New grad nurse at Alzheimer's facility - Scared to lose my license!

[ILNurse728]

Hi guys!

I'm a new grad nurse with my BSN and working at an assisted living facility for residents with Alzheimer's. I've been working here for the past two summers as a caregiver.

But anyways, I'm on my 2nd day of orientation and have only 2 more days left before I am on my own & I don't feel like I can do this job!! I feel extremely overwhelmed.

Once I am supposed to be on my own, I'll be the only nurse (3-11pm) for 50 residents! We have a LOT of meds to pass and it's been taking me extra longer, since they have Alzheimer's.

I want to talk to my boss later today and tell her how I feel. Ultimately, I want to work at a hospital as soon as possible, and she knows about that. However, I thought I would be able to handle this job in the meantime - but these orientation days have been hectic for me :\ I don't feel 100% confident that I can work here alone as a new grad and not make a mistake that can harm a resident, which terrifies me!!

Also, I felt like my orientation has been VERY rushed and disorganized. They're frantically looking for a new night nurse, so I know they are desperate to keep me around.

My biggest fear is that once I'm on my own next week I'm going to be overwhelmed and make mistakes I just have a bad feeling about this job and want to leave while I can. The thing that worries me is that it's going to hinder my job hunt. I've only worked at this place as a healthcare-related job, so my boss will probably give me a bad reference to employers. Weighing the options, though, I'd rather do that versus unintentionally harm a resident and lose my license...

What do you guys think? Do you think I'm making the right decision?

[Cricket183, BSN, RN]

Four days orientation as a new grad and then you will be on your own and the only RN on shift with 50 patients? Not just no but HECK NO! (Stronger language implied but against terms of service!) Run as fast as you can. Better to have a bad reference than no license or worse yet be put in a position where harm comes to a patient and have to live with that.

[TheGooch]

That sounds like the NH my Mom was at. One nurse at night for 50 residents.

If something goes wrong it will be your butt on the line.

[Oceanpacific]

I would think that 25 dementia patients would be too much. Your orientation period is not sufficient by a long shot. You need a preceptor for your first several weeks (at least) of practice. They need to let you work days with the day RN as your preceptor until you feel solid about being solo. Maybe they will be more accommodating if they think they are going to lose you outright.

If you do leave, you may have worked with others there who could give you a positive reference. Frankly they have no reason to give you a poor reference. If you are asked about this job in the future, just be very matter-of-fact and say you didn't feel you could practice safely if you were solo with 50 dementia patients. Most reasonable employers would understand that. Your current employer should be ashamed for setting you up to fail and they have invested very little in you. Good luck and let us know what happens.

[AutumnApple]

Self preservation is a personal responsibility. Your current job, your boss, won't do it for you.

What that means is, if you feel like you are not ready you have to act like you are not ready. Do this by informing your boss you are not willing to take a shift on your own yet. Don't ask not to, say you are not. Leave other options for her to initiate, such as more training (I'd not accept anything less than 10 days which is two weeks). Or suggest staying in your old position perhaps, get your first RN experience elsewhere.

Make sure you have a detailed account of why you find your training up to now insufficient. Also include what could have made it better.

In the end, they are likely going to challenge you. They will have every reason that you should be ready and why everyone else could do the job with the training you received. The budget and not having the money for any more training will also come up.

And at that point, its up to you to decide if you are willing to accept the job or not. Sounds like you already have, but perhaps have a little bit of fear about actually doing what needs done.

Don't be tricked or be naive about this. If something happens, its on you, not them. Why? Because it's hour responsibility to decide if the conditions of the job are suitable or not. Best to do that now while you can, even if your decision upsets them.

[vintagemother, BSN, CNA, LVN, RN]

I worked at a few places with ratios like that. One was absurd. I didn't last long. As a new nurse I wanted to do things by the book which just wasn't possible. The ratio was 1:45. It was a dementia unit.

At the 2nd place, the set up was a bit better because, while there was only 1 medication nurse to 54, there was another nurse to help with injections, falls, md communication, etc. I liked this place a great deal and stayed for a year. I'll also add that my supervisor DON, who wasn't on the floor was always available via text/email/ phone.

I recommend that, while you're on orientation, you completely do a med pass while you have an orienter present to help you out. Then take on both med passes while you still have a trainer at your side. Mine used to laugh at me, saying, "you're doing it all! Im being paid just to do nothing" 😀😊 but I felt better practicing a first shift with someone to help me in case I messed up.

[TheCommuter, BSN, RN]

Weighing the options, though, I'd rather do that versus unintentionally harm a resident and lose my license...

Womp, womp, womp...now all we need is the depressing organ player that we see at every funeral service.

Statistically, the vast majority of nurses lose their licensure over problems that involve addiction: impaired practice, diverting medications, theft, and failing to complete impaired nurse programs (IPNs). Nurses generally do not lose their licenses for patient care mistakes.

Your fears are overblown and dramatic. A 50-resident medication pass is possible in a three-hour time window as long as you strictly pass the meds. Good luck to you.

[AutumnApple]

Womp, womp, womp...now all we need is the depressing organ player that we see at every funeral service.

Statistically, the vast majority of nurses lose their licensure over problems that involve addiction: impaired practice, diverting medications, theft, and failing to complete impaired nurse programs (IPNs). Nurses generally do not lose their licenses for patient care mistakes.

Your fears are overblown and dramatic. A 50-resident medication pass is possible in a three-hour time window as long as you strictly pass the meds. Good luck to you.

I agree, its not as easy to lose a license as many believe. I think some people, lacking the time/interest to educate themselves on how it works, let themselves become naive. Then when some manager says to them "You can lose your license for not working extra holidays, so you have to work Christmas again" they fall for it.

With that said, if the OP doesn't feel up to snuff with the job duties, she has got to make a decision. I'm not in her shoes, so, not gonna make any assumptions about whether her fears are warranted or not.

Loss of license is only one of many concerns if the OP is right. She even said it herself, she fears having a bad reference.

That's a big concern these days, especially for a new grad. While making a mistake may not cause her to lose her license, it will lead to being fired and having a void in the resume.......another "do not call this employer" slot on the applications.

Just one won't hurt you, but get too many of them and you'll never get hired for anything. Employers can be picky about who they hire these days. You may not lose your license, but you'll never use it. Same jail, prettier cell.

I used to travel nurse. Some friends thought I was paranoid about how picky I was when accepting a contract or not. Three times I watched others go into things blindly, chasing the top dollar with no eye on whether the workload was reasonable/safe. Mistakes were made, or they had issues with coworkers/management and they were let go. This process wouldn't happen every time, but it happened more than once. Two of them stopped travel nursing because of it, the other I lost contact with.

They didn't lose their license, no. What they lost was their ability to negotiate for themselves. Most employers, upon seeing they had issues, lost interest in them. Of the ones left that were willing to hire them, the pay was meek and the conditions deplorable.

My point being, no harm in being cautious about what work environment you're willing to accept. It's not always about "Will I lose my license?". Just because you 'could' do it doesn't mean you should.

[BibleBarb56]

Doesn't your facility have PCAs/CMAs that are permitted to administer meds? The facility that I now work used to have Assisted Living and Basic Care Residents. We went to all Basic Care this past November. We have CMAs ( Certified Medication Assistants) who are assigned to give meds on the residents in their assignment. We have 70 residents in our facility and we provide medication assistance to maybe 60 of them as some of them self administer. I could not imagine having to administer meds for 50 people by myself even if meds were my only responsibility. Our nurses, we only have 1 nurse per shift do not generally pass meds. I do because I work night shift and since am meds are heavier it takes some of the pressure off of the day shift aides providing them with more time to give cares.

I have never worked in Assisted Living before 3 years ago. I moved out of state to live near my youngest daughter and her family 3 yrs ago. I took the job I have now because I have health issues and thought it would be easier on me. I have to say that at first I felt much the same way you do. I was very overwhelmed. I have been a nurse for over 20 years and I still thought that I couldn't handle it on my own after orientation. I was really scared. Living in a new state, working in a different type of facility than what I was used to was terrifying even for a seasoned nurse. I had a hard time with the policies. We are not only responsible for our facility, but for a sister facility that is all Assisted living. They only have a nurse during the daytime. If we get a call from them in the off hours we have to tell the CNAs what to do for a resident sight unseen or sometimes we have to go there to take care of more serious issues. Last week I had to go work there as a CNA for 2 hrs because they had a call off and I couldn't find coverage. I didn't think at first that I would be able to do this job, but because of my age and my health issues I decided to stick with it for fear of not being able to find another job. I have to tell you that here I am 3 yrs later and I'm so glad I decided to stick it out. I love my job. Yes, it was very scary at first. My first night on my own I had palpitations I was so scared, but I survived and my residents survived. I took each day as it came. All of us nurses started somewhere and not one of them can say they were not scared. Its natural to be scared of new things.

My advice would be for you to give it a little time before you decide to leave. Talk to your supervisor about your concerns especially about a med pass for 50 residents. The most I have ever had at any job was 30 residents and that was hard enough, but not impossible. I have always found that if you voice your fears to a supervisor, most often than not they will try to help you. Sometimes we misunderstand our duties and in talking about things to a supervisor we find that we heard wrong or misunderstood. Every position we take has risks, but unless we don't work at all, we have to take those risks.

I do hope you will choose to give the job a chance. You will find a routine that you will hopefully feel comfortable with. Your CNAs are your backbone and they will help you with what they can. I hope to read a post from you 3 yrs from now that you absolutely love your job there!!! Hang In There :)

[Emergent, RN]

Way back when, I worked in a small, 60 bed nursing home. There where two halls, 30 beds apiece. When I first started (my first job out of school), I was on evenings. I had maybe 4 days orientation, it was my first nursing job. During day and evening shift each nurse had 30 pts. I couldn't even tell the residents apart at first, they all looked alike, mostly old ladies with white hair.

It didn't take long to get up to speed. Later on I worked nights. I was the only nurse with two CNAs for 60 residents. It was totally doable.

Ditto to what Commuter said, I've heard a lot of nurses dramatically say "I'm going to lose my license!". I think that's actually nurse speak for 'I feel overwhelmed'.