New Grad Freaking Out!!!!!!!!!!!

KrysyRN, BSN · Sep 26, 2011

45 patients are way too many. Run for the hills. Not safe nor fair. That's one of the biggest patient loads I've ever heard of for that shift. I can't believe it would even be possible to get the work done in 8 hrs.

Good Morning, Gil · Sep 26, 2011

RUN! Agree with everyone else...that is not a safe ratio for any nurse, experienced or new! There is a difference between non-ideal staffing and unsafe staffing. This would be an example of unsafe. 45 residents for 1 nurse, all meds, all tx. What happens if 2 or 3 of your residents fall? Now how about if something happens on your shift....resident becomes unstable? Or with that pt load, it's likely to be more than 1. What if you have total care patients, like 10 of them? There is no way they can be turned/changed often enough with that pt load, sounds like pressure ulcer city to me. My advice: look for another job. Like, the above poster said, there are good LTC facilities out there, just need to find one.

justjojo · Sep 26, 2011

Congratulations on getting a job! There are some that don't even consider working in an SNF as their 1st job as a nurse. But yeah, you will be FINE. Take it from me. I've worked in SNF for 2 years+ and honestly, I didn't like it at first. Because working with old folks really wasn't my thing. But I came to the point of liking it somehow. It's really a matter of knowing your residents and having a routine and squeezing in both med. pass and treatments (if your facility has a wound nurse, you are lucky!) in 8 hrs. Oh i forgot charting! That's a toughie! Unlike acute, you'll have different patients in a matter of days.

Bottomline is you have a job as a new grad and be proud of it.

Looking at the posts before me, hmmmm, i didn't realized the number of patients u mentioned. Sorry but I guess you have to look into the caseload and think it through. I had 33 pts from my last job. I was ok but I think more than that will be a disaster. Hmmm, why don't you look for other LTCs and look onto their census/caseloads before saying "YES!" to the HR peeps. Sorry about that again. :uhoh3:

I Am ReadyRN, BSN · Sep 26, 2011

I agree, that position sounds like a disaster waiting to happen :eek: Funny how multiple times after I ask a nurse/recruiter what I should do to get a job as a recent grad (after being rejected for a position), they tell me to look into nursing homes, "They're hiring new grads" :icon_roll What's a new grad to do in these difficult times? :crying2:

misava · Sep 27, 2011

Wow, 5 days out to my orientation in a skilled nursing facility of three months. I can't imagine being on my own yet. good luck, and if you don't feel comfortable, talk to someone before you walk out!

totallackofsurprise · Sep 27, 2011

Other replies are right. That's far too little orientation and far too many patients for a nurse like you having no experience and only five days orientation. I understand if quitting is not an option, and the job market is no picnic now. One of the previous posters said, "When in doubt, send them out" and he/she is right.

Well, I work ER and we get lots of LTC patients. The bad thing is, we get a lot of these LTC patients really LATE -- like when they're already in septic shock from pneumonia or all their MRSA-infected Stage 4 decubs. Both are a direct result of overwhelmed and understaffed LTC RNs with CNAs doing most of the work because the RN is too busy passing meds. You need to be able to assess your patients, not just pass meds. If you don't have time to pass meds on time, you won't have time to assess them, and that is how they wind up with septic shock by the time we get them in the ER.

Do your best, but in your situation, your best may not be enough because you have no experience and they should never throw you out there with only 5 days of training. I agree with others: run. If you can, just run. Many experienced nurses would find it hard to do well what they are asking of you. How well do you think you can do, if they would have a hard time of it?

And while your license is a major concern, what will bother you more is the guilt if you are so overwhelmed you make a mistake. Even if the patient suffers no consequences, you will still feel bad. But you will feel even worse if the patient does suffer consequences from a mistake of yours. For your license, it's not really worth it. For your conscience, it is definitely not worth it.

That's just my experience. Your mileage may vary. But your instincts are right: this is not a good situation and five days of training is nowhere near enough.

nola1202 · Oct 1, 2011

Other replies are right. That's far too little orientation and far too many patients for a nurse like you having no experience and only five days orientation. I understand if quitting is not an option, and the job market is no picnic now. One of the previous posters said, "When in doubt, send them out" and he/she is right.
Well, I work ER and we get lots of LTC patients. The bad thing is, we get a lot of these LTC patients really LATE -- like when they're already in septic shock from pneumonia or all their MRSA-infected Stage 4 decubs. Both are a direct result of overwhelmed and understaffed LTC RNs with CNAs doing most of the work because the RN is too busy passing meds. You need to be able to assess your patients, not just pass meds. If you don't have time to pass meds on time, you won't have time to assess them, and that is how they wind up with septic shock by the time we get them in the ER.
Do your best, but in your situation, your best may not be enough because you have no experience and they should never throw you out there with only 5 days of training. I agree with others: run. If you can, just run. Many experienced nurses would find it hard to do well what they are asking of you. How well do you think you can do, if they would have a hard time of it?
And while your license is a major concern, what will bother you more is the guilt if you are so overwhelmed you make a mistake. Even if the patient suffers no consequences, you will still feel bad. But you will feel even worse if the patient does suffer consequences from a mistake of yours. For your license, it's not really worth it. For your conscience, it is definitely not worth it.
That's just my experience. Your mileage may vary. But your instincts are right: this is not a good situation and five days of training is nowhere near enough.

and more and more the trend is keep them in house, we can treat them here with po abx and IVF IV ABX if needed. Total crap. By the time we pull labs, UA C&S we have lost valuble hours, even a day in treatment. The outside labs just don't do stat like a hospital can..portable X-Rays same. I'm fine with comfort care for DNR's, and I'm not one for agressive care unless the patient wants the care. (more often it's the family, and the patient is confused, aphasic or just told, "oh honey we need you to get better, or you're just feeling bad that's all."

You are one of the few ER people who say this. Many are sick to death of LTC pt's and call them GOMERS (get out of my ER) or dumps. Sometimes they are sent back rapidly with a condesending report, becuz us dumb lil LTC nurses don't know nothin or we wouldn't be workin in LTC.

re new grad: it's up to you but people seem more willing to report you to the board in the last few years. I can tell you as a seasoned nurse (barbeque!) I had to list a lot of meds as refused the first med pass. (I had to go in cold, not my assigned job, knew no-one. Pt's put to bed so quickly and I was so slow...felt guilty as all heck but a recent grad said, "look we do the best we can. The first few times I passed meds, I had the same problem." She advised me with time and knowing my residents the rest would come. She also told me to have the aides tell me who went to bed first so I could do those first, lable my MARS with color coded paperclips or stickies for early, and stay up lates. She reminded me, CNA's would hold off putting to bed if you just asked. So it can be done, remember that CNA's can be your best friend..esp if a pt. doesn't look right to them. Stop and check on the pt. They'll also alert you to bruises, skin tears, red bottoms and more. Say thank you, and bring candy or buy pizza for the unit once in a while..that kind of stuff.

Forever Sunshine, ASN, RN · Oct 2, 2011

Well back when I first started there were 2 LPNs on the unit. One was charge. the other did meds for the entire floor (50 beds). I can tell you.. that the medpass took 8 1/2 hours. There was no 4:30 medpass, one hour before, one hour after.. because it took the ENTIRE SHIFT 4:30 meds I finished at about 9pm. 11pm rolled around and I was still passing 8:30pm meds. Why? Because not only did I have one hallway to do.. but I had another hallway on top of that that I sometimes didn't even touch the 4:30pm meds until 7pm.

Thank god they stopped that experiment. It didn't work and nobody liked it. Most meds were obviously late.

We still have 2 LPNs on the unit. 1 is charge. 25 patients each..meds are much more do-able and I usually finish my first medpass around 7pm if I start on time. 3-11 also has dinner right in the middle of the medpass so those who don't get their meds before dinner.. have to get them after.