LTC Orientation...rough start

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Hi Everyone,

I wanted to share my Orientation experience and would appreciate any thoughts or opinions. I just completed 10 days of Orientation as RN in Skilled Nursing. First let me say I applied to the position because it was 6 days per pay period (2 weeks) including every other weekend on 3-11 shift.

Okay, first 2 days Orientation is on day shift. It was great. There was a nurse supervisor on the desk helping with admissions, discharges, taking off Orders, incident reports...etc. There was unit secretary there for 8 hours. There were 2 nurses, each with 27 skilled nursing residents. All the nurses got their 1/2 hour lunch break. Although, it was busy, it seemed doable.

Then I started Orientation on my shift 3-11:30. Only 2 nurses for same exact residents, no nurse supervisor and unit secretary for only several hours to help answer phone. Evening nurse, who was orienting me, told me "we are just as busy as day shift, but they are not going to get a 3rd nurse...not gonna happen". That nurse has worked that shift for 2 years and has never taken a meal break...says she can't...have to run around just in case anything of of the ordinary comes up...fever, admission, incident. We all know...that stuff that DOES happen on a daily basis.

So, essentially we are running around like crazy...meds, admissions, discharges, incidents, orders, families, sundowners in evening...etc. I think how am I going to do all this when nurse who has been doing this for 2 years is literally running?? Okay...so I dig in and figure I'll hang in there and it will get easier over time. I didn't expect it to be easy. Still felt a little sting after being on the day shift with the extra nurse, but thought okay...let's see how this goes.

Well on my last night of Orientation, one of my residents came up to me and said he just took the wrong cup of pills. The nurse from the other hall gave my resident someone else's meds. I immediately went over to the nurse who was "orientating" me who was sitting at the desk drinking coffee. I said we need to tell the other nurse of her mistake and do an incident report. She said No...don't want to say anything!! I told her I was not comfortable "hiding" anything and was going to call the Nurse Manager. She again said no, not to say anything.

Well, I was in Orientation, but I know right from wrong. I had to go to DON and report this nurse, as I could not convince her to do Incident report. Well, she got fired. I feel awful starting this way. I know I did the right thing. Then DON then offers me the full time position. I respectfully told her no, I don't want full time. I applied to the position specifically because it was part time.

I am literally just off my 10 day Orientation and the DON has me all over the schedule. The job is overwhelming as it is. Only 10 days in...and feel lousy. Sorry so long. I hate to say I hate this place already. Any thoughts or perspectives for me? Thank you!!!

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Sorry to break this to you but when that nurse said "not gonna happen", she/he means it. Doing skilled nursing in a nursing home a.k.a Medicare wards/Post-acute is like signing a death warrant for your nursing career. Having such high acuity in the nursing home setting ideally should result to a better nurse-patient ratio but no, especially with the current Medicare standards of staffing. The same is true to my current workplace. I work night shift and I handle 30 patients, all skilled, post-acute. 80% of the patients are alert and oriented and spend a lot of time complaining about previous shifts and that alone takes a chunk of my time at night and worse, PRN here, PRN there. The remaining 20% can either have some psyche moments and eats even more of your time (incident reporting etc). And then there's the insane volume of laboratory req's that we have to put in the system, the chart check and the dreadful orders that are left flagged and never carried out since the previous 2 shifts and some of them are stats. All these are due to the relative high volume of admissions that the floor nurses (who have 20 patients max during day and eve shift) do and at the same time providing nursing care, med pass and *gulp* wound care which in turn leaves work undone and passed on to the night shift.

The best thing you can do is do your best, prioritize patients that are more unstable and get a hold of their vital signs right away at the start of your shift. Do your rounds with the nurse you're working behind and work together to solve/get orders for anything that is not good according to your nursing judgment. Eat your lunch while on the go if you can. I joked one time that we nurses should start getting portable tube feeding system upon employment just to nourish ourselves.

When in doubt, ask your more experienced co workers. If it does not cut it, go to your nurse manager/ADON/DON.

The current state of skilled nursing in LTC's is a sad reminder of the current state of healthcare AND also the high nurse turnover in such places.

Good luck and remember, you are just human. We're not gunning to be super nurses in this field.

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Specializes in Med/Surge, Psych, LTC, Home Health.

"Doing skilled nursing in a nursing home a.k.a Medicare wards/Post-acute is like signing a death warrant for your nursing career."

What in the world do you mean by that?

OP: I have to agree with the post above. In most nursing homes, it is strictly Medicare/Medicaid

reimbursement rates, that dictate how many staff you're gonna have.

Now, having SAID that... it does irritate the holy crap out of me when I'm running my tail off

caring for my 50+ residents on night shift, while another NURSE is SITTING with a resident

that does not even NEED a sitter IMO. That's what occurred last night. A nurse getting

paid to sit for 8 hours, with a resident who has been a 1:1 for about a month because

he tried to get some nurse to kiss him.

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Specializes in LTC.
"Doing skilled nursing in a nursing home a.k.a Medicare wards/Post-acute is like signing a death warrant for your nursing career."

What in the world do you mean by that?

OP: I have to agree with the post above. In most nursing homes, it is strictly Medicare/Medicaid

reimbursement rates, that dictate how many staff you're gonna have.

Now, having SAID that... it does irritate the holy crap out of me when I'm running my tail off

caring for my 50+ residents on night shift, while another NURSE is SITTING with a resident

that does not even NEED a sitter IMO. That's what occurred last night. A nurse getting

paid to sit for 8 hours, with a resident who has been a 1:1 for about a month because

he tried to get some nurse to kiss him.

Why is a nurse being used a sitter and not a CNA?

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Doing skilled nursing in a nursing home a.k.a Medicare wards/Post-acute is like signing a death warrant for your nursing career. Why is that?????????

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I don't agree. Time management is the key. Things are never going to be perfect. Nursing in any place is going to have challenges. Some of the best nurses I know work in Medicare units. You need to ask yourself if it is right for you. I applaud you for sticking to your guns and reporting that nurse. Even the best nurses make mistakes and you kept your patient first. That's the kind of nurse that belongs there. She knew what she did was wrong and should be ashamed of herself!

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Thank you all for your thoughts, perspectives and advice. I appreciate it!

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I feel the same way, 1st job in LTC [ got a post up top as well] 18-24 pts. Same problems working 7p- 7a usually im out by 830a, ya no lunch break.

They won't schedule more RNs because "low census" but IMO more RNs = better pt care/happier RN'S = more residents want to go there word of mouth etc= more money for company??????

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Specializes in Med/Surge, Psych, LTC, Home Health.
Why is a nurse being used a sitter and not a CNA?

I *guess* because SOMEONE had to sit with him and that nurse was the

only extra body available. Still makes me mad that in SPITE of my LTC

having this extremely TIGHT budget, there was a NURSE sitting with

this resident who IMO doesn't NEED a sitter, while I busted my rear end

just like I do EVERY night, without FAIL.

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Thank you all for taking the time to read and respond to my post about my rough start. I am hanging in there and was off Orientation and on my own this weekend. Tonight I had to send one of my residents out to the hospital. I had been taking care of him all week. Tonight when I was assessing him, he said to me "You are too good a nurse to be here". I responded by saying, "And don't you deserve a good nurse!" So, yes it's exhausting, but I feel like I will get my routine down and take the best care I possibly can of my residents and be a good co-worker to my fellow nurses. Nursing is a tough job, period. But tonight, I was exhausted, but felt like a million bucks, when my resident hugged me before he got in the ambulance and thanked me for taking such good care of him.

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Specializes in Med/Surge, Psych, LTC, Home Health.

Hang in there. I have to say, I hated my current place of employment as

well when I started, but now I'm strangely having a hard time wanting to

leave. The residents really grow on ya. It gets easier. Good luck. =)

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