New confused nurse

MHaffer · Mar 3, 2009

While I can't give you first-hand advice since I am still a student, I can tell you this much from what I have heard from professors, friends/family who are nurses, and from allnurses.com: what you are experiencing is VERY normal!!! Go over to the new grads board, and pretty much every other post is about being terrified and feeling like they have no idea what they are doing. It seems like this is a very typical experience for new nurses and that it changes with time. It MUST get better, or else nobody would want to be a nurse! Hang in there, you obviously know something if you got a 3.5! Have confidence in yourself and then others will, too. Before you know it you won't have to FAKE the confidence anymore, you'll actually BE confident!

Daytonite, BSN, RN · Mar 3, 2009

I worked in LTC a lot so I know what LPNs needed to be able to do. Just what is it that you don't know? You should know how to give medications one of the biggest parts of your new job that you are being asked to do. Of course there are nuances to the art of giving medications that comes with time and experience, but not knowing them the first day doesn't mean you are "dumb". It just means you are a greenhorn. There's a difference.

TinkerNurse · Mar 3, 2009

I worked in LTC a lot so I know what LPNs needed to be able to do. Just what is it that you don't know? You should know how to give medications one of the biggest parts of your new job that you are being asked to do. Of course there are nuances to the art of giving medications that comes with time and experience, but not knowing them the first day doesn't mean you are "dumb". It just means you are a greenhorn. There's a difference.

Mainly the paperwork. The mar is fairly straightforward but the facility seems a little disorganized. People scribble in the mar their own little notes all the time. Also they have policies regarding daily charting for medicare, etc and when I asked to see the policy and procedures book, no one was able to find it. I want to know exactly what I need to do in a day but no one gives me the same answer. Also, skills like recognizing when someone needs to be sent out, or how you're SURE that someone that fell can be moved. Passing meds is the easiest part. Its the paperwork and some of the assessment that confuses me 0_0. I mean I am a new grad and apparently three nurses quit from this facility the same month...I guess they have a hard time keeping nurses for some of the reasons I listed...but it is the only facility around here that would hire me since I am still in school....ug 8(

Daytonite, BSN, RN · Mar 3, 2009

the person you can go to for the lowdown on paperwork is the medical record clerk or who ever is responsible in the office for doing the medical records. that person can tell you about every form the facility uses and pretty much what is supposed to be charted on it. that person should also know where a copy of the facility policy and procedure manual is located. believe me, when the state surveyors are due to come around, copies of this thing are going to magically show up. they are probably in cupboards of the medication room behind closed cupboard doors. your pharmacy service (the place that provides your drugs) can tell you exactly what is supposed to be charted (abbreviations, etc) on the mars and tars if they are the ones printing them out for the facility. the mds nurse, or whoever is doing the mds assessments and care plans, is a good one to ask about what assessments need to be done on a regular basis because the mds nurse does the ones that brings the big money into the facility and relies on what the charge nurses are charting to do her work. overall, the director of nursing and her subordinates (assistant don and supervisors) should know the answers to these questions. just keep asking them.

when i did charge nursing i usually started my shift by doing a real quick walking round (i mean really fast) of the patients to make sure they were all breathing and not lying on the floor. did cna assignments next and got all their squabbling out of the way. then started the am med pass. by 10 am i was starting treatments. noon was a new med pass. 1-2 pm was some treatments and charting. in between all that you stamp out fires. if a patient falls, has a skin tear or i got an admission i had to take care of it. most doctor's orders are handled by fax. most doctors came in during the evening but there were a few that would come in on an afternoon and make a big sweep of the place. some want a nurse to go with them; some just want you to pull all their charts for them. then you have to sit and sign off their orders and get those initiated (that's a pain in the orifice). medicare patients have to be charted on every shift (q8h) and you need to know what they are to be charted on (the mds nurse will always know). patient's who had a fall, skin tear, temp or any change in condition in the last 24 hours also need to be charted on q8 hours for 72 hours (3 days) specifically about that problem so change of shift report is important to listen to. the facility should have some kind of report book with that kind of info in it (these books mysteriously disappear when surveyors are in the building because they are violations of hipaa but everyone has them). the don's home number is the person you call when there is an emergency and it is just you and the patient's in the building. if she doesn't answer you call the administrator. if a patient codes and they are not a dnr you call 911.

you might want to start hanging out, reading and asking questions on the geriatric nurses and ltc nursing forum of allnurses. i loved working ltc. it's a bit different from the hospital and you will truly be a charge nurse. the trick is to learn who knows what so you know who to go to for information. knowledge is power--remember that. when you learn where these things are and who to go to for your answers, that will be half your battle.

here are the medicare laws for ltc: http://www.access.gpo.gov/nara/cfr/waisidx_05/42cfr483_05.html

TinkerNurse · Mar 3, 2009

the person you can go to for the lowdown on paperwork is the medical record clerk or who ever is responsible in the office for doing the medical records. that person can tell you about every form the facility uses and pretty much what is supposed to be charted on it. that person should also know where a copy of the facility policy and procedure manual is located. believe me, when the state surveyors are due to come around, copies of this thing are going to magically show up. they are probably in cupboards of the medication room behind closed cupboard doors. your pharmacy service (the place that provides your drugs) can tell you exactly what is supposed to be charted (abbreviations, etc) on the mars and tars if they are the ones printing them out for the facility. the mds nurse, or whoever is doing the mds assessments and care plans, is a good one to ask about what assessments need to be done on a regular basis because the mds nurse does the ones that brings the big money into the facility and relies on what the charge nurses are charting to do her work. overall, the director of nursing and her subordinates (assistant don and supervisors) should know the answers to these questions. just keep asking them.
when i did charge nursing i usually started my shift by doing a real quick walking round (i mean really fast) of the patients to make sure they were all breathing and not lying on the floor. did cna assignments next and got all their squabbling out of the way. then started the am med pass. by 10 am i was starting treatments. noon was a new med pass. 1-2 pm was some treatments and charting. in between all that you stamp out fires. if a patient falls, has a skin tear or i got an admission i had to take care of it. most doctor's orders are handled by fax. most doctors came in during the evening but there were a few that would come in on an afternoon and make a big sweep of the place. some want a nurse to go with them; some just want you to pull all their charts for them. then you have to sit and sign off their orders and get those initiated (that's a pain in the orifice). medicare patients have to be charted on every shift (q8h) and you need to know what they are to be charted on (the mds nurse will always know). patient's who had a fall, skin tear, temp or any change in condition in the last 24 hours also need to be charted on q8 hours for 72 hours (3 days) specifically about that problem so change of shift report is important to listen to. the facility should have some kind of report book with that kind of info in it (these books mysteriously disappear when surveyors are in the building because they are violations of hipaa but everyone has them). the don's home number is the person you call when there is an emergency and it is just you and the patient's in the building. if she doesn't answer you call the administrator. if a patient codes and they are not a dnr you call 911.
you might want to start hanging out, reading and asking questions on the geriatric nurses and ltc nursing forum of allnurses. i loved working ltc. it's a bit different from the hospital and you will truly be a charge nurse. the trick is to learn who knows what so you know who to go to for information. knowledge is power--remember that. when you learn where these things are and who to go to for your answers, that will be half your battle.
here are the medicare laws for ltc: http://www.access.gpo.gov/nara/cfr/waisidx_05/42cfr483_05.html

thank you!!!! :)