LTC new nurse burnt out!

Ginger80 · Mar 1, 2011

Hi.

I don't really have advice, but I know EXACTLY what you're going through. I'm a new LPN working in LTC also. I work nights (2300-0700) and have 151 residents under my care, with 4 cnas. It gets extremely crazy at times, and 2 nights ago, I broke down in tears because needed help and my supervisor was not there for me at all.

I too get walked over by the cnas. Some are honestly the laziest people I have ever met, and I feel somewhat intimidated to tell them to do their jobs. I hate feeling like a babysitter. Some of the other LPNs on my shift are "buddies" with their CNAs, and I honestly cannot do that. I'm not trying to be cold or unfriendly toward them, but I don't see how becoming friends with them will help. I need to keep things professional. Some of them blare music, most of them are constantly texting (each other) ALL NIGHT. I run around like a mad woman, and I depend on them to keep an eye on the residents, but honestly, I can't trust 90% of them.

I am looking elsewhere for work, but right now, this "pays the bills".

Sorry I can't offer you advice, but know that you are not alone. :hug:

MouseMichelle · Mar 1, 2011

Hi there;

I have worked in LTC facilities on and off for 8 years, I've done home health and worked in adult day healthcare.

It's a very stressful job. And I want people to understand that there are good LTC units and bad ones. Now even though my boss is a witch (if you read my on thread you'll know why), I'm lucky in that I have night CNA's (I work part time nights) who do their job well, and we respect one another. I work with my CNA's, I help them and they help me. I treat them with kindness and respect.

I'm lucky I only have 50 patients under my belt. When I first did LTC oh boy did I feel overwhelmed, I wanted to quit but because I'm so stubborn I didn't. It's all a matter of time management. I have my routine and I stick with it. Yes emergencies happen, but I've done this for so long I know how to handle them effeciently and get the paper work done quickly. If LTC is somethign you really want to do then I would suggest looking to work in another facility. Also what I do is I actually will speak to the nurses working there after my interview and ask them for their honest opinion. Now of course they're going to lie, but you may get the gist of it. I also observe, I usually just walk around the facility see what type of patients they have, watch the staff etc.

If this job is something you have to stick with for a while, trust me after about a year you'll have it down. Also try not to let the bosses bully you. It sounds like all you have to do is way too much and your DON is not doing a good job because you have a lot on your shoulders.

How I manage my staff, is with respect but then again I'm lucky I have very very very good night cna's. Have you spoken to your boss about what the CNA's don't do? Are they insubordinate to you? If so write them up. I wrote one cna up for screaming at me for giving me an extra shower. It caused issues between her and I but I generally ignored her.

The only good thing I will say about my boss is that she does nip things in the bud, if I tell I found a CNA sleeping she does something about it.

This sounds like a lot of poor management on your DON's side.

as for being friends with my CNA's they are my friends, but I don't do things with them outside of work. I can't help being friends with one particular CNA as I've worked with her four years, but she knows that I still tell her something needs to be done and I expect it to be done.

A good question to ask when you interview is "how do you handle staff that are not doing their job" and get a sense of if what they're telling you is true or not.

That's the best advice I can offer.

Good luck to you

Michelle

Kookie2412 · Mar 1, 2011

SO...I am a new nurse (approx 6 months) at a LTC facility. I care for 40+ patients from 6p-6a. I am very overwhelmed. I can handle the residents, I just have a hard time handling the staff. I work with very poor CNAs. Usually we are short staffed. (most of the time) I know this is really a normal occurence at these types of places. I have gathered that from these threads. I know I need to get out of here. I am working on that. I plan on going back to school to get my RN.
I feel that I am getting bullied. Other nurses count the breathing TX vials, sign off non-narcotic pills, ect. I give all my pills. I try to make sure they are given no earlier than 1 hour before scheduled and no later than 1 hour after. Sometimes, this doesn't happen. And I do all my TX. I had a lady vomiting coffee ground emesis x5 one evening right in the middle of my med pass, and it through off all of my pills, including my HS BS checks. That really upset me. I tried to get my QMA to do the discharge paperwork to send the lady to the ER, but was later told by my supervisor that I had to stop what I was doing and get the paperwork filled out. I was in tears. It is much much much more stressful being a nurse that I thought it would be. I was a CNA for 3 years prior to becoming a nurse. It looked so easy. I know that all the CNAs think I have such an easy job. I hate to see them sitting around at 11pm when they have only been there an hour and I am still frantically giving my lantus injections. I dont feel LTC nursing is for me. I do not like to supervise people. The CNAs walk all over me. I am just too nice. I hate to tell them bad news.
I am a single, no children, woman who is 22, and when I am at home, I read threads on this website, look up nursing tips, and watch youtube videos about nursing. Basically, I try all that I can (within my power) to learn more about nursing, and to be a better nurse/manager. I ran out and bought a littmann electonic stetheschope. I love nursing, I really do, I just do not want to manage staff. What should I do??? please help me! :) thanks, Miranda, LPN

Hey, I am an RN in canada. I have been through this Hell. We had 2 RPN to give meds to 120 residents and 1 RN to do paperwork, doctors, wound care and all other stuff. and every other day when RPN would take a sick leave or not show up RN gets to do the Med pass for 60 residents twice per shift. This was my 1st job as a new grad, very very very very stressful. You would think they would have pity on me when I was 5 months pregnant giving out meds to 60 patients. I have cried through my shifts out of being overwhelmed and to let my stress out so that I can finish the job of giving out pills which I MUST do. Please leave, before you start to hate nursing. I developed pelvic prolapse ( due to being 5 months pregnant) through my pregnancy for being on my feel for constant 8 hours to finish medpass with 10-15 mins of quick lunch break.

Good Luck.

GLORIAmunchkin72 · Mar 1, 2011

I'm a bit confused: you have a qma yet you are doing all the med pass and the txs?

NamasteNurse, BSN, RN · Mar 1, 2011

I feel your pain. It's totally ridiculous and unmanageable at times. Especially when you have to stop and do paperwork. I'm in the same boat, alone with 43 residents. CNA's texting etc, and doing the bare minimum. You are young which makes it harder for you to be a boss to your peers and some of those CNA's are way older, more experienced etc. It's gotta be scary. Also, what's up with so many mean people in nursing? I thought it was supposed to be a caring profession??

systoly · Mar 1, 2011

You are giving a lot of info in your pro. I'm afraid this could come back to haunt you. Please consider changing your pro.

In reference to your post, look at your heading. You speak of burn out, but you occupy yourelf with all nursing related staff in your free time. I know you want to excell in your discipline, but even super athletes need to get R&R some times.

msmassey · Mar 1, 2011

I was right where you are straight outta nursing school. I worked at a nursing home 12 hr shifts and was completely and totally overwhelmed. I was supposed to be the med nurse and they had someone who did wound care and an RN was supposed to be on shift (days) to handle to MD orders/visits/phone and alot of the paperwork.....it ended up being us LPNs doing alot of that and more- 12 hrs turned into 14 hr shifts nearly everyday ! I left crying many times. I took another job within the same corperation but totally different facility and discovered with better management - my job there was SOOO much easier. They had a clearer and more fair division of work and the acuity level of the patients was much higher.

That being said -my job was still hard and when we had admissions or had to send someone out to the ER or even just had a fall - it would put you behind....so it had its awful overwhelming moments too.

Here is the thing - find someone on staff to mentor you informally. They can show you ways to prioritize care and save time. Also - remember - stuff happens - if someone gets thier meds late cause another resident is vomiting blood...what can you do? Apologize and move on.

I work assisted living now-it is so much easier and less stress than both nursing homes I worked at! If you like LTC and Geriatrics try Assisted living.

tiroka03, LPN · Mar 1, 2011

I have been doing this night nurse LTC shift for years. I can totally understand what you are saying. I work this shift because with handicapped children, it allows me to be able to run to school when and if I am needed. I also enjoy having evenings free.

Since I have not worked all my years in the same facility, I can say that some places are run differently than others. Some places actually treat you fairly well, while others are very difficult. I had CNA's that run the gammet from riduculus and danagerous, to downright lazy, to cruel to very caring and hardworking. It is the luck of the draw.

This is my opinion, if you notice someone causing pain by thier actions or lack of action, you must speak up. And a note of reality, if they don't care about the patients, they won't care about your opintion either. You first need to realize that CNA is an adult, and their anger is their own. You don't need to take their stares and yelling internally. You are there to bring order to chasos. No one want to have a boss, but you signed on to be one. So, nip it in the bud and stand up. Once you stand up and they still ignore you, and yell, that is when you need to let them know that you are considering a write up, giving them a chance to calm down on their own. Usually they do, but will be angry to you. They may snip and give you the cold shoulder, because that is easier than to look honestly at their own selves. It's easier to say that ****, if it weren't for her. But, you know the truth, just keep being polite and their angry will eventually wane (until the next time). Of course there is a time to bring in other leadership if necessary.

The work load can be crazy hard. I say this after many many years of doing it. It seems to get harder and more complex every year. But, you can learn ways to save time. For instance if you lay out all your accu check wipes, lancets and strips in advance, you can really whip through accu checks faster.(I do mine all at once, just go down the line, and write them on a paper, inputing them in the computer when I pass the meds, which is the next thing I do). I generally have about 20 accu checks in the morning. This could for instance save you 10-15 mins or more. That may not seem like a big deal, but say the next night you find a way to shave of 4 mins of time. Each night you add up the time you find, soon you will be saving an hour or more. Then you will find time to do more lovely paperwork. It really is a learned thing, each day on your drive home, you review the day and find a way you could have done something better or faster. Then apply it the following day. It may take a while, but the time really does add up.

The other night, (I have 60 pt) I got an admit, a readmit and sent someone to the hospital, had two 1:1 (with 3 CNA's). and had to discipline one of them. I called 3 doctors and wrote new orders. I got out 8 mins late and all the work was done. Why? Not because I am so good. But each time you do something, you review your actions and find ways to save time. I am sure you do this (trick), walk in with a smile and a warm greeting, while reaching for their hands to do an accu check. The kindness goes a long way, people are happy to feel warmth and will in most cases remember and make your job easier. But, inintally the first couple of times you need to spend more time- in order to spend less later. People also sense your stress, and then slow down, get cranky and take longer to take meds or cooperate. When ever I am stressed, I tend to stress out my pts, then it stresses me more. In times like those, you need to s l o w down and get in a bathroom or a storage area and take a quick min for yourself. Wow, I am really making a long post. Hopefully, you can find something to use in this one.

CT Pixie, BSN, RN · Mar 1, 2011

you are giving a lot of info in your pro. i'm afraid this could come back to haunt you. please consider changing your pro.

yeah that!! seriously. miranda, you are giving way, way, way too much info in your profile! right now, i know your full name (just from your sign on name), your profession (lpn) and i know exactly what city, state and exact facility you work at. i also know the hours you work! i'm harmless and have no ill will toward anyone, stalking is not my thing. but if i were, you'd be an easy target. not to mention, your co-workers (if they are on this board) can see it all too.

please, please consider changing your info to be a little less specific. firstly for your safety (this is a public board and anyone good or bad, can read all this info) secondly, for your anonymity so that you can vent with out being known.

Selene006, BSN, LPN · Mar 1, 2011

I understand just how you are feeling! I also understand how difficult it may be to have to respectfully address staff members about how can they can be more helpful when they have no interest in working hard with you. It sounds like you truly are dedicated to your patients and your nursing role. Take a class about being more assertive in the workplace. It may give you some insight into why you feel as though you're being bullied. When you're on youtube, try surfing for topics such as speaking publicly or speaking privately in the workplace. Being a doormat in the profession of nursing can make for a quick exit out of the field. So hold your head up high and come out swinging!

elprup, BSN, RN · Mar 1, 2011

I totally hear where you are coming from. I hated working in LTC for these very reasons.....and did not last as long as you. Good luck in whatever you choose.