the result is done in the hospital setting. I can't imagine any facility policy in LTC saying to wait for the result unless they have a lab in-house (when pigs fly). The pharmacy will use the trough to determine the next dose.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I consider myself a task-oriented nurse. Thus, when I worked in SNF (skilled nursing facility) rehab, I always created a to-do list and crossed off my tasks as I completed them. The rehab/SNF nursing setting is filled with tasks, and you must keep some organized way to stay on top of it all. The following is somewhat of a re-post.

Here is how I used to organize my shift. I worked 16 hour weekend double shifts from 6am to 10pm. I normally had about 15 patients to care for. At the beginning of the shift I would look through the MARs and TARs and, as I went, I jotted down the tasks that needed to be done in my notebook. My to-do list in my notebook was how I organized my shift, and as a result, I wouldn't forget to do anything.

Here is how an old notebook page from 2007 appeared (names have been changed due to HIPAA):

9-23-2007

DIABETICS, FINGER STICKS: Agnes (BID), Norma (AC & HS), Bill (AC & HS), Pauline (AC & HS), Rex (BID), Jack (BID), Ethel (AC & HS), Marjorie (0600, 1200, 1800, 2400)

NEBULIZERS: Marjorie, Ethel, Bill, Jack, Pauline

DRESSING CHANGES: Pauline, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Pauline (Vancomycin), Agnes (Flagyl), Rex (ProcAlamine)

COUMADIN: Agnes, Rose, John, Lucille

INJECTIONS: Agnes (lovenox), Lillian (arixtra), Rex (heparin), Bill (70/30 insulin), Ethel (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Pauline (wound infection), Rose (UTI), Rex (pneumonia),

1200, 1300, 1400 meds: Marjorie, Lillian, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura, Louise

REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Norma's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

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Specializes in Pediatrics, Emergency, Trauma.
Just reading that gives me an idea of how unorganized you may be at work. It actually made my head start to hurt a little bit. Do you use any sort of cheat sheet to help you remember to tie up loose ends? I find it helpful to keep a short list (index card sized) of "must complete" tasks with me at all times. I constantly refer to the list, add new tasks, erase completed tasks and re-prioritize.

It was OK to wait for the fax, initially ...but when the fax didn't come (within a few hours) it should have been followed up on. Your supervisor's reaction was a little severe, but I get the impression this is not the first thing about your work that has upset her. From what you wrote, it also seems you are quick to "pass the buck" and blame others when things don't go right. That can be infuriating to people trying to correct or guide you.

My "tough love" response would be to get organized and use common sense. Don't say, "Jill told me to leave all the bed rails down so it's not my fault the patient fell and fractured his skull." And when you do get corrected, own it. Let the person know that you understand what you did wrong and why it was wrong. And most importantly, let them know what you plan to do differently in the future.

:yes:

Read the OP's previous posts; the OP has a pattern of passing the buck, being sensitive to superior's suggestions when they are supposed to be knowledgeable; she even quit a Urgent Care job when a PA instructed her on what she was doing "wrong"; I'm almost inclined to think that the OP takes things personally and doesn't commit to advancing their practice past a beginner phase because they internalize their mistakes instead of taking criticism maturely and correcting their missteps.

OP, you have been given good advice on numerous posts, yet you keep quitting; I suggest you follow each of these replies from you posts, and start to self reflect-everyone is not going to treat you how you think you need to be treated; hence, you need to develop your practice and take the criticism in order to move from novice to expert-the more you keep moving around, passing the buck, not taking responsibility and being "sensitive" and internalizing instead of taking what you need despite delivery and correcting your mistakes, your practice will continue to suffer, especially since you claim you love taking care of pts.

Best wishes.

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Specializes in Complex pedi to LTC/SA & now a manager.

You keep internalizing and blaming others (including your supervisor who IS responsible to monitor your performance whether or not you like it, clearly with all the issues you reported in multiple threads close monitoring is ABSOLUTELY necessary to keep the facility from being cited and patients safe--gloves in the hall/nursing station, passing meds in the dining area, yelling patient medication info in the halls, not assessing a patient fall when alerted by a CNA, not following up on a needed lab and delaying a high risk antibiotic dose unnecessarily...)

You need a brain sheet/organization method. You need to stop blaming others and take responsibility for your own practice & choices, learn to accept criticism and use it to change your practice. You need to stop thinking you're a victim when your choices/practices are corrected by administration they are doing their job. You need to stop quitting jobs when criticized or you will never increase your organization, skills, competency, confidence and proficiency choosing to remain a novice nurse. You don't know what you don't know and may end up injuring a patient as a result. The courts won't accept "Well nurse Suzie said to wait for the lab..." When you choose to hold a med without alerting the physician or supervisor. They likely would have told you to call the lab!

Your supervisor isn't wrong to continue with administrative work if another nurse is available to assist)

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I once was like you. You are a fairly new nurse. You need to fiND your rythm. Prioritize. Prioritize .I don't know if your facility allows it. I always leave my charting till last. Unless it's something that needs to be documented asap. I make sure patient care, meds and all my treatments are done. That way I can thoroughly chart on my patients. Your supervisor was harsh no doubt. I'm curious to know do you have a nurse manager there. Never be afraid to ask them for help it's part of their job. I was fortunate to have an awesome nurse manager on my first Lpn job. Hang in there

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I consider myself a task-oriented nurse. Thus, when I worked in SNF (skilled nursing facility) rehab, I always created a to-do list and crossed off my tasks as I completed them. The rehab/SNF nursing setting is filled with tasks, and you must keep some organized way to stay on top of it all. The following is somewhat of a re-post.

Here is how I used to organize my shift. I worked 16 hour weekend double shifts from 6am to 10pm. I normally had about 15 patients to care for. At the beginning of the shift I would look through the MARs and TARs and, as I went, I jotted down the tasks that needed to be done in my notebook. My to-do list in my notebook was how I organized my shift, and as a result, I wouldn't forget to do anything.

Here is how an old notebook page from 2007 appeared (names have been changed due to HIPAA):

9-23-2007

DIABETICS, FINGER STICKS: Agnes (BID), Norma (AC & HS), Bill (AC & HS), Pauline (AC & HS), Rex (BID), Jack (BID), Ethel (AC & HS), Marjorie (0600, 1200, 1800, 2400)

NEBULIZERS: Marjorie, Ethel, Bill, Jack, Pauline

DRESSING CHANGES: Pauline, Bill, John, Jack, Lillian, Rose, Lucille

IV THERAPY: Pauline (Vancomycin), Agnes (Flagyl), Rex (ProcAlamine)

COUMADIN: Agnes, Rose, John, Lucille

INJECTIONS: Agnes (lovenox), Lillian (arixtra), Rex (heparin), Bill (70/30 insulin), Ethel (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Pauline (wound infection), Rose (UTI), Rex (pneumonia),

1200, 1300, 1400 meds: Marjorie, Lillian, Rose, John, Jane, Jack

1600, 1700, 1800 meds: Rose, John, Rex, Lucille, Lillian, Laura, Louise

REMINDERS: assessments due on Agatha, Jill, and Louise; restock the cart; fill all holes in the MAR; follow up on Norma's recent fall, fax all labs to Dr. Smith before I leave, order a CBC on Rex...

Excellent advice and example

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Specializes in Psych, LTC/SNF, Rehab, Corrections.

Didnt you just create a thread about this same issue?

Seems like you work 3-11? If the vanc was to be hung, why didnt the two shifts before you do it? I dont understand that.

Anyway, so, okay, - you did call lab which was good. The supv wasnt aware of that so you likely didnt document your correspondence with lab... which was bad. (Lol. Document these things, op).

You didn't hang the vanc, though, because it was 'too late' -- what does that even mean, OP? (lol) What is 'too late' when the pt was supposed to recv ABT two days ago? What are you people waiting for - sepsis? (lol)

But, you think this is about the lab not sending timely faxes? And you're all offended that the supv called you "on your day off" about the giant boo-boo you made? "She yelled at me -- !"

Well, you know what, OP? Jesus would've had to 'take the wheel' from me, too. (lol) This is the second thread from and every correction is met with a rebuttal. "...but, they didnt -"

"...but, but, but --" Jesus...take the wheel! That's your pt. That is your pts life youre dealing with. This is serious business.

No one wants to see you fail, OP. But, no one wants our pts harmed, too. If you need help, if you have questions, just ask. Just...ask, honey. For one thing, Im sure you told nightshift about the vanc situation in report. So... unless theyre new too, I cant believe that nightshift wouldnt correct you on the spot. If they did, and I'm almost certain they did, you shouldve hung ABT before you left.

You shouldn't have quit. Youre just gonna run into the same issues at your new place. Waltzing around with gloves on, not assessing/documenting injury, leaving keys all over, wasting narcs on your own, etc.... That's you on the floor. You're told to not pass in the dining hall. You do it anyway. You hang ABT whenever you feel like it. God forbid that someone RIGHTFULLY and sternly correct you or youll swear up and down that youre being bullied.

"Aint nobody got time for alluh dat!" , OP.

You only had 20 pts. 1 ABT, Im assuming. Handful of accuchecks -- that's nothing. Seems like a decent place, to me, because that's a cake assignment. Youre so new, you dont even how good you have it! I work at a few facilities. You dont even want to know how many pts per nurse there are or how many accuchecks/crappy PEGs that are forever clogged/bolus/iso/IV pts exist in the bunch. You shouldnt have quit.

Some Tips?

-- At your next job? Request more days of orientation and stay away from 3-11. It's the hardest shift in most places Ive worked, imo, because they do everything mornings does PLUS The admissions, the phone, the visitors, the sundowning, a heavy 5p med pass, and MINUS the support. It's too much for a new nurse. Most new nurses that Ive seen just dont last on that shift. They crash and burn. 7 t 3 or 11 t 7 is best. For you, Id recommend 11 t 7 while pulling am shifts throughout the week BECAUSE you wont learn everything you need to know on nightshift (or weekends) because you dont have to do whats commonly done on mornings. 7 t 3, allows for a more wellrounded skillset. In my opinion.

- Get in the habit of writing things down. I take report with a notepad. Everyone gives report differently. Even if I only recv info on 2 rooms, I write a list of room/bed numbers and I jot down things as they happen during your shift. Every prn given with times, every accucheck, every O2sat/temp/bp taken, etc....

- When you accept your pt assignment, you need to know: Your diabetics. Your bolus/pegs. Who is crushed/whole. Who is ABT. Who fell/had seizures. Your PRNs. Your hospice pts. Of course check folks with status changes first.

- I dont chart until the end.

- Youre new. Youre going to be slow. Its okay. Start earlier if you must.

- Always check your people at the start of the shift. It doesnt always occur to new nurses to do this. Im flexible but I do prefer bedside reporting.

- Make sure the carts ready for next shift. Even if youre running behind, you shld be ready to surrender keys at the appointed time. I finish my medpass, check narc count, clean/restock the cart...sit down and chart. If I'm behind and reliefs coming in 10-20 minutes, I stop and make sure that the count is good so that they can start their work.

You want to keep things timely. "I have to see the TAR/MAR to --" No, Im using it. Fill in holes when Im done or fill them in tomorrow. Get off the cart and get outta the way. (lol) The other shift has work to do. You work around them, not the other way around. Im projecting a bit, I'll admit. To be clear, Im not talking about being 5 minutes late. More like a whole hour. One of my workplaces, two nurses who repeat offenders. LPN and an RN. The LPN, I followed. Experienced but 3t11 shift is nasty at that place. I know how she works so Im never bothered. The RN was new to ltc/snf and couldn't be timely. It happens but the bad news was, she was nightshift and would hold up morning shift. Im talking a full hr before 7t3/7t11p could get the cart. Routinely. I had to work behind her on mornings on occasion. It was a mess.

-- If you work nights, get your urine specimen at the start of the shift with the aides. I have more luck then.

Good luck, OP.

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