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New grad......did I make a mistake?

TaylorJ TaylorJ (New) New Nurse

I graduated in May of this year and started a job on a covid unit in a nursing home about three weeks ago. I trained for a about a week and a half and I was put out on my own. I hate it. I hate my job. I cry when thinking about going in. I make a lot of mistakes, thankfully none that result in patient harm, but mistakes none the less. I wanted a hospital job so bad but I couldn’t get into any residency programs. Everyday I go to work and everyday I wonder if I even really want to be a nurse. I enjoy the nursing aspect but the workload and the lack of training for a new grad like me makes me feel like maybe I’m not cut out to be a nurse. I spent four years working towards my degree and I’m already ready to tap out one month in. I want to quit so bad. But I know that’s not professional. And I have bills to pay.

amoLucia

Specializes in LTC.

OP - you DID NOT make a mistake! You just had the AWFUL misfortune of having been thrown into this C19 horrific time for all HC job seekers and new & current employees.

Sadly, your LTC experience is not UNusual for newbies. The degree to which you are experiencing your distress is most likely compounded exponentially by the current C19 state of the industry all around.

And LTC and covid-ICUs are prob the most diff units in these times. No matter where you would seek, the problems will also be there, maybe a little bit better, but maybe a WHOLE lot worse. NO nook, cranny or niche is safe & exempt from these looney times.

My best advice would be to slow down and try to concentrate on being GOOD to YOURSELF. Try getting adequate sleep, nourish and hydrate as you need to. Do something nice for YOU - buy a book, a record or a sweater. I don't know that I'd recommend talking with a counselor, but maybe a fav instructor from school could lend a sympathetic ear.

If you've been reading along with many of the posts from newbies here, most are experiencing almost identical feelings as you. You are NOT alone. Only time will influence the situation, however it turns out. For the better, I pray.

As for work, let your nsg admin/mgt know you're struggling. But you're still trying to do the best you can. Perhaps they can help in some way for some more training time or precepting (DON'T expect extravagant amt of extra time!) Focus on the priorities at work, your meds, tx, req documentation, etc. Delegate as approp. No way to do everything all at once. Slowly, all the other 'things' will fall into place.

Good luck

8 hours ago, TaylorJ said:

I trained for a about a week and a half and I was put out on my own.

This is apparently normal in some settings.
Normal and OK are very different. Nothing about this is OK. Brand new nurse, less than two weeks of training with no resource person or direct supervision is unsafe, regardless of whether it is common practice.

My perspective as a hospital based ER nurse. Maybe other LTC nurse will chime in and tell you how to practice safely under these conditions.

Regardless, best of luck.

Couple of different things:

21 hours ago, TaylorJ said:

I trained for a about a week and a half and I was put out on my own. I hate it. I hate my job. I cry when thinking about going in. I make a lot of mistakes, thankfully none that result in patient harm, but mistakes none the less.

1) I agree with pp that this is not adequate training for a new nurse.

I don't know what kind of mistakes you are making, but if they are potentially serious ones then you must focus on slowing down and being conscientious about what you're doing; do it according to how you were taught in school. If some of your lesser duties (as instructed or preferred by your employer) don't get done due to the absolute need to deprioritize them, that's just the way it is. If you can figure out how to be safe and your workplace is not tarnishing your professional record when their lesser objectives are not met, then it's possible to steadily move forward.

If you cannot slow down enough to operate safely or your workplace is causing trouble because they are dissatisfied with your conscientiously-paced performance, then you will need to leave.

22 hours ago, TaylorJ said:

I wanted a hospital job so bad but I couldn’t get into any residency programs.

2) In addition to actual job stressors, this ^ is likely greatly influencing how you feel right now. While that is understandable, you kind of have a decision to make in this realm, too. You either decide to commit to trying to make the best of your circumstances, or you decide that they are unacceptable and you would rather be back to looking for a job. But don't try to do job B while constantly agonizing over how much you wanted job A. Don't doom yourself to failure that way.

Take each day one at a time, purpose yourself to be conscientious and to resist feeling pressured to compromise yourself on important matters. Assessing your patients, intervening as necessary, and delivering correct meds and treatments are top priorities. Almost every other thing is going to be lower priority than those items.

Good luck to you ~

amoLucia

Specializes in LTC.

JKL33 - as per usual, you give good advice.

hhern - sadly, LTC cannot provide, nor AFFORD, the prolonged, structured orientation time to give new nurses, most esp NEWBIE nurses need. It's just the nature of the beast. Even hosps are hard-pressed to be the post-SON educator that is soooo sorely needed for the margiinally prepared newbie. Really, it's NOT THEIR JOB to be SON, part 2.

So SNFs/NHs do what they can and just hope that the new hire/newbie will fit in/function as well as poss and eventually progress & improve.

In NO way is this ideal, for the rudely awakened and thoroughly stressed-out employee, but most imp, pt safety is at risk.

Advice given to OP is for prioritizing, slowing down and following good technique as taught in school. Not much else can be done. If OP can friend-up with an experienced shift co-worker, or one before/after shift, support and a resource becomes avail. Maybe a transfer to a less acute unit might help, if admin approves. Or a shift change.

But given the current C19 times, the status of SON education/preparation and the nature of the industry, OP can only try to stick it out, or resign and look for another job. But even then, hard times are awaiting!

Good luck to OP.

RN-to- BSN, ADN, RN

Specializes in SCRN.

These are tough times to be a new nurse. Please, try to find healthy coping strategies.

2 weeks training in LTC is acceptable. The difference is they give you and your preceptor a normal patient load when you train, and when you are on your own, the short staffing happens. Been there: a new grad in LTC. Could not get into the hospital for a year and a half.

Keep applying, maybe consider doing part time at the LTC.

Your employer should be ashamed of themselves for that type of training! Go to a hospital that gives a healthy, long onboarding for new grads. Some hospitals onboard a new grad for up to 6 months. It is at least easier to apply for another job when you are currently working....

KalipsoRed21, BSN

Specializes in Currently: Home Health.

So you were totally thrown to the wolves. No new grad should only be given a couple of weeks of training and that’s it. However, while I would tell you to keep looking for other positions and jump this ship you are on ASAP, that overwhelmed dread that you feel is not likely to go away for a year or two. Sorry, Healthcare is just really poopy about abusing the good nature of all of us who want to help others. You are likely ALWAYS going to have WAY more work to do than you can actually complete. To survive 1) Always put the patient’s need first. 2)When you are 13 hours behind in charting tell your damn employer they can pay for you to come in on one of your regular shifts and not have patients so you can catch up. Your time is yours and even if they are willing to pay you twice the pay, don’t give up your time unless YOU want to. Good luck!

RN-to- BSN, ADN, RN

Specializes in SCRN.

8 hours ago, KalipsoRed21 said:

When you are 13 hours behind in charting tell your damn employer they can pay for you to come in on one of your regular shifts and not have patients so you can catch up

What?

Have you successfully used this strategy?

My thought- no employer would ever allow this, unless they are my mom.

RN-to- BSN, ADN, RN

Specializes in SCRN.

When working in LTC ( PM shift), I remember they compressed evening medpass and added 2100 statins to 1700 0r 1800 med pass. It helped.

2 minutes ago, RN-to- BSN said:

What?

Have you successfully used this strategy?

My thought- no employer would ever allow this, unless they are my mom.

If my mom allowed this the amount of nagging that accompanied it would make it a very undesirable course of action.

1 minute ago, RN-to- BSN said:

When working in LTC ( PM shift), I remember they compressed evening medpass and added 2100 statins to 1700 0r 1800 med pass. It helped.

Many nurses combine med passes as a matter of course in LTC facilities.

moomin, LPN

Specializes in LVN.

I know how you feel. I am pretty much in the same boat as you. I am a new nurse working at a SNF and didn't get much training either. I am having bad anxiety lately about it. I have already quit one job at a SNF after two weeks and now I am working at another one and not very happy with the environment. I used to work there as a CNA and the facility has gone down hill so much since I was a CNA there, I can't even believe it. They are always understaffed and the environment is depressing and stressful. I am about to switch to part-time because it is taking a toll on my mental health. I am also continuing my job search for a place with less beds. I know it's not easy being a new grad and entering this field during a pandemic. All staff is stressed and more rules and pressures are placed on us during these times. Try not to give up just yet. I have hope that the tides will eventually change for us after we get 6 months to a year of experience. Hang in there and know you are not alone. A lot of new grad nurses are feeling the same way.

KalipsoRed21, BSN

Specializes in Currently: Home Health.

On 8/13/2020 at 7:29 AM, RN-to- BSN said:

What?

Have you successfully used this strategy?

My thought- no employer would ever allow this, unless they are my mom.

Yes, actually I have. Look if the standard is that I should be able to see 6 patients and drive no more than 75 miles in a day and I’m getting 7 patients and driving 90 miles in the day, it is no reasonable to believe that I will spend extra time getting charting done when they over booked me. Now do I know that’s what they WANT us to do and twist it into some mockery of accountability to get us to do it on our time? Sure. But you can flat out refuse to give them more of your time. I will always make sure my patients are cared for, but if they want to be able to bill for all that care they had better give me the time to chart. On their time, not mine.

RN-to- BSN, ADN, RN

Specializes in SCRN.

8 hours ago, KalipsoRed21 said:

Yes, actually I have. Look if the standard is that I should be able to see 6 patients and drive no more than 75 miles in a day and I’m getting 7 patients and driving 90 miles in the day, it is no reasonable to believe that I will spend extra time getting charting done when they over booked me. Now do I know that’s what they WANT us to do and twist it into some mockery of accountability to get us to do it on our time? Sure. But you can flat out refuse to give them more of your time. I will always make sure my patients are cared for, but if they want to be able to bill for all that care they had better give me the time to chart. On their time, not mine.

Thanks for your POV. We are talking LTC here, no employer will let you come in, take no patients, and chart. Usually catch up charting is done after report was given to oncoming nurse. Even then one risks being reprimanded for chronic overtime.

KalipsoRed21, BSN

Specializes in Currently: Home Health.

1 hour ago, RN-to- BSN said:

Thanks for your POV. We are talking LTC here, no employer will let you come in, take no patients, and chart. Usually catch up charting is done after report was given to oncoming nurse. Even then one risks being reprimanded for chronic overtime.

Look, at any facility, if you have proven you are a responsible dedicated employee for a year or so, I can guarantee you that they WILL work something out for you. I do this with homecare now, but don’t think for a second that I didn’t do it when I worked the floor. Of course they are going to TELL you that it is impossible to do this. They are also going to try to face slap you with some perceived notion that if you aren’t willing to continue to work over on your time that you are being derelict in your DUTY as a nurse. I know exactly how they act when you stand your ground and tell them you aren’t working more than the time that you agreed to, no matter what charting is done. I very explicitly let them know if they didn’t assign me appropriate duties and patient loads that every chart I was unable to complete DURING MY SHIFT I would be putting in a note that stated, “Chart incomplete by this RN due to employer inappropriately staffed department and RN not given appropriate time to complete this care task. As patient care comes first this RN chose to spend the time available caring for patient need. This RN will not work outside of agreed upon hours of employment to catch up documentation for employer and employer is unwilling to give this RN time during work hours to catch up charting.”
You bet your bottom dollar that if you let your manager know that you are about to start putting that in all of your incomplete charts and, barring an actual life and death related patient issue, you are going to arrive on time for work and leave on time when work hours are over....they will start working with you. The key is that you have to prove you are worth it with about a year of servitude and then you have to gradually over 2-3 weeks become very LOUD about your time and the unacceptable work conditions that require you to do to much. If your employer isn’t willing to budge I would say high tail it out of there. We are not slaves to our employer or our patients. Don’t confuse a duty to do right by people as a duty to do poorly to your self.

Edited by KalipsoRed21

LubbDubb77, LPN

Specializes in Pediatrics.

I am a new LPN and graduate with my RN in december. I am in pediatrics and LOVE being a nurse. When the covid hit, our census was low, and I got put on per diem. So, I went into a LTC facility to get some hours and UGH - GIRL, I feeeeel you. It is just not for me and I absolutely hated it. This area may just not be for you! I met a lot of nurses in the LTC that became nurses to work in LTC. There are soooo many directions to go in nursing - don't give up on what you went to school for, for so long! You got this!

I am also a new grad. I definitely understanding how stressful the first year can be. I however do not work on a COVID unit so I can only imagine that challenges brought forward there. You did not make a mistake. You are a great nurse. We are all our own worst critics. Making mistakes, especially this early in our careers, does not definite our quality as nurses. Nursing involves life-long learning and even experienced nurses make mistakes. If you really feel that that job position is not a good fit for you, then I would recommend seeing if they will transfer you to a non-Covid postion. I personally feel like working on a Covid unit is too much for a new grad nurse. I currently work in a hospital and our COVID units requires 1-2 years of nursing experience to be hired there. As your confidence grows you will feel more comfortable. This pandemic has truly put a strain of the nursing profession. It's sad because I see so many posts about burn-out and experienced nurses saying that they're leaving the profession soon. As a new grad nurse, this is saddening. However, I always keep my mind on why I decided to pursue nursing in the first place. With that thought in mind, I will not let the pandemic destroy my passion for nursing. In actuality, this pandemic has widened my interests and I plan to begin working in community/public health nursing in the next few years.

amoLucia

Specializes in LTC.

14 hours ago, KalipsoRed21 said:

... “Chart incomplete by this RN due to employer inappropriately staffed department and RN not given appropriate time to complete this care task. As patient care comes first this RN chose to spend the time available caring for patient need. This RN will not work outside of agreed upon hours of employment to catch up documentation for employer and employer is unwilling to give this RN time during work hours to catch up charting.”

We are not slaves to our employer or our patients. Don’t confuse a duty to do right by people as a duty to do poorly to your self.

Kalipso - Are you SERIOUS ?!?! Have you ever, EVER really charted such an entry into any chart?????? I am dumbfounded because I seriously doubt any employer would tolerate that type of employee action.

Seriously, I see you being suspended and/or fired the first time Admin saw such an entry. (However TRUE it might be, and I agree with your sentiment!)

In the time it would take you to write that type of note, you could just document a brief, down & dirty entry.

Maybe it's just me, but I think that was BAD advice.

I do have to compliment you for your last sentence. Very true.

KalipsoRed21, BSN

Specializes in Currently: Home Health.

On 8/15/2020 at 1:57 PM, amoLucia said:

Kalipso - Are you SERIOUS ?!?! Have you ever, EVER really charted such an entry into any chart?????? I am dumbfounded because I seriously doubt any employer would tolerate that type of employee action.

Seriously, I see you being suspended and/or fired the first time Admin saw such an entry. (However TRUE it might be, and I agree with your sentiment!)

In the time it would take you to write that type of note, you could just document a brief, down & dirty entry.

Maybe it's just me, but I think that was BAD advice.

I do have to compliment you for your last sentence. Very true.

I’m dead serious that I WOULD do this. And fortunately, NO, I have never had to do it. Like I said, if you have proven your-self a decent reliable employee ,as much as your employer will continue to attempt to bully you into doing more and try to make you feel like it is your responsibility AND duty to be overworked, if you put your foot down hard they will back off. What I discussed charting would be a last Hail Mary threat...and yes I’ve had to Hail Mary several times in the past...but it comes down to how high is the turn over and how much are they wanting to try to train someone new. Most employers desire the person to stay and while they will talk to you like you aren’t doing enough, that you aren’t meeting expectations by refusing to be overworked, and that charting is part of good patient care.....they will back down when you stand up. 1) I did take an oath to take good care of people. Charting, aside from vitals and an assessment, is not taking care of people. It does put my license at risk to not have a through documentation of the course of the day, but to me, no matter how much hard labor I put into getting my BSN, if organizations are going to bully me into taking more than I can handle and get the job done right, then I have no choice but to quit or stand up. I live in a rural area so jobs are limited, thus I must stand up for myself. Charting, more than it is care, is a means for your employer to bill for services and to ensure the liability is lower, thus if you threaten it with charting a statement that puts them at fault, they really hate that. Legally they cannot make you change your charting, they can only request that you do. 2) My responsibilities vs their profitability. I want my employer to be profitable. And I always work to help them in that goal, however, if when I got hired they state that I will have 8 post op ortho patients, no aid, no secretary in a 12 hour shift...then that is what I agreed to be able to handle in 12 hours. (You have to watch this because these managers purposely don’t have these things written down...it is part of your verbal interview.) I do write it down at the start of every job. And I will take a couple of hits and let them over book me by one or two people....but then their is the creep. Suddenly 80-90% of the time you are getting 9-10 people assigned to you. Then you bring actual numbers up to the manager. “So 7 of my last 10 shifts I have been over booked, please staff me appropriately.” And the great gaslighters they are they will probably say something like “It has been very busy lately, ratios are not a hard and fast rule.” And then I have to say, “I agreed to these conditions ________ upon hire. I am informing you that you are taking advantage of our hire on agreement and I need you to fix it by my next shift.” Then you come in the next shift and they give you 10 and you call the house supervisor and state you need to fill out an incident report for unsafe staffing. And then they get their feathers in a bunch, but stay calm and restate your initial complaint. “I understand the hospital is full tonight and you state you have attempted to get extra staff to no avail. I still need to fill out an incident report because this is an unsafe patient load.” And they will suddenly start asking your coworkers who also have 10 patients to go up by one more so they can take you down to 8. And you will feel like *** because those nurses should say no but because nurses are people pleasers and easily manipulated more likely than not your coworkers will be curing your name but they will do it. (And frankly that’s their stupid fault. What they SHOULD be doing is saying no and filling out incident reports with you.) But that is how they will by pass the incident reports for the first few times. But then they’ll get sneaky and start bringing up admits and placing them on you so now you still have 10. And THAT’s when you start charting what I posted in my previous post. Look, I’m all for being a part of a team and working my butt off. But you and I both know that the conditions that they talk upon hire are the doable conditions and then, for the name of the almighty dollar, they will try to manipulate you to doing more so they can have better numbers. And unfortunately what they pay you to stay over time to get this done is not enough of a deterrent....otherwise they wouldn’t do it. I manage my home budget so I don’t have to work more....I don’t want to work more...full time is enough. So the real question is, is that extra $20-60 bucks you are making that day worth the time you lost with your family/friends/community? If not, put your foot down and hard. Experienced nurses are in high demand. I have never been more than a week without a job...and I think that is where people get hung up, they work so long at one place that they forget their own value. Of course I’ve had to take a crappier job to get out of a decent job that abused my time. I didn’t say it was easy, but it is worth it and I would advise all other nurses to do the same. When we all aren’t bending over and taking it in the butt then that will no longer be the expectation.

amoLucia

Specializes in LTC.

Kalipso - There is a BIG difference between what you REALLY did and what you WOULD do. I still hold that that kind of charting would net you serious backlash. Even the rest of your post blows me away - you must be way more a risk-taker than I.

While I agree with you in principle in some areas, I'm more skeptical than you.

I think our fundamental difference is that you believe employers will respond as you expect. I believe many won't care. You see yourself as valuable/ important to them. Sorry, but they've a full basket of potential new applicants just chomping at the bit for your job. You ARE replaceable. Regardless how good an employee you are and in reality good for the facility's operation, you push their buttons hard enough & often enough, they will respond not in the way I believe you think they will. You've the experience, confidence and moxie to speak up & negotiate for yourself.

But for OP, she needs her job. You feel comfortable enough to pick up your marbles & move on, but she is struggling. Her employer has no vested interest in her. Even though her motivation/interest is good and she has decent skills from school, and she's TRYING and she CARES, she is stuck. She can only try some of the suggestions offered here on how to work within the job limitations, or she can leave (not too great).

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