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Discussion

LPN with questions

Hello...I am an LPN and have recently re-activated my 10 year+ inactive license. I was able to do the clinical aspect of my re-activation/skills check list at a nursing facility close to my home. Needless to say it has been quite an undertaking refreshing my skills, and trying to learn the new meds out there...but I am vigilant and eager to be the best nurse I can be. My license is now active, and I am eager to work.

The facility that I trained in is quite a busy place, there are 2 halls of long term residents, and then those post surgery, and admitted temporarily for PT, and post Op care. In doing my orientation I have spent time on both halls, one of which was literally more than I could handle. (I admit this with great humbleness, as I really thought I had what it takes to be a task oriented, caring, organized, observant, "get'er done" type of a person.) I found myself to tears in a moment I grabbed alone in the bathroom. It was just so much...so fast! One wing of the facility has 45 beds, all of which the charge nurse is responsible for. I have observed/shadowed several of the staff during my clinical time, and my orientation time, and they seem to be able to handle the load. (some do run over the shift to chart, much to the shigrin of the admin.) My question is...how does a new nurse with visions of Florence Nightingale, and wanting to be the best nurse she can, manage such a load as 45 patients? What time saving techniques could help me? In a single day shift there is the 8:00am med pass (VERY HEAVY), and then the 10:00am treatments (eye drops, ect.) then the 11:00 am accu checks and insulins, then the 12:00 Noon Med pass, then heavy MDS, and ABT charting, and faxes/labs/orders/POA calls, Dr. visits, ect... to answer to, then the 2:00pm med pass (neb tx's, G/T flushes, straight cath's, ect...) I never sat down. I went as fast as I could (using caution in passing the meds), and yet there was NO WAY I could even get to the charting till what was my scheduled time to leave. (I need to note admin is NOT wanting ANY to work over there scheduled time. Quite labor conscious in these times.) I felt like a failure, and did not handle the pressure of that work load well at all, and I am a confident person. Did I mention I was shadowed by the ADON? How do you manage your time? Are there shortcuts I didn't do? Is a 45 person patient Load a normal load in nursing homes? I feel so inadequate, and "green", and yet as I said I went full bore. I did not feel I gave very good care, or observation to those people, but rather I was task oriented ALL day long, and still didn't get to the work I needed to get too. (ADON did much of my charting). Also, in MDS charting how can a facility like this expect a "new" nurse to chart on the residents that she knows virtually nothing about, save for maybe there room number (maybe)? I was not the nurse I want to be in this environment...I had no time to smile, and ask them how they were feeling. I was simply doing the "work", and even then I fell short. I love being a nurse, and I genuinely care for those people, but how do you balance it all? :o

I need to add that I did 100 hours clinicals with the facility, (just on skills however, never in the med cart). My orientation has been 2 days, on both wings. My initial orientation was the same however, after my first day passing meds, missing many in the time allowed, and my obvious slowness...the ADON appologized to me. She never realized this was my first time in the cart. She was angry at staff, but I didn't realize anything was out of the norm for orienting. On what was to be my last and 4th day I spoke to the DON about my not being ready, and feeling very lost. At that point the ADON took over my orientation. The ADON spoke to DON and Admin. and approved 4 more days for me to orient. So I got 2 days in each hall, passing Meds, and conducting myself as the charge nurse. Yesterday (4th day) I was told my orientation was complete. I was also told I was doing myself a disservice by not accepting a Noc shift (sorry, but not interested in 3rd shift), and also by my voicing that I could not at this time accept being a prn charge nurse for this incredibly busy wing, but felt more comfortable at the other.

Yes, I now recognize residents faces, and some names, however, I have literally spent 4 days in the med, and treatment carts. Prior to this time I was handed meds to "get to know faces", and told what res. needs what treatments, and given the meds/supplies. Is there a standard time for orientation into a facility? How can this place possibly think 4 days is enough? They want me PRN, but how can I keep up my learning when I have only had this limted exposure? Should I just skip this facility all together? Was this perhaps a test I failed? In accepting a position as prn is it within my rights to ask for more orientation?

Featured Replies

Doing nursing by the book is just not possible in this environment. Some of it will get easier. If you are on the same hall every day you will get to know usual residents and their meds and treatments. Only occasionally will there be changes or new meds you have to familiarize yourself with. Right now you are on a steep learning curve. Having been out of nursing for a long time it will take awhile to level off. If it never levelled off you would have no one working there so there has got to be light at the end of the tunnel as they say.

I have NO idea how anyone thinks this is safe.

This is not safe if you ask me, and a ticket for burnout. I am the director of nursing of a 67 bed nursing home in rural Tennessee. We usually have 60 residents. When I took over this position 3½ yrs ago, I pleaded with corporate to let me have more staff. I explained the legal liability. No nurse can provide the kind of care and attention to 45+ residents on any shift and do it to my satisfaction. Our nite nurse was the sole nurse for the whole 60. So now my staffing is so much better. On days we have the 2 LPNs on the floor, an LPN who does treatments, draws blood, and monitors restorative (we've had no in-house wounds in 4 yrs, but we take patients from the hosp with wounds), and we have 3 RNs there during the day...myself, my ADON and the MDS coordinator. Oh, and an LPN in med records. If my floor staff is overwhelmed, office nurses, including myself, are expected to get up and go help. That is not an option. My evening crew has 2 LPNs. One of the RNs stays until 7pm. From 7p-7a we have another RN. Nites also has 2 LPNs now. The nite RN does all evening treatments. Furthermore, all newly hired nurses get 4 days of orientation. New grads or ones re-entering nursing after a few yrs absence can have up to 2 wks orientation. What you are being expected to do is overwhelming. I want my staff to have time to love our residents, not just hand them a container of pills.

This seems ridiculous to me!!! No wonder you feel so overwhelmed! I dare say I don't think your having been out of nursing for 10 yrs. has anything to do with it - anyone would feel this way, in my opinion. My best friend has 26 pts. per day at her facility & it took her at least 6 months to feel like she was doing anything correctly. She cried all the time, but now says she's glad she stuck with it, as she has such a great knowledge base now & feels so much more confident in her skills. I could not do it - my job is MUCH slower-paced...right up my alley! Best of luck to you in whatever you decide...thanks for sharing your experience. I can't imagine any board of nursing knowing that this is what nurses are facing these days & being ok with it...but I guess they are. It makes me angry, though. What if one of their family members was in a facility such as this & an overworked nurse made an innocent mistake? I'll bet things would be looked at very differently if this happened more often. It's easy for the powers-that-be to turn their heads as long as it doesn't affect them. That saddens me greatly for the patients we are all assuming responsibility for. They are the ones at our mercy with few choices about their care. Scary, isn't it?

Hi I know its overwhelming , it is very common in NHomes ,I have been an LPN for 22yrs and most of it in nhomes.I got burnt out I gave and gave un til I had nothing left. I think you should try a smaller nhome. Doing everything that needs to be done is next to immpossible you will wear yourself out.Geriatrics is great if you can find the right place to work. Don't give up on nsg its not you its the way they run nhomes. Leo2

I would love to work for you! Leo2

This is not safe if you ask me, and a ticket for burnout. I am the director of nursing of a 67 bed nursing home in rural Tennessee. We usually have 60 residents. When I took over this position 3½ yrs ago, I pleaded with corporate to let me have more staff. I explained the legal liability. No nurse can provide the kind of care and attention to 45+ residents on any shift and do it to my satisfaction. Our nite nurse was the sole nurse for the whole 60. So now my staffing is so much better. On days we have the 2 LPNs on the floor, an LPN who does treatments, draws blood, and monitors restorative (we've had no in-house wounds in 4 yrs, but we take patients from the hosp with wounds), and we have 3 RNs there during the day...myself, my ADON and the MDS coordinator. Oh, and an LPN in med records. If my floor staff is overwhelmed, office nurses, including myself, are expected to get up and go help. That is not an option. My evening crew has 2 LPNs. One of the RNs stays until 7pm. From 7p-7a we have another RN. Nites also has 2 LPNs now. The nite RN does all evening treatments. Furthermore, all newly hired nurses get 4 days of orientation. New grads or ones re-entering nursing after a few yrs absence can have up to 2 wks orientation. What you are being expected to do is overwhelming. I want my staff to have time to love our residents, not just hand them a container of pills.
I would love to work for you.Most are just like the person above described. Leo2
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